Testing mediators hypothesized to account for the effects of a dissonance-based eating disorder prevention program over longer term follow-up.

Objective: Test the hypothesis that reductions in thin-ideal internalization and body dissatisfaction mediate the effects of a dissonance-based eating disorder prevention program on reductions in eating disorder symptoms over 1-year follow-up. Method: Data were drawn from a randomized effectiveness trial in which 306 female high school students (mean age = 15.7 years, SD = 1.1) with body image concerns were randomized to the 4-session dissonance-based prevention program or an educational brochure control condition, wherein school counselors and nurses were responsible for participant recruitment and intervention delivery. Results: Dissonance-intervention participants showed greater reductions in thin-ideal internalization, body dissatisfaction, and eating disorder symptoms; change in thin-ideal internalization predicted change in body dissatisfaction and symptoms; change in body dissatisfaction predicted change in symptoms; and all indirect effects were significant. Change in thin-ideal internalization fully mediated the effects of intervention condition on change in body dissatisfaction and partially mediated the effects on symptoms; change in body dissatisfaction partially mediated the effect of intervention condition on change in symptoms. Conclusions: Findings provided support for the intervention theory of this eating disorder prevention program over longer term follow-up, extending the evidence base for this effective intervention. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

High- and low-level dissonance-based eating disorder prevention programs with young women with body image concerns: An experimental trial.

Objective: As cognitive dissonance is theorized to contribute to the effects of dissonance-based eating disorder prevention programs, we evaluated a high-dissonance version of this program against a low-dissonance version and a wait-list control condition to provide an experimental test of the mechanism of intervention effects. Method: Female college students (N = 124, mean age = 20.9 years, SD = 3.9) with body image concerns were randomized to the 3 conditions. The high-dissonance program was designed to maximize dissonance induction, and the low-dissonance program was designed to minimize it; the substantive content of the 2 programs was matched. Results: Relative to controls, those in the high-dissonance condition showed significantly greater reductions in thin-ideal internalization, body dissatisfaction, dieting, and eating disorder symptoms by posttest, and those in the low-dissonance condition showed significantly greater reductions in the first 3 outcomes by posttest, with most of these effects persisting to 3-month follow-up. High-dissonance participants showed significantly greater reductions in eating disorder symptoms than low-dissonance participants did by posttest, but this effect was nonsignificant by 3-month follow-up. Conclusions: Results suggest that dissonance induction contributes to intervention effects but imply that the intervention content, nonspecific factors, and demand characteristics play a much more potent role in producing effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dissonance and healthy weight eating disorder prevention programs: Long-term effects from a randomized efficacy trial.

Adolescent girls with body dissatisfaction (N = 481, SD = 1.4) were randomized to a dissonance-based thin-ideal internalization reduction program, healthy weight control program, expressive writing control condition, or assessment-only control condition. Dissonance participants showed significantly greater decreases in thin-ideal internalization, body dissatisfaction, negative affect, eating disorder symptoms, and psychosocial impairment and lower risk for eating pathology onset through 2- to 3-year follow-up than did assessment-only controls. Dissonance participants showed greater decreases in thin-ideal internalization, body dissatisfaction, and psychosocial impairment than did expressive writing controls. Healthy weight participants showed greater decreases in thin-ideal internalization, body dissatisfaction, negative affect, eating disorder symptoms, and psychosocial impairment; less increases in weight; and lower risk for eating pathology and obesity onset through 2- to 3-year follow-up than did assessment-only controls. Healthy weight participants showed greater decreases in thin-ideal internalization and weight than did expressive writing controls. Dissonance participants showed a 60% reduction in risk for eating pathology onset, and healthy weight participants showed a 61% reduction in risk for eating pathology onset and a 55% reduction in risk for obesity onset relative to assessment-only controls through 3-year follow-up, implying that the effects are clinically important and enduring. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An effectiveness trial of a selected dissonance-based eating disorder prevention program for female high school students: Long-term effects.

Objective: Efficacy trials found that a dissonance-based eating disorder prevention program in which female high school and college students with body image concerns critique the thin ideal reduced eating disorder risk factors, eating disorder symptoms, and future eating disorder onset. The present effectiveness trial tested whether this program produces effects through long-term follow-up when high school clinicians recruit students and deliver the intervention under real-world conditions. Method: Female high school students with body image concerns (N = 306; M age = 15.7 years, SD = 1.1) were randomized to the dissonance intervention or an educational brochure control condition and completed assessments through 3-year follow-up. Results: Dissonance participants showed significantly greater decreases in body dissatisfaction at 2-year follow-up and eating disorder symptoms at 3-year follow-up than controls; effects on other risk factors, risk for eating disorder onset, and other outcomes (e.g., body mass) were marginal or nonsignificant. Conclusions: Although it was encouraging that some key effects persisted over long-term follow-up, effects were on average smaller in this effectiveness trial than previous efficacy trials, which could be due to (a) facilitator selection, training, and supervision; (b) the lower risk status of participants; or (c) the use of a control condition that produces some effects. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Testing mediators of intervention effects in randomized controlled trials: An evaluation of two eating disorder prevention programs.

The authors investigated mediators hypothesized to account for the effects of 2 eating disorder prevention programs using data from 355 adolescent girls who were randomized to a dissonance or a healthy weight intervention or an active control condition. The dissonance intervention produced significant reductions in outcomes (body dissatisfaction, dieting, negative affect, bulimic symptoms) and the mediator (thin-ideal internalization), change in the mediator correlated with change in outcomes and usually occurred before change in outcomes, and intervention effects became significantly weaker when change in the mediator was partialed, providing support for the hypothesized mediators and this new approach to testing mediation in randomized trials. Findings provide somewhat less support for the hypothesis that change in healthy eating and exercise would mediate the healthy weight intervention effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dissonance and healthy weight eating disorder prevention programs: A randomized efficacy trial.

In this trial, adolescent girls with body dissatisfaction (N = 481, M age = 17 years) were randomized to an eating disorder prevention program involving dissonance-inducing activities that reduce thin-ideal internalization, a prevention program promoting healthy weight management, an expressive writing control condition, or an assessment-only control condition. Dissonance participants showed significantly greater reductions in eating disorder risk factors and bulimic symptoms than healthy weight, expressive writing, and assessment-only participants, and healthy weight participants showed significantly greater reductions in risk factors and symptoms than expressive writing and assessment-only participants from pretest to posttest. Although these effects faded over 6-month and 12-month follow-ups, dissonance and healthy weight participants showed significantly lower binge eating and obesity onset and reduced service utilization through 12-month follow-up, suggesting that both interventions have public health potential. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of peer-led eating disorders prevention: A replication trial.

The aim of this study was to replicate and extend results of a previous trial that investigated the effectiveness of 2 peer-led eating disorders prevention interventions in reducing eating disorder risk factors in undergraduate women (C. B. Becker, L. M. Smith, & A. C. Ciao, 2006). To extend findings from the previous study by allowing for investigation of differential response, the authors randomly assigned a larger sample of both higher and lower risk sorority members (N = 188; age M = 18.64 years, range = 18-21; 20% minority) to either a cognitive dissonance (CD) or a media advocacy (MA) intervention under naturalistic conditions. Interventions were delivered by trained sorority peer leaders and consisted of two 2-hr group sessions. Participants completed questionnaires that assessed eating disorder risk factors at pretreatment, posttreatment, 7-week follow-up, and 8-month follow-up. Results indicate that both interventions reduced thin-ideal internalization, body dissatisfaction, dietary restraint, and bulimic pathology at 8 months, although higher and lower risk participants responded somewhat differently. Both CD and MA generally appeared effective for higher risk participants; only CD, however, appeared to benefit lower risk participants. Results further support the viability of using peer leaders in dissonance-based prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Body-image and eating disturbances prospectively predict increases in depressive symptoms in adolescent girls: A growth curve analysis.

Using data from a longitudinal community study (N?=?231), the authors tested whether body-image and eating disturbances might partially explain the increase in depression observed in adolescent girls. Initial pressure to be thin, thin-ideal internalization, body dissatisfaction, dieting, and bulimic symptoms, but not body mass, predicted subsequent increases in depressive symptoms, as did increases in these risk factors over the study. There was also prospective support for each of the hypothesized mediational relations linking these risk factors to increases in depressive symptoms. Effects remained significant when other established gender-nonspecific risk factors for depression (social support and emotionality) were statistically controlled. Results provide support for the assertion that body-image and eating disturbances, operating above and beyond gender-nonspecific risk factors, contribute to the elevated depression in adolescent girls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective test of the dual-pathway model of bulimic pathology: Mediating effects of dieting and negative affect.

Because there have been few longitudinal investigations of integrative etiological theories of bulimia nervosa, this study prospectively tested the dual-pathway model using random regression growth curve models and data from a 3-wave community sample of adolescent girls (N?=?231). Initial pressure to be thin and thin-ideal internalization predicted subsequent growth in body dissatisfaction, initial body dissatisfaction predicted growth in dieting and negative affect, and initial dieting and negative affect predicted growth in bulimic symptoms. There was prospective evidence for most of the hypothesized mediational effects. Results are consistent with the assertion that pressure to be thin, thin-ideal internalization, body dissatisfaction, dieting, and negative affect are risk factors for bulimic pathology and provide support for the dual-pathway model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of adolescent dieting behaviors: A longitudinal study.

Research suggests that dieting is a risk factor for bulimia nervosa, yet little is known about the predictors of dieting. Accordingly, this study examined the correlates and prospective predictors of dieting in a community sample of 320 adolescent females (aged 16–19 yrs). Results indicate that body mass, pressure to be thin, thin-ideal internalization, body dissatisfaction, and binge eating were positively correlated with dieting. Moreover, body mass, pressure to be thin, body dissatisfaction, and binge eating prospectively predicted increased dieting over a 9-mo period. Multivariate analyses revealed that this set of predictors accounted for significant variance in concurrent and subsequent dieting, although only some of the unique effects were significant in the full models. Not only do these findings identify several risk factors for dieting, but they also suggest that dieting may be a response to bulimic pathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The thin ideal and body image: An experimental study of implicit attitudes.

Thin-ideal internalization is a core construct in body dissatisfaction, central to eating disorders and generally assessed with explicit measures. To compare implicit and explicit measures of thin-ideal internalization and their relationship to body image, the authors developed a thin-ideal implicit association test (IAT). Although the IAT revealed a strong cognitive bias toward fat as negative (differences in response latencies: t[85]=9.829, p     

Magazine exposure: Internalization, self-objectification, eating attitudes, and body satisfaction in male and female university students.

Investigated the relationships among magazine exposure, self-objectification, body shape dissatisfaction, and eating disorder symptomatology in 150 men and women (aged 18-42 yrs). Women reading beauty magazines and men reading fitness magazines internalized societal ideals (internalization). For women, beauty magazines predicted self-objectification, mediated by internalization. For men, only internalization predicted self-objectification. For men, fitness magazines predicted body shape dissatisfaction, mediated by internalization. For women, only internalization predicted body shape dissatisfaction. Reading magazines also predicted eating problems for men and women, for women this was mediated by internalization. Findings suggest that magazine reading is related to concerns with physical appearance and eating behaviors. Many of the relationships previously found for women are similar for men. A sociocultural model is used to explain these results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for body dissatisfaction in adolescent girls: A longitudinal investigation.

Because few prospective studies have examined predictors of body dissatisfaction--an established risk factor for eating disorders--the authors tested whether a set of sociocultural, biological, interpersonal, and affective factors predicted increases in body dissatisfaction using longitudinal data from adolescent girls (N=496). Elevated adiposity, perceived pressure to be thin, thin-ideal internalization, and social support deficits predicted increases in body dissatisfaction, but early menarche, weight-related teasing, and depression did not. There was evidence of 2 distinct pathways to body dissatisfaction--1 involving pressure to be thin and 1 involving adiposity. Results support the contention that certain sociocultural, biological, and interpersonal factors increase the risk for body dissatisfaction, but suggest that other accepted risk factors are not related to this outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for binge eating onset in adolescent girls: A 2-year prospective investigation.

Because little is known about the predictors of binge eating (a risk factor for obesity), a set of putative risk factors for binge eating was investigated in a longitudinal study of adolescent girls. Results verified that binge eating predicted obesity onset. Elevated dieting, pressure to be thin, modeling of eating disturbances, appearance overvaluation, body dissatisfaction, depressive symptoms, emotional eating, body mass, and low self-esteem and social support predicted binge eating onset with 92% accuracy, Classification tree analysis revealed an interaction between appearance overvaluation, body mass, dieting, and depressive symptoms, suggesting qualitatively different pathways to binge eating and identifying subgroups at extreme risk for this outcome. Results support the assertion that these psychosocial and biological factors increase risk for binge eating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Objectification theory and deaf cultural identity attitudes: Roles in deaf women's eating disorder symptomatology.

This study examined the generalizability of direct and mediated links posited in objectification theory among internalization of sociocultural standards of beauty, body surveillance, body shame, and eating disorder symptoms with a sample of Deaf women. The study also examined the role of marginal Deaf cultural identity attitudes within this framework. Data from 177 Deaf women indicated positive relations among internalization, body surveillance, body shame, and eating disorder symptomatology. Consistent with tenets of objectification theory, body shame mediated the links of internalization and body surveillance with eating disorder symptoms. In addition, marginal Deaf identity attitudes (but not hearing, immersion, or bicultural attitudes) were linked uniquely with eating disorder constructs and had significant indirect relations through internalization with body surveillance, body shame, and eating disorder symptoms. Implications for practice and future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Peer-facilitated eating disorder prevention: A randomized effectiveness trial of cognitive dissonance and media advocacy.

The authors investigated the effectiveness of 2 interventions in reducing eating disorder risk factors under naturalistic conditions in sororities. On the basis of previous research, the campus sororities chose to implement a semimandatory, 2-session eating disorder prevention program to all new sorority members (N = 90) during sorority orientation. To facilitate evaluation, sororities agreed to random assignment of new members to either a cognitive dissonance or a media advocacy intervention. Undergraduate peer facilitators ran the groups. Although both interventions had an effect, cognitive dissonance generally was superior at 8-month follow-up. Results further support the utility of cognitive dissonance in reducing eating disorder risk factors and suggest that nondoctoral-level leaders can deliver the program. Results also indicate that a semimandatory format does not reduce effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of the media in body image concerns among women: A meta-analysis of experimental and correlational studies.

Research suggests that exposure to mass media depicting the thin-ideal body may be linked to body image disturbance in women. This meta-analysis examined experimental and correlational studies testing the links between media exposure to women's body dissatisfaction, internalization of the thin ideal, and eating behaviors and beliefs with a sample of 77 studies that yielded 141 effect sizes. The mean effect sizes were small to moderate (ds = -.28, -.39, and -.30, respectively). Effects for some outcome variables were moderated by publication year and study design. The findings support the notion that exposure to media images depicting the thin-ideal body is related to body image concerns for women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moderators of the body dissatisfaction-eating disorder symptomatology relationship: Replication and extension.

In this study, research conducted by T. L. Tylka (2004) was replicated and extended by examining perfectionism (self-oriented and socially prescribed), ego goal orientation, body surveillance, and neuroticism as moderators of the relationship between body dissatisfaction and bulimic and anorexic symptomatology among female undergraduates (N = 398). Hierarchical moderated regression was used to test the main and interactive effects of the models and to control for physical size and social desirability. As expected, body dissatisfaction was strongly related to the measures of disordered eating, accounting for 16% to 26% of the variance. Two variables (neuroticism and body surveillance) received support as moderators of the relationships between body dissatisfaction and bulimic and anorexic symptoms. Ego goal orientation and socially prescribed perfectionism moderated the effects of body dissatisfaction on bulimic symptoms, whereas self-oriented perfectionism served as a moderator only for anorexic symptoms. In all instances, higher levels of body dissatisfaction paired with higher levels of the moderator were associated with more disturbed eating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk and maintenance factors for eating pathology: A meta-analytic review.

This meta-analytic review of prospective and experimental studies reveals that several accepted risk factors for eating pathology have not received empirical support (e.g., sexual abuse) or have received contradictory support (e.g., dieting). There was consistent support for less-accepted risk factors (e.g., thin-ideal internalization) as well as emerging evidence for variables that potentiate and mitigate the effects of risk factors (e.g., social support) and factors that predict eating pathology maintenance (e.g., negative affect). In addition, certain multivariate etiologic and maintenance models received preliminary support. However, the predictive power of individual risk and maintenance factors was limited, suggesting it will be important to search for additional risk and maintenance factors, develop more comprehensive multivariate models, and address methodological limitations that attenuate effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Body image and eating disorder symptoms in sexual minority men: A test and extension of objectification theory.

On the basis of integrating objectification theory research with research on body image and eating problems among sexual minority men, the present study examined relations among sociocultural and psychological correlates of eating disorder symptoms with a sample of 231 sexual minority men. Results of a path analysis supported tenets of objectification theory with the sample. Specifically, findings were consistent with relations posited in objectification theory among sexual objectification experiences, internalization of cultural standards of attractiveness, body surveillance, body shame, and eating disorder symptoms. Within this set of positive relations, internalization of cultural standards of attractiveness partially mediated the link of sexual objectification experiences with body surveillance; body surveillance partially mediated the relation of internalization with body shame; and body shame partially mediated the relation of body surveillance with eating disorder symptoms. In addition to these relations, internalized homophobia was related to greater eating disorder symptoms through body shame, and recalled childhood harassment for gender nonconformity was linked with eating disorder symptoms through a positive series of relations involving internalization of cultural standards of attractiveness, body surveillance, and body shame. (PsycINFO Database Record (c) 2010 APA, all rights reserved)