Media internalization and conformity to traditional masculine norms in relation to body image concerns among men

Women are lean and men are also lean: nutrition titles in women's and men's health magazines

BACKGROUND

Whether nutrition messages in popular health magazines differ by country or season has seldom been studied. We assessed the nutrition topics featured in the headlines of Men's Health® (MH) and Women's Health® (WH) magazines from different countries.

METHODS

We sampled MH and WH magazines from Portugal, South Africa, Spain, the UK and the USA. Nutrition-related headlines were categorized as weight loss, weight gain, micronutrients and other.

RESULTS

The most frequent topics were "Other" (44%) and "weight loss" (41%), while "micronutrients" represented 4%. Topics related to weight gain were more frequent in MH (19% vs. 2% in WH), while no difference was found for weight loss (44% vs. 37% in WH). On multivariable analysis, weight gain had a higher likelihood of being present in MH than in WH, Odds ratio and (95% confidence interval): 8.3 (2.2-90.9), p = 0.002, while no association was found for weight loss: OR 1.1 (0.6-2.0), p = 0.80. Weight loss was absent from the US WH and present in two thirds of the Portuguese WH; in MH, weight gain was evenly distributed between countries. Prevalence of the weight loss topic was lower in March (15% vs. 54% in January, p < 0.01 by logistic regression) and to a lesser degree in June (35%) and July (35%). No seasonality was found for the "weight gain" topic.

CONCLUSION

In WH and MH magazines, nutrition topics vary according to gender, country, and season. Weight gain remains a male topic, while weight loss is equally prevalent in both women's and men's magazines.

Exploring risk factors of drive for muscularity and muscle dysmorphia in male adolescents from a resource-limited setting in Burkina Faso

In low-income countries, Muscle Dysmorphia (MD) has only been investigated in adult south African amateur-bodybuilders. To date, there is no epidemic study about MD or its cardinal symptom "drive for muscularity" (DFM) and its impact on young men's lives in African low-income settings. We analyzed a population-representative cross-sectional study of 838 adolescent males aged 12-20 in the rural northwestern Burkina Faso. Participants were assessed for MD with the research criteria of Pope and its cardinal symptom DFM based on the DFM scale (DMS). Since DFM has not been studied in a comparable sample so far, all possible influencing variables were examined exploratively in a linear regression model. Many respondents were underweight (41.5%) and few overweight (1.3%). No-one met standard clinical MD criteria. While 60.1% of 837 wished to be more muscular, only 8.7% of 824 desired a lower body-fat percentage. Regression analysis revealed that higher DMS scores were associated with greater internalization of the muscular body ideal, going to school, living in a rural area, older age, and a history of having faced sexual harassment or assault, but not with media exposure. Our results show that levels of DMS in Burkinabe adolescents were elevated. Risk factors for DFM in environmental circumstances where undernutrition and poverty are common are discussed.

#Sponseredathlete: the marketing of image and performance enhancing drugs on Facebook and Instagram

This article sets out to investigate the marketing of image and performance enhancing drugs (IPEDs) on the social media platforms Facebook and Instagram. Drawing upon a 'connective' ethnographic exploration of IPED use and supply, the paper first outlines a supplier typology on these platforms, before shedding light on the marketing strategies employed by sellers in order to overcome the inherent distrust of online sales and build a trustworthy brand. Techniques identified include athlete sponsorship, the sharing of bodybuilding fitspiration content, self-objectification, posting images showcasing transformation photos and customer feedback, and seasonal sales and promotions. Analysis encompasses the centrality of product branding, the overlaps between licit and illicit market advertising strategies, and the affordances of the platforms under study. Finally, conclusions relating to the implications of these findings to scholarship, policy, and regulation are offered.

A comic-based body image intervention for adolescents in semi-rural Indian schools: Study protocol for a randomized controlled trial

Adolescents in India experience body dissatisfaction, however, empirically supported interventions are lacking. This paper describes the protocol for the development, acceptability testing, and cluster randomized controlled trial (RCT) of a six-session comic-based intervention, which aims to improve body image and related outcomes among adolescents in semi-rural Indian schools. If found to be acceptable and effective, UNICEF will disseminate the intervention across schools in eight states of India. The acceptability study will be conducted with 24 students in Classes 6-8 (age 11-14) and nine teachers from Hindi-medium government schools using interviews and focus groups. The subsequent RCT will be conducted with 2400 students, with schools randomized to either the comic-based intervention or lessons-as-usual (control) groups. The primary outcome is body esteem, and secondary outcomes are disordered eating, appearance ideal internalization, body-image-related life disengagement, self-esteem, negative affect, and positive affect. Additional exploratory outcome measures are skin colour dissatisfaction, body hair dissatisfaction, appearance-based teasing, and endorsement of traditional gender roles. These outcomes will be examined at three timepoints: baseline (T1), 1 week-post-intervention (T2), and 12-weeks follow-up (T3). Analyses will compare outcomes in the intervention with the control group. This will be the first study to evaluate a body image intervention for adolescents in semi-rural Indian schools.

A systematic review of interventions aiming to promote positive body image in children and adolescents

Evidence shows interventions can improve positive body image in adult women. This systematic review examined the evidence of efficacy of interventions that aimed to increase positive body image in children and young people aged under 18 years. The authors followed PRISMA guidelines for the review. Searches of CINAHL Plus, Medline, PsychINFO, Wiley Online Library, SCOPUS and grey literature were conducted up to February 2021 and identified 4171 papers. Thirteen studies evaluating 12 interventions, designed for children/adolescents aged 9-18 years, were eligible and evaluated using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. The studies evaluated body appreciation, body-esteem, and embodiment. Studies using cognitive dissonance, peer support, and psychoeducation had evidence of improving body appreciation and body-esteem in adolescent girls. However, evidence of efficacy for younger children and boys was lacking and the studies ranged in methodological quality. Further research should rigorously evaluate positive body image interventions using second-generation measures that assess specific components of positive body image and consider how to promote positive body image in young children and boys.

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.

A longitudinal study investigating positive body image, eating disorder symptoms, and other related factors among a community sample of men in the UK

Emerging research suggests that positive body image-an overall love and respect for one's body- may be a protective factor for eating disorder (ED) symptoms. This study aimed to explore the relationships between positive body image, ED symptoms, and related factors among men across time. A community sample of 440 British men completed questionnaires at Time 1 and Time 2 (1 year later). Linear models showed that, unexpectedly, positive body image at Time 1 did not predict change in ED symptoms at Time 2, and ED symptoms at Time 1 did not predict change in positive body image at Time 2. However, positive body image at Time 1 did predict increased appearance satisfaction and decreased appearance-ideal internalisation at Time 2. Increased positive body image at Time 2 was only predicted by appearance satisfaction at Time 1. Although no evidence for a longitudinal relationship between positive body image and ED symptoms was found, positive body image did predict change in established risk factors for disordered eating among men. Future research on positive body image and eating behaviour among men could be improved by including assessments of muscularity-oriented and adaptive eating behaviours.

Psychometric properties of a Silhouette Rating Scale assessing current and ideal body size and body dissatisfaction in adults

PURPOSE

The study aims at validating a new pictorial tool, the Silhouette Rating Scale (SRS). It consists of a series of nine female or male silhouettes. It was created to assess current and ideal body size evaluation, and body dissatisfaction. Our aims were to test the concurrent, convergent and discriminant validity of the scale, evaluating possible gender differences.

METHOD

A first sample of 754 young adults (age M = 26.10 ± 8.50, males N = 218) and a second sample of 210 young adults (age M = 21.19 ± 3.22, males = 43) completed the SRS, and other self-report measures assessing body size evaluation, disordered eating, body satisfaction, depression, emotion regulation and insomnia.

RESULTS

Statistical analyses performed on the first sample largely support the concurrent validity of the scale. Results obtained from the second sample confirm its convergent validity, showing strong correlations with the Contour Drawing Rating Scale. In addition, the correlations performed between the three responses of the SRS and other measures of eating disorders, depression, insomnia and emotion regulation indicated a good discriminant validity, though some of the variables measured seem to be significantly correlated.

CONCLUSIONS

The SRS is a reliable and valid tool for assessing current body size, body ideal and body dissatisfaction as compared to other widely used scales. It guarantees the universality of use thanks to the absence of details related to ethnicity or culture and at the same time, maintaining a right level of realism. Future studies will evaluate test-retest validity and its potential within clinical populations.

LEVE OF EVIDENCE

V, descriptive cross sectional study.

Testing of a model for risk factors for eating disorders and higher weight among emerging adults: Baseline evaluation

Although a range of risk factors have been identified for disordered eating and weight status, the breadth of risk factors have been rarely considered within a single, comprehensive model. The robustness of these findings across countries also remains an open question. The present study sampled 6272 participants aged 18-30 years from eight countries in an attempt to evaluate combined and unique predictors for these two conditions, and to explore possible cross-country differences in these models. Participants completed a range of demographic, biological, behavioral, psychological, and sociocultural measures to test a comprehensive model of the contributions of these predictors for disordered eating and weight-related constructs (binge eating, body mass index, compensatory behaviors, dietary restraint, drive for muscularity, and drive for leanness). Structural invariance testing within a multigroup path analysis framework revealed that a single model across the eight countries provided poor model fit. Freeing of 22% of parameters across countries provided excellent fit and a satisfactory compromise for country-invariant and country-variant parameters in the model. Overall, predictors accounted for between 15% and 60% of variance in the outcome measures, with lowest explained variance for the disordered eating outcomes. Significant unique contributions to prediction were observed for each of the five risk factor variable types and across the eight countries. Thus, the findings show strong support for this model as an explanatory framework of both disordered eating and weight status.

Perceptions of the Body and Body Dissatisfaction in Primary Education Children According to Gender and Age. A Cross-Sectional Study

Body image (BI) is a trending topic of study since health problems derived from a negative perception of the body are increasing and affecting people of all ages, with an increasing incidence among children from the age of eight. The objective of this study was to evaluate the current perception of the body against the desired body and the degree of body satisfaction of Galician primary education students. A total of 355 students (167 boys (47%)) between 9 and 12 years old participated (mean = 10.53; SD = 0.84). Sociodemographic data (sex, age, height, and weight) were collected, and the Figure Rating Scale was used. There are statistically significant differences between boys and girls in the current perceived figure (p = 0.003) and in the desired figure (p < 0.001). Depending on age, the differences were in current (p = 0.010) and desired (p = 0.021) body perception. In conclusion, boys perceive themselves as having a larger figure than girls do, but this perception is far from reality according to the body mass index. For the desired figure, both boys and girls want to be slimmer, but girls want a slimmer figure. Regarding age, the current perceived figure size increases with age as it increases in those students dissatisfied with their body.

The Relationships Between COVID-19 Anxiety, Ageism, and Ableism

The COVID-19 pandemic is a source of anxiety globally, and lockdowns have increased anxiety symptoms, contributed to economic stress, and influenced an increase in prejudice, particularly prejudice directed at the elderly and people with disabilities. Terror management theory serves as an explanation for the association between COVID-19 anxiety, ageism, and ableism. Recruiting participants from Amazon MTurk, I assessed anxiety about COVID-19, ageism, and ableism. Hierarchical linear regression analyses demonstrate that COVID-19 anxiety is significantly associated with ageism, and with ableism, as well as age and gender. The results of this study have implications for the effect of COVID-19 anxiety on those who are most vulnerable in the current pandemic, particularly with regards to isolation and social connection; those who are most anxious about the pandemic might spend less time trying to connect with their older friends and relatives, and likewise for the people in their lives who might have a disability.

Weight control intentions and mental health among Canadian adolescents: a gender-based analysis of students in the COMPASS study

INTRODUCTION

Little is known about gender differences in associations between weight control intentions and mental health in adolescents. Our objective was to examine these associations in a large sample of adolescent girls and boys.

METHODS

Using data from Year 6 (2017-18) of the COMPASS study (n = 57 324), we performed a series of multivariable linear regressions to examine whether weight control intentions (gain, lose, stay the same, no intention) were associated with depression, anxiety and self-concept, while adjusting for relevant covariates including body mass index. Models were stratified by self-reported gender.

RESULTS

Compared to those with no intentions, girls who intended to lose weight reported higher symptoms of depression (B = 0.52, p < 0.001) and anxiety (B = 0.41, p < 0.001) and poorer self-concept (B = 2.06, p < 0.001). Girls who intended to gain weight also reported higher symptoms of depression (B = 0.54, p < 0.001), anxiety (B = 0.50, p < 0.001) and self-concept (B = 1.25, p < 0.001). Boys who intended to lose weight reported greater symptoms of depression (B = 0.26, p < 0.001) and anxiety (B = 0.33, p < 0.001) and poor self-concept (B = 1.10, p < 0.001). In boys, weight-gain intentions were associated with greater symptoms of anxiety (B = 0.17, p < 0.05), but not depression or self-concept.

CONCLUSION

Intentions to gain or lose weight were associated with symptoms of mental disorder and poor self-concept in our large sample of adolescents, and these relationships differed in boys and girls. These findings have important implications for school-based programs promoting healthy weight and body image.

'Everybody's Different: The Appearance Game'. A randomised controlled trial evaluating an appearance-related board game intervention with children aged 9-11 years

This study evaluated the effectiveness of an educational board game aimed at increasing knowledge of appearance-related issues, positive body image, media literacy, and acceptance of appearance diversity with British school children. Two hundred and fifty-nine children, aged 9-11 (Mage = 10.26), from three primary schools in South-West England participated in a two-arm matched cluster randomised controlled trial. Outcome measures were collected pre-, post- and at two-week follow-up. Knowledge of appearance-related issues significantly increased in the intervention group, compared to the control group post-intervention, but was not maintained at follow-up. There were no significant differences between groups for body appreciation, media literacy or acceptance of visible difference. Of the intervention arm, 78 % (n=117) they would like to play again and 85.3 % (n=128) thought other children would like to play. Qualitative data suggests participants learned the key messages of the game. The findings suggest 'Everybody's Different: The Appearance Game' is an enjoyable way to increase knowledge of appearance-related issues. In future, researchers should consider how to increase body appreciation, media literacy and acceptance of appearance diversity, for example by increasing the dosage of the game or using it in conjunction with discussions and lessons surrounding appearance diversity and appearance-altering conditions.

Adherence to cultural values and the internalization of sociocultural appearance ideals are associated with exercise dependence symptoms in Asian/Asian American men

This study examined sociocultural correlates of exercise dependence symptoms (EDSX) in young Asian/Asian American men. We hypothesized that greater adherence to Asian cultural values would be positively associated with EDSX and that the internalization of muscularity and thinness appearance ideals would exacerbate this link. Participants included 266 Asian/Asian American men (18-30y, Mage = 24.4 ± 3.6y; MBMI = 24.2 ± 5 kg/m²) enrolled in a larger study examining disordered eating and body image concerns in ethnically/racially diverse young men. Participants completed an online survey that assessed demographics, adherence to Asian values, internalization of muscularity and thinness appearance ideals, and EDSX. After adjusting for BMI, income, education, and presence of a psychiatric diagnosis, a linear regression model indicated that adherence to Asian values was significantly and positively associated with EDSX (B = 12.13, p = .036). Neither internalization of muscularity (p = .812) nor thinness (p = .967) appearance ideals moderated this association. However, independently, both internalization of muscularity (B = 10.93, p < .001) and thinness appearance ideals (B = 7.92, p < .001) were positively associated with EDSX. The current study highlights the importance of considering cultural factors, such as adherence to traditional norms, in our investigations of EDSX in young Asian/Asian American men and the need to develop tailored interventions for young men's disordered eating symptoms. Our data also support the link between sociocultural ideals of attractiveness and young men's excessive exercise behaviors, contributing to a robust body of literature highlighting the problems with a cultural emphasis on specific body sizes and shapes.

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

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

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.

Television exposure, consumer culture values, and lower well-being among preadolescent children: The mediating role of consumer-focused coping strategies

Previous research has linked materialism to lower well-being in children, and recent findings suggest that this link is heightened among those exposed to high levels of advertising. One proposal is that children may be pursuing consumer culture ideals (CCIs) - orienting to material possessions and physical appearance - as a maladaptive coping strategy for dealing with underlying distress. The present work offers the first direct evaluation of this theoretically plausible hypothesis. In Study 1, higher scores on our measure of consumer-focused coping (CFC) not only predicted lower well-being in a sample of 109 9- to 11-year-olds, but also served as mediator in the indirect link between the number of hours spent watching television and lower well-being. Study 2 tested our expanded model of these processes in a sample of 380 9- to 11-year-olds. Specifically, structural equation modelling revealed that frequency of watching commercial (advertising-rich) television in particular predicted greater CFC. This, in turn, predicted greater endorsement of CCIs, which then predicted lower well-being. Implications for theoretical models and educational interventions are discussed.

Psychosocial factors underlying symptoms of muscle dysmorphia in a non-clinical sample of men

Muscle dysmorphia is primarily characterized by an excessive preoccupation that one's body is not muscular or lean enough. Muscle dysmorphia has shown clinical similarities with eating disorders. The present study aims to explore the psychosocial factors underlying muscle dysmorphia symptoms by referring to Stice's dual pathway model (1994), a theoretical model of eating disorders. Three hundred and eighty-six men were recruited to complete an online survey including questionnaires assessing social pressures to reach a muscular body and internalization of the muscular body, drive for muscularity, muscular-enhancing behaviors, negative affect, narcissistic traits, and symptoms of muscle dysmorphia. Path analyses showed that the original model has a good fit, without, however, confirming a significant relationship between the drive for muscularity and negative affect. Thus, social pressure to reach a muscular body and its internalization were associated to a drive for muscularity and then, to muscle dysmorphia symptoms. The drive for muscularity was indirectly related to symptoms of muscle dysmorphia through muscle-enhancing behaviors as well as negative affect (although, only for individuals with higher levels of narcissistic vulnerability). Results supported the adaptation of the Stice's model to explain muscle dysmorphia symptoms and underlined the possible influence of narcissistic vulnerability traits in this condition.

Body appreciation in British men: Correlates and variation across sexual orientation

Investigations of positive body image among men and across various social identities are lacking, and could contribute to a more complete understanding of the construct, including how positive body image can be improved. This study addressed this gap by investigating correlates of body appreciation - a key facet of positive body image - in men, and testing whether levels of body appreciation vary across sexual orientation. Data from a British community sample of 439 men (M_age = 39.13) showed that body appreciation inversely correlated with conformity to masculine norms and upward appearance-based social comparisons, and positively correlated with physical activity. Body appreciation was lower among sexual minority compared to heterosexual men, and athletic appearance-ideal internalisation and upward appearance-based social comparisons mediated this relationship. Replicating prior research among men, body appreciation positively correlated with body satisfaction, and inversely correlated with perceived appearance pressures from media and eating pathology. These findings have implications for interventions addressing body image among men.

Cross-sectional associations between gender-linked personality traits and use of weight-loss and muscle-building products among U.S. young adults

This study examined the cross-sectional associations between gender-linked personality traits and use of products for weight loss and muscle building using data from young adults participating in Wave III of the National Longitudinal Study of Adolescent to Adult Health who completed the short-form Bem Sex-Role Inventory (n = 3,343). Among men, a higher score on the masculinity scale was associated with greater odds of diet pill use, legal performance-enhancing substance (PES) use, and illicit PES use, while a higher score on the femininity scale was associated with lower odds of illicit PES use. These findings can inform interventions for men with weight/shape concerns.

Viewing Sexually Explicit Media and Its Association with Mental Health Among Gay and Bisexual Men Across the U.S

Gay and bisexual men (GBM) have reported viewing significantly more sexually explicit media (SEM) than heterosexual men. There is evidence that viewing greater amounts of SEM may result in more negative body attitude and negative affect. However, no studies have examined these variables within the same model. A national sample of 1071 HIV-negative GBM in the U.S. participating in a larger study completed an online survey, which included measures of SEM consumption, male body attitudes, anxiety, and depression. Participants reported viewing 3 h of SEM per week, on average, and 96% of participants reported recently viewing at least some SEM. Greater consumption of SEM was directly related to more negative body attitude and both depressive and anxious symptomology. There was also a significant indirect effect of SEM consumption on depressive and anxious symptomology through body attitude. These findings highlight the relevance of both SEM on body image and negative affect along with the role body image plays in anxiety and depression outcomes for GBM. They also indicate a potential role for body image in explaining the co-occurrence of SEM consumption and negative affect. For interventions looking to alleviate negative affect for GBM, it may be important to address SEM consumption and body image as they are shown to be associated with both anxious and depressive symptomology.

Perceptions of eating disorder diagnoses and body image issues in four male cases in Singapore

BACKGROUND

Despite the increasing number of patients presenting for treatment, little is still known about male eating disorders cases. The current study presents four male eating disorder cases presented to our specialized treatment facility in Singapore.

CASE PRESENTATION

Cases 1, 2 and 3 are homosexual males in their twenties and thirties who presented with anorexia nervosa and bulimia nervosa. Case 4 is a heterosexual male in his twenties diagnosed with binge eating disorder. All four cases expressed body image dissatisfaction, fat phobia and fear of weight gain. Additionally, all of them sought treatment because of comorbid psychiatric conditions or parental wishes. Premorbid obesity and homosexual orientation may be potential risk factors for males in developing eating disorders.

CONCLUSIONS

These findings suggest that more exploration needs to be done for males diagnosed with eating disorders, particularly in the Asian society. A deeper understanding into factors associated with symptom presentation and treatment-seeking behaviors would greatly assist in informing the direction and focus of treatment in the region.