No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Women and weight: A normative discontent.
Abstract
Suggests that cultural norms and female sex-role stereotypes and attitudes provide a context for understanding women's preoccupation with thinness and their pursuit of beauty. In this society, obesity is a strongly stigmatized condition and is met with punishment (psychological, social, and economic). In examining biological aspects of weight reduction, it is suggested that the contemporary beauty ideal of "thinness equals attractiveness" prescribes a body weight that is unrealistically low due to developmental milestones that tend to increase fat (e.g., puberty, pregnancy, menopause) and women's metabolic systems. It is argued that women's preoccupation with their appearance comes out of shame and social pressure and leads to psychological consequences such as decreased self-esteem, distorted body image, and feelings of helplessness and frustration in response to unsuccessful dieting efforts. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Body image is a multi-faceted psychological experience incorporating perceptions, thoughts, feelings, and behaviours related to one's body (Cash, 2004). Body dissatisfaction has long been considered a 'normative discontent' (Rodin et al., 1984) and is observed in children, adolescents, and adults across the lifespan (Kilpela et al., 2015;Martini et al., 2022;Mellor et al., 2010;Swami et al., 2010). Body dissatisfaction is correlated with depression, poorer quality of life, disordered eating, lower self-esteem, and problematic health behaviours such as smoking and poorer engagement in physical exercise (Kilpela et al., 2015;Mellor et al., 2010;Mond et al., 2013). ...
The aim of this study was to provide a definition for body neutrality and understand the key strategies recommended to improve body neutrality for testing in future interventions. There is minimal academic literature on body neutrality and thus this study focused on examining websites where the concept has been discussed for some time. This was achieved using a realist synthesis of websites and a common elements approach to extract the key definition elements of body neutrality, strategies to improve body neutrality, in addition to the common critiques of both the body positivity and body neutrality movements. The initial search found 175 websites, of which 107 were included in the final synthesis, and common elements analysis followed after removal of duplicates and ineligible websites. Three elements, with several sub-elements, best operationalised the definition of body neutrality. Six strategies were found for development of a body neutrality intervention. This innovative study paves the way for rigorous evaluation of body neutrality. Recommendations for future work are provided, including the use of current measures, creating a new measure, and evaluating prevention and intervention programs including Single Session Interventions (SSIs).
... The "walking the middle path" skill taught in dialectical behavioural therapy (DBT; Linehan, 2014) could be introduced to encourage a balance of self-acceptance with the desire for self-improvement. Given the prevalence of "normative body discontent" (Rodin et al., 1984), prevention programs could nonjudgmentally acknowledge the common desire of women to diet for both body image and health purposes. If many young women are going to take a "careful but moderate approach to healthy eating" (Cairns & Johnston, 2015) and some are going to engage in pathological food restriction, perhaps prevention programs could engage those in the former camp to reflect on what cues would indicate they had "tipped the scales" from careful monitoring for health to extreme dietary restriction for body image. ...
With the popularity of image-based social media platforms like Instagram, researchers have begun to study relationships between social media and body image. Much of this research has used quantitative research methods, which cannot capture the rich, inner experiences of individuals. Given the dearth of qualitative research on what young women internally experience when viewing "Thinspiration" or "Fitspiration," this study used the consensual qualitative research (CQR) method, with the aim of capturing in their own words what young women feel and think in response to viewing fitspiration and thinspiration. Twelve young women viewed Fitspiration and Thinspiration profiles and were interviewed about these and similar everyday experiences. The CQR analytic team identified 10 general, 18 typical, and 11 variant domains (i.e., topic areas). An example general domain was "body image," under which the category "body dissatisfaction," fell; by viewing Thinspiration or Fitspiration, these young women were reminded how they are dissatisfied with how they see their own body or were prompted to believe others are reminded of this when viewing such content. An example typical domain was "diet/disordered eating"; several participants associated Thinspiration or Fitspiration with diet or disordered eating. From five of the 10 general domains emerged what we call an emergent dialectical theory of social media and body image. When viewing Thinspiration or Fitspiration, young women often seemed to feel or think two seemingly opposite things simultaneously within the topic areas of attainability, emotional reactions, social comparison, body image, and health.
... El fenómeno de la estigmatización social de los cuerpos gordos ha recibido abundante atención desde las ciencias sociales y su existencia ha sido ampliamente demostrada (Garner et al., 1980;DeJong, 1980;Allon, 1982;Rodin et al., 1984;Sobal y Stunkard, 1989;Rothblum, 1992;Carr y Friedman, 2005;Puhl y Heuer, 2009;Olea Herrera, 2019). El rechazo a la gordura, de hecho, suele ser expresado con total impunidad (Goode y Preissler, 1983: 199) y de forma explícita (Crandall, 1994: 890), incluso en los medios de comunicación de masas (Puhl y Heuer, 2009: 951;Reyes, 2018). ...
Este trabajo ofrece una descripción y análisis de manifestaciones concretas del activismo gordo crítico en cuentas de Instagram de España y Latinoamérica. Para contextualizar el tema, definimos los principales conceptos del activismo gordo, describimos las formas de opresión que sufre el colectivo y revisamos la relación, no exenta de fricciones, entre feminismo y activismo gordo. Sigue el estudio de calas concretas en cuentas y publicaciones recientes de Instagram que reflejan los puntos de debate esenciales hoy en el movimiento: la lucha contra la invisibilización de la gordura, el empoderamiento del sujeto gordo mediante la apropiación de los insultos "gorda", "gordo" y "gorde", la expresión pública de la herida mediante la confesión personal y, en definitiva, la politización del concepto.
... Body image dissatisfaction often contributes to ED symptoms [31,32]. Since body dissatisfaction, is a widespread phenomenon, which was also called "normative discontent" [33], some authors have started to stress the importance for individuals to develop the ability to adjust the negative feelings about their body and not let them affect their life and well-being by applying body image flexibility [34,35]. Some studies have reported that lower BII (i.e., greater ability to cope with negative appearance-related thoughts and emotions) was associated with better treatment outcomes in interventions dealing with ED [36,37]. ...
1) Background: The common factors which potentially contribute to the development of eating disorders and exercise dependence during early adulthood are still relatively unclear. The present study aimed to examine the role of BMI, body image inflexibility, and generalized anxiety in these two behavioral problems in a sample of college students. 2) Methods: In total, 878 habitual exercisers (58.1% male with BMI = 22.12 ± 2.39; 41.9% female with BMI = 20.55 ± 2.21) with age of 20.09 ± 1.76 years participated in this study. The main outcomes of interest are exercise dependence symptoms, eating disorders symptoms, body image inflexibility, and symptoms of generalized anxiety (as measured by Exercise Dependence Scale-Revised, Eating Disorder Examination-Questionnaire-Short Form, Body Image Acceptance and Action Questionnaire, and Generalized Anxiety Disorder-7, respectively). Pearson correlation, path analysis, and model fit information were tested. 3) Results: After controlling for age, gender, and field of study, lower BMI was linked to more exercise dependence symptoms but this association was not statistically significant, while a greater BMI was significantly associated with a higher risk of developing eating disorders (β = −0.08, p < 0.001). Moreover, higher body image inflexibility significantly and positively contributed to severe exercise dependence (β = 0.26, p < 0.001) as well as abnormal eating attitudes and behaviors (β = 0.74, p < 0.001). Furthermore, generalized anxiety is a significant contributor to exercise dependence symptoms (β = 0.14, p < 0.001) but not eating disorders symptoms. 4) Conclusion: Based on our finding that body image inflexibility is a common risk factor for the development of exercise dependence and eating disorders, the prevention and treatment of these two disorders should involve the improvement of psychological flexibility. In addition, the individual with a higher BMI is more vulnerable to developing eating disorders, while those who have severer generalized anxiety symptoms should be given more attention when screening for exercise dependence.
... Nonetheless, greater discrepancy with high body esteem characters resulted in lower state body image, in line with research examining social comparisons and relevant self-concepts (Knobloch-Westerwick et al., 2020). Body image scholarship indicates women traditionally are conditioned to express normative discontent with their bodies (Rodin et al., 1984); however, these results shed light on the increasing pressures to espouse favorable views toward one's body and its possible inadvertent damaging effects on others. ...
Through two experiments (N = 497), we documented how distinct portrayals of women in stories can impact readers’ engagement in social comparisons and influence important aspects of their self-concepts. Specifically, this research investigated the effects of character body size (thin vs. large), body esteem (low vs. high), and story ending valence (sad vs. happy) with two distinct storylines. Results indicated that high (vs. low) body esteem characters are not only rated more aspirational, but also led readers with greater self-discrepancy to report lower state body image, suggesting upward social comparison processes are at play. Further, results indicated that reading about characters with large (vs. thin) bodies can positively affect readers’ body image; however, this positive effect may be explained by downward social comparison. Findings highlight the complexities of body appearance and confidence. Strategies for effectively promoting body positivity via text-based interventions are discussed.
... Women's dissatisfaction with their bodies is also expressed as persisted across the life span [7]. Accordingly, body dissatisfaction is labeled a 'normative discontent among women, particularly in Western society [8]. The consequences of body dissatisfaction are linked with many negative results, starting from unnecessary control of weight in normal and underweight [9], poor self-esteem that increases anxiety and depression [10], to the extent of clinical conditions, such as eating disorders [1] and body dysmorphic disorder [11]. ...
... Dissatisfaction related to looks is more common among females (Rozin & Fallon, 1988). Due to these facts physical appearance, body image and eating disorders and their association with psychological health and performance was discussed as female specific concern (Rodin et al, 1985;. ...
The aim of this study was to find out the gender difference with reference to sociocultural attitude towards appearance among young adults. The sample consisted of 253 males and 256 female students of Karachi University with age range 18-24 years. Urdu translated version of Sociocultural Attitudes towards Appearance-4 (Thompson et al, 2015) scale was used to explore the gender difference in social and cultural aspect for ideal appearance. SATAQ-4 consist of five subscales two internal (thin/low body fat and muscular/ athlete) and three external (pressure peer, pressure family and pressure media). Males significantly scored higher on Internalization- Muscular/ Athletic and on all three subscales of external pressure (peer, family and media) as compared to female participants. The results of this study reveal that in our society, males are more conscious about their appearance and feel more pressure from external world through various means to retain their physique and fulfill social criteria of attractiveness. Although the female participants also facing internal pressures to have thin body having low fats to meet criteria of beauty as they scored higher on internalization - Thin / Low Body Fat subscale but the finding was insignificant. Keywords: Gender, appearance, SATAQ-4, Pakistan, young adults
Background/Objectives: Appearance-related social media, such as “thinspiration” and “fitspiration” posts, have been shown to contribute to poor body image and disordered eating. Food-related social media is becoming increasingly popular; however, far less is known about its relationship to body image and disordered eating. Methods: The current review searched PsycNet and PubMed (Medline) for all the literature examining food-related social media and its relationship with body image and/or disordered eating outcomes. Results: From 796 initial hits, the search identified 16 relevant studies. The study designs and types of media examined varied widely, including mukbang videos, food blogs, and “What I Eat In A Day” videos. Findings on the relationship between food-related social media and outcome variables were quite mixed, perhaps speaking to the wide variety of media included in the review. Conclusions: The existing literature is sparce, but overall, it suggests a potential relationship between food-related social media, negative body image, and disordered eating. Additional experimental research is needed to clarify outcomes for different media types (e.g., food blogs versus mukbang videos) and to determine the direction of causality for each.
Body image is an important aspect of psychological well-being that is influenced by several biological and psychosocial risk factors. Cultural determinants of body image include the patterns of shared beliefs, values, practices, and social norms within a group that can act as a lens through which a person perceives, compares, and evaluates their body. Women tend to experience higher rates of body dissatisfaction than men, with reproductive milestones such as puberty, pregnancy, and postpartum being windows of vulnerability for body image concerns. The menopausal transition is another reproductive stage of women's lives that involves major physical changes, psychological challenges, and social pressures that can impact body image negatively. However, the literature on the influence of cultural determinants on the body image of menopausal women is limited. Therefore, this perspective review paper aims to discuss the potential role of cultural determinants in influencing body image satisfaction in women undergoing the menopausal transition. To this end, the relationships between different cultural perspectives and body image around the world are first discussed. Sociocultural influences on body image throughout women's lifespan and reproductive stages are then presented. Finally, cultural perspectives on menopause and aging and their potential influence on the body image of menopausal women are explored. This paper underscores the importance of considering culture and sociocultural factors when studying body image and highlights the need for further research on the cultural determinants of body image during the menopausal transition.
Background/Objectives: Body dissatisfaction among women has been on the rise, prompting an urgent need to understand the underlying factors influencing their body image. This study explores the perceptions and influencing factors of body image among women in Greek society. Methods: Six in-depth interviews were conducted and analyzed using Interpretative Phenomenological Analysis. Results: The findings reveal that negative comments from parents and romantic partners, pregnancy, and peer influences are key factors affecting women's perceptions about their body. Body dissatisfaction was primarily driven by social media and a desire to feel attractive to the opposite gender, leading to extreme behaviors such as excessive exercise, low-calorie intake, and surgical procedures. The aspiration to undergo cosmetic surgeries was significantly influenced by social media portrayals of beauty. On the one hand, the ideal physique for women was characterized by curves and toned muscles, but on the other hand, women described the ideal self as being reconciled with their bodies and less self-critical. Conclusions: This study highlights the complex interplay of personal relationships and societal pressures in shaping women's body image and underscores the need for more qualitative research in this area. Understanding these dynamics is crucial for developing interventions to mitigate the negative physical and mental health repercussions associated with body dissatisfaction .
Disordered eating (DE) is associated with elevated cardiometabolic risk (CMR) factors, yet little is known about this association in non-Western countries. We examined the association between DE characteristics and CMR and tested the potential mediating role of BMI. This cross-sectional study included 2005 Chinese women (aged 18–50 years) from the 2015 China Health and Nutrition Survey. Loss of control, restraint, shape concern and weight concern were assessed using selected questions from the SCOFF questionnaire and the Eating Disorder Examination-Questionnaire. Eight CMR were measured by trained staff. Generalised linear models examined associations between DE characteristics with CMR accounting for dependencies between individuals in the same household. We tested whether BMI potentially mediated significant associations using structural equation modelling. Shape concern was associated with systolic blood pressure ( β (95 % CI) 0·06 (0·01, 0·10)), diastolic blood pressure (DBP) (0·07 (95 % CI 0·03, 0·11)) and high-density lipoprotein (HDL)-cholesterol (–0·08 (95 % CI –0·12, −0·04)). Weight concern was associated with DBP (0·06 (95 % CI 0·02, 0·10)), triglyceride (0·06 (95 % CI 0·02, 0·10)) and HDL-cholesterol (–0·10 (95 % CI –0·14, −0·07)). Higher scores on DE characteristics were associated with higher BMI, and higher BMI was further associated with lower HDL-cholesterol and higher other CMR. In summary, we observed significant associations between shape and weight concerns with some CMR in Chinese women, and these associations were potentially partially mediated by BMI. Our findings suggest that prevention and intervention strategies focusing on addressing DE could potentially help reduce the burden of CMR in China, possibly through controlling BMI.
Background
Avoidant Restrictive Food Intake Disorder (ARFID) is a newly classified eating disorder that requires further understanding of its presentation. There is no previous report of ARFID in a child post-tonsillectomy. ARFID may be a potential negative outcome for children following oropharyngeal surgery.
Case presentation
A female child aged 10 years and 2 months presented with ARFID associated with depression, anxiety and nutritional deficiency following tonsillectomy. She had more difficulty in swallowing solids than fluids and had repeated vomiting and spitting food after chewing it. She became dehydrated and malnourished with a BMI of 10.5 and was misdiagnosed with myasthenic gravis.
Conclusions
To our knowledge, this is the first case report of ARFID in a child post-tonsillectomy. We discuss the pathophysiology of ARFID, which remains elusive, and recommend psychiatric assessment when evaluating children post operative tonsillectomy.
This quantitative study explores the rich tapestry of early childhood interactions and their substantial impact on a number of adult well-being variables. Using a broad sample size, the study seeks to identify the intricate relationships between early experiences and adult sexual satisfaction, body image, self-esteem, and positive and negative affect. The study uses a quantitative methodology, gathering data from a sizable and varied cohort with the use of surveys and standardised instruments. Early childhood connections are seen as a complex construct that includes impacts from peers, families, and society at large. The study looks for patterns and links between these variables using statistical analyses and correlation models. The findings of this research could make a substantial contribution to the domains of sociology, psychology, and human development by illuminating the long-term effects of early connections.
Introduction
This research aimed to examine predictors of discrepancies between actual and ideal body images, specifically body fat and muscularity discrepancies, in kinesiology students.
Methods
Volunteer participants (N = 174, men = 112, women = 62) filled out the sex-specific Somatomorphic Matrices (NSM-M and SM-F) as well as The Positive and Negative Perfectionism Scale (PNPS), Rosenberg Self-esteem Scale (RSE), and the Eating Attitudes Test (EAT-26) using paper and pencil tools.
Results
The median and Mann–Whitney U tests were used to determine sex differences, and regression analyses were used to determine the contribution of sex, perfectionism, self-esteem, and eating attitudes in explaining the variances in body fat and muscularity dissatisfaction. The results showed no sex differences in body fat discrepancy, while men showed more discrepancy between actual and ideal muscularity than women. In regression analyses, sex was the only significant predictor of muscularity discrepancy, while disordered eating attitudes were a positive, and positive perfectionism was a negative predictor of body fat discrepancy.
Discussion
This study showed that while muscularity dissatisfaction is linked to the male sex, body fat dissatisfaction is not related to sex but to psychological variables of disordered eating attitudes and positive perfectionism in a population of youths that may be above average when it comes to physical activity.
Cultural stereotypes might help explain why smoking is less prevalent among Hispanic than non-Hispanic White women, whereas obesity is more prevalent. Hispanic (n = 130) and non-Hispanic White (n = 114) women rated their thoughts and feelings regarding a female smoker and an overweight woman. Ethnicity did not influence evaluations, but attitudes toward smokers were more positive among more acculturated Hispanic women, F(1, 66) = 9.9, p < .01. Less acculturated women evaluated an overweight woman more positively than a smoker, F(1, 28) = 5.65, p < .05; more acculturated women did the opposite, F(1, 36) = 5.92, p < .05. Smokers evaluated smokers more positively than overweight women, F(1, 86) = 40.8, p < .01; nonsmokers did the opposite, F(1, 138) = 7.7, p < .01. Personal body weight did not influence evaluations. Acculturation and smoking status appear to have a greater influence than ethnicity or weight status on women's attitudes toward smoking and weight.
The fear of fat, or fear of gaining weight, is conceptually related to both weight stigma and eating disorders. Since sociocultural pressures related to the thin ideal are important to examine within sociocultural models of body image, the Sociocultural Influences on Fear of Fat (SI-FAT) was created and validated on a sample of predominantly White college women. The purpose of this study was to examine the factor structure of the SI-FAT in a sample of racially and ethnically diverse college women, given potential differences in experiences of fear of fat and the need to measure sociocultural pressures related to fear of fat in multiple groups. A sample of college women (72.8% Hispanic/Latina, 14.85% Black, and 12.35% White) completed the SI-FAT as well as measures of weight stigma and body image. Results suggested that the factor structure of the SI-FAT were consistent across racial and ethnic groups. These findings indicate that the SI-FAT is appropriate for use among racially and ethnically diverse samples of young women. Directions for future research, including examining differences between sociocultural pressures related to weight gain and self-reported fear of fat are discussed.
The U.S. Body Project I examined predictors and prevalence of body image concerns among 11,620 adults recruited via Mechanical Turk. Researchers were invited to propose hypotheses or conduct secondary data analysis on the anonymized dataset. This resulted in 11 papers for this special issue. The first four papers examined the demographic predictors and prevalence of (1) body satisfaction, (2) objectification and tripartite model constructs, (3) sexuality-related body image concerns, and (4) face image satisfaction. The next four papers tested different structural equation models linking objectification and tripartite constructs to outcomes among women (5) and men (6) varying in body mass, and across racial (7) and sexual orientation (8) groups. We then tested measurement invariance of the scales (9) and introduced an abbreviated measure (10), and applied machine learning to examine associations among variables (11). Here we reflect on our personal and academic journeys leading to this project, and lessons learned.
This project aimed to establish whether meaningful body image profiles (BIPs) could be identified across measures of body shame, body appreciation, and body mass index (BMI), and whether these profiles could differentiate key health behaviours. Data came from 1200 adult women who responded to an online body image survey. Latent profile analysis was used to identify BIPs based on relative levels of body shame, body appreciation and BMI. Differences in dietary restraint and weekly exercise amount were investigated according to BIP membership. Latent profile analysis revealed four unique BIPs; 1. Appreciative BIP (AP-BIP); 2. Medium Shame BIP (MS-BIP); 3. High Shame BIP (HS-BIP) and 4. Average BIP (AV-BIP). Dietary restraint and exercise amount differed significantly according to BIP in most comparisons. Women in the High Shame BIP exhibited the highest dietary restraint and lowest exercise. Women in the Appreciative BIP exhibited the lowest dietary restraint and highest exercise. Body shame and body appreciation intersect with BMI to form unique profiles (BIPs) that differentiate dietary restraint and exercise. Using BIPs to tailor interventions designed to promote healthful diet and exercise should be considered in public health initiatives.
Negative attitudes towards one’s own body are common among women and are linked to adverse consequences including negative affect, low self-esteem, and eating pathology. Self-compassion has been found effective in improving body image; however, few published studies have examined self-compassion in populations with higher BMIs despite the positive correlation between weight and body dissatisfaction. The current study examined the efficacy of a self-compassion letter-writing exercise versus two active control groups in response to a negative body image induction. The sample of college-aged females (M age = 20.91 years; SD = 5.47) was split between higher and lower BMI to determine whether self-compassion affects body image, affect, and self-esteem differently across weight groups. Weight bias internalization (WBI: i.e., internalization of society’s negative stigma against those with higher BMIs) was examined as a moderator of this relationship in the higher BMI group. Results suggest that letter writing improved body image regardless of condition (p < 0.001). The self-compassion exercise promoted more adaptive body image (p = 0.007) and self-compassion (p = 0.013) than one control condition for those with high WBI. Results suggest that self-compassion can be helpful in ameliorating negative body image for females of all sizes, and that levels of WBI may alter the effect of body image interventions.
This meta-analysis synthesized longitudinal data on mean-level change in body image, focusing on the constructs of body satisfaction and dissatisfaction, body esteem, perceived attractiveness, valuation, self-objectification, and body shame. We searched five databases and accessed unpublished data to identify studies that assessed body image at two or more time points over six months or longer. Analyses were based on data from 142 samples representing a total of 128,254 participants. The age associated with the midpoint of measurement intervals ranged from 6 to 54 years. Multilevel metaregression models examined standardized yearly mean change, and the potential moderators of body image construct, gender, birth cohort, attrition rate, age, and time lag. Boys and men showed fluctuations in overall body image with net-improvements between ages 10 and 24. Girls and women showed worsening body image between ages 10 and 16, but improvements between ages 16 and 24. Change was greatest between ages 10 and 14, and stabilized around age 24. We found no effect of construct, birth cohort, or attrition rate. Results suggest a need to revise understandings of normative body image development: sensitive periods may occur somewhat earlier than previously believed, and body image may show mean-level improvements during certain age ranges.
Sobre cómo envejecemos las mujeres
Body dissatisfaction is defined as the negative subjective evaluation of one’s body and is considered a risk factor for, and symptom of, eating disorders. Some studies show women with high body dissatisfaction display an attentional bias towards low weight bodies; however, this finding is not consistent, and results are yet to be systematically synthesised. We conducted a qualitative and quantitative synthesis of cross-sectional studies investigating the relationship between body dissatisfaction and attentional bias to low weight bodies in non-clinical samples of women. We searched PubMed, Scopus, Web of Science, PsycINFO, ProQuest, and OpenGrey for studies up until September 2022. We identified 34 eligible studies involving a total of 2857 women. A meta-analysis of 26 studies (75 effects) found some evidence from gaze tracking studies for a positive association between body dissatisfaction and attentional bias to low weight bodies. We found no evidence for an association from studies measuring attention using the dot probe task, electroencephalogram (EEG) recording, or the modified spatial cueing task. The results together provide partial support for the positive association between body dissatisfaction and attentional bias to low weight bodies in women. These findings can be used to inform future attentional bias research.
Body image is an integral aspect of the psychology of the self. Idealized body images are ubiquitous in both traditional media forms (e.g., magazines, television) and social media (e.g., Facebook, Instagram). The classic sociocultural model of body image (i.e., the Tripartite Influence Model) emphasizes pathways between idealized body norms, appearance comparisons, internalization of body ideals, and body dissatisfaction and its outcomes. We summarize the model and identify some issues to be addressed in future work, particularly in light of the immense popularity of social media. We review three topics that are not included in the sociocultural model but that provide a more complete picture of the influence of societal body norms on body image: (1) body shame, (2) positive body image, and (3) self-compassion. Research on the nature, assessment, and relevance of these constructs is reviewed in detail. In terms of clinical applications of these areas of research for individuals at risk of body dissatisfaction, we suggest assessing for and targeting body shame, cultivating facets of positive body image, and teaching strategies for developing self-compassion.
Qualitative studies have shown that people with endometriosis report feeling discontent with their bodies relating to the visual and functional effects of the disease. However, few studies exist which compare people with endometriosis to those without, leaving it largely unknown as to whether this discontentment differs from that regularly experienced by women. The current study therefore aimed to 1) quantitatively assess body image, namely appearance satisfaction and functionality appreciation, in people with and without endometriosis, and 2) explore the relationship between endometriosis-related pelvic pain and body image. Australians aged 18 and over were recruited for two groups: those with endometriosis (n = 312, 99 % female, Mage = 30.78, SDage = 7.40) and a control group without suspected or diagnosed endometriosis (n = 74, 100 % female, Mage = 32.38, SDage = 8.84). Participants completed an online survey consisting of measures of appearance satisfaction, functionality appreciation, and pelvic-pain impact. The endometriosis group demonstrated significantly poorer body image when compared to the control group, and endometriosis-related pelvic pain was shown to negatively correlate with body image. These findings demonstrate the likely negative effects endometriosis and pelvic pain have on body image and provide much needed insight to help develop interventions tailored to endometriosis.
Body dissatisfaction is a common condition that poses health behavior risks, such as the use of maladaptive eating styles instead of adaptive eating styles. Few studies have simultaneously examined both adaptive and maladaptive eating styles and their association with body dissatisfaction in a comprehensive manner. To address this gap, this study examined how body dissatisfaction is related to an array of adaptive and maladaptive eating styles, weight-related behaviors, and health status as well as the associations of health status, BMI, and weight-related behaviors with body dissatisfaction in 261 young adult women. Maladaptive eating styles, such as emotional eating, tended to rise in tandem with body dissatisfaction, differing significantly among body-dissatisfaction levels with medium to large effect sizes. For adaptive eating styles, as body dissatisfaction increased, compensatory restraint increased, intuitive eating declined, and mindful eating did not differ. Weight-related dietary, physical activity, and sleep behaviors did not differ by body dissatisfaction level. BMI increased and health status decreased as body dissatisfaction increased. Binary logistic regression revealed those who were body-dissatisfied had significantly lower health status, higher BMIs, and did not differ on weight-related behaviors. Study findings suggest strategies to improve health-promotion interventions aiming to increase body satisfaction.
Discontent with one’s appearance (body image dissatisfaction) has become a global phenomenon, associated with the development of extreme behaviours in order to correct perceived body image problems. Much of the literature has focused on associated destructive behaviours that result from body image dissatisfaction; however, there has been a dearth of research examining risk factors for body image problems in adults. Thus, the current study aimed to investigate risk factors associated with adult body image problems, focusing on two variables highlighted in the literature (gender and maladaptive perfectionism). The current study (1) compared gender differences in body image dissatisfaction and (2) investigated psychological wellbeing as a mediator between maladaptive perfectionism and body image dissatisfaction. The sample included 139 Australian adults from universities (55.7%) and the community (44.3%). Participants completed demographic questions, the Frost Multidimensional Perfectionism Scale, the Psychological Wellbeing questionnaire, the Multidimensional Body-Self Relations Questionnaire, and Marlowe-Crowne Social Desirability Scale. In contrast to predictions, females had higher body area satisfaction and appearance evaluation scores. Furthermore, in line with the hypotheses, psychological wellbeing fully mediated the relationship between maladaptive perfectionism and poor body image. The findings suggest gender, maladaptive perfectionism, and psychological wellbeing may act as risk factors for body image dissatisfaction.
This study investigates how the facial cues of tour guides in their profile pictures, and especially aesthetically pleasing facial features, play a role in the different stages of a tourist’s decision-making process. Facilitated by an artificial intelligence (AI) facial recognition system, a comprehensive model is developed which incorporates the facial and service cues of 3786 tour guides. The results show that beauty scores and smiles have a positive effect on purchase decisions, while post-service ratings are only subject to service cues. The contingency effects of the beauty premium are also examined. The results indicate greater beauty premium effects for females, and for tour guides who are responsible for chauffeured, package or walking tours. This research is a pioneering study in AI-based facial analyses in the context of tourism, and offers insights into the impression management of online profiles in the customer decision-making stages.
To learn about the gendered experience of bodily loss, this paper analyzes interviews with women diagnosed with meta-static breast cancer (N = 32). Across the interviews, we find that specific bodily sites-hair, breast(s), thinness-and the gender norms associated with these sites do not loosen their grip near the end of life, but rather constitute meaningful sites of loss. Interviews demonstrate that when women lose a valued physical characteristic they also feel the loss of gendered statuses associated with that aspect of the body. We theorize the resulting emotional experience as positionality grief, or sorrow over an injured sense of self and that is tied to a sense of lowered place on social hierarchies. For feminist scholars, our study links women's complex desires with their particular forms of embodiment that delimit spaces of possibility in the social world. For Bourdieusian scholars, our study calls attention to the importance of focusing not just on the acquisition, but the loss of embodied capital in social life. The implications of these bodily changes, therefore, structure how women grapple with gender and sexuality over the course of their lives.
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.
Recent studies have shed light on how the COVID-19 pandemic changed our lives, and most of them have documented its detrimental effect on eating habits. Until now, the effects of this global crisis on negative body image and its association with disordered eating behaviors remain largely understudied. This study aimed to investigate changes in frequency of disordered eating behaviors (i.e., restrictive eating, emotional eating, and overeating) and negative body image (i.e., shape and weight concern, and body dissatisfaction) among a community sample of women during the COVID-19 pandemic (October 2020–May 2021). Furthermore, we explored the possible relation between body image-related variables and changes in the frequency of disordered eating behaviors in the context of the pandemic. A total of 161 self-identified female participants enrolled in an online-based survey. Descriptive statistics showed that women did not report clinically significant levels of weight and body shape concerns, but participants reported being dissatisfied with their body. One sample Wilcoxon Signed Rank tests revealed a tendency toward an increasing of the frequency of all disordered eating behaviors during the COVID-19 pandemic. Multinomial logistic regressions showed that weight concerns predicted an overall increase in the frequency of restrictive eating behaviors, whereas higher body dissatisfaction was associated with a moderate self-perceived increase in the frequency of emotional eating. These results shed light on a risk pattern of phenomena in a non-clinical sample of women, as they represent the key risk factors for the development of eating disorders. Findings could have implications for designing and implementing prevention programs.
Literature on body image and health behaviors has largely been pathology-based, investigating body dissatisfaction and disordered eating. Body appreciation is a useful construct of positive body image and has been used to understand its relationship with health behaviors beyond eating. This scoping review explores the literature on the relationship between body appreciation and physical health-promoting behaviors and health-compromising behaviors. A comprehensive search of databases was conducted to gather correlational studies written in English between January 2005 and November 2019. Behaviors related to eating and exercise were excluded. Nine quantitative studies met inclusion criteria. Evidence suggests an overall positive relationship between body appreciation and health-promoting behaviors, including preventive sexual health behaviors, preventive cancer behaviors, and seeking medical attention. Alternatively, body appreciation is negatively associated with health-compromising behaviors including risky sexual activity and alcohol and tobacco use. Promoting positive body image, above and beyond the reduction of body dissatisfaction, may play a crucial role in the health and well-being of women and girls. Research that examines positive body image in groups that are racially diverse and include sexual and gender minorities and people without healthcare access is urgently needed.
We examined how gender, body mass, race, age, and sexual orientation were linked to appearance evaluation, overweight preoccupation, and body image-related quality of life among 11,620 adults recruited via Mechanical Turk. Men were less likely than women to report low appearance evaluation, high overweight preoccupation, negative effects of body image on their quality of life, being on a weight-loss diet, and trying to lose weight with crash diets/fasting. Racial differences were generally small, but greater appearance evaluation was reported by Black men versus other groups and Black women versus White women. Across all measures, gay and bisexual men reported poorer body image than heterosexual men, with only small effect sizes observed for sexual orientation differences among women. Body mass, but not age, was strongly associated with body image. The prevalence of poor body image highlights the need for interventions. On the positive side, half of men and women reported high appearance evaluation. Examination of this group could identify factors promoting positive body image.
Nutritionism creates hegemonic norms for eating and defining subjectivity, but this chapter demonstrates the specifically gendered effects of this ideology. Examining how diet and wellness media communicate stereotypical ideas about gender through salad, the chapter analyses a variety of source material, including the photo essay “Women Laughing Alone with Salad”, the Men’s Health and Women’s Health websites, Instagram images, and numerous food and “wellness” trends. Such sources create nutritionism’s subjects in ways closely aligned with existing dynamics of patriarchy, whiteness, affluence, and bodily ability and size. This analysis demonstrates how the refrain “salad is feminine” endorses and reinforces notions of identity, power, and inequity through specifically nutricentric means that permeate women’s diet and wellness media.
Introduction and Purpose
The aim of this study is to investigate the factors affecting University students' attitudes toward aesthetic surgery.
Materials and Methods
This descriptive study was carried out in the spring semester of the 2018-2019 academic year with the students of the nursing Karabuk University. A form determining the sociodemographic characteristics of the students, the Cosmetic Surgery Acceptance Scale, and the Social Appearance Anxiety Scale were used to collect the study data.
Results
The mean age of the students participating in the study was 21 ± 1.9 years, the mean body mass index was 22.54 ± 3.8, 72.5% were female, and 97.2% were single. The mean scores of the students obtained from the Cosmetic Surgery Acceptance Scale and Social Appearance Anxiety Scale were 45.73 ± 17.68, 34.85 ± 10.05, respectively. A significant relationship was determined between the mean of the Cosmetic Surgery Acceptance Scale and the ages of the students ( P < 0.0001). In addition, there was a positive and strong relationship between the mean scores of the sub-dimensions of the Cosmetic Surgery Acceptance Scale (personal, social, and intellectual levels) and the mean score of the Social Appearance Anxiety Scale ( P < 0.0001).
Conclusion
In this study, it was determined that age and social appearance anxiety among university students are the factors that increase the possibility of opting for aesthetic surgery. Before aesthetic surgery interventions, determining psychological factors such as aging anxiety and social appearance anxiety that affect attitude toward aesthetic surgery in psychosocial evaluations and integrating the necessary interventions into nursing care will be beneficial in evaluating the suitability of patients for surgical intervention more accurately, applying more qualified nursing care, and increasing patient satisfaction.
Background
Negative mood often triggers binge eating in bulimia nervosa (BN). We investigated motivational salience as a possible underlying mechanism using event-related potentials (ERPs) as indicators of motivated attention allocation (P300) and sustained processing (LPP).
Methods
We collected ERPs (P300: 350–400 ms; LPP: 600–1000 ms) from 21 women with full-syndrome or partially remitted BN and 21 healthy women (HC), matched for age and body mass index. Idiosyncratic negative and neutral situations were used to induce corresponding mood states (counterbalanced), before participants viewed images of high- and low-calorie foods and neutral objects, and provided ratings for pleasantness and desire to eat.
Results
P300 was larger for foods than objects; LPP was largest for high-calorie foods, followed by low-calorie foods, then objects. The BN group showed an increased desire to eat high-calorie foods under negative mood and stronger mood induction effects on ERPs than the HC group, with generally reduced P300 and a small increase in LPP for high-calorie foods. Effects were limited to circumscribed electrode positions. Exploratory analyses showed clearer effects when comparing high vs. low emotional eaters.
Conclusion
We argue that negative mood decreased the availability of cognitive resources (decreased P300) in BN, thereby facilitating disinhibition and food cravings (increased desire-to-eat ratings). Increased sustained processing might be linked to emotional eating tendencies rather than BN pathology per se, and reflect approach motivation, conflict, or regulatory processes. Negative mood appears to induce complex changes in food image processing, whose understanding may contribute to the development of tailored interventions in the future.
With prevalence of obesity increasing worldwide, understanding body image in individuals with excessive weight is important, as unawareness of weight excess can prevent weight loss attempts. We explored the associations among measured and self-reported body mass index (BMI), body image and body satisfaction among Spanish females and males with overweight or obesity, with a special focus in discriminating individuals who are and are not satisfied with their body and wish or not to change their appearance. Just unifying all individuals with excessive weight may lead to uncover or deny different realities and to develop unfitted clinical management options. Updating findings for the Spanish population, we found that most participants correctly estimated their weight, but 3 in 10 underestimated it. Similarly, their body images corresponded to adults with overweight or obesity who desired to be thinner, but in average they reported a perceived body just slightly overweight and a moderate satisfaction with their body. Complementing the existing evidence, BMI and sex-gender interacted for influencing body weight estimation and desired weight change. In addition, three different subgroups were found for desired change of weight and size, depending on their BMI and body satisfaction. Discovering and considering different subjective realities and corporeal experiences among individuals with weight excess will help professionals to develop appropriate therapeutic interventions. Thus, the personal experiences that individuals have with obesity, instead of obesity itself, should be considered for disentangling management efforts.
To increase internet traffic, some online media try to attract attention by presenting pictures that cover the sexual organs of the body. However, compared with naked pictures, it remains unclear whether these covered pictures can evoke similar levels of sexual arousal in heterosexual young adults and category-specific patterns in men. To examine the above problems, this research divided female and male pictures into 4 types (fully dressed pictures, naked pictures, covered pictures and underwear-wearing pictures). Behavioral experiments, eye-movement technology and ERP measurements were employed to explore the different levels of sexual arousal between men and women in response to pictures of different sexes and types. The results revealed that the level of sexual arousal induced by covered pictures was significantly higher than that induced by naked pictures. There was no significant difference in the P300 amplitude of the parietal lobe between covered pictures and naked pictures, but in the frontal lobe, the P300 amplitude induced by covered pictures was significantly higher than that induced by naked pictures. The results indicated that unlike the process of sexual arousal induced by naked pictures, the process of sexual arousal induced by covered pictures not only included the processing of visual stimuli but also required the frontal lobe to actively construct to perceive pictures of covered sexual organs as naked pictures and thus induce sexual arousal. In addition, we also found that both covered pictures (as reflected in the levels of sexual arousal and the average amplitude of P300) and naked pictures (as reflected in the levels of sexual arousal, the number of fixations and the average amplitude of P300) can induce category specificity in heterosexual men. On the one hand, this research extends knowledge regarding sexual cognition and finds that covered pictures can also evoke category specificity in men; on the other hand, from the perspective of brain cognition, the difference in sexual cognitive processing between covered pictures and naked pictures is recognized.
Research has demonstrated that mothers transmit body-related attitudes and eating behaviors to their daughters, but little is known about the role of self-compassion—treating oneself with kindness and being mindful about one’s experiences—in this transmission. This research examined the intrapersonal and interpersonal associations between mothers’ and daughters’ self-compassion, body esteem (i.e., positive self-evaluations about one’s appearance), and emotional eating (i.e., the tendency to eat in response to negative affect). Dyads (N = 191) of Canadian mothers (mean age: 57.37) and daughters (mean age: 28.76) completed self-report questionnaires. Dyadic, structural equation modeling and bootstrapping analyses were conducted to examine relationships among the study variables. Controlling for mothers’ and daughters’ body mass index, self-compassionate mothers and daughters reported higher body esteem. Additionally, daughters of self-compassionate mothers were more self-compassionate and had higher body esteem, which in turn predicted lower emotional eating. Adding to the literature on the intergenerational transmission of eating-related attitudes and behaviors, results suggest a relation between mother and daughter self-compassion, body esteem, and eating behaviors. Results also showed that attitudes toward oneself were related to eating behaviors. Mothers’ self-compassion might provide a model for daughters, which in turn is associated with daughters’ improved body esteem and eating behaviors.
The mediational sequence from body dissatisfaction through dieting to bulimia—often referred to as the “restraint pathway”—has been validated in numerous samples of adolescent girls, but the prevalence rate of bulimic pathology pales in comparison to rates of body dissatisfaction and dieting in this risk group. This discrepancy indicates that the restraint pathway may only apply to adolescent girls possessing certain characteristics or experiencing certain circumstances. Accordingly, the current study examined the moderating roles of thin-ideal internalization, interoceptive deficits, and age by using self-report data from a community sample of 353 middle school ( n = 115), high school ( n = 112), and college girls ( n = 126). We found that (a) body-dissatisfied girls who reported high, versus low, thin-ideal internalization engaged in greater dietary restraint; (b) only dieters who reported high interoceptive deficits and were of college age expressed bulimic symptoms; and (c) the mediating effect pertained only to college girls with high interoceptive deficits, but was strongest for those who reported high, versus low, thin-ideal internalization. These results suggest that the restraint pathway's precision may be fine-tuned through greater sensitivity to potentiating factors and developmental context. Theoretical, empirical, and practical implications are discussed.
Objective:
We examined distinctiveness of different aspects of body-image disturbance in persons categorized with eating/weight disorders. We compared dissatisfaction with weight/shape, overvaluation of weight/shape, preoccupation with weight/shape, and fear of weight gain - in three study groups of persons categorized with overweight/obesity [O/O], bulimia nervosa [BN], and binge-eating disorder [BED] and examined how each body-image construct relates to clinical measures within and between the study groups.
Method:
1017 community volunteers completed measures of body-image, eating-disorder psychopathology, and depression. Participants were categorized into three study groups: O/O (N = 511), BN-purging type (N = 167), and BED (N = 339).
Results:
Groups differed significantly on the four body-image constructs (medium-to-large effect sizes) with a consistent severity gradient with BN greater than BED greater than O/O. Both within and between groups, the four body-image constructs varied in strengths of association among themselves and with clinical measures. Analyses revealed considerable variability in variance accounted for in the clinical measures; distinctive significant patterns observed across the groups included: dissatisfaction with BMI, preoccupation and fear with eating concerns and restraint, and overvaluation with depression.
Conclusion:
Clinical manifestations of body-image disturbances are complex and show important differences across study groups defined as overweight/obesity, BN, and BED. Improved understanding of distinctions between different body-image constructs and their differential salience across different eating/weight disorders is needed to improve case conceptualization and treatment formulation.
Gender-based differences in body image dissatisfaction are not conclusive. Women’s body experiences and their impact on sexual satisfaction may advance knowledge on how heterosexual, bisexual, and lesbian women internalize heterosexist values. In this study, we quantitatively examined the degree of body image and sexual dissatisfaction experienced by heterosexual, bisexual, and lesbian women, to determine whether body dissatisfaction can predict sexual dissatisfaction. Three hundred and fifty-four women completed an online survey measuring body and sexual dissatisfaction. No sexual orientation-based differences were observed in body or sexual dissatisfaction; however, body concerns were found to have less influence on sexual dissatisfaction in lesbian women compared to heterosexual and bisexual women. Standards of beauty remain constant among all women, yet removing themselves from the male gaze may be interpreted as a protective factor which shields women from expressing concern about their appearance during sexual activity.
It is believed that Women’s exposure to Western sociocultural pressures to attain a “thin-ideal” results in the internalization of a desire to be thin that consequently leads to body dissatisfaction (BD). It is also well documented that body mass index (BMI; kg/m²) correlates with BD. We tested for the first time a conditional mediation model where thin-ideal Awareness predicted BD through Internalization of the thin ideal and the path from Internalization to BD was hypothesized to be moderated by BMI and Nationality (Argentine vs. Spanish). The model was tested with a sample of 499 young women (age = 18 to 29) from Argentina (n = 290) and Spain (n = 209). Awareness and internalization were measured with the SATAQ-4 (Schaefer et al., 2015) and BD was measured with the BSQ (Cooper et al., 1987). The model was analyzed using PROCESS v3.1 (Hayes, 2018). As hypothesized, thin-ideal awareness predicted BD through internalization and the path from internalization to BD was moderated by BMI and nationality. Specifically, internalization predicted BD at all level of BMI and in both samples, but the relationship between internalization and BD increased with BMI and was also stronger among Spaniards than Argentines. We argue that the findings are congruent with theories that predict that economic development and modernization contribute to normative female BD through internalization of the thin ideal and that upward social comparisons or cognitive discrepancy between self-perceived body image and the sociocultural thin ideal interacts synergistically with thin-ideal internalization to increase BD.
Dissatisfaction with one’s appearance is commonplace among Western women. Body image dissatisfaction is believed to be a consequence of societal emphases on appearance reinforced through norms and media. However, some Amish cultural values and norms differ from prevailing Western influences, which may result in a rate of body image dissatisfaction at variance with Western women. The following pilot study explores how religious affiliation and religiosity may relate to body image factors (body dissatisfaction, appearance investment, and body coping strategies) and life satisfaction in Amish (N = 32), Catholic (N = 40), and non-religious (N = 40) women. Results suggest that the Amish have a more positive body image than Catholic women; results were inconclusive when comparing to non-religious women. As this pilot study’s sampling proceduce and size limit our ability to draw definitive conclusions, future research should work toward an expanded, systematic sample. If results from this study are confirmed, research is needed that examines the specific aspects of the Amish culture that may be associated with higher rates of body image satisfaction.
Most theories emphasize the role of sociocultural factors in the etiology of eating disorders (EDs). This article uses a broad search strategy to identify current etiologic studies. Women with an ED outnumber men in each diagnosis, but gender differences vary by diagnosis. Men were underrepresented in study samples, and information about variable risk factors in men is sparse. Findings suggest transdiagnostic risk factors and disorder-specific risk factors. Extracting data from population-based registers represents a major advance. Novel analytic approaches suggest complex pathways to ED. Although used in several studies, reliance on a transdiagnostic ED category (vs diagnosis-specific groupings) is premature.
Although high body mass index (BMI) alone does not invariably lead to body dissatisfaction (BD) and BD alone does not invariably lead to eating pathology (EP), research has suggested that there are clear relationships between each predictor and its respective criterion. We have a limited understanding of the factors that explain why some women at higher risk for BD (because of their BMI) do not report being dissatisfied with their bodies and why some women who are highly dissatisfied, do not engage in pathological eating behaviors. The present study examined such factors. A university sample of New Zealand women (N = 166) completed the Personality Assessment Inventory (Morey, 1991) and questionnaires measuring BD and EP. The tendency to report lower BD than would be predicted by one’s BMI, and the tendency to report lower EP than would be expected based on one’s BD, were characterized by lower overall distress (i.e., lower levels of anxiety and depression) and greater mood stability compared to those who followed the predicted outcome. Greater understanding of the factors that protect high-risk women from BD and EP may contribute to prevention and intervention strategies.
Body dissatisfaction has been regularly associated with negative consequences on health of young women, but less is known regarding middle-aged or older women. However, body dissatisfaction in women has been seen for long as a "normative discontent" (i.e. widespread and chronic dissatisfaction) because of its high prevalence among all age categories. The goal of this study was to explore the relationships between the desire to lose weight, energy intake and psychological health in community-dwelling women issued from the second wave (cross-sectional data) of the cohort study CoLaus (2009-2012, Switzerland), taking age categories (40-59 and 60-80) and body mass index (BMI, normal and overweight/obese) into account. Results showed that the desire to lose weight was common even in women with normal BMI and whatever the age category. Women with normal BMI who wished to lose weight reported lower energy and protein intake per kg of body weight, more signs of depression and less satisfaction with their quality of life than those who did not wish to lose weight in both age groups. The desire to lose weight was similarly associated with psychological health in women with overweight/obesity, in both age categories as well. These results indicate that the desire to lose weight may be associated with an impaired psychological health also in middle-aged and older women, even in those with normal BMI. This should not be considered as normal by health care professionals but as a possible indicator of psychological health and of the capacity to comply with dietary recommendations.
This meta-analytic review of prospective and experimental studies reveals that several accepted risk factors for eating pathology have not received empirical support (e.g., sexual abuse) or have received contradictory support (e.g., dieting). There was consistent support for less-accepted risk factors(e.g., thin-ideal internalization) as well as emerging evidence for variables that potentiate and mitigate the effects of risk factors(e.g., social support) and factors that predict eating pathology maintenance(e.g., negative affect). In addition, certain multivariate etiologic and maintenance models received preliminary support. However, the predictive power of individual risk and maintenance factors was limited, suggesting it will be important to search for additional risk and maintenance factors, develop more comprehensive multivariate models, and address methodological limitations that attenuate effects.
A review of 144 published studies of the relationship between socioeconomic status (SES) and obesity reveals a strong inverse relationship among women in developed societies. The relationship is inconsistent for men and children in developed societies. In developing societies, however, a strong direct relationship exists between SES and obesity among men, women, and children. A review of social attitudes toward obesity and thinness reveals values congruent with the distribution of obesity by SES in different societies. Several variables may mediate the influence of attitudes toward obesity and thinness among women in developed societies that result in the inverse relationship between SES and obesity. They include dietary restraint, physical activity, social mobility, and inheritance.
This study extends the literature on eating disorder symptomatology by testing, based on extant literature on objectification theory (B. L. Fredrickson & T. Roberts, 1997) and the role of sociocultural standards of beauty (e.g., L. J. Heinberg, J. K. Thompson, & S. Stormer, 1995), a model that examines (a) links of reported sexual objectification experiences to eating disorder-related variables and (b) the mediating roles of body surveillance, body shame, and internalization of sociocultural standards of beauty. Consistent with hypotheses, with a sample of 221 young women, support was found for a model in which (a) internalization of sociocultural standards of beauty mediated the links of sexual objectification experiences to body surveillance, body shame, and eating disorder symptoms, (b) body surveillance was an additional mediator of the link of reported sexual objectification experiences to body shame, and (c) body shame mediated the links of internalization and body surveillance to disordered eating. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Synopsis
A genetic analysis of the co-occurrence of bulimia and major depression (MD) was performed on 1033 female twin pairs obtained from a population based register. Personal interviews were conducted and clinical diagnoses made according to DSM-III-R criteria.
Additive genes, but not family environment, are found to play an important aetiological role in both bulimia and MD. The genetic liabilities of the two disorders are correlated 0·456. While unique environmental factors account for around half of the variation in liability to both bulimia and MD, these risk factors appear to be unrelated, i.e., each disorder has its own set of unique environmental risk factors. Thus, the genetic liability of bulimia and MD is neither highly specific nor entirely nonspecific. There is some genetic correlation between the two disorders as well as some genetic and environmental risk factors unique to each disorder. Limitations and directions for future research are discussed.
Various factors have been implicated in the development of body image dissatisfaction. Especially important are three constructs: awareness of a thin ideal, internalization of a thin ideal, and perceived pressures to be thin. Using meta-analysis, we calculated the strength of the relationships between each of these constructs and body image, and we evaluated the differences in magnitude across the average effect sizes. We also tested the moderating effects of age and ethnicity, and we compared the average effect sizes with those from meta-analyses of prospective and experimental studies in order to determine whether the effect sizes differed by study design. The results indicated the following: all three sociocultural factors had statistically significant relationships with body image; internalization and perceived pressures have a significantly stronger relationship to body image than does awareness; the effect sizes from cross-sectional studies were significantly larger than those of both longitudinal and experimental studies; and neither age nor ethnicity was a statistically significant moderator of the relationship between awareness and body image or that between internalization and body image. In this article, we discuss the limitations and implications of the findings on future research, theory, and clinical application.
The authors seek to clarify, from both an epidemiologic and genetic perspective, the major risk factors for bulimia nervosa and to understand the relationship between narrowly defined bulimia and bulimia-like syndromes.
Personal structured psychiatric interviews were conducted with 2,163 female twins from a population-based register. Psychiatric disorders were assessed using DSM-III-R criteria.
Lifetime prevalence and risk for narrowly defined bulimia were 2.8% and 4.2%, respectively. Including bulimia-like syndromes increased these estimates to 5.7% and 8.0%, respectively. Risk factors for bulimia included 1) birth after 1960, 2) low paternal care, 3) a history of wide weight fluctuation, dieting, or frequent exercise, 4) a slim ideal body image, 5) low self-esteem, 6) an external locus of control, and 7) high levels of neuroticism. Significant comorbidity was found between bulimia and anorexia nervosa, alcoholism, panic disorder, generalized anxiety disorder, phobia, and major depression. Proband-wise concordance for narrowly defined bulimia was 22.9% in monozygotic and 8.7% in dizygotic twins. The best-fitting model indicated that familial aggregation was due solely to genetic factors with a heritability of liability of 55%. A multiple threshold model indicated that narrowly defined bulimia nervosa and bulimia-like syndromes represented different levels of severity on the same continuum of liability.
The liability to fully syndromal bulimia nervosa, which affects around one in 25 women at some point in their lives, is substantially influenced by both epidemiologic and genetic risk factors. The same factors that influence the risk for narrowly defined bulimia also influence the risk for less severe bulimia-like syndromes.
An investigation of current American society's depiction of the ideal female body was performed. Body measurements of Playboy magazine centerfolds and Miss America contestants for 1979-1988 indicated body weight 13-19% below expected weight for women in that age group. Miss America contestants showed a significant decrease in expected weight between 1979 and 1988. Comparisons were made with an earlier study which had demonstrated that body measurements of both groups had decreased during the period 1959-1978. Diet-for-weight-loss and exercise articles in six women's magazines were tabulated for 1959-1988. A significant increase in both diet articles and exercise articles occurred during this period. These findings suggest that the overvaluation of thinness continues and thinness is now sought through both dieting and exercise.
Objective: This study examined the importance of potential risk factors for eating disorder onset in a large multiethnic sample followed for up to 3 years, with assessment instruments validated for the target population and a structured clinical interview used to make diagnoses. Method: Participants were 1,103 girls initially assessed in grades 6-9 in school districts in Arizona and California. Each year, students completed the McKnight Risk Factor Survey, had body height and weight measured, and underwent a structured clinical interview. The McKnight Risk Factor Survey, a self-report instrument developed for this age group, includes questions related to risk factors for eating disorders. Results: During follow-up, 32 girls (2.9%) developed a partial- or full-syndrome eating disorder. At the Arizona site, there was a significant interaction between Hispanics and higher scores on a factor measuring thin body preoccupation and social pressure in predicting onset of eating disorders. An increase in negative life events also predicted onset of eating disorders in this sample. At the California site, only thin body preoccupation and social pressure predicted onset of eating disorders. A four-item screen derived from thin body preoccupation and social pressure had a sensitivity of 0.72, a specificity of 0.80, and an efficiency of 0.79. Conclusions: Thin body preoccupation and social pressure are important risk factors for the development of eating disorders in adolescents. Some Hispanic groups are at risk of developing eating disorders. Efforts to reduce peer, cultural, and other sources of thin body peeoccupation may be necessary to prevent eating disorders.
Eating disorders, such as anorexia nervosa (AN) and bulimia nervosa (BN), have genetic and environmental underpinnings. To explore genetic contributions to AN, we measured psychiatric, personality and temperament phenotypes of individuals diagnosed with eating disorders from 196 multiplex families, all accessed through an AN proband, as well as genotyping a battery of 387 short tandem repeat (STR) markers distributed across the genome. On these data we performed a multipoint affected sibling pair (ASP) linkage analysis using a novel method that incorporates covariates. By exploring seven attributes thought to typify individuals with eating disorders, we identified two variables, drive-for-thinness and obsessionality, which delimit populations among the ASPs. For both of these traits, or covariates, there were a cluster of ASPs who have high and concordant values for these traits, in keeping with our expectations for individuals with AN, and other clusters of ASPs who did not meet those expectations. When we incorporated these covariates into the ASP linkage analysis, both jointly and separately, we found several regions of suggestive linkage: one close to genome-wide significance on chromosome 1 (at 210 cM, D1S1660; LOD = 3.46, P = 0.00003), another on chromosome 2 (at 114 cM, D2S1790; LOD = 2.22, P= 0.00070) and a third region on chromosome 13 (at 26 cM, D13S894; LOD = 2.50, P = 0.00035). By comparing our results to those implemented using more standard linkage methods, we find the covariates convey substantial information for the linkage analysis.
In 1932, Cambridge University Press published Remembering, by psychologist, Frederic Bartlett. The landmark book described fascinating studies of memory and presented the theory of schema which informs much of cognitive science and psychology today. In Bartlett's most famous experiment, he had subjects read a Native American story about ghosts and had them retell the tale later. Because their background was so different from the cultural context of the story, the subjects changed details in the story that they could not understand. Based on observations like these, Bartlett developed his claim that memory is a process of reconstruction, and that this construction is in important ways a social act. His concerns about the social psychology of memory and the cultural context of remembering were long neglected but are finding an interested and responsive audience today. Now reissued in paperback, Remembering has a new Introduction by Walter Kintsch of the University of Colorado, Boulder.
Eating disorders have been studied extensively over the past several decades, yet research of their etiology has lagged behind treatment outcome research. This article reviews the challenges inherent in this research. It illustrates the epidemiologic designs that have been used to test risk factor hypotheses and describes the major studies designed to answer the question of what causes eating disorders. It points to significant gaps in knowledge, chief among them the absence of representative data on prevalence and correlates of eating disorders, and the lack of data regarding eating disorders in ethnic minority populations.
1. In August last I presented to the Society a memoir on the inheritance of coat-colour in thoroughbred horses, and of eye-colour in man. This memoir, which was read in November of last year, presented the novel feature of determining correlation between characters which were not capable à priori of being quantitatively measured. The theoretical part of that memoir was somewhat brief, but I showed by illustrations that the method could be extended to deal with problems like the effectiveness of vaccination and of the antitoxin treatment in diphtheria.
Objectives of review. This chapter reviews articles published in 2005 and 2006 on the influence of culture, ethnicity and gender on eating disorders. Specific social environmental factors, including media portrayals of body ideals and peer and family environment, are also reviewed. Summary of recent findings. Certain non-Western values may increase the risk of eating disorders. Ethnicity and gender may moderate associ- ations between risk factors and disordered eating. The media promote different body image ideals for women and men that may contribute to gender differences in the rates and expression of eating disorders. Peers and family translate broad cultural values into personally relevant ideals that influence behavior. Future directions. Much of the research on sociocultural factors remains focused on the role of the thin ideal. Future work could examine the influence of collectivism, anonymity, and shifts from multigenerational to predominantly peer social environments as possible sociocultural factors that increase the risk of eating disorders.
(1) The cephalic index, when used to test any theory of heredity, ssesses many merits, and at the same time one or two defects, the first place it is supposed to be a marked racial character, and erefore might be considered to be strongly inherited. In the next ace it remains sensibly constant after two years of age; thus the rength of inheritance can be ascertained by measurements on mng children, whose parents are more frequently alive than if we ive to wait for measurement till the offspring are of adult age. urther, although the cephalic index requires a more trained and to measure it than some other measurements on the living object, the trained observer will always deduce sensibly the same suits; on the other hand, stature measurements vary sensibly ith the hour of the day, and with the observer.
Although laboratory experiments indicate that brief exposure to thin models leads to acute body dissatisfaction and negative affect in women, research has not tested whether longer term exposure results in lasting effects. Accordingly, we randomly assigned 219 adolescent girls to a 15-month fashion magazine subscription or a no-subscription condition and followed them over time. Despite evidence that the experimental manipulation successfully increased exposure to the fashion magazine and the ample statistical power, there were no main effects of long-term exposure to thin images on thin-ideal internalization, body dissatisfaction, dieting, negative affect, or bulimic symptoms. However, there was evidence that vulnerable adolescents, characterized by initial elevations in perceived pressure to be thin and body dissatisfaction and deficits in social support, were adversely affected by exposure to these images. Results suggest that exposure to thin-ideal images has lasting negative effects for vulnerable youth.
Debate Question
The economic transformation in Eastern Europe following the decline of communism and the adoption of a market philosophy is bound to affect women's perception of themselves and of their societal roles. This theoretically should increase their confusion over gender roles and subsequently their propensity to develop eating disorders.
Background:
Women who have anorexia nervosa may experience difficulties with fertility and reproduction.
Method:
We examined fertility and reproductive history in 66 women who had a history of anorexia nervosa (DSM-III-R) and 98 randomly selected community controls as part of a follow-up investigation examining the course of anorexia nervosa.
Results:
Although women with a history of anorexia nervosa and controls did not differ on rate of pregnancy, mean number of pregnancies per woman, or age at first pregnancy, women with anorexia nervosa had significantly more miscarriages and cesarean deliveries, and the offspring of women with anorexia nervosa were significantly more likely to be born prematurely and were of lower birth weight than offspring of controls. There were no differences between women with active versus remitted anorexia nervosa on any of these measures; however, offspring of anorexic women with no history of bulimia nervosa had significantly lower body weight than offspring of anorexic women with a lifetime history of bulimia nervosa.
Conclusion:
Our results argue for intensive prenatal care for women with both active and remitted anorexia nervosa to ensure adequate prenatal nutrition and fetal development.
Examined the prevalence of comorbid psychopathology, family psychiatric history, and perceptions of family environment in 20 women with binge-eating disorder (BED) and 20 non-binge-eating obese controls. Women with BED were significantly more likely to report current or lifetime affective and anxiety disorders as well as family histories of BED. Family histories of substance abuse did not differ across groups. Significantly more women with BED rated their parents' parenting style as consistent with "affectionless control" on the Parental Bonding Instrument (G. Parker et al, 1979), and reported significantly lower cohesion, expressiveness, conflict, independence, intellectual-cultural orientation, and active-recreational orientation on the Family Environment Scale. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Objective
Recent consensus on the subclassification of the eating disorder bulimia nervosa into purging and nonpurging forms is examined in the context of a large psychiatric epidemiological survey in Ontario, Canada. Method: Among a sample of 8,116 individuals, 62 met criteria for bulimia nervosa. Of these, the 17 who were of the purging subtype could be distinguished from the nonpurging group on a variety of parameters of comorbidity, family history, and childhood environment. Results: The purging subtype was distinguishable on the basis of early age of onset, and high rates of affective disorders and anxiety and alcoholism, sexual abuse, and parental discord. Discussion: The data support the taxonomy and point to the need for better understanding of the meaning of purging behavior. © 1996 by John Wiley & Sons, Inc.
After an initial consideration of psychological experimentation, the author describes a long series of experiments in the fields of perception, imagination, and remembering, using material which approximated that found in everyday life. The work on perceiving utilized chiefly geometrical diagrams; and that on imagination, ink-blots. The results in these two cases revealed the influence of the subjects' attitudes and indicated their tendency to introduce previously learned material. In the experiments on remembering two methods were used, one the method of repeated reproduction by a given subject and the other the method of serial reproduction where the material reproduced by one subject became the learning material for a second subject whose recall constituted the learning material for a third subject, etc. This latter series of experiments showed that proper names and titles are very unstable in recall, that there is a bias toward the concrete, that individualizing aspects of the material (stories) tend to be lost, and that abbreviations and rationalizations occur. Throughout the book emphasis is placed on the social determinants of the manner and matter of recall, a point of view which is supported in the anthropological material cited. "Remembering is not the re-excitation of innumerable fixed, lifeless and fragmentary traces. It is an imaginative reconstruction, or construction, built out of the relation of our attitude towards a whole active mass of organized past reactions or experience, and to a little outstanding detail which commonly appears in image or in language form." (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Objective
The current study presents the long-term course of anorexia nervosa (AN) over 12 years in a large sample of 103 patients diagnosed according to criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).Method
Assessments were made at the beginning of therapy, at the end of therapy, at the 2-year follow-up, at the 6-year follow-up, and at the 12-year follow-up. Self-rating and an expert-rating interview data were obtained.ResultsThe participation rate at the 12-year follow-up was 88% of those alive. There was substantial improvement during therapy, a moderate (in many instances nonsignificant) decline during the first 2 years posttreatment, and further improvement from 3 to 12 years posttreatment. Based on a global 12-year outcome score, 27.5% had a good outcome, 25.3% an intermediate outcome, 39.6% had a poor outcome, and 7 (7.7%) were deceased. At the 12-year follow-up 19.0% had AN, 9.5% had bulimia nervosa-purging type (BN-P), 19.0% were classified as eating disorder not otherwise specified (EDNOS). A total of 52.4% showed no major DSM-IV eating disorder and 0% had binge eating disorder (BED). Systematic—strictly empirically based—model building resulted in a parsimonious model including four predictors of unfavorable 12-year outcome explaining 45% of the variance, that is, sexual problems, impulsivity, long duration of inpatient treatment, and long duration of an eating disorder.Conclusion
Mortality was high and symptomatic recovery protracted. Impulsivity, symptom severity, and chronicity were the important factors for predicting the 12-year outcome. © 2005 by Wiley Periodicals, Inc.
Objective
Twin methodology has been used to delineate etiological factors in many medical disorders and behavioral traits including eating disorders. Although twin studies are powerful tools, their methodology can be arcane and their implications easily misinterpreted.Method
The goals of this study are to (a) review the theoretical rationale for twin studies; (b) provide a framework for their interpretation and evaluation; (c) review extant twin studies on eating disorders; and (d) explore the implications for understanding etiological issues in eating disorders.DiscussionOn the basis of this review, it is not possible to draw firm conclusions regarding the precise contribution of genetic and environmental factors to anorexia nervosa. Twin studies confirm that bulimia nervosa is familial and reveal significant contributions of additive genetic effects and of unique environmental factors in liability to bulimia nervosa. The magnitude of the contribution of shared environment is less clear, but in the studies with the greatest statistical power, it appears to be less prominent than additive genetic factors. © 2000 by John Wiley & Sons, Inc. Int J Eat Disord 27: 1–20, 2000.
Recent research on anorexia nervosa (AN) has focused on examining the genetic underpinnings of its etiology. The current article reviews molecular genetic studies that have focused on this aspect of AN development. Medline and PsychInfo literature searches, in addition to close inspection of study reference sections, were used to identify studies that examined the genetic diathesis for AN. Findings from association studies indicate some role for the serotonin system in the development of AN. Genomic regions on chromosomes 1 and 10 are also likely to harbor susceptibility genes for AN as well as a range of eating pathologies. Findings corroborate those of neurobiologic studies suggesting that alterations in serotonergic functioning may contribute to the pathogenesis of AN. Nonetheless, future molecular genetic research would benefit from larger and more sustained investigations of candidate genes in homogeneous phenotypes. © 2005 by Wiley Periodicals, Inc.
Because of the growing prevalence of obesity among children and adolescents, increased attention is being directed toward its prevention. An important question is: Can we simultaneously work toward the prevention of obesity and eating disorders? To address this question, we need to determine (a) if there is a need for integrated approaches; (b) if we can bridge the fields of obesity and eating disorders; (c) if we can foster the development of environments that promote healthy eating and physical activity choices and the acceptance of diverse body shapes and sizes; and (d) if we can work toward the development of interventions that have relevance to a broad spectrum of weight-related conditions and behaviors. © 2005 by Wiley Periodicals, Inc.
Objective:
This study investigates the longitudinal course of eating problems from childhood though adulthood. The following questions are answered: (1) How stable are eating disorder symptoms and diagnoses over a 17-year interval from childhood to adulthood? (2) Do early childhood eating problems predict the occurrence of eating disorders in adulthood?
Method:
An epidemiologically selected sample of approximately 800 children and their mothers received DSM-based structured psychiatric assessments in 1975, 1983, 1985, and 1992. The stability of full DSM diagnostic criteria for anorexia nervosa and bulimia nervosa, symptom scales derived from DSM criteria, and individual symptoms such as binge eating or dieting between early adolescence, late adolescence, and young adulthood was examined.
Results:
Early adolescent bulimia nervosa is associated with a 9-fold increase in risk for late adolescent bulimia nervosa and a 20-fold increase in risk for adult bulimia nervosa. Late adolescent bulimia nervosa is associated with a 35-fold increase in risk for adult bulimia nervosa. Symptom scale scores for anorexia nervosa and bulimia nervosa correlate in the 0.3 to 0.5 range from early to late adolescence and young adulthood. For both anorexia nervosa and bulimia nervosa, gender, as well as eating symptoms at early and late adolescence, all predict young-adult eating disorder symptoms. Risk factors for the later development of eating disorders comprise eating conflicts, struggles with food, and unpleasant meals in early childhood.
Conclusion:
The presence of eating problems in early childhood or an eating disorder in adolescence confers a strong risk for an eating disorder in young adulthood.
Current psychological theories on anorexia nervosa share a common assumption that symptoms of the condition are related to cultural factors. The present article argues that the disorder can be fruitfully understood in the context of one definition of culture-bound syndromes. By way of introduction two contrasting models of the cross-cultural study of psycho-pathology are outlined in order to contextualize the agrument in a particular paradigm. Anorexia nervosa is shown to fit the criteria of the Cassidy/Ritenbaugh definition of culture-bound syndromes, and the definition is shown to have some use in elucidating issues.Implications for a more flexible approach to theory development and therapeutic practice are discussed, and suggestions are made for further work demonstrating the negotiated nature of the disorder.
It is well known that obtaining adequate statistical power to detect linkage to or association with genes for complex quantitative traits can be very difficult. In response, investigators have developed a number of power-enhancing strategies that consider restraints such as genotyping (and/or phenotyping) costs. In the context of both association and sib pair linkage studies of quantitative traits, one of the most widely discussed techniques is the selective sampling of phenotypically extreme individuals. Several papers have demonstrated that such extreme sampling can markedly increase power (under certain circumstances). However, the parenthetical phrase in the previous sentence has generally not been made explicit and it appears to be implied that the more phenotypically extreme the individuals, the more power one has. In this paper, we show by simulation that this is not true under all circumstances. In particular, we show that under oligogenic models, where some biallelic quantitative trait loci (QTLs) have markedly asymmetric allele frequencies and large mean displacement among genotypes, and others have less asymmetric allele frequencies and smaller mean displacement among genotypes, power to detect linkage to or association with the latter QTL can actually decrease by sampling more extreme sib pairs. This suggests that more extreme sampling is not always better. The 'optimal' sampling scheme may depend on both what one suspects the underlying genetic architecture to be and which of the oligogenic QTL one has greatest interest in detecting.
Synopsis
Thirty patients were selected for a prospective study according to two criteria: (i) an irresistible urge to overeat (bulimia nervosa), followed by self-induced vomiting or purging; (ii) a morbid fear of becoming fat. The majority of the patients had a previous history of true or cryptic anorexia nervosa. Self-induced vomiting and purging are secondary devices used by the patients to counteract the effects of overeating and prevent a gain in weight. These devices are dangerous for they are habit-forming and lead to potassium loss and other physical complications. In common with true anorexia nervosa, the patients were determined to keep their weight below a self-imposed threshold. Its level was set below the patient‘s healthy weight, defined as the weight reached before the onset of the eating disorder. In contrast with true anorexia nervosa, the patients tended to be heavier, more active sexually, and more likely to menstruate regularly and remain fertile. Depressive symptoms were often severe and distressing and led to a high risk of suicide.
A theoretical model is described to emphasize the interdependence of the various symptoms and the role of self-perpetuating mechanisms in the maintenance of the disorder. The main aims of treatment are (i) to interrupt the vicious circle of overeating and self-induced vomiting (or purging), (ii) to persuade the patients to accept a higher weight. Prognosis appears less favourable than in uncomplicated anorexia nervosa.
Synopsis
Prevalence of bulimia was estimated from a cross-sectional general population survey of 1498 adults, using the Diagnostic Interview Schedule (DIS) administered by trained lay interviewers. Lifetime prevalence of the DSM-III syndrome in adults aged 18–64 was 1·0% and this was concentrated in young women: in women aged 18–44 lifetime prevalence was 2·6%, and 1·0% currently had the disorder. Based on clinicians' reinterviews of random respondents and identified and marginal cases, the prevalence of current disorder using criteria for draft DSM-III-R bulimia was 0·5%, for DSM-III it was 0·2%, and for Russell's Criteria bulimia nervosa 0·0%. A strong cohort effect was found, with higher lifetime prevalence among younger women, which is consistent with a growing incidence of the disorder among young women in recent years. Although elements of the syndromes were so common as to suggest that dysfunctional attitudes to eating and disturbed behaviour surrounding eating are widespread, there was little evidence of the bulimia syndrome having become an epidemic on the scale suggested by early reports.
Background. Many human fetuses and infants have to adapt to a limited supply of nutrients, and in doing so they permanently change their physiology and metabolism. These programmed changes may be the origins of a number of diseases in later life, including coronary heart disease, stroke, diabetes and hypertension.
Coronary heart disease. We have become accustomed to the idea that coronary heart disease, the commonest cause of death in the Western world, may result from the “unhealthy” lifestyle that is associated with increasing affluence. The influences of this “unhealthy” lifestyle (e. g. obesity, cigarette smoking, dietary fat, stress), however, go only a small way towards explaining why increasing affluence in the Third world is so regularly followed by epidemics of the disease, or why in the Western world these epidemics have risen steeply to become the commonest cause of death but thereafter have declined. Neither do they explain why the highest rates of coronary heart disease in Western countries occur among the poor?
Fetal origins. Answers to these questions may come from an understanding of how the structure of the heart and processes such as blood pressure regulation and the way the body handles sugar and fat are established in the womb. The “fetal origins” hypothesis states that coronary heart disease and the disorders related to it – hypertension, adult-onset diabetes and stroke – originate through adaptations that the fetus makes when it is under-nourished. Unlike adaptations made in adult life those made during early development tend to have permanent effects on the body's structure and function – a phenomenon sometimes referred to as programming. They allow the fetus to survive and continue to grow but at the price of a shortened life.
The concept culture-bound syndrome' (CBS) is elusive. In this paper an attempt has been made to tie the concept down more firmly by proposing a strict definition, examining the appropriateness of this definition in determining the CBS status of two new syndromes (anorexia nervosa and brain-fag) and analysing the usefulness or not of the basic CBS concept. A CBS is defined as a collection of signs and symptoms of disease (not including notions of cause as recently proposed in the anthropological literature) which is restricted to a limited number of cultures by reason of certain of their psychosocial features. Anorexia nervosa appears to fit the definition but further empirical evidence is required to assure that the illness is restricted to Western cultures or cultures strongly influenced by them. The question of the CBS status of brain-fag demonstrates the need to clearly differentiate such disease features as symptom clusters, labels for those clusters, and notions of etiology. Failure to keep such features distinct has led to considerable controversy, but if the proposed definition is strictly adhered to, brain-fag does qualify for the CBS designation. As regards the usefulness of the CBS concept, it is proposed that the question hinges upon whether CBS's signal a difference that makes a difference. It is demonstrated that the CBS concept is useful for medical anthropologists or transcultural psychiatrists who are concerned about relationships between symptom patterns and cultural processes. It is also useful to epidemiologists who, for example, may be interested in estimating the prevalence of depression; it is important to know that they must count some cases of CBS's along with cases of depression with a more typically Western symptomatology. The concept may be redundant for psychopharmacologists who find that they successfully treat many different culture bound syndromes with the same drugs.
A review of 144 published studies of the relationship between socioeconomic status (SES) and obesity reveals a strong inverse relationship among women in developed societies. The relationship is inconsistent for men and children in developed societies. In developing societies, however, a strong direct relationship exists between SES and obesity among men, women, and children. A review of social attitudes toward obesity and thinness reveals values congruent with the distribution of obesity by SES in different societies. Several variables may mediate the influence of attitudes toward obesity and thinness among women in developed societies that result in the inverse relationship between SES and obesity. They include dietary restraint, physical activity, social mobility, and inheritance.