Background Poor body image is prevalent among adolescents and associated with several negative outcomes for their physical and psychological health. There is a pressing need to address this growing public health concern, yet there are few evidence-informed universal programmes for older adolescents that address contemporary body image concerns (i.e., social media). BodyKind is a four lesson, school-based, teacher led, universal body image programme that incorporates empirically supported principles of cognitive dissonance, self-compassion, compassion for others and social activism, to support positive body image development. Building on previous pilot trials in the USA, this paper outlines the protocol for a cluster randomised control trial (cRCT) and implementation evaluation of the BodyKind programme which was culturally adapted for the Irish cultural context. Methods We aim to recruit 600 students aged 15-17 years in Transition Year (4th year) across 26 second-level schools in Ireland. Using minimisation, schools will be randomly assigned to receive BodyKind (intervention condition, n=300) or classes as usual (waitlist control, n=300). Teachers in intervention groups will receive training and deliver the programme to students over four weeks, at a rate of one lesson per week. Primary outcomes of body appreciation, body dissatisfaction and psychological wellbeing and secondary outcomes of self-compassion, compassion for others, body ideal internalisation, social justice motives and appearance-based social media use will be assessed at pre-, post- and 2 month follow up. Mediation and moderation analyses will be conducted to identify how and for whom the intervention works best. An implementation evaluation will assess the quality of programme implementation across schools and how this may influence intervention outcomes. Waitlist control schools will receive the programme after the 2-month follow up. Conclusion This study will be the first to implement a cRCT and an implementation evaluation to assess the impact of this multicomponent school-based body image programme designed to support healthy body image development. If shown to be effective, BodyKind will have the potential to improve adolescent body image and wellbeing and inform efforts to implement sustainable and scalable programmes in schools. Trial registration The trial was retrospectively registered on 10/10/2023 on ClinicalTrials.gov NCT06076993.

Body dissatisfaction is prevalent among adolescents and a primary risk factor for eating disorders, yet there are few body image interventions for older adolescents that support development of positive body image. Therefore, we assessed the feasibility, acceptability and preliminary effectiveness of BodyKind, a four-lesson, mixed gender, teacher-led, school-based curriculum for older adolescents, that combines principles of self-compassion, compassion for others, cognitive dissonance, and social activism to address contemporary adolescent body image concerns (i.e., appearance bias, comparisons on social media) and strengthen positive body image development. The sample contained 147 adolescents, predominantly racial/ethnic minorities (>95%), 54.8% male, 41.5% female and 4.1% gender-minority students aged 15-18 years (M=16.24, SD=.96) from a low-income, inner-city high school in the Midwestern US. Two teachers received training and delivered the curriculum to students. This single arm, mixed methods trial assessed student and teacher acceptability, teacher fidelity and student intervention outcomes. Despite reasonable teacher fidelity, recruitment/attendance rates, post-intervention data loss (35% attrition) limited evaluations of program effectiveness and study feasibility. Important learnings regarding study feasibility will inform optimisation for future school-based trials. Findings demonstrate high acceptability of BodyKind among teachers and adolescents in a lower socioeconomic school setting, and further randomized controlled effectiveness trials are required.

The COVID-19 pandemic provided a context associated with negative consequences for body image and eating behavior. However, little is known about what factors helped to mitigate these consequences and build a positive body image. Previous research pointed to the significance of body image flexibility and perceived body acceptance by others in predicting body appreciation. However, as most of the studies have been cross-sectional, causal relationships are poorly understood. This longitudinal study tested the reciprocal association between body appreciation, body image flexibility, and perceived body acceptance by others during the COVID-19 pandemic in Germany. We analyzed data from a large community sample consisting of 1436 women and 704 men who were invited to complete the study measures (BAS-2, BI-AAQ-5, BAOS-2) at three time points, each approximately six months apart. Latent cross-lagged panel analyses revealed that greater T1 body appreciation predicted an increase in T2 body image flexibility among both genders, while for women, we additionally observed reciprocal effects between T2 and T3. Among both genders, we further found that greater body appreciation predicted increased perceived body acceptance by others over both measurement intervals (but not vice versa). Our findings are discussed in light of pandemical constraints during the studies' assessments.

Recently, the accruing scientific evidence base confirms the benefits of the ancient healing practice of yoga for reducing disordered eating and body image disturbance. Simultaneously, emerging population-based scholarship has revealed that yoga practitioners are particularly vulnerable to engaging in disordered eating behaviors including endorsing problematic levels of orthorexia symptoms (OS). Although orthorexia tends to be characterized by a hypervigilance over consuming “healthy” or “clean” foods based on quality attributes, it’s associations with variables related to broader diet culture [e.g., internalized weight bias (IWB) and body-related shame, guilt, and hubristic pride] remain under examined. Additionally, previous research has yet to explore the psychological correlates of OS specifically among yoga professionals who are uniquely positioned to influence their students’ and clients’ orientations towards eating and embodied well-being. Therefore, the current study investigated the relationships among IWB, body and fitness-related self-conscious emotions (BFSCE), role-modeling positive body image (RMPBI), and OS in a diverse sample of 406 female yoga professionals living in the US and Canada (37% racial/ethnic minority, 13% sexual minority). We also examined whether the hypothesized link between IWB and OS was in part explained by BFSCE and RMPBI. Nearly 40% of participants reported an exclusively vegetarian or vegan diet and 25% identified as engaging in “clean eating.” Positive associations were observed between IWB and OS (r =.36, p<.001), shame (r =.68, p <.001), and guilt (r =.62, p <.001). Inverse associations were observed between IWB and RMPBI (r =-.11, p<.05) and authentic pride (r = -.13, p<.01). Whereas, OS were positively linked to all forms of BFSCE (ps <.001) and to RMPBI (r=.12, p <.05). Further, the indirect effect of IWB on OS via shame was significant (B = .16; 95% CI: .07, .26). The indirect effect via RMPBI was non-significant. Findings contribute to the nascent body of scholarship recognizing that OS is linked to aspects of harmful diet culture among yoga professionals which may reflect how they: 1) regulate internal body- and fitness-related shame stemming from IWB and 2) overtly model “positive” body image for at-risk students and clients. Results call for increased collaboration and outreach efforts to bring awareness to and effectively target addressing these public health concerns within the broader yoga community.