Effects of Gender and Appearance Comparisons on Associations Between Media-Based Appearance Pressure and Disordered Eating: Testing a Moderated Mediation Model

Validation of the Appearance-Related Social Media Consciousness Scale with Chinese adolescents and young adults

Research has revealed a negative association between appearance-related social media consciousness (ASMC) and mental health, but the impact of this association in the Chinese population remains understudied. This study examined the psychometric properties of the ASMC scale among Chinese adolescents and young adults and to further investigate the scale's measurement invariance and differences in ASMC across gender and age groups. Exploratory and confirmatory factor analyses were conducted to examine the ASMC scale's factorial structure among Chinese adolescents and young adults, including 1109 adolescents (50.0% boys) aged 12-18 (mean, 14.89) years and 457 young adults (42.5% men) aged 18-25 (mean, 20.75) years. The measurement invariance across gender and age groups, internal consistency and convergent validity were examined. ASMC scale was found to have a unidimensional structure and to be invariant across gender and age groups. It exhibited excellent internal consistency and strong construct validity. Moderate gender differences and pronounced age differences in ASMC scale scores were observed. Our findings support the validity of the ASMC scale as an effective instrument for the measurement of appearance-related social media consciousness experience among Chinese young adults and adolescents. Further study is required to evaluate the status of ASMC as a risk factor for disordered eating and target for preventive interventions within Chinese samples.

Altered connectivity patterns of medial and lateral orbitofrontal cortex underlie the severity of bulimic symptoms

Objective

Compared to clinical bulimia nervosa, sub-threshold bulimic symptoms are becoming more prevalent in non-clinical or general population, which is repeatedly linked with the connectivity in orbitofrontal cortex (OFC), including functionally heterogeneous the medial and lateral OFC (mOFC; lOFC). However, the specific connectivity patterns of the mOFC and lOFC in individuals with severe or mild bulimic symptoms (SB; MB) remain poorly understood.

Methods

We first utilized resting-state functional connectivity (FC) and spectral dynamic causal modeling (spDCM) to investigate abnormal functional and effective connectivity (EC) of OFC subregions in adults with different severity of bulimic. The SB group (n = 21), MB group (n = 114), and healthy controls (HC, n = 91) underwent rs-fMRI scans. A generalized linear model was applied to determine the OFC-seeded whole-brain FC across the three groups. Subsequently, spDCM was used to estimate differences in EC among the three groups based on the FC results.

Results

We observed a shared neural basis for SB and MB groups (i.e., weaker lOFC-superior parietal lobule connectivity), which may support the role of dysfunctional inhibitory control in general bulimic symptomatology. Whereas, SB group displayed greater lOFC-occipital pole connectivity than MB group, suggesting the specificity of the neural correlates of full-threshold/severe bulimia. The directional links from the mOFC to lOFC and amygdala could further explain the aberrant interactions of reward sensitivity with inhibitory control and homeostatic energy in sub-threshold/mild condition.

Conclusion

The current study provides novel evidence that divergent connectivity patterns of the lOFC and mOFC may contribute to different severities of bulimia, which will expands our understanding of the neurobiological substrates underlying bulimia across a spectrum from healthy to unhealthy.

Examining an integrated sociocultural and objectification model of thinness- and muscularity-oriented disordered eating in Chinese older men and women

OBJECTIVE

We tested an integrated model of three prominent theories of disordered eating (tripartite influence theory, objectification theory, and social comparison theory) in a sample of older Chinese men and women.

METHOD

Chinese older men (n = 270) and women (n = 160) completed questionnaires assessing the tripartite influence, objectification, and social comparison theories and thinness- and muscularity-oriented disordered eating. Two structural equation models were tested in Chinese older men and women.

RESULTS

The integrated model showed good model fit and described meaningful variance in thinness- and muscularity-oriented disordered eating in Chinese older men and women. Higher appearance pressures were uniquely related to higher muscularity-oriented disordered eating in men. Across both gender groups, higher thinness internalization was uniquely related to higher thinness- and muscularity-oriented disordered eating, and in women only, higher muscularity internalization was uniquely related to lower thinness-oriented disordered eating. In men, higher upward and downward body image comparisons were uniquely related to higher and lower, respectively, muscularity-oriented disordered eating. In women, higher upward body image comparisons were only uniquely related to higher muscularity-oriented disordered eating while higher downward body image comparisons were uniquely related to both outcomes. Higher body shame was uniquely related to higher thinness-oriented disordered eating across both groups and in men alone, higher body shame was also uniquely related to higher muscularity-oriented disordered eating.

DISCUSSION

Findings, which tested the integration of tripartite influence, objectification, and social comparison theories, inform the prevention and treatment of disordered eating in Chinese older populations.

PUBLIC SIGNIFICANCE

The present study is the first to describe theories of disordered eating (tripartite influence, objectification, and social comparison) in Chinese older adults. Findings suggested good model fit and the integrated models described meaningful variance in thinness- and muscularity-oriented disordered eating in Chinese older women and men. Findings extend existing theories of disordered eating and, pending further study, may inform theory-driven prevention and treatment approaches in Chinese older adults.

Connectome-based prediction of eating disorder-associated symptomatology

BACKGROUND

Despite increasing knowledge on the neuroimaging patterns of eating disorder (ED) symptoms in non-clinical populations, studies using whole-brain machine learning to identify connectome-based neuromarkers of ED symptomatology are absent. This study examined the association of connectivity within and between large-scale functional networks with specific symptomatic behaviors and cognitions using connectome-based predictive modeling (CPM).

METHODS

CPM with ten-fold cross-validation was carried out to probe functional networks that were predictive of ED-associated symptomatology, including body image concerns, binge eating, and compensatory behaviors, within the discovery sample of 660 participants. The predictive ability of the identified networks was validated using an independent sample of 821 participants.

RESULTS

The connectivity predictive of body image concerns was identified within and between networks implicated in cognitive control (frontoparietal and medial frontal), reward sensitivity (subcortical), and visual perception (visual). Crucially, the set of connections in the positive network related to body image concerns identified in one sample was generalized to predict body image concerns in an independent sample, suggesting the replicability of this effect.

CONCLUSIONS

These findings point to the feasibility of using the functional connectome to predict ED symptomatology in the general population and provide the first evidence that functional interplay among distributed networks predicts body shape/weight concerns.

Social Comparison and Female Adolescents' Selfie Behaviors: Body Surveillance as the Mediator and Self-Esteem as the Moderator

The current study aimed to examine whether body surveillance mediated the relation between social comparison and selfie behaviors, and whether this mediating process was moderated by self-esteem. A sample of 339 female adolescents were recruited to participate in the present study and completed self-report measures of selfie behaviors, upward and downward appearance comparisons with peers, self-objectification and self-esteem. Results indicated that body surveillance mediated the association between upward physical appearance comparison and selfie behaviors. In addition, self-esteem moderated the relation between body surveillance and selfie behaviors. These findings add to the extant literature by suggesting that selfies may be some new ways of body surveillance and physical appearance comparison, which have some theoretical and practical implications.

Relationships between weight bias internalization and biopsychosocial health outcomes: A prospective study in Chinese adolescents

OBJECTIVE

An extensive literature has documented the deleterious effects of weight bias internalization (WBI) on biopsychosocial health outcomes. Still, this research is largely confined to the Western context. Furthermore, few studies have explored associations between WBI and biopsychosocial health outcomes, including in non-Western adolescent populations.

METHOD

The present study explored the longitudinal relationships between WBI and body dissatisfaction, disordered eating, psychosocial impairment related to eating disorder features, and psychological and physical well-being in a sample (N = 1549; aged 11-18 years at baseline) of Chinese adolescents. Relationships between study variables were examined between two waves of data measurement (Time 1, baseline, and Time 2, 6-month). Cross-lagged and multivariate models were used to explore prospective relationships between WBI and biopsychosocial correlates.

RESULTS

Bidirectional relationships were observed between WBI and biopsychosocial correlates in Chinese adolescents. Adjusting for covariates and other predictor variables, higher body dissatisfaction, disordered eating, psychosocial impairment, and psychological distress at Time 1 predicted higher WBI at Time 2. Furthermore, higher WBI at Time 1 predicted higher body dissatisfaction, disordered eating, psychosocial impairment, and psychological distress at Time 2.

DISCUSSION

Weight bias internalization and psychosocial correlates were interrelated across time in Chinese adolescents. Improving WBI might be promising in the prevention of eating and body image disturbances and diminished psychosocial well-being. Similarly, reducing eating and body image disturbances and improving psychosocial well-being might be useful prevention targets in reducing WBI in Chinese adolescents.

PUBLIC SIGNIFICANCE

The present study represents an initial effort to explore bidirectional relationships between WBI and biopsychosocial health outcomes in Chinese adolescents. Findings suggest bidirectional relationships between WBI and psychosocial variables, highlighting the potential utility of incorporating WBI interventions into eating pathology and poor psychosocial well-being prevention designs for Chinese adolescents.

Examining appearance pressures, thinness and muscularity internalizations, and social comparisons as correlates of drive for muscularity and thinness-oriented disordered eating in Chinese heterosexual men and women: Testing an integrated model

Given existing empirical support for the tripartite influence and social comparison models to explain variance in body dissatisfaction and disordered eating across diverse populations in the Western context, research is needed to describe these models in non-Western populations. The present study tested an integrated model inclusive of appearance pressures, thinness and muscularity internalizations, and social comparisons in relation to drive for muscularity and thinness-oriented disordered eating in heterosexual Chinese adult men (n = 510) and women (n = 473). Separated by gender, two integrated models had good fit statistics per structural equation modeling. In men and women, higher appearance pressures were uniquely related to higher drive for muscularity and thinness-oriented disordered eating. In men and women, higher thinness and muscularity internalizations were uniquely related to higher thinness-oriented disordered eating and drive for muscularity, respectively. In men and women, higher upward body image comparisons were uniquely related to higher drive for muscularity, and in men only, higher downward body image comparisons were uniquely related to higher thinness-oriented disordered eating. The present findings, which extend theories of eating pathology, may aid in improving treatment efforts for body dissatisfaction and disordered eating in heterosexual Chinese adult men and women.

Integrating the tripartite influence, minority stress, and social comparison theories to explain body image and disordered eating in Chinese sexual minority men and women

Theories of eating pathology explain body image and disordered eating in diverse populations, including sexual minority (SM) individuals. Yet, previous efforts to extend theories of eating pathology to SM individuals have mostly focused on Western populations. The present study integrated the tripartite influence, minority stress, and social comparison models to explain variance in body image and disordered eating in Chinese SM men and women. Chinese self-identified SM adults (N = 1051; n = 519 men, n = 532 women) completed an online, cross-sectional study that assessed sociocultural influences (e.g., tripartite influence), minority stress, social comparisons, drive for muscularity, and disordered eating. Two integrated models were tested for men and women using structural equation modeling. Across both populations, sociocultural influences exerted the largest direct positive effects on body image and disordered eating. In men, only downward body image comparisons were uniquely related to outcomes. In women, higher upward body image comparisons were uniquely associated with higher drive for muscularity and higher downward body image comparisons were uniquely associated with higher thinness-oriented disordered eating. Minority stressors (e.g., sexual orientation concealment, internalized homophobia) were uniquely related to outcomes in men, not women. Findings extend existing theories of body image and disordered eating to Chinese SM populations.

Orbitofrontal neural dissociation of healthy and unhealthy food reward sensitivity in normal-weight binge eaters

OBJECTIVE

The orbitofrontal cortex (OFC) has been repeatedly found to play an important role in food reward processing and binge eating (BE) episodes. However, most studies have focused mainly on reward-related neural alterations in clinical binge eating patients, with little consideration of preclinical individuals with BE that are more likely to develop from non-clinical individuals to clinical patients in the future. This study aimed to examine whether preclinical binge eaters exhibited OFC-related resting-state functional connectivity (rsFC) in the context of food reward.

METHOD

Binge eaters (BE group, n = 28) and healthy controls (HCs, n = 28) matched for age and body mass index (BMI) underwent rs-fMRI scans and completed self-reported assessment of BE symptoms. Food reward sensitivity was measured using the modified food incentive delay task. Analysis of covariance was used to assess the between-group differences in the medial and lateral OFC (a priori selected regions of interest) connectivity patterns in the context of food reward, while controlling for age, sex, and BMI.

RESULTS

Lower unhealthy food (UF) reward sensitivity was significantly associated with stronger inverse OFC-putamen connectivity for HCs, while the BE group showed no association between UF reward sensitivity and the OFC-putamen connectivity. Higher healthy food (HF) reward sensitivity in the BE group was significantly correlated with stronger positive OFC-middle frontal gyrus and OFC-inferior parietal gyrus connectivity, while the opposite was found for HCs.

CONCLUSIONS

Binge eaters showed less functional synchrony within reward regions contributing to the UF reward sensitivity, but enhanced neural interactions between reward and inhibitory control regions correlated with the HF reward sensitivity. These novel findings may demonstrate the potential orbitofrontal neural dissociation of unhealthy and healthy food reward sensitivity in normal-weight binge eaters.

Testing links between unfavorable living conditions, fast life-history strategy adoption, and overeating: a four-wave longitudinal study

Although overeating increases risk for chronic illness and premature mortality, evolutionary life-history theorists posit that such behaviors arise as a potential outcome of using fast life-history strategies to function in environments that are harsh or unpredictable. To test this premise, we examined links between harsh, unpredictable living conditions (HULC), the adoption of fast life-history (LH) strategies, and overeating among early adolescents using a four-wave longitudinal design. Participants were 2547 Chinese adolescents (1202 girls, 1345 boys) who completed baseline questionnaires assessing experiences of HULC, preferences for use of fast LH strategies, and overeating. Measures were re-administered in follow-ups 7, 13, and 20 months later. Analyses indicated HULC predicted increased use of fast LH strategies within each gender. However, fast LH strategy adoption contributed to increases in overeating only among girls. Findings supported specific tenets of life-history theory and underscored gender as an important consideration in understanding links between living conditions, the adoption of fast LH strategies, and risk for overeating. Interventions focused on reducing poverty and increasing stable, nurturing family, and community environments may aid in reducing overeating and obesity for adolescents.

Gender Differences in Body Appreciation and Its Associations With Psychiatric Symptoms Among Chinese College Students: A Nationwide Survey

BACKGROUND

Body appreciation (BA hereafter), which reflects approval, acceptance, and respect for one's body while also rejecting media-promoted appearance ideals as the only form of human beauty, is an important aspect of positive body image. Much of the BA literature has been conducted on samples from Western nations but less is known about BA or its correlates in Asian cultural contexts wherein concerns with body image are also common. Toward addressing this gap, we examined gender differences in BA and its associations with common psychiatric symptoms (i.e., depressive symptoms, anxiety symptoms, and suicidality) within a national college student sample from China.

METHOD

This cross-sectional, nationwide study was conducted between December 27, 2020, and January 18, 2021, based on snowball sampling. Aside from measures of demographics and background factors, Chinese versions of the Body Appreciation Scale-2 (BAS-2), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and a standard item on suicidal ideation and planning were administered to assess BA, depressive and anxiety symptoms, and suicidality, respectively.

RESULTS

In total, 2,058 college students (665 men, 1,393 women) in China were assessed. An analysis of covariance revealed that the men had a significantly higher average BA level than did women [F _(1,2058) = 13.244, P < 0.001, Cohen's d = 0.193]. Hierarchical multiple regression analyses revealed BA was negatively associated with symptoms of depression, anxiety, and suicidality within the entire sample (depressive symptoms, β = -0.129, P < 0.001; anxiety symptoms, β = -0.101, P < 0.001; suicidality, OR = 0.788 P = 0.020) and among women (depressive symptoms, β = -0.172, P < 0.001; anxiety symptoms, β = -0.131, P < 0.001; suicidality, OR = 0.639 P = 0.001) but not men.

CONCLUSION

Chinese college women reported lower BA than their male peers did. Furthermore, among women but not men, elevations in BA corresponded with protective mental health experiences including lower levels of depressive symptoms, anxiety symptoms and suicidality. Findings underscore the potential utility of including BA in mental health assessments of Chinese college students, especially women. Findings also provide foundations for continued research on interventions to increase BA among at-risk young women in China.

Resting-state functional network connectivity underlying eating disorder symptoms in healthy young adults

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This study examined the resting-state functional network connectivity underlying eating disorder symptoms in a large sample of healthy young adults (n = 693).

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Individuals with higher levels of eating disorder symptoms displayed weaker intra-network connectivity of the executive control network and basal ganglia network, as well as weaker inter-network connectivity in the three examined networks (i.e., the executive control network, basal ganglia network, and default mode network).

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The findings suggest that these neural circuits may play a key role in symptoms of disordered eating in healthy adults. They further reveal that the less efficient information exchange within and between intrinsic networks associated with self-referential thinking, inhibitory control, and reward sensitivity are strongly related to eating disorder symptoms.

Previous neuroimaging research of eating disorders such as anorexia nervosa and bulimia nervosa has mainly focused on clinical patients, indicating the crucial role of intrinsic connectivity networks involved in aberrant behavioral control (i.e., executive control network), reward reactivity (i.e., basal ganglia network), and excessive self-focused and body-focused ruminations (i.e., default mode network) in the onset and maintenance of eating disturbances. However, examinations of large-scale resting-state networks that support the role of cognitive control, reward sensitivity, and self-directed thinking in disordered eating have rarely involved non-clinical samples from the general population. This study, involving a total of 693 healthy young adults (68.69% females; mean age, 18.37 years), investigated these issues by using pre-defined functional regions of interest from the executive control network, basal ganglia network, default mode network, and a seed-based region of interest-to-region of interest approach. After statistically controlling for differences in age, sex, body mass index, and head motion, we observed significant associations of higher levels of eating disorder symptoms, especially bulimia-type eating (i.e., binge eating and a combination of binge eating and compensatory behaviors, such as purging via self-induced vomiting or laxative use, and compulsive exercise), with weaker intra-network and inter-network functional synchrony. These results remained significant after excluding underweight, overweight, and obese participants. These findings suggest that these neural circuits may play a key role in the symptoms of disordered eating in healthy adults. They further reveal that the less efficient information exchange within and between intrinsic networks associated with self-referential thinking, inhibitory control, and reward sensitivity are strongly related to eating disorder symptoms.

Effectiveness of an Internet Dissonance-Based Eating Disorder Prevention Intervention Among Body-Dissatisfied Young Chinese Women

Body image disturbances are widespread in highly populated, rapidly developing Asian nations such as China, but there are severe shortages of practitioners qualified to treat these issues. In such contexts, validated online interventions offer a potentially viable approach for addressing the lack of treatment resources. In this study, we evaluated effects of the eBody Project, an online, dissonance-based eating disorder prevention program, on functioning among body-dissatisfied young Chinese women. Participating women were randomly assigned to the 6-week eBody Project intervention (n = 191) versus an education brochure control condition (n = 181). Self-report assessments of eating disorder risk factors (body dissatisfaction, thin ideal internalization, depressive symptoms, restrained eating), self-esteem, body appreciation, and disordered eating were completed at baseline, posttreatment, and a 6-month follow-up. There were no intervention differences on outcomes before treatment but eBody Project women experienced significantly larger improvements on all outcomes following treatment and/or at follow-up compared to controls; corresponding effect sizes were small to medium. Results indicated the eBody Project program is a promising intervention for young women at risk for eating disorders in China and provide foundations for broad implementation in low- and middle-income countries where resources for in-person therapy and supervision are limited or unavailable altogether.

Asian versus Western appearance media influences and changes in body image concerns of young Chinese women: A 12-month prospective study

Appearance-related media from the United States and other Western nations has been implicated in explanations of increased body images concerns among non-Western women. However, researchers have rarely examined the impact of endogenous appearance media versus Western appearance media on body image issues, particularly within longitudinal research designs. Therefore, in this 12-month prospective study, we assessed associations of experiences with appearance media imported from Western nations versus appearance media from China and other Asian nations on body image concerns and cosmetic surgery interest among young Chinese women. Participating women (N = 1836) completed self-report measures tapping specific sources of appearance dissatisfaction (fatness, facial features, stature), cosmetic surgery interest, and appearance media influences at baseline and a 12-month follow-up. The women reported significantly more pressure from and stronger preferences for appearance depictions in Asian than Western media. Elevations in appearance pressure and preferences from Asian media explained more unique variance in specific body image concerns at follow-up than did complementary Western media influences. Contrary to "Westernization" hypotheses, Asian appearance media influences are more salient for young Chinese women and should be prioritized as targets of interventions to reduce body image disturbances in this group.