Sociocultural Attitudes Towards Appearance Questionnaire-3 Research Articles

Maternal Modeling Online

This study explored the dynamics of mother/daughter dyads on social networking sites (SNSs). 40 mother/daughter dyads completed online surveys. Predictor variables included overall SNS use, photo activities, and interaction activities. Outcome variables included Rosenberg self-esteem scale (RSES), body shape satisfaction scale (BSSS), sociocultural attitudes towards appearance questionnaire-4 (SATAQ-4), children's eating attitude test (ChEAT)/the eating attitudes test (EAT-26), and physical activity. A pooled regression actor-partner interdependence model was used. Notably, of daughter partner effects: Overall SNS use and RSES (t = -2.28), Overall SNS use and BSSS (t = -2.50), Overall SNS use and SATAQ-4 (t = 4.47), Overall SNS use and EAT-26/ChEAT (t = 4.59), SNS photo activities and SATAQ-4 (t = 4.03), SNS photo activities and EAT-26/ChEAT (t = 3.92), SNS interaction activities and RSES (t = 2.46), and SNS interaction activities and RSES (t = -3.83) were significant (p<.05); suggesting mothers need to foster positive SNS behavior.

Translation and psychometric properties of the Chinese version of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) in college students

The current study aimed to translate the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) into Mandarin Chinese and to examine its psychometric properties. In Study 1 (N = 842, 427 women, 415 men), exploratory factor analysis supported a 4-factor solution for the Mandarin Chinese SATAQ-4, namely Internalization: Thin/Low body fat, Internalization: Muscular/Athletic, Pressures: Family/Peers, and Pressures: Media. Evidence also supported the high internal consistency and convergent validity of the male-subject and female-subject versions of Mandarin Chinese SATAQ-4. In Study 2 (N = 497, 290 women), confirmatory factor analyses supported the previously found 4-factor model, after allowing correlation between residuals of three pairs of items. In Study 3 (N = 294, 129 women), we examined the 3-month test-retest reliability across gender, and the results showed satisfactory ICC for both women (ICC =0.53–0.79) and men (ICC =0.56–0.66). Taken together, the male-subject and female-subject versions of the Mandarin Chinese SATAQ-4 are reliable and valid in evaluating sociocultural attitudes towards appearance.

Mass media pressure on psychological and healthy well-being. An explanatory model as a function of physical activity

ObjectivesThe present research aims to identify and establish the relationships between media pressure, psychological well-being, age, physical activity and adherence to the Mediterranean diet. This objective is broken down into (a) developing an explanatory model of media pressure, psychological well-being, age, physical activity and adherence to the Mediterranean diet and (b) testing the structural model by means of a multi-group analysis according to physical activity level.Material and methodsTo this end, a quantitative, non-experimental (ex post facto), comparative and cross-sectional study was carried out on a sample of 634 participants (35.18 ± 9.68). The instruments used were an ad hoc questionnaire, the Spanish version of Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4), the Psychological Well-Being Scales (PWBS) and the Prevention with Mediterranean Diet (PREDIMED).ConclusionsThe data reveal that meeting the WHO physical activity criteria improves the relationships between media pressure, psychological well-being and healthy well-being.

Relationship of young women's body appreciation with eating disorders and psychological variables

Introduction: Obesity, body image and eating disorders are particularly common among adolescent girls and young women. While negative body image is the major focus of research, it is also important from the aspect of prevention to explore the factors that influence positive attitudes towards our bodies and body appreciation. Objective: Our aim was to analyze the determinants of body appreciation in young women, including different types of eating disorders, physical activity, body mass index, various psychological characteristics, and whether there is a family history of eating disorders or obesity. Method: Participants were a sample of female university students (n = 262; mean age: 22.0 ± 2.2 years). Data were collected via an online questionnaire. Body appreciation was measured using the Body Appreciation Scale (BAS-2), supplemented by the Eating Attitudes Test (EAT), the Rosenberg Self-Esteem Scale, the Life Orientation Test (LOT-R), and the “Internalization – General” subscale of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3) to measure psychological characteristics. Results: Multivariate linear regression analysis showed that self-esteem has the strongest relationship with young women’s body appreciation; sporting and optimism are also significant but to a lesser extent, while body mass index and dieting are negative predictors. Likewise, a strong susceptibility to the internalization of media content is also detrimental to body appreciation. Oral control, which can be found among the symptoms of anorexia nervosa, is a mild positive predictor of body appreciation. Conclusion: Our data highlight the importance of body appreciation in the treatment and prevention of body image and eating disorders. There is a great need for fostering positive body image and body appreciation, as the lack of acceptance of our bodies and the extreme adherence towards an overemphasized skinny body ideal can easily lead to pathological dieting.

Media Pressures, Internalization of Appearance Ideals and Disordered Eating among Adolescent Girls and Boys: Testing the Moderating Role of Body Appreciation.

The aim of the present study was to test the moderating role of body appreciation in the mediation model of media pressures, internalization of appearance ideals, and disordered eating in adolescents. One thousand four hundred and twelve Lithuanian adolescents (40.4% were boys, age range: 15–18 years) participated in the cross-sectional study. The mean age of the sample was 16.9 (SD (standard deviation) = 0.5) for girls and 17.0 (SD = 0.4) for boys. Adolescents completed a questionnaire consisting of measures of body appreciation (Body Appreciation Scale-2 (BAS-2)), disordered eating (Eating Disorder Examination Questionnaire 6 (EDE-Q 6)), attitudes towards sociocultural pressures towards appearance (Sociocultural Attitudes towards Appearance Questionnaire 4 (SATAQ-4)), and time browsing internet for leisure purposes. To assess the primary hypotheses, moderated mediation models were tested separately in boys and girls. In girls, body appreciation moderated associations between media pressures and internalization of thin body ideals and between internalization of thin appearance ideals and disordered eating. In boys, body appreciation moderated only the association between media pressures and disordered eating. The effect of media pressures on disordered eating was the highest in boys with the lowest body appreciation. Body appreciation protects adolescent girls from internalization of thin appearance ideals in the presence of media pressures and from disordered eating in the case of internalization of thin body appearance ideals. In boys, body appreciation provides a protective effect from media pressures towards appearance to disordered eating behaviors. The findings of the present study could inform intervention programs that aim to prevent disordered eating, strengthen positive body image, and promote healthy eating in adolescent girls and boys. Specific programs might be beneficial in preventing disordered eating in boys with low body appreciation.

Sociocultural Attitudes Towards Appearance Questionnaire-4: Psychometric properties among a French clinical eating disorder sample and normative comparisons

Although the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) has been shown to be a reliable and valid tool for assessing appearance pressures and appearance ideal internalization among French college students, to date its psychometric properties among French clinical populations have not been examined. The aim of this study was to evaluate the factor structure, reliability, and validity of the SATAQ-4 among a French female clinical eating disorder sample, and to compare the mean SATAQ-4 scores from this clinical sample to previously published means observed among French female college women. The current sample included 192 French women consecutively recruited from an outpatient eating disorders unit in France. Participants completed the SATAQ-4, as well as validated measures of body image and eating pathology. Confirmatory factor analysis revealed that the original 22-item five-factor solution provided less than adequate fit to the data. In contrast, the reduced 20-item five-factor solution identified among French college students provided a good fit to the data. The SATAQ-4 subscales generally exhibited moderate positive associations with convergent measures of body image and eating disturbance, consistent with expectations. Differences in SATAQ-4 subscale means across diagnostic groups were observed. In addition, the clinical group reported higher scores on the Internalization: Thin/Low Body Fat and Internalization: Muscular/Athletic subscales compared to a non-clinical French sample. Findings support the SATAQ-4 as a valuable tool for assessing sociocultural influences on body image and eating concerns among French women with eating disorders.

Sexual Orientation-Based Differential Item Functioning in Measures of Body Image Concerns and Ideals among Men.

Body image concerns and body ideals are linked with eating disorders and psychological health. Body image and ideals among men differ by sexual orientation, which may influence the utility of common measures of such constructs. The present study used differential item functioning (DIF) analyses to examine whether item endorsement differs as a function of sexual orientation in three commonly used measures of body image concerns and ideals. Participants were sexual minority (n=209) and heterosexual (n=494) men in the United States. Scores on the Drive for Muscularity Scale (DMS), Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4), and Objectified Body Consciousness Scale (OBCS) were examined. DIF was tested in a three-step regression wherein item scores were predicted by: (1) subscale score, (2) subscale and sexual orientation, and (3) subscale, sexual orientation and their product term. Model fit and variance explain comparisons identified DIF. Δ pseudo R2 value ≥ .035 from step 1 to 3 signified clinical significant DIF. There was no evidence of clinically significant DIF for the DMS, SATAQ-4, or OBSC. Findings suggest that DMS, SATAQ-4, and OBSC perform similarly for sexual minority and heterosexual men.

Influence of Media on Body Image for Fitness Center Users

ABSTRACT Mass media influences one’s body esteem, and images seen in the media may lead to unhealthy behaviors to achieve an ideal body. Body esteem may be shaped by one’s ethnicity, gender, and age, as well. Media image and body satisfaction have been investigated in the context of ethnicity, as illustrated by studies comparing Caucasian and African American women. However, research has not looked at the relationship of these issues specifically for an American Indian population. The present study investigated the relationship of media influence and body dissatisfaction (or negative body esteem) for American Indian members of a fitness center in rural, southeastern North Carolina through use of the Body Esteem Scale (BES) and the Sociocultural Attitudes towards Appearance Questionnaire-3 (SATAQ-3). Within this group of participants, gender and age were examined as they relate to body esteem and media influence. Hypothesis testing revealed that men had higher body esteem than women. Additionally, for the sample population there was a weak negative correlation between body esteem and media image.

Translation, Adaptation and Psychometric Properties of SATAQ-4R for Brazilian Children

BackgroundThe Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) is one of the most investigated instruments for the evaluation of sociocultural pressure and internalization of the beauty standard, and it is considered to be one of the most robust instruments for this purpose. The most recent version of this questionnaire is the SATAQ-4R, originally designed for adults and teenagers, which has been used in different countries, contexts, and populations. The cross-cultural adaptation and validation of the SATAQ-4R for Brazilian children are appropriate and necessary.ObjectiveThe general objective of this study was to translate, adapt, and verify the psychometric qualities of the SATAQ-4R for Brazilian girls and boys aged between 7 and 11 years old.MethodsStudy 1 describes the cross-cultural adaptation, from the translation stage to the pretest in children of both sexes (n = 36, M = 8.76, SD = 1.59 years). SATAQ-4R has been demonstrated to be easily understood by Brazilian children. Studies 2 and 3 analyze the psychometric qualities of such an instrument in 566 girls (M = 9.18, SD = 1.23 years) and in 592 boys (M = 9.18, SD = 1.23), respectively. Exploratory and confirmatory factor analyses have been performed with independent samples.ResultsBoth instruments presented factor structures composed of five factors, good reliability, and convergent validity.ConclusionWe concluded that SATAQ-4R-Female and SATAQ-4R-Male are useful tools for evaluating the internalization of beauty standards and of sociocultural pressure on Brazilian children.

Uso das redes sociais, imagem corporal e influência da mídia em acadêmicos dos cursos de educação física

A aparência corporal está se tornando cada vez mais importante para nossa sociedade e a forma como é utilizada pela mídia é preocupante, encarada como produto e sendo alvo da instituição de padrões de corpo a serem seguidos. As redes sociais são um instrumento atual usado pela mídia para difundir informações. O padrão de corpo disseminado, através das redes sociais é, na maioria das vezes, inalcançável para a população, causando insatisfação com a imagem corporal. A partir de tais observações, surge este trabalho que teve por base de pesquisa a coleta de informações. A pesquisa foi realizada com 112 estudantes dos cursos de Educação Física, licenciatura e bacharelado, sendo de todos os períodos, ambos os sexos e sem idade definida para a participação. Eles responderam a três questionários, o primeiro sociodemográfico; o segundo sobre o uso das redes sociais, elaborado pela pesquisadora, com perguntas referentes à frequência, tempo e conteúdo de uso dessas ferramentas. O terceiro é o Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3), validado para o Brasil por Amaral (2011). Os dados foram organizados e analisados por meio do programa SPSS, versão 2.0 para Windows. Foi adotado o nível de significância estatística p<0,05 e realizada uma análise descritiva dos dados. Como principais resultados da pesquisa, 99,1% da amostra (48,2% do sexo masculino e 50,9% do sexo feminino) afirma fazer uso das redes sociais e apenas uma pessoa do sexo masculino (0,9%) diz não utilizar. Sobre as redes sociais mais usadas em função do sexo, as mais mencionadas são: whatsApp 96,4%, instagram 79,5% e facebook 75,9%. Em relação aos fatores SATAQ-3, os que obtiveram maior pontuação foram os fatores 1 (internalização geral dos padrões estabelecidos), seguido do fator 4 (mídia como fonte de informações sobre aparência) para ambos os sexos, o que indica que esses fatores possuem maior influência sobre as participantes. Podemos verificar que há uma influência por parte da mídia, em ambos os sexos, verificamos que as diferenças são mínimas, o que nos leva a concluir que a influência da mídia ocorre de forma igualitária em ambos os sexos.

Validation of the Lithuanian Version of the Sociocultural Attitudes towards Appearance Questionnaire-4 (SATAQ-4) in a Student Sample.

The Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) is one of the most broadly used self-report tools that assess the general role of sociocultural influences on body image and appearance-related internalization. The present study aimed to examine the reliability, validity, and factor structure of the Lithuanian version of the SATAQ-4 (LT-SATAQ-4), as a screening self-report instrument for assessing the role of sociocultural influences on body image. A mixed-gender sample (N = 1850) of undergraduate students (88.7%) and graduate students (11.3%) from different state universities and colleges participated in this study (average age 21.6 ±5.0). The students completed a self-report online questionnaire. Intraclass correlation coefficients (ICCs) were calculated for assessing test-retest reliability. The construct validity of the Lithuanian Sociocultural Attitudes Towards Appearance Questionnaire-4 (LT-SATAQ-4) was studied performing exploratory factor analysis (EFA), and then confirmatory factor analysis (CFA). The mean scores for the LT-SATAQ-4 subscales ranged from 1.6 ± 0.9 (Pressure subscale: Peers) to 2.7 ± 1.2 (Internalization subscale: Thin/Low Body Fat). Test-retest reliability was good to excellent for the general and subscale scores (0.85–1.00) except for the Pressure subscale: Peers (0.60). The original 5-factor structure was confirmed by EFA and CFA. Good to excellent internal consistency for each subscale (attempted 0.9 and more) and for the LT-SATAQ-4 global scale (0.91) was obtained. The LT-SATAQ-4 scores had adequate concurrent validity with the measures of the body image, disordered eating, self-esteem, and body mass index. The results support the psychometric properties of the LT-SATAQ-4 and its’ use in Lithuanian student samples. The Lithuanian SATAQ-4 is a useful measure to examine the pressures to internalize appearance ideals in Lithuanian-speaking samples of young individuals.

Measurement invariance of the SATAQ-4 in Black and White undergraduate women

The Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) is a widely used measure of sociocultural factors affecting body image. Despite evidence sociocultural appearance ideals and pressures might differ between White and Black women, the SATAQ-4′s invariance has not been formally evaluated. The current study examined its measurement invariance across White and Black college women. Women (N = 730; 68.5 % White, 31.5 % Black), recruited from a large, public university in the United States completed measures online. Confirmatory factor analysis (CFA) showed the original five-factor structure was adequate in each group, and it appeared equivalent across groups. However, full metric invariance was not supported. Factor loadings on one item differed, suggesting differences in how this item contributed to thin-ideal internalization between groups. Similarly, one threshold differed, suggesting Black women who mostly agreed they wanted a “very thin” body had more thin-ideal internalization than White women with the same rating. These results suggest comparisons between these groups on the thin-ideal internalization subscale should be interpreted cautiously, as group differences could reflect some measurement bias. Given appearance pressures and ideals extend beyond thinness, particularly for Black women, future research should consider refining or developing culturally sensitive measures, to enhance relevance between and within racial/ethnic groups.

Acceptance of Cosmetic Surgery among Hungarian Women in a Global Context: the Hungarian Version of the Acceptance of Cosmetic Surgery Scale (ACSS)

In recent years, the popularity of surgical cosmetic procedures has dramatically increased in the Western world. The Acceptance of Cosmetic Surgery Scale (ACSS) provides a measure of psychological acceptance of cosmetic surgery. The original instrument (ACSS) contains three subscales (Interpersonal, Social, and Consider). Since its publication, the ACSS has been adapted for many languages. The primary objective of the present study was to develop the Hungarian version of the ACSS. Furthermore, focus was laid on whether the original factor structure could be replicated with a Hungarian sample despite expectable cultural differences from other national samples. To obtain cross-culturally comparable data, the same scales were used for psychometric analysis as those used in the development of the original ACSS and its various national versions. The Hungarian sample included 482 female participants aged between 18 and 68 years (M = 29.02, SD = 10.71), who completed a questionnaire battery. Validity of the Hungarian version was tested with the following measures: the Rosenberg Self-Esteem Scale (RSES), the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3), the Satisfaction with Life Scale (SWLS), the Body Appreciation Scale (BAS), and the Photographic Figure Rating Scale (PFRS) developed for women. The results show that the obtained Hungarian version of the ACSS is a reliable and valid measure, which enables researchers in the field to study Hungarian samples. Furthermore, the factor structure of the Hungarian scale is identical with that of the original ACSS, which enables reliable cross-cultural comparisons. For these reasons, the authors expect that the Hungarian ACSS will stimulate more in-depth quantitative research on attitudes towards cosmetic surgery within the Hungarian context, and it will also contribute to a better understanding of acceptance of cosmetic surgery from a cross-cultural perspective.

The Development of the Internalization of Sociocultural Body Ideals Scale Using Items From the Sociocultural Attitudes Towards Appearance Questionnaire: Validity, Reliability, and Measurement Invariance Testing

Eating disorders and body image disturbance are known to result in unhealthy consequences. When attempting to understand the etiology and management of these disorders, sociocultural models of body image disturbance and disordered eating have been predominant. The objective of the present study was to develop and validate the Internalization of Sociocultural Body Ideals Scale (ISBIS), a psychometric instrument that utilizes items from various versions of the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ). The ISBIS was developed to overcome some of the limitations found in existing instruments (including the SATAQ) that assess the internalization of sociocultural body ideals. The sample comprised 1130 students aged between 10 and 14 years. The psychometric properties of the ISBIS were examined using different analyses. The results supported the eight-item structure: four items for thin body ideal internalization and four items for thin body muscular/athletic internalization. The structure showed invariance to gender and achieved acceptable internal consistency and temporal stability indexes. Controlling for gender and body mass index, the results also showed that the internalization of the thin body ideal positively predicted social-physique anxiety in a statistically significant way. The results provide empirical evidence that the ISBIS is a reliable and valid instrument for assessing sociocultural body ideals in Spanish preadolescents.

Validation of an Italian version of the Sociocultural Attitudes Towards Appearance Questionnaire-4-Revised (SATAQ-4R) on non-clinical Italian women and men

Appearance-ideal internalization and appearance pressures are empirically-supported risk factors for body image disturbance and disordered eating in Western countries. Such a relationship has emerged also in the Italian context, where high rates of body dissatisfaction and disordered eating are present. The Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) and its revisions are among the most commonly used instruments to assess the role of sociocultural influences on body image. Two studies were conducted to examine the psychometric properties of the female (Study 1, N = 732) and male (Study 2, N = 364) Italian versions of the SATAQ-4-Revised (SATAQ-4R-Female, SATAQ-4R-Male). Confirmatory factor analysis (CFA) indicated that the original seven-factor structure was replicated for women and men. The seven subscales (Internalization: Thin/Low Body Fat; Internalization: Muscular; Internalization: General Attractiveness; Pressures: Family; Pressures: Peers; Pressures: Significant Others; and Pressures: Media) showed good internal consistency and 4-week test-retest reliability. Associations between SATAQ-4R subscales and body dissatisfaction, eating disorder symptomatology, drive for muscularity, self-esteem, family influences, and peer influences, suggested good convergent validity among both women and men. The present study provides evidence for the validity and reliability of the male and female Italian versions of the SATAQ-4R.

Influence of the Mass Media and Body Dissatisfaction on the Risk in Adolescents of Developing Eating Disorders.

Media influence may lead adolescents to internalize patterns of physical beauty, resulting in dissatisfaction with their own bodies when they are unable to match up to these patterns. In the constant search for an ‘ideal body’, adolescents may begin to develop risk behaviors for the development of eating disorders (ED). The object of this study was to analyze the influence of the mass media on body dissatisfaction (BD) and on ED in adolescents, comparing genders. We also analyzed the influence of BD on the risk of developing unsuitable eating behaviors, with risk of ED, comparing genders. A cross-sectional study was carried out with 1011 adolescents: 527 girls and 484 boys. The BMI of each adolescent was determined, and the instruments EAT-26, Sociocultural Attitudes towards Appearance Questionnaire-3 (SATAQ-3), and body shape questionnaire (BSQ), were applied. For statistical analysis, we used Student’s t-test, the chi-square test, Pearson’s correlation test, the odds ratio, and hierarchical multiple linear regression. The influence of the mass media is associated with a greater probability of adolescents presenting BD. An increase in BD is associated with an increased risk of developing ED in adolescents of both genders but is greater in girls than in boys. Furthermore, the influence of the MM and BMI are predictors of BD in both genders; and BD is a predictor of ED risk in both girls and boys.

An exploration of the psychometric properties of the SATAQ-4 among adolescent boys in Japan

Research among Western adult and adolescent males suggests that sociocultural influences are implicated in the drive for muscularity and weight-change behaviors. However, few studies have examined these relationships among adolescent boys from non-Western backgrounds. The current study sought to assess the psychometric properties of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4), a 22-item, 5-factor measure of sociocultural influence on appearance ideals, among Japanese (n = 984) adolescent boys. Relationships between appearance-related pressures, appearance ideal internalization, appearance-related teasing, drive for muscularity, and weight-change behaviors were also assessed. Exploratory and confirmatory factor analyses identified a four factor solution (Internalization: Thin/Low Body Fat, Internalization: Muscular/Athletic, Pressures: Media, and Pressures: Family/Peers) with 16 items in this sample. Correlational analyses supported the construct validity of the SATAQ-4. Thin internalization was associated with strategies to lose weight, while muscular internalization was associated with drive for muscularity and strategies to gain weight. Further, peer and parental appearance teasing was associated with perceived appearance pressures from family and peers, as well as weight change strategies. Overall, results suggested modification of the SATAQ-4 when used with Japanese samples, but supported its use to assess sociocultural influences. Additionally, the results highlight that sociocultural influences and muscularity concerns among Japanese adolescent boys are associated in similar ways with weight change strategies as has been established for adolescent males in Western countries.

Comparing internalization of appearance ideals and appearance-related pressures among women from the United States, Italy, England, and Australia.

Researchers have observed variation in levels of body image disturbance and eating pathology among women from different Western countries. Examination of cross-cultural differences in the established risk factors (i.e., thin-ideal internalization, muscular-ideal internalization, and appearance pressures from family, peers, and media) for negative outcomes may help to elucidate the prominence of specific risk factors within a given Western society and guide associated interventions. Women from the United States (US), Italy, England, and Australia completed the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4). Analysis of covariance controlling for age and BMI indicated significant cross-country differences for all SATAQ-4 subscales. Results typically indicated higher levels of appearance-ideal internalization and appearance pressures in the US and lower levels in Italy; however, associated effect sizes were generally small. A medium effect of country was observed for peer-appearance pressures, which were highest in the US compared with all other countries. Repeated-measures analysis of variance and paired samples t tests conducted within each country identified thin-ideal internalization and media appearance pressures as the predominant risk factors for all four countries. Overall, findings suggest more cross-country similarities than differences, and highlight the importance of delivering interventions to address thin-ideal internalization and media appearance pressures among women from Western backgrounds.Level of evidence Descriptive study, Level V.

Thin-ideal internalization: How much is too much?

Internalization of the thin-ideal is a risk factor for eating disorders that frequently persists into recovery and increases patient risk for relapse. Addressing thin-ideal internalization as a core element of eating disorder prevention and treatment produces significant reductions in eating pathology. However, research has not yet quantified levels of thin-ideal internalization that may signal increased versus decreased risk for disordered eating. To address this gap in the literature, receiver operating characteristic (ROC) curve analysis was used to identify a thin-ideal internalization cutoff score that signified clinically-meaningful eating disorder pathology. 787 college women (age M = 20.17, SD = 2.41; BMI M = 23.58, SD = 5.29) were classified as "healthy" (N = 717) or those with significant disordered eating (N = 70) using established clinical cutoffs for the Eating Disorder Examination-Questionnaire. ROC curve analysis was used to test the performance of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) Internalization: Thin/Low Body Fat subscale in predicting disordered eating status, and to identify a cutoff score that maximized sensitivity and specificity to discriminate between healthy and disordered eating samples. Mean SATAQ-4 internalization scores were 3.29 (SD = 0.92) and 4.27 (SD = 0.62) for healthy and disordered eating participants, respectively. The SATAQ-4 internalization scores were good predictors of disordered eating status (area under the curve = 0.81, 95% CI: 0.76-0.86). The optimal cutoff of 3.78 (measured on a 1-5 Likert scale) yielded a sensitivity of 0.81 and specificity of 0.64. Overall, results provide preliminary support for the discriminant validity of SATAQ-4 thin internalization scores and suggest that even moderate levels of thin-ideal internalization may be predictive of clinically-significant eating pathology. It may be important for prevention and intervention work to actively seek to reduce internalization levels below this clinical cutoff, though future work is needed to bear this out.

On the measurement of thin-ideal internalization: Implications for interpretation of risk factors and treatment outcome in eating disorders research.

Although the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) and Ideal Body Stereotype Scale (IBSS) are used interchangeably to assess thin ideal internalization, limited work has examined the assumption that the two measures index the same construct. The current study utilized confirmatory factor analysis to examine whether these measures capture a single construct (one-factor), two constructs (two-factor), or both shared and unique constructs (bifactor). The SATAQ-4R-Internalization: Thin/Low Body Fat subscale and IBSS-Revised were administered to 1,114 college females. A bifactor model provided the best fit to the data. Further, the SATAQ-4R was more strongly related to disordered eating and body satisfaction than the IBSS-R. Results indicate that the two most commonly used measures of internalization capture both shared and unique constructs. While both measures appear to contribute to the assessment of a global internalization factor, the SATAQ-4R may be better suited to assess personal acceptance of and desire to achieve a thin body, while the IBSS-R may be better suited to assess an awareness or acknowledgement of broader sociocultural ideals (e.g., toned, shapely bodies). Continued psychometric investigation of the scales is recommended in order to ensure targeted assessment of the intended constructs.