Multidimensional body image comparisons among patients with eating disorders,body dysmorphic disorder,and clinical controls: A multisite study

Body image disturbance is considered a core characteristic of eating disorders and body dysmorphic disorder (BDD), however its definition has been unclear within the literature. This study examined the multidimensional nature of body image functioning among individuals with either anorexia nervosa (AN; n = 35), bulimia nervosa (BN; n = 26), or BDD (n = 56), relative to female (n = 34) and male (n = 36) psychiatric controls. Participants were recruited from 10 treatment centers in the United States and England and completed psychometrically validated and standardized self-report measures of body image. Overall, the AN, BN, and BDD groups were characterized by significantly elevated disturbances in most body image dimensions relative to their gender-matched clinical controls. There was variability, however, in the comparisons among the three groups of interest, including foci of body dissatisfaction and body image coping patterns. On omnibus indices of body image disturbance and body image quality of life, patients with BDD reported more body image impairment than those with eating disorders. Although AN, BN, and BDD are characterized by body image disturbances, similar and partially distinctive cognitive, behavioral, and emotional elements of body image functioning exist among these groups. The study's empirical and clinical implications are considered.     

Exposure-Based Family Therapy (FBT-E): An Open Case Series of a New Treatment for Anorexia Nervosa

The overlap between anorexia nervosa (AN) and anxiety disorders has led to the development of anxiety-based etiological models of AN and anxiety-based interventions for AN, including exposure treatment. Family-based treatment (FBT) is an efficacious intervention for adolescents with AN; however, it has recently been proposed that FBT accomplishes parent-facilitated exposure and habituation to food and related triggers in the individual's natural environment. FBT was recently altered to include an explicit exposure component that targets the broad construct of anxiety, including fear, worry, and disgust. This case series examines the application of FBT with an exposure component (FBT-E) to a group of adolescents meeting diagnostic criteria for AN (n = 4) and eating disorder not otherwise specified–restricting type (SAN, n = 6). Ten outpatients (ages 12–17, mean age: 15.28) participated in a course of FBT-E. Session-by-session weight was examined, along with BMI at pre- and posttreatment and responses to self-report measures of eating disorder symptoms (Eating Disorder Examination Questionnaire; EDE-Q), depression and anxiety. Parent reports of their adolescents' anxiety were also collected. The results of this study provide preliminary evidence that FBT-E may effectively target disordered eating and anxiety symptoms and may be a viable alternative to traditional FBT. Implications and future directions are discussed.     

Randomized Controlled Trial of an Internet-Based Cognitive-Behavioral Treatment Program for Binge-Eating Disorder

Binge-eating disorder (BED) is a prevalent health condition associated with obesity. Few people with BED receive appropriate treatment. Personal barriers include shame, fear of stigma, geographic distance to mental health services, and long wait-lists. The aims of this study were to examine the efficacy of an Internet-based cognitive-behavioral intervention for adults with threshold BED (DSM-IV) and to examine the stability of treatment effects over 12 months. Participants were randomly assigned to a 16-week Internet-based cognitive-behavioral intervention (n = 69) or a wait-list condition (n = 70). Binge-eating frequency and eating disorder psychopathology were measured with the Eating Disorder Examination–Questionnaire and the Eating Disorder Examination administered over the telephone. Additionally, body weight and body mass index, depression, and anxiety were assessed before and immediately after treatment. Three-, 6-, and 12-month follow-up data were recorded in the treatment group. Immediately after the treatment the number of binge-eating episodes showed significant improvement (d = 1.02, between group) in the treatment group relative to the wait-list condition. The treatment group had also significantly reduced symptoms of all eating psychopathology outcomes relative to the wait-list condition (0.82 ≤ d ≤ 1.11). In the treatment group significant improvement was still observed for all measures 1 year after the intervention relative to pretreatment levels. The Internet-based intervention proved to be efficacious, significantly reducing the number of binge-eating episodes and eating disorder pathology long term. Low-threshold e-health interventions should be further evaluated to improve treatment access for patients suffering from BED.     

Exploring the integration of thin-ideal internalization and self-objectification in the prevention of eating disorders

Analyses of thin-ideal internalization and self-objectification were conducted within the context of a cognitive dissonance based eating disorder prevention program implemented in an undergraduate sorority. Participants completed self-report assessments at baseline (n = 177), post-intervention (n = 169), 5-month (n = 159), and 1-year follow-up (n = 105). Cross-sectional path analysis indicated that thin-ideal internalization and self-objectification predict each other and both predict body dissatisfaction, which in turn, predicts eating disorder symptoms. A longitudinal examination conducted using hierarchical linear modeling indicated that participants showed significant reductions in thin-ideal internalization, self-objectification, body dissatisfaction, and eating disorder symptoms after participating in the prevention program. Reductions of symptoms were maintained 1-year post-intervention, with the exception of self-objectification, which was significantly reduced up to 5-months post-intervention. Collectively, results suggest that targeting both thin-ideal internalization and self-objectification simultaneously within eating disorder prevention programs could increase the reduction of eating disorder symptoms.     

Integrative Response Therapy for Binge Eating Disorder

Binge eating disorder (BED), a chronic condition characterized by eating disorder psychopathology and physical and social disability, represents a significant public health problem. Guided self-help (GSH) treatments for BED appear promising and may be more readily disseminable to mental health care providers, accessible to patients, and cost-effective than existing, efficacious BED specialty treatments, which are limited in public health utility and impact given their time and expense demands. No existing BED GSH treatment has incorporated affect regulation models of binge eating, which appears warranted given research linking negative affect and binge eating. This article describes Integrative Response Therapy (IRT), a new group-based guided self-help treatment based on the affect regulation model of binge eating, which has shown initial promise in a pilot sample of adults meeting DSM-IV criteria for BED. Fifty-four percent and 67% of participants were abstinent at posttreatment and 3-month follow-up, respectively. There was a significant reduction in the number of binge days over the previous 28 days from baseline to posttreatment [14.44 (± 7.16) to 3.15 (± 5.70); t = 7.71, p < .001; d = 2.2] and from baseline to follow-up [14.44 (± 7.16) to 1.50 (± 2.88); t = 5.64, p < .001; d = 1.7]. All subscales from both the Eating Disorder Examination–Questionnaire and Emotional Eating Scale were significantly lower at posttreatment compared to baseline. One hundred percent of IRT participants would recommend the program to a friend or family member in need. IRT's longer-term efficacy and acceptability are presently being tested in a NIMH-funded randomized controlled trial.     

Screening Solid Foods Infants 1 (SSFI-1) development of a screening tool to detect problems in the transition from milk to solid food in infants from six to nine months of age

AimTo establish the psychometric properties of a newly developed screening tool Screening Solid Foods Infants 1 (SSFI-1) used by early childhood professionals, to detect problems in the transition from milk to solid food of smooth consistency in infants 6–9 months of age.MethodsThe SSFI-1 score was filled out by the parents of a subgroup with term infants (n = 35); healthy preterm infants (n = 26); infants with comorbidity (n = 17); infants with feeding problems (n = 13). Internal consistency, reproducibility, construct, criterion and related validity was evaluated.ResultsThe preterm subgroup differed significantly in age when starting with fruits/vegetables and period of experience (p < 0.01). The SSFI-1 was sufficiently reliable for the total group and term subgroup (α = 0.78 and 0.76), but not for the preterm and comorbidity/feeding problem subgroup (α = 0.51 and 0.69). Inter-rater reliability was high for the total score (n = 25, ICC r = 0.93), and moderate to good for individual items (weighted kappa range 0.55–0.95). Validity was confirmed by significantly higher scores for the comorbidity/feeding problem subgroups and clinically distinguishable subgroups (p < 0.05) and area under the curve values > 0.78. The initial 10-item screening tool was modified to a seven item screening tool. A SSFI-1 score of 4, +2 SD of the term subgroup, had 76.9% sensitivity and 82.1% specificity, for detecting the presence of a feeding problem.ConclusionThe seven-item screening tool Screening Solid Foods 1 may be used as a screening tool for term infants. Further testing of the SSFI-1 in new infants is needed, to confirm reliability and validity both for term, preterm and (risk for) feeding problem infants.     

The Child Food Rejection Scale: Development and validation of a new scale to assess food neophobia and pickiness among 2- to 7-year-old French children

IntroductionThe two strongest obstacles to extend children's consumption of fruit and vegetables are food neophobia and pickiness, assumed to be the main kinds of food rejection in children. Accordingly, psychometric tools that provide a clear assessment of these kinds of food rejections are greatly needed.ObjectiveTo design and validate a new scale for the assessment of food neophobia and pickiness, thus filling a major gap in the psychometric assessment of food rejection by French children.MethodWe concentrated on French children aged 2–7 years, as no such scale exists for this young population, and on the two known dimensions of food rejection, namely food neophobia and pickiness, as the nature of the relationship between them is still unclear. The scale was tested on two samples (N₁ = 168; N₂ = 256) of caregivers who responded for their children. Additionally, a food choice task was administered to 17 children to check the scale's predictive validity.ResultsThe resulting scale, called the Child Food Rejection Scale (CFRS), included six items relating to food neophobia and five items relating to pickiness. A factor analysis confirmed the two-dimensional structure of the scale. Internal consistency, test–retest reliability, and convergent and discriminant validity were all satisfactory. Moreover, results from the food choice task showed that scores on the CFRS accurately predicted children's attitudes toward new and familiar foods.ConclusionTaken together, these findings suggest that the CFRS, a short and easy-to-administer scale, represents a valuable tool for studying food rejection tendencies in French children.     

Effects of exercise self-regulation on subsequent eating self-regulation: Implications for depletion vs. improvement based on behavioral treatment foci

IntroductionAn improved understanding of individuals’ ability to self-regulate through barriers in the management of their weight-loss behaviors is important. Although self-regulation related to exercise might carry-over to increased eating-related self-regulation through the development of such skills, it also might be depleted because self-regulation is thought to be a limited resource. Additionally, mood might affect self-regulation change.ObjectiveThis field study aimed to determine if exercise-related self-regulation was associated with subsequent eating-related self-regulation, how treatment foci affected that relationship, and if mood change concurrently influenced self-regulation.MethodAn educational weight-loss treatment (n = 52) and a behaviorally based self-regulatory-focused treatment (n = 57) was administered to women with obesity via a community health-promotion setting. Baseline – Month 3 changes in their exercise self-regulation and overall negative mood, and Months 3–6 change in eating self-regulation, were assessed.ResultsImprovements were significantly greater in the self-regulation treatment group on exercise self-regulation, eating self-regulation, and mood. For the self-regulation group, there was a significant positive relationship between changes in exercise self-regulation and eating self-regulation, β = 0.27, p = 0.044. Conversely, the association of those variables was significant and inverse in the educational group, β = −0.29, p = 0.039. Reduction in negative mood was significantly related to increased exercise self-regulation, across groups, β = −0.32, p = 0.001.ConclusionWhen self-regulation was focused upon and rehearsed within an exercise context, its changes positively affected subsequent changes in eating self-regulation. However, when self-regulation was not targeted, self-regulation used for maintaining exercise depleted eating-focused self-regulation. Findings contributed to self-regulatory theory and had implications for the improvement of behavioral weight-loss treatments.     

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.     

Achievement goal theory and disordered eating: Relationships of disordered eating with goal orientations and motivational climate in female gymnasts and dancers

ObjectivesTo examine the relationships between disordered eating in female gymnasts and dancers and their perspective towards achievement in sport and dance, respectively. With an emphasis on outperforming others (ego involvement), more disordered eating was expected than when personal progress (task involvement) was emphasized.MethodsNinety-four aesthetic performers from gymnastics (n = 59) and dance (n = 35) completed questionnaires measuring ego and task involvement (individual orientation and motivational climate), dieting, self-esteem, perfectionism and weight-related peer and coach pressure.ResultsPartial correlations indicated that a stronger ego orientation was related to more dieting, greater perfectionism, more weight-related peer pressure, and lower self-esteem. Similar relationships were found for performance climate. Mastery climate on the other hand was negatively related to dieting, and coach and peer pressure, suggesting that when performers perceived the motivational climate as mastery, less frequent dieting was reported and less weight-related coach and peer pressure was perceived. No relationships were found between task orientation and disordered eating. Most importantly, regression analysis showed that after controlling for BMI, both ego orientation and mastery climate made a unique significant contribution to explaining dieting variance.ConclusionsGoal achievement theory is an important framework for explaining disordered eating in female aesthetic performers. Both ego orientation and mastery climate play a role in dieting of gymnasts and dancers. Aesthetic performers who are strongly ego-oriented tend to display more disordered eating correlates. Furthermore, it seems that to protect against disordered eating, coaches and teachers should create a mastery climate and target self-improvement and self-referenced comparisons over interpersonal competitiveness.     

Emotional eating and cognitive conflicts as predictors of binge eating disorder in patients with obesity

Background/Objectives: Binge Eating Disorder (BED) is often associated with obesity. In order to identify the variables that allow to better detect the presence of BED, people with overnutrition were compared with and without BED in the presence of cognitive conflicts, eating symptoms and anxious-depressive symptoms. The inclusion of cognitive conflicts had been relevant in bulimia studies but had not been investigated with respect to BED. Method: Two groups with obesity were evaluated, one without BED (OB, n = 54) and the other with BED (OB-BED, n = 48), using a social-demographic questionnaire as well as a semi-structured interview to assess BED, questionnaires (DASS-21, EDE-Q, EEQ) and the Repertory Grid Technique. Results: Overall, the OB-BED group presented more conflicts and more symptoms. The model that best differentiated between the groups included emotional eating and level of cognitive conflicts, correctly classifying 91.4% of the sample. Conclusion: These results highlight the role played by cognitive conflicts and emotional eating as differentiating elements between OB and OB-BED, with a high level of predictive accuracy.     

Personal values and unsanctioned aggression inherent in contact sports: The role of self-regulatory mechanisms,aggressiveness, and demographic variables

IntroductionTo date, research-examining factors related to the sociocognitive self-regulatory mechanisms governing unsanctioned aggression have received scant attention in applied sport psychology.ObjectiveA mediating model as influenced by various demographic variables was applied to explore the relationships between athletes’ personal values and their unsanctioned aggression directly and indirectly through the mediating role of resistive self-regulatory efficacy, moral disengagement, and aggressiveness.MethodA sample of 301 French competitors of different age (young: n = 200 and adult: n = 101), gender (male: n = 172 and female: n = 129), type of sport (high: n = 131 and low contact: n = 170), level of competition (beginner: n = 115, intermediate: n = 110, and advanced: n = 76), and length of practice (brief: n = 109, intermediate: n = 49, and extensive: n = 143) completed a questionnaire assessing the aforementioned variables.ResultsStructural equation modelling demonstrates that self-transcendence and self-enhancement values have only indirect negative and positive effects, respectively, on unsanctioned aggression through the full mediating effect of the mediators. Also, age, gender, and type of sport were predictive only of some personal values and mediators.ConclusionThese findings offer evidence that resistive self-regulatory efficacy, moral disengagement, and aggressiveness are mediators that fully govern the impact of athletes’ personal values and certain demographic variables on their unsanctioned aggression. Several limitations, implications and suggestions for further research are discussed.     

Comparison of fetal and maternal heart rate measures using electrocardiographic and cardiotocographic methods

PurposeTo determine the reliability at term of: (1) two methods of measuring fetal heart rate (HR), electrocardiographic (ECG, the ‘gold standard’) and cardiotocographic (CTG) and (2) two ECG methods of measuring maternal HR variability over relatively brief periods of time (s–min).MethodsDuring 20 min of rest (N = 39) and during 2 min of auditory stimulation (mother's recorded voice, n = 19), fetal HR data were collected using an ECG (Monica AN24) and a Hewlett-Packard Model 1351A CTG. Simultaneously, maternal HR data (n = 37) were collected using the same ECG device (Monica AN24) and a second stand-alone cardiac monitor (Spacelab 514T cardiac monitor with a QRS detector).ResultsDuring 20 min of maternal rest, correlations of individual fetal CTG with ECG measures of HR at each second were moderate to high (r = .57–.97) for 77% of fetuses. Correlations of HR averaged over fetuses and over each of the 20 min were high (r = .93–.97); fetal HR averaged over 20 min varied between devices from 0.0 to 0.8 bpm. During 2 min of maternal voice presentation, correlations of fetal HR over each second were moderate to high (r = .54–.99) for 95% of fetuses and high (all rs = .99) when averaged across fetuses in 30 s or 2 min epochs. Average fetal HR between devices over the 2 min voice varied from 0.0 to 0.6 bpm. Correlations and/or % agreement between the two ECG methods of measuring maternal HR were high. Average maternal HR over 10 min showed 81% of pairs with a difference of ≤1 bpm; correlations for HR variability measures varied from r = .89 to .97.ConclusionsGood reliability was demonstrated between individual spontaneous and auditory induced fetal CTG and ECG with high correlations when HR data were averaged over fetuses or in 30–120 s epochs. High reliability of maternal HR measures was obtained using two ECG devices.     

Personality traits and body mass index in Asian populations

Research on personality and adiposity has focused primarily on Western samples; less is known about the personality correlates of BMI in Asian populations. We examined the association between personality and body mass index (BMI) among community-dwelling Japanese adults (N = 380), Chinese adolescents (N = 5882), and a meta-analysis inclusive of a published Korean sample (total N = 10,304). In the new samples and meta-analysis, Extraversion and Agreeableness were associated with higher BMI among men. In contrast to what is often found in Western samples, Conscientiousness was mostly unrelated to adiposity. These findings link pro-social tendencies to overweight among Asian men; Conscientiousness may be less relevant for BMI in Eastern societies with a low prevalence of obesity and strong social norms for eating but not thinness.     

Under what conditions do lay people and health professionals accept a breach of doctor-patient confidentiality regarding a patient with signs of terrorist radicalization?

IntroductionConfidentiality is crucial to the establishment of a strong patient-physician relationship. However, certain situations create a dilemma for the physician who is faced with the choice of either respecting medical confidentiality or protecting others from a serious risk of violence.ObjectiveThis study aimed to observe how lay people and health professionals assessed the acceptability of breaching confidentiality when a physician is confronted to a patient showing signs of terrorist radicalization.MethodA total of 228 participants (174 from the general population and 54 health professionals) judged the acceptability of 54 scenarios which were constructed through the orthogonal combination of 4 factors frequently mentioned in the literature: presence of a “Psychiatric disorder”; “Signs of radicalization”; “Projects of violence”; “Collegiality”. Variance and cluster analyses were performed on all the raw data.ResultsResults showed that all factors influenced the judgment of participants but that “Psychiatric disorders” had a weaker impact. Five clusters were identified: “Favorable if collegiality” (n = 23); “Favorable to breach confidentiality” (n = 77); “Unfavorable to breach confidentiality” (n = 26); “Sensitive to all factors” (n = 71); “Favorable if violence” (n = 31), respectively with mean ratings of 5.87, 8.42, 3.64, 6.30 and 7.16, on an acceptability scale of 0–10.ConclusionThe importance that the great majority of participants attribute to these factors indicates that they influence their judgments in this specific context.     

Weight stigmatization and disordered eating in obese women: The mediating effects of self-esteem and fear of negative appearance evaluation

ObjectiveThe aim of this study is to examine whether self-esteem and fear of negative appearance evaluation are significant mediators in the association between weight-related self-devaluation and disordered eating.MethodA sample of obese Canadian women (N = 111, M age = 40.9, SD = 10.2) completed the Weight Self-Stigma Questionnaire (WSSQ), the Rosenberg Self-Esteem Scale (RSES), the Fear of Negative Appearance Evaluation Scale (FNAES), and the Eating Disorder Examination Questionnaire (EDE-Q).ResultsSelf-esteem mediated the relationship between weight-related self-devaluation and restraint and weight concerns, whereas fear of negative appearance evaluation mediated the relationship with weight, shape and eating concerns.ConclusionSince, for obese women, self-esteem and fear of negative appearance evaluation are likely to maintain disordered eating, they should be more frequently taken into consideration by researchers, health professionals and public policy stakeholders.     

Generalization of theory-based predictions for improved nutrition to adults with morbid obesity: Implications of initiating exercise

Exercise is a robust predictor of long-term success with weight loss, and research based on social cognitive theory suggests that exercise program-induced changes in self-regulation, mood, and self-efficacy transfer to improved eating. These relationships were tested in adults with morbid obesity (overall M_age = 43 years; 86% female; M_{body mass index} = 45 kg/m²) participating in a 6-month treatment of cognitive-behaviorally supported exercise paired with either standard nutrition education (n = 87) or cognitive-behavioral methods for controlled eating (n = 89). Based on multiple mediation analyses, improvements in self-regulation and self-efficacy were significantly associated with increased fruit and vegetable intake and reduced body mass index (BMI). The cognitive-behavioral nutrition methods were associated with greater improvements in fruit and vegetable intake and BMI, however, within both models, complete mediation was found after simultaneous entry of changes in self-regulation, mood, and self-efficacy, and exercise volume as mediators. Only the indirect effect of change in self-regulation was a significant (or marginally significant) independent mediator. Generalization of previously identified relationships between exercise program-induced improvements in psychosocial variables and improvements in nutrition and BMI were supported for individuals with morbid obesity. Based on these relationships, implications for behavioral treatments were discussed.     

The Spanish validation of the Short Health Anxiety Inventory: Psychometric properties and clinical utility

Background/ObjectiveThe Short Health Anxiety Inventory (SHAI) is a widely used self-report instrument to evaluate health anxiety. To assess the SHAI's factor structure, psychometric properties, and accuracy in differentiating Spanish non-clinical individuals from patients with severe health anxiety or hypochondriasis.MethodA total of 342 community participants (61.6% women; M_age = 34.60, SD = 14.91) and 31 hypochondriacal patients (51.6% women; M_age = 32.74, SD = 9.69) completed the SHAI and other self-reports assessing symptoms of hypochondriasis, depression, anxiety sensitivity, worry, and obsessive-compulsive.ResultsThe original two-factor structure was selected as the best structure, based on its parsimony and empirical support (Factor 1: Illness likelihood; Factor 2: Negative consequences of illness). Moreover, the Spanish version of the SHAI demonstrated good construct and concurrent and discriminant validity, and internal consistency. A cutoff of 40.5 (total score) accurately distinguished non-clinical individuals from patients with severe health anxiety or hypochondriasis.ConclusionsThe SHAI is an adequate screening instrument to measure health anxiety in Spanish-speaking community adults.     

Clinical functioning and cutoff of eccentricity dimension with psychiatric patients and non-patients

ObjectivesThis study investigated the Eccentricity scale's clinical functioning from the Dimensional Clinical Personality Inventory 2 (IDCP-2). Additionally, we sought to establish a cutoff for a screening scenario to be taken as the first indicator of Eccentricity characteristics’ possible clinically relevant functioning.MethodIn total, 2167 adults, aged from 18 to 90 years (M = 28.98, SD = 11.12), being 1244 women (63%), and the majority of undergraduate students (67.9%). Total sample was comprised into five groups, namely, outpatients diagnosed with both schizotypal and schizoid PDs (n = 3), outpatients diagnosed with schizotypal PD (n = 5), outpatients diagnosed with schizoid PD (n = 2), outpatients diagnosed with other PDs and clinical disorders (n = 172), and a general population-based sample (n = 1985). Not all participants answered all the items from IDCP-2; therefore, we used the equating procedure.ResultsThe groups were statistically different in ANOVA. For the −0.40 cutoff in the theta metric scale, equivalent to a total score of 38, the area under the curve was equal to 0.85, reaching 90% of sensitivity and 87.4% of specificity.ConclusionsFindings provide clinical data on the Eccentricity scale, supporting its professional use in a clinical setting; specifically, we suggested a clinical cutoff to the scale, helping the professional address typical characteristics from schizoid schizotypal functioning.     

Testing the Tripartite Influence Model of body image and eating disturbance among Hungarian adolescents

We tested the Tripartite Influence Model of body image and eating disturbance on two separate samples of Hungarian boys (n = 145) and girls (n = 225), aged 10–16 years. Our results supported the model among Hungarian adolescents; however we found notable gender differences. The associations were stronger in girls compared to boys; moreover, internalization and body dissatisfaction mediated the relationship between appearance-related sociocultural influences and self-esteem only in girls. BMI and weight perception were also involved in the model, and we could present evidence that the sociocultural influence and the weight perception predict independently body dissatisfaction. Our data are in line with previous results; however, further exploration of gender, age, and culture-related differences in the pattern of associations may contribute to the refinement of intervention programs.