Multidimensional Assessment of Body Dissatisfaction and Disordered Eating in Korean and US College Women: A Comparative Study

The Prevalence of Disordered Eating Behaviours (DEBs) among Adolescent Female School Students in Riyadh, Saudi Arabia: A Cross-Sectional Study

Adolescence is a sensitive stage of life that is particularly vulnerable to nutritional problems, including DEBs. This cross-sectional study aims to explore the prevalence of DEBs among adolescent female school students in four intermediate and secondary schools in the city of Riyadh and to examine predictors associated with DEBs, including age, BMI and school regions. A total of 416 female students aged 12-19 years took part in this study. Weight and height were measured for students before the EAT-26 test was completed. Overweight and obesity were observed among 37.7% (n = 157) of students, 50.7% (n = 211) had a normal BMI and 11.5% (n = 48) were underweight. Results indicated that 123 (29.6%) students reported an EAT-26 score of 20 or more, indicating a high risk of DEB. Age was a significant predictor of DEB risk (OR = 3.087, 95% CI = 1.228-7.760), with the older age group (16-19 years) reporting a higher risk than the younger age group (12-15 years) (p = 0.017). DEB risk partially differed by school region, but BMI was not a statistically significant predictor. The high-risk group reported more binging (p = 0.008), induced vomiting (p < 0.001), laxative consumption (p < 0.001) and exercising (p < 0.001) compared with the low-risk group. Further research is warranted to understand DEB current patterns and predictors.

Validation and measurement invariance of a Korean version of the Body Appreciation Scale-2 in cisgender sexual minorities and heterosexual adults

The Body Appreciation Scale-2 (BAS-2) has been validated in various languages across samples with different characteristics. However, its validation and invariance based on sexual orientation in Korean samples have yet to be examined. The current study validated the psychometric properties of the BAS-2 in Korean sexual minorities, and examined measurement invariance between sexual minority and heterosexual individuals and between sexual minority cisgender women and men. Responses from 449 sexual minority and 400 heterosexual individuals were analyzed. In the sexual minority sample, a confirmatory factor analysis supported the scale's unidimensional structure, exhibiting strong factorial validity; further, a correlation analysis revealed positive correlations with body satisfaction, positive sexual minority identity, life satisfaction, and self-esteem, supporting the convergent and criterion-related validity. A hierarchical regression analysis confirmed the incremental validity of the BAS-2 on life satisfaction and self-esteem. The BAS-2 was invariant across women and men at the scalar level in the sexual minority sample, and across sexual minorities and heterosexuals at the partial scalar level in the total sample. Latent mean comparisons indicated no significant differences in BAS-2 scores between sexual minority women and men, while sexual minorities scored significantly lower than heterosexuals. The multiple-indicators multiple-causes model provided evidence of differential item functioning.

Social comparison, disordered eating, and body dissatisfaction among postpartum women

The postpartum period is a window of vulnerability for disordered eating. Postpartum women experience pressures to "bounce back" to their pre-pregnancy weight which may lead to social comparisons, however it is unknown what postpartum women compare (e.g., body, eating), and to whom they compare themselves (e.g., celebrities, peers). This study evaluated links between different types (what is compared) and sources (to whom do they compare) of social comparison that postpartum women engage in. Included was self-oriented comparison, a novel construct conceptualized as comparisons of one's current postpartum appearance to one's pre-pregnancy appearance. A total of 306 postpartum women who gave birth in the past year and 153 control women who had never been pregnant completed an online survey. Results demonstrated postpartum women engaged in more frequent self-oriented comparison than controls. Postpartum women compared their bodies more frequently to their pre-pregnant selves, than to other sources. Although all types and sources of comparison were positively correlated with each disordered eating construct, eating comparison and self-oriented body comparison emerged as the dominant types and sources of comparison explaining unique variance in a range of disordered eating. Results suggest social comparison factors may be critical in understanding postpartum disordered eating risk.

Does culture moderate the relationship between body dissatisfaction and quality of life? A comparative study of Australian and Malaysian emerging adults

Investigating moderating effects of culture between body dissatisfaction (BD) and quality of life (QoL) is paramount, as BD affects psychosocial functioning. Participants include 866 females (18–25) years old from Australia (n = 464) M (20.88) SD (3.38) and Malaysia (n = 402) M (20.63) SD (2.05). Higher levels of BD predicted lower levels of QoL across all four domains. BD had the strongest effect on psychological QoL for both cultures. Culture moderated the relationship between BD and: (i) physical QoL and (ii) environmental QoL. The adverse impact of BD on all domains of QoL, highlights the importance of BD as a public health problem.

Sociocultural Influences, Drive for Thinness, Drive for Muscularity, and Body Dissatisfaction among Korean Undergraduates

For many years, body dissatisfaction was considered a western phenomenon, and was studied mostly in Caucasian women. Recent studies, however, suggest that these issues are also present in men and in other ethnic groups. This research investigated the differential effects of various sociocultural pressures transmitted from the media, one’s parents, and one’s peers on the drives for thinness and muscularity, and body dissatisfaction among 1125 Korean college students (56% male) using structural equation modeling. The results indicate that, after controlling for body mass index and exercise, media pressures exerted the largest effects on participants’ body ideals and, in turn, body dissatisfaction across both genders (β = 0.44, and 0.30, p < 0.05, for females and males, respectively). This study’s results also indicate that there are considerable gender differences in this relationship. Specifically, the results show that parental and media pressure had significant indirect relationships with body dissatisfaction via the drive for thinness among females, while peer and media pressures had significant indirect relationships with body dissatisfaction via the drive for muscularity among males. As body dissatisfaction is known to significantly affect an individual’s mental and physical health, future research needs to identify relevant influential factors in this area, as well as the paths they have leading to increased body dissatisfaction.

Appearance Comparison, Appearance Self-Schema, Perfectionism, and Body Esteem Among Korean College Students

In this study, we examined whether the constructs of appearance self-schema and perfectionistic self-presentation were significant mediators for the direct association between physical appearance comparison and body esteem. A total of 290 South Korean students from a university in South Korea participated in this study. Results from structural equation modeling supported that both appearance self-schema and perfectionistic self-presentation were significant mediators for the relationship between physical appearance comparison and body esteem. A bootstrap method was used to assess the magnitude of the indirect effect, with 33% of the variance in body esteem accounted for by physical appearance comparison, appearance self-schema, and perfectionistic self-presentation. A multiple-group analysis showed that the mediation model could be applied equally to both men and women students in South Korea. The current study demonstrates how body esteem issues may unfold in a Korean cultural context where appearance is highly salient to one’s identity.

Risk factors for disordered weight control behaviors among Korean adolescents: Multilevel analysis of the Korea Youth Risk Behavior Survey

OBJECTIVE

To investigate the prevalence and risk factors for disordered weight control behaviors (DWCB) in South Korean adolescents at multiple levels, including individual, family, school, and geographic area.

METHOD

We drew participants from the 11th Korea Youth Risk Behavior Web-based Survey, conducted in 2015, with 65,529 adolescents (31,687 girls, 33,842 boys) aged 12-18 years. DWCB was defined as engaging in any of the following behaviors for weight control over the past month: fasting, one-food diet (eating only one food over an extended period of time for weight control), vomiting, and taking laxatives/diuretics/unprescribed diet pills. Sex-stratified four-level multilevel logistic models examined potential predictors of DWCB, including age, body-mass index, puberty, perceived household economic status, parental education, living structure, school type and sex-composition, percentage of students participating in school nutrition programs, and urbanicity.

RESULTS

Overall, 6.2% of Korean adolescents (8.9% of girls, 3.7% of boys) exhibited any DWCB. We found significant between-school variation among girls and boys and between-classroom variation among girls. Older age, overweight/obesity, pubertal maturity, high household economic status (vs. mid-range economic status), and vocational schooling (vs. general) were positively associated with DWCB among girls and boys. Low household economic status (vs. mid-range economic status), higher parental education, and coeducational schooling (vs. single-sex) were positively associated with DWCB among girls only.

DISCUSSION

The findings suggest that DWCB are prevalent among Korean adolescents across age, sex, and socioeconomic status. Social contextual factors including school and familial environmental factors, as well as individual characteristics, should be considered when developing effective prevention strategies.

Weight, gender, and depressive symptoms in South Korea

Objectives

Obesity consistently predicts depression risk, but the underlying mechanisms are poorly understood. Body concerns are proposed as key. South Korean society is characterized by extremely high levels of explicit weight stigma, possibly the highest globally. Using cross‐sectional Korean 2014 National Health Examination Survey (KNHANES) data, we test this proposition in a nationally representative sample of South Korean adults (N = 5,632).

Methods

Depressive symptoms (outcome variable), was based on the PHQ‐9. Weight status (predictor variable), was based on direct measures of height and weight converted to BMI. Weight concern was self‐reported. Mediation analyses tested how weight concern mediated the influence of weight status on depressive symptoms for women and men.

Results

Current weight status influenced depressive symptoms in Korean adults, but not always directly. Concerns of being “fat” mediated that relationship. The effect increased significantly as BMI increased within “normal” and overweight/obese categories for women, and in overweight/obese categories for men. Even though women classified as underweight were significantly more depressed than those in other weight categories, there was no similar mediation effect related to weight concerns.

Conclusion

For South Koreans, the stress of adhering to social norms and avoiding stigma related to body weight seems to explain the relationship between higher body weight and more depressive symptoms. Women are more vulnerable overall, but men are not immune. This study demonstrates that body concerns help explain why weight predicts depression, and more broadly supports the proposition that widespread weight‐related stigma is a potentially major, if unrecognized, driver of population‐level health disparities.

Body Dissatisfaction and Disordered Eating among College Women in China, South Korea, and the United States: Contrasting Predictions from Sociocultural and Feminist Theories

Body dissatisfaction and disordered eating were compared across groups of college women from China ( n = 109), South Korea ( n = 137), and the United States ( n = 102). Based on cultural differences in the amount of exposure to Western appearance standards, particularly the thin-body ideal, sociocultural theory ( Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999 ) would predict that body dissatisfaction and disordered eating would be highest in the U.S. sample and lowest in the Chinese sample. In contrast, based on the speed and pervasiveness of changes in women's roles, feminist theory ( Bordo, 1993 ; Jeffreys, 2005 ) would predict that body dissatisfaction and disordered eating would be highest in the Korean sample and lowest in the U.S. sample. Multidimensional measures indicated the highest levels of body dissatisfaction and disordered eating in the Korean sample and the lowest levels in the U.S. sample, indicating that predictions derived from feminist theory were a better fit to the data than predictions derived from sociocultural theory. Results indicated that theoretical understandings of body dissatisfaction must recognize not only differences between Western and non-Western cultures, but also differences among non-Western cultures.

Body Dissatisfaction and Mental Health Outcomes Among Korean College Students

For many years, body dissatisfaction and mental health were thought of as Western phenomena and were studied mostly in Caucasian women. Recent studies, however, suggest that these issues are also present in men and in other ethnic groups. This study examined the association between body dissatisfaction and mental health outcomes, with personality traits and neuroticism playing possible predictive roles, using a Korean sample. A total of 545 college students, from five private universities in South Korea, completed assessment measures for depression, self-esteem, neuroticism, and body esteem scales. After controlling for covariates including body mass index and exercise time, body dissatisfaction was seen to play a mediating role between neuroticism and mental health outcomes. Differences between the sexes were also found in this relationship. For men, body dissatisfaction acted as a mediator between neuroticism and depression. For women, body dissatisfaction acted as a mediator between neuroticism and both depression and self-esteem.

Sociocultural pressure, internalization, BMI, exercise, and body dissatisfaction in Korean female college students

This research investigated the differential effects of sociocultural pressures from media, peers, and parents on the thin ideal internalization and body dissatisfaction of 472 Korean female college students using structural equation modeling. Results indicated that after controlling for body mass index and exercise, media pressure exerted the largest effects, followed by peer pressure and parental pressure, on thin ideal internalization, and in turn, body dissatisfaction. Furthermore, parent and media pressures were found to exert direct effects on body dissatisfaction as well as indirect effects through thin ideal internalization. The results and implications of the study are discussed.

The rise of eating disorders in Asia: a review

Once concentrated among adolescent Caucasian females in high-income Western countries, today, eating disorders (EDs) are truly global. Building upon previous work describing the rise of EDs among cultures in transition, we contextualize the emergence of EDs in Asia by locating this development within the broader discourse about the processes of change that have radically transformed Asian societies over the last three decades. By identifying where EDs are emerging in the region, and by examining their particular expression, our aim is to explicate a fuller story of the relationship between culture and eating disorders. Much of the discussion of EDs in non-Western societies is predicated upon the assumption that an increase in EDs is the by-product of "Westernization", the term used to describe the process by which increased cultural contact with the West results in the transmission of so-called 'Western' ideas and cultural norms to a non-Western culture. While the Westernization literature represents a historical anchor in our understanding of EDs in Asia, we propose that this analysis is incomplete in that societal change in the form of industrialization and urbanization occurring independently from, or in tandem with, "Western" influence are critical factors contributing to the rise of EDs in Asia. Further, our review of eating disorders in Asia suggests that an understanding of the diversity and distinctiveness of the individual countries and cultures that comprise 'Asia' is crucial to understanding the emergence and rise of EDs across this vast region, suggesting that eating disorders are not culture-bound or culture-specific, but rather culture-reactive. Taking into account both the historical influence of Western culture and the more contemporary effects of Asian industrialization and urbanization, key distinctions among respective Asian cultures expands our understanding of the development and expression of EDs globally.

Social media use, body image, and psychological well-being: a cross-cultural comparison of Korea and the United States

This study examined the relationships among social media use for information, self-status seeking and socializing, body image, self-esteem, and psychological well-being, and some cultural effects moderating these relationships. Americans (n = 502) and Koreans (n = 518) completed an online survey. The main findings showed that (a) social media use for information about body image is negatively related to body satisfaction in the United States and Korea, while social media use for self-status seeking regarding body image is positively related to body satisfaction only in Korea; and (b) body satisfaction has direct and indirect positive effects on psychological well-being manifested in similar ways in the United States and Korea. Implications and future research directions are discussed.

Cultural trends and eating disorders

PURPOSE OF REVIEW

Culture has long been recognized as significant to the cause and expression of eating disorders. We reviewed the recent literature about recent trends in the occurrence of eating disorders in different cultures.

RECENT FINDINGS

While historically, eating disorders were conceptualized as primarily afflicting Caucasian adolescent or young adult women within high-income, industrialized Western Europe and North America, eating disorders are increasingly documented in diverse countries and cultures worldwide. This study highlights recent trends that reflect the changing landscape of culture and eating disorders: stabilization of the incidence of anorexia nervosa and possibly lower incidence rates of bulimia nervosa in Caucasian North American and Northern European groups; increasing rates of eating disorders in Asia; increasing rates of eating disorders in the Arab region; and increasing rates of binge eating and bulimia nervosa in Hispanic and Black American minority groups in North America.

SUMMARY

The changing face of eating disorders calls for a new conceptualization of culture in both the emergence and spread of eating disorders across the globe.

A cross-cultural study investigating body features associated with male adolescents' body dissatisfaction in Australia, China, and Malaysia

This study investigated how dissatisfaction with particular aspects of the body was associated with overall body dissatisfaction among male adolescents in Western and Asian cultures. One hundred and six Malaysian Malays, 55 Malaysian Chinese, 195 Chinese from China, and 45 non-Asian Australians aged 12 to 19 years completed a questionnaire assessing dissatisfaction with their overall body and dissatisfaction with varying aspects of their body. Dissatisfaction with the face, height, and hair was positively correlated with overall body dissatisfaction among Malaysian Malays after body mass index, age and dissatisfaction with body areas typically included in measures (weight/shape, upper, middle, and lower body, and muscles) had been controlled for. Dissatisfaction with the face was positively correlated with overall body dissatisfaction among Malaysian Chinese. These findings demonstrate the differences in body focus for males from different cultures and the importance of using assessment measures that address all possible areas of body focus.

A test of the resource security and the body mass index reference point hypotheses of body dissatisfaction amongst adolescents in eight countries

OBJECTIVE

This study aimed to identify cultural-level variables that may influence the extent to which adolescents from different cultural groups are dissatisfied with their bodies.

DESIGN

A sample of 1730 male and 2000 female adolescents from Australia, Fiji, Malaysia, Tonga, Tongans in New Zealand, China, Chile, and Greece completed measures of body satisfaction, and the sociocultural influences on body image and body change questionnaire, and self-reported height and weight. Country gross domestic product and national obesity were recorded using global databases.

RESULTS

Prevalence of obesity/overweight and cultural endorsement of appearance standards explained variance in individual-level body dissatisfaction (BD) scores, even after controlling for the influence of individual differences in body mass index and internalization of appearance standards.

CONCLUSIONS

Cultural-level variables may account for the development of adolescent BD.

Which body features are associated with female adolescents' body dissatisfaction? A cross-cultural study in Australia, China and Malaysia

This study investigated how dissatisfaction with various aspects of the body is associated with overall body dissatisfaction among female adolescents in Western and Asian cultures. Data used in the study were obtained from 58 Malaysian Malays, 95 Malaysian Chinese, 242 Chinese from China, and 81 non-Asian Australians aged 12-19 years (M=15.72, SD=1.72) who were recruited from high schools. Participants completed a questionnaire assessing dissatisfaction with their body overall, and dissatisfaction with varying aspects of their body. Malaysian Chinese were the most dissatisfied with their bodies. After controlling for body mass index (BMI), age and dissatisfaction with weight/shape, upper, middle and lower body, and muscles, dissatisfaction with the face was positively correlated with overall body dissatisfaction among Malaysian Malays and Australians. These findings demonstrate the importance of using assessment measures that address all possible areas of body focus as well as being tailored to the relevant culture.