Effects of improved dietary behaviors and increased physical activity on low body satisfaction: Theory-based psychological mechanisms of change in women within a behavioral obesity treatment

Black women are at high risk for obesity and obesity-related health problems (1). Nearly 50% of black women compared to 30% of white women are obese (2,3). While many women who attempt to lose weight do so through caloric restriction and/or physical activity, smoking has been identified as an alternate strategy used for weight loss among black women with weight concerns or body image concerns (4). Nicotine's suppression of body weight facilitates initiation and maintenance of smoking among women (5,6,7). Despite the deadly health risks associated with tobacco use, 23.1% of women smoke (8). Female smokers are more likely to report smoking cigarettes to control weight (6,9) and less likely to quit smoking due to weight concern (10). Perkins et al. and Pirke and Laessle note that women tend to suffer more postcessation weight gain than men (as cited in Copeland) (11). Smoking cessation is less likely among women who fear postcessation weight gain or benefit from weight control when smoking. Additionally, women with the intention to control body weight by restrictive eating are more likely to smoke to control appetite and weight (12). Black women tend to have lower rates of smoking cessation and physical activity and higher dietary fat intake (13,14,15). Factors contributing to low prevalence of weight management among black women need to be identified for the development of appropriate interventions. Less reported social pressure to achieve thinness and greater perceived attractiveness at higher body weights may limit motivation for healthy weight management among many black women. The 2003–2008 National Health and Nutrition Examination Survey found weight control through physical activity or dietary change to be positively associated with weight perception (odds ratio women 3.74; 95% confidence interval 2.96, 4.73) (16). Several authors assert that historical black-white differences in ideal female body image (17) and acceptance of overweight (18) may contribute in part to explaining racial differences in weight loss efforts and modifiable weight management behaviors. It has been indicated that black women have a high prevalence of obesity partly because self-image is not strongly dependent on body size (19). Body shape perception often varies by race and gender with blacks generally perceiving their bodies as lighter than indicated by their BMI (20). An understanding of factors such as body image and their relationship to weight loss behaviors is necessary to promote healthier lifestyles. This review investigates the association between body image satisfaction and dietary behavior, physical activity, and smoking as tools for weight control among black women. Due to the paucity of literature focusing solely on black women, this article considers both the experiences of black women alone and with other groups. Studies were identified through computerized searches of biomedical and psychological databases, namely PubMed, CINAHL, Psych Abstracts, Science Direct, and Web of Science and manual searches of article bibliographies focusing on dietary behaviors, physical activity, and smoking/alternative weight control techniques since 1990. Searches were performed on recurring authors and in recurring journals for additional articles on the topics. Variations of the term "body image," including "body dissatisfaction," "satisfaction," and "esteem," as well as "size," "shape," and "weight" were sought. Searches included these terms in combination with the target health behaviors, namely diet, physical activity, and smoking. The search was limited to studies including black or African-American females. We did not restrict our search to only studies that investigated ethnic differences because it is our aim to understand body image as it relates to health behaviors among black women to determine whether it may be a factor to address in designing interventions. We were not specifically investigating racial differences in regards to body image. Additionally, we found that many studies did not distinguish results by race or ethnicity. Thirty-one articles have been cited in this article. The list may not be exhaustive. Some identified articles were excluded for several reasons. Studies investigating dietary disorders were omitted as well as those that did not evaluate body image in association with the health behaviors. Findings and critiques of the remaining articles follow. Over the last decade, several seminal papers have documented the positive association between components of body image dissatisfaction and dieting frequency or dieting status among US adults and adolescents. An accumulating body of research has directly evaluated the relationship between dimensions of body image and dieting behavior or dieting status specifically in black women (see Table 1). Two studies bear mentioning first as findings have acknowledged the importance of identifying potential within group variation among black women with respect to dieting and body image disturbance (see Table 1). Kumanyika and colleagues were among the first to begin to clarify the link between dieting and weight satisfaction in a large sample of black women from the Washington DC community (1). Results showed that less satisfaction with weight and a history of dieting were more likely among the overweight women. Similarly, among black female participants in the CARDIA multisite investigation, a positive relationship between dimensions of body dissatisfaction and dieting for weight reduction was evidenced across BMI tertiles despite women of greater BMI reporting poorer body image (19). It is unclear however, whether results varied by study site. A series of cross-sectional studies assessed body image (using diverse instrumentation) among multiethnic samples of self-identified dieters inclusive of appreciable numbers of black females (21,22,23,24,25,26). In both adults and adolescents few differences in body image disturbance were observed between black and white female dieters (Table 1). This parity was particularly evident when analyses were adjusted for covariates correlated with both dieting status and body image perceptions (e.g., age, BMI regardless of race (21,23,25). Only a few studies to date have examined these relationships including nondieting controls as a comparison (22,24). In one early report, adolescent dieters residing in the Midwest irrespective of race, gender, and actual overweight status typically endorsed more disturbed body image attitudes relative to nondieting peers (24). Similarly, in a more recent investigation conducted in Los Angeles, both black and white adult female chronic dieters exhibiting high dietary restraint reported greater distortions in aspects of body image than nondieting females and male chronic dieters (22). However, these results were not controlled for BMI, age, or socioeconomic status. Another series of cross-sectional investigations compared the relationship between dimensions of body image and dietary restraint/dieting in ethnically diverse groups of black and white adult and adolescent females. Again, it appears that in general, the correlations between these factors are robust independent of age and race in community (22,27,28,29,30) and in-patient (26) samples. Notable exceptions, however, were observed in a few instances where patterns of relationships between indicators of poor body image and dieting behavior differed between women of both racial groups (Table 1 and see refs. 26,28,29). Interestingly, the one investigation in which no significant relationship emerged between components of body dissatisfaction and dieting among black females was conducted in the southern US region (26). A few recent reports have begun to explore the association between measures of body image and various dietary consumption patterns among black females and others (Table 2; please see Ard et al., for a description of findings using qualitative methodology) (31). Dependent variables included frequency of skipping meals (32,33), fast food consumption (34), and composite measures of dietary weight control (35) in predominantly black or ethnically diverse samples spanning a spectrum of ages and US regions. Components of body image disturbance tended to covary positively with poorer nutritional content (35) and behavior patterns (36) and negatively correlated with healthy dietary intake (37) with some exceptions (38,39). However, BMI and other socioeconomic status variables were not consistently controlled in analyzing these relationships. There have been varied findings regarding the association between body satisfaction and participation in physical activity (see Table 3). One study identified body image as a motivating factor for engaging in physical activity (14). Taylor et al. (14) investigated reasons for adolescent girls' participating or not participating in physical activity. Focus groups of black and Latina girls revealed that concerns with body image facilitated physical activity. The girls reported that extra body fat and size affected how they felt about themselves. Some noted positive effects of exercise were "keeping your right size," "a flat stomach," and "losing weight" as well as the desire to be skinny like the people on the exercise programs on TV and to lift weights to give shape to your body. Although there is qualitative evidence of body image being a motivating factor for physical activity, several other studies have found that low body satisfaction is associated with low physical activity. In a 5-year longitudinal study of socioeconomically and ethnically diverse adolescents, Neumark-Sztainer and colleagues (40) found that lower body satisfaction predicted lower levels of physical activity among females. Separate findings for black and white females were not presented. However, results were weighted by ethnicity, race, and socioeconomic status of respondents. Similarly, Yancey et al. (41) found that overweight black women and men were less likely to perceive themselves to be overweight than overweight Latinos or whites. Average weight blacks and Latinos who perceived themselves as being overweight were more likely to be sedentary than their white counterparts. In subgroup analyses by race/ethnicity, black and Latina women were grouped together due to small numbers (41). In another study, adolescents who perceived themselves as overweight were less likely to engage in physical activity despite trying to lose weight. Exercising was the method more often reported by whites than by other racial and ethnic groups (32). Some studies support the notion of cultural acceptance of fatness suggesting that blacks are less likely to engage in weight loss behaviors due to acceptance of large body shapes (42,43). Kelly et al. (33,42) found that black girls were more likely than white girls to report high body satisfaction. Results suggested that adolescent girls with high body satisfaction were less likely to use healthy or unhealthy weight control behaviors, including exercise, eating more fruits and vegetables, and eating fewer sweets and high-fat foods (42). Similarly, Mabry and colleagues (43) found that black adolescent girls demonstrated more acceptance and self-esteem with regards to having a larger body size than their white peers. This acceptance was associated with less participation in physical activity (43). Although many investigators are concerned with the impact of body image satisfaction on engagement in physical activities, others have investigated the opposite relationship. Some studies have found participation in physical activity to lead to improved body image (20,44,45,46). In a convenience sample with 60% black women Smith and Michel found that pregnant women who participated in an aquatic aerobic program reported improved body image scores. While analyses were not stratified by race/ethnicity, the diversity of the sample suggested that this association was true across race and ethnic groups (44). Likewise, Miller and Levy found that female athletes exhibited significantly more positive body image self-concept than female nonathletes (45). Again, results were not stratified by race. In a biracial population of young adults aged 18.5–35 in Bogalusa, LA, physical activity was not found to be a significant predictor of body image perception (20). While both black women and white women expressed negative body image views that countered the cultural tolerance of fatness theory attributed to black women, these groups expressed differences in ideal weight-loss methods. White women emphasized physical activity whereas black women emphasized food characteristics with no mention of physical activity (46). Some studies investigated both body image and physical activity but did not assess the association between these two factors; however, racial/ethnic differences were noted. Studies suggest that there is no significant difference between blacks and whites over age 22, whereas white teens and college-aged women are more dissatisfied with their looks than black women at this age (47). Perry et al. found that white girls had greater physical activity whereas black girls had higher ideal body sizes and greater body satisfaction than white girls. There was no significant difference between black girls and Hispanic girls on body satisfaction or physical activity (48). Contrarily, another study found that black women had higher ideal body image and more sedentary behaviors than Latin-American women (49). While there is evidence of contrary findings of the relationship between body image and physical activity and differences by race/ethnicity, in general the association tends to vary by age. Several researchers have examined the relationship between body image and smoking among females. However, the sample sizes of many of these studies assessing the role of body image on decisions to start smoking or smoking cessation included few blacks. King (13) noted that researchers had not examined the role of tobacco use for weight management among black women. Several clinical trials regarding tobacco cessation have assessed the impact that body image or weight image has in influencing smoking patterns among females. The studies can be separated into two types—those examining smoking initiation or smoking cessation. Several cross-sectional studies examined whether perceptions of attractiveness influenced smoking behaviors (50,51,52). Findings suggest that women smokers felt less attractive and disliked their bodies more than nonsmokers (52) (Table 4). Women with weight concern were more likely to smoke to achieve a smaller figure. Knauss and colleagues (50) found that female smokers considered other smokers to be more attractive and rated smoking as appealing. Utilization of media (magazines and television) may encourage smoking among weight-concerned adolescents. Carson surveyed 967 12th graders to examine whether exposure to media and drive for thinness influenced smoking among this population. Teens who read fashion, entertainment, and gossip magazines were more likely to be current smokers. The authors asserted that smoking is used by these teens in order to maintain a thin figure (51). Among studies of smoking for weight management, few studies have assessed the use of smoking for weight management among black women (53). An earlier review of barriers to smoking cessation among minority women did not include weight control as a barrier to quitting smoking (13). Many prior studies included small numbers of blacks. However, four studies examined the relationships between smoking and weight concern among larger numbers of black females. Several clinical trials have assessed factors affecting smoking cessation among black females. One study examined smoking cessation among blacks with HIV/AIDS (54). Another examined smoking cessation among low-income blacks (55). Both found black females with less weight concern were more likely to smoke. Only one study has assessed the role of weight concerns in smoking initiation among black females (53). Whereas 5.6% of African-American women initiated smoking as a result of weight concern, 11.3% of white women felt that weight was an important factor in smoking initiation. Using data from the National Longitudinal Survey of Youth (NLSY97) Cawley and colleagues (56) found that adolescent females with a higher BMI who were trying to lose weight were more likely to initiate smoking than the females who did not consider themselves overweight. Results were not stratified by race. Several studies assessed whether weight concern reduced smoking cessation among black women. Pomerleau et al. (53) found that overweight black smokers were less willing to risk weight gain by quitting smoking and concluded that weight concerns may motivate black women as powerfully as white women to continue to smoke. Two studies found that the majority of black female smokers were not concerned about postcessation weight gain (54,57). Obese black females were least concerned about postcessation weight gain. In contrast, another study reported that black female smokers were concerned about postcessation weight gain (56). Concerns about body shapes or the fear of postcessation weight gain differ from those of white females, yet have influenced some black women's decisions about smoking cessation. Further efforts must be made to provide weight gain education and prevention among black females (57). Numerous studies have investigated the association between body image and modifiable weight-loss behaviors among black females. In general, body dissatisfaction was found to be associated with poorer health behaviors. Females who were dissatisfied with their bodies were more likely to practice poor nutritional behaviors and less likely to participate in physical activity or to stop smoking. There were variations in findings due to race, age, and overweight status. Notable aspects of some previous studies regarding body image and weight control measures were the use of diverse populations, longitudinal study designs, and the consideration of inverse relationships. Several studies of body image and dieting behavior are particularly noteworthy for their methodological rigor of executing prospective longitudinal study designs (34,57) and for strategically sampling from both traditionally underrepresented groups in health research (e.g., ethnically diverse female hospital workers in an urban locale: (55) and from large regional segments of the US adolescent population (36,58,59). With small numbers of black females generally included in body image studies, two studies on smoking cessation are also noteworthy for investigating large groups of black females (54,57). The women in these studies were low-income, and in one study, the black women were HIV-infected. The bidirectional association between components of body image and weight control behaviors was highlighted by physical activity studies which investigated the impact of body image satisfaction on participation in physical activity(14,40,41,42,43,60) as well as the inverse influence of physical activity on body satisfaction (38,39,40,42) to assess motivators and barriers to weight control. Contrary to the strengths of a few studies, many studies suffered from analytical, methodological, and inclusion deficiencies. Little is known about the bidirectional relationship between changes in specific weight control behaviors and shifts in how black females may perceive their bodies and whether these patterns correspond with those reported by white females in this country. Most studies were cross-sectional in nature and unable to infer a clear directional relationship. The variations in findings of the associations suggest the need for more longitudinal research to clarify the directionality of this association. Additionally, there was great variation in measures of body image and classifications for dieting and physical activity status and perception. Most studies utilized a measure of self-perceived body image or weight status. It has been found that black females tend to be more accepting of larger bodies and generally underestimate their actual weight status with those who are overweight less likely to perceive themselves as overweight compared to other races (41,61). Those who are overweight perceive themselves as normal weight, and the obese consider themselves overweight (61). This discrepancy suggests the need for more culturally tailored programs to increase self-awareness of weight status, health consequences, and healthy lifestyle changes. Many studies on body image were mainly conducted on white females. Unfortunately, only small percentages of black females were usually included in the studies, therefore making any efforts to test for the potential differential impact of race on the relationship between measures of body image and behaviors untenable. Most authors discussed general findings irrespective of race (59,62), used race simply as a sociodemographic control variable versus testing it as a possible effect modifier (35,58), or tended to prefer emphasizing differences observed due to gender (37,59) or to overweight status (58). Additionally, studies were performed on a broad range of age cohorts suggesting an influence of body image throughout the stages of development and the need for further studies at each age level. Further investigation into differences by race/ethnicity within various age groups is needed. To design appropriate interventions to reduce obesity among black females it is necessary to understand whether body image is gaining influence in promoting dietary, physical activity, and smoking changes within the context of weight control. Based on the review of the literature offered here, the current state of the evidence is insufficient to adequately address this question at present. There are several factors to consider in improving the quality of the research produced and therefore strengthening confidence in the validity and applicability of findings. Chief among these is the need for greater attention to designing prospective longitudinal studies that would provide a more robust test of how dimensions of body image may act as determinants of weight control behaviors among black females. Additionally, with perceived overweight as well as high satisfaction with body image both being associated with more sedentariness, this presents quite a challenge for identifying motivators for black females to engage in health-promoting activities. A central question to target in future efforts is: What factors may modify the impact of weight and body dissatisfaction on engaging in dieting, physical activity, and smoking cessation among black females? The current review has provided some preliminary clues that may be involved in further delineating important individual differences in this line of research. These include overweight status (1), level of acculturation to mainstream US culture (22), and likely regional variation in the value placed on weight loss and tuning into feelings about the body as a mechanism of change (35,39). It is our hope that this critique may serve as a preliminary roadmap for both existing and future qualitative and quantitative research in this area to be effectively translated into culturally attuned healthy weight management promotion efforts among ethnically diverse females. The authors declared no conflict of interest.

Effects of behavioral obesity treatments on changes in emotional eating (EmEat) and its psychological correlates in women who increased their physical activity (PA) was evaluated. Women with obesity, who increased their PA from baseline to Month 3 by the equivalent of three walks/week, were randomized into weight-loss treatments with either a cognitive behavioral (n = 40) or educational (n = 35) focus. They completed a series of theory-based psychological surveys at baseline and Month 3 and had their weight measured at intervals over 24 months. The significant association of treatment type and 3-month change in EmEat was significantly mediated by changes in eating-related self-efficacy, negative mood, eating-related self-regulation, and body satisfaction. Only self-efficacy change was a significant independent mediator. In subsequent analyses, changes in mood and self-regulation independently explained significant portions of the variance in eating-related self-efficacy change. Reduction in EmEat significantly predicted weight-loss. Although psychological changes associated with moderate increases in PA have been a consistent predictor of reductions in EmEat, this research supported the effects of cognitive behavioral processes (e.g., self-regulation; self-efficacy) beyond PA-associated biochemical effects. Associations between reductions in EmEat and weight reinforced the practical utility of the findings. Targets for future behavioral obesity treatments were elucidated.

Behavioral obesity treatments are typically unable to facilitate meaningful weight loss beyond the short term. Implications of malleable psychosocial factors are unclear, which limits behavioral intervention contents. The current aim was to inform obesity treatments to improve their foci on psychosocial factors leading to resilient behavioral changes and maintained weight loss. Based on pre-planned analyses, women participating in a community-based obesity treatment emphasizing self-regulation and exercise, and who lost at least 3% of their initial weight (N = 89), were measured on eating-related self-efficacy, negative mood, emotional eating, body satisfaction, and self-regulating eating at baseline, Month 3, and Month 6; and on weight change over 12months. From baseline to Month 6, there was a significant overall improvement in each psychosocial variable. In separate multiple regression equations, scores at (1) Month 6, (2) change from baseline to Month 6, and (3) change from Month 3 to Month 6 were entered as predictors of maintained weight loss from Month 6 to Month 12. Using a backward elimination process, only negative mood was retained in the final Month 6 model, and significantly predicted maintained weight loss (R2adjusted = .03, p = .050). Changes in self-efficacy, mood, emotional eating, and self-regulation were retained in the final baseline to Month 6 model, and significantly predicted weight loss maintained over 12months (R2adjusted = .30, p < .001). Findings add to research on obesity treatment development by suggesting an enhanced focus on facilitating changes in self-efficacy, mood, emotional eating, and self-regulation may enhance maintenance of lost weight (or increase weight loss).

Research on coaction suggests improvements in physical activity and emotional eating will occur in a reciprocal manner. To determine if changes in body satisfaction mediate relations between physical activity and emotional eating changes and if age affects degree of change in those variables. Groups of early adult (n = 43) and middle-age (n = 52) women participants of a community-based obesity treatment were assessed on behavioral and psychological variables over 3 and 6 months. Improvements in physical activity, anxiety-related emotional eating, body satisfaction, anxiety, and exercise self-efficacy were significant overall. Early adults demonstrated greater reductions in emotional eating. Physical activity increase over 3 months significantly predicted 6-month reduction in emotional eating but not vice versa. Body satisfaction change significantly mediated the physical activity-emotional eating relationships. Changes in anxiety and exercise self-efficacy moderated activity → emotional eating and body satisfaction → physical activity relationships, respectively. Findings can inform both theory and behavioral obesity interventions.

To assess effects of cognitive-behavioural weight-loss treatments on self-efficacy to control emotionally cued eating and whether those changes mediate relationships between body satisfaction and emotional eating. Emotional eating is common, especially in women with obesity. A better understanding of relationships of its psychosocial correlates might benefit behavioural weight-loss treatments. A field-based, quantitative study incorporated two theoretically derived weight-loss treatments using repeated measures analyses that employed validated surveys. Women with obesity volunteered for a community-based weight-loss study and were assigned to either a treatment of a manual plus phone support (n=47), or in-person contacts emphasizing self-regulation (n=48), over 6months. Both emphasized physical activity, healthy eating and building self-efficacy for enabling the health-behaviour changes. Data were collected between 2013-2014. Multiple regression analyses assessed predictors of self-efficacy change. Mixed-model analysis of variances assessed treatment differences in psychosocial changes. Mediation analyses assessed mediation of the relationships between body satisfaction and emotional eating changes. Changes in Overall mood and Self-regulation significantly predicted change in Self-efficacy to control emotionally cued eating. Changes in Body satisfaction, Emotional eating, Mood, Self-regulating eating and Self-efficacy were significant overall, and each significantly greater in the in-person treatment. Self-efficacy significantly mediated the relationship between changes in Body satisfaction and Emotional eating total (and Emotional eating when depressed or anxious, but not when frustrated/angry). Results clarified mediation of the dynamic relationship between body satisfaction and emotional eating, which might enable behavioural weight-loss treatments to better-address emotional eating.

An improved understanding of the implications of race on body satisfaction might optimize the weight loss process and quality of life in women with obesity. Women with obesity (mean [standard deviation] age, 33.0 [13.8] years) of black (n = 32) and white (n = 38) racial groups volunteered for a cognitive-behavioral weight management program. Body satisfaction scores at baseline and month 3 were significantly higher in the black group; however, the significant within-group improvements in that variable and on weight, physical activity, fruit and vegetable consumption, sweets intake, perceived ability to control eating, and emotional eating did not significantly differ by racial group. Neither weight nor age significantly added to the strength of the association between race and body satisfaction. Perceived ability to control eating mediated the associations between race and body satisfaction as well as change in weight and change in body satisfaction. In post hoc analyses, inverse associations between body satisfaction and emotional eating were detected regardless of race. The findings of this study increased understanding of body satisfaction in women with obesity and have implications for addressing psychosocial factors within weight loss treatments across racial and at-risk groups.

I. The Problem: Childhood Obesity—A Burgeoning Epidemic e490II. Childhood Obesity Research Summit.........e490III. Pathophysiology and Morbidity ofChildhood Obesity e490A. Pathophysiology of Obesity e490B. Medical Consequences of Childhood Obesity. . .e490C. Psychosocial and Societal Consequences ofChildhood Obesity e490IV. Current Healthcare Practices in ChildhoodObesity Prevention and Treatment e492A. Lifestyle Assessment: Diet and Physical Activity . . . .e492B. Clinical Assessment e493C. Psychosocial/Behavioral Assessment .......e493D. Implementing Effective Prevention andTreatment Options: Diet e494E. Implementing Effective Prevention and TreatmentOptions: Exercise and Sedentary Behaviors . . . .e495F. Implementing Effective Prevention TreatmentOptions: Family and Behavioral Approaches . . .e496G. Behavioral Management e497H. Medical and Pharmacological Management. . . .e497I. Surgical Management e498V. Barriers to Optimum Care e498A. Healthcare System Factors e4981. Preparedness of Providers e4982. Models of Coverage and Care e4993. Uninsurance and Underinsurance AmongChildren and Families e5004. Healthcare Providers and Settings asRole Models e500B. The Challenge of Behavior Change ........e5011. Motivational Interviewing for Pediatric Obesity. .e5012. Psychosocial Factors InfluencingBehavior Change e5023. Environmental Factors InfluencingBehavioral Change e503VI. Practice-Based Resources for Preventionand Management e503A. Models From Other Disciplines e5031. Adult Chronic Care Model e5032. Treatment of Heart Failure e5043. Treatment of Type 2 Diabetes Mellitus .....e5044. Treatment of Childhood Asthma.........e505B. Public Health Measures forChildhood Obesity e5061. Tobacco Control: Implications forChildhood Obesity e506C. Specific Research Issues e5061. Specifying Priorities in the Context of aComplex, Multifactorial Problem ........e5062. Taking a Developmental Approach .......e5073. Engaging Stakeholders e5074. Targeting the Appropriate Outcome .......e508VII. Research Challenges e509A. Research in the Busy Practice e509B. Bring Research Into Practices: Web-BasedAssessment for the PediatricObesity Clinic e509C. Research Agenda: NHLBI and thePediatric Heart Network e510D. Research Agenda: The Children’sOncology Group e510E. Research Agenda: CDC e511F. Research Agenda: Foundations e511VIII. Research and Policy: KnowledgeTranslation e512A. From Practice to Policy to Practice ........e512IX. Concluding Remarks e512Appendix A: Planning Committee e513Appendix B: Presenters e513

A lack of satisfaction with one's body is common among women with obesity, often prompting unhealthy "dieting." Beyond typically slow improvements in weight and body composition, behavioral factors might also affect change in body satisfaction. Age and race/ethnicity (African American vs. White) might moderate such change. Obese women (N = 246; M(age) = 43 years; M BMI = 39 kg/m(2)) initiating a 6-month cognitive-behaviorally based physical activity and nutrition treatment were assessed on possible predictors of body satisfaction change. At baseline, African American and younger women had significantly higher body satisfaction. The treatment was associated with significant within-group improvements in mood, health behaviors (physical activity and fruit/vegetable intake), and body composition (waist circumference). A multiple regression analysis indicated that mood, health behavior, and body composition changes explained a significant 27% of the variance in body satisfaction change. Of these predictors, changes in mood (β = -.36, p < .001) and health behaviors (β = .18, p = .01) made significant, unique contributions to the variance in change in body satisfaction that was accounted for, while only the measure of actual physiological change (body composition) did not. Neither age nor race/ethnicity was a significant moderator when each was entered separately into the multiple regression equation. Practical implications for leveraging manageable changes in behavioral factors for improving body satisfaction were discussed.

Effects of Women's Body Satisfaction, Emotional Eating, and Race on Short-, Mid-, and Long-term Weight Loss

Although an increase in fruit and vegetable (FV) consumption in adults might result in reductions in their intake of sweets, there has been minimal direct testing of this. Women participated in 6-month community-based obesity treatment conditions where either their psychological skills development (n = 66) or knowledge regarding healthful eating and exercise (n = 39) was emphasized. Improvements in FV and sweets intake, eating-related self-regulation, self-efficacy for controlled eating, and negative mood were significantly more pronounced in the psychological skills group participants. Together, participants’ change in self-regulation, self-efficacy, and mood significantly mediated the relationship of their changes in FV and sweets. Within simple mediation analyses, participants’ changes in self-efficacy and negative mood were significant mediators, and their treatment group membership moderated effects on sweets. We provided suggestions for future treatments based on the present findings.

The aim of this paper was to investigate the effect of different types of TikTok dance challenge videos on young women's body satisfaction. Study 1 involved 262 women aged between 18 and 25 years, who were randomly assigned to watch TikTok videos featuring either thin dancers, large dancers, or amusing animal videos. Body satisfaction significantly increased after watching large dancer TikTok videos and decreased after watching thin dancer TikTok videos, although this decrease was not significant. Study 2 replicated and extended study 1 and involved 280 women aged between 18 and 25 years. Females body satisfaction significantly decreased after watching the thin dancer TikTok videos and significantly increased after watching the large dancer TikTok videos. There was no significant difference between the participants in terms of state appearance comparison. Females in the thin dancer condition engaged in upward social comparison, whereas the females in the large dancer condition engaged in downward social compression. The impact of video type was not moderated either by trait appearance comparison, or thin ideal internalization. The effect of video type was not mediated by state appearance comparison but was fully mediated by the direction of social comparison. Study 3 involved 375 women aged between 18 and 25 years and found that body satisfaction was lower after watching the thin dancers than after watching the large dancers. This study shows that findings from the previous two studies could not be explained by the demand characteristics in the design of these studies. All three studies show that exposure to large dancers on TikTok has a positive impact on women's body satisfaction, whereas exposure to thin dancers has a negative impact on women's body satisfaction. The implications of these findings for the design of social media are discussed.

ABSTRACTBackgroundPrevious studies have acknowledged that higher body weight and waist circumference were associated with an increased risk of heart failure. Notably, both body weight and waist circumference can change over time. However, no previous study has investigated the association between combined changes in weight and waist circumference in middle‐aged and older adults and incident heart failure.MethodsThis prospective study included 45 620 middle‐aged and older Chinese adults (aged 45–104 years). These participants were free of critical diseases at baseline, including coronary heart disease, stroke, heart failure, atrial fibrillation and cancer. Weight change from 2006–2007 to 2012–2013 was categorized into five groups: excessive weight loss (change < −10%, N = 3943), lesser weight loss (−10% ≤ change < −5%, N = 5890), stable weight (±5%, N = 23 208), lesser weight gain (5% < change ≤ 10%, N = 7153) and excessive weight gain (> 10%, N = 5426). Waist circumference change was categorized into five groups: excessive waist circumference loss (change < −10%, N = 8236), lesser waist circumference loss (−10% ≤ change < −5%, N = 6215), stable waist circumference (±5%, N = 16 953), lesser waist circumference gain (5% < change ≤ 10%, N = 6642) and excessive waist circumference gain (> 10%, N = 7574). Combined changes in weight and waist circumference were divided into 25 groups, i.e., cross‐classified combinations derived from the five categories of weight change and five categories of waist circumference change. Incident heart failure cases that occurred from 2012–2013 to December 31, 2022 were recorded. Cox proportional hazards regression models were used to estimate the associations of weight change, waist circumference change or both with heart failure. Multivariate models were stratified by age at risk (in 5‐year intervals) and sex, and were adjusted for variables including height, smoking, drinking, educational attainment, occupation, dietary pattern, physical activity, hypertension, fasting blood glucose and total serum cholesterol. In the analysis of weight change, we additionally adjusted for weight at baseline and waist circumference change. Conversely, for the analysis of waist circumference change, adjustments were made for baseline waist circumference and weight change. When examining combined weight and waist circumference changes, adjustments were made for both baseline weight and waist circumference. Additionally, we employed restricted cubic spline analyses to examine the nonlinear associations between changes in weight or waist circumference and heart failure.ResultsWe identified 1036 heart failure cases during follow‐up. The median (interquartile range, IQR) of follow‐up time was 9.66 (9.40, 9.96) years. The incidence rate of heart failure was 2.47 cases per 1000 person‐years. The median (IQR) age of our participants was 52.1 (46.8, 57.7) years. The proportion of men was 77.9%. The mean (standard deviation) of weight and waist circumference at baseline (baseline, 2006–2007) was 70.1 (10.4) kg and 87.2 (9.0) cm, respectively. Compared with those who kept stable weight, participants in the excessive weight gain group had a higher risk (HR [hazard ratio], 1.27; 95% CI [confidence interval]: 1.03–1.57). Compared with those who kept stable waist circumference, participants in the excessive waist circumference gain group had a higher risk (HR, 1.28; 95% CI: 1.05–1.56), while those in the excessive waist circumference loss group had a lower risk of heart failure (HR, 0.76; 95% CI: 0.64–0.92). Compared with participants with stable weight and waist circumference, those who lost excessive weight and kept stable waist circumference (HR, 1.53; 95% CI: 1.10–2.14), those who lost lesser weight and gained excessive waist circumference (HR, 2.19; 95% CI: 1.38–3.46), and those who gained excessive weight and excessive waist circumference (HR, 1.48; 95% CI: 1.03–2.14) had a higher risk of heart failure. The restricted cubic spline illustrated a U‐shaped relation between weight change and incident heart failure (P overall = 0.027, P for non‐linear relation = 0.007), whereas a positive linear relation was observed for waist circumference change with incident heart failure (p overall < 0.001, p for non‐linear relation = 0.675).ConclusionsExcessive weight gain and waist circumference gain were associated with 27% and 28% higher risk of heart failure, while excessive waist circumference loss was associated with a 24% lower risk of heart failure.

The present longitudinal study examines whether changes in waist circumference are best predicted by relatively stable and broad personality traits (dispositional optimism and pessimism), by modifiable and domain-specific social cognitions (health-related self-efficacy), or a combination of these. Altogether 385 participants (74% women; 50-65 years) attended the GOAL Implementation Trial, a lifestyle counseling intervention to improve diet and physical activity. Measurements were conducted prior to the intervention (Time 1), and 3 months (Time 2) and 12 months (Time 3) after Time 1. Three different models of the potential interplay between dispositional optimism and pessimism and health-related self-efficacy were tested. The analyses showed that the change in health-related self-efficacy during the intervention (Time 1-Time 2) was negatively related with waist circumference change between Time 1 and Time 3, indicating that increases in self-efficacy during the intervention resulted in reduction in waist circumference over 12 months. However, optimism and pessimism were unrelated to waist circumference change either directly or indirectly through changes in self-efficacy. Interventions enhancing participants' positive health-related expectancies such as self-efficacy are likely to be effective even when participants' dispositional expectancies are pessimistic.

Dietary restraint moderates the effects of food exposure on women's body and weight satisfaction

Mediation of the relationship of behavioural treatment type and changes in psychological predictors of healthy eating by body satisfaction changes in women with obesity