Body checking and avoidance and the core features of eating disorders among obese men and women seeking bariatric surgery

This study examined two aspects of body checking and avoidance, and their relations to the core psychopathology of eating disorders (EDs), in severely obese men and women seeking bariatric surgery. A consecutive series of 260 (44 male and 216 female) gastric bypass candidates were administered measures to assess body checking and avoidance, binge eating, restraint, and overevaluation of weight and shape. The majority of patients reported regularly pinching areas of their body to check for fatness and avoided wearing clothing that made them particularly aware of their body. Significant associations were observed between checking and restraint, and between avoidance and binge eating. Both checking and avoidance behaviors were significantly associated with overevaluation of weight and shape. The positive associations between each of the two behaviors (body checking and avoidance) with overevaluation of weight/shape remained significant even after controlling for the effects of avoidance on body checking and vice versa. Stepwise multiple regression analyses revealed that binge eating, body checking, and avoidance behaviors made significant unique contributions and jointly accounted for 22-25% of the variance in overevaluation of weight and shape, respectively. This study documents the presence of eating disorder psychopathology among severely obese patients seeking bariatric surgery. The findings support the view that body checking and avoidance behaviors are manifestations of overevaluation of weight and shape and disordered eating.     

A naturalistic study of fat talk and its behavioral and affective consequences

Fat talk is a style of verbal expression among young women involving negative self-statements, complaints about physical appearance, and weight management. This research used ecological momentary assessment to examine the impact of naturalistic fat talk experiences on body dissatisfaction, body checking, negative affect, and disordered eating behaviors. We examined trait self-objectification as a moderator. Sixty-five female college students completed a baseline questionnaire and responded to questions when randomly prompted by palm pilot devices for five days. Results indicated fat talk is common and associated with greater body dissatisfaction, body checking, negative affect, and disordered eating behaviors. Fat talk participation was associated with greater body checking than overhearing fat talk. Greater trait self-objectification was associated with greater body dissatisfaction and body checking following fat talk. These results suggest that fat talk negatively impacts the cognitions, affect, and behavior of young women and has increased negative effects for women higher in self-objectification.     

The importance of body satisfaction to physical self‐concept and body mass index in Spanish adolescents

This research examines the association between measured body mass index (BMI) and the perception of BMI by young students. Moreover, this research tests the importance of BMI and self‐concept, in order to predict body dissatisfaction in high school students. The sample consisted of 2087 individuals from different high schools in Extremadura, Spain, both males (n = 1046) and females (n = 1041), ranging in age from 15 to 17 years old (M = 15.42; SD = 0.86). Initially, participants' BMIs were assessed through anthropometry. Later, all individuals were asked about their weight and height, and their self‐reported BMI was calculated. Participants also answered a questionnaire about their perception of self‐concept, as well as completed a test about body image perception using Stunkard images. Outcomes revealed that factors concerning self‐concept and perceived BMI explained body dissatisfaction. Finally, results are discussed with the aim of improving knowledge in body dissatisfaction context.     

Body checking and avoidance in ethnically diverse female college students

Although body checking and avoidance behaviors are common in women with eating disorders, minimal research has examined the nature or correlates of these behaviors in ethnically diverse female college students without eating disorders. Self-identified European American (n = 268), Asian American (n = 163), Latina (n = 146), and African American (n = 73) women completed self-report measures of body checking and avoidance, thin-ideal internalization, eating pathology, and clinical impairment. Results indicated that European and Asian American women reported significantly more body checking and avoidance than African American and Latina women. Generally, correlates of body checking and avoidance were consistent across ethnic groups: Regression analyses indicated that type of ethnicity predicted body checking and avoidance; and ethnicity, body checking, and body avoidance predicted eating pathology and clinical impairment. These associations suggest that body checking and avoidance are not benign behaviors in diverse nonclinical women.     

Body checking behaviors in men

Males have been facing increasing pressure from the media to attain a lean, muscular physique, and are at risk for body dissatisfaction, disturbed eating and exercise behaviors, and abuse of appearance- and performance-enhancing drugs (APEDs). The aim of the current study was to examine the relationship between body checking and mood, symptoms of muscle dysmorphia, importance of shape and weight, and APED use in undergraduate males. Body checking in males was correlated with weight and shape concern, symptoms of muscle dysmorphia, depression, negative affect, and APED use. Body checking predicted APED use and uniquely accounted for the largest amount of variance in Muscle Dysmorphic Disorder Inventory (MDDI) scores (16%). Findings support the view that body checking is an important construct in male body image, muscle dysmorphia, and body change strategies and suggest a need for further research.     

Ethnic differences in BMI, weight concerns, and eating behaviors: comparison of Native American, White, and Hispanic adolescents

Evidence suggests that substantial proportions of adolescents, regardless of ethnicity or gender, are engaged in excessive weight control behaviors. Crago and Shisslak (2003), however, have noted that small samples and poorly validated instruments have limited the value of previous ethnic difference studies. Using the McKnight Risk Factor Survey, we compared Native American, White, and Hispanic adolescents. Native students were divided into groups with one (NA-mixed) or two (NA) Native American biological parents. Surveys were completed by 5th through 10th grade students. BMI z-scores were significantly higher for boys and girls in the NA group, and boys in this group were significantly more engaged in weight control behaviors, including purging. A higher percentage of Native and Hispanic girls preferred a larger body size. BMI was positively correlated with weight and shape concerns and with weight control behaviors, regardless of ethnicity or gender. Overweight among Native adolescents may put them at greater risk for eating problems than their White peers.     

Perceived teasing experiences in body dysmorphic disorder

Individuals with body dysmorphic disorder (BDD) are excessively concerned about imagined or slight defects in their appearance (e.g., asymmetrical facial features). Cognitive-behavioral models of BDD propose that several factors, including dysfunctional appearance-related beliefs and life experiences, such as teasing, contribute to the avoidance behaviors or rituals (e.g., mirror checking, grooming) characteristic of BDD. Previous research has demonstrated an association between perceived teasing and body dissatisfaction. In the current study, we examined whether individuals with BDD (n = 16) report to have been teased more often than do mentally healthy controls (n = 17). The group comprising individuals with BDD reported more appearance- and competency-related teasing than did control participants. This study provides preliminary evidence for the association between perceived teasing and BDD.     

Experiential avoidance in body dysmorphic disorder

Experiential avoidance (i.e., the attempt to avoid certain internal experiences including bodily sensations, thoughts, emotions, memories, and urges) has been studied in various psychological disorders. However, research examining experiential avoidance in individuals with body dysmorphic disorder (BDD) is limited and inconsistent. The present study compared experiential avoidance in individuals with primary BDD (n = 23) to healthy controls (n = 22). Standardized measures were used to assess baseline clinical characteristics as well as experiential avoidance. Compared to healthy controls, individuals with BDD presented with significantly greater experiential avoidance (p < .001, d = −2.51). In BDD, experiential avoidance was positively correlated with depressive symptoms (p < .01) and avoidant coping strategies (p < .01). Clinician sensitivity to experiential avoidance may serve to improve the course of treatment for BDD.     

Self-compassion moderates the relationship between body mass index and both eating disorder pathology and body image flexibility

The current study examined whether self-compassion, the tendency to treat oneself kindly during distress and disappointments, would attenuate the positive relationship between body mass index (BMI) and eating disorder pathology, and the negative relationship between BMI and body image flexibility. One-hundred and fifty-three female undergraduate students completed measures of self-compassion, self-esteem, eating disorder pathology, and body image flexibility, which refers to one's acceptance of negative body image experiences. Controlling for self-esteem, hierarchical regressions revealed that self-compassion moderated the relationships between BMI and the criteria. Specifically, the positive relationship between BMI and eating disorder pathology and the negative relationship between BMI and body image flexibility were weaker the higher women's levels of self-compassion. Among young women, self-compassion may help to protect against the greater eating disturbances that coincide with a higher BMI, and may facilitate the positive body image experiences that tend to be lower the higher one's BMI.     

The impact of gender on the assessment of body checking behavior

Body checking includes any behavior aimed at global or specific evaluations of appearance characteristics. Men and women are believed to express these behaviors differently, possibly reflecting different socialization. However, there has been no empirical test of the impact of gender on body checking. A total of 1024 male and female college students completed two measures of body checking, the Body Checking Questionnaire and the Male Body Checking Questionnaire. Using multiple group confirmatory factor analysis, differential item functioning (DIF) was explored in a composite of these measures. Two global latent factors were identified (female and male body checking severity), and there were expected gender differences in these factors even after controlling for DIF. Ten items were found to be unbiased by gender and provide a suitable brief measure of body checking for mixed gender research. Practical applications for body checking assessment and theoretical implications are discussed.     

Considering an affect regulation framework for examining the association between body dissatisfaction and positive body image in Black older adolescent females: Does body mass index matter?

The present study provided an initial evaluation of an affect regulation model describing the association between body dissatisfaction and two contemporary measures of positive body image among 247 Black college-bound older adolescent females. We further tested whether possessing a higher body mass index (BMI) would strengthen these associations. Self-reported height and weight were used to calculate BMI. Respondents also completed a culturally-sensitive figure rating scale along with assessments of body appreciation and body image flexibility. Results indicated a robust positive association between the two measures of positive body image; BMI was the strongest predictor of both body appreciation and body image flexibility with body size discrepancy (current minus ideal) contributing incremental variance to both models tested. Implications for improving our understanding of the association between positive and negative body image and bolstering positive body image to promote health-protective behaviors among Black young women at this developmental juncture are discussed.     

Body dissatisfaction and body change behaviors in Chile: the role of sociocultural factors

With interest in body image and body change behaviors growing around the world, there has been surprisingly little research conducted in Latin America on these issues. In order to gain some understanding of them in this context, this study investigated body image and body change behaviors, and the sociocultural factors that may influence them, among 337 Chilean adolescents aged 12–18 years. Participants completed a questionnaire that assessed BMI, body dissatisfaction, strategies to lose weight and strategies to increase muscle bulk. In addition, perceived pressure from family, peers, and the media to change body shape was evaluated. Results were partially consistent with those reported in Western nations. Girls were found to report greater body dissatisfaction than boys, but no difference was found between males and females in perceived pressure from adults in the family or from older siblings/cousins to lose weight. However, girls experienced higher levels of perceived pressure to lose weight from the media than boys, and boys reported greater perceived pressure from peers to lose weight than girls, and more pressure than girls from all sources to increase muscle bulk. These findings are discussed in relation to research conducted in other contexts, and it is concluded that findings from other locations may not be applied universally.     

A comparison of actual-ideal weight discrepancy, body appreciation, and media influence between street-dancers and non-dancers

Previous work on body image has tended to treat dancers as a relatively homogenous group, despite the existence of different dance styles and genres. In the current study, we examined body image among individuals involved in street-dancing (genres that typically evolved outside formal settings and are often improvisational in nature) and an age-matched comparison of non-dancers. A total of 83 street-dancers and 84 non-dancers completed scales measuring their actual-ideal weight discrepancy, body appreciation, sociocultural attitudes toward appearance, and demographics. Controlling for participant body mass index (BMI), results showed no significant between-group difference in actual-ideal weight discrepancy, although street-dancers had significantly higher body appreciation than non-dancers. In addition, media influences were implicated in body image concepts for both groups, although internalisation of athletic ideals was more important for street-dancers. These results are discussed in relation to the extant research on body image among dancers.     

Body image and cosmetic medical treatments

Cosmetic medical treatments have become increasingly popular over the past decade. The explosion in popularity can be attributed to several factors—the evolution of safer, minimally invasive procedures, increased mass media attention, and the greater willingness of individuals to undergo cosmetic procedures as a means to enhance physical appearance. Medical and mental health professionals have long been interested in understanding both the motivations for seeking a change in physical appearance as well as the psychological outcomes of these treatments. Body image has been thought to play a key role in the decision to seek cosmetic procedures, however, only recently have studies investigated the pre- and postoperative body image concerns of patients. While body image dissatisfaction may motivate the pursuit of cosmetic medical treatments, psychiatric disorders characterized by body image disturbances, such as body dysmorphic disorder and eating disorders, may be relatively common among these patients. Subsequent research on persons who alter their physical appearance through cosmetic medical treatments are likely provide important information on the nature of body image.     

Influence of weight loss therapy programs in body image self-perception in adults with intellectual disabilities

Some studies suggest that people with intellectual disabilities (ID) might show distortions regarding body image self-perception. The objectives of this study were to investigate whether people with ID could correctly identify their body image and to determine if participating in a weight loss therapy program (WLTP) influenced in any way that perception. For that purpose, an experiment was proposed and all along a weight loss therapy program, a comparison between a body image subjective measure, as the Stunkard scale, and an objective one, as body mass index, was performed. The results obtained showed that individuals with ID (n = 24) perceived in a wrong way their body image before any intervention program (58%). After applying the WLTP for ten weeks, an accentuation in this perception distortion (83%), mostly related with underestimation, was observed with respect to actual body mass index values. The strongest conclusion that can be drawn from this study is that people with ID do not correctly identify their body image. Furthermore, participating in WLTP influences their physical self-concept perception in the way that controlling two variables, as exercise and caloric restriction, causes greater disruption in that perception than controlling only one of them.     

Selfie-posting on social networking sites,body surveillance,and exercise for weight control among Chinese young women with low body mass index

Under the perspective of self-perception theory and objectification theory, this study aims to examine the association between selfie-posting on social networking sites (SNSs) and exercise for weight control among Chinese young women, as well as the mediating role of body surveillance. A sample of 467 Chinese female students with a BMI lower than 24 were recruited. Participants voluntarily completed questionnaires assessing their selfie-posting behavior on SNSs, body surveillance, and their weight control motivation for exercise. The results show that selfie-posting on SNSs is positively associated with exercise for weight control, and that body surveillance significantly mediates this association. The results suggest that interventions targeting selfie behaviors on SNSs may be an effective way to prevent unhealthy exercise motivations, such as exercise for weight control, among young women with a low BMI.     

The link between women's body image disturbances and body-focused cancer screening behaviors: A critical review of the literature and a new integrated model for women

A large body of literature demonstrates the association between body image disturbances and health compromising behaviors among women (e.g., pathological eating, substance use, inappropriate exercise). However, given that disturbed body image is a pervasive problem, it is likely inversely related to health maintenance behaviors. Cancer screenings for breast, skin, and cervical cancer represent an important type of health maintenance behavior, yet adherence rates are low. Given the body-focused nature of these screenings, body image may be a salient predictor. This paper reviews the literature on the relationship between body image disturbances and cancer screening behaviors among women culminating in the proposal of a theoretical model. This model posits that body shame and body avoidance predict performance of cancer screenings and that variables drawn from the cancer literature, including risk perception, health anxiety, subjective norms, and self-efficacy, may moderate this relationship. Clinical implications and suggestions for research are discussed.     

Body-image and obesity in adolescence: a comparative study of social-demographic, psychological, and behavioral aspects

In current society, body and beauty's cult emerge as one of the main factors of adolescence. That leads adolescents to be dissatisfied with their own appearance, to psychological maladjustment, and nutritional disorders. This quantitative, exploratory, and cross-sectional research evaluates how adolescents perceive their weight and the prevalence of obesity in a sample of adolescents from the district of Viseu (Portugal). It also attempted to compare the relation of body-image and obesity with sociodemographic (school, sex, age, socioeconomic status, family functioning), psychological (self-concept, depression, school success) and behavioral aspects (physical inactivity). After data analyses, it was verified that the prevalence of obesity was 8.8% but 12.7% considered themselves obese. These adolescents had higher physical inactivity, poorer family functioning, a lower self-concept, and a higher depression index. The really obese adolescents were older and had poorer academic results. Obesity was higher in boys, but girls perceived themselves more as being obese. In conclusion, it is essential to evaluate weight perception in addition to body mass index (BMI), because the main problem could be related not only to being obese, but also to the perception of having a higher than ideal weight.     

Perceived control, coping efficacy, and avoidance coping as mediators between spouses' unsupportive behaviors and cancer patients' psychological distress.

This study examined whether avoidance, coping efficacy, and perceived control mediate the effects of spouses' unsupportive behaviors on patient psychological distress among 191 married individuals enrolled in cancer treatment. Results of the structural equation analyses suggested that avoidance and coping efficacy mediated the relationship between spouses' unsupportive behaviors and patient psychological distress. Perceived control of emotional aspects of the illness, including emotional responses and relationships with family and friends, and perceived control of the medical course of the cancer did not mediate the relationship between spouses' unsupportive behaviors and patient psychological distress. These findings suggest 2 mechanisms to explain why unsupportive responses from spouses may be associated with psychological distress among cancer patients.     

Body Image: A Study in a Tri-Ethnic Sample of Low Income Women

This study was designed to examine the evaluative, affective, and behavioral components of body image among 1,217 low-income European American, African American, and Latina women. Participants completed a multidimensional body image questionnaire while awaiting an outpatient clinic appointment. Body mass index (BMI) was determined by medical chart review. Nearly all normal weight and a number of overweight and obese African Americans characterized their weight as normal. In contrast, nearly all overweight and obese European Americans and Latinas regarded themselves as overweight as did over 30% of those of normal weight. European Americans and Latinas with higher BMIs reported more appearance shame than their lower BMI peers did; this pattern was not observed among African Americans. Among Latinas, body image was influenced by length of residency in the U.S. Dr. Berenson is supported by Grant Number K24HD043659, a Midcareer Investigator Award in Patient-Oriented Research, from the National Institute of Child Health and Human Development. Heather Littleton is now at Sam Houston State University.