Body weight dissatisfaction: a comparison of women with and without eating disorders

Screening of the Risk of Eating Disorders Among Medical Students in the MENA region and Its Associated Factors: A Multinational Cross-Sectional Study

BACKGROUND

Eating disorders (EDs) are a group of mental diseases marked by disrupted eating behaviors, and are associated with several factors. Medical students are highly exposed to this mental disorder with a prevalence of 17.35% in 2022.

OBJECTIVE

To evaluate the risk of EDs and its associated factors among medical students in the Middle East and North Africa (MENA) region.

METHODS

A web-based cross-sectional study was conducted among medical students in the MENA region during the months of June and July 2024. The primary data collection instrument was a comprehensive questionnaire that contained the Eating Attitudes Test (EAT-26) and sociodemographic and clinical features and designed using Google Forms and distributed via social media platforms.

RESULTS

The total number of participants was 5061. The mean age in our population was 22.58 ± 3.27. Our population's average EAT-26 score was 13.87 ± 10.7, with ranges varying from 0 to 72. Based on their EAT-26 scores being 20 or above, 1254 people (24.8%) were deemed to be at risk of EDs. Among the participants, 8% were underweight. The multivariable logistic regression model revealed several eating disorder risk factors such as T1DM, schizophrenia, autism, female gender, IBD, and daily exposure to thin body ideal. Regular sports practice and weight satisfaction were protective factors.

CONCLUSION

There exists a higher prevalence of individuals at risk for the development of EDs in the MENA region especially females, students with comorbidities, and those having conflictual relationships with their parents. Regular sports practice and weight satisfaction are protective factors.

A living experience proposal for the co-occurring diagnosis of avoidant/restrictive food intake disorder and other eating disorders

The eating and feeding disorder section of the Diagnostic and Statistical Manual of Mental Disorders 5 Text Revision (DSM-5-TR) is organized by a diagnostic algorithm that limits the contemporaneous assignment of multiple eating disorder diagnoses. Avoidant/restrictive food intake disorder (ARFID) is a disturbance in food intake typically associated with lack of interest in food, food avoidance based on sensory characteristics, and/or fear of aversive consequences from eating. According to the DSM-5-TR, an ARFID diagnosis cannot be made when weight or shape disturbances are present, and ARFID cannot be co-diagnosed with other eating disorders characterized by these disturbances. However, emerging evidence from both clinical and lived experience contexts suggests that the co-occurrence of ARFID with multiple other types of eating disorders may be problematically invisibilized by this trumping scheme. The diagnostic criteria for ARFID can contribute to inappropriate diagnosis or exclusion from diagnosis due to excessive ambiguity and disqualification based on body image disturbance and other eating disorder pathology, even if unrelated to the food restriction or avoidance. This harmfully limits the ability of diagnostic codes to accurately describe an individual's eating disorder symptomatology, impacting access to specialized and appropriate eating disorder care. Therefore, revision of the DSM-5-TR criteria for ARFID and removal of limitations on the diagnosis of ARFID concurrent to other full-syndrome eating disorders stands to improve identification, diagnosis, and support of the full spectrum of ARFID presentations.

Hiking, indoor biking, and body liking: a cross-sectional study examining the link between physical activity arenas and adults' body appreciation

BACKGROUND

Body appreciation might serve as a protective factor for developing eating disorders and is associated with participation in physical activity. Less is known about whether various arenas for physical activity may be linked to body appreciation. Therefore, the current study sought to (1) identify potential associations between physical activity level and arenas for physical activity, connectedness with nature, self-compassion, and body appreciation in adults, and (2) explore physical activity level and arenas, connectedness with nature, and self-compassion as explanatory factors for body appreciation.

METHODS

A total of 360 adult Norwegian inhabitants (75% women, mean (SD) age 42.58 (12.30) yrs) responded to an online questionnaire. Instruments included the Body Appreciation Scale, the Connectedness with Nature Scale, and the Self-Compassion Scale.

RESULTS

The percentage of participants who engaged in various physical activity arenas were 98.5% for nature, 57.5% for fitness centers, and 43.0% for organized sports. Small, positive associations were found between body appreciation and the frequency of using fitness centers and nature as physical activity arenas. Self-compassion, connectedness with nature, and frequency of using fitness centers and nature as physical activity arenas explained 39% of the variance in body appreciation.

DISCUSSION

The importance of both fitness centers and nature as arenas for physical activity to explain body appreciation was surprising and might reflect different use of fitness centers among adults compared to younger age groups.

CONCLUSION

Physical activity at fitness centers and in nature were positively associated with body appreciation in adults. Self-compassion, connectedness with nature, and using fitness centers and nature as arenas for physical activity, were found to explain variation in body appreciation in adults.

Prevalence, correlates, and gender disparities related to eating disordered behaviors among health science students and healthcare practitioners in Lebanon: Findings of a national cross sectional study

Background

The raised prevalence of eating disorders (ED) amongst health science students and health professionals is of mounting concern. This study aims to determine the prevalence and correlates of eating disorders risk amongst a sample of Lebanese health science students and healthcare practitioners of both genders.

Methods

This cross-sectional study enrolled a convenient sample of 1,000 participants (mean age: 23 ± 5.4; females: 74.9%) from faculties of health sciences, clinics, pharmacies, and hospitals. The validated Eating Attitudes Test (EAT-26) was used to screen for eating disorders. Anthropometric data were self-reported by respondents to assess their nutritional status.

Results

The risk of eating disorders was prevalent in 22.5% of participants. Females were at higher risk of ED compared to males p = 0.03. Eating disorders risk did not differ between students and practitioners (p = 0.3). The highest proportion of high-risk participants were students studying nutrition and practitioners (40.9%), outracing their counterparts in nursing (18.7%), medicine (17.8%), pharmacy (17.7%), and midwifery (4.9%) sciences (p = 0.02). Most high-risk participants had normal body weight (60.4%), and 28.9% were overweight (p = 0.001). Female gender, nutrition profession, and dieting were associated with increasing the odd of ED. Particularly, dieting increased the risk around five times. Further, each 3 participants over 10 were facing binge eating behavior.

Conclusion

This study uncovers an undervalued profession-related-health-disorder in Lebanese health science students and healthcare practitioners. Specific attention should be given to EDs in professional educational programmes across healthcare disciplines.

Giving a Body a Different Face—How Men and Women Evaluate Their Own Body vs. That of Others

Eating disorders affect women more than men. Women reportedly dislike their body shape more and appreciate it less than do men. One factor influencing body image might be the application of different standards for oneself than for other people when evaluating bodies. To investigate this possibility, we determined whether the application of double standards is different between men and women. We presented 57 women and 54 men (aged 18–30 and of average weight) with pictures of their own bodies and pictures of average weight, overweight, and “ideal” bodies attached to the participants’ own face and to another person’s face. Participants were instructed to evaluate their emotional reaction to the pictures and then rate the various pictures on aspects of attractiveness, body fat, and muscle mass. The degree of the double standard was defined as the difference between ratings of what appeared to be one’s own body and what appeared to be someone else’s according to the presented face. The analyses revealed, firstly, that both genders applied self-deprecating double standards when viewing overweight and average-weight bodies. Women, but not men, also showed self-deprecating double standards when viewing the ideal body and their own body. By contrast, men applied fewer double standards when viewing the ideal body and self-enhancing double standards when viewing their own body. The study suggests that young, average-weight men are more or less satisfied with their own bodies, whereas young, average-weight women tend to apply a stricter standard for themselves than for others, thus devaluing their own bodies. This vulnerability to body image is hypothesized as contributing to the prevalence of eating disorders in women.

Detrimental Effects of Online Pro-Eating Disorder Communities on Weight Loss and Desired Weight: Longitudinal Observational Study

BACKGROUND

Online pro-eating disorder (pro-ED) communities are considered harmful because of their detrimental effects on their users' body dissatisfaction, dieting, and help seeking. To date, it is unknown to which extent participation in pro-ED communities affects users' body weight and desired weight loss.

OBJECTIVE

This study aims to investigate the changes in the current and desired body weight of users of a pro-ED community (r/proed) on the social media website Reddit over time.

METHODS

Data on 1170 users and the unsolicited weight information they shared with the pro-ED community were collected over a period of 15 months. Linear growth models were used to model changes in the users' current and desired BMI over time.

RESULTS

Both current and desired BMI decreased over time, with a predicted rate of 0.087 and 0.015 BMI points per week, respectively. Weight loss was moderated by the users' activity level in the community, with more active users losing more weight. Users with a higher baseline BMI experienced greater weight loss, but even users with a very low baseline weight (BMI <17 kg/m²) lost weight during their participation. In addition, users decreased their desired weight over time, with many pursuing extremely low, unrealistic weight goals. Changes in the desired weight were moderated by the baseline current BMI and baseline desired BMI. Users with higher desired weight and lower body weight at baseline decreased their desired weight more over time.

CONCLUSIONS

This is the first study to demonstrate the detrimental effects of pro-ED communities in a longitudinal study based on a large data set of user-generated online data. The results extend the literature detailing the harmful effects of online pro-ED communities by showing users' weight loss, decreases in desired weight, and that higher activity levels lead to greater weight loss. Users could be driven to pursue very low, unrealistic weight loss goals by images of very thin bodies presented in these communities.

Body perception treatment, a possible way to treat body image disturbance in eating disorders: a case-control efficacy study

BACKGROUND

The body image disturbance (BID) is a common symptom in eating disorders, often observed and described in anorexia nervosa (AN) and bulimia nervosa (BN). Recently, this symptom has also been observed in binge eating disorder (BED). The research underlines that the BID presents three different altered components: affective, cognitive, and perceptual one. Current treatments for BID have mainly focused on the affective and cognitive components. Nowadays, the need emerges for treatments focused also on the perceptual component of the BID. In this paper, we present the results of an efficacy study on the body perception treatment (BPT), a new treatment for BID focused on the perceptual component of the disorder.

OBJECTIVE

We looked for an additional treatment effect on a protocol for ED inpatients to evaluate the efficacy of BPT. We performed the study through statistical analysis of admission and discharge scores.

METHODS

We conducted a case-control study in a hospital ward specialized in eating disorders. Two groups were identified: the control group (TAU; N = 91) and the experimental group (TAU + BPT; N = 91). The experimental group performed BTP activities in addition to the treatment at usual. All patients in both groups had an eating disorder diagnosis (AN, BN, BED and EDNOS/OSFED). Sampling occurred on a time basis and not by randomization. Moreover, all patients admitted in the ED hospital ward in the time frame considered (from end-2009 to mid-2017) were included in the study. BPT activities were introduced in mid-2013 and three psychometric instruments upon entry and discharge were used: Symptom Check List-90 (SCL-90) to measure the general psychopathological state; the Eating Disorder Inventory-3 (EDI-3) to estimate the incidence of personality traits strongly correlated to eating disorders; the body uneasiness test (BUT) to measure the body uneasiness. We performed a pre/post analysis for both groups; we studied the additional effect of the treatment through deltas analysis of the three questionnaires (Δ = assessment at discharge - assessment at the entrance). Data were analyzed using the Student T and the Wilcoxon rank-sum test.

RESULTS

The pre/post analysis showed statistically significant improvement in both conditions (TAU and TAU + BPT) in the general psychopathological state (SCL-90) and in the incidence of personality traits (EDI-3). Improvements in body uneasiness (BUT) were observed only in the experimental group (TAU + BPT). Furthermore, the analysis of the deltas shows more significant improvements in TAU + BPT compared to TAU in all the variables considered.

CONCLUSION

We found an additional effect of the BPT on TAU. The usual ED protocol added with BPT activities showed significantly better clinical results. We have interpreted these results in light of recent developments in the neuroscientific field of body image.

LEVEL OF EVIDENCE

Level II: controlled trial without randomization.

Factors associated with anxiety disorders among patients with substance use disorders in Lebanon: Results of a cross-sectional study

OBJECTIVES

Estimate the rate of anxiety disorders (AD) and associated factors among patients with substance use disorder (SUD) in Lebanon.

METHODS

A cross-sectional study, conducted between April and September 2017, enrolled 57 inpatients with SUD.

RESULTS

The rate of AD in patients with SUD was 61.4%. The university level of education compared to the primary level of education (ORa = 0.221) was significantly associated with lower anxiety among patients with SUD. Being sexually abused and having a family history of depression tended to significance.

PRACTICAL IMPLICATIONS

AD is widespread in Lebanon and high rates of anxiety in patients with SUD were found, warranting the implementation of strategic interventions and establishing national policies and legislation for mental health services to provide optimal care.

Double standards in body evaluation? The influence of identification with body stimuli on ratings of attractiveness, body fat, and muscle mass

Although it is well documented that women evaluate their own body differently from other bodies, it remains unclear whether this discrepancy is based on double standards because of identity or on objective differences between these bodies. The aim of this study was therefore to test whether women apply double standards depending on a body's identity when evaluating the same bodies presented with different faces. Average-weight women (N = 104) rated body attractiveness, body fat, and muscle mass of thin, average-weight, overweight, athletic, and hypermuscular bodies with either another female's face or their own face. With their own face, subjects rated overweight bodies as more unattractive, higher in body fat and lower in muscle mass than with another female's face. However, for non-overweight bodies, body ratings did not differ depending on body identity. Based on the self-deprecating double standards for overweight bodies, a body-related identity bias might be considered in theoretical models of body image.Level of evidence Level V, descriptive study.

Factors associated with body dissatisfaction among the Lebanese population

OBJECTIVE

To evaluate the factors associated with body dissatisfaction among the Lebanese population, including sociodemographic characteristics, self-esteem, stress, anxiety, depression, emotional regulation, emotional eating and the adult attachment style.

METHODS

This cross-sectional study, conducted between January and May 2018, enrolled 811 adult participants from all districts of Lebanon. The body dissatisfaction subscale of the eating disorder inventory version 2 (EDI-2) was used to measure body disturbance.

RESULTS

The mean age of the participants was 27.59 ± 11.76 years, with 66.5% females. The final model of the regression analysis showed that a higher binge eating score (Beta = 0.202), being married (Beta = 1.233), having a family history of eating disorders (Beta = 1.933), higher BMI (Beta = 0.076), dieting to lose weight (past 30 days) (Beta = 2.345), receiving comments from the family (Beta = 2.234) and pressure from TV/magazines to lose weight (Beta = 1.320), vomiting or taking laxatives to lose weight (past 30 days) (Beta = 1.861), higher depression (Beta = 0.103) and higher perceived stress (Beta = 0.107) were associated with a higher body dissatisfaction score. However, higher self-esteem (Beta = - 0.246), increased physical activity (Beta = - 0.022) and being divorced (Beta = - 4.226) were significantly associated with a lower body dissatisfaction score.

CONCLUSION

A significant association was found in this current study between the main variables: depression, self-esteem, social anxiety, eating disorders, family and television pressure and body image dissatisfaction.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Influence of the Mass Media and Body Dissatisfaction on the Risk in Adolescents of Developing Eating Disorders

Media influence may lead adolescents to internalize patterns of physical beauty, resulting in dissatisfaction with their own bodies when they are unable to match up to these patterns. In the constant search for an ‘ideal body’, adolescents may begin to develop risk behaviors for the development of eating disorders (ED). The object of this study was to analyze the influence of the mass media on body dissatisfaction (BD) and on ED in adolescents, comparing genders. We also analyzed the influence of BD on the risk of developing unsuitable eating behaviors, with risk of ED, comparing genders. A cross-sectional study was carried out with 1011 adolescents: 527 girls and 484 boys. The BMI of each adolescent was determined, and the instruments EAT-26, Sociocultural Attitudes towards Appearance Questionnaire-3 (SATAQ-3), and body shape questionnaire (BSQ), were applied. For statistical analysis, we used Student’s t-test, the chi-square test, Pearson’s correlation test, the odds ratio, and hierarchical multiple linear regression. The influence of the mass media is associated with a greater probability of adolescents presenting BD. An increase in BD is associated with an increased risk of developing ED in adolescents of both genders but is greater in girls than in boys. Furthermore, the influence of the MM and BMI are predictors of BD in both genders; and BD is a predictor of ED risk in both girls and boys.

Desired weight and treatment outcome among adolescents in a novel family-based partial hospitalization program

The purpose of the current study was to investigate desired weight percentage and weight difference percentage and their association with treatment outcome in a novel family-based partial hospitalization program. Twenty-six adolescents with anorexia nervosa or subthreshold anorexia nervosa between the ages of 12 and 19 completed the Eating Disorder Examination (EDE) at intake and upon completion from a partial hospitalization program in which parents played a large role in the recovery process, consistent with family-based treatment principles. Lower desired weight percentage at baseline was associated with higher scores on the restraint subscale of the EDE at end of treatment. Higher weight difference percentage (greater desire to lose weight) at baseline was associated with higher scores on all EDE subscales and global score at end of treatment. Neither desired weight percentage nor weight difference percentage at baseline were associated with treatment dropout or percent expected body weight at end of treatment. In a family-based program, participants' desired weight may be related to eating disorder thoughts (for example, shape or weight concerns) but not to behavioral outcomes such as weight gain or treatment dropout, which may be more directly under the influence of the parents.

Sustained hypervigilance for one's own body in women with weight and shape concerns: Competition effects in early visual processing investigated by steady-state visual evoked potentials (SSVEP)

This study aimed to analyze the covert attentional time course in early body processing areas in women with high body concerns. Therefore, we assessed the effect of pictures of one's own body and other bodies as distractions from a demanding dot detection task in 24 women with low and 20 women with high body concerns. Participants were instructed to attend to flickering dots eliciting steady-state visual evoked potentials (SSVEP) measured by EEG. Both groups showed a sustained SSVEP amplitude reduction, which was more pronounced for average-weight or thin bodies than for overweight bodies. For women with high body concerns, SSVEP amplitudes decreased more in the case of pictures of their own body. The results indicate covert vigilance and maintenance patterns for body stimuli, especially for bodies representing the thin ideal. Moreover, women with high body concerns attend more to information about their own body, which might maintain body dissatisfaction.

Desire to Be Underweight: Exploratory Study on a Weight Loss App Community and User Perceptions of the Impact on Disordered Eating Behaviors

Background

Mobile health (mHealth) apps for weight loss (weight loss apps) can be useful diet and exercise tools for individuals in need of losing weight. Most studies view weight loss app users as these types of individuals, but not all users have the same needs. In fact, users with disordered eating behaviors who desire to be underweight are also utilizing weight loss apps; however, few studies give a sense of the prevalence of these users in weight loss app communities and their perceptions of weight loss apps in relation to disordered eating behaviors.

Objective

The aim of this study was to provide an analysis of users’ body mass indices (BMIs) in a weight loss app community and examples of how users with underweight BMI goals perceive the impact of the app on disordered eating behaviors.

Methods

We focused on two aspects of a weight loss app (DropPounds): profile data and forum posts, and we moved from a broader picture of the community to a narrower focus on users’ perceptions. We analyzed profile data to better understand the goal BMIs of all users, highlighting the prevalence of users with underweight BMI goals. Then we explored how users with a desire to be underweight discussed the weight loss app’s impact on disordered eating behaviors.

Results

We found three main results: (1) no user (regardless of start BMI) starts with a weight gain goal, and most users want to lose weight; (2) 6.78% (1261/18,601) of the community want to be underweight, and most identify as female; (3) users with underweight BMI goals tend to view the app as positive, especially for reducing bingeing; however, some acknowledge its role in exacerbating disordered eating behaviors.

Conclusions

These findings are important for our understanding of the different types of users who utilize weight loss apps, the perceptions of weight loss apps related to disordered eating, and how weight loss apps may impact users with a desire to be underweight. Whereas these users had underweight goals, they often view the app as helpful in reducing disordered eating behaviors, which led to additional questions. Therefore, future research is needed.

Neurobiochemical and psychological factors influencing the eating behaviors and attitudes in anorexia nervosa

The aim of this study was to determine the characteristic features which contribute to inappropriate eating attitudes in people suffering from anorexia nervosa, based on an analysis of recent data. Factors influencing these attitudes have a genetic, neurobiological, biochemical, affective-motivational, cognitive, and behavioral background. Another important issue addressed in the paper is a description of the mechanism leading to continuous dietary restrictions. The altered activity of neurotransmitters modulating patients’ moods after the consumption of food and a disturbed responsiveness to enterohormones enhance affective-motivational and cognitive aspects which, in turn, impede the improvement of eating behaviors. An understanding of the mechanisms behind the factors affecting the maintenance of inappropriate eating attitudes may contribute to greater effectiveness in the treatment of anorexia nervosa.

Trends in body image of adolescent females in metropolitan and non-metropolitan regions: a longitudinal study

BACKGROUND

Body dissatisfaction is associated with a range of adverse outcomes, including impaired psychological health, low physical activity and disordered eating. This longitudinal study used the Factors Influencing Transitions in Girls' Active Leisure and Sport (FITGALS) dataset to examine trends in body image of adolescent females. Specifically, the study examined satisfaction with body size, physical appearance and dieting behaviour for two cohorts at transitional life phases in two geographic regions longitudinally over a 3-year period.

METHODS

A sample of 732 adolescent females in Grade 7 (n = 489, 66.8 %) and Grade 11 (n = 243, 33.2 %) at randomly selected Australian metropolitan and non-metropolitan secondary schools responded to a questionnaire in three successive years from 2008 to 2010. Participants reported perceptions about their body size and physical appearance and whether they were, or ought to be, on a diet. The data were analysed using a series of longitudinal logistic regression models.

RESULTS

Dieting and dissatisfaction with body size significantly increased over time and more so for older than younger girls. Region significantly moderated the effect of grade level regarding dissatisfaction with body size but not dieting. In non-metropolitan regions, those in the younger cohort were significantly more likely to be dissatisfied with their body size than the older cohort; whereas in metropolitan regions, those in the older cohort were significantly more likely to be dissatisfied with their body size than the younger cohort. Adolescent female's perceptions of their appearance were unchanged over time, region and grade level.

CONCLUSIONS

Differences across time, region and grade level were found among adolescent females on body size and dieting behaviour, but not physical appearance. Adolescent females experience early and increasing body size dissatisfaction and dieting as they age, but stable perceptions of physical appearance. Age and geographic region are important considerations for the timing and targeting of interventions to address body image concerns. Further investigation of regional differences in body image perceptions and factors that affect these is warranted. The findings of this study highlight the ongoing need for strategies during adolescence to promote a healthy appreciation of body size and appearance.

Weight acceptance versus body dissatisfaction: Effects on stigma, perceived self-esteem, and perceived psychopathology

OBJECTIVE

It is unknown whether weight acceptance or body dissatisfaction impact anti-fat stigma. Therefore, this study utilized a 2×2 between-subject experimental design to examine of the relationship between body acceptance and stigmatization.

METHOD

Participants were university undergraduates (N=394, 70% women, mean age=20.8 years, mean BMI=23.61 kg/m(2)) who were randomly assigned to read vignettes describing an obese or normal-weight target described as either accepting or not accepting of her weight. Participants completed measures of stigma (the Fat Phobia Scale (FPS), the modified Anti-fat Attitudes Scale (AFA)), perceived self-esteem (assessed with the modified Rosenberg Self-Esteem Scale (RSE)), and perceived psychopathology.

RESULTS

Analyses revealed significant main effects for acceptance. Notably, targets who accepted their weight were less stigmatized on the FPS (F(1, 354)=66.82, p<.001) and the AFA willpower subscale (F(1, 373)=37.90, p<.001), and they were perceived as having better self esteem (F(1, 371)=166.16, p<.001) and fewer psychological problems (F(1, 381)=123.19, p<.001) than those who did not accept their weight.

CONCLUSION

Results from this study suggest that size acceptance, even when practiced by obese targets, was significantly less stigmatized than body dissatisfaction and associated with better perceived self esteem and mental health.

Attention bias modification produces no changes to appearance-related bias, state or trait body dissatisfaction in nonclinical women

The potential of attention bias modification to reduce appearance-related attentional biases and female body dissatisfaction has not been investigated. Immediate and short-term effects were therefore examined across attentional biases, state and trait body dissatisfaction in a randomised controlled trial consisting of 62 female participants aged 18–35 years. The results show no changes to attentional bias across either the experimental or control condition and no significant changes in body dissatisfaction immediately post-training or at 1–2 weeks follow-up. Single-session attention bias modification protocols may therefore not be sufficient in modifying appearance-based biases and associated disordered body schemas within a nonclinical sample.