Improve Body Image Research Articles

The Effectiveness of Group Compassion-Focused Therapy on Body Image and Interpersonal Stress among Women with Breast Cancer: A Randomized Controlled Trial

Background: Breast cancer ranks as the most common cancer among women globally, with over 6% of deaths annually attributed to this disease. Compassion-focused therapy (CFT) alters existing emotional patterns, empowering individuals to enhance their self-care and support. It diminishes self-criticism and emotional issues while fostering self-acceptance, thereby improving individuals' ability to handle their own well-being and interpersonal relationships more effectively in difficult circumstances like breast cancer. Objectives: This study aimed to examine the impact of group CFT on body image and interpersonal stress among women with breast cancer. It sought to assess the average scores for body image and interpersonal stress, along with their respective subscales, within the CFT and control groups before, after the intervention, and during the follow-up phase. Methods: The study included 44 women diagnosed with breast cancer, referred to hospitals in Kashan, Iran, in 2022. With informed consent obtained, participants were randomly allocated to the CFT group (n = 22) or the control group (n = 22). They completed the Body Image Scale (BIS) and the Interpersonal Stress Scale (ISS) before treatment, after treatment, and at a 2-month follow-up. Results: The findings indicated no significant differences in demographic variables (such as age, marital status, employment status, number of children, and education level) between the two groups. Repeated measures of analysis of variance (ANOVA) analysis demonstrated that CFT significantly improved body image and reduced interpersonal stress among women with breast cancer. Conclusions: Compassion-focused therapy proves to be a potentially effective therapeutic strategy for women with breast cancer. Further studies are necessary to comprehensively explore the benefits of CFT for breast cancer patients and its integration into conventional care practices.

Women's Experiences of Sequelae After Mastectomy: A 3, 6, and 12 Months' Follow-up Study.

Postoperative experiences after breast cancer surgery, such as lymphedema, phantom breast sensations, persistent chronic pain, and changes in body image and sexuality, can negatively impact women's quality of life. To investigate women's experiences of sequelae at 3, 6, and 12 months after mastectomy. A survey including women ≥18 years, cognitively intact, and Danish speaking was conducted from May 2021 to October 2021. The researchers contacted the participants by telephone using 4 validated questionnaires investigating phantom sensation, body image, quality of life, and sexuality. Forty-four women were eligible for participation, and 23 (14 women aged ≤65 years and 9 women aged >66 years) were included in the analysis. The results showed an overall decrease in the severity of physical sequelae and an improvement in body image and sexual function. However, the women reported concerns about the future and decreased sexual enjoyment. Nearly half of the women received information about sexuality from healthcare professionals. The study demonstrated decreased sequelae during the follow-up period. Still, there seem to be unanswered questions concerning the quality of life and the content of information regarding sexuality. The findings require attention and further research to benefit the individual woman and her partner in accommodating the consequences after mastectomy. Persistent pain and concerns for the future are present for half of the women after 1 year. Information about possible changes in sexuality is not standard. A nurse-patient dialogue that discusses hospitalization and sexuality on an individual level can be a way to address concerns and challenges.

The Moderating Role of Gender in the Effects of an Exercise and Nutrition Intervention Module on Body Composition and Fitness Profiles Among Obese College Students

Introduction: This study explores how gender and body composition moderate the effects of an exercise and nutrition intervention module on body composition and fitness profiles in obese college students in China, addressing a growing health concern. Problem Statements: Obesity is on the rise among Chinese college students, necessitating effective intervention strategies. However, the impact of such interventions may vary based on gender and body composition, a knowledge gaps this study aims to fill. Methodology/Study Design: Quantitative research involved 337 college students from the Modern College of Humanities and Sciences, Shanxi Normal University, Linfen, China. Scales were used to assess fitness profiles, body image, exercise, nutrition intervention, and demographics. Data analysis utilised Partial Least Squares Structural Equation Modelling (PLS-SEM). Results/Findings: The exercise and diet intervention significantly improved body image and fitness profiles among obese college students. Notably, gender and body composition played crucial roles in moderating the intervention's effects on body image. Female participants experienced more substantial improvements in body image compared to males, with body composition also influencing the exercise-body image relationship. Implication/Significance: These findings have theoretical and practical implications. They enhance our understanding of exercise and diet interventions in reshaping body image and fitness profiles among obese college students. Importantly, they highlight the need for personalised interventions, considering gender and body composition. Policymakers and healthcare providers can use these insights to develop more effective programmes, to address the obesity issue among college students in China.
 
 Received: 4 October 2023 / Accepted: 19 January 2024 / Published: 5 March 2024

Women with disabilities, body image, and wellbeing: Assessing the effectiveness of dance sessions

IntroductionThere is growing research evidence on bodily discourses and body image issues of women with disabilities. Within the art-based intervention repertoire for persons with disabilities, dance and movement-based therapies and interventions are gaining prominence. The aim of this study was to examine the impact of dance sessions (delivered online) on body image, body satisfaction/dissatisfaction, and wellbeing of women with disabilities. MethodA quasi-experimental waitlist control design study was conducted with data collected at two time points: baseline or pre-test and five-months later or post-test. Outcomes were measured using the Body Image Scale and the WHO-5-Wellbeing Index. ResultsThe dance sessions were effective (Hedges’ g = −0.56 –0.88; p < 0.01) and post-test body dissatisfaction scores were lower and wellbeing scores were higher for participants with a college degree or postgraduate degree, self-employed or students, and whose intervention compliance was above threshold (>50% dance sessions attended and corresponding homework sessions completed). Tobit regression models indicated that it was possible to estimate post-test outcomes due to dance sessions alone, controlling for significant socio-demographics. DiscussionThe domain knowledge of non-pharmacological art-based interventions for persons with disabilities, particularly women, is supported. ConclusionsFindings commend dance sessions as effective psychotherapeutic mechanisms to mitigate body dissatisfaction, improve body image and wellbeing of women with disabilities. Future research may focus on large-scale cross-sectional trials, variations in the repertoire for women with different disability types and histories, and qualitative narratives.

혈액투석 환자의 신체상, 증상 경험이 삶의 질에 미치는 영향

The purpose of this study is to determine the effect of hemodialysis patients' body image and symptom experience on their quality of life. The data was targeted at patients who were diagnosed with end-stage renal failure at a tertiary general hospital located in J province and receiving regular hemodialysis treatment. The data collection period was from July 20, 2023 to August 11, 2023, and 160 structured questionnaires were distributed, of which 153 were used in the final analysis. Data were analyzed using t-test, One-way ANOVA, Pearson correlation coefficients and multiple regression analysis with the SPSS 28.0 program. Through multiple regression analysis, the factors influencing quality of life were body image (β=.46, p&lt;.001), having an average monthly household income (over 3 million won)(β=.22, p=.002), and symptom experience (β=-.20, p=.001). The combined explanatory power for quality of life was determined to be 47%. It is necessary to accurately assess and intervene, develop educational programs and integrated management programs that reduce symptom experience and improve body image, and establish work standard guidelines.

Comparative study of Cavitation and Extracorporeal Shock Wave Therapy

Nowadays, a person's body image is an important issue that affects cognitive function, and mental and physical health. Today, people seek to improve their body contours and reduce body fat through non-invasive, safe, painless, and comfortable solutions. These conditions have led to the rapid development of non-invasive devices that use the technology of ultrasound and help to immediately and effectively improve body image. In this article, two technologies are based on ultrasound. The first is cavitation, and the second is shock wave ultrasound that will be presented, their characteristics will be developed and they will be compared in terms of their effectiveness and their advantages among the currently available research data.

(144) Contemporary Trends in Testicular Prosthesis Placement: An Analysis Of U.S. Claims Data

Abstract Introduction Testicular prosthesis placement (TPP) is a procedure associated with high patient satisfaction that improves body image and quality of life following orchiectomy. However little information exists regarding contemporary TPP as placement for metastatic prostate cancer has fallen out of favor and gender affirming surgery is on the rise. Objective This study sought to describe current trends in TPP in the United States. Methods Using the IBM® MarketScan® Research Databases (DOI 10.57761/ray7-1g16) we performed a retrospective analysis from 2007 to 2021 and identified 1,059 adult men who had undergone placement of a testicular prosthesis based on ICD-9 codes. Results The median age of TPP was 34 (IQR 23-44; range 18-80). At least 433 (35.5%) men were married. A total of 536 (43.8%) men had orchiectomy concurrently at the time of TPP. Just under half of the cases prescribed antibiotics postoperatively (44.9%). The five most common indications at the time of TPP were malignancy (54.7%), gender dysphoria (10.4%), cryptorchidism (9.6%), atrophy/hypofunction (6.6%), and testicular torsion (3.9%). A total of 46 (3.8%) of men underwent subsequent removal of their prosthesis. A diagnosis of gender dysphoria was associated with prosthesis removal (odds ratio (OR) 4.51, 95% CI 2.10-9.86). No significant associations were seen for other indications, Charlson Comorbidity Index scores, post-operative antibiotic use, tobacco use, psychiatric diagnoses, or prior pain diagnoses. Rates of testicular prosthesis placement for a diagnosis of gender dysphoria are rapidly increasing while placement for prostate cancer is increasingly rare. Conclusions Among the studied population the primary indication for testicular prosthesis placement is for testicular cancer, contradicting the findings of earlier series. We also show that TPP for gender dysphoria is increasingly common. Additionally, we report rates of explanation and complications related to prosthesis that are higher than what is described in the literature. Disclosure No.

Role of yogic practice influence the psychological factors in the development of women sports

The involvement of women in sports in India is generally low owing to a dearth of spectator interest and inadequate coverage of women's sports. Factors such as women's limited access to education, societal perceptions of women in sports, self-esteem, self-confidence, menstruation abnormalities, self-image or body image, gender role orientation, and competitiveness should all be taken into account. Yoga is sometimes seen as not being a sport, although it is really a physical exercise that follows rules, can be done competitively, and has measurable outcomes. Multiple reasons contribute to the low engagement of women in sports throughout society. Family has a profound impact, often initiating early engagement in sports, although this differs according to gender. Female participation in sports is often seen unfavorably. Societal attitudes and biases are another factor that impacts sports participation. For instance, many girls refrain from engaging in certain hobbies out of concern that they would be seen as masculine. This is because societal attitudes and biases about sexuality hinder females from participating. Female athletes possess psychological traits that include gender role orientation in several sports, including wrestling, weight lifting, and bodybuilding. These activities have traditionally been deemed unsuitable for women due to the possible adverse consequences of masculinization. Intensive training contributes to the improvement of self-esteem, self-image, and body image. Engaging in athletic activities also aids in the promotion of positive body image. It enhances body contour and promotes a harmonious physique, thereby enhancing self-perception. Yoga enhances strength, flexibility, and balance, all of which are vital for athletes. The majority of yoga postures are essential for enhancing strength, improving the range of motion, mobility, and coordination in athletic performance, as well as preventing injuries

Supplemental Material for Your Body, My Experience: A Systematic Review of Embodiment Illusions as a Function of and Method to Improve Body Image Disturbance

Supplemental Material for Your Body, My Experience: A Systematic Review of Embodiment Illusions as a Function of and Method to Improve Body Image Disturbance

BodyThink program-based body image education improves Korean adolescents’ attitudes toward cosmetic surgery: randomized controlled trial

BackgroundThe aims of this study were to modify the widely used BodyThink program to suit the circumstances of Korean schools and determine its effects on body esteem, body image, appearance stress, depression, and attitudes toward cosmetic surgery.MethodsParticipants were 184 third-grade students from two middle schools in Korea, who were randomly assigned to a control or intervention group. Two of the participants dropped out; hence, data from 182 students were analyzed. The control group received the existing curriculum for 4 sessions, and the experimental group was provided with 4 sessions of the revised BodyThink program. Before and after the intervention, all participants completed questionnaires.ResultsIn the BodyThink group, improved body image, decreased depression, and positive improvements in attitudes toward cosmetic plastic surgery were observed after the intervention.DiscussionThese results suggest that school health nurses can utilize interventions based on BodyThink program in their curricula to improve the physical and emotional health of adolescents.Trial registrationThis study has been retrospectively registered with the Clinical Research information Service (CRIS) in Korea on October 5, 2023 (KCT0008839).

The Effect of a Training Program Based on the Bar-on Model for Emotional Intelligence to Improve Body Image in Jordan

Objectives: The study aimed to investigate the effectiveness of an emotional intelligence-based training program on improving body image among a sample of adolescent girls aged between 12 and 15 years. Methods: The study sample consisted of 28 adolescent girls who scored the lowest on the body image scale, randomly assigned to an experimental group and a control group. To achieve the study objectives, a training program consisting of 21 sessions was developed based on the dimensions of the Bar-On model: Personal dimension, Interpersonal dimension, Adaptability, Stress Management, and General Mood. Results: The Mann-Whitney U test and Wilcoxon signed-rank test revealed the effectiveness of the training program in improving body image among adolescent girls at a significance level of (α≤0.05) in favor of the experimental group. The results also showed improvements in the dimensions of overall appearance, weight, face, and body areas for the experimental group in the post-test, but no significant changes were observed in the attitude towards cosmetic procedures. This might be attributed to the models presented to adolescents through media, modern communication, and intensive promotion of cosmetic procedures via these platforms. Conclusions: Based on the results, it is evident that the emotional intelligence program was effective in improving body image among adolescent girls.

Conventional standard-sized bra with prosthesis or patient’s bra with customized hand-knitted external prosthesis after mastectomy: Mixed-methods evaluation of patients’ preferences

INTRODUCTION: In breast cancer patients undergoing mastectomy without reconstruction, an external breast prosthesis could aid patients’ recovery, improve body image and confidence by helping to regain a symmetrical chest appearance when dressed. However, external breast prosthesis preferences among Asian breast cancer patients were not widely studied. We aimed to compare patients’ experience with the conventional commercially manufactured standard-sized (small, medium, large, extra-large) bra and prosthesis versus customized hand-knitted external breast prosthesis with patient’s bra after unilateral mastectomy at a tertiary hospital. This is the first such study in Asian women, to our knowledge. METHODS: In this prospective study, participants used the conventional bra-prosthesis followed by the customized one consecutively, each for at least 3 months before they were administered an identical questionnaire at 3 and 6 months respectively. The questionnaire assessed the patients’ experience with the prosthesis on the aspects of comfort, body image and satisfaction etc. Patients were also invited for in-depth interviews. RESULTS: Of 155 eligible patients, 148 patients participated with a response rate of 95.5%. 99 (67%) participants preferred the customized prosthesis, while 38 (25.7%) did not. 11 (7.4%) participants were undecided. Seventeen participants underwent in-depth interviews until data saturation on major qualitative themes was achieved. More patients experienced excessive sweating (p &lt; 0.0001), greater discomfort (p = 0.0195) and higher rates of prosthesis dislodgement (p = 0.0269) with the conventional bra-prosthesis. CONCLUSION: Customized external breast prostheses could be an alternative to the conventional ones for breast cancer patients with mastectomy, with additional benefits of less sweating, more comfort and less dislodgement perceived.

Enablers and Barriers Related to Preconception Physical Activity: Insights from Women of Reproductive Age Using Mixed Methods

Engaging in regular preconception physical activity (PA) is associated with benefits, including improved cardiovascular health and mental well-being. However, most women do not meet PA recommendations in the preconception period. This study aimed to investigate enablers and barriers related to PA in preconception women using a sequential mixed method design. An online survey was followed by Zoom interviews with women of reproductive age (aged 18–45 years). A weaving approach and the Capability Opportunity Motivation Behaviour (COM-B) model were used to integrate and present the data. Seven hundred and eighty-eight non-pregnant women from Australia, India, and the US completed the quantitative survey, and 13 Australian-based women participated in a qualitative interview. Physical activity levels were associated with having social support, a desire to improve body image, and becoming a healthier person. Women encountered barriers such as misconceptions about PA, competing priorities, financial constraints, and a lack of accessibility. Enablers for participation in PA included knowledge of its importance, a desire to be healthier, weight loss, social support, and having goals. The multifaceted and intricate nature of enablers and barriers for preconception PA lays the groundwork for developing tailored interventions and policies aimed at promoting preconception PA among women.

The effect of counseling with cognitive behavior approach on self-esteem and body image in lactating mothers: randomized clinical trial

BackgroundSome of the women experience low self-esteem and negative body image in pregnancy and postpartum. These two factors along with other factors can reduce the rate of exclusive breastfeeding among women. Cognitive-behavior therapy (CBT) is one of the psychological approaches that is effective on the betterment of many of the psychological and personality disorders such as body image disorders as well as improvement of self-esteem. The aim of this randomized control trial is to recognize the effects of CBT during pregnancy period on self-esteem, body image (primary outcome) and exclusive breastfeeding (secondary outcome).MethodIn this randomized controlled trial, 70 eligible pregnant women referring to health centers of Tabriz- Iran were assigned to two groups of 35 as intervention and control groups using randomized blocking method. For intervention group, 8 sessions of CBT based on Cash and Strachan’s body image protocol and Michael Freeʼs for self-esteem were performed. Control group was received routine pregnancy care by their health provider. Rosenberg self-esteem scale and multidimensional body self-relation questionnaire (MBSRQ) were completed before intervention, immediately after intervention and 4 weeks after delivery. Likewise, exclusive breastfeeding questionnaire was completed 4 weeks after childbirth. Independent t-test, chi square and repeated measures ANOVA tests were used to analyze the data.ResultsAccording to repeated measures ANOVA test and with controlling baseline score, the mean scores on self-esteem (AMD): 7.18; 95%confidence interval (CI): 4.43 to 9.94; p < 0.001)) and body image (AMD: 49.74; 95%CI = 28.57 to 70.91; p < 0.001) in the intervention group were significantly higher than the control group. Also, after intervention, the mean score of body image subscales including appearance evaluation (p = 0.010), appearance orientation (p = 0.001), fitness evaluation (p = 0.004), fitness orientation (p = 0.001), health evaluation (p = 0.001), health orientation (p = 0.018), and illness orientation (p = 0.002) was significantly higher in the intervention group than the control group.ConclusionsCBT was effective on the improvement of self-esteem and body image and through which might lead to the increase of exclusive breastfeeding among women.Trial registration numberIRCT20110524006582N33. First Date of registration: 17/10/2022. Submission ID 4ca86cd4-8459-4b86-9fe5-63f6a8184956.

Pathways by Which Self-Compassion Improves Positive Body Image: A Qualitative Analysis.

The current study applied consensual qualitative research-modified to essays written by 51 college women completing an expressive writing intervention over three time points for a total of 153 essays to identify how increases in self-compassion improve body image. A qualitative coding team tracked changes in affect and cognition over three time points. The results demonstrated that college women consistently expressed body acceptance and psychological flexibility. Additionally, the participants expressed important increases in mindfulness as well as decreases in social influences, feelings of separation, negative health behaviors, and attention to media messages. Decreases were found in their expressions of body functionality, love and kindness toward their body, and internal locus of control. These findings suggest pathways through which self-compassion may improve women's body image by increasing mindfulness and decreasing the negative ways of relating to one's body, specifically in the areas of media, clothing, make-up, and negative social interactions.

A non-competitive sporting challenge: experience shared by a group of women

ABSTRACT Given that scientific evidence shows that regular physical activity (PA) has physical, psychological, and social benefits, multiple initiatives have been implemented to promote its practice among women. One such initiative is Le Défi des Roses, a non-competitive sporting challenge in Quebec, Canada. A mixed method study consisting of a questionnaire (n = 141) and individual interviews (n = 38) was used among women enrolled in the challenge to: 1) assess participants’ physical, psychological, and social profile at the beginning of their training and 2) describe the physical, psychological, and social impacts of the challenge on participants. Le Défi des Roses had positive impacts physically (e.g. increase in the diversity of PA practice), psychologically (e.g. improvement in body image) and socially (e.g. increased influence over family members). These results could inspire other active leisure organizations designed to promote women’s regular PA, and ultimately, their physical, psychological, and social well-being.

Addressing Body Image Disturbance through Metaverse-Related Technologies: A Systematic Review

There is an increasing awareness about body image disturbance and eating disorders which calls for a multidisciplinary approach. The usefulness of new technologies for improving body image distortion has been addressed in the scientific literature, but has not included current strategies such as Metaverse-related technologies. Seemingly, this is the first systematic review which focuses on the efficacy of Metaverse-related technologies in reducing body image disturbance related to eating disorders like Anorexia nervosa and Bulimia nervosa. The main objective of this study was to review the scientific studies published in the last decade to answer the following three questions: (1) Are Metaverse-related technologies useful in mitigating body image disturbance in patients diagnosed with Anorexia nervosa and Bulimia nervosa? (2) What are the advantages and disadvantages? (3) Are the patients satisfied after using this kind of technology? The results obtained were that 80% of the included studies found metaverse-related technologies useful for the improvement in body image disturbance, in addition to various advantages, such as a decrease in eating disorder symptomatology. Whereas patient satisfaction was only evaluated in 20% of the included studies, with the majority of patients evaluating the use of metaverse-related technologies positively. We will conduct a systematic review of the peer-reviewed literature from EBSCO Discovery Service, and Web of Science (WOS), following the PRISMA statements. Only Journal articles published from 2013 to the present, written in the English language, will be reviewed. The findings are expected to offer valuable insights for the development of novel approaches for the improvement in body image disturbance in healthcare settings.

Effectiveness of interventional package on body image perception and self-esteem among adolescents - A pilot study.

In adolescence various physical and psychological changes, impact their overall perception that leads to either satisfaction or dissatisfaction with body image. Adolescents can suffer from body image dissatisfaction. Counselling sessions, video and documentaries can be used to improve the body image concerns. So, this study aims to evaluate the impact of interventional package on the body image perception and self-esteem among adolescents. The sampling technique used to enrol 65 adolescents was simple random. Body image was assessed in the form of affective and behavioural body image perception. Two different structured scales were used to assess affective and behavioural body image perception. Pre-test was conducted to assess the body image perception among adolescents; then, documentary was shown in the form of intervention 1 and the post-test 1 was taken, again booklet was distributed as intervention 2 and post-test -2 was taken. A statistically significant improvement in the satisfaction with weight, height, complexion, hair, teeth, buttocks, thigh and moustache, after the use of interventional package. In behavioural perception of body image, no significant association was found in pre-test, post-test 1 and 2, there is statistically significant improvement in self-esteem of adolescents, as P = 0.03. Interventional package in the form of documentary and booklet is useful in improving body image perception among adolescents. Significant improvement was seen in perception related to certain body parts.

Functionality appreciation is associated with improvements in positive and negative body image in patients with an eating disorder and following recovery

BackgroundResearch on body image in eating disorders has predominantly focused on negative body image, only recently shifting to positive body image. Findings suggest that enhancing positive body image can, amongst other things, serve as a protective mechanism against (re)developing a negative body image. One suggested way of enhancing positive body image is to focus on enhancing body functionality appreciation. Although studies show promising effects, this research is mainly conducted in non-clinical samples.MethodsThe current study investigated the levels of positive and negative body image in an online community sample of patients with an eating disorder (PAT, n = 227), patients recovered from an eating disorder (REC, n = 102) and controls (HC, n = 175) (self-reported diagnosis, not confirmed). In addition, we tested whether body functionality appreciation was associated with appearance dissatisfaction (negative body image) and body appreciation (positive body image).ResultsREC showed similar results to controls to most of the body image measures except for how much importance one places on their appearance (no different between REC and PAT), and how satisfied one is with certain body parts. For this measure, REC scored in-between PAT and HC. We further found functionality appreciation to be significantly associated with of both positive and negative body image, except for appearance evaluation in patients with an eating disorder.ConclusionsThis study showed a positive association between body functionality appreciation and positive body image and a negative association between body functionality appreciation and negative body image. Further research is required to investigate the effectiveness of interventions targeting body functionality appreciation in clinical settings.

Exploring the tripartite influence model of body image and disordered eating among adolescent girls living in Australia, China, India, and Iran

The aim of this study was to evaluate the tripartite influence model of body image and disordered eating among 12–18-year-old girls (N = 900) living in Australia (n = 184), China (n = 293), India (n = 223), and Iran (n = 200). Participants completed measures about appearance pressures from family, peers, and media, thin-ideal internalization, appearance comparisons, appearance satisfaction, and disordered eating. Results indicated that media- pressures were most salient in Australia, whereas Iranians perceived family pressures to be the strongest. Indians felt the most pressure to look attractive from their family and peers, whereas Chinese felt similar levels of pressure from family, peers, and media. Path analyses suggested direct associations from one or more sociocultural factors to appearance satisfaction or disordered eating, with indirect paths via thin-ideal internalization and appearance comparisons emerging in all countries. Certain sociocultural factors contributed more strongly to the internalization of ideals and appearance comparisons within some countries. Multigroup path analyses demonstrated some cross-cultural variations in the strength of the pathways. Findings extend cross-cultural support for a modified tripartite influence model emphasizing culture-based specificities that can further guide preventative efforts to improve body image and eating attitudes among young girls in these four countries.