Go big or go home: A thematic content analysis of pro-muscularity websites

Discretionary Food Consumption Patterns of Polish Schoolchildren in Relation to Anthropometric, Socio-Demographic, and Lifestyle Factors: Report from the Junior-Edu-Żywienie (JEŻ) Project

Background: Discretionary foods are not necessary for a healthy diet and are too high in saturated fat and/or added sugars, added salt, or alcohol and are low in fiber. The aim of this study was to identify patterns of discretionary food (DF) consumption in Polish adolescents in relation to anthropometric, socio-demographic, and lifestyle factors. It is important to learn about discretionary food consumption habits to identify health risks and plan strategies to reduce DF consumption. Methods: The cross-sectional study was conducted among 2849 primary school students aged 10-12 from Poland. Socio-demographic data, eating habits, lifestyle factors, and nutritional knowledge of children were assessed using questionnaires: KomPAN® and SF-FFQ4PolishChildren®. Body composition testing was performed by bioelectrical impedance analysis (BIA) using a TANITA MC-780 S MA multi-frequency segmented analyzer. Results: Four dietary patterns were identified with different frequencies of discretionary food consumption: LowDF, MediumDF, HighDF, and HighSweet pattern. Children from the LowDF and MediumDF patterns had higher BMI and body fat content than children from the HighDF and HighSweets patterns (p < 0.0001). The majority of children (68.4%) were of normal weight, 22.3% were overweight or obese, and 9.4% were underweight. Children in the LowDF and MediumDF patterns had higher body fat (24% and 23.5%, respectively) than children in the HighDF and HighSweetDF patterns (22.4% and 22.4%, respectively). Most of the children showed adherence to the MediumDF pattern, and they were mainly boys (38 vs. 32.5%). Girls predominate in LowDF, HighDF, and HighSweets patterns (33.5, 18.4, and 15.5%, respectively). Children in the LowDF and MediumDF patterns tended to be more physically active in their leisure time (OR = 1.758 (CI:1.32 2.34) p < 0.0001; OR = 1.354 (CI:1.04; 1.76) p = 0.0227) and the opposite relationship was observed in the HighDF pattern (OR = 0.495 (CI:0.38; 0.65) p < 0.0001). Children in the HighSweets pattern had low adherence to high physical activity (OR = 0.666 (CI:0.48; 0.92) p = 0.0132), but high adherence to moderate (OR = 1.29 (CI:1.01; 1.65) p = 0.0443) and high (OR = 1.54 (CI:1.04; 2.38) p = 0.0428) nutrition knowledge. Conclusions: Consumption of discretionary foods by Polish adolescents is related to body composition, socio-demographic, and lifestyle factors. Given the global emphasis on improving the daily diet, it seems necessary to implement intervention programs in Poland that would, among other things, clarify recommendations for the consumption of discretionary foods, following the example of other countries that have already achieved results in this regard. From a public health perspective, interventions to increase nutritional knowledge and improve lifestyles should be implemented with both adolescents and their parents in coordination with the school.

Beyond thinness: The contribution of muscularity-oriented disordered eating to clinical impairment across cultures

Muscularity-oriented disordered eating (MODE) has been linked to negative outcomes, even when controlling for thinness-oriented disordered eating; however, its contribution to clinical impairment across demographic groups remains understudied. This study examined whether MODE independently contributes to clinical impairment while accounting for cognitive restraint, restricting, and purging, and whether this relationship differs by gender and country. Female (n = 1575) and male (n = 906) students from Canada, the United States, and Iran completed self-report measures of MODE, thinness-oriented disordered eating, and clinical impairment. Hierarchical multiple regressions were conducted with gender and country as moderators. Analyses were pre-registered on Open Science Framework. The addition of MODE to the model significantly accounted for 11 % of unique variance in clinical impairment. No significant moderation effects of gender and country were found. Results suggest that across women and men from both Western and non-Western cultural contexts, the unique aspects of MODE are associated with disruptions in daily functioning in multiple domains. These findings challenge the belief that dieting for muscularity is inherently beneficial for well-being. More clinical attention on MODE is warranted, such as targeted prevention and treatment efforts that address MODE specifically, rather than conceptualizing it as an extension of thinness-oriented eating disorders.

The 'ideal' dancer: An investigation into predictors of body image dissatisfaction among male dancers, female dancers and their non-dancing counterparts

Body image dissatisfaction is consistently highlighted as a precursor for eating disorders, arising from several factors. One factor surrounds social expectations of being thin, which can be emphasised in certain physical activities, like dance. Whilst research is available for body image dissatisfaction among female dancers, literature has neglected the male demographic. The present study investigated seven predictors of body image dissatisfaction within male and female dancers, from a variety of genres. The study employed a non-experimental quantitative method, utilising an independent groups correlational design. The role of clothing practices, body ideal internalisation and sociocultural influences were investigated as predictors for body image dissatisfaction. Data from 180 participants (mean age = 23.7, SD = 7.51) was analysed from an online survey. Hierarchical multiple regression revealed that the model consisting of all predictors significantly accounted for over 60% of variance in body image dissatisfaction scores within all independent groups. The individual contribution of predictors differed between groups, with clothing practice being the only significant predictor in all four groups. Media pressure was a significant predictor within non-dancer groups only. This research highlights the importance of clothing practices, specifically tight-fitting garments within the dance environment and general population. Future research should investigate potential differences in the predictors between each level of dance.

Multidimensional perfectionism and orthorexia: a systematic review and meta-analysis

PURPOSE

We provide the first systematic review and meta-analysis of research examining multidimensional perfectionism-perfectionistic strivings and perfectionistic concerns-and orthorexia.

METHODS

The systematic review and meta-analysis was pre-registered and conducted using a search of PsycINFO, MEDLINE, Education Abstracts, and Oxford Academic, and ScienceDirect up to April 2023. PRISMA guidelines were also followed. Meta-analysis using random-effects models was used to derive independent and unique effects of perfectionism, as well as total unique effects (TUE), and relative weights. Moderation of effects were examined for age, gender, domain, perfectionism and orthorexia instruments, and methodological quality.

RESULTS

Eighteen studies, including 19 samples (n = 7064), met the eligibility criteria with 12 of these studies (with 13 samples; n = 4984) providing sufficient information for meta-analysis. Meta-analysis revealed that perfectionistic strivings (r+  = 0.27, 95% CI [0.21, 0.32]) and perfectionistic concerns (r+  = 0.25, 95% CI [0.18, 0.31]) had positive relationships with orthorexia. After controlling for the relationship between perfectionism dimensions, only perfectionistic strivings predicted orthorexia which also contributed marginally more to an overall positive total unique effect of perfectionism (TUE = 0.35; 95% CI [0.28, 0.42]). There was tentative evidence that orthorexia instrument moderated the perfectionistic concerns-orthorexia relationship.

DISCUSSION

Research has generally found that both dimensions of perfectionism are positively related to orthorexia. More high-quality research is needed to examine explanatory mechanisms while also gathering further evidence on differences in findings due to how orthorexia is measured, as well as other possible moderating factors.

LEVEL OF EVIDENCE

Level 1, systematic review and meta-analysis.

Exploring the Role of Discrepancy Stress and Muscle Dysmorphia in the Association Between Gender Role Discrepancy and Masculine Depression in Israeli Men

Guided by the dynamic model of masculinity and men's psychopathology, the current study aimed to explore the mediating role of masculine discrepancy stress and each of the muscle dysmorphia dimensions (drive for size, appearance intolerance, and functional impairments) in the association between masculine gender role discrepancy and masculine depression. For the present study, 936 Israeli men completed a structured self-report questionnaire. Masculine discrepancy stress and some of the muscle dysmorphia dimensions were found to partially mediate the association between masculine gender role discrepancy and masculine depression. The findings demonstrate how the internalization of social gender expectations and men's gender role discrepancy is reflected in the gap between perception of self and the typical man, which is eventually related to mental health outcomes. In turn, men attempt to mitigate the stress through what they perceive as masculine, reflecting muscle dysmorphia: drive for size, appearance intolerance, and functional impairments, which in turn predict masculine depression. Therefore, mental and physical health professionals are advised to be aware of these mechanisms, in order to recognize the negative mental health outcomes arising from traditional societal gender role expectations and provide specific solutions for them.

Adaptation and validation of the muscle dysmorphic disorder inventory in a population of French athletes (MDDI-Fr)

INTRODUCTION

Muscle dysmorphia, a theme mainly investigated by Anglo-Saxon research, is a specific body dysmorphic disorder that characterizes individuals who think they are insufficiently muscular and lean. Understudied in francophone countries, tools translated and validated in French to measure the symptomatology of muscle dysmorphia remain rare.

OBJECTIVES

The aim of this study was the translation into French and the psychometric validation of a tool evaluating muscle dysmorphia, the Muscle Dysmorphic Disorder Inventory (MDDI-Fr), through 13 items divided into three dimensions: the "Drive For Size" (DFS), the "Appearance Intolerance" (AI) and the "Functional Impairment" (FI).

METHODOLOGY

A first translation step was conducted, followed by two cross-sectional studies conducted in France. In both of the latter studies, a sociodemographic questionnaire and the Muscle Dysmorphic Disorder Inventory - French version (MDDI-Fr) were administered. The first study included 342 university students (Mage=20.9; SDage=2.9), and 1822 athletes for the second study (Mage=23.9; SDage=5.9). Validation was performed using internal consistency measures and confirmatory factor analysis.

RESULTS

The correlation matrices showed good significant results between items and dimensions. The three dimensions appeared distinct from each other with significant intra-dimension correlations. The internal consistency of the tool and its three dimensions show valid Cronbach's alphas (study 1: DFS=0.79, AI=0.74, FI=0.75, MDDI=0.74; study 2: DFS=0.72, AI=0.75, FI=0.83, MDDI=0.75). In addition, the tri-factor analysis shows significant and promising scores for the tool in three dimensions and 13 items for study 1 (χ2/df=4.67, CFI=0.85, TLI=0.83, RMSEA=0.10, SRMR=0.00), as for study 2 (χ2/df=16.08, CFI=0.87, TLI=0.84, RMSEA=0.09, SRMR=.06). Gender analyses were conducted on study 2, which showed that the DFS subscale (items 1, 4, 5) and the AI subscale (items 6 and 9) presented the greatest differences in factor loadings between genders.

CONCLUSION

The translation, as well as the validation of the MDDI-Fr structured with 13 items and three dimensions, showed significantly satisfying results for its adaptation in French in a population of French men and women practicing weight training. However, the "Appearance Intolerance" dimension shows moderate links with the global tool, which should be investigated in future studies. Although the psychometric properties of the MDDI-Fr are promising, additional research is needed to gain a better understanding of gender differences in the results, especially for the DFS dimension.

The 'not-so-healthy' appearance pursuit? Disentangling unique associations of female drive for toned muscularity with disordered eating and compulsive exercise

Today, many women are driven to subscribe to a more athletically oriented appearance ideal hallmarked by muscle tone (referred to as athletic- or fit-looking). However, the constellation of unhealthy eating and exercise behaviors that may accompany the pursuit of toned muscularity among women is not yet well characterized. To address this knowledge gap, our study evaluated the associations among the female drive for toned muscularity and both thinness-oriented disordered eating behaviors (e.g., dietary restriction) and muscularity-oriented disordered eating behaviors (e.g., excessive scrutiny of macro-nutrient values of food), as well as dimensions of compulsive exercise. Participants were 388 Australian undergraduate women who completed an online questionnaire including self-report measures of said constructs. Hierarchical regression models were used to determine whether the drive for toned muscularity accounted for unique variance in eating and exercise behaviors after adjusting for theoretically relevant covariates. Results indicated independent relationships between the drive for toned muscularity and several facets of thinness- and muscularity-oriented disordered eating, as well as compulsive exercise (e.g., exercise rigidity). Our findings further contribute to an emerging literature illustrating that women driven to attain a toned appearance may be vulnerable to engaging in a wide range of maladaptive eating and exercise practices.

Characterizing cheat meals among a national sample of Canadian adolescents and young adults

BACKGROUND

"Cheat meals", described as brief eating episodes that depart from established dietary practices to consume prohibited foods, represent a novel and increasingly common eating behavior with particular salience in adolescence and young adulthood. However, knowledge gaps remain regarding the frequency and characterization of foods and calories consumed during cheat meals, and their associations with eating disorder behaviors and psychopathology. Thus, the aims of this study were to delineate engagement in cheat meals among a large, national sample of Canadian adolescents and young adults.

METHODS

Participants (N = 2,717) were from the Canadian Study of Adolescent Health Behaviors. Frequencies of engagement in cheat meals, and associated foods and calories consumed, in the past 12 months and 30 days were determined. The associations between engagement in cheat meals and eating disorder behaviors and psychopathology were determined using modified Poisson regression analyses.

RESULTS

Engagement in cheat meals in the past 12 months was highest among men (60.9%) compared to women (53.7%) and transgender/gender non-conforming (TGNC; 52.5%) participants. Cheat meals consisting between 1,000 and 1,499 cal were those most frequently reported among all participants. Mean number of cheat meals in the past 12 months was equivalent to > 1 per week, which was similar to engagement in the past 30 days. Finally, engagement in cheat meals in the past 12 months and 30 days was associated with patterns of eating disorder behaviors and psychopathology among all participants, including binge-eating-related behaviors.

CONCLUSIONS

This study further characterized and extended knowledge of cheat meal engagement across genders, aligning with prior research by demonstrating that engagement is associated with greater eating disorder psychopathology. Findings from this study add to the growing characterization of the novel behavioral phenomenon of cheat meals. Specifically, over half of adolescents and young adults across all 13 provinces and territories in Canada reported engaging in > 1 cal dense cheat meal per week, over the past 12 months. Despite the normalization and promotion of cheat meal engagement among the general public and unique fitness communities, engagement in this behavior is linked to greater eating disorder behaviors and psychopathology, including binge-eating episodes. Our findings emphasize the need for further research, public awareness, and clinical interventions aimed at addressing this potentially harmful eating behavior.

Problematic muscularity-oriented behaviors: Overview, key gaps, and ideas for future research

Problematic muscularity-oriented behaviors, such as excessive weightlifting and muscle-building supplement and substance use (e.g., creatine, steroids), are common among young people, particularly boys and men. Theoretical models of eating disorders, and their constructs, are helpful in conceptualizing a number of risk factors that may increase the likelihood of developing problematic muscularity-oriented behaviors; however, these models lack a clear delineation of the factors that may specifically lead to the initiation and pursuit of these behaviors. This paper provides a brief overview of the theoretical models that have usefully framed research on problematic muscularity-oriented behaviors and the risk factors that been identified through this work. In addition, it identifies gaps related to understanding the factors leading to the initiation and continued or discontinued engagement in these behaviors, and it provides ideas for future research to help fill these gaps. Understanding the ways in which risk factors combine sequentially and interactively, to produce pathways to problematic muscularity-oriented behaviors is crucial for researchers to strengthen theoretical understandings of these behaviors, to inform intervention efforts, and guide policy and practice to decrease their rates among youth.

Weight gain attempts and diet modification efforts among adults in five countries: a cross-sectional study

BACKGROUND

Recent research has emphasized a growing trend of weight gain attempts, particularly among adolescents and boys and young men. Little research has investigated these efforts among adults, as well as the specific diet modifications individuals who are trying to gain weight engage in. Therefore, the aims of this study were to characterize the diet modification efforts used by adults across five countries who reported engaging in weight gain attempts and to determine the associations between weight gain attempts and concerted diet modification efforts.

METHODS

Cross-sectional data from the 2018 and 2019 International Food Policy Study, including participants from Australia, Canada, Mexico, the United Kingdom, and the United States (N = 42,108), were analyzed. In reference to the past 12 months, participants reported on weight gain attempts and diet modification efforts related to increased consumption of calories, protein, fiber, fruits and vegetables, whole grains, dairy products, all meats, red meat only, fats, sugar/added sugar, salt/sodium, and processed foods. Unadjusted (chi-square tests) and adjusted (modified Poisson regressions) analyses were conducted to examine associations between weight gain attempts and diet modification efforts.

RESULTS

Weight gain attempts were significantly associated with higher likelihood of each of the 12 forms of diet modification efforts among male participants, and 10 of the diet modification efforts among female participants. Notably, this included higher likelihood of efforts to consume more calories (males: adjusted prevalence ratio [aPR] 3.25, 95% confidence interval [CI] 2.94-3.59; females: aPR 4.05, 95% CI 3.50-4.70) and fats (males: aPR 2.71, 95% CI 2.42-3.03; females: aPR 3.03, 95% CI 2.58-3.55).

CONCLUSIONS

Overall, the patterns of association between weight gain attempts and diet modification efforts may be indicative of the phenomenon of muscularity-oriented eating behaviors. Findings further highlight the types of foods and nutrients adults from five countries may try to consume in attempts to gain weight.

Disordered eating behaviors among CrossFit athletes

ABSTRACT Objective: Evaluate differences in disordered eating symptoms between men and women who practice CrossFit and to evaluate its predictors in this population. Methods: A cross-sectional study (April to June 2019) was carried out with 194 adults (103 women and 91 men) enrolled in private CrossFit boxes in Brazil, with a mean age of 30.19 years (SD = 5.34). Participants answered a sociodemographic questionnaire, the Eating Attitudes Test-26 (disordered eating), the Sociocultural Attitudes Towards Appearance Questionnaire-3 (body-ideal internalization), and the Drive for Muscularity Scale (drive for muscularity). A series of Student's t-tests was applied to test differences in disordered eating symptoms between men and women. Multiple linear regressions were conducted to evaluate predictors of disordered eating for both sexes. Results: Women showed greater disordered eating symptoms, dietary restrictions and excessive concern about thinness than men. Moreover, younger women with a higher BMI are more likely to have disordered eating symptoms. Higher drive for muscularity and greater general body-ideal internalization were also associated with disordered eating among women. In men, muscularity-oriented behavior was the only predictor of disordered eating. Conclusion: These findings are relevant, as they point out that women who practice CrossFit seem to be a high risk group for the development of eating disorders. In addition, muscularity-oriented behaviors in men and the drive for muscularity, internalization of the ideal body, BMI and age in women are predictors of disordered eating in CrossFit practitioners.

Disentangling the contributions of agentic, antagonistic, and neurotic narcissism to drive for thinness and drive for muscularity

Body image concerns revolving around body ideals (thin ideal, muscular ideal) are widespread among women. Whereas a stronger preoccupation with ideal physical appearance is often assumed for narcissistic women, previous empirical findings have been mixed. Following a tripartite structure of agentic, antagonistic, and neurotic narcissism facets, we reexamined whether trait narcissism predicted drive for thinness and drive for muscularity. We further explored the role of importance of appearance as a mediator and moderator of the relation between narcissism and body image concerns. Latent structural equation modeling was applied to self-report data from two independent nonclinical female samples (NSample1 = 224, NSample2 = 342). Results underlined the importance of distinguishing between narcissism facets: Neurotic (but not agentic or antagonistic) narcissism uniquely predicted drive for thinness and drive for muscularity. Importance of appearance mediated but did not robustly moderate these relations. Hence, neurotic narcissistic women (characterized by hypersensitivity, shame, and a fragile self-esteem) are particularly prone to body image concerns. This vulnerability seems partly driven by how much importance they ascribe to their appearance. Future work might build on these insights to further unravel the processes linking neurotic narcissism to body image concerns and how these can be targeted in practical interventions.

The impact of social media on self-evaluations of men striving for a muscular ideal

This paper describes an innovative approach combining a content analysis of commentary and images on a Facebook page with a thematic analysis of the subjective experience expressed in interviews of those impacted by the text and images. Interview participants were asked about their perceptions of the representation of the muscularity-focused identity on social media, including the specific Facebook page. Content analysis of the Facebook page comments showed that very muscular male images attracted predominantly negative feedback from the public, a trend supported by the interview participants. Thematic analysis of the interviews indicated that a negative social media representation and commentary can affect young men's self-esteem and increase body concern. Some men represented on the Page found it humorous, which could serve as a form of bonding for the muscularity-focused online community. Other young men acknowledged how harmful such negative feedback can be on their self-evaluations and body image, consistent with the sociocultural framework whereby negative representations can lead to increased body dissatisfaction.

Intentional weight gain efforts among young Canadian adults aged 17-32 years

Research related to body weight management often focuses on weight loss but attempts to gain weight may be common given societal ideals related to body shape and size. The objectives of this study were to examine the prevalence and correlates of intentional weight gain attempts and to characterize weight gain strategies reported among young Canadian adults. Cross-sectional data were drawn from a 2017 online survey of young adults, aged 17 to 32 years, recruited from five large cities (n=976, 493 men and 483 women). The prevalence of weight gain attempts and specific strategies used were estimated, with multivariable logistic regression used to examine correlates of intent to gain weight. Over one in five men (23.1%) and approximately one in twenty women (6.0%) reported attempting to gain weight in the past 12 months. Men, those who perceived themselves as underweight (compared to "just about right"), and those who reported one or more racial/ethnic identity or did not state their race/ethnicity (compared to white only) had higher odds of reporting attempting to gain weight. Individuals who perceived themselves as overweight or who self-reported heights and weights corresponding to a BMI between 25 and 29.9 had lower odds of reporting attempting to gain weight. Those attempting to gain weight reported using three strategies on average, with the most prevalent among both men and women including eating more overall, eating more protein, and exercising/weightlifting. The results suggest that, while less common than dieting, weight gain attempts are not rare, especially among young men.

The development and validation of the muscularity-oriented eating test: A novel measure of muscularity-oriented disordered eating

OBJECTIVE

Body dissatisfaction is intricately linked to the development of disordered eating. However, as male body dissatisfaction appears more oriented toward muscularity, versus thinness per se, existing measures of eating disorder psychopathology may lack sensitivity in capturing disordered eating that is muscularity-focused. The aim of the present study was to develop a specific measure of muscularity-oriented disordered eating-the muscularity-oriented eating test (MOET).

METHOD

Candidate items were generated and refined in consultation with eating disorder-focused researchers and focus groups of men with eating disorders. Examination of the MOET comprised two studies, consisting of 511 undergraduate men, divided into two component samples. In Study 1 (n = 307), candidate items were generated and refined via exploratory factor analysis (EFA). Confirmatory factor analysis (CFA) was then used to confirm the single factor structure in Study 2 (n = 204).

RESULTS

EFA revealed a 15-item single factor structure, which was later confirmed through CFA in a separate sample of undergraduate men. Furthermore, the MOET yielded evidence of internal consistency (Study 1: omega = 0.93, 95% CI [0.91, 0.94]; Study 2: omega = 0.92, 95% CI [0.90, 0.93]), 7-day (Study 1) and 21-days (Study 2) test-retest correlation (r_s = .75, for Study 1 and 2) and convergent and divergent validity.

DISCUSSION

The MOET represents a psychometrically sound, novel measure of muscularity-oriented disordered eating. Future research should examine its utility in clinical samples and research into muscularity-oriented disordered eating.

Reactions to ideal body shapes

Difficult-to-attain beauty standards that are promulgated by the media could contribute to body dissatisfaction, but their potential impact upon body image remains unclear. The present study examined reactions to thin-ideal and muscular-ideal images, and examined the effects of ideal image exposure on preferred body shape and time spent deliberating about ideal shape. In a 2 × 2 experimental design, 200 Internet users completed the Kessler psychological distress scale (K10) and were randomly assigned to view idealistic body images or houses (and rated them on semantic differential dimensions). Females viewed thin ideal images and males viewed muscular ideal images, while the control groups viewed images of houses. Between group measures analysis of variance revealed women reacted negatively to thinspirational images. Women were more driven for thinness and idealized a thinner shape for the female body than men. Psychologically distressed participants had a stronger drive for thinness and greater body dissatisfaction compared to low-distress participants. In addition, although beauty ideal imagery had no significant impact on males, females spent more time in choosing ideal body figure. Viewing thin bodies for females created a trend toward desiring a slimmer figure, as well as increased preoccupation with size as they spent more time deliberating over a photorealistic figure rating scale. Therefore, exposure to thinspiration promotes dissatisfaction with self and leads women to dwell more upon their body image.

Eating Disorders in Males

Eating disorders are serious psychiatric disorders, associated with significant psychiatric and medical consequences. Although traditionally considered a female disorder, more recent evidence has determined that EDs among males are not uncommon and are equally severe in symptom presentation. Among youth and adolescent males, certain factors increase the risk for ED, including muscularity-focused body image concerns and sexual orientation. Future study of these and other factors that may increase the risk for or maintain EDs among adolescent males is critical to improving screening, assessment, and precision treatment efforts.

Support for people who use Anabolic Androgenic Steroids: A Systematic Scoping Review into what they want and what they access

BACKGROUND

Since there is a paucity of research on support for people using Anabolic Androgenic Steroids (AAS), we aimed to identify and synthesise the available evidence in this field. Gaining an understanding of the support both accessed and wanted by recreational AAS users will be of use to professionals who provide services to intravenous substance users and also to those working in the fields of public health and social care, with the aim to increase engagement of those using AAS.

METHODS

A systematic scoping review of the literature to explore and identify the nature and scope of information and support both accessed and wanted by non-prescribed AAS users. Any support services or information designed to help people who use AAS were considered.

RESULTS

We identified 23 papers and one report for review, which indicated that AAS users access a range of sources of information on: how to inject, substance effectiveness, dosages and side effects, suggesting this is the type of information users want. AAS users sought support from a range of sources including medical professionals, needle and syringe programmes, friends, dealers, and via the internet, suggesting that, different sources were used dependent on the information or support sought.

DISCUSSION

AAS users tended to prefer peer advice and support over that of professionals, and access information online via specialist forums, reflecting the stigma that is experienced by AAS users. These tendencies can act as barriers to accessing services provided by professionals.

CONCLUSIONS

Support needs to be specific and targeted towards AAS users. Sensitivity to their perceptions of their drug-use and the associated stigma of being classified in the same sub-set as other illicit drug users is relevant to facilitating successful engagement.

Asessing the male body image: Spanish validation of two instruments

Despite the literature suggesting that body dissatisfaction is increasing among males, only few measures on specific body image concerns in men have been validated in Spanish male populations. The aim of this study was to reassess the factor structure of the Spanish versions of the Muscle Dysmorphic Disorder Inventory (MMDI) and the Adonis Complex Questionnaire (ACQ). A cross-sectional study was conducted among 298 Sport Sciences male students to examine: reliability, the factorial structure, and several evidences of validity -concurrent and convergent- of both scales. The questionnaires present adequate reliability. The three-factor structure proposed for the MMDI was replicated. Nevertheless, the confirmatory factor analysis supports a second-order factor structure for the ACQ instead of the three-factor structure proposed. Moreover, the MDDI shows greater association than ACQ with the variables studied. This study represents an advance in the use of adequate and reliable scales of body image tools in the Hispanic population.

How does exposure to thinspiration and fitspiration relate to symptom severity among individuals with eating disorders? Evaluation of a proposed model

Thinspiration and fitspiration are classes of social media content characterised by idealised depictions of excessively thin and overtly fit/lean bodies, respectively. It is currently unknown whether and how exposure to thinspiration and fitspiration relates to symptom severity within high-risk clinical populations. Thus, in a clinical sample of individuals with eating disorders, we evaluated a model explaining how exposure to thinspiration and fitspiration relates to eating disorder symptoms. Individuals with self-reported eating disorders (N = 228, 47% with anorexia, 93% female) completed measures of image-centric social media use, thinspiration and fitspiration exposure, physical appearance comparisons, and symptom severity. Results showed that more frequent use of image-centric social media was associated with more frequent exposures to both thinspiration and fitspiration. In turn, these exposures were associated with more frequent physical appearance comparisons, and through these, greater symptom severity. Physical appearance comparisons mediated the relationships of both thinspiration and fitspiration exposure with symptom severity. Exposure to fitspiration was more common than exposure to thinspiration. However, thinspiration exposure evidenced stronger associations with symptom severity than fitspiration exposure. In conclusion, our model provides a useful account of how eating disorder symptoms relate to thinspiration and fitspiration exposure, and to image-centric social media more generally.

Cheat meals: A benign or ominous variant of binge eating behavior?

OBJECTIVE

Engagement in "cheat meals" has been recently documented as a socially endorsed dietary practice oriented towards pursuing physique ideals, and which bears qualitative semblance to disordered eating behavior. However, the clinical significance of this dietary practice remains unclear.

METHODS

We recruited a sample of young adults (n = 248; 56% women; M_age = 19.29 ± 0.58) and examined the prevalence and characteristics of cheat meal engagement, including its associations with eating disorder pathology, psychological distress, and impairment in role functioning.

RESULTS

Findings revealed that 89.1% of participants engaged in cheat meal consumption that was either planned or spontaneous, with planned cheat meals being predominantly aimed at managing food cravings and sustaining strict dietary regimens. Among men, the frequency of cheat meal engagement was positively associated with global eating disorder symptoms (p = 0.04), and objective binge episodes (p = 0.03), however cheat meals were not associated with psychological distress or clinical impairment for either gender (p > 0.05).

CONCLUSIONS

These preliminary findings suggest that cheat meal engagement is commonly endorsed among young adults, and particularly among men. Moreover, cheat meals may reflect psychopathological properties akin to binge episodes, although do not confer psychological distress. Future research is urged in elucidating the definitional properties of cheat meal engagement, and examining clinical implications for this widespread dietary practice.

Pornography use in sexual minority males: Associations with body dissatisfaction, eating disorder symptoms, thoughts about using anabolic steroids and quality of life

OBJECTIVE

We examined two hypotheses regarding the potential association of pornography use with body image-related and eating disorder-related psychopathology among sexual minority males (i.e. non-heterosexual males). Our primary hypothesis was that pornography use would be associated with males' body dissatisfaction, eating disorder symptoms, thoughts about using anabolic steroids and quality of life impairment; our secondary hypothesis was that the type of pornography, namely, professional versus amateur pornography, which contains idealised and non-idealised (i.e. regular) bodies, respectively, would moderate these associations.

METHODS

A sample of 2733 sexual minority males living in Australia and New Zealand completed an online survey that contained measures of pornography use, body dissatisfaction, eating disorder symptoms, thoughts about using anabolic steroids and quality of life.

RESULTS

Almost all (98.2%) participants reported pornography use with a median use of 5.33 hours per month. Multivariate analyses revealed that increased pornography use was associated with greater dissatisfaction with muscularity, body fat and height; greater eating disorder symptoms; more frequent thoughts about using anabolic steroids; and lower quality of life. Effect sizes for these associations were uniformly small. Neither relationship status nor genital dissatisfaction was associated with pornography use. The association between pornography use and thoughts about using anabolic steroids was stronger for viewers of professional pornography than viewers of amateur pornography.

CONCLUSION

The findings suggest that the use of pornography is weakly associated with body dissatisfaction and related variables and that the type of pornography (amateur vs professional) viewed may be a moderating factor in some cases. Within the limits of a cross-sectional study design, these findings may have implications for clinicians who treat individuals with eating disorders, body dysmorphic disorder, anabolic-androgenic steroid dependence and related concerns.

Thinness and muscularity internalization: Associations with disordered eating and muscle dysmorphia in men

OBJECTIVE

The tripartite influence model of body image identifies internalization of societal body ideals as a risk factor for developing body dissatisfaction, and subsequent disordered eating behavior. In men, internalization of two dimensions of body image ideals, thinness and muscularity, is associated with body dissatisfaction and eating concerns. However, it is unknown how thinness and muscularity internalization interact in predicting muscle dysmorphia and disordered eating in men.

METHOD

Data were collected online from 180 undergraduate men, with ages ranging from 18 to 33 years (19.6, SD = 2.6). Regression models were used to test the interactive effects of thinness and muscularity internalization on (a) muscle dysmorphia symptoms and (b) disordered eating. Subsequent simple slope analyses probed effects at the mean, and ±1 standard deviation of thinness internalization.

RESULTS

Muscularity and thinness internalization were independently positively related to muscle dysmorphia symptoms and disordered eating. Additionally, a significant interaction revealed that muscularity internalization was increasingly related to muscle dysmorphia symptoms as thinness internalization decreased.

DISCUSSION

Men who internalized the muscular ideal had higher levels of muscle dysmorphia when they did not highly internalize the thin ideal. However, greater internalization of both the muscularity and thin ideal independently may be most relevant in the development of disordered eating in men. Future research is needed to explore variability in experiences of muscle dysmorphia compared with disordered eating in males.

Fitspiration and thinspiration: a comparison across three social networking sites

BACKGROUND

Fitspiration, or images and text promoting health and fitness, and thinspiration, or images and text promoting thinness, have both received criticism for their negative effects on body image and dieting behaviors. In this study, we critically examined and compared the content of fitspiration and thinspiration on three social networking sites (SNS).

METHODS

Fitspiration and thinspiration posts (N = 360) from three photo-sharing SNS (Instagram, Tumblr, and Twitter) were collected quasi-randomly on four days over two weeks. Image and associated text content were coded for variables related to weight and shape, muscularity, thin ideal, and eating. Chi-square and Fisher's exact tests compared content of fitspiration and thinspiration posts overall and among the three SNS.

RESULTS

Thinspiration images portrayed body parts more frequently than fitspiration (69.8% vs. 30.2%). Similarly, posts highlighting bony body features and references to mental illness appeared only in thinspiration. No differences were found between fitspiration and thinspiration posts with regard to sexual suggestiveness, appearance comparison, and messages encouraging restrictive eating. Fitspiration and thinspiration posts included similar images across the three SNS-focusing on appearance, sexually suggestive images, and restrictive eating-with three exceptions. Fitspiration posts exhibiting body positivity were found only on Tumblr. In thinspiration posts, references to mental illness were more frequent on Tumblr and Instagram than on Twitter, and bone emphasis was coded more frequently on Twitter than on Instagram.

CONCLUSIONS

Although fitspiration posts were less extreme than thinspiration posts on the whole, notable similarities in their content support that fitspiration endorses problematic attitudes towards fitness, body image, and restrictive eating in pursuit of a fit-and-thin body ideal.

A thematic content analysis of #cheatmeal images on social media: Characterizing an emerging dietary trend

Despite the pervasive social endorsement of "cheat meals" within pro-muscularity online communities, there is an absence of empirical work examining this dietary phenomenon. The present study aimed to characterize cheat meals, and explore the meaning ascribed to engagement in this practice. Thematic content analysis was employed to code the photographic and textual elements of a sample (n = 600) that was extracted from over 1.6 million images marked with the #cheatmeal tag on the social networking site, Instagram. Analysis of the volume and type of food revealed the presence of very large quantities (54.5%) of calorie-dense foods (71.3%) that was rated to qualify as an objective binge episode. Photographic content of people commonly portrayed highly-muscular bodies (60.7%) in the act of intentional body exposure (40.0%). Meanwhile, textual content exemplified the idealization of overconsumption, a strict commitment to fitness, and a reward-based framework around diet and fitness. Collectively, these findings position cheat meals as goal-oriented dietary practices in the pursuit of physique-ideals, thus underscoring the potential clinical repercussions of this socially-endorsed dietary phenomenon.

Men, Muscles, and Eating Disorders: an Overview of Traditional and Muscularity-Oriented Disordered Eating

PURPOSE OF REVIEW

There is growing recognition that eating disorder (ED) symptoms, particularly those of a muscularity-oriented nature, are more common in men than previously understood. The purpose of the current review is to describe contemporary directions and implications of research on traditional and muscularity-oriented ED symptoms among males.

RECENT FINDINGS

Evidence indicates that ED symptoms occur in a substantial minority of men. Importantly, recent research has focused on muscularity-oriented body image and disordered eating in males, demonstrating the prevalence, correlates, and consequences of maladaptive muscularity-oriented attitudes and behaviors. A growing number of assessments are available to measure these constructs in males, and preliminary treatment considerations have begun to be addressed in the literature. Research on male EDs and body image is increasingly focusing on muscularity-oriented manifestations. Continued empirical work will be critical to improve our understanding of the onset, maintenance, and treatment of muscularity-oriented disordered eating in males.

"Fitspiration" on Social Media: A Content Analysis of Gendered Images

BACKGROUND

"Fitspiration" (also known as "fitspo") aims to inspire individuals to exercise and be healthy, but emerging research indicates exposure can negatively impact female body image. Fitspiration is frequently accessed on social media; however, it is currently unclear the degree to which messages about body image and exercise differ by gender of the subject.

OBJECTIVE

The aim of our study was to conduct a content analysis to identify the characteristics of fitspiration content posted across social media and whether this differs according to subject gender.

METHODS

Content tagged with #fitspo across Instagram, Facebook, Twitter, and Tumblr was extracted over a composite 30-minute period. All posts were analyzed by 2 independent coders according to a codebook.

RESULTS

Of the 415/476 (87.2%) relevant posts extracted, most posts were on Instagram (360/415, 86.8%). Most posts (308/415, 74.2%) related thematically to exercise, and 81/415 (19.6%) related thematically to food. In total, 151 (36.4%) posts depicted only female subjects and 114/415 (27.5%) depicted only male subjects. Female subjects were typically thin but toned; male subjects were often muscular or hypermuscular. Within the images, female subjects were significantly more likely to be aged under 25 years (P<.001) than the male subjects, to have their full body visible (P=.001), and to have their buttocks emphasized (P<.001). Male subjects were more likely to have their face visible in the post (P=.005) than the female subjects. Female subjects were more likely to be sexualized than the male subjects (P=.002).

CONCLUSIONS

Female #fitspo subjects typically adhered to the thin or athletic ideal, and male subjects typically adhered to the muscular ideal. Future research and interventional efforts should consider the potential objectifying messages in fitspiration, as it relates to both female and male body image.

The Transition From Thinness-Oriented to Muscularity-Oriented Disordered Eating in Adolescent Males: A Clinical Observation

PURPOSE

Robust empirical evidence has illustrated a rising prevalence of body dissatisfaction and disordered eating among males, noting that both may be oriented more toward muscularity-as opposed to thinness-oriented concerns. While an elevated prevalence of premorbid anorexia nervosa (AN) has been noted among those with muscle dysmorphia, little evidence has examined the process of this transition from thinness-oriented to muscularity-oriented disordered eating.

METHODS

This clinical observation presents a case of AN in an adolescent male, whose symptom presentation transitioned during the course of treatment for AN, into more muscularity-oriented disordered eating.

RESULTS

Despite the core body image disturbance and disordered eating behaviors being retained, the behavioral expression of muscularity-oriented disordered eating was difficult to detect during treatment for AN, and he was discharged from treatment as his muscularity-oriented disordered eating escalated.

CONCLUSIONS

Transdiagnostic crossover between thinness-oriented and muscularity-oriented disordered eating represents an important clinical concern, which may be challenging to measure and assess. Implications for treatment are discussed, and the early detection of muscularity-oriented disordered eating.

Muscle Dysmorphia: An Overview of Clinical Features and Treatment Options

An increasing public and empirical focus on male body image indicates that muscularity is a preeminent concern among boys and men. For some, these concerns develop into a complex and disabling psychiatric disorder termedmuscle dysmorphia(MD), the hallmark of which is an intense preoccupation regarding one’s (subjectively) insufficient muscularity. Treatment of MD is critical; however, evidence to inform treatment approaches is sorely lacking. The purpose of this article is twofold. First, we provide an overview of the clinical features of MD, drawing particular attention to the preoccupation, functional impairment and psychiatric comorbidity associated with the disorder. Second, we discuss and recommend potential treatment directions for MD, including techniques that have demonstrated efficacy in the treatment of related disorders, namely, body dysmorphic disorder and eating disorders (and anorexia nervosa in particular). Psychotherapeutic techniques, including cognitive restructuring of deleterious perfectionistic and egosyntonic beliefs, and dialectical behavioral techniques to improve the repertoire of emotion regulation skills available to afflicted individuals, are discussed, in addition to psychopharmacological approaches.