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Body image  2013;10(4):481-488.
This study tested the efficacy of an Internet-based health promotion program, BodiMojo, designed to promote positive body image in adolescents. Participants were 178 students (mean age 15.2 years, 67.6% ethnic minority) in three public high schools. Intervention groups used BodiMojo for four weekly health class periods, while controls participated in their usual health curriculum. Body image measures were given at baseline, post-intervention, and 3 months. Girls reported decreased body dissatisfaction (p < .05), decreased physical appearance comparison (p < .05), and increased appearance satisfaction (p < .05), relative to controls. Effects were not maintained at 3 month follow-up. No significant differences were found between the intervention and control groups with boys. Moderation analyses suggested positive effects for diverse adolescents as well as those who were overweight or indicated baseline high body dissatisfaction. BodiMojo appears to be modestly effective in decreasing body image concerns among adolescent girls in the short term.
PMCID: PMC3786011  PMID: 23768797
Internet; Body image; Adolescents; Technology; Prevention
2.  The phenomenology of self-reported body dysmorphic disorder by proxy 
Body image  2013;10(2):243-246.
Body dysmorphic disorder by proxy (BDDBP), a preoccupation with a perceived defect in another person’s appearance may represent a variant of BDD. However, BDDBP has received little empirical attention. We present here the phenomenology of 11 individuals with self-reported BDDBP. Participants completed an internet-based survey that assessed symptoms, psychosocial impact, and treatment history. Participants (8 females, 3 males) reported preoccupation with a wide array of individuals (e.g., spouse, stranger). Body parts of concern most commonly involved the face and head. Most participants spent several (e.g., 3–8) hours per day preoccupied by perceived defects in the person of concern (POC). All participants engaged in rituals to try to alleviate distress or improve the POC’s appearance. Most avoided social/occupational activities, including contact with the POC. The impact of BDDBP was profound, particularly on relationships. Findings may help elucidate diagnostic criteria, course, and treatment.
PMCID: PMC4043138  PMID: 23384683
Body dysmorphic disorder; Body dysmorphic disorder by proxy; Dysmorphophobia; Obsessive compulsive spectrum; BDD
3.  Relationship of Body Image to Breast and Skin-Self Examination Intentions and Behaviors 
Body image  2008;6(1):60-63.
Breast self-examinations (BSE) and skin self-examinations (SSE) represent cost-effective and time-efficient approaches to cancer detections. Given their utility, it is important to determine who is likely to perform these behaviors regularly and why. Because BSE and SSE require close examination of one's body, women who are less satisfied and less comfortable with their bodies may perform these behaviors less often. This study sought to determine if a relationship exists between body image and BSE and SSE behaviors and intentions. Ninety-three women completed measures assessing body image, past performance of and future intentions to perform BSE and SSE. Results indicated that body image was related to past performance of SSE. Having greater satisfaction with overall appearance and evaluating oneself as more attractive were related to having performed SSE more frequently in the past year. Future research should further examine this relationship utilizing longitudinal designs and more diverse populations.
PMCID: PMC4030289  PMID: 19010096
4.  Racial/ethnic Differences in Body Mass Index: The Roles of Beliefs about Thinness and Dietary Restriction 
Body image  2008;5(3):291-298.
The greater BMI of African American relative to Caucasian women is implicated in racial/ethnic disparities in health outcomes. The principal aim of the current study was to evaluate a theoretical account of racial/ethnic differences in BMI. Thin-ideal internalization, the perceived romantic appeal of thinness, dietary restriction, weight, and height were assessed via self-report measures on a sample of female undergraduates of African American (n = 140) and Caucasian (n = 676) race/ethnicity. Using structural equation modeling, support was obtained for the primary hypothesis that racial/ethnic differences in BMI are explained by Caucasian women’s greater thin-ideal internalization and perceived romantic appeal of thinness, thereby resulting in greater levels of dietary restriction. Current findings illustrate the potential for racial/ethnic differences in sociocultural standards of appearance to influence racial/ethnic disparities in physical health, of which BMI is a marker, via effects on weight control behavior.
PMCID: PMC4029410  PMID: 18585109
Racial/ethnic differences; thin-ideal internalization; body mass; dietary restriction
5.  Psychosocial Correlates of Frequent Indoor Tanning among Adolescent Boys 
Body image  2012;10(2):259-262.
The aim of the current study was to assess psychosocial correlates (i.e., perceived weight, weight control strategies, substance use, and victimization) of frequent indoor tanning in adolescent boys—a group at high risk for developing skin cancer. Participants (N = 7,907) were drawn from a nationally-representative sample of adolescent boys attending high school in the United States. Binary logistic regression revealed that extreme weight control strategies, particularly steroid use (odds ratio = 3.67) and compensatory vomiting (odds ratio = 2.34), along with substance use and victimization, were significantly related to frequent indoor tanning. These results highlight the role of appearance-changing, and health-risk behaviors in the context of frequent indoor tanning. Skin cancer prevention interventions may benefit from adopting approaches that integrate the treatment of body dissatisfaction and subsequent maladaptive behaviors.
PMCID: PMC3596489  PMID: 23276832
indoor tanning; steroids; eating pathology; victimization; adolescent boys; skin cancer
6.  Sociocultural pressures and adolescent eating in the absence of hunger 
Body image  2013;10(2):182-190.
Parental feeding practices and sociocultural pressures theoretically influence eating behavior. Yet, whether these factors relate to eating in the absence of hunger (EAH) is unknown. We assessed if sociocultural pressures were associated with EAH among 90 adolescents (Mage = 15.27, SD = 1.39; 48% female). Parents completed the Child Feeding Questionnaire. Adolescents completed the Perceived Sociocultural Pressures Scale, Sociocultural Attitudes Towards Appearance Questionnaire-3, and Multidimensional Body Self-Relations Questionnaire-Appearance Scales. On two occasions, EAH was assessed as snack food intake after adolescents ate to satiety. Controlling for body composition and demographics, parental restriction and family pressure to be thin were associated with greater EAH. Media pressure was related to more EAH in girls. Appearance orientation and preoccupation with becoming overweight mediated links between sociocultural pressures and EAH. Findings support the notion that sociocultural pressures and their links to body image may contribute to the course of disinhibited eating behaviors during adolescence.
PMCID: PMC3671847  PMID: 23394966
Body image; Adolescence; Eating in the absence of hunger; Pressure to be thin; Obesity
7.  Is Intensive Measurement of Body Image Reactive? A Two-Study Evaluation Using Ecological Momentary Assessment Suggests Not 
Body image  2012;10(1):35-44.
Intensive assessment methods (e.g., Ecological Momentary Assessment [EMA]) are increasingly used to capture body image experiences in daily life. One concern with EMA is multiple assessments may increase reactivity to internal or external cues, potentially biasing measurement. Reactivity to EMA was evaluated in two studies (Study 1: N = 63 female undergraduates, Study 2: N = 131 women with high body dissatisfaction/disordered eating). Participants completed five daily surveys on handheld computers for 1–2 weeks and body image-related questionnaires at the start and end of each study. Results showed no systematic changes in pre- and post-EMA measures or momentary EMA reports, suggesting women were not reactive to the EMA protocols. Completing 1–2 weeks of EMA does not appear to affect body dissatisfaction, mood, or attitudes in non-clinical or at-risk samples of women. These studies provide evidence that EMA methods can be used to assess real-world body image experiences without undue concern about measurement reactivity.
PMCID: PMC3532563  PMID: 22999225
Ecological Momentary Assessment (EMA); measurement reactivity; body image; body dissatisfaction; disordered eating; college women
8.  Moderators of the Association Between Exercise Identity and Obligatory Exercise Among Participants of an Athletic Event 
Body image  2012;10(1):70-77.
Previous research has connected exercise identity with obligatory exercise, yet to date no empirical studies have identified moderator variables of this association. The current study included participants of an athletic event (full marathon, n = 582; half marathon, n = 1,106; shorter distance, n = 733) who completed questionnaires about exercise behaviors, obligatory exercise, and internalization of both the thin-ideal and athletic-ideal body shapes. General linear model analyses were conducted to examine the exercise identity-obligatory exercise relationship; moderator variables included gender, internalization of the thin-ideal body shape, and internalization of the athletic-ideal body shape. After controlling for the effects of body mass index, age, and distance group, the three-way interaction of exercise identity, gender, and internalization of the athletic-ideal body shape predicted obligatory exercise. Findings suggest that women who report high identification with exercise and high value on having an athletic physique may be vulnerable to obligatory exercise.
PMCID: PMC3534926  PMID: 23092850
exercise identity; obligatory exercise; internalization
9.  Body checking behaviors in men 
Body image  2009;6(3):10.1016/j.bodyim.2009.05.001.
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.
PMCID: PMC3838885  PMID: 19482568
Body checking; Muscularity; Body image; Body dissatisfaction; Muscle dysmorphia; Anabolic-androgenic steroids
10.  The Pathophysiology of Body Dysmorphic Disorder 
Body image  2008;5(1):10.1016/j.bodyim.2007.11.002.
Body dysmorphic disorder (BDD) is an often severe and disabling condition, affecting up to 2% of the population. Despite its prevalence and clinical significance, very little is known about the pathophysiology of BDD. However, clues to its possible neurobiological substrates and abnormalities in information processing are starting to emerge. This article reviews findings from genetic, brain lesion, neuroimaging, neuropsychological, and psychopharmacological studies that have allowed us to develop a tentative model of the functional neuroanatomy of BDD. There is likely a complex interplay of dysfunctions in several brain networks underlying the pathophysiology of BDD. A combination of dysfunctions in frontal-subcortical circuits, temporal, parietal, and limbic structures, and possibly involving hemispheric imbalances in information processing, may produce both the characteristic symptoms and neurocognitive deficits seen in BDD. An improved understanding of the pathophysiology of BDD will be crucial to guide the development of better treatments.
PMCID: PMC3836287  PMID: 18314401
body dysmorphic disorder; pathophysiology; perception
11.  Body Dissatisfaction from Adolescence to Young Adulthood: Findings from a 10-Year Longitudinal Study 
Body image  2012;10(1):10.1016/j.bodyim.2012.09.001.
Given mixed findings regarding the unique trajectories of female and male adolescents’ body dissatisfaction over time, comprehensive longitudinal examinations are needed. This 10-year longitudinal, population-based study, with 1,902 participants from diverse ethnic/racial and socioeconomic backgrounds in the Minneapolis/St. Paul metropolitan area, examined changes in body dissatisfaction from adolescence to young adulthood. Results revealed that: (a) female and male participants’ body dissatisfaction increased between middle and high school,(b) body dissatisfaction increased further during the transition to young adulthood, and (c) this increase was associated with an increase in BMI over time, such that the upward trend in body dissatisfaction became non-significant when BMI was controlled. These results highlight a trend in which diverse female and male youth are increasingly dissatisfied with their bodies as their BMI increases from middle school to young adulthood, and emphasize the need for targeted prevention efforts to intervene in this trajectory and mitigate potential harm.
PMCID: PMC3814026  PMID: 23084464
12.  [No title available] 
PMCID: PMC3643298  PMID: 23394967
13.  Ethnic and Racial Differences in Body Size Perception and Satisfaction 
Body image  2010;7(2):131-136.
Body dissatisfaction in women in the United States is common. We explored how women from various racial and ethnic groups used figural stimuli by exploring differences in current and preferred silhouette, and their discrepancy. We surveyed 4,023 women ages 25-45 in an on-line investigation. Participants were identified using a national quota-sampling procedure. Asian women chose a smaller silhouette to represent their current body size, which did not remain significant after adjusting for self-reported BMI. After controlling for BMI, African American women selected a smaller silhouette than White women to represent their current size. Both African American and women reporting “Other” race preferred larger silhouettes than White women even after controlling for BMI. The discrepancy score revealed lower body dissatisfaction among African American than White women. Understanding factors that promote body satisfaction differentially across racial and ethnic groups could become a tool in appropriately tailored interventions designed to prevent eating disorders.
PMCID: PMC3593344  PMID: 20096656
body image; figural stimuli; body mass index; race; ethnicity
14.  Experimental Evidence that Changes in Mood Cause Changes in Body Dissatisfaction among Undergraduate Women 
Body Image  2011;9(2):216-220.
Previous research has found concurrent and prospective associations between negative mood and body dissatisfaction; however, only experimental research can establish causal relationships. This study utilized an experimental design to examine the influence of negative mood on body dissatisfaction. Undergraduate women were randomly assigned to an experimental or control condition. Participants in the experimental condition (n = 21) completed a negative mood induction procedure. Participants in the control condition (n = 24) completed a neutral mood procedure. All participants completed visual analogue scales regarding their mood and satisfaction with weight and shape before and after each manipulation. Body dissatisfaction increased following the procedure for experimental but not control participants, suggesting that negative mood caused increased body dissatisfaction. In cultures that idealize thinness, body dissatisfaction may arise from funneling general feelings of dysphoria into more concrete and culturally meaningful negative feelings about the body.
PMCID: PMC3312938  PMID: 22210105
body image; experiment; negative affect; undergraduate women
15.  Social Engagement in Adolescence Moderates the Association between Weight Status and Body Image 
Body Image  2012;9(2):221-226.
This study examined whether the association between adolescent weight status and body image varies by social engagement. A nationally representative sample of 6,909 students in grades 6 to 10 completed the 2006 HBSC survey. Separate linear regressions for boys and girls, controlling for age, race/ethnicity and socioeconomic status, were conducted with an interaction term (weight status x social engagement). Adolescents’ overweight/obese status was related to body dissatisfaction. Social engagement moderated the relationship between weight status and body image for girls but not for boys. Overweight/obese boys had more body dissatisfaction compared to their normal/underweight peers, regardless of their social engagement. However, overweight/obese girls with more social engagement were more likely to have body satisfaction compared to overweight/obese girls with less social engagement. Encouraging adolescent girls to develop healthy relationships with peers may prevent them from developing body dissatisfaction.
PMCID: PMC3312953  PMID: 22325852
Body Image; Adolescents; Obesity; Social Engagement
16.  Gender and Racial/Ethnic Differences in Body Image Development Among College Students 
Body image  2011;9(1):126-130.
In the present study we used longitudinal methods to examine body image development during the early part of college. Students (N = 390; 54% female) who identified as African American (32%), Latino/a American (27%), and European American (41%) completed surveys during their first, second, and third semesters at college. There were overall gender and racial/ethnic differences in all three aspects of body image, and both stability and change in body image development. Female students’ appearance evaluation became more positive, whereas male students’ appearance evaluation showed no significant change. Individuals’ body areas satisfaction increased over time, but remained stable when controlling for BMI. Appearance orientation did not change, and there were no racial/ethnic differences in body image development. Experiences in the college environment may play a role in these trends.
PMCID: PMC3246027  PMID: 21983339
body image development; longitudinal design; college students; gender; race/ethnicity
17.  Representations of Celebrities’ Weight and Shape during Pregnancy and Postpartum: A Content Analysis of Three Entertainment Magazine Websites 
Body image  2011;9(1):172-175.
Entertainment magazine websites provide a continuous stream of celebrity news accessed by over 13 million unique viewers each month. Celebrities’ experiences of pregnancy and new motherhood appear to be popular topics within these media outlets; however, little research has investigated the content of this coverage. In this study, investigators coded articles (N = 387) published between August 1, 2007 and August 1, 2008 on three popular entertainment magazine websites. Relatively few articles about celebrities’ pregnancies discussed weight (13%) or shape (30%), and an even smaller proportion (6.2%) included any discussion of postpartum body dissatisfaction. This suggests a gap between portrayal of celebrities’ pregnancies and postpartum experiences and those of non-celebrity women. This disparity is concerning as it might lead to unrealistic expectations about pregnancy and postpartum for both pregnant readers and a more general audience. This study provides important initial information about the messages these media provide regarding pregnancy-related appearance.
PMCID: PMC3246040  PMID: 21873126
entertainment magazines; celebrity; objectification; pregnancy; postpartum; thin ideal
18.  Can we reduce eating disorder risk factors in female college athletes? A randomized exploratory investigation of two peer-led interventions 
Body image  2011;9(1):31-42.
Female athletes are at least as at risk as other women for eating disorders (EDs) and at risk for the female athlete triad (i.e., inadequate energy availability, menstrual disorders, and osteoporosis). This study investigated whether two evidence-based programs appear promising for future study if modified to address the unique needs of female athletes. Athletes were randomly assigned to athlete-modified dissonance prevention or healthy weight intervention (AM-HWI). ED risk factors were assessed pre/post-treatment, and 6-week and 1-year follow-up. Results (analyzed sample N = 157) indicated that both interventions reduced thin-ideal internalization, dietary restraint, bulimic pathology, shape and weight concern, and negative affect at 6 weeks, and bulimic pathology, shape concern, and negative affect at 1 year. Unexpectedly we observed an increase in students spontaneously seeking medical consultation for the triad. Qualitative results suggested that AM-HWI may be more preferred by athletes.
PMCID: PMC3246101  PMID: 22019502
Eating Disorders; Prevention; Athletes; Cognitive Dissonance; Healthy Weight
19.  An Exploration of Body Dissatisfaction and Perceptions of Black and White Girls Enrolled in an Intervention for Overweight Children 
Body image  2011;8(4):379-384.
Silhouette measures are one approach to assessing body dissatisfaction in children, although little is known about their use among racially diverse, overweight girls seeking weight-loss treatment. This study assessed racial differences in body dissatisfaction and body size perceptions of 58 girls (ages 6–11, 66% Black, 34% White) participating in a randomized trial for pediatric overweight. Body dissatisfaction did not differ between races; 99% of girls reported an ideal figure smaller than their current one. Black girls selected a larger silhouette to represent their ideal body size, and most girls in both racial groups underestimated their actual size. Outcomes strengthen the argument that, despite an overall preference for a larger body size, obesity might mitigate cultural factors that protect Black girls from body dissatisfaction. Additional research is needed to enhance understanding of children’s body size perceptions and dissatisfaction to inform assessment and treatment of pediatric obesity and associated disordered eating symptoms.
PMCID: PMC3170454  PMID: 21700518
overweight; obesity; child; Black; body dissatisfaction; silhouette measure
20.  Muscularity versus Leanness: An Examination of Body Ideals and Predictors of Disordered Eating in Heterosexual and Gay College Students 
Body image  2011;8(3):232-236.
The aim of the current study was to add to the growing body of research on men with eating disorders by examining the association between different types of body dissatisfaction (muscularity and body fat) and disordered eating in heterosexual and gay men. Two hundred four participants (over one-third were gay) completed measures assessing disordered eating, muscularity and body fat dissatisfaction, and sexual orientation. Body fat dissatisfaction, but not muscularity dissatisfaction, predicted disordered eating, dietary restraint, and concerns about weight and eating in gay and heterosexual men. These findings were consistent across all measures of body fat and muscularity dissatisfaction, providing stronger evidence that body fat dissatisfaction may be a greater risk factor for disordered eating in both gay and heterosexual college aged men than muscularity dissatisfaction.
PMCID: PMC3124584  PMID: 21561818
eating disorders; body image; body dissatisfaction; muscularity; leanness; human males; sexual orientation
21.  Body Satisfaction During Pregnancy 
Body image  2011;8(3):297-300.
The current study examines how body satisfaction of pregnant women compares to that of nonpregnant women. The sample included 68 pregnant and 927 nonpregnant young women who participated in a population-based longitudinal study examining eating and weight concerns in young adults. Body satisfaction was assessed using a 10-item modified version of the Body Shape Satisfaction Scale. The longitudinal design allowed for the assessment of body satisfaction among women both prior to and during their pregnancy. Mean body satisfaction was higher in pregnant women (32.6, 95% CI: 30.7–34.5) than nonpregnant women (29.6, 95% CI: 29.1–30.1) with moderate effect size 0.32, after adjusting for body satisfaction and body mass index prior to pregnancy, indicating that pregnant women experienced a significant increase in body satisfaction from the time prior to their pregnancy (p = .003) despite weight gain. These findings have important implications for clinicians delivering weight-related messages to women during pregnancy.
PMCID: PMC3124621  PMID: 21561821
body satisfaction; pregnancy; young adult
22.  Correlates of self worth and body size dissatisfaction among obese Latino youth 
Body image  2011;8(2):173-178.
The current study examined self-worth and body size dissatisfaction, and their association with maternal acculturation among obese Latino youth enrolled in a community-based obesity intervention program. Upon entry to the program, a sample of 113 participants reported global self-worth comparable to general population norms, but lower athletic competence and perception of physical appearance. Interestingly, body size dissatisfaction was more prevalent among younger respondents. Youth body size dissatisfaction was associated with less acculturated mothers and higher maternal dissatisfaction with their child's body size. By contrast, although global self-worth was significantly related to body dissatisfaction, it was not influenced by mothers’ acculturation or dissatisfaction with their own or their child’s body size. Obesity intervention programs targeted to Latino youth need to address self-worth concerns among the youth as well as addressing maternal dissatisfaction with their children’s body size.
PMCID: PMC3072832  PMID: 21354881
self-worth; body size dissatisfaction; acculturation; obese Latino youth
23.  Heterosocial Involvement, Peer Pressure for Thinness, and Body Dissatisfaction among Young Adolescent Girls 
Body image  2011;8(2):143-148.
The purpose of this study was to examine longitudinal connections among young adolescent heterosocial involvement (i.e., mixed-sex interactions), peer pressure for thinness, and body dissatisfaction. Three years of self-report questionnaire data were collected from 88 adolescent girls as they completed 6th through 8th grades. Results indicated that the relation between heterosocial involvement and body dissatisfaction was mediated by perceived peer pressure for thinness. Within this model, heterosocial involvement was associated with greater peer pressure for thinness. In turn, peer pressure for thinness was associated with greater body dissatisfaction. Results are discussed in terms of their implications for prevention and intervention efforts aimed at girls during their middle-school years.
PMCID: PMC3086491  PMID: 21354882
Mixed-Sex Interactions; Peer Relations; Adolescence; Girls; Body Image; Body Dissatisfaction
24.  The Impact of Gender on the Assessment of Body Checking Behavior 
Body image  2010;8(1):20-25.
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.
PMCID: PMC3053001  PMID: 21093393
25.  Self-Esteem, Social Support, Collectivism, and the Thin-Ideal in Latina College Undergraduates 
Body image  2010;8(1):82-85.
Thin-ideal internalization (TII) reflects agreement that thinness equates with beauty. TII is a risk factor for body dissatisfaction and eating pathology; this phenomenon and its correlates, however, are just beginning to be studied in Latina undergraduates. This study examined the ability of self-esteem, social support, and collectivism to predict TII in Latina undergraduates. It was hypothesized that higher levels of self-esteem, social support, and collectivism would predict lower levels of TII. Cross-sectional data were analyzed using multiple regression; the model was significant, p < .01. Although both self-esteem and social support negatively correlated with thin-ideal internalization, only self-esteem accounted for a significant amount of variance. Results indicate that investigations of self-esteem as a protective factor against TII in Latina undergraduates would be fruitful, as would how self-esteem and social support affect the relationship between TII and other variables. Implications and limitations are discussed.
PMCID: PMC3063392  PMID: 21147052
thin-ideal internalization; Latina undergraduates; self-esteem; social support; collectivism

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