Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 268: (i) Behav Wt Manage & ED Risk; (ii) Asian Identity; (iii) PBI, Part 1 (n = 3); (iv) Early ID/Intervent, Part 2 (n = 2); (v) Pregnancy, Part 2 (n = 2); & (vi) Eating Pathology, Part 1 (n = 3)
Colleagues (N now = 1457 in 49 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 BY AND/OR ASSISTANCE RECRUITING
Participants who are 18 years or Older and Who are Professionals Who Support Nonbinary Individuals in Cultivating a Positive Body Image
from our own Dr. Jennifer Paff (USA), College of Health and Human Sciences at Colorado State University
for a study entitled
Development of a Positive Body Image Program for Nonbinary Individuals: A Community-Based Participatory Approach
Received 12 May 2026 via an everything-is-advocacy email from our own Dr. Jennifer Paff (USA).
ML NOTE 1: Dr. Paff, her colleagues, and I would appreciate it if you would participate if eligible and/or pass this request along to any and all who are eligible and/or who know people who are eligible.
Development of a Positive Body Image Program for Nonbinary Individuals: A Community-Based Participatory Approach
Researchers at Colorado State University, University of Denver, and Illinois State University are recruiting professionals who support nonbinary individuals in cultivating a positive body image for a study (Development of a Positive Body Image Program for Nonbinary Individuals: A Community-Based Participatory Approach, CSU IRB #7474) focused on developing a positive body image program designed specifically for the nonbinary community.
The research team is seeking participants who are 18 years or older and who are professionals who support nonbinary individuals in cultivating a positive body image. Participants will be invited to (a) share their perceptions of what components would be valuable to include in a program designed to support positive body image among nonbinary individuals and (b) respond to some preliminary ideas for inclusion in such a program developed by the research team.
This study uses a community-based participatory approach, meaning participants’ input will directly shape the development of the program so that it reflects the needs and perspectives of the nonbinary community.
Participation includes:
A brief online screening survey (about 5 minutes)
A virtual focus group (approximately 2 hours)
A short post-focus group survey (about 5 minutes)
Optional follow-up interview (up to 1 hour, if clarification is needed)
Opportunity for further collaboration as a community researcher, if interested
All participation is voluntary and confidential, and compensation will be provided.
To participate in the study, please use this link:
https://udenver.qualtrics.com/jfe/form/SV_0c664drQMQtDfy6
If you have any questions about the study, please contact Dr. Jennifer Paff (Jennifer.Ogle@colostate.edu). Please pass this information to whoever may be interested! Thank you!
EATING DISORDERS/DIET CULTURE LITERACY
[our own] Ms. Robyn Goldberg’s (USA)
The Eating Disorder Trap Podcast - Episode #210:
Weight Cycling
with Evelyn Tribole, MS, RDN (USA)
Retrieved from the website (https://theeatingdisordertrap.com/the-eating-disorder-trap-podcast/) of the The Eating Disorder Trap Podcast, created and moderated by our own Ms. Robyn L. Goldberg, RDN, CEDRD-S (USA; http://www.askaboutfood.com).
ML NOTE 2 (paraphrasing from the website): If you have any questions regarding the topics discussed on this podcast—and/or, I would add, if you believe you could contribute as a guest of this podcast, as have a number of members of this Group (e.g., Carolyn Costin in Episode 199, Dr. Charlotte Markey in Episode 179, Dr. Adele Lafrance in Episode 170, and Dr. Karen Samuels in Episode 138)—please reach out to Robyn directly via email a rlgrd@askaboutfood.co
Episode #210: Weight Cycling with Evelyn Tribole, MS, RDN (USA)
Listen (~21 min) at: https://tinyurl.com/mvx7pjes
IN THIS EPISODE
Evelyn Tribole, MS, RDN is the author of 10 books, including co-author of the best-selling Intuitive Eating, a mind-body self-care eating framework, which has given rise to over 200 studies to date. Her newest book is Intuitive Eating for Every Day: 365 Inspirations and Practices.
As an international speaker, Evelyn enjoys training health professionals on how to help their clients cultivate a healthy relationship with food, mind, and body through the process of Intuitive Eating. To date there are over 2,600 Certified Intuitive Eating Counselors in 60 countries.
The media often seeks Evelyn for her expertise, including New York Times, CNN, NBC’s Today Show, MSNBC, Fox News, USA Today, The Wall Street Journal, The Atlantic, Vogue, Ten Percent Happier, and People magazine. Evelyn was the nutrition expert for Good Morning America, and a national spokesperson for the Academy of Nutrition and Dietetics for six years.
We discuss topics including:
Studies that show what health problems we increase our risk for developing
The problem with disrupting insulin
Decreasing lean body mass and regaining fat
Problems with GLP medications and their impact on weight cycling
The state of your body when weight cycling
SHOW NOTES:
Falkenhain, K., Redman, L. M., Chen, W., Martin, C. K., Ravussin, E., & Shen, W. (2025). Effect of caloric restriction on organ size and its contribution to metabolic adaptation: an ancillary analysis of CALERIE 2. Scientific reports, 15(1), 30374. https://doi.org/10.1038/s41598-024-83762-0
Gaesser & Angadi (2021). Ob*sity treatment: Weight loss versus increasing fitness and physical activity for reducing health risks. iScience 24 102995. Open Access
Li, W., & Chen, W. (2023). Weight cycling based on altered immune microenvironment as a result of metaflammation. Nutrition & metabolism, 20(1), 13. https://doi.org/10.1186/s12986-023-00731-6
Zamboni, M., Giani, A., Fantin, F., Rossi, A. P., Mazzali, G., & Zoico, E. (2025). Weight cycling and its effects on muscle mass, sarcopenia and sarcopenic obesity. Reviews in endocrine & metabolic disorders, 10.1007/s11154-025-09963-8. Advance online publication. https://doi.org/10.1007/s11154-025-09963-8
Research Publication Categories in This Newsletter
(i) Behavioral Weight Management & ED Risk; (ii) Asian Identity; (iii) Positive Body Image, Part 1 (n = 3); (iv) Early Identification/Intervention, Part 2 (n = 2); (v) Pregnancy, Part 2 (n = 2); and (vi) Eating Pathology, Part 1 (n = 3)
CONGRATULATIONS to our own
Dr. Hiba Jibeile (Australia) and colleagues for publication of the Behavioral Weight Management and ED Risk review article in #1.
Dr. Neha Goel (USA), Dr. Shruti Kinkel-Ram (USA), Sonakshi Negi (USA), Sarah Johnson-Munguia (USA), and Dr. Nadia Craddock (England) and colleagues for publication of the Rethinking Asian Identity article in #2.
Dr. Wesley Barnhart (USA), Reza Sahlan (USA), and Drs. Jason Nagata (USA; see also #11), Tiffany Brown (USA; see also #11), and Jinbo He (China) and colleagues for publication of the Positive Body Image research article in #3.
Karuna Nair (Australia) and Drs. Kristen Murray (Australia) and Jasmine Fardouly (Australia) and colleague for publication of the Positive Body Image research article in #4.
Drs. Karina Allen (England) and Ulrike Schmidt (England) and colleagues for publication of the Early Intervention research article in #6.
Dr. Samantha Hahn (USA), Kelsey Rose (USA), and Drs. Heather Davis (USA) and Caitlin Martin-Wagar (USA) and colleagues for publication of the Eating Pathology as Risk article in #11.
Drs. Jason Nagata (USA), Jason Lavender (USA), Emilio Compte (Chile/Mexico), Tiffany Brown (USA), and Kelsie Forbush (USA) and colleagues for publication of the Eating Pathology as Risk article in #12.
BEHAVIORAL WEIGHT MANAGEMENT and ED RISK
1. Melville, H., Jebeile, H., Libesman, S., Garnett, S. P., Hunter, K. E., Jardine, I. R., Khalid, R., Lorien, S. J., Williams, J. G., Baur, L. A., Seidler, A. L., Lister, N. B., & the EDIT Collaboration. (2026). A systematic mapping review of individual participant factors related to eating disorder risk collected in behavioural weight management trials. Eating and Weight Disorders. Advance online publication. https://doi.org/10.1007/s40519-026-01866-0
Full text available for download at: https://tinyurl.com/yc6cm5b9
ABSTRACT. Purpose: The purpose of this study was to identify which factors potentially relevant to eating disorder risk were collected by trials included in the Eating Disorders In weight-related Therapy (EDIT) Collaboration.
Methods: Databases were systematically searched to March 2022, and clinical trial registries to May 2022, to identify behavioural weight management randomised controlled trials assessing eating disorder risk in adolescents (10–18 years) and adults (≥ 19 years) with overweight/obesity. Individual participant data were requested from eligible trials across 11 domains (demographics, anthropometry, medical history, history of dieting and weight loss attempts, mental health, personality, psychosocial health, sleep quality, weight stigma, eating behaviours, cardiometabolic health), including 58 participant factors identified through a consensus study as relevant to eating disorder risk. Trial data were mapped and summarised descriptively.
Results: We identified 106 eligible trials, of which 46 (20 adolescent, 26 adult) individual participant datasets were provided. Adolescent and adult datasets both included factors across a median (range) of 6 (4–9) domains. There was broad coverage across demographics, medical history, anthropometry, mental health, psychosocial health, and eating behaviours, where each domain was included in > 50% of datasets. Each of the remaining domains were included in ≤ 50% of datasets.
Conclusion: Trials collected many diverse factors potentially relevant to eating disorder risk. Further exploration is needed within underrepresented domains, such as weight stigma, to better understand their contribution to eating disorder risk within behavioural weight management. Level of evidence: Level V, Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
RETHINKING ASIAN IDENTITY
2. Goel, N. J., Wang, P., Singh, S., Kinkel-Ram, S. S., Negi, S., Yu, K., Wong, V. Z., Johnson-Munguia, S., & Craddock, N. (2026). Rethinking the “Asian” identity in eating disorders research: A call to action. Eating Disorders: The Journal of Treatment & Prevention. Advance online publication. https://doi.org/10.1080/10640266.2026.2669113
Full text available for download at: https://tinyurl.com/3a93vjnr
ABSTRACT. Despite descending from the largest continent in the world, people with Asian heritage are under-researched and underrepresented within the eating disorders (EDs) literature. Moreover, when Asian groups are included in ED research, they are usually subsumed into an amorphous “Asian” category. This conflation across subgroups critically impacts assessment, prevention, and treatment.
In this paper, we present a call to action to disaggregate Asian subgroups in ED research and outline four concrete guidelines for how to collect, report, and discuss research involving Asian subgroups, namely: (1) reporting specific ethnic data (2) considering the cultural validity of ED assessments; (3) avoiding use of race and/or ethnicity as proxies for other cultural variables; and (4) collaboration with non-research stakeholders to improve Asian representation in research. These guidelines aim to shift the field toward a more nuanced and inclusive understanding of EDs, one that accounts for the vast variations within Asian communities.
POSITIVE BODY IMAGE, Part 1 of 5
3. Liu, X., Wang, P., Barnhart, W. R., Sahlan, R. N., Cui, S., Cao, H., Nagata, J. M., Brown, T. A., & He, J. (2026). Examining differences in positive body image across sexual orientation among Chinese male and female adults: A measurement invariance study of three widely-used self-report measures. Body Image, 57. Advance online publication. https://doi.org/10.1016/j.bodyim.2026.102076
Email address for correspondence: Jinbo.He@xjtlu.edu.cn
ABSTRACT. Positive body image is a multifaceted construct, encompassing factors including body appreciation, functionality appreciation, and body image flexibility – commonly measured with the Body Appreciation Scale-2 (BAS-2), Functionality Appreciation Scale (FAS), and Body Image-Acceptance and Action Questionnaire-5 (BI-AAQ-5), respectively. Research has mostly supported the unidimensional factor structure of these three scales. However, there is limited research on their measurement invariance and potential mean differences across sexual orientations, particularly in non-Western contexts. Given the prevalence of body image issues among sexually minoritized populations and the considerable subgroup heterogeneity, establishing a psychometric foundation seems crucial for future rigorous group comparisons.
Thus, we examined the measurement invariance of the BAS-2, FAS, and BI-AAQ-5 using an online sample of Chinese male and female adults with diverse sexual orientations (N = 2034, age 18–51 years), including sexually minoritized women (n = 532), heterosexual women (n = 473), sexually minoritized men (n = 519), and heterosexual men (n = 510). Should scalar invariance be achieved, mean differences across measures were examined among the four groups. Results revealed scalar invariance and significant mean-score differences across all three measures. Particularly, sexually minoritized men had the lowest FAS and BI-AAQ-5 scores among the four groups; sexually minoritized women had lower BI-AAQ-5 scores than both heterosexual men and women; and heterosexual women had lower BAS-2 scores than heterosexual men.
Overall, this research provided preliminary evidence to support comparing scores on the BAS-2, BI-AAQ-5, and FAS among the four groups. Healthcare providers should be cognizant of the role of sexual orientation in the Chinese cultural context when providing body image interventions.
ML NOTE 3: In regard to second sentence of the Abstract of the article described below in #4, Drs. Tracy Tylka (USA; Editor-in-Chief of Body Image) and Nicole Wood-Barcalow (USA) are members of this Newsletter Group. See:
Tylka, T. L., & Wood-Barcalow, N. L. (2015). What is and what is not positive body image? Conceptual foundations and construct definition. Body Image, 14, 118–129. https://doi.org/10.1016/j.bodyim.2015.04.001 [Email address for correspondence: tylka.2@osu.edu]
4. Nair, K., Murray, K., Fardouly, J., & Farrer, L. M. (2026). Distinguishing the theoretical components of positive body image via expert consensus. Body Image, 57. Advance online publication. https://doi.org/10.1016/j.bodyim.2026.102072
Full text available for download at: https://tinyurl.com/2889kaw4
ABSTRACT. Positive body image is a multifaceted construct associated with a range of well-being outcomes. Tylka and Wood-Barcalow’s (2015) framework outlined six overlapping yet unique components: (i) body appreciation, (ii) body acceptance and love, (iii) broadly conceptualizing beauty, (iv) adaptive appearance investment, (v) inner positivity, and (vi) filtering information in a body-protective manner. However, to examine their relative importance in well-being, there is a need to distinguish between these components to enable experimental operationalization.
The present study used a Delphi method, seeking expert consensus to inform development of distinct definitions. Feedback on the incorporation of body functionality across component definitions was also sought to expand the focus beyond appearance. 24 researchers with expertise in positive body image provided qualitative and quantitative feedback on proposed definitions over three rounds, comprising ratings of importance, clarity, and distinctiveness.
Findings supported retention of body appreciation, body acceptance, broadly conceptualizing beauty, adaptive body investment, and protective filtering, with clear and distinct definitions agreed upon. Consensus feedback indicated that inner positivity was not viewed as important or distinct relative to the other components, leading to its removal from further consideration in the study. Experts generally agreed on the incorporation of body functionality into most components, apart from broadly conceptualizing beauty which was seen as best focused on appearance. The agreed definitions and findings inform theory-building, development of measures, and comparison of interventions which target different aspects of positive body image.
5. Koçak, T., Kocyigit, E., Demirel Ozbek, Y., & Celik, İ. (2026). Weight self-stigma, weight bias internalization, and eating attitudes in relation to body appreciation. Frontiers in Psychology, 17, 1772302. https://doi.org/10.3389/fpsyg.2026.1772302
Full text available for download at: https://tinyurl.com/yc7h3mr5
ABSTRACT. Objective: This study aimed to investigate the relationships between weight self-stigma, weight bias internalization, eating attitudes, and body appreciation in young adults, and to ascertain the distinct impact of these variables on body appreciation. Methods: A cross-sectional study was carried out including young adults aged 19 to 35 years, comprising 69.6% females and 30.4% males. Participants completed a questionnaire evaluating weight self-stigma, internalization of weight bias, eating attitudes, and body appreciation. Hierarchical multiple regression analyses were used to assess the additional impacts of weight-related stigma and eating attitudes on body appreciation, while adjusting for demographic and anthropometric factors.
Results: Weight self-stigma, particularly the internalization of weight bias, showed a significant negative association with body appreciation. Weight self-stigma and its subdimensions (self-devaluation and fear of enacted stigma) had substantial negative correlations with body appreciation. These correlations encompassed the subdimensions of body appreciation, specifically general body appreciation and body image investment. While eating attitudes did not show a significant correlation with body appreciation at the bivariate level, they became a significant predictor in the hierarchical regression model, suggesting a conditional (suppression) effect after accounting for weight-related stigma and BMI.
Conclusion: The findings emphasize the important function of weight-related stigma in diminishing body appreciation among young adults and stress the necessity of examining eating attitudes in conjunction with stigma-related factors. Interventions designed to enhance positive body image should focus on both internalized weight stigma and maladaptive eating-related attitudes.
EARLY IDENTIFICATION and INTERVENTION, Part 2 of 2
6. Hyam, L., Gallagher, L. M., Di Clemente, G., Killackey, E., Glennon, D., Griffiths, J., Mills, R., Wilkins, J., Ahmed, M., Allen, K. L., & Schmidt, U. (2026). To fidelity and beyond: Development of an implementation fidelity tool for early intervention for eating disorders services. Early Intervention in Psychiatry, 20(1), e70132. https://doi.org/10.1111/eip.70132
Full text available for download at: https://tinyurl.com/2s4fvyc6
ABSTRACT. Introduction: First Episode Rapid Early Intervention for Eating Disorders (FREED) is an early intervention service model for young people with recent-onset eating disorders. This manuscript describes the development and pilot testing of an implementation fidelity tool for FREED or similar early intervention models, exploring feasibility of the tool and changes in fidelity over time.
Methods: An iterative consultation process within the FREED national team reviewed the core aims, functions, principles, and key components of FREED services. A set of items and a scoring rubric were drafted and pilot-tested via two assessments in a London-based FREED service with routine data and interviews with team members. Items were scored independently by two raters. Inter-rater reliability was assessed.
Results: The fidelity tool comprised 35 items across two components: (1) rapid access to the service and (2) adherence to the FREED care package (e.g., family involvement, attention to transitions). Overall fidelity scores were 63% at time 1% and 60% at time 2, indicating ‘lower’ fidelity. Component scores ranged from ‘not satisfactory’ for rapid access, to ‘medium fidelity’ for care package components. Weighted Cohen’s kappa indicated almost perfect agreement across assessments.
Conclusion: This is the first fidelity measurement tool for early intervention eating disorders services. It demonstrated feasibility, simple administration, and time efficiency. Pilot testing suggested fidelity to some aspects of FREED, but further support is required to improve fidelity. Future work should focus on refining the tool (e.g., further psychometric evaluation) and testing it in more services to investigate whether ongoing assessments support fidelity.
7. Öğütlü, H., Tekeoğlu, U., & McNicholas, F. (2026). More than just awareness: Longitudinal evaluation of an eating disorders training program for school counselors. Eating Behaviors. Advance online publication. https://doi.org/10.1016/j.eatbeh.2026.102072
Email address for correspondence: hogutlu@gmail.com
ABSTRACT. Background: Eating disorders (EDs) are complex psychiatric conditions that often remain undetected in school settings. School counselors (SCs), as frontline observers, may play an important role in early recognition and referral. This study evaluated the effectiveness of a training program designed to support SCs’ knowledge, attitudes, and practices regarding EDs in Türkiye.
Methods: Data were obtained from forty-nine SCs from Erzincan, Türkiye, who had previously provided baseline data (T0) and participated in a longitudinal study with two additional assessment time points: post-training (T1) and three-month follow-up (T2). The training consisted of a full-day, primarily didactic seminar incorporating clinical vignettes. Participants’ recognition knowledge, referral preferences, attitudes, and stigma levels were assessed using a structured, study-specific questionnaire.
Results: The training led to a short-term increase in preference for hospital-based referral (T0: 61%, T1: 83%, p = .005), but this effect diminished at follow-up (T2: 67%). Knowledge about anorexia nervosa also improved post-training but declined significantly by T2. No significant changes were observed in correct diagnostic recognition, referral to a psychiatrist, or most attitudinal measures. Total stigma scores increased immediately after training (T0: 30.7, T1: 34.1, p < .001), partially decreasing at follow-up.
Conclusion: A didactic, vignette-based training program was associated with temporary changes in selected knowledge domains and referral preferences, but these effects were not sustained. The absence of improvement in diagnostic recognition and the short-term increase in stigma highlight the limitations of brief, information-focused approaches. Future studies may explore whether more interactive, empathy-focused, and repeated training formats are associated with more durable and balanced outcomes.
PREGNANCY, Part 2 of 2
8. Zaguri-Vittenberg, S., & Kahalon, R. (2025). Body appreciation moderates the relationship between self-objectification and disordered eating among pregnant women. Body Image, 55. Advance online publication. https://doi.org/10.1016/j.bodyim.2025.101990
Full text available for download at: https://tinyurl.com/y5r92xmr
ABSTRACT. Literature has consistently documented an adverse association between self-objectification and eating disorders in the general population. Yet, this association has received less attention during pregnancy. Focusing on pregnant women, we tested whether body appreciation, i.e., a positive attitude toward one’s body regardless of its appearance, may serve as a protective factor in the relationship between self-objectification and disordered eating symptoms.
In a cross-sectional study, 389 primiparous pregnant women in their second to third trimester (Mage = 30.39) were recruited through relevant social media platforms. Participants completed a socio-demographic and health background questionnaire and self-objectification, disordered eating and body appreciation measures. Self-objectification was significantly and positively correlation with disordered eating symptoms. Moreover, body appreciation significantly moderated this relation, such that the relationship was significant for pregnant women with low and medium body appreciation levels, while it was nonsignificant for pregnant women with high body appreciation.
The findings suggest that while women with high self-objectification may be more prone to disordered eating during pregnancy, high levels of body appreciation may serve as a protective factor, potentially mitigating negative experiences during the transition to motherhood. Thus, the findings highlight the clinical importance of prenatal interventions to foster body appreciation during pregnancy.
9. Jouppi, R. J., Levine, M. D., Conlon, R. P. K., & Brown, L. B. (2026). A systematic scoping review of factors contributing to loss of control eating during pregnancy. European Eating Disorders Review. Advance online publication. https://doi.org/10.1002/erv.70092
Full text available for download at: https://tinyurl.com/4h5pum78
ABSTRACT. Objective: Evidence suggests loss of control eating (LOC) during pregnancy is prevalent and linked to adverse health consequences for birthing individuals and their offspring; however, factors underlying risk for prenatal LOC remain unclear. This systematic scoping review assessed empirical literature on factors related to the development/maintenance of prenatal LOC.
Method: Eligibility criteria for studies required inclusion of participants endorsing prenatal LOC and concurrent or prospective examination of factors in relation to prenatal LOC. Data on study location/design, sample composition, LOC measurement, and associations between factors and LOC were extracted and synthesised.
Results: Most of the 36 included studies were conducted in Western, industrialised nations; with predominantly White-identifying, highly educated samples; cross-sectionally; using single items or binge-spectrum disorder diagnostic criteria. Most demonstrated that transdiagnostic factors found to contribute risk for mental/physical health outcomes among non-pregnant individuals are similarly associated with risk for LOC among pregnant individuals; investigation of factors specific to the prenatal context was comparatively lacking.
Conclusions: Inclusion of marginalised populations, use of validated measures that capture prenatal LOC frequency/severity, prospective and longitudinal data, and more sophisticated analytic approaches are crucial next steps in moving the field towards clarifying the course and mechanisms underlying prenatal LOC.
EATING PATHOLOGY (DISORDERED EATING BEHAVIORS and ED PSYCHOPATHOLOGY), Part 1 of 7: EP as Risk for EDs
10. Jürgensen, V.C., Halbeisen, G., Lehe, M. S., & Paslakis, G. (2026). Associations between socio-demographic patterns, body dissatisfaction, and eating disorder risk in women: A cluster-based approach. Journal of Eating Disorders, 14, 112. https://doi.org/10.1186/s40337-026-01616-8
Full text available for download at: https://tinyurl.com/3ve7kmec
ABSTRACT. Objective: This study examined the association between socio-demographic patterns and eating disorder (ED) risk in 298 women (mean age = 28.4 years). We focused on women, as existing research suggests that EDs disproportionately affect women. Within this sample, we took into account the intersections of different socio-demographic variables. Additionally, we assessed body dissatisfaction and subjective health status (S-HS) as self-reported measures to gain a more comprehensive understanding of ED risk.
Method: We conducted a cluster analysis (k-means) using ten demographic variables (e.g., sexual orientation, migration history, presence of disabilities), which revealed three distinct participant clusters. Then, we applied two multiple logistic regression models using cluster membership, body dissatisfaction related to fat (BD-F) and muscularity (BD-M), and S-HS as determinants, with the outcome being ED risk measured using two scales (EAT-8; EDE-Q).
Results: Cluster Three – notably characterized by queer women with a migration history and identification as part of an ethnic minority - showed a consistently higher ED risk. In contrast, Cluster One, which included a higher proportion of older individuals as well as individuals with disabilities, or caregiving responsibilities, showed the lowest risk for ED. In Cluster Two an increased risk for EDs was observed in the EAT-8, but not in the EDE-Q, suggesting measurement-specific differences. BD-F and BD-M were significantly associated with ED risk. BD-F proved to be the factor with the strongest influence. Conclusions: We emphasize the importance of considering person-centered socio-demographic positions and different forms of body dissatisfaction to assess the risk of ED.
11. Hahn, S. L., Rojas, G. B., Rubinovich, U., Rose, K. L., Davis, H. A., & Martin-Wagar, C. A. (2026). “Everyone knows everyone”: A qualitative examination of influences of eating disorder risk among rural US adolescents. Journal of Eating Disorders. Advance online publication. https://doi.org/10.1186/s40337-026-01629-3
Full text available for download at: https://tinyurl.com/5ek6zu6t
ABSTRACT. Background: Rural adolescents face disproportionately higher rates of disordered eating, though it is unknown what about living in a rural community impacts disordered eating risk. The objective of the present study was to understand how rural adolescents describe their rural culture as impacting eating disorder risk using a qualitative study design. Methods: Semi-structured interviews using the American Psychiatric Association Cultural Formulation Interview were conducted among individuals (Mage = 20.0, Range 16–25) who developed disordered eating as an adolescent (10–19 years of age) while living in a rural community. Interviews were recorded and transcribed verbatim, and transcripts were analyzed using inductive thematic analysis.
Results: Four themes were identified: “Everyone knows everyone,” Diet Culture & Weight Stigma, Body Ideals, and Initiating Events. Participants reported that everyone in their community knew everyone else and about their lives. Participants described this innate sense of community as being helpful at times, and harmful at other times. The sense of community was seen as a strength when participants felt they could get support from their community members. But felt that the close sense of community was harmful as there was a very narrow definition of acceptable social standards and a strong pressure to meet those expectations.
Participants reported a strong cultural overvaluation of thinness, including the normalization of dieting and disordered eating, as well as frequent experiences of implicit and explicit weight stigma. Relatedly, body ideals differed by gender, but thinness was valued by girls and younger adults and muscularity by boys. Participants described many situations they believed contributed to their disordered eating, including chronic stressors like food insecurity, traumatic events like deaths, and a fear of rejection for not fitting social expectations in their rural communities.
Conclusions: Findings suggest that specific aspects of living in rural communities may uniquely increase eating disorder risk, particularly the pressure to fit the narrowly defined social expectations in rural communities. However, the study also identified aspects of living in rural communities that participants viewed as protective and potentially useful in future preventative efforts, such as having a strong sense of community and support from that community.
12. Nagata, J. M., Otmar, C. D., Potes, C., Murakami, K., Lavender, J. M., Compte, E. J., Brown, T. A., Forbush, K. T., Flentje, A., Obedin-Maliver, J., & Lunn, M. R. (2026). Validation of the Brief Assessment of Stress and Eating (BASE) in transgender and gender-diverse adults. Eating Behaviors. Advance online publication. https://doi.org/10.1016/j.eatbeh.2026.102088
Full text available for download at: https://tinyurl.com/4njvs3zc
ABSTRACT. Objective: Eating disorders (EDs) are frequently underdiagnosed in transgender and gender-diverse (TGD) adults. Many existing ED screeners were developed in cisgender, White, female samples and may miss symptom patterns relevant to TGD adults. This study evaluated internal consistency and screening accuracy of the Brief Assessment of Stress and Eating (BASE), a 10-item ED screener, in a national sample of TGD adults.
Method: Participants were 2098 TGD adults (57.5% gender diverse; 28.5% transgender men; 14.0% transgender women) enrolled in The PRIDE Study, a U.S.-based longitudinal cohort. Participants completed the BASE and SCOFF and were identified for elevated ED risk using a DSM-5–aligned Eating Disorder Diagnostic Scale algorithm. We examined internal consistency and classification accuracy using receiver operating characteristic and precision-recall curves, and compared BASE and SCOFF performance overall and by gender subgroup.
Results: The BASE showed good internal consistency (ordinal α = 0.80). In the full sample, the BASE outperformed the SCOFF (AUC = 0.803 vs. 0.764, p = .0003), with a similar pattern among transgender men (AUC = 0.793 vs. 0.730). Among transgender women and gender-diverse adults, AUCs did not differ significantly between the BASE and SCOFF. Cut-scores based on Youden’s J (7.5–8.5) produced balanced sensitivity (0.68–0.75) and specificity (0.70–0.77), whereas more liberal cut-scores (5–6) increased sensitivity (>0.85) with reduced specificity.
Discussion: The BASE is a psychometrically sound and low-burden screener for elevated ED risk in TGD adults. Its broader symptom coverage and comparable performance across TGD subgroups support use in primary care and gender-affirming services to improve identification of probable EDs.