Emotion Dysregulation as a Mediator of the Relationship between Anxiety, Compulsive Exercise and Eating Disorder Symptoms in Adolescents

Anxiety has been suggested to be a key contributing factor for compulsive exercise, however, existing literature has demonstrated contradictory relationships between anxiety and compulsive exercise among adolescents. According to the Emotional Cascade Model (ECM), factors such as rumination and emotional suppression may mediate the association between affect and exercise. The current study therefore aimed to investigate whether rumination and emotional suppression mediate the relationship between anxiety and compulsive exercise in predicting ED symptoms in adolescents. Questionnaires assessing compulsive exercise, anxiety, depressive rumination, emotional suppression, and ED symptoms were completed by 212 adolescent males (Mage = 13.39, SD = 1.22) and 189 adolescent females (Mage = 13.64, SD = 1.29). The structural equation model showed indirect effects between anxiety and compulsive exercise through rumination and emotional suppression in males but not in females. Moreover, anxiety had an indirect effect on eating disorder symptoms through rumination, emotional suppression and compulsive exercise in both males and females. In line with ECM, the results suggest that rumination and emotional suppression may have a key role in the association between anxiety, compulsive exercise and eating disorder symptoms in adolescents. These findings suggest that compulsive exercise may be used as a dysfunctional coping mechanism to escape from a negative emotional cascade generated by the interaction of anxiety, rumination and emotional suppression. Future longitudinal studies to test the role of compulsive exercise as a dysfunctional behaviour in the ECM are needed.

Psychosocial etiology of maladaptive exercise and its role in eating disorders: A systematic review

OBJECTIVE

Although maladaptive exercise (ME) is widely recognized as a clinical feature in transdiagnostic eating disorders, less is known about psychosocial factors that give rise to and perpetuate this behavior. This systematic review aimed to examine the empirical status of this association.

METHOD

We reviewed 46 full text articles examining longitudinal associations between psychosocial variables and ME.

RESULTS

Eighteen studies met full inclusion criteria. Based on our qualitative synthesis, evidence suggests reasonably consistent associations between early concern with weight and shape, and negative affect on later development of ME.

DISCUSSION

Inconsistent and insufficient assessment of ME across a majority of studies underscores caution in interpretation of results, but guides important discussion for future clinical and research efforts.

Lessons for Local Policy Initiatives to Address Dietary Supplement Use Among Adolescents: A Qualitative Study of Stakeholders' Perceptions

PURPOSE

Weight-loss and muscle-building dietary supplements can have adverse health consequences for youth. At a time, when the Food and Drug Administration is considering increasing oversight of dietary supplements, this study aimed to explore community stakeholders' perceptions about the use of and access to such supplements among adolescents and to identify challenges and opportunities to engage stakeholders with policy initiatives to curtail youth access to supplements at the local level.

METHOD

We conducted 32 key informant semistructured interviews in four municipalities in Massachusetts with purposefully selected participants representing three categories of community stakeholders who could contribute to policy agenda setting at the local level: policy professionals, youth service providers, and young adults aged 18-25 years who used weight-loss or muscle-building supplements as minors. Interviews were audio-recorded, transcribed, deidentified, and analyzed using thematic analysis approach, facilitated by Dedoose software.

RESULTS

Community stakeholders reported wide availability and easy access to dietary supplements. Most participants were unaware of health risks. Many stakeholders did not perceive the use of these products as an issue impacting youth in their communities. The challenges identified in engaging stakeholders were competing concerns on the policy agenda, limited capacity of stakeholders, and uncertainty about who is accountable for the problem.

CONCLUSION

This study indicates the need for complementary, multipronged approaches at the municipal level to address the problem of weak regulation and easy access to potentially dangerous weight-loss and muscle-building supplements for youth.

Sociocultural Appearance Standards and Risk Factors for Eating Disorders in Adolescents and Women of Various Ages

The main aim of the present study was to verify the level of impact of sociocultural appearance standards (passive awareness and active internalization) have on body dissatisfaction, the desire to engage in a relentless pursuit of thinness, the adoption of a perfectionistic attitude toward the body, and the development of a tendency to engage in bulimic eating behavior, which can develop in adolescent girls and women of varying ages. The study group comprised 234 individuals: 95 secondary school girls, 33 high school girls, 56 female students, and 50 employed women, all of whom were living in southern Poland. Participants were not diagnosed with any psychiatric disorders (including eating disorders). The variables were measured using the Polish version of Garner’s Eating Disorder Inventory and the Polish Sociocultural Attitudes Towards Physical Appearance and Body Image Inventory [based on the SATAQ-3 (Sociocultural Attitudes Towards Appearance Questionnaire Scale-3)]. The findings revealed that the youngest Polish girls (aged 12–15) reported the highest level of risk factors for eating disorders. Among the entire study group, the internalization of appearance standards and the pressure associated with various media messages were determined to be predictors of the pursuit of thinness, regardless of age and body mass index values. The second most significant variable explained by the internalization of sociocultural standards was body dissatisfaction. The internalization of sociocultural norms provided a significant explanation of bulimic tendencies only in the youngest girls. Perfectionism proved not to be affected by the sociocultural impact of mass media. The adult women had the lowest average scores over the entire study population regarding exposure frequency to body images in mass media and regarding the experience of pressure exerted by sociocultural norms. The high level of internalization of sociocultural appearance standards seems to be significantly linked to body satisfaction in women aged 30 and older. Young adolescent girls constitute a high-risk group for a specific psychological proneness to developing eating disorders as a result of the sociocultural influence exerted by mass media. The obtained study results can prove helpful in creating education programs in preventive healthcare aimed particularly at the youngest adolescents.

Research-to-policy translation for prevention of disordered weight and shape control behaviors: A case example targeting dietary supplements sold for weight loss and muscle building

New approaches to universal eating disorders prevention and interventions targeting macro-environmental change are greatly needed, and research-to-policy translation efforts hold promise for advancing both of these goals. This paper describes as a policy-translation case example an academic-community-government partnership of the Strategic Training Initiative for the Prevention of Eating Disorders, Multi-Service Eating Disorders Association, and the office of Massachusetts Representative Kay Khan, all based in Massachusetts, USA. The partnership's research-to-policy translation project focused on dietary supplements sold for weight loss and muscle building, which have been linked with serious injury and death in consumers. Youth and people of all ages with eating disorders and body dysmorphic disorder may be especially vulnerable to use these products due to deceptive promises of fast and safe weight loss and muscle gain. The research-to-policy translation project was informed by a triggers-to-action framework to establish the evidentiary base of harm to consumers, operationalize policy solutions to mitigate harm through legislation, and generate political will to support action through legislation introduced in the Massachusetts legislature to restrict sales of weight-loss and muscle-building dietary supplements. The paper concludes with lessons learned from this unique policy translation effort for the prevention of disordered weight and shape control behaviors and offers recommendations for next steps for the field to advance research and practice for universal, macro-environmentally targeted prevention.

Sociocultural influences and body change strategies in Spanish adolescent boys of different weight status

The aim of the present study was to examine the association between sociocultural influences to attain an ideal body and body change strategies (BCS) in Spanish adolescent boys of different weight status. A total of 594 Spanish boys (M=13.94 years, SD=0.20) participated. Measures included in the study were weight status according to body mass index (BMI), sociocultural influences (perceived pressures to attain an ideal body, general internalization of an ideal body, internalization of an athletic-ideal body), BCS to lose/control weight (dieting, healthy and unhealthy weight-control behaviors), and BCS to gain weight and muscles. Underweight boys engaged more frequently in weight-gain behaviors. Overweight boys reported higher levels of perceived sociocultural pressures and general internalization compared to normal-weight boys, and were more likely to be engaged in BCS to lose/control weight compared with the other weight-status groups. There were no differences between groups in terms of internalization of an athletic-ideal body and BCS to increase muscles. Future research and prevention programs should consider male-specific behaviors and weight-status differences.

A longitudinal study of body dissatisfaction and pubertal timing in an ethnically diverse adolescent sample

In a 7-year study, adolescents' body dissatisfaction (N=1370) was examined across four high school years as a function of pubertal development (perceived timing relative to peers and self-reported physical changes measured during Grades 6-10) in the context of the high school transition. Boys and girls who, during early high school, perceived themselves to be late relative to peers were at risk for body dissatisfaction across the high school years. Boys who were late in pubertal development reported more body dissatisfaction in early high school than on-time boys, but then decreased over time. African-American girls reported less body dissatisfaction across the high school years relative to other girls. Asian girls reported more dissatisfaction in early high school than African-American, Latina, and Multiethnic girls, and increased over time. Results highlight the importance of considering late development within context as a risk factor in body dissatisfaction research.

Toward understanding body image importance: individual differences in a Canadian sample of undergraduate students

This study examined the relationships between body image importance (BII) and perfectionism and body satisfaction in a Canadian sample of undergraduate students. Specifically, perfectionism was conceptualized as a common cause of BII and body satisfaction. Furthermore, gender-schematic processing was examined as a moderator of sex differences in BII, which have been inconsistently found. As hypothesized, there was no significant partial correlation between BII and body satisfaction, controlling for perfectionism. Also, a significant Sex × Gender Schematicity interaction indicated that gender schematicity moderates sex differences in BII. Implications for understanding individual differences in, and elevated levels of BII are discussed.

Unhealthy weight-control behaviours, dieting and weight status: a cross-cultural comparison between North American and Spanish adolescents

The aim of the current study was to examine and compare dieting and unhealthy weight-control behaviours (UWCB) in population-based samples in two large urban areas in Spain (Barcelona) and in the USA (Twin Cities of Minneapolis and St. Paul, Minnesota). Additionally, use of UWCB across weight categories was explored in both samples. Participants included 1501 adolescents from Barcelona (48% girls, 52% boys) and 2793 adolescents from the Twin Cities (53% girls, 47% boys). The main outcome measures were dieting, UWCB (less extreme and extreme) and weight status. Although dieting and UWCB were prevalent in both samples, particularly among girls, the prevalence was higher in the US sample. In both countries, the report of dieting and use of UWCB was highest among overweight and obese youth. Prevention interventions that address the broad spectrum of eating and weight-related problems should be warranted in light of the high prevalence and co-occurrence of overweight and unhealthy weight-related behaviours.

Moderators of the internalization-body dissatisfaction relationship in middle school girls

The purpose of the present study was to replicate and extend previous research by examining the moderating effects of self-esteem, physical self-concept, physical appearance comparisons, BMI, pubertal status, and cardiorespiratory fitness, on the internalization-body dissatisfaction relationship in middle school girls. Hierarchical multiple regression (HMR) was used to examine direct and moderating effects of these variables. Internalization was related directly and significantly to body dissatisfaction, as were the proposed moderators (i.e., self-esteem, physical self-concept, physical appearance comparisons, BMI, pubertal status, and cardiorespiratory fitness); however, these variables failed to significantly influence the internalization-body dissatisfaction relationship. Possible explanations for the lack of moderating effects and directions for future research are discussed.

Long-term outcome of pediatric eating pathology and predictors for the onset of loss of control over eating following weight-loss treatment

OBJECTIVE

To investigate the stability of eating pathology over a 6-year period and predictors for the onset of loss of control (LC) over eating among overweight youngsters having undergone weight-loss treatment.

METHOD

Structured clinical interviews and self-report questionnaires were administered to a sample of 56 overweight youngsters (M age = 13 years) who were at the start of weight-loss treatment in 2000 and again 6 years later.

RESULTS

Mean levels of eating concerns, drive for thinness, bulimic symptoms, and body dissatisfaction decreased over the 6-year period. Dietary restraint, weight, and shape concerns were stable over time. Also, in 50% of those reporting objective binge eating at baseline, binge-eating episodes remained stable. Youngsters characterized by symptoms of depression in early adolescence were at a higher risk for developing new episodes of LC 6 years later. Neither concerns about eating, shape, and weight nor dietary restraint independently predicted LC.

DISCUSSION

Six years after following structured weight-loss treatment, some eating pathology variables still remain stable. Especially youngsters who already report LC at young ages appear to develop a more stable pattern of disordered eating behavior.