Cultural differences in body dissatisfaction: Japanese adolescents compared with adolescents from China, Malaysia, Australia, Tonga, and Fiji

Translation and validation of the Body Esteem Scale in Adults and Adolescents among Indonesian adolescents

There is a need for a psychometrically robust body image measure to advance body image scholarship among Indonesian adolescents. This study aimed to validate a Bahasa Indonesia version of the Body Esteem Scale for Adults and Adolescents (BESAA). The measure was forward and back translated from English into Bahasa Indonesia (i.e., primary Indonesian language) and was assessed for comprehension and cultural appropriateness using cognitive interviews and expert reviews. The factor structure, reliability, and validity of the measure was tested with adolescents aged 11-17 years from two districts in Indonesia (N = 650; 51.5 % girls). Exploratory factor analysis identified a suitable 17-item three-factor solution for the BESAA, with Appearance Positive, Appearance Negative, and Weight subscales. This model was confirmed via confirmatory factor analysis and found to be largely invariant across gender and age. Test re-test reliability and internal consistency of the subscales were acceptable. The Bahasa Indonesia version of the BESAA is a psychometrically robust measure suitable for use among Indonesian adolescents. Reasons as to why the factor structure of the BESAA differentiates across cultural contexts are discussed.

Evaluating a school-based body image lesson in Indonesia: A randomised controlled trial

Negative body image is a common public health concern among adolescents, globally. The aim of the current study was to evaluate the effectiveness, implementation fidelity, and acceptability of a single session, school-based universal body image intervention in Indonesia. A total of 1926 adolescents (59.4 % girls) and 12 school guidance counsellors (lesson facilitators) from nine state junior secondary schools in Surabaya, East Java took part in a two-arm open parallel cluster randomised controlled trial. In response to the changing circumstances due to the COVID-19 pandemic, half of the lessons were conducted in person and half were delivered online. Results showed that the lesson did not significantly improve adolescent body image or secondary outcomes relative to the control, though there was no evidence of harm. There were no substantive findings regarding intervention effectiveness by gender. The mode of intervention delivery (online vs. in-person) did not significantly influence the main findings. Implementation fidelity varied widely, and the lesson content and pedagogy were largely acceptable, though there was a strong preference for in-person lesson delivery. Findings have implications for researchers aiming to improve adolescent body image in low- and middle-income countries. Lessons learned can inform future school-based efforts to support adolescent body image.

A cognitive dissonance body image intervention 'Free Being Me' delivered by guide leaders to adolescent girl guides in India: A pilot and acceptability trial

This pilot study assessed the acceptability and pre-post intervention effects of a cognitive dissonance-based body image intervention, Free Being Me, delivered by Guide leaders to adolescent girls in India. Girls aged 11-14 years (Mage = 12.6, N = 117), who were members of the national scouting and guiding association of India, received the intervention across five weekly 1-hour group sessions. The primary outcome (body esteem) and secondary outcomes (self-esteem, internalisation of appearance ideals, negative and positive affect, and life disengagement) were measured pre-intervention and immediately post-intervention. The intervention was acceptable. Adolescent girls reported high levels of comfort (89%), enjoyment (90%), and perceived importance (92%) with suggestions for improvement including more interactive activities. Facilitator adherence and competence delivering Free Being Me was rated good. Significant within-groups pre-post intervention improvements in body esteem (Cohen's d = 0.28) and reductions in internalisation of appearance ideals (Cohen's d = 0.49) were identified. No changes to self-esteem, negative or positive affect, or life disengagement were observed. This study suggests that Free Being Me is acceptable for community-based delivery and Guide leader format with promising pre-post intervention effects. Going forward, a randomised controlled trial is necessary to make confident interpretations on the effectiveness of Free Being Me.

Olapegba P, Sawamiya Y, Suzuki T, Yamamiya Y, Wagner MJ, Drysch M, Lehnhardt M, Behr B. Interethnic Influencing Factors Regarding Buttocks Body Image in Women from Nigeria, Germany, USA and Japan

BACKGROUND

Body image research deals a lot with awareness of the body as an entity. Studies that consider individual anatomical aspects and place them in an intercultural context are rarely present.

METHODS

For this purpose, general data, body perception and judgment of body images from 2163 (48% female and 52% male) participants from Germany, Nigeria, the USA and Japan were evaluated as part of a survey.

RESULTS

There were clear differences in the personal body image of the participants' own buttocks, the buttocks as a beauty ideal and the way in which dissatisfaction was dealt with in different countries. In addition to sexual well-being (importance score: 0.405 a.u.), the country of origin (0.353), media consumption (0.042) and one's own weight (0.069) were also identified as influencing factors for satisfaction with one's own buttocks. A clear evolution could be derived regarding a WHR (waist-to-hip ratio) of well below 0.7, which was consistently favored by the participants but also propagated by influencers through images (p < 0.001). In this context, participants who indicated celebrities as role models for the buttocks showed a correspondingly high level of dissatisfaction with their own buttocks (R = -0.207, p < 0.001, ρ = -0.218).

CONCLUSION

Overall, a highly significant correlation was shown between the consumption frequency of Instagram, TikTok and pornography with the negative perception of women's own buttocks.

Development and validation of the body image scale for youth (BISY)

BACKGROUND

Body dissatisfaction has been known as an important public health concern that can influence the physical and psycho-social health of adolescents. Hence, health professionals need a valid and reliable tool to assess this problem and its related factors in youth. This study aims to develop and assess the psychometric properties of an indigenous scale for the evaluation of body image and to investigate its association with body weight status among Iranian adolescents.

METHODS

This study was conducted on 857 adolescents who completed the body image scale for Youth (BISY) and self-reported their body weight and height. Face, content, and construct validity methods were used to assess the validity of the BISY. Exploratory factor analysis (EFA) was used to assess construct validity. Moreover, the internal consistency of the scale was assessed by calculating Cronbach's alpha coefficient (α), and test-retest reliability was examined using the intra-class correlation coefficient (ICC). To compare the BISY scores across sex and body weight status groups, the Independent samples t-test and the analysis of variance (ANOVA) or Welch tests were used, respectively.

RESULTS

Mean age and body mass index (BMI) of participants were 16.5 ± 1.1 years and 22.4 ± 4.5 kg/m², respectively. The EFA showed a 10-factor construct which explained 57% of the variance. The Cronbach's alpha coefficient for overall items of the scale was 0.896 and ranged from 0.42 to 0.92 for subscales. The test-retest reliability result was acceptable for the BISY (ICC = 0.805). The ICC values ranged from 0.753 to 0.990 for BISY subscales. The BISY total score was significantly higher in girls compared to boys (34.8 ± 12.7 vs. 31.3 ± 10.2; p < 0.001). In girls, the BISY total score was significantly lower in normal-weight girls compared to their overweight (p = 0.009), and obese (p = 0.012) counterparts. This difference was not observed in boys.

CONCLUSION

These findings support the reliability and validity of the BISY for the assessment of body image in Iranian adolescents; this scale can be applied as an appropriate tool for the assessment of body image in adolescents in related future studies. Current findings highlight considering body image as an important aspect of intervention programs targeting overweight and obesity in adolescents, specifically girls. Negative body image has been known as an important public health concern that can adversely influence different aspects of adolescents' health. Hence, a valid and reliable tool is necessary to identify adolescents at risk of developing negative body image and its related disorders. There is a lack of an indigenous scale that can comprehensively assess body image and its related factors in Iranian adolescents; hence, the current study aimed to develop and assess the psychometric properties of an indigenous scale for evaluation of body image and further investigate the association between body image and body weight status among Iranian adolescents. The current findings support the reliability and validity of the BISY. In addition, more negative body images were observed in girls compared to boys and in overweight/obese girls compared to their normal-weight counterparts. Therefore, promoting a healthy body image should be incorporated as an important component of future health promotion programs to address obesity, eating disorders, and other health-related concerns among adolescents, specifically girls.

Evaluating the Efficacy of a Social Media-Based Intervention (Warna-Warni Waktu) to Improve Body Image Among Young Indonesian Women: Parallel Randomized Controlled Trial (Preprint)

BACKGROUND

Body dissatisfaction is a global issue, particularly among adolescent girls and young women. Effective body image interventions exist but face barriers to scaling up, particularly in lower- and middle-income countries, such as Indonesia, where a need exists.

OBJECTIVE

We aimed to evaluate the acceptability and efficacy of Warna-Warni Waktu, a social media-based, fictional 6-episode video series with self-guided web-based activities for improving body image among young Indonesian adolescent girls and young women. We hypothesized that Warna-Warni Waktu would increase trait body satisfaction and mood and decrease internalization of appearance ideals and skin shade dissatisfaction relative to the waitlist control condition. We also anticipated improvements in state body satisfaction and mood immediately following each video.

METHODS

We conducted a web-based, 2-arm randomized controlled trial among 2000 adolescent girls and young women, aged 15 to 19 years, recruited via telephone by an Indonesian research agency. Block randomization (1:1 allocation) was performed. Participants and researchers were not concealed from the randomized arm. Participants completed self-report assessments of trait body satisfaction (primary outcome) and the internalization of appearance ideals, mood, and skin shade dissatisfaction at baseline (before randomization), time 2 (1 day after the intervention [T2]), and time 3 (1 month after the intervention [T3]). Participants also completed state body satisfaction and mood measures immediately before and after each video. Data were evaluated using linear mixed models with an intent-to-treat analysis. Intervention adherence was tracked. Acceptability data were collected.

RESULTS

There were 1847 participants. Relative to the control condition (n=923), the intervention group (n=924) showed reduced internalization of appearance ideals at T2 (F_1,1758=40.56, P<.001, partial η²=0.022) and T3 (F_1,1782=54.03, P<.001, partial η²=0.03) and reduced skin shade dissatisfaction at T2 (F_1,1744=8.05, P=.005, partial η²=0.005). Trait body satisfaction improvements occurred in the intervention group at T3 (F_{1, 1781}=9.02, P=.005, partial η²=0.005), which was completely mediated by the internalization change scores between baseline and T2 (indirect effect: β=.03, 95% CI 0.017-0.041; direct effect: β=.03, P=.13), consistent with the Tripartite Influence Model of body dissatisfaction. Trait mood showed no significant effects. Dependent sample t tests (2-tailed) found each video improved state body satisfaction and mood. Cumulative analyses found significant and progressive improvements in pre- and poststate body satisfaction and mood. Intervention adherence was good; participants watched an average of 5.2 (SD 1.66) videos. Acceptability scores were high for understandability, enjoyment, age appropriateness, usefulness, and likelihood to recommend.

CONCLUSIONS

Warna-Warni Waktu is an effective eHealth intervention to reduce body dissatisfaction among Indonesian adolescent girls and young women. Although the effects were small, Warna-Warni Waktu is a scalable, cost-effective alternative to more intense interventions. Initially, dissemination through paid social media advertising will reach thousands of young Indonesian women.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05383807, https://clinicaltrials.gov/ct2/show/NCT05383807 ; ISRCTN Registry ISRCTN35483207, https://www.isrctn.com/ISRCTN35483207.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/33596.

A Novel, Scalable Social Media-Based Intervention ("Warna-Warni Waktu") to Reduce Body Dissatisfaction Among Young Indonesian Women: Protocol for a Parallel Randomized Controlled Trial

Background

Despite the prevalence of body dissatisfaction among young Indonesian women and its consequential negative impacts, there are currently no evidence-based, culturally appropriate interventions to tackle this issue. Therefore, there is a need to develop scalable, cost-effective, and accessible interventions to improve body image among this population.

Objective

This paper describes the study protocol of a parallel randomized controlled trial to evaluate the effectiveness of Warna-Warni Waktu, a social media–based intervention that aims to reduce state and trait body dissatisfaction and improve mood among young Indonesian women aged 15-19 years.

Methods

The trial will take place online. Approximately 1800 young women from 10 cities in Indonesia, evenly split across the ages of 15-19 years, will be recruited via a local research agency’s established research panel. Participants will be randomly allocated to the intervention condition or a waitlist control condition. The intervention consists of six 5-minute videos, with each video supplemented with up to five brief interactive activities. The videos (and associated activities) will be delivered at a rate of one per day across 6 days. All participants will complete three self-report assessments: at baseline (Day 1), 1 day following the intervention (Day 9), and 1 month following the intervention (Day 36). The primary outcome will be change in trait body dissatisfaction. Secondary outcomes include change in internalization of appearance ideals, trait mood, and skin shade satisfaction. Intervention effectiveness on these outcomes will be analyzed using linear mixed models by a statistician blinded to the randomized condition. Intervention participants will also complete state measures of body satisfaction and mood before and after watching each video to assess the immediate impact of each video. This secondary analysis of state measures will be conducted at the within-group level.

Results

Recruitment began in October 2021, with baseline assessments underway shortly thereafter. The results of the study will be submitted for publication in 2022.

Conclusions

This is the first study to evaluate an eHealth intervention aimed at reducing body dissatisfaction among young Indonesian women. If effective, the intervention will be disseminated to over half a million young women in Indonesia via Facebook, Instagram, and YouTube.

Trial Registration

ClinicalTrials.gov NCT05023213; https://clinicaltrials.gov/ct2/show/NCT05023213

International Registered Report Identifier (IRRID)

PRR1-10.2196/33596

'Dove Confident Me Indonesia: Single Session': study protocol for a randomised controlled trial to evaluate a school-based body image intervention among Indonesian adolescents

Background

Due to the prevalence and associated adverse health consequences of negative body image among adolescents globally, there is a need to develop acceptable, effective, and scalable interventions. School-based body image interventions delivered by trained teachers show promise in reducing negative body image in adolescents. However, there is currently a lack of evidenced-based body image interventions for use in low- and middle-income countries (LMICs). This paper outlines a protocol for the development and evaluation of Dove Confident Me Indonesia: Single Session, a single-session, teacher-led body image intervention for Indonesian adolescents.

Method

The effectiveness of the intervention will be evaluated using a cluster randomised controlled trial design. Due to the COVID-19 pandemic, the trial will be conducted online. Trained teachers or school guidance counsellors will deliver the intervention. Self-report questionnaires will be collected at three time points: baseline, post-intervention, and two-month follow-up. The primary outcome is body esteem. Secondary outcomes are internalisation of appearance ideals, mood, engagement in life activities, tendency to engage in appearance comparisons, and skin shade satisfaction. A minimum of 1000 participants will provide 95% power to detect small-to-medium intervention effects. To account for attrition and potential internet issues, the sample will comprise of 2000 Indonesian adolescents in grades 7–9, attending state junior high schools in Surabaya, East Java. Quantitative and qualitative data on acceptability of the intervention will also be collected from teachers and students. Additionally, fidelity of lesson implementation will be assessed. This project received ethical approval from the Universitas Indonesia and the University of the West of England. The intervention will be disseminated in junior high schools throughout Indonesia via UNICEF’s Life Skills Education (LSE) programme, which will be freely available for teachers to download.

Discussion

This paper presents Dove Confident Me Indonesia: Single Session, a culturally adapted school-based intervention designed to improve Indonesian adolescents’ body image. It details the plan for evaluation, highlighting the strengths and limitations of the proposed study design. It will be informative for others aiming to adapt evidence-based school curricula to promote well-being among adolescents in LMICs.

Trial registration

NCT04665557. Registered 11th December 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11770-0.

Beauty ideals, social media, and body positivity: A qualitative investigation of influences on body image among young women in Japan

Body image and eating concerns are prevalent among Japanese young women and result in part from exposure to unrealistic media imagery. In Western contexts, a growing body of research has explored the impact of social media on body image and eating disorder risk, and the potential for body positive media to mitigate these harmful effects. However, similar research in Japan is lacking. The aim of the present study was to qualitatively explore media and social media influences on body image and associated behaviors among young women in Japan, with a specific focus on body positive media content. Female university students in Japan (n = 29) participated in majority group and some individual interviews. Thematic analysis revealed four primary themes: (1) media appearance pressures: additive pressures of Japanese and Western ideals through globalization, (2) criticism of, resistance to, and negotiating appearance ideals, and (3) presence of body positivity in Japan, and (4) media as a background for interpersonal appearance pressures. High pressure towards thinness emerged, perceived as contributing to weight control behaviors that were calibrated to avoid being "unhealthy." Desire for greater body diversity in Japanese media emerged; however, findings suggest body positive messaging is scarce and mainly limited to high-profile celebrities.

The application of the Chinese version of the Body Image Disturbance Questionnaire in patients with systemic lupus erythematosus

This study aimed to translate the Body Image Disturbance Questionnaire (BIDQ) into Chinese and evaluate its reliability and validity in a sample of patients with systemic lupus erythematosus (SLE).Following the translation and revision of the Chinese version of the BIDQ, 169 patients with SLE were chosen as respondents to test the questionnaire's reliability and validity. We tested the content's validity through expert group evaluation. It is structural validity was examined through exploratory factor analysis and confirmatory factor analysis, and reliability was evaluated using Cronbach's α and test-retest reliability.The Chinese version of the BIDQ showed a content validity of .92. A two-factor structure was revealed by exploratory factor analysis, which explained 67.83% of the variance and proved by confirmatory factor analysis. Its overall Cronbach's α was .82 (P  < .001), and the Cronbach's α for each item ranged from .76 to .83. The test-retest reliability was .82, with the Cronbach's α for each item ranging from .76 to .84.Thus, adequate reliability and validity of the Chinese version of the BIDQ were demonstrated for use in patients with SLE.

A school-based eating disorder prevention program (Me, You & Us) for young adolescents in Korea: A 3-year follow-up study

OBJECTIVE

The study aimed to examine the feasibility and long-term effects of a school-based eating disorder prevention program for young adolescents in Korea.

METHOD

We followed up the students (n = 133) who had participated in the prevention program at 3 years ago to evaluate changes in body esteem and self-esteem between postintervention and 3-year follow-up, with investigating whether gender moderated the effect of time.

RESULTS

Boys showed no decline in body esteem and self-esteem from postintervention to 3-year follow-up, indicating that the prevention program alleviated decreases in body esteem and self-esteem over time. Girls showed decreases in body esteem and self-esteem from postintervention to 3-years follow-up.

DISCUSSION

This study provides evidence supporting the feasibility of the school-based eating disorder prevention program targeting mixed-sex, young adolescents in Korea. Given the developmental trajectories of decrease in body esteem and self-esteem during adolescence, the program may be efficient for boys over time. Boosters and/or complementary prevention approaches across gender are needed.

The main physical components of body image from the perspectives of Iranian adolescents: a qualitative study

Background

Although different aspects of body image have been extensively studied in Western societies, there is little evidence regarding the main physical components that contribute to perceptions of body image from the perspective of adolescents, especially in Eastern-Mediterranean regions. This study aims to investigate main physical components of body image from the perspectives of Iranian boys and girls.

Methods

This qualitative study has been conducted using a grounded theory approach. The focus of the current study was on identifying the main physical characteristics of body image as perceived by participants. A total of 13 semi-structured focus group discussions were conducted with 84 adolescents (42 girls and 42 boys), aged 15–18 years. All focus group discussions were audio recorded and transcribed verbatim. Data collection continued until saturation was reached.

Results

The mean age and BMI of participants were 16.2±0.9 years and 24.3±8.0 kg/m² respectively. Regarding main physical components of body image, three main themes emerged from the data: 1) perceived face/hair, which included three subthemes-facial features, facial shape/form and hair, 2) perceived body, which included three subthemes-body size, body shape and bone structure and 3) perceived physical functioning which included three subthemes-physical ability, physical health and voice tone. Among mentioned themes, perceived body was the concept which was most frequently addressed by both adolescent boys and girls. Additionally, in terms of the other remaining two themes, when adolescents were talking about their bodies, girls more frequently mentioned their faces and its features, while boys tended to talk more about their physical functioning.

Conclusion

This qualitative study provide further insight into the physical components of body image as perceived by Iranian boys and girls. Current findings indicated that besides those features that focused on body appearance and its aesthetic aspects, physical functioning was another main component of perceived body image by participants. These findings can contribute to the design and implementation of effective interventions aiming at improving body image and its related disorders in Iranian adolescents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-10096-7.

Estimated prevalence of eating disorders in Singapore

OBJECTIVE

There is a lack of research on the prevalence of eating disorders (EDs) in Singapore. The aims of our study were to (a) estimate the prevalence of EDs, risk status, and help-seeking behaviors among adults in Singapore, (b) examine gender differences between ED status groups, and (c) characterize clinical profiles of ED status groups.

METHOD

We administered a cross-sectional survey that included a validated EDs screening tool to adults in Singapore.

RESULTS

A total of 797 Singaporean adults ages 21-77 years completed the ED screen. The majority of participants screened positive for a current DSM-5 clinical ED (6.2%), other specified feeding or ED (37.0%) or at high risk of developing an ED (19.5%). Only 1.6% of those who screened positive for an ED reported currently being in treatment. The ratio of males to females who screened positive for an ED was nearly 1:1. The clinical profiles of ED groups were consistent with the clinical presentations found in Western nations.

DISCUSSION

This is the first study in Singapore to estimate the prevalence of EDs in a large sample of adults. Results highlight the urgent need for more ED research and expansion of prevention and treatment programs to address the high prevalence of ED psychopathology in Singapore.

Dimensions of national culture associated with different trajectories of male and female mean body mass index in countries over 25 years

Cultural determinants of obesity prevalence have been little studied but could explain significant variations in body mass index (BMI) trajectories among countries. This ecological study quantified longitudinal associations between six dimensions of national culture and mean population BMI over 25 years. National mean male and female BMI data 1990 to 2014 provided dependent variables. National dimensions of culture (from the Hofstede database for up to 87 countries) were independent variables: Individualism, Uncertainty avoidance, Indulgence, Long-term orientation, Power distance, and Masculinity. Analyses used mixed models for repeated measures for each dimension of national culture with male and female adult BMI trajectories, controlling for confounders. A higher mean BMI was significantly associated with higher Individualism, Uncertainty avoidance, Indulgence, and Masculine orientation and with lower Power distance (males only) and lower Long-term orientation (males only). Overall, the national cultural dimensions explained 62.4% (males) and 53.5% (females) of the variance in mean BMI among countries. National cultural characteristics, especially Individualism and Uncertainty avoidance, are strongly related to obesity prevalence, explaining over half of the variance among countries. More research and theory development is needed to understand the pathways for these associations so that cultural contexts can be better accounted for in policies, social marketing messages, and community-based actions for obesity prevention.

An exploration of the psychometric properties of the SATAQ-4 among adolescent boys in Japan

Research among Western adult and adolescent males suggests that sociocultural influences are implicated in the drive for muscularity and weight-change behaviors. However, few studies have examined these relationships among adolescent boys from non-Western backgrounds. The current study sought to assess the psychometric properties of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4), a 22-item, 5-factor measure of sociocultural influence on appearance ideals, among Japanese (n = 984) adolescent boys. Relationships between appearance-related pressures, appearance ideal internalization, appearance-related teasing, drive for muscularity, and weight-change behaviors were also assessed. Exploratory and confirmatory factor analyses identified a four factor solution (Internalization: Thin/Low Body Fat, Internalization: Muscular/Athletic, Pressures: Media, and Pressures: Family/Peers) with 16 items in this sample. Correlational analyses supported the construct validity of the SATAQ-4. Thin internalization was associated with strategies to lose weight, while muscular internalization was associated with drive for muscularity and strategies to gain weight. Further, peer and parental appearance teasing was associated with perceived appearance pressures from family and peers, as well as weight change strategies. Overall, results suggested modification of the SATAQ-4 when used with Japanese samples, but supported its use to assess sociocultural influences. Additionally, the results highlight that sociocultural influences and muscularity concerns among Japanese adolescent boys are associated in similar ways with weight change strategies as has been established for adolescent males in Western countries.

Neural correlates of body comparison and weight estimation in weight-recovered anorexia nervosa: a functional magnetic resonance imaging study

Background

The neural mechanisms underlying body dissatisfaction and emotional problems evoked by social comparisons in patients with anorexia nervosa (AN) are currently unclear. Here, we elucidate patterns of brain activation among recovered patients with AN (recAN) during body comparison and weight estimation with functional magnetic resonance imaging (fMRI).

Methods

We used fMRI to examine 12 patients with recAN and 13 healthy controls while they performed body comparison and weight estimation tasks with images of underweight, healthy weight, and overweight female bodies. In the body comparison task, participants rated their anxiety levels while comparing their own body with the presented image. In the weight estimation task, participants estimated the weight of the body in the presented image. We used between-group region of interest (ROI) analyses of the blood oxygen level dependent (BOLD) signal to analyze differences in brain activation patterns between the groups. In addition, to investigate activation outside predetermined ROIs, we performed an exploratory whole-brain analysis to identify group differences.

Results

We found that, compared to healthy controls, patients with recAN exhibited significantly greater activation in the pregenual anterior cingulate cortex (pgACC) when comparing their own bodies with images of underweight female bodies. In addition, we found that, compared with healthy controls, patients with recAN exhibited significantly smaller activation in the middle temporal gyrus corresponding to the extrastriate body area (EBA) when comparing their own bodies, irrespective of weight, during self-other comparisons of body shape.

Conclusions

Our findings from a group of patients with recAN suggest that the pathology of AN may lie in an inability to regulate negative affect in response to body images via pgACC activation during body comparisons. The findings also suggest that altered body image processing in the brain persists even after recovery from AN.

Electronic supplementary material

The online version of this article (10.1186/s13030-018-0134-z) contains supplementary material, which is available to authorized users.