Risk Factors For Eating Disorders Research Articles

The diabetes body project: Study protocol of a multi-site trial of a virtually delivered eating disorder prevention program for young women with type 1 diabetes.

Young women with type 1 diabetes are a high-risk population for eating disorders (ED). Prevention programs are lacking. In young women without diabetes, the Body Project has produced reductions in ED risk factors, ED symptoms and future ED onset. Therefore, the Body Project was adapted to type 1 diabetes, the Diabetes Body Project (DBP). In this protocol, we describe the multi-site randomized controlled trial (RCT) to evaluate efficacy of the DBP. This is an ongoing RCT with four sites (Europe and US). In total 280, 14-35 year-old, women with type 1 diabetes ≥1 year and some level of body image concerns will be recruited in 2023. Participants are randomized to either virtual DBP groups or an educational control. The study constitutes 5 measurement points distributed over 2 years. The primary aim is to test if DBP will produce significantly greater reductions in ED behaviours, ED symptoms and future ED onset. The secondary aim is to test if DBP has significantly greater improvements in diabetes distress, quality of life and glycaemic outcomes. We expect that DBP will be more efficacious in reducing ED behaviours, ED symptoms and ED onset compared to the control condition. Additionally, we hope to gain new knowledge on how DBP may affect diabetes-related outcomes. If DBP proves efficacious, it has potential for immediate, clinical implementation at low-cost and may contribute to broad prevention of future ED onset among young women with type 1 diabetes. NCT05399446.

The Relationship between Level of Therapist Support and Efficacy and Adherence in Internet-Based Cognitive Behavioral Therapy for Disordered Eating Behaviors

Background: Therapist support is an important intervention design factor in internet-delivered psychotherapy. However, the relationship between therapist support and intervention outcomes is not well established. This study examined the relationship between therapist support, efficacy, and adherence to Internet-based Cognitive Behavioral Therapy (I-CBT) for disordered eating behaviors.Methods: Thirty-six women with disordered eating behaviors were recruited and randomly assigned to three groups: low, medium, and high levels of therapist support. The participants received eight sessions of I-CBT, twice a week, with varying levels of therapist support.Results: While all three groups showed a reduction in eating disorder risk factors (i.e., body image disturbance, disordered eating behaviors, depression, and anxiety), there were no significant differences in these improvements by therapist support level. However, there were significant differences in intervention completion rates by therapist support level, with higher levels of support associated with increased intervention completion rates.Conclusions: Therapist support can potentially improve adherence to internet-based interventions.

A pilot study of a virtually delivered dissonance-based eating disorder prevention program for young women with type 1 diabetes: within-subject changes over 6-month follow-up

ABSTRACT Introduction: In an uncontrolled study, we previously demonstrated the feasibility and preliminary efficacy of our virtual diabetes-specific version (Diabetes Body Project) of the eating disorder (ED) prevention program the Body Project. The aim of the current study was to evaluate further this program for women with type 1 diabetes (T1D) by assessing within-subject changes in outcomes from pretest over 6-month follow-up. Methods: Young women with T1D aged 16–35 years were invited to participate in Diabetes Body Project groups. A total of 35 participants were allocated to five Diabetes Body Project groups (six meetings over 6 weeks). Primary outcome measures included ED risk factors and symptoms, and secondary outcomes included three T1D-specific constructs previously found to be associated with ED pathology: glycemic control as measured by HbA1c level, diabetes distress, and illness perceptions. Results: Within-subject reductions, with medium-to-large effect sizes, were observed for the primary (ED pathology, body dissatisfaction, thin-ideal internalization, and appearance ideals and pressures) and secondary outcomes (within-condition Cohen’s ds ranged from .34 to 1.70). Conclusion: The virtual Diabetes Body Project appears to be a promising intervention worthy of more rigorous evaluation. A randomized controlled trial with at least a 1-year follow-up is warranted to determine its efficacy compared to a control condition.

A controlled trial assessing the acceptability and efficacy of a yoga-based eating disorder prevention program among division I athletes: Eat Breathe Thrive (EBT)

ABSTRACT Objective This study evaluated the acceptability and effectiveness of the Eat Breathe Thrive (EBT) program as an eating disorder prevention intervention among women collegiate athletes. Method Change over time in eating disorder risk and competencies of positive embodiment were examined in 94 women (n = 48 EBT participants and n = 46 matched-controls) from one National Collegiate Athletic Association (NCAA) Division I-classified university in the United States. Eating disorder risk factors were measured using the Eating Disorder Examination Questionnaire (EDE-Q) and State Trait Anxiety Inventory (STAI). Aspects of positive embodiment were measured using the Multidimensional Assessment of Interoceptive Awareness (MAIA) and The Mindful Self-Care Scale (MSCS). Data were collected through participants’ completion of online surveys across three time-points. Results Repeated measures ANOVAS revealed EBT participants reported experiencing significantly less state anxiety and greater interoceptive body trusting over time relative to matched-controls. No other significant interactions were found. Respondents found the EBT program acceptable. Discussion Acceptability and partial support for integrative, yoga-based, interventions targeting Division I student-athletes is indicated.

The ignored role of disadvantage in eating disorders

The misconception that eating disorders are conditions of affluence has shaped research and public understanding for decades. Here, we highlight links between socioeconomic disadvantage and eating disorder risk. With prevailing stereotypes discredited, we argue that considering disadvantage as a key eating disorder risk factor will advance science and reduce disparities

Evaluation of a novel eating disorder prevention program for young women with type 1 diabetes: A preliminary randomized trial

ObjectiveEvaluate whether the Body Project prevention program adapted for young women with type 1 diabetes (Diabetes Body Project) reduces eating disorder (ED) risk factors and symptoms. MethodsYoung women (aged 15–30) at high-risk for EDs due to having type 1 diabetes and body image concerns (N = 55) were randomized to virtually delivered Diabetes Body Project groups or an educational control condition, completing measures at pretest, posttest, and 3-month follow-up. ResultsDiabetes Body Project versus the control participants showed significantly greater reductions in thin-ideal internalization, body dissatisfaction, diabetes distress, diabetes eating pathology, and ED symptoms by posttest, and greater reductions in diabetes eating pathology and ED symptoms, and greater improvements in quality of life by 3-month follow-up, which were medium to large effects (d’s ranged from −0.43 to −0.90). Although control participants showed a worsening of glycemic control (time in range) verses Diabetes Body Project participants, this difference was non-significant (d = 0.26). ConclusionsVirtually delivered Diabetes Body Project decreased ED risk factors and symptoms in young women with type 1 diabetes. A well powered randomized controlled trial is warranted to evaluate this intervention over longer follow-up.

Intersecting gender identity and racial/ethnic inequities in eating disorder risk factors, symptoms, and diagnosis among U.S. college students: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy.

There are documented inequities in eating disorders (EDs) by gender and race/ethnicity, yet, little is known about population-level prevalence of ED risk factors, symptoms, and diagnosis at the intersection of diverse gender and racial/ethnic identities. Data from the Healthy Minds Study 2015-2019 (N = 251,310 U.S. university students) were used in a multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Participants were nested in 35 intersectional strata given by all combinations of 5 gender and 7 racial/ethnic categories. Multilevel logistic models with participants at level 1 and intersectional strata at level 2 were used to estimate stratum-specific predicted prevalence estimates for self-reported thin-ideal internalization, ED symptoms, and ED diagnosis. The variance partition coefficient (VPC) was calculated to quantify the contextual effect of the strata. There was considerable heterogeneity in the predicted prevalence of our ED outcomes across the strata (e.g., .3%-18.3% for ED diagnoses). There were large disparities in all three outcomes, with transgender participants of color having a higher predicted prevalence than expected based on the additive effects of gender and race/ethnicity. Moderation by race/ethnicity was also apparent, such that racial/ethnic disparities were wider within the cisgender groups relative to the transgender groups. VPCs indicated that ~10% of the total variance in ED outcomes was due to intersectionality between gender and race/ethnicity, over and above variance due to individual-level differences. Findings suggest that gender and racial/ethnic disparities in EDs are interrelated, underscoring the need to develop preventive interventions centering health equity. Despite evidence that sexism, racism, and cissexism (i.e., anti-transgender prejudice) can impact EDs risk, little research examines the social patterning of EDs at the intersection of diverse gender and racial/ethnic identities. Using data from a sample of 250,000 U.S. university students, this study found that gender and racial/ethnic disparities in eating disorder risk are interrelated, highlighting the need to develop health equity centered preventive interventions.

Understanding early risk factors for eating disorder symptoms in adolescence: the role of body dissatisfaction, negative emotional reactivity and self-esteem at age 10–11 years

ABSTRACT Objective Risk factors associated with eating disorders (EDs) have been widely studied, although previous research has been limited to largely cross-sectional data or understanding risk factors in adult populations. Little is therefore known about the role of risk factors in early adolescence for the subsequent development of ED symptoms in adolescence. Method The present study examined factors identified in transdiagnostic models of EDs, in a sample of 2,372 adolescents who participated in Waves 3, 4 and 7 of the Longitudinal Study of Australian Children. The present study examined the association between body dissatisfaction, negative emotional reactivity and self-esteem in adolescents aged 10–11, and probable ED status measured via self-report at age 16–17, while adjusting for confounders measured at age 8–9 years. Results Negative reactivity and self-esteem at age 10–11 years were not significantly associated with ED status at age 16–17. Body dissatisfaction was associated with a decreased likelihood of meeting probable ED status at age 16–17, however this effect was small and likely not clinically significant, with only 2% of variance in probable ED status accounted for by body dissatisfaction. Conclusion Findings of the study suggest that transdiagnostic models of EDs may not capture the key risk factors for EDs in early adolescence.

Risk factors of disordered eating in adolescent girls from a community sample: a multidimensional approach.

Eating disorders (ED) are severe, chronic, and complex in nature mental illnesses that are difficult to treat. One of the ways to stave off EDs is by screening among adolescents to preempt the development of clinical forms of ED in risk groups. 1) to investigate the prevalence of ED risk among adolescent girls and compare subgroups at high and low risk of ED; 2) to investigate using a multidimensional approach those variables that can interact with temperament and character traits to predict ED symptomatology. The cross-sectional observational self-report study of a community sample of adolescent girls 1217 years old (n=298; M=14.771.13) was carried out in the city of Ryazan, Russia. The Russian versions of Eating Attitudes Test and Cloningers Temperament and Character Inventory-Revised were used. In addition, an original questionnaire (Risk Factors of Eating Disorders) was developed. Regression models (to test for significant moderation) and path analysis (to test for significant mediations) were used. Girls at risk of developing EDs are characterized by a heightened level of concern about weight and dissatisfaction with their body, tend to suffer from low self-directedness, higher novelty seeking and tendency to higher harm avoidance, display high alexithymia, experience self-distrust, negative emotionality and are dissatisfied with family relationships. They also suffer from low self-esteem and tend to be perfectionism and engage in risk behavior. Significant moderating effects were uncovered between the following ED risk factors: (1) self-distrust/risk behavior and BMI; (2) alexithymia/negative emotionality/self-esteem and cooperativeness; and (3) negative emotionality/risk behavior and self-transcendence. Family relationship dissatisfaction mediates the association between self-directedness/cooperativeness/self-transcendence and disordered eating. There are various mutual influences between the numerous ED risk and prevention factors, which all together determine the paths between the predictors and final outcome.

Non-suicidal self-injuries and suicide risk in adolescent girls with eating disorders: associations with weight control, body mass index, and interpersonal sensitivity.

Eating disorders (EDs) are associated with a risk of premature death, as well as suicidal and self-injurious behavior. A low or high body mass index (BMI) and weight control behavior can also have an impact on self-injurious and suicidal behavior. While some studies show that interpersonal sensitivity is a risk factor for EDs, affective disorders, and self-injurious behavior, in-depth studies of these issues have not been done. The present study investigates how self-injurious and suicidal behavior relate to weight control behavior, BMI, and interpersonal sensitivity in adolescent girls from a clinical population with diagnosed EDs compared with adolescent girls from the general population. The main group was comprised of 31 girls with a diagnosis of ED (as the main diagnosis or co-occurring with affective disorders, M=151.13 years), being treated in in the Eating Disorder Clinic of the Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva. The comparison group consisted of 27 adolescent girls recruited from Proton Educational Center (M=15.511.09 years). The measures included a qualitative survey that yielded data on weight control behavior, and self-injurious behavior, a Blitz questionnaire probing the suicide risk (used only in the main group), and the Interpersonal Sensitivity Measure. Height and weight data were also recorded for BMI calculation. The qualitative analysis of weight control behavior yielded the following results: purging behavior, restrictive behavior, and corrective behavior. Participants in the main group used purging and restrictive behavior more often, whereas participants in the comparison group used strategies associated with a healthy lifestyle. The main group and participants who practiced purging and restrictive weight control in the overall sample had the smallest BMI. Self-injurious behavior was approximately evenly distributed both amongst the main and comparison groups. Self-cutting was the most prevalent type of self-injury. In the main group, self-injury was associated with a smaller BMI, while in the comparison group it was associated with an increase in the fear of rejection and overall interpersonal sensitivity. Based on the assessment of the suicide risk, six participants in the main group were deemed high-risk; they also displayed increased fear of rejection, dependence on the assessments of others, and overall interpersonal sensitivity. All girls in the suicide risk subgroup had non-suicidal self-injuries. The results of our study broaden our understanding of the risk factors of suicidal and self-injurious behavior in adolescent girls with EDs and reveal the characteristics of the type of weight control behavior used by this group in comparison with adolescent girls in the general population. Girls with EDs who were considered at the risk of committing suicide demonstrated high interpersonal sensitivity, which provides a rationale for further studying the general interpersonal mechanisms that underlie the pathogenesis of EDs, as well as that of self-injurious and suicidal behavior.

Sex and Body Mass Index differences after one-year follow-up of an eating disorders risk factors universal prevention intervention in university students in Mexico City

Introduction. Interventions based on cognitive dissonance theory are the most effective for preventing eating disorders. Objective. To identify the changes at one year follow-up of a universal prevention intervention in disordered eating behaviors (DEB), thin-ideal internalization (TII), and drive for muscularity (DM). Method. A pre-experimental, pretest-posttest study was conducted on 602 university student subjects (76.1% women and 23.9% men) with an average age of 20.74 years at a public (30.6%) and a private university (69.4%) in Mexico City. A Split Plot ANOVA was performed with the intrasubject variable equal to each measurement (pretest, posttest, and follow-up), as well as the sex and body mass index (BMI) intersubject variables to analyze whether there was a significant interaction between these variables and the changes in dependent variables, as well as the changes through each measurement by group. Results. In the intrasubject analyses, statistically significant differences were found for DEB through the various measurements, without taking the interactions into account. Statistically significant interactions were observed between each measurement and BMI, and between each measurement and sex and BMI for the DM variable. Discussion and conclusion. Since a reduction of TII in women and DM in men was achieved, together with a decrease in DEB in women, the workshop can be said to have fully achieved its objectives for women and partly so for men.

Considerations of eating disorder risk during obesity treatment in Australia: Current practice, attitudes and barriers

IntroductionPeople with obesity are vulnerable to eating disorders. It has been suggested that screening for eating disorder risk be part of obesity care. However, it is unclear what current practice entails. ObjectiveTo explore considerations of eating disorder risk during treatment of obesity, including assessment and intervention strategies used in clinical practice. Materials and MethodsAn online (REDCap) cross-sectional survey was distributed to health professionals working with individuals with obesity in Australia through professional societies and social media. The survey had three sections: 1. Characteristics of Clinician/Practice, 2. Current Practice, 3. Attitudes. Data were summarised using descriptive statistics and free-text comments were independently coded in duplicate to identify themes. Results59 health professionals completed the survey. Most were dietitians (n = 29), identified as women (n = 45) and worked within a public hospital (n = 30) and/or private practice (n = 29). Overall, 50 respondents reported assessing for eating disorder risk. Most reported that having a history of, or risk factors of eating disorders should not preclude obesity care but emphasised the importance of treatment modification including using a patient-centred approach involving a multidisciplinary team and promoting healthy eating behaviours, with less emphasis on calorie restriction or bariatric surgery. Management approaches did not differ for those with eating disorder risk factors or a diagnosed eating disorder. Clinicians identified the need for additional training and clear referral pathways. ConclusionIndividualised care, balancing models of care for eating disorders and obesity and further access to training and services will be important in improving care of patients with obesity.

Practical Considerations for Using the Eating Disorder Examination Interview with Adolescents.

Approximately 35 years after its initial publication, the Eating Disorder Examination (EDE) remains one of the most widely used semi-structured interviews for assessing eating disorder diagnoses and symptomatology. Although the interview provides certain advantages over other common measurement approaches (ie, questionnaires), there are particular considerations regarding the EDE that warrant attention, including in its use with adolescents. The aims of this paper are therefore to: 1) provide a brief overview of the interview itself, as well as a description of its origin and underlying conceptual framework; 2) describe relevant factors for administering the interview with adolescents; 3) review potential limitations regarding use of the EDE with adolescents; 4) address considerations for using the EDE with pertinent subpopulations of adolescents who may experience distinct eating disorder symptoms and/or risk factors; and 5) discuss the integration of self-report questionnaires with the EDE. Advantages of using the EDE include the ability for interviewers to clarify complex concepts and mitigate inattentive responding, enhanced orientation to the interview timeframe to improve recall, increased diagnostic accuracy compared to questionnaires, and accounting for potentially salient external factors (eg, food/eating rules imposed by a parent/guardian). Limitations include more extensive training requirements, greater assessment burden, variable psychometric performance across subgroups, lack of items evaluating muscularity-oriented symptoms and avoidant/restrictive food intake disorder diagnostic criteria, and lack of explicit consideration for salient risk factors other than weight and shape concerns (eg, food insecurity).

Adolescents at risk of eating disorders: The mediating role of emotional distress in the relationship between differentiation of self and eating disorders.

Adolescents may feel dissatisfied with their bodies, which may lead to a risk of eating disorders (EDs) due to several factors, with emotional distress being one of the most important. Evidence suggests that family might be one of the most significant factors that may increase or decrease emotional distress. An important family pattern found to contribute to mental and physical health is the differentiation of self (DoS). The primary purpose of the current study was to map the complex relationships between DoS, emotional distress, and EDs among adolescents. We hypothesized that emotional distress would mediate the relationship between DoS and the risk of EDs among adolescents. Moreover, based on findings indicating a higher risk of EDs among females, we expected sex differences in the research indices and the mediation model. The sample included 194 non-clinical adolescents (mean age 15.15; mean BMI 21.66). Preliminary analyses examined differences between males and females using t-tests. In addition, Pearson correlations were run to assess the association between background variables and the study metrics among males and females. To examine the mediation effect, we ran SEM. Due to a sex moderation effect, two mediation models were run (SEM), one for females and one for males. Results indicated that emotional distress partially mediated the relationships between DoS and the risk of EDs. In addition, sex differences were found in the mediated indices, showing that among female adolescents, perfectionism is the only dimension of EDs that was associated with DoS through the mediation of emotional distress. While the relationship between emotional distress and the risk of EDs is well documented. It is concluded that high DoS may reduce emotional distress, which may, in turn, decrease the risk of EDs. In addition, the results enable an in-depth understanding of specific risk factors of EDs that characterize each sex.

Feeling the urge: Using ecological momentary assessment to test the relationship of interoception with disordered eating and nonsuicidal self-injury.

We used ecological momentary assessment to test the temporal relationship between interoception (the perception of internal body states) and self-injurious behavior (SIB), specifically eating disorders (ED) and nonsuicidal self-injury (NSSI). Adults (N = 128) reported SIB and interoceptive attention several times a day for 14 days. Higher average interoception is associated with lower risk for SIB, whereas higher momentary interoception is associated with higher risk for SIB. Furthermore, interoceptive attention appears to fluctuate rather than change, and greater instability of interoceptive attention is associated with SIB. Our results demonstrate that an individual's absolute level of interoceptive attention is less predictive of SIB than fluctuation in interoceptive attention. These findings point to the importance of future research examining the possible etiological role of interoceptive variability in SIB, as well as the development of interventions to target interoceptive lability as a modifiable risk factor for ED and NSSI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Testing the efficacy of the Virtual Body Project in a sample of Turkish female university students using a Randomized Controlled Trial

The current study aimed to test the effectiveness of the Virtual Body Project (vBP) on self-esteem, disordered eating attitudes, and psychological symptoms in young females. A pretest posttest control group design was used in the study. The intervention (vBP, N = 40) and placebo (Expressive Writing, N=33) groups were determined using random assignment. The Body Mass Index (BMI), Brief Symptom Inventory (BSI), Eating Disorder Examination Questionnaire (EDE-Q), Body Image Quality of Life (BIQLI), and Rosenberg Self-Esteem Scale (RSES) were administered. The groups did not differ in terms of pretest scores. However, the intervention group had significantly lower EDE-Q, BIQLI, BSI scores, and higher RSES scores than the placebo group in the post-test assessment. Within-subjects comparisons showed that the placebo group’s pretest and post-test scores were not significantly different. However, the EDE-Q, BIQLI, and BSI posttest scores were found to be significantly lower than the pretest scores in the intervention group. In addition, the RSES post-test scores were significantly higher than the RSES pretest scores in the intervention group. The current study indicated that the Virtual Body Project was found to be an effective intervention on eating disorder risk factors, psychological symptoms, and self-esteem in young females. It is thought that the Virtual Body Project, which is applied to groups online, makes an extremely important contribution to preventive mental health studies.

Eating disorder risk in rural US adolescents: What do we know and where do we go?

Adolescence is a vulnerable period for the development of eating disorders, but there are disparities in eating disorder risk among adolescents. One population that may be at increased risk but is vastly understudied, is adolescents residing in rural regions within the United States. Rural communities face many mental and physical health disparities; however, the literature on rural adolescent eating disorder risk is nearly nonexistent. In this paper we summarize the scant literature on disordered eating and eating disorder risk and prevalence among rural US adolescents. We also detail eating disorder risk factors that may have unique influence in this population, including socioeconomic status, food insecurity, healthcare access, body image, and weight stigma. Given the presence of numerous eating disorder risk factors, we speculate that rural adolescents may be a particularly vulnerable population for eating disorders and we propose critical next steps in research for understanding eating disorder risk among the understudied population of rural adolescents. PUBLIC SIGNIFICANCE: Rural adolescents may be at increased risk for eating disorders due to disproportionate burden of known risk factors, though this relationship remains understudied. We present a summary of the literature on prevalence and unique risk factors, proposing that this may be a high-risk population. We detail next steps for research to understand eating disorder risk in this population to inform future prevention, identification, and treatment efforts needed in this community.

Prevalence of probable eating disorders and associated risk factors: An analysis of the Northern Ireland Youth Wellbeing Survey using the SCOFF.

Eating disorders (ED) are associated with significant morbidity and mortality rates and are most common in young people aged between 15 and 19 years. Large representative surveys on disordered eating in youth are lacking. The main aims were to estimate the prevalence of disordered eating in a representative sample of 11-19 year olds in Northern Ireland and investigate the associations between probable eating disorder and a range of risk factors. A large nationally representative household survey was conducted, and the bivariate and multivariate associations between demographic, familial, economic and psychological risk factors and probable eating disorder were assessed. A total of 16.2% (n= 211) of the sample met the SCOFF screening criteria for disordered eating. Probable eating disorder was associated with being female (OR=2.44), having a parent with mental health problems (OR=1.68), suffering from certain psychological problems, such as mood or anxiety disorder (OR=2.55), social media disorder (OR=2.95), being the victim of physical bullying (OR=1.71) and having smoked (OR=2.46). This study provides the first prevalence estimates of probable eating disorder among youth in Northern Ireland. Furthermore, the study identifies unique risk factors for probable eating disorder among this representative sample.

An Examination of a Cognitive Dissonance Body Image and Health Intervention for the College Classroom

Creating a positive college environment regarding body image concerns is warranted given their strong association with eating disorders (EDs) and the alarming rates of EDs on college campuses. There is also a growing need to universally diversify ED prevention programs and enhance selective prevention recruitment initiatives. This study included 132 undergraduate students in a universal and mixed-gendered setting (i.e., classrooms). Participants in the intervention condition received a single session of an adapted cognitive dissonance-based intervention aimed at reducing ED risk factors. The control condition included participants who received a general classroom lecture. Women and men in the two conditions were compared at pre-intervention, post-intervention, and 1-month follow-up timepoints on appearance-ideal internalization (thin-ideal and muscular-ideal), body image satisfaction, and behavioral intention to enroll in a selective ED prevention program, known as The Body Project (BP). Using mixed-effects modeling, results showed that women in the intervention condition significantly lowered muscular-ideal internalization scores at follow-up when compared to the control condition. There were no significant differences across all other variables, which suggests that the single session universal intervention was not effective in reducing body image dissatisfaction or triaging participants into The BP. Implications include further exploration of muscular-ideal internalization in ED development for women and the examination of other underlying dimensions of body image, such as internalized weight stigma and body functionality. Mixed-gendered settings might also benefit from cultivating conversations regarding the social injustices of beauty standards. These adjustments may help enhance the levels of cognitive dissonance experienced by participants.

Caregiver-reported household food insecurity and child-reported food insecurity in relation to eating disorder risk factors and symptoms among preadolescent children.

To examine the relation of caregiver-reported household food insecurity (FI) and child-reported FI with eating disorder (ED) risk factors and symptoms, including effect modification by gender, in preadolescent children. Data were from the Family Food Study, a cross-sectional study of households with incomes ≤200% of the federal poverty line in southeastern Michigan. Children aged 8-10 years (n= 194) and their female primary caregivers reported separately on FI status. Children reported ED risk factors/symptoms via the 24-item Children's Eating Attitudes Test (ChEAT-24), with higher scores indicating more ED risk factors/symptoms. Linear mixed models were used to examine associations between FI measures with the ChEAT-24 total score, plus subscale scores for dieting, food preoccupation, weight preoccupation, vomiting, and social pressure to eat/gain weight. Models were adjusted for child age, child gender, caregiver race/ethnicity, caregiver education, and household income. Among all children, child-reported FI, but not caregiver-reported household FI, was associated with more ED risk factors/symptoms. Child-reported FI (vs. no FI) was associated with higher average ChEAT-24 total score (β=2.41, 95% CI: 0.57, 4.25). Child-reported FI was also associated with more food preoccupation, more weight preoccupation, and more social pressure to eat. Caregiver-reported household FI was marginally associated with less dieting in girls, and child-reported FI was associated with more dieting in boys. Child-reported FI may be more salient than caregiver-reported household FI as a risk factor for ED-related outcomes in preadolescent children. Gender may modify the association between FI and dieting behavior. More child-reported food insecurity, but not parent-reported household food insecurity, was associated with more eating disorder risk factors and symptoms among preadolescent boys and girls. These findings emphasize the need for future studies that investigate the role of food insecurity in the development of eating disorders, especially studies that measure child-reported experience of food insecurity.