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A large body of research suggests that thin-ideal internalization is a robust predictor of eating pathology in women and, to some degree, in men. Recent research is exploring the relationships between thin-ideal internalization and culture-specific factors that may be salient to women and men who live in the US but are marginalized based on racial or ethnic background, such as acculturation. This systematic review summarizes published articles examining the relationships among thin-ideal internalization, acculturation-related constructs (including assimilation, marginalization, biculturalism, and acculturative stress), and eating pathology in US adults. Following the PRISMA method, 15 empirical studies met inclusion criteria. Although existing literature was sparse and conflicting in large part due to heterogeneity in acculturation measures, results yielded some support for positive correlational relationships between acculturative stress, thin-ideal internalization, and eating pathology for both men and women (in 4 out of 5 relevant studies). Research on other aspects of acculturation (eg, integration, assimilation) is mixed, with some existing research suggesting a positive relationship and other research finding no statistically significant relationship. Future research would particularly benefit from a gold-standard, multidimensional transcultural measure of acculturation to examine how the acculturation process relates to thin-ideal internalization and eating pathology in ethnic and racial minorities in the US. more...

The nature and presentation of eating pathology in ethnically diverse men are not well defined. This study examined associations among ethnicity, body image, and eating pathology in nonclinical college men (N = 343). Analysis of variance analyses indicated that markers of eating, weight, and shape concerns differed by ethnicity: Asian and Hispanic/Latino men reported more pathological levels than European and African American men. Hierarchical multiple regression analyses indicated that ethnicity moderated the relationship between drive for muscularity and body checking, which was strongest for Asian men. Results increase awareness of how ethnicity interacts with body image and eating pathology, which underscores the need for individualized, culturally sensitive treatment for ethnically diverse men. more...

This article reports the results of a qualitative exploration of fat women’s experiences with weight-related microaggressions in psychotherapy. We conducted semi-structured interviews with ...

Objective We examined whether media exposure and media-induced stress contributed to eating disorder behaviors immediately and over the course of a day in women with anorexia nervosa (AN). Method Women with AN (N = 118) completed a 2-week ecological momentary assessment protocol during which they reported on exposure to food, shape, or weight-related media, associated stress, and eating behaviors. Results Food, weight, or shape-related media exposure alone did not predict more frequent daily eating disorder behaviors. However, stress associated with media exposure was prospectively associated with a greater likelihood of binge eating and vomiting at the next assessment point. In addition, media-induced stress increased the probability of restrictive eating and fluid intake, vomiting, and laxative abuse across the day. Discussion Media-induced stress may contribute to increased eating disorder behaviors in women with AN, as women who saw a media image and reported this experience as stressful were more likely to engage in momentary binge eating or vomiting. Reducing stress associated with viewing media images could be a potential target for therapeutic intervention with disordered eating. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:617–621). more...

Objective The overarching purpose of this study was to explore the relationships among acculturative stress, self-esteem, and eating pathology in Asian American and Latina female college students. Method Participants (N = 638, mean age = 19.88) completed self-report measures of the variables of interest online. Results Bivariate correlations indicated that for women of both ethnic groups, acculturative stress was negatively correlated with self-esteem and positively correlated with eating pathology. Multigroup structural equation modeling indicated that for Asian American and Latina women, self-esteem partially mediated the relationship between acculturative stress and eating pathology. However, self-esteem did not serve as a significant moderator of this relationship for either ethnic group. Conclusion Overall, data suggest that acculturative stress is associated with increased eating pathology and self-esteem may mediate this relationship. These relationships suggest that assessment of eating pathology and self-esteem may be indicated for women presenting clinically with acculturative stress concerns. more...

While the Body Checking Questionnaire (BCQ; Reas et al., 2002 ) is the most commonly-used measure of body checking behaviors, findings on the factor structure in nonclinical samples are mixed. This study investigated the factor structure and psychometric properties of the BCQ among nonclinical college women. In Study 1 (n = 326), an exploratory factor analysis indicated factors corresponding to (a) behavioral and (b) visual checking. In Study 2 (n = 1013), a confirmatory factor analysis revealed adequate fit for these factors, better than the original or total score solutions. Scales based upon the two factors demonstrated good internal consistency, convergent validity with measures of eating pathology, and sensitivity for detecting at-risk eating pathology. Results suggest an alternate two-factor solution that differs from the original three-factor solution. more...

a b s t r a c t Despite research documenting a relationship between social anxiety and perfectionism, very little research has examined the relationship between social anxiety and clinical perfectionism, defined as the combination of high personal standards and high maladaptive perfectionistic evaluative concern. In the current studies we examined whether clinical perfectionism predicted social anxiety in a large sample of undergraduates (N = 602), in a clinical sample of participants diagnosed with social anxiety disorder (SAD; N = 180), and by using a variance decomposition model of self- and informant-report of perfectionism (N = 134). Using self-report, we found that an interaction of personal standards and eval- uative concern predicted both social interaction anxiety and fear of scrutiny, but not in the theorized direction. Specifically, we found that self-report of low standards and high evaluative concern was asso- ciated with the highest levels of social anxiety, suggesting that when individuals with SAD hold low expectations for themselves combined with high concerns about evaluation, social anxiety symptoms may increase. Alternatively, when an informants' perspective was considered, and more consistent with the original theory, we found that the interaction of informant-only report of personal standards and shared-report (between both primary participant and informant) of concern over mistakes was associ- ated with self-reported social anxiety, such that high concern over mistakes and high personal standards predicted the highest levels of social anxiety. Theoretical, clinical, and measurement implications for clinical perfectionism are discussed. more...

Few studies examine the mechanisms that link body image to sexual satisfaction in women. Using the tenets of objectification theory, this study investigated the relationships between body surveillance, body shame, body self-consciousness during sexual activities, and sexual satisfaction in an ethnically diverse sample of American female college students (N = 368), while controlling for relationship status and body mass index. Results based on self-report measures of these constructs suggested that body shame and body self-consciousness during sexual activity were negatively correlated with sexual satisfaction. Additionally, path analysis indicated that body surveillance predicted increased body self-consciousness during sexual activity, partially mediated by body shame. Body self-consciousness, in turn, predicted decreased sexual satisfaction. Overall, study findings highlight the negative consequences of body image concerns for women's sexual satisfaction. more...

Objective The goal of this study was to create a Spanish version of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) and examine its factorial validity, reliability, and convergent validity in a sample of women from Spain. Method Two hundred and sixty female college students from Spain completed the Spanish version of the SATAQ-4 and measures for eating pathology. Results Internal consistency was high; data from EFA and CFA supported the original five-factor structure; and results showed good convergent validity with measures of body-image and eating problems. Discussion Results strongly support the psychometric properties of the Spanish version of SATAQ-4 and its use to examine perceived pressure for thinness from parents, peers and the media; and thin- and muscular/athletic-ideal internalization in Spanish-speaking adult women. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:170–175) more...

Las mujeres reportadas a las agencias de servicios de protección infantil, con frecuencia presentan problemas que interfieren con la salud y el bienestar de ellas y de sus hijos. Los programas de intervención conductual parecen ser eficaces en el manejo de problemas coexistentes como: la violencia doméstica y el abuso de drogas. Sin embargo, los tratamientos cuya eficacia ya ha sido demostrada en ocasiones anteriores, rara vez se han puesto en práctica en casos clínicos complicados, sobre todo en los centros de asistencia a menores. Por lo tanto, en este caso clínico, se describe el proceso de adaptación de un tratamiento eficaz para ayudar a controlar los problemas coexistentes de salud de una mujer acusada de negligencia infantil y abuso de drogas. Al finalizar el tratamiento, la participante informó sobre la mejoría en sus relaciones familiares, sobre su consumo de drogas y la negligencia infantil; aunque otros resultados relacionados con su salud no quedaron completamente claros. Gran parte de las mejorías se mantuvieron hasta 4 meses después de haber concluido el tratamiento. Antes de implementar cada fase del tratamiento, discutimos los contextos de la comunidad, aumentando así la probabilidad de obtener resultados positivos y respetando la integridad y el ajuste del tratamiento estándar para evitar que se presenten problemas en un futuro.Esta investigación se financió gracias a una subvención del Instituto Nacional de Drogodependencia (1R01DA020548-01A1) otorgada a Brad Donohue. Los autores desean agradecer a Sally K. Miller, PhD, APN, FAANP y Profesora Asociada de la Escuela de Enfermería de La Universidad de Nevada Las Vegas, por el examen físico inicial que se llevó a cabo en el domicilio de la participante de este proyecto. more...

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. more...

Social anxiety and eating disorders are highly comorbid. Social appearance anxiety (i.e., fear of negative evaluation of one's appearance), general fear of negative evaluation, and perfectionism have each been proposed as risk factors for both social anxiety disorder and the eating disorders. However, no research to date has examined all three factors simultaneously. Using structural equation modeling in two diverse samples (N = 236; N = 136) we tested a model in which each of these risk factors were uniquely associated with social anxiety and eating disorder symptoms. We found support for social appearance anxiety as a shared risk factor between social anxiety and eating disorder symptoms, whereas fear of negative evaluation was a risk factor only for social anxiety symptoms. Despite significant zero-order relationships, two facets of perfectionism (high standards and maladaptive perfectionism) did not emerge as a risk factor for either disorder when all constructs were considered. These results were maintained when gender, body mass index, trait negative affect, and depression were included in the model. It is possible that treating negative appearance evaluation fears may reduce both eating disorder and social anxiety symptoms. more...

Objective The goal of this study was to translate the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3; Thompson, van den Berg, Roehrig, Guarda, & Heinberg, 2004) into Spanish and psychometrically evaluate the comparability of the Spanish translation to the original English version. Method 638 female college students from Spain and the United States completed the SATAQ-3 in Spanish and English, respectively. Results Internal consistency was high in both languages. Tests of factor equivalence suggested that the four pre-established factors of the SATAQ-3 (i.e., knowledge, perceived pressure, thin-ideal internalization, athletic-ideal internalization) were relatively similar between the two groups. Differences that emerged between groups (on items 6 and 20) were in the expected direction and appeared to be influenced by reverse-scoring or item wording. Conclusions Results support the psychometric properties of this Spanish translation of the SATAQ-3 and support its use to measure endorsement of Western values and ideals of appearance in adult women. more...

Dissatisfaction with one's physical appearance is rampant among women living in western cultures. However, little research has examined dissatisfaction with body areas that may be more salient to racial-minority groups (e.g., hair, eyes, skin colour). This study examined dissatisfaction with racially salient appearance areas and ethnic identity in self-identified black (n=76), white (n=104) and Latina (n=106) female college students in the southern USA. Results revealed that Latina women reported significantly more dissatisfaction with their eyes and nose than white and black women. Additionally, white and Latina women reported significantly more dissatisfaction with their facial features, lips, lower body and overall body than black women. Stronger ethnic identity predicted lower levels of body dissatisfaction on most appearance areas for all women. These results suggest that social scientists should consider racially salient appearance areas in the measurement and conceptualization of body dissa... more...

Although body dissatisfaction and drive for thinness are commonplace in college-aged women, their relationships with fat talk and stress are understudied. This study examined (a) whether fat talk predicts body dissatisfaction and drive for thinness and (b) whether stress moderates these relationships. Results from self-report questionnaires completed by 121 female college students revealed that fat talk and perceived stress were significantly positively correlated with body dissatisfaction and drive for thinness. Although fat talk was a significant independent predictor of body dissatisfaction and drive for thinness, stress moderated these relationships such that they were stronger at lower stress levels. Although contrary to predictions, these results are logical when means are considered. Results suggest that fat talk positively predicts body dissatisfaction and drive for thinness in students with relatively lower stress levels, but does not for students under high stress because mean levels of these constructs are all already high. more...

Mainstream North American media promotes the message that attaining a thin, youthful appearance is central to a woman’s value and social role while appearing older is highly undesirable. However, appearance ideals and attitudes toward aging differ substantially across cultural and ethnic groups, which may influence the degree to which one internalizes media ideals and holds anti-aging attitudes. Consequently, this study examined the relationships between internalization of the youthful, thin-ideal appearance perpetuated by mainstream North American media and attitudes toward the elderly in a sample of 281 undergraduate females under the age of 30 attending a university in the Western United States. Specifically, European American (n = 115), Asian American/Pacific Islander (n = 74), Hispanic/Latina (n = 52), and African American (n = 42) women voluntarily completed self-report measures of internalization of media ideals and attitudes towards older adults. Attitudes towards the elderly were significantly more negative at higher levels of internalization of North American appearance ideals, independent of ethnicity. These data suggest that internalization of North American appearance ideals perpetuated by media are related to negative attitudes towards older adults. Future research should investigate the influence of negative attitudes about aging on behaviors toward older adults or one’s own aging process. more...

Using a sociocultural framework, this cross-sectional study examined eating pathology among 235 Latino adolescents from the Southwestern U.S. who differed in generational status. Participants completed self-report measures of media pressures, internalization, social comparison, and eating pathology. Overall, results revealed stronger relationships between these sociocultural variables and eating pathology for girls. Girls reported greater social comparison, thin-ideal pressure and internalization, and eating pathology than boys. Generational status was positively correlated with these sociocultural variables and eating pathology for girls only. Moderated hierarchical regression analyses indicated that athletic-ideal internalization was a key predictor of eating pathology for girls but not boys. Discussion highlights gender, more than generational status, as critical to a sociocultural framework for eating pathology among adolescent Latino Americans. more...

Patients with eating disorders bring unique challenges to treatment providers. The purpose of this study was to explore treatment providers' experiences working with patients with eating disorders. Specifically, we investigated 1) the frequency and management of commentary about the treatment providers' appearance from patients, 2) personal changes in affect, vigilance around appearance, and eating behaviors in treatment providers, and 3) feedback and suggestions about effectively working with these patients. Using quantitative and qualitative methods, 43 professional eating disorder treatment providers attending the Multiservice Eating Disorder Association (MEDA) annual conference completed a questionnaire created for this study. Results suggest that most treatment providers experienced direct and indirect commentary about their appearance from patients and experienced notable changes in their view of food, eating behaviors, and vigilance of their own and others' appearance while working with these patients. Recommendations and suggestions from treatment providers about effectively treating these patients and managing personal changes are explored. more...

To understand the relevance of the fear of fatness construct across culture and gender, we translated the Goldfarb Fear of Fat Scale (GFFS) and examined its psychometric properties in English and Spanish languages in a sample of Euro-American male (n = 111) and female (n = 100), and Spanish male (n = 114) and female (n = 544) college students in the United States and Spain. Confirmatory and exploratory analyses tested the measurement equivalence of the instrument across samples by gender and culture. Eight of the 10 items appeared to demonstrate measurement invariance. Mean comparisons on the eight-item version suggested that there was a gender by country interaction, with Euro-American women scoring substantially higher than the three other groups. Overall, these results highlight the need for additional examinations of cross-cultural instrument invariance and explorations of the fear of fatness construct. more...

English and Spanish versions of the FCQ-T [Cepeda-Benito, A., Gleaves, D. H., Williams, T. L., & Erath, S. A. (2000). The development and validation of the state and trait food-cravings questionnaires. Behavior Therapy, 31, 151-173] were adapted to create the food chocolate-craving questionnaire trait (FCCQ-T). Female college students from England (N=293), and Spain (N=373) completed the FCCQ-T. Good and similar measurement fits for the English and Spanish versions were found. In concordance with the higher consumption of chocolate in Britain, British women reported greater chocolate cravings than Spanish women. Overall, the FCCQ-T appears a well-suited instrument to investigate chocolate cravings in English- and Spanish-speaking populations. more...

The overarching purpose of this study was to explore the relationships among acculturative stress, self-esteem, and eating pathology in Asian American and Latina female college students.Participants (N = 638, mean age = 19.88) completed self-report measures of the variables of interest online.Bivariate correlations indicated that for women of both ethnic groups, acculturative stress was negatively correlated with self-esteem and positively correlated with eating pathology. Multigroup structural equation modeling indicated that for Asian American and Latina women, self-esteem partially mediated the relationship between acculturative stress and eating pathology. However, self-esteem did not serve as a significant moderator of this relationship for either ethnic group.Overall, data suggest that acculturative stress is associated with increased eating pathology and self-esteem may mediate this relationship. These relationships suggest that assessment of eating pathology and self-esteem may be indicated for women presenting clinically with acculturative stress concerns. more...

Objective Recent research offers conflicting views of whether women high in dietary restraint are inspired or demoralized after viewing thin-ideal images. We conducted two studies to explore the impact of diet commercials featuring the thin-ideal image on snack food consumption. Method In Study 1, 91 high school women watched a sad movie interrupted with diet or neutral commercials. In Study 2, 102 college women saw diet commercials early or midway through a sad movie. Results In Study 1, high restraint participants consumed more snacks after exposure to diet commercials than to neutral commercials. In Study 2, early commercials reduced snacking in low restraint women but not in high restraint women. Discussion Thin-ideal images embedded in diet commercials do not inspire high restraint women but can modify the eating of low restraint women. © 2005 by Wiley Periodicals, Inc. more...

We examined the potential for ethnicity to moderate the relationships between awareness and internalization of sociocultural ideals of appearance and between internalization and body dissatisfaction.Spanish (n = 100), Mexican American (n = 100), and European American (n = 100) female participants completed measures of sociocultural attitudes and body dissatisfaction. Path analysis using maximum likelihood with robust standard errors tested the relationships across and within ethnic groups.There was evidence for the mediational effect of internalization on the relationship between awareness and body dissatisfaction. Furthermore, both relationships were significantly stronger for European American women than for Mexican American or Spanish women (the predicted moderator effect).Results demonstrate how ethnicity may protect against the development of eating disorder symptoms and suggest that eating disorder prevention should involve denouncing the thin ideal, minimizing appearance as an indicator of value, and emphasizing traits other than appearance as determinants of worth. more...

Are the eating disorders discrete diagnostic entities or do they fall along one or more continua ranging from normal body weight, eating behavior, and weight concerns to severely disturbed patterns? Researchers have debated this question for at least 30 years and have used numerous creative strategies to examine this and related questions. This body of research is reviewed with particular attention to the more recent use of taxometric methods. Although somewhat mixed, much of the earlier research has been interpreted as supporting the continuity model. However, more recent taxometric research suggests the presence of one or more latent discontinuities, particularly with disorders associated with binge eating. These findings have implications for assessment, treatment, and possible prevention of eating disorders, and may ultimately allow us to better predict who will or will not develop an eating disorder in response to dieting, as well as who will or will not respond to particular treatments for an existing eating disorder. more...

Objective: For binge eating disorder (BED) to be accepted as a distinct diagnostic category in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, it must be demonstrated that the criteria identify a diagnostic entity that is distinct from bulimia nervosa and obesity. This study examined the difference in total energy intake per day, patterns of energy intake throughout the day, and nutrient content of foods consumed in obese individuals who met the criteria for BED (on binge and non-binge days) and those who did not. Research Methods and Procedures: Twenty women, 12 who met Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, criteria for BED and 8 matched obese controls, participated in the study. All participants underwent six random 24-hour dietary recall telephone interviews conducted by experienced interviewers using the Nutrition Data Software System. Results: The BED group ingested significantly more kilocalories on days when they had binge eating episodes than the obese control group on average. The BED group ate significantly more in the evening on binge days than their control group counterparts. There is some indication in the data that those with BED may be restricting caloric intake. Finally, data indicated that the BED group ate significantly more protein, carbohydrate, and fat on binge days than on non-binge days. However, the proportion of kilocalories from each nutrient shifted on BED binge days compared with non-binge days to favor consumption of fat over carbohydrates. Discussion: More research needs to be done to determine if these findings are reproducible. Then, the neurobiological underpinnings of these differences in nutrient intake patterns and nutrient selection can be studied to help to determine the biological basis of the disorder. more...

Emerging research suggests that ethnic identity and American identity are associated with mental health in ethnic minorities and European Americans, respectively. Furthermore, although ethnic identity is associated with diminished body dissatisfaction in minority women, the relationship between American identity and body dissatisfaction is unexplored in all ethnic groups. Accordingly, this study examined the relationships among ethnic identity, American identity, thin-ideal internalization, pressures for thinness, and body dissatisfaction in 1018 ethnically diverse college women. Ethnic identity negatively predicted body dissatisfaction for African Americans, and attenuated the relationship between pressures for thinness and body dissatisfaction for African Americans and Asian Americans, but not European Americans or Latina Americans. Results for American identity were inconclusive. Findings suggest that ethnic identity may be a protective factor against eating pathology for Asian American and African American women. more...

Although much research suggests that ethnic identity is positively correlated with psychological health for ethnic minority women, research examining ethnic identity's relationships to thin-ideal internalization, weight concerns, and eating concerns is sparse. Consequently, this study examined these relationships in European American, African American, Latina, and Asian American college women (N=816). As expected, univariate analyses of variance indicated that European American women scored lowest on ethnic identity and highest on eating and weight concerns, whereas African American women scored lowest on thin-ideal internalization. Hierarchical regression analyses indicated that ethnic identity was negatively associated with eating and weight concerns, while body mass index and thin-ideal internalization were positively associated. Ethnic identity moderated the relationship between thin-ideal internalization and eating concerns such that the relationship was stronger for participants with lower ethnic identity. These results suggest ethnic identity may be a direct or interactive protective factor against eating concerns in ethnically diverse college women. more...

The goal of this study was to create a Spanish version of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) and examine its factorial validity, reliability, and convergent validity in a sample of women from Spain.Two hundred and sixty female college students from Spain completed the Spanish version of the SATAQ-4 and measures for eating pathology.Internal consistency was high; data from EFA and CFA supported the original five-factor structure; and results showed good convergent validity with measures of body-image and eating problems.Results strongly support the psychometric properties of the Spanish version of SATAQ-4 and its use to examine perceived pressure for thinness from parents, peers and the media; and thin- and muscular/athletic-ideal internalization in Spanish-speaking adult women. more...

Using qualitative methodology, this study examined the experiences of treatment providers with a personal history of eating pathology. A total of 139 eating disorder treatment providers completed a questionnaire designed by the authors that (a) asked whether and how their personal history influences treatment of patients with eating disorders and (b) elicited feedback for other therapists. Results indicated that the large majority of participants (94%) believed that their eating disorder history positively influenced their treatment of patients (e.g., increased empathy, greater understanding of the disorder, more positive personal outlook). Conversely, only 8% identified ways in which it can negatively influence treatment (e.g., feeling personally triggered, over-identifying with patients). Feedback for other professionals included the importance of personally recovering before treating this population and monitoring one's experiences in session (e.g., notice countertransference). Continued discourse regarding the benefits and challenges of a personal history of eating pathology in treatment providers is warranted. more...

The goal of this study was to translate the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3; Thompson, van den Berg, Roehrig, Guarda,Heinberg, 2004) into Spanish and psychometrically evaluate the comparability of the Spanish translation to the original English version.638 female college students from Spain and the United States completed the SATAQ-3 in Spanish and English, respectively.Internal consistency was high in both languages. Tests of factor equivalence suggested that the four pre-established factors of the SATAQ-3 (i.e., knowledge, perceived pressure, thin-ideal internalization, athletic-ideal internalization) were relatively similar between the two groups. Differences that emerged between groups (on items 6 and 20) were in the expected direction and appeared to be influenced by reverse-scoring or item wording.Results support the psychometric properties of this Spanish translation of the SATAQ-3 and support its use to measure endorsement of Western values and ideals of appearance in adult women. more...

Eating pathology can be found among Hispanic Americans at comparable rates to Caucasians. Despite this, little research on the assessment of eating pathology in Hispanic Americans exists. This review provides a thorough review of the literature on select clinical interviews and paper and pencil questionnaires related to eating pathology in Hispanic Americans, and provides the relevant information for researchers and practitioners to assist their decision making process when using assessments. Cultural considerations, norms for measures, limits of the existing literature, and future research are also discussed. Thus, this review serves as a basic tool for clinicians and researchers alike interested in eating pathology in Hispanic Americans. more...

Given that women increasingly report using drugs to lose weight, substance abuse treatment programs must include body image, weight, eating pathology, and health knowledge as core intervention targets. This study tested the efficacy of a supplemental health and body image curriculum designed for women in substance abuse treatment who report weight concerns called Healthy Steps to Freedom (HSF). Data from 124 adult women recruited from substance abuse treatment facilities in southern Nevada completed measures of drug use, body dissatisfaction, eating pathology, thin-ideal internalization, and health knowledge/behaviors before and after participation in the 12-week HSF program. Results revealed that thin-ideal internalization, body dissatisfaction, and eating disorder symptoms significantly decreased after HSF program participation, whereas health-related behaviors (e.g., increased healthy food consumption) and knowledge (e.g., understanding of basic nutrition, exercise) increased. These results suggest that the inclusion of the HSF program in substance abuse treatment improves weight-related issues in substance-abusing women. more...

This study investigated the relationships between body surveillance, body shame, and contextual body image during sexual activity in American female college students of European, African, Asian, and Hispanic/Latina descent (N = 1174). Responses to self-report questionnaires indicated that body surveillance and body shame were significantly positively correlated with contextual body concern during sexual activities for women of all ethnic groups. Examination of direct and indirect effects using structural equation modeling indicated that body shame partially mediated the relationship between body surveillance and contextual body image during sexual activity for the sample as a whole. However, multiple-group analyses (i.e., path invariance tests) showed that some of these relationships differed by ethnic group, with European American women reporting the strongest relationships. Study results generally support the mediational role of body shame, but highlight that the strength of these relationships and means may differ across ethnic groups. more...

This study examined the relationship between obesity status, binge-eating disorder (BED), and quality of life (QOL) in a large, ethnically diverse community sample of adult men and women. Using data from the Collaborative Psychiatric Epidemiological Surveys (N = 20,013), individuals were categorized into four groups: nonobese with BED (n = 142), nonobese without BED (n = 14,301), obese with BED (n = 136), and obese without BED (n = 4,863). Results indicated obese individuals with BED consistently reported the poorest QOL. Findings suggested that obesity status was more strongly related to physical health-related QOL variables (e.g., number of physical conditions, mobility impairment) whereas diagnostic status was more predictive of mental health and social functioning QOL variables (e.g., cognitive impairment, social interaction impairment, time out of role). The degree to which lifetime BED diagnosis was associated with impairment in social interaction differed across ethnic groups. For black individuals, the number of physical health conditions was associated with BED presence moreso than weight status. more...

This study examined how deprivation of chocolate affects state-level chocolate cravings, mood, and chocolate consumption in high and low trait-level chocolate-cravers. After identifying high and low chocolate cravers (N=58), half of the participants were instructed not to eat any chocolate for 2weeks. This created four experimental groups: deprived high-cravers (n=14), deprived low-cravers (n=14), non-deprived high-cravers (n=15), and non-deprived low-cravers (n=15). Following 2-week deprivation, state-level food cravings, mood, and chocolate intake were measured in a laboratory setting and compared across groups. Analyses revealed that anxiety increased over time for high-cravers (both deprived and non-deprived); state-level chocolate- and food-craving increased over time for both deprived groups and non-deprived high-cravers; non-deprived high-cravers ate the most chocolate; and, high-cravers were more joyful and guilty than low-cravers after eating chocolate in the laboratory. Theoretically, these results suggest that chocolate consumption may be better explained by trait-level of chocolate craving than by deprivation and highlighted significant differences in mood, state-level cravings, and chocolate intake between cravers and non-cravers following deprivation. more...

Food cravings are subjective, motivational states thought to induce binge eating among eating disorder patients. This study compared food cravings across eating disorders. Women (N = 135) diagnosed with anorexia nervosa, restrictive (ANR) or binge–purging (ANBP) types, or bulimia nervosa, non-purging (BNNP) or purging (BNP) types completed measures of food cravings. Discriminant analysis yielded two statistically significant functions. The first function differentiated between all the four group pairs except ANBP and BNNP, with levels of various food-craving dimensions successively increasing for ANR, ANBP, BNNP, and BNP participants. The second function differentiated between ANBP and BNNP participants. Overall, the functions improved classification accuracy above chance level (44% fewer errors). The findings suggest that cravings are more strongly associated with loss of control over eating than with dietary restraint tendencies. more...

Objective: This study compares multiple methods of assessing food intake in obese women with binge eating disorder (BED). Method: Twelve women meeting BED criteria completed six random 24-hour dietary recalls, engaged in a laboratory binge eating episode, and completed the EDE interview. Results: There was not a significant difference in total or macronutrient intake when binge eating episodes were assessed via the recall and laboratory methods. However, within-individual correlations were low for the size of different binge eating episodes collected by the two methods. Significantly more calories were consumed during objective than during subjective binges, and significant differences in macronutrient composition were observed. Meal patterning data collected by the EDE and the recalls were comparable. Conclusion: The findings suggest only moderate agreement between the methods that were examined. Future investigations with larger sample sizes are needed to examine the relationship among these different methods of assessing food intake. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006; 39:685–693 more...

Reference Citation: Cororve Fingeret M, Warren CS, Cepeda-Benito A, Gleaves DH. Eating disorder prevention research: a meta-analysis. Eat Disord. 2006;14(3):191–213. Clinical Questions: (1) Does presenting educational material on eating disorders produce iatrogenic (harmful because of the intervention) effects on eating attitudes and behaviors? (2) Is targeting specific populations with eating disorder prevention more beneficial than targeting general populations? (3) Which outcome variables are most affected by intervention efforts? (4) To what degree can interventions effectively influence behavioral outcome variables? Data Sources: Studies included in the meta-analysis were found using PsycInfo, Web of Science, Dissertation Abstracts International, and ERIC. Studies were also located using the reference lists from searched articles and by contacting researchers in the field for unpublished studies. The search terms used were eating disorders, prevention, intervention, eating, attitudes, and behaviors. These terms were used in various combinations in the search to find appropriate articles. Study Selection: Only empirical studies that tested interventions focused on reducing the risk of eating disorders or improving protective factors were included. These studies also had to include a nonclinical sample and a comparison group. Any studies that did not report data for a control group, did not report SDs, or only presented adjusted means were excluded because data were insufficient to determine an effect size. As a result of the small number of studies with male participants and the difference in eating disorder risk between males and females, only studies with female participants were analyzed. Data Extraction: Because of the different clinical questions addressed, each study had specific features that were coded to ease data comparison among studies. Three categories of features were coded: population targeted, length of intervention and follow-up, and intervention strategies. To code for the targeted population, the Gordon (1983) classification system was used, including universal (normal), selective (at-risk), and indicated (symptomatic) populations. The intervention strategies used in each study were also categorized in the meta-analysis. One category of intervention strategies looked at the amount of information related to eating disorders included in the prevention program. In addition, the authors categorized the intervention strategies as being (1) purely educational, (2) enhanced educational with elements of cognitive-behavioral therapy, or (3) purely interactive cognitive-behavioral therapy with no educational component. The first 2 authors rated and coded the studies independently. Standardized mean difference effect size (d) was calculated from reported means and SDs or was estimated from reported t and F values. Statistics were analyzed using DSTAT 1.10 and Comprehensive Meta-Analysis software programs. Data were analyzed based on the outcome variables of knowledge, general eating abnormalities, dieting, body dissatisfaction, and thin-ideal internalization. These outcome variables were used to evaluate the efficacy of the intervention programs. Each outcome set had weighted mean effect sizes determined, and the variability of the effect sizes was assessed using the homogeneity statistic Q. These were calculated for both the posttest and follow-up results. Homogeneity among effect sizes was the desired outcome, and a positive value indicated a more desirable outcome. The effect sizes were described as small (d ≤ .20), medium (d = .50), or large (d ≥ .80). Main Results: A total of 57 studies were identified by the search criteria. Eleven studies were excluded because they provided insufficient data to calculate effect sizes. The final pool included 46 studies (32 published and 14 unpublished). All eating disorder prevention programs produced the largest positive change in participant knowledge (d = .75) without regard to the targeted population. The biggest gains in knowledge occurred right after completion of the prevention program (d = 1.2). During follow-up, the gains in knowledge decreased but still remained higher than knowledge before the program. General eating abnormalities, dieting, and thin-ideal internalization showed small positive changes. Even though the changes were relatively small at posttest for all the outcomes (d = .17 to .21), they seemed to last, because the follow-up studies showed results very similar to those obtained at posttest (d = .13 to .18). Body dissatisfaction was the most frequently measured outcome but had the smallest change. Effect sizes for body dissatisfaction at posttest (d = .13) and at follow-up (d = .07) were not different from zero (95% confidence interval = −0.02, 0.15). Thus, even though small positive trends were noted in participants' body dissatisfaction after the interventions, the measured changes may have been due to measurement error. All outcome variables measured appeared to show improvements; however, most of the effect sizes were small and may not be clinically significant. All outcome variables were also analyzed while comparing the targeted populations. During posttest measurements, targeted at-risk participant groups had more positive scores related to dieting (d = .28) than did the symptomatic (d = .07) and normal (d = −.01) groups. Targeted, symptomatic participant groups showed greater improvement regarding thin-ideal internalization during the posttest (d = .48) than did the at-risk (d = .13) or normal (d = .18) subgroups. At follow-up, the same positive trend was apparent, but the changes were no longer significant. Comparably, the targeted, symptomatic group also showed greater improvement with regard to body dissatisfaction (d = .30) than did the at-risk (d = .11) and normal (d = .08) subgroups during posttest measurements, yet the results were not significant at follow-up. General positive trends were found regarding participant knowledge for symptomatic, at-risk, and normal subgroups, but because of the wide range of results among studies, no decisive interpretations could be made. The third measured variable was intervention strategy used. No differences were noted between educational and enhanced educational interventions concerning dieting behavior at posttest, thin-ideal internalization at posttest, or body dissatisfaction at posttest or follow-up. No differences were found among groups for the outcome sets related to potential harmful effects resulting from the prevention programs. From these findings, the authors determined that no harmful effects occurred as a result of including educational information about eating disorders in an eating disorder prevention program. Conclusions: Currently, evidence supports the potential benefits of eating disorder prevention programs for targeted populations, specifically those already demonstrating signs of an eating disorder. Eating disorder prevention programs seem to increase participants' knowledge of eating disorders. Limited evidence indicates small improvements on the behavioral outcome variables, dieting behaviors, and general eating abnormalities for a range of population groups. Knowledge is the outcome variable most affected by eating disorder prevention programs. No evidence indicating that providing educational information about eating disorders causes potentially harmful effects on attitudes or behaviors was found. Specific symptoms that signal an eating disorder were excluded from research assessments, so accurate conclusions regarding the actual prevention of eating disorders resulting directly from eating disorder prevention programs cannot be made. more...

Background: This study evaluated the score reliability and equivalence of factor structure of the Sociocultural Attitudes towards Appearance Questionnaire-3 (SATAQ-3) [1] in a sample of female college students from the four largest ethnic groups in the USA. Conclusions: Results support the use of the SATAQ-3 in female college students of these four ethnicities. Methods: Participants were 1245 women who self-identified as European American/White (n = 543), African American/Black (n = 137), Asian American (n = 317), or Latina/Hispanic (n = 248). All completed the SATAQ-3 and a demographic questionnaire. To test the factor similarity and score reliability across groups, we used exploratory factor analysis and calculated Cronbach's alphas (respectively). Results: Score reliability was high for all groups. Tests of factor equivalence suggested that the four pre-established factors of the SATAQ-3 (i.e., knowledge, perceived pressure, thin-ideal internalization, athletic-ideal internalization) were similar for women of all ethnic groups. Only two items (20 and 27) did not consistently load on the previously identified scale across all four groups. When scored, African Americans reported significantly less perceived pressure and internalization than all other groups. Refereed/Peer-reviewed more...