Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 47: (i) Soc Media; (ii) Wt. Stigma, Pt. 1 (n = 2); (iii) Orthorexia Nervosa (n = 3); (iv) Recovery; (v) Stigma & BED; and (vi) Nature of EDs, Pt. 6 (n = 2)
Colleagues (N now = 1203 in 48 countries),
Please (a) continue to send me any and all announcements (e.g., conferences, awards, webinars, prevention resources, your recent publications); and (b) pass along the following to anyone who would like to join this free email list.
REQUEST FOR RESEARCH PARTICIPATION AND/OR ASSISTANCE RECRUITING
People who are 18 years or older, currently in treatment for an eating disorder and have internet access
from [our own] Dr. Kara Christensen Pacella at the University of Nevada at Las Vegas, for a study
[ML, paraphrasing, has] entitled
Developing a New Program to Help Improve Sleep for People with Eating Disorders
Received 16 July 2024 (California time) via an email from our own Dr. Kara Christensen Pacella (USA).
ML NOTE 1: Dr. Christensen Pacella, her colleagues and students, and I would appreciate it if you would (a) participate in this study, if eligible; and/or (b) pass this along to anyone who is 18 years or older, currently in treatment for an eating disorder and have internet access, as well as clinicians, other therapists, physicians, etc., who are working with such people.
For a flyer/announcement with the details (and a QR code along with the link below), contact Dr. Christensen Pacella at kara.christensen@unlv.edu.
[Dr. Christensen Pacella writes:]
The Clinic for Research on Eating, Sleep, and Therapy (CREST) at University of Nevada, Las Vegas (PI: Kara Christensen Pacella, Ph.D.) is recruiting participants for a research study on opinions about a new program to help improve sleep for people with eating disorders.
Eligible participants will review the program online and provide written feedback about the design and content of the program. Then they will complete a 1.5 hour audiorecorded focus group with 6-8 other participants on Zoom in which they will discuss their perceptions of the program and suggestions for improvement.
In order to participate, you should be 18 years or older, currently in treatment for an eating disorder and have internet access. Compensation up to $50 via Amazon gift card: $20 for the online survey and $30 for the focus group available.
For more information on the study, please email our team at crest@unlv.edu or call 702-895-2099.
To complete our eligibility screening survey, follow the link here.
Kara Christensen Pacella, Ph.D. | Assistant Professor | Director, Clinic for Research on Eating, Sleep, and Therapy (CREST) | Department of Psychology | University of Nevada, Las Vegas | kara.christensen@unlv.edu | Office: 702-895-2279
ANNOUNCEMENT — Opportunities (Plural) for Doctoral Studies in Eating Disorders with
The Scientific Work in Anorexia Nervosa (SWAN) & Other Eating Disorders Research Group,
[under the direction of our own] Dr. (A/Prof) Andrea Phillipou at The University of Melbourne and ORYGEN in Australia
Expressions of interested accepted until 30 August 2024
Received 18 July 2024 via an everything-is-advocacy email from our own Dr. Stephanie Miles (Australia) on behalf of our own Dr. Andrea Phillipou (Australia; see #7 below) and their colleagues at ORYGEN / The University of Melbourne.
ML NOTE 2: Drs. Phillipou and Miles, their colleagues and students, and I would appreciate it if you would pass this announcement/opportunity along to anyone who (a) is qualified and might be interested and/or (b) is working with/mentoring people who are qualified and might be interested.
[Dr. Miles writes:]
The Scientific Work in Anorexia Nervosa (SWAN) & Other Eating Disorders research group is seeking students who are interested in completing a PhD on the topic of anorexia nervosa. Our group is led by A/Prof Andrea Phillipou and is based at The University of Melbourne and Orygen in Australia. Our group has expertise in cognition, clinical trials, and bio-psycho-social approaches to understanding eating disorders. We are taking expressions of interest until 30th Aug. Anyone can email us at eatingdisorders@orygen.org.au
Dr. Stephanie Miles, BA, BPsych(Hons), PhD | ORYGEN / The University of Melbourne | Adjunct Research Fellow, Swinburne University of Technology
Research Publication Categories in This Newsletter
(i) Social Media; (ii) Weight Stigma, Part 1 (n = 2); (iii) Orthorexia Nervosa (n = 3); (iv) Recovery; (v) Stigma and BED; and (vi) Nature/Correlates of Eating Disorders, Part 6 (n = 2)
CONGRATULATIONS to our own
Dr. Mary Pritchard (USA) and colleagues for publication of the Social Media research article in #2.
Ms. Belinda Caldwell (Australia) and Drs. Andrea Phillipou (Australia), Leah Brennan (Australia), and Zoe Jenkins (Australia) and colleagues for publication of the Recovery research article in #7.
Dr. Hunna Watson (Australia/USA) and colleagues for publication of the Nature, Course, and Correlates of Eating Disorders article in #9.
Dr. Giuseppe Riva (Italy) and colleagues for publication of the Nature, Course, and Correlates of Eating Disorders article in #10.
Social Media
1. Brasil, K. M., Mims, C. E., Pritchard, M. E., & McDermott, R. C. (2024). Social media and body image: Relationships between social media appearance preoccupation, self-objectification, and body image. Body Image, 51. Advance online publication. https://doi.org/10.1016/j.bodyim.2024.101767
Email address for correspondence: kb1926@jagmail.southalabama.edu
ABSTRACT. Nearly 85 % of emerging adults report using at least one social media site. Research suggests that viewing and internalizing unrealistic body ideals often displayed online may pose harmful effects on young people’s body image. However, studies on the relationships between social media usage and body image have predominantly focused on women’s drive for thinness.
We sought to explore the relationships between social media appearance-related preoccupation (SMARP), body shame and surveillance, and drives for leanness, muscularity, and thinness, specifically examining the moderating role of gender within these relationships. Data from 939 undergraduate students (n = 240 men) were analyzed using multigroup structural equation modeling.
Surveillance significantly mediated the positive associations between SMARP and drive for leanness for women and men. For SMARP and drive for muscularity, surveillance was a mediator for men only. Shame emerged as a significant mediator of the positive association between SMARP and drive for thinness for women and men. Moderated mediation was supported, such that the indirect effect of SMARP on drive for thinness was significantly stronger for women. These results suggest that for men in particular, SMARP is not necessarily associated with increased drives for leanness and muscularity unless men are also engaging in body surveillance
Weight Stigma, Part 1 of 3
2. Wetzel, K. E., & Himmelstein, M. S. (2024). Weight stigma is uniquely tied to maladaptive eating across different racial, ethnic, and gender groups. Appetite. Advance online publication. https://doi.org/10.1016/j.appet.2024.107604
Email address for correspondence: karenewetzel@gmail.com
ABSTRACT. Weight stigma, racism, and sexism (social devaluation due to body weight, race or ethnicity, and sex or gender), have been linked to increased maladaptive eating behaviors; however, no research has investigated the unique associations between different forms of stigma and eating concurrently.
We analyzed within-group (by race/ethnicity and sex) effects of different forms of stigma on maladaptive eating behaviors to test whether there is some unique relationship between weight stigma and maladaptive eating across identities. Additionally, we explored differences by racial/ethnic group and sex, as well as BMI category, in levels of reported weight stigma, racism, sexism, and maladaptive eating. Participants (N=1051) were recruited so that there were approximately even numbers of participants identifying as Black (33.3%), Hispanic or Latino (32.8%), and White (33.9%).
Overall, participants reported similar amounts of weight stigma by race/ethnicity and sex, but different levels of racism and sexism. Weight stigma, but not racism or sexism consistently predicted binge eating and eating to cope across groups, controlling for education, income, BMI, and age. Restricted dieting, however, was only predicted by weight discrimination for Hispanic/Latino and Black men.
These findings suggest that weight stigma is a unique predictor of maladaptive eating, even when considering the effects of racism and sexism. This study provides evidence of a more focused model of weight stigma and eating outcomes, rather than a more general model of the effect of stigma on eating outcomes due to overall stress. Future research should investigate when and why weight stigma drives restricted dieting, since this relationship seems strongest in men, going against many common inclinations about weight stigma.
ML NOTE 3: The article described below in #3 came to my attention via the Obesity and Energetics Offerings online newsletter of 19 July 2024. For more information about free participation in this ongoing and valuable exercise in education, research methods, and critical thinking, see Obesity and Energetics Offerings.
3. Côté, M., Forouhar, V., Edache, I. Y., & Alberga, A. S. (2024). Weight bias among Canadians: Associations with sociodemographics, BMI and body image constructs. Social Science & Medicine, 354. Advance online publication. https://doi.org/10.1016/j.socscimed.2024.117061
Full text available for download at: marilou.cote.2@ulaval.ca
ABSTRACT. This cross-sectional study examined the associations between sociodemographic characteristics, BMI, and body image constructs (body satisfaction and weight bias internalization; WBI) and explicit weight bias. A near-representative sample of 995 English-speaking Canadian adults (52% Female) completed a survey which assessed explicit weight bias (Anti-Fat Attitudes questionnaire), body satisfaction (Body Shape Satisfaction Scale), WBI (Modified Weight Bias Internalization Scale), and self-reported height and weight. Multiple linear regression analyses were run.
Results showed that the variable that explained the most variance in explicit weight bias was WBI, followed by BMI. Higher levels of WBI and a lower BMI were both significantly associated with greater explicit weight bias. Male sex was associated with both disliking people with obesity and thinking obesity is attributable to lack of willpower, whereas female sex was associated with worrying about weight gain. The current findings emphasize the importance of future research efforts aimed at preventing or mitigating WBI to reduce negative attitudes about people with obesity.
Orthorexia Nervosa
4. Arreguin, D. H., Shields-Rhodes, K. S., Harel, M. L., & Oberle, C. D. (2024). Racial and ethnic differences in orthorexia nervosa symptomatology and other disordered eating. Open Journal of Psychiatry, 14(4). Advance online publication. https:/doi.org/10.4236/ojpsych.2024.144016
Full text available for download at: https://www.scirp.org/journal/paperinformation?paperid=133798
ABSTRACT. While some research has explored racial and ethnic differences in disordered eating, this study may be the first to examine these differences in orthorexia nervosa, involving obsessive-compulsive thoughts and behaviors concerning healthy eating, which negatively impact one’s life. Adult participants, recruited from college courses and social media, completed an online survey with the Orthorexia Nervosa Inventory (ONI) and the Eating Attitudes Test-26 (EAT-26). Regarding racial and ethnic background, 743 were White, 249 were Hispanic, 87 were Black, 61 were Asian or Pacific Islander, and 110 were biracial/multiracial.
A MANCOVA revealed that the racial and ethnic groups did not differ on the ONI subscales assessing orthorexic behaviors, impairments, and emotions, after accounting for gender, BMI, and EAT-26 total scores that were covariates. In contrast, a second MANCOVA did reveal group differences on the EAT-26 subscales, after accounting for gender, BMI, and ONI total scores that were covariates. Black participants scored significantly lower than the other racial and ethnic groups on the subscale assessing dieting behaviors characteristic of anorexia nervosa, and the subscale assessing binge-eating and purging behaviors characteristic of bulimia nervosa. Further, Hispanic participants scored significantly lower than White participants on the latter subscale.
These findings suggest that while orthorexic symptomatology does not differ based on race and ethnicity, a Black race and Hispanic ethnicity may be protective factors against disordered eating, perhaps related either to cultural norms concerning body image or to the resiliency and social support among the Black and Hispanic communities.
5. Greville-Harris, M., Vuillier, L., Goodall, S., Talbot, C. V., Walker, C., & A ppleton, K. M. (2024). Striving for the perfect diet? The mediating role of perfectionism in the relationship between obsessive compulsive symptoms and traits of orthorexia nervosa. Journal of Eating Disorders, 12, 91. https://doi.org/10.1186/s40337-024-01032-w
Full text available for download at: https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-024-01032-w#citeas
ABSTRACT. Background: Orthorexia Nervosa (ON) is a disordered eating style involving an unhealthy obsession with ‘healthy’ or ‘clean’ eating. Its aetiology is still poorly understood and is not yet recognised in diagnostic manuals. While ON has been associated with Obsessive Compulsive (OC) symptoms and perfectionism, no study to date has looked at the relationship between OC symptoms and ON tendencies via perfectionism, or the influence of two facets of perfectionism in this relationship, namely evaluative concern and achievement striving. Examining the potential role of perfectionism helps to understand the aetiology of ON as well as inform potential treatments tailored specifically for ON and comorbid OC symptoms.
Methods: In this cross sectional study, we tested 507 participants (n = 70 males, n = 69 at risk of ON) on questionnaires measuring OC symptoms, perfectionism and ON symptoms. We ran two mediation analyses to look at the overall relationship between perfectionism and OC and ON symptoms (Model 1) as well as the specific contribution of evaluative concern and achievement striving in the relationship between OC and ON symptoms (Model 2).
Results: We found that perfectionism partially mediated the relationship between OC and ON symptoms. Specifically, we found that while achievement striving and evaluative concern were associated with OC symptoms, only achievement striving was significantly associated with ON symptoms, mediating the relationship between OC and ON symptoms.
Conclusions: This study highlighted the role of one key facet of perfectionism (achievement striving) in the aetiology of ON. The role of achievement striving was indicated as a transdiagnostic construct explaining the link between ON and OC symptoms. These findings are discussed in terms of their implications for treatment models, specifically in terms of the potential role of targeting perfectionism in ON treatment.
Plain English summary: Orthorexia Nervosa (ON) is a disordered eating style involving an obsession with extreme ‘healthy’ eating, causing the person distress and impairment. People with ON are more likely to have symptoms of Obsessive Compulsive Disorder (OCD), such as obsessive thoughts that are reduced by repetitive behaviours. There is also evidence that perfectionism (e.g. having very high personal standards) plays an important role in both ON and OCD.
Our study of 507 participants looked at whether two aspects of perfectionism: (1) concern about being evaluated negatively by others; ‘evaluative concern’, and: 2) striving for very high standards; ‘achievement striving’ were linked to higher levels of orthorexic and obsessive-compulsive symptoms. Our research also looked at whether these aspects of perfectionism explained the link between orthorexic and obsessive-compulsive symptoms.
We found that both aspects of perfectionism were linked to obsessive-compulsive symptoms. However, achievement striving specifically helped to explain the link between orthorexic and obsessive-compulsive symptoms. These findings suggest that treatment focusing on achievement striving might be particularly useful for people with ON, and for those who have both orthorexic and obsessive-compulsive symptoms.
6. Lakritz, C., Iceta, S. & Lafraire, J. (2024). Food categorization performance and strategies in orthorexia nervosa. Cognitive Therapy and Research. Advance online publication. https://doi.org/10.1007/s10608-024-10495-9
Email address for correspondence: clara.lakritz.1@ulaval.ca
ABSTRACT. Background: Orthorexia nervosa (ON) is an obsession with healthy eating and is notably characterized by food hyper-selectivity with the exclusion of food considered unhealthy. The cognitive mechanisms that underlie this type of food selectivity remain poorly understood. Recent research on anorexia nervosa, which overlap with ON traits, has revealed specific categorization performance (i.e., accuracy in discriminating between food categories) and strategies (tendencies to avoid one type of error over another) as well as categorization flexibility impairments in subjects suffering from anorexia nervosa. The present study includes three experiments that investigated food categorization according to ON traits.
Methods: Experiment 1 explored subjects’ abilities to categorize foods as healthy or unhealthy according to ON traits. Experiment 2 investigated subjects’ cognitive flexibility according to ON traits in the food domain. Experiment 3 tested subjects’ strategies using the signal detection theory framework, according to ON traits. The three experiments were conducted in France and replicated in Quebec.
Results: Although the results did not allow us to conclude whether the ON scores affected the subjects' performance or cognitive flexibility, the results did reveal significant effects of ON scores on the subjects’ strategies when categorizing food as healthy or unhealthy, reflecting the fear of mistaking unhealthy foods for healthy ones when subjects exhibited high ON scores. Conclusion: The findings challenge the standard way to define ON and pave the way for future research on emotional distress about food in subjects with high ON scores.
Recovery
7. Raspovic, A., Duck, R., Synnot, A., Caldwell, B., Phillipou, A., Castle, D., Newton, R., Brennan, L., Jenkins, Z., Cunich, M., Maguire, S., & Miskovic-Wheatley, J. (2024). A peer mentoring program for eating disorders: improved symptomatology and reduced hospital admissions, three years and a pandemic on. Journal of Eating Disorders, 12, 99. https://doi.org/10.1186/s40337-024-01051-7
Full text available for download at: https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-024-01051-7
ABSTRACT. Background: Peer support involves people (mentors) using their own experiences to assist others (mentees). The impetus to include peer support in eating disorder recovery is high, however research on implementation of peer roles in eating disorder management is limited. A previous pilot study found positive but preliminary results for a Peer Mentor Program (PMP) for eating disorders. The PMP has since developed over time, including broadening its eligibility criteria and shifting to predominantly online delivery during COVID-19. This study aimed to evaluate the updated version of the PMP, on a larger and more diverse group of mentees.
Methods: Previously collected PMP service data from July 2020 to April 2022 (during COVID-19 lockdowns) was evaluated for fifty-one mentees using mixed methods. Data from program start (baseline), mid-point (3-months) and end (6-months) for measures of eating disorder symptoms as measured by the Eating Disorder Examination Questionnaire (EDE-Q) and psychological wellbeing as measured by the Depression, Anxiety and Stress Scale (DASS) was evaluated.
Frequency of eating disorder-related hospital admissions during PMP participation versus the 6 months prior, direct program costs and qualitative mentee feedback were also analysed. One way ANOVA’s with post hoc tests were used to evaluate symptom change and thematic analysis was conducted on qualitative data.
Results: Program attendance averaged 12.12 (SD ± 1.57) of a possible 13 sessions. Statistically significant and clinically meaningful improvements were demonstrated across all subscales of the eating disorder and psychological wellbeing symptom measures. EDE-Q Global score and DASS scores decreased significantly by program end. Fewer eating disorder-related hospital admissions were reported during PMP than the 6-months prior.
Qualitative findings were positive and themed around the unique benefits of lived experience connection, a new kind of space for recovery, hope and motivation for change. Challenges with the time limited nature of the mentee-mentor relationship were expressed.
Conclusions: The important benefits of a PMP for individuals with eating disorders are further supported. There is a pressing need for high quality, co-produced research, utilising a mixture of designs and fidelity to core peer work principles, to inform further implementation of peer work into eating disorder policy and practice.
Plain English summary: Peer mentoring involves people using their personal lived experiences to support others. A pilot Peer Mentoring Program for eating disorders (PMP) offered through Eating Disorders Victoria (EDV) was evaluated previously, showing positive findings. Subsequent demand for the program was high. As a result, the PMP has been running and evolving over time. Key changes included a broadening of program eligibility to all individuals with an eating disorder (versus only people recently discharged from hospital), larger participant numbers and a shift to largely online delivery due to COVID-19.
This study evaluated this current version of the PMP. Five rounds of anonymised PMP data, from July 2020 to April 2022, were evaluated with mentee prior consent. Individuals in recovery from an eating disorder (mentees), had been paired with individuals recovered from an eating disorder for 2-years minimum (mentors). PMP rounds were 6-months, with fortnightly meetings.
Mentees overall showed improvements in eating disorder symptoms and psychological wellbeing. Fewer mentee eating disorder-related hospital admissions during PMP participation were reported, compared to the 6-months prior. Feedback from mentees identified many positive benefits and some challenges. Overall, the results provide further support for the use of peer mentoring in eating disorder recovery.
Stigma and BED
8. Chan, W. S., Po, S. K., & Ng, A. S. Y. (2024). Stigma of binge‐eating disorder in Hong Kong Chinese adults: Effects of weight status, diagnostic labeling, and etiological explanations. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24251
Full text available for download at: https://onlinelibrary.wiley.com/doi/full/10.1002/eat.2425
ABSTRACT. Objective: Binge-eating disorder (BED) is a strongly stigmatized condition and is often complicated by weight stigma. Research on the intersection between BED and weight stigma is scarce especially in Chinese populations. The present study examined BED stigma in Chinese, whether BED stigma was independent from weight stigma, and whether diagnostic labeling and etiological explanations influenced the degree of BED stigma.
Method: Using a between-subject experimental vignette study, 642 participants (mean age = 29.74 years, SD = 11.34) were randomly assigned to read one of the 18 vignettes, describing a character with information on BED symptoms, weight status, diagnostic labeling, and etiological explanations, followed by measures of stigma and help-seeking intentions.
Results: The character with BED symptoms was ascribed more negative personality characteristics, elicited more negative affective reactions, and triggered greater desired social distance compared to the character without BED symptoms. No evidence for weight stigma was found nor for its interaction with BED stigma. The Cantonese diagnostic label of BED, kwong sik zing, was associated with lower levels of volitional stigma and greater help-seeking intentions than the diagnostic label of eating disorders, jam sik sat tiu, and the absence of labeling.
The effect of etiological explanations was only significant in the univariate test, indicating that providing either a psychosocial or a biogenetic etiological explanation lessened the negative evaluations of personality characteristics. Discussion: The present study provided first evidence for BED stigma in Chinese. BED stigma appeared to be attributable to the presence of disordered eating behavior rather than the BED diagnosis.
Nature, Course, and Correlates of Eating Disorders, Part 6 of now 8
9. Egan, S.J., Filippetto, D., Greene, D., Pauley-Gadd, S. B., Shu, C. Y., Hoiles, K. J., Kane, R. T., O'Mara, M., & Hunna J. Watson, H. J. (2024). The role of actual-ideal weight discrepancy in the relationships between perfectionism, self-esteem, self-compassion and eating pathology in adolescents with eating disorders. Current Psychology. Advance online publication. https://doi.org/10.1007/s12144-024-06317-6
Full text available for download at: https://link.springer.com/article/10.1007/s12144-024-06317-6#citeas
ABSTRACT. Understanding factors associated with adolescent eating disorders is important for improving treatment outcomes. Actual-ideal weight discrepancy refers to the discrepancy between actual weight and the ideal weight an individual wants to achieve. Actual-ideal weight discrepancy is associated with poorer treatment outcome in eating disorders.
It is important to understand factors associated with weight discrepancy to identify targets for treatment to improve outcomes. The aim of this study was to examine self-related constructs associated with actual-ideal weight discrepancy. The specific aim was to determine if perfectionism, self-esteem, and self-compassion contribute to eating disorder symptoms in adolescents, both independently, and through the mediating pathway of actual-ideal weight discrepancy.
Participants comprised 114 female adolescents, aged 12–17 years with an eating disorder (40% anorexia nervosa, 33% atypical anorexia nervosa, 16% bulimia nervosa, 5% other specified and 5% unspecified feeding and eating disorders). Higher actual-ideal weight discrepancy, higher perfectionism, lower self-esteem, and lower self-compassion were associated with greater eating disorder symptoms.
When the predictors of perfectionism, self-esteem, and self-compassion were included together in a path model predicting eating disorder symptoms, the model explained 59% of variance, and self-esteem and actual-ideal weight discrepancy were the only significant predictors of eating disorder symptoms. Lower self-esteem predicted greater eating disorder symptoms directly and through the mediator of actual-ideal weight discrepancy.
10. Wareing, L., Readman, M. R., Linkenauger, S. A., & Riva, G. (2024). The re-embodiment project: Exploring the role of interoception and embodiment in anorexia nervosa. Cyberpsychology, Behavior, and Social Networking. Advance online publication. https://doi.org/10.1089/cyber.2024.0379
Email address for correspondence: l.wareing2@lancaster.ac.uk,
ABSTRACT. (None). First page available for review at https://tinyurl.com/5d7hy5uj.