Pursuit of the muscular ideal: Physical and psychological consequences and putative risk factors

Developing a lean muscular figure for the purposes of sports and/or appearance has become a central issue for males. Concern has been raised because the desire to develop such a body build may lead to the adoption of numerous health-threatening behaviors. Consequently, this review presents a comprehensive analysis of the physical and psychological consequences that result from the use of steroids (legal and illegal), ephedrine, and deleterious dieting strategies specific to males. Putative risk factors for these behaviors will be identified, and the clinical disorder associated with the extreme abuse of these behaviors, muscle dysmorphia, will be examined.

Energy expenditure and the body cell mass in Cystic Fibrosis

Poor nutritional status in patients with cystic fibrosis (CF) is associated with severe lung disease, and possible causative factors include inadequate intake, malabsorption, and increased energy requirements. Body cell mass (which can be quantified by measurement of total body potassium) provides an ideal standard for measurements of energy expenditure. The aim of this study was to compare resting energy expenditure (REE) in patients with CF with both predicted values and age-matched healthy children and to    determine whether REE was related to either nutritional status or pulmonary function. REE was measured by indirect calorimetry and body cell mass by scanning with total body potassium in 30 patients with CF (12 male, mean AGE = 13.07 ± 0.55 y) and 18 healthy children (six male, mean AGE = 12.56 ± 1.25 y). Nutritional status was expressed as a percentage of predicted total body potassium. Lung function was measured in the CF group by spirometry and expressed as the percentage of predicted forced expiratory volume in 1 s. Mean REE was significantly increased in the patients with CF compared with healthy children (119.3 ± 3.1% predicted versus 103.6 ± 5% predicted, P < 0.001) and, using multiple regression techniques, REE for total body potassium was significantly increased in patients with CF (P = 0.0001). There was no relation between REE and nutritional status or pulmonary disease status in the CF group. In conclusion, REE is increased in children and adolescents with CF but is not directly related to nutritional status or pulmonary disease.

Implications of accuracy, sensitivity, and variability of body size estimations to disordered eating

The current study was conducted to investigate the relationships between body size estimations and disordered eating symptomatology. The method of constant stimuli was used to derive three measures of self-perceived body size in 93 women: (1) accuracy of body size estimations (body image distortion); (2) sensitivity in discriminating body size within blocks of trials (body image sensitivity); and (3) variability in making body size estimations between blocks of trials (body image variability). Participants also completed measures of disordered eating. Although body image distortion correlated with dietary restraint and eating concern, body image variability accounted for additional variance in these variables, as well as variance in binge eating. The relationships involving body image variability were found to be mediated by body dissatisfaction and internalization of the thin ideal. Together, these results are consistent with the proposition that body image variability is a significant factor in disordered eating.

How well do women adapt to changes in their body size and shape across the course of pregnancy

This study examined body image across pregnancy. Pregnant women ( N = 158) completed measures of general attractiveness, feeling fat, fitness and strength, salience of weight and shape, and ideal and current body size at pre-pregnancy (retrospective), and in early, middle and late pregnancy. Body image was found to be fairly stable across pregnancy such that women who started with greater body concerns maintained them over time. Although women were least satisfied with their stomach size at late pregnancy, women's ideal body shape increased in parallel with increases in body size. Women with the most body concerns reported more depressive symptoms, tendency towards dieting, and smoking during pregnancy suggesting they were at greater risk in terms of health and well-being during pregnancy.

Acculturation, body image, and eating behaviours in Muslim-Australian women

The relationship between western acculturation, body dissatisfaction, and eating behaviours was examined in a sample of 101 Muslim-Australian women between 18 and 44 years of age (M=27.3, SD=7.5). A questionnaire was completed containing measures of cultural identification (heritage and mainstream), body dissatisfaction and disordered eating (dietary control, bingeing and purging), internalization of the thin ideal, and self-esteem. A series of path analyses identified significant positive relationships between mainstream identification and the measures of body dissatisfaction and disordered eating that were mediated by thin-ideal internalization. Path analyses also identified significant negative relationships between heritage identification and the measures of body dissatisfaction and disordered eating that were mediated by self-esteem. These results are indicative of the potential risks to body image incurred by women who adopt Western values, and of the benefits in retaining heritage cultural values that promote a positive self image.

Body dissatisfaction and body change strategies among adolescents : a longitudinal investigation

This thesis examined body dissatisfaction and body change behaviors among adolescent girls and boys from a biopsychosocial framework. The contribution of biological, psychological and sociocultural factors were examined in relation to body dissatisfaction, weight loss, weight gain and increased muscle tone behaviors among early adolescent girls and boys. In particular, pubertal maturation, body mass index (BMI), perception of body shape and size and psychological factors, such as depression, anxiety, ineffectiveness, self-esteem and perfectionism, were examined as possible factors that may precipitate or maintain body dissatisfaction and engagement in body change strategies. The sociocultural factors evaluated were the quality of family and peer relationships, as well as the influence of family and peers in predicting the adoption of specific body change strategies. The specific mechanisms by which these influences were transmitted were also examined. These included perceived discussion, encouragement and modelling of various body change strategies, as well as perceived teasing about body shape and size. A number of separate cross-sectional and longitudinal studies were conducted to examine the above relationships and identify the factors that contribute to weight loss, weight gain and increased muscle tone behaviors in adolescents. Study 1 examined the psychometric properties and principal components structure of the Bulimia Test Revised (BULIT-R; Thelen, Farmer, Wonderlich, & Smith, 1991) to assess its applicability to adolescent samples. Study 2 investigated the nature of body dissatisfaction and weight loss behaviors among 603 adolescents (306 girls and 297 boys) using a standardised questionnaire. This preliminary study was conducted to ascertain whether variables previously found to be relevant to adolescent girls, could also be related to the development of body dissatisfaction and weight loss behaviors among adolescent boys. Studies 3 and 4 described the development and validation of a body modification scale that measured weight loss, weight gain and increased muscle tone behaviors. Studies 5 and 6 were designed to modify an Excessive Exercise Scale developed by Long, Smith, Midgley, and Cassidy (1993) into a shorter form, and validate this scale with an adolescent sample. Study 7 investigated the factors that contribute to weight loss, weight gain and increased muscle among adolescent girls and boys both cross-sectionally and longitudinally (over one year). Structural equation modelling was used to examine associations among self-reported body dissatisfaction, body change strategies and a range of biological, psychological and sociocultural variables both cross-sectionally and longitudinally. Overall, the results suggested that both girls and boys experience body dissatisfaction and engage in a number of different body change strategies in order to achieve an ideal size. A number of gender similarities and differences were identified in the expression of body dissatisfaction and the adoption of body change strategies for both girls and boys. Girls were more likely than boys to report body dissatisfaction and engage in weight loss behaviors, while boys were more likely than girls to engage in weight gain and increased muscle tone behaviors. Generally, the same factors were found to contribute to weight loss, and more specifically, bulimic symptomatology, ad weight gain in both adolescent girls and boys. While a combination of biological, psychological and sociocultural factors contributed to bulimic symptomatology, only biological and psychological factors were found to contribute to weight gain in adolescents. The most notable gender differences were found in the model of increased muscle tone. Sociocultural and biological factors contributed to increased muscle tone behaviors in girls, while sociocultural and psychological factors were implicated in these behaviors in adolescent boys. With the exception of the model of increased muscle tone for boys, body dissatisfaction was a consistent factor in the adoption of body change behaviors. Consistent with previous investigations, the present thesis provides empirical support for the need to examine the etiology and maintenance of such concerns and behaviors from a multifaceted perspective.

A comparison of the socio-cultural influences on body size perceptions and values among European Australian and Indigenous Fijian adolescent girls

Western women are experiencing increases in the prevalence of overweight and obesity despite valuing slimness as ideal and equating thinness with attractiveness and beauty. Pacific populations are also experiencing high prevalence rates of overweight and obesity. A lage body size, however, has many positive connotations among pacific populations that stem from rich cultural practices such as feasts and deliberate fattening of women. There appears to be many sociocultural factors however, such as images of the slim ideal portrayed in Western media, influencing body image concerns that are shared between the two groups. A qualitative study involving semi-structured interviews was conducted to examine and compare the sociocultural influences on body size perceptionsand values. Participants include 16 European Australian and 16 Indigenous Fijian adolescent girls aged between 15 and 17 years. Inductive thematic analysis and analytical induction were qualitativemethods employed to facilitate interpretation of the findings. Preliminary findings suggest that Fijian adolescent girls experience greater conflict than European Australian girls about the desired body size endorsed in their community. Results also suggest that Indigenous Fijian girls place less importance than Australian girls on manipulating their body to achieve a specific ideal. Specific results of this study are reviewed and recommendations for future research are discussed.

Socio-cultural messages, body image, and body change strategies in men

The thesis found that men received information about the ideal male body from perceived media messages and peers through encouragement, teasing, or modelled behaviours. Body mass index (BMI) also influenced participant's perceptions of their body-image and the strategies they used to change their shape. Sexual partners generally held positive views of men's body shape and weight. The portfolio examines the barriers experienced by individuals with co-occuring disorders within the current treatment system, by analysing four case studies.

The attractive female body weight and female body dissatisfaction in 26 countries across 10 world regions : results of the international body project 1

This study reports results from the first International Body Project (IBP-I), which surveyed 7,434 individuals in 10 major world regions about body weight ideals and body dissatisfaction. Participants completed the female Contour Drawing Figure Rating Scale (CDFRS) and self-reported their exposure to Western and local media. Results indicated there were significant cross-regional differences in the ideal female figure and body dissatisfaction, but effect sizes were small across highsocioeconomic-status (SES) sites. Within cultures, heavier bodies were preferred in low-SES sites compared to high-SES sites in Malaysia and South Africa (ds = 1.94-2.49) but not in Austria. Participant age, body mass index (BMI), and Western media exposure predicted body weight ideals. BMI and Western media exposure predicted body dissatisfaction among women. Our results show that body dissatisfaction and desire for thinness is commonplace in high-SES settings across world regions, highlighting the need for international attention to this problem.

Examining the dissociative basis for body image disturbances

Although dissociative symptoms have been linked with both food- and appearance-related aspects of eating disorders, the psychological mechanisms underlying these relationships remain unclear. The present study evaluated the hypothesis that the disturbances of self-identity attributed to dissociation can manifest as disturbances of body image and, in turn, undermine body-specific self-evaluations relevant to disordered eating (i.e., body comparison, body dissatisfaction, and internalization of the thin ideal). Ninety-three female university students completed self-report measures of dissociation and body-related aspects of disordered eating. In addition, the method of constant stimuli was used to experimentally derive three measures of body image disturbance: (1) accuracy of body size estimations (body image distortion), (2) ability to discriminate between different body sizes (body image sensitivity), and (3) consistency in one’s body size estimations (body image variability). The findings show that dissociation is related to symptoms of disordered eating, and that these relationships may be mediated by body image instability. Collectively, these findings support the notion that the body image attitudes and behaviours that characterize eating disorders may derive from proprioceptive deficits due to dissociation.

Intergenerational differences in food, physical activity, and body size perceptions among African migrants

We assessed intergenerational differences in food, physical activity, and body size perceptions among refugees and migrants from the Horn of Africa living in Victoria, Australia. We used a qualitative design and obtained data from 48 participants (18 individual interviews; 3 semistructured focus groups). Three major themes emerged: (a) food and physical activity, (b) preference of body size and social expectations, and (c) perceived consequences of various body sizes. For parents, large body size was perceived to equate with being beautiful and wealthy; slimness was associated with chronic illness and poverty. Parents adopted strategies that promoted weight gain in children. These included tailored food practices and restricting children’s involvement in physical activity. For young people, slimness was the ideal body size endorsed by their peers, and they adopted strategies to resist parental pressure to gain weight. Obesity-prevention programs in this subpopulation need to adopt a multigenerational approach.

The role of cultural values and religion on views of body size and eating practices among adolescents from Fiji, Tonga and Australia

Objectives This study investigated cultural values related to body image and eating practices in Western and non-Western societies.

Design and Methods In total, 628 Fijian, 463 Indo-Fijian, 598 Tongan, and 534 Australian adolescents completed measures of cultural values and religious influences in relation to the ideal body and eating practices.

Results Fijian and Tongan adolescents were more likely to value a large body. Religious influences were most strongly associated with eating practices for Fijians, Indo-Fijians, and Tongans.

Conclusions The findings support the role of religion in transmitting cultural values regarding eating practices in Pacific Island communities.

Statement of contribution
What is already known on this subject? Previous research has demonstrated that sociocultural factors shape body image and eating behaviours. Most of this research has been conducted in Western countries.

What does this study add? The current study identifies the role of cultural values and religious influences on body image and eating behaviours in a number of different cultural groups. This is the first study to use the same methodology to explore these relationships across Western and Pacific Island communities.

Preschoolers' body-knowledge inaccuracy: perceptual self-deficit and attitudinal bias

Body image research with young children has typically examined their body satisfaction and overlooked developmental theories pertaining to their emergent body-knowledge. Though existing research suggests that preschoolers do demonstrate anti-fat attitudes and weight-related stigmatisation, body dissatisfaction can be difficult to assess in preschoolers due to developmental differences in their (i) ability to perceive their actual body size accurately and (ii) make comparisons with a hypothetical ideal. We review current findings on the attitudinal component of body image in preschoolers, together with findings on the accuracy of their body size perceptions and their emergent body awareness abilities. Such an integration of the cognitive development literature is key to identifying when and how young children understand their physical size and shape; this in turn is critical for informing methodological design targeted at assessing body dissatisfaction and anti-fat attitudes in early childhood.

A qualitative exploration of body image experiences of women progressing through pregnancy

BACKGROUND: Pregnancy provides an interesting challenge to body image theories in that the natural physiological changes push women further from the socioculturally prescribed thin ideal which these theories hinge upon. The impact that these significant physiological changes have on the woman's body image during pregnancy may depend on the extent to which they retain or revise the ideal. However, little is known about body image experiences during pregnancy. AIM: To provide a comprehensive exploration of the body image experiences of pregnant women. METHODS: Individual structured interviews were conducted with 19 currently pregnant women. Transcriptions were analysed using a thematic content analysis approach. FINDINGS: Themes extracted from the qualitative data included: (1) women's body image experiences during pregnancy were complex and changing, and shaped by the salience of specific body parts, the women's expectations for future changes to their body within the perinatal period, the functionality of the body, and their experience of maternity clothing, (2) women were able to negotiate the changes to their bodies as they recognised the functionality of the pregnant body, (3) women were surprised by the public nature of the pregnant body, (4) partner support and positive feedback about the pregnant body was highly valued, and (5) the importance of open communication around weight and body image in antenatal healthcare. DISCUSSION: Our findings highlight the need for the adaptation and expansion of existing body image theories to be used as a framework for women's experiences of pregnancy.

Changing guards: time to move beyond body mass index for population monitoring of excess adiposity

With the obesity epidemic, and the effects of aging populations, human phenotypes have changed over two generations, possibly more dramatically than in other species previously. As obesity is an important and growing hazard for population health, we recommend a systematic evaluation of the optimal measure(s) for population-level excess body fat. Ideal measure(s) for monitoring body composition and obesity should be simple, as accurate and sensitive as possible, and provide good categorization of related health risks. Combinations of anthropometric markers or predictive equations may facilitate better use of anthropometric data than single measures to estimate body composition for populations. Here, we provide new evidence that increasing proportions of aging populations are at high health-risk according to waist circumference, but not body mass index (BMI), so continued use of BMI as the principal population-level measure substantially underestimates the health-burden from excess adiposity.