Cultural adaptation of an integrated eating disorders prevention and healthy weight management program.

BACKGROUND: Both eating disorder (ED) prevention and weight management interventions often focus on the thin ideal. Yet, many Black and Latina women do not view thinness as their body ideal. This study used focus groups to investigate the influence of race, ethnicity, and culture on appearance ideals and inform the cultural adaptation and integration of two established programs addressing EDs and weight management: the Body Project, and Healthy Weight Interventions. METHODS: White (n = 10), Black (n = 14), and Latina (n = 6) women participated in racially and ethnically homogenous focus groups. RESULTS: Thematic analysis identified several themes, including: (1) diverse beauty standards across groups, (2) lack of acknowledgement of racialized beauty standards in prevention and cultural appropriation, (3) culturally-specific impacts of standards, (4) harm of appearance-related comments, (5) limitations of available resources, (6) stigma/minimization of mental health, (7) barriers to inclusive programming, and (8) facilitators of inclusive programming. CONCLUSIONS: Results suggested that current programs' emphasis on thinness limit their relevance for women of color, and perpetuate the misconception that EDs primarily affect White women. Findings highlight the need for culturally responsive prevention.

Both eating disorder (ED) prevention and weight management interventions often focus on thinness as the ideal. Yet, many Black and Latina women do not view thinness as their ideal body shape. This study interviewed women in focus groups to investigate the influence of race, ethnicity, and culture on appearance ideals and inform the cultural adaptation and integration of two established programs addressing EDs and weight management: the Body Project, and Healthy Weight Interventions. White (n = 10), Black (n = 14), and Latina (n = 6) women participated in racially and ethnically homogenous focus groups. Several themes emerged, including: (1) diverse beauty standards across groups, (2) lack of acknowledgement of racialized beauty standards in prevention and cultural appropriation, (3) culturally-specific impacts of standards, (4) harm of appearance-related comments, (5) limitations of available resources, (6) stigma/minimization of mental health, (7) barriers to inclusive programming, and (8) facilitators of inclusive programming. Results suggested that current interventions over-emphasize thinness, limiting their relevance for women of color, and perpetuate the misconception that EDs primarily affect White women. Findings highlight the need for more culturally responsive approaches to prevention.

"What will people say?": Mental Health Stigmatization as a Barrier to Eating Disorder Treatment-Seeking for South Asian American Women.

This study used focus group methodology to identify culturally-specific barriers to, and facilitators of, eating disorder (ED) treatment-seeking for South Asian (SA) American women. Seven focus groups were conducted with 54 participants (Mage=20.11 years, SD=2.52), all of whom had lived in the United States (US) for at least three years (63.0% of the sample was born in the US). Transcripts were independently coded by a team of researchers (n=4) and the final codebook included codes present in at least half of the transcripts. Thematic analysis identified salient themes (barriers, n=6; facilitators, n=3) for SA American women. Barriers to ED-treatment seeking were inextricable from barriers to mental health treatment, more broadly. In addition to generalized mental health stigma, participants cited social stigma (i.e., a pervasive fear of social ostracization), as a significant treatment-seeking barrier. Additional barriers were: cultural influences on the etiology and treatment of mental illness, parents' unresolved mental health concerns (usually tied to immigration), healthcare providers' biases, general lack of knowledge about EDs, and minimal SA representation within ED research/clinical care. To address these obstacles, participants recommended that clinicians facilitate intergenerational conversations about mental health and EDs, partner with SA communities to create targeted ED psychoeducational health campaigns, and train providers in culturally-sensitive practices for detecting and treating EDs. SA American women face multiple family, community, and institutional barriers to accessing mental health treatment generally, which limits their ability to access ED-specific care. Recommendations to improve ED treatment access include: (a) campaigns to destigmatize mental health more systematically, (b) collaboration with SA communities and, (c) and training providers in culturally-sensitive care.

The burden of a brain tumor: guiding patient centric care in neuro-oncology.

PURPOSE: Brain tumor patients report an overwhelming sense of uncertainty when navigating the course of their terminal disease. Historically, organizational experts and/or treating physicians have established neuro-oncology programs. However, given the disease burden and incurable nature of current medical treatments, patient-centric care should be prioritized alongside institutional and academic objectives. Integrating patient perspectives into interdisciplinary programmatic development can improve comprehensive care and empower patients to advocate for their own quality healthcare needs. METHODS: Data was derived from four focus groups with adult brain tumor patients (N = 15; Mage = 46 years, 53% female). A trained moderator led each 90-min group and posed semi-structured questions regarding patients' care needs throughout their neuro-oncological disease trajectory. Emphasis was placed on quality of life and psychological distress reduction for both patients and their loved ones. Common themes were identified via thematic content analysis using NVivo software. A high inter-rater reliability (Mkappa = 0.92, range= 0.85-0.93) was achieved. RESULTS: Six distinct themes emerged, where the frequency of each theme ranged from 12.5 to 23.3%. Specifically, patients discussed relational concerns, navigation of interdisciplinary care, neurobehavioral impacts, emotional responses to stressors, existential concerns, and caregiver support. A discussion of themes follows. CONCLUSIONS: It is imperative that we include the patient perspective in the development of neuro-oncology programs; considering the quality of survival in addition to quantity. Neuro-oncology quality care themes identified were relational concerns, navigating interdisciplinary care, neurobehavioral impact, emotional response to stressors, existential concerns, and caregiver support. A paramount concentration for comprehensive neuro-oncology programs must include patients' quality needs.

A systematic review of sociodemographic reporting and representation in eating disorder psychotherapy treatment trials in the United States.

OBJECTIVE: Eating disorders (EDs) were once conceptualized as primarily affecting affluent, White women, a misconception that informed research and practice for many years. Abundant evidence now discredits this stereotype, but it is unclear if prevailing "evidence-based" treatments have been evaluated in samples representative of the diversity of individuals affected by EDs. Our goal was to evaluate the reporting, inclusion, and analysis of sociodemographic variables in ED psychotherapeutic treatment randomized controlled trials (RCTs) in the US through 2020. METHODS: We conducted a systematic review of ED psychotherapeutic treatment RCTs in the US and examined the reporting and inclusion of gender identity, age, race/ethnicity, sexual orientation, and socioeconomic status (SES) of enrolled participants, as well as recruitment methods, power analyses, and discussion of limitations and generalizability. RESULTS: Our search yielded 58 studies meeting inclusion criteria dating back to 1985. Reporting was at times incomplete, absent, or centered on the racial/gender majority group. No studies reported gender diverse participants, and men and people of color were underrepresented generally, with differences noted across diagnoses. A minority of papers considered sociodemographic variables in analyses or acknowledged limitations related to sample characteristics. Some progress was made across the decades, with studies increasingly providing full racial and ethnic data, and more men included over time. Although racial and ethnic diversity improved somewhat, progress appeared to stall in the last decade. DISCUSSION: We summarize findings, consider context and challenges for RCT researchers, and offer suggestions for researchers, journal editors, and reviewers on improving representation, reporting, and analytic practices. PUBLIC SIGNIFICANCE: Randomized controlled trials of eating disorder psychotherapeutic treatment in the US are increasingly reporting full race/ethnicity data, but information on SES is inconsistent and sexual orientation absent. White women still comprise the overwhelming majority of participants, with few men and people of color, and no gender-diverse individuals. Findings underscore the need to improve reporting and increase representation to ensure evidence-based treatments are effective across and within diverse groups.

OBJETIVO: Los trastornos de la conducta alimentaria (TCA) alguna vez se conceptualizaron como enfermedades que afectaban principalmente a las mujeres blancas, adineradas, un concepto erróneo que informó la investigación y la práctica clínica durante muchos años. Abundante evidencia ahora desacredita este estereotipo, pero no está claro si los tratamientos prevalecientes "basados en la evidencia" se han evaluado en muestras representativas de la diversidad de individuos afectados por los TCA. Nuestro objetivo fue evaluar el informe, la inclusión y el análisis de las variables sociodemográficas en los ensayos controlados aleatorios (ECA) del tratamiento psicoterapéutico para TCA en los Estados Unidos hasta 2020. MÉTODOS: Se realizó una revisión sistemática de los ECA de tratamiento psicoterapéutico de los TCA en los Estados Unidos y se examinó el informe y la inclusión de la identidad de género, la edad, la raza/etnia, la orientación sexual y el estado socioeconómico (ESE) de los participantes inscritos, así como los métodos de reclutamiento, los análisis de poder y la discusión de las limitaciones y la generalización. RESULTADOS: La búsqueda arrojó 58 estudios que cumplieron los criterios de inclusión que datan de 1985. Los informes a veces eran incompletos, ausentes o centrados en el grupo mayoritario racial / de género. Ningún estudio informó participantes con diversidad de género, y los hombres y las personas de color estuvieron subrepresentados en general, con diferencias observadas entre los diagnósticos. Una minoría de los artículos consideró variables sociodemográficas en los análisis o reconoció limitaciones relacionadas con las características de la muestra. Se lograron algunos avances a lo largo de las décadas, con estudios que proporcionan cada vez más datos raciales y étnicos completos, y más hombres incluidos con el tiempo. Aunque la diversidad racial y étnica mejoró un poco, el progreso pareció estancarse en la última década. DISCUSIÓN: Resumimos los hallazgos, consideramos el contexto y los desafíos para los investigadores de ECA, y ofrecemos sugerencias para investigadores, editores de revistas y revisores sobre cómo mejorar la representación, el informe y las prácticas analíticas.

BMI and Disordered Eating in Black College Women: The Potential Mediating Role of Body Appreciation and Moderating Role of Ethnic Identity.

Multiple studies indicate Black American women have disproportionately higher rates of obesity compared with other groups in United States. Although body image is associated with obesity, this relation is understudied among Black women. The purpose of the current study was to (1) examine the relations among body appreciation, body dissatisfaction and disordered eating; (2) assess body appreciation as a mediator of the relation between body mass index (BMI) and disordered eating, and (3) explore ethnic identity as a moderator in this association. Participants were 191 Black women recruited from a mid-Atlantic university. Participants' mean age was 19.16 years (SD = 1.95). Body appreciation partially mediated the relation between BMI and disordered eating behaviors and attitudes, such that women with higher BMIs reported lower body appreciation, which was associated with greater disordered eating symptoms. Ethnic identity was not a significant moderator of the association between BMI and body appreciation. Results support screening Black women with higher BMIs for disordered eating symptomatology and suggest it might be helpful to include body appreciation in interventions for Black women.

Body Image and Eating Disorders Among South Asian American Women: What Are We Missing?

This study used focus group methodology to examine South Asian (SA) American women's conceptualizations of eating disorders (EDs) and body dissatisfaction, and their perspectives regarding cultural influences on these conditions. Using a qualitative descriptive approach, seven focus groups were conducted (N = 54, mean age = 20.11 years, SD = 2.52). Themes (n = 15) were organized according to the amended objectification theory framework. Women described experiences of cultural stressors specifically related to living in the United States, and weight stigma from multiple sources, especially older women (e.g., mothers, relatives, and aunties). Participants also experienced pressures to achieve competing body and appearance ideals ("thin" and "healthy"). In addition, they reported pressures to possess light skin, dark black hair, minimal body hair, and marry young, and noted these pressures negatively impacted their body esteem. Findings indicate that a combination of "traditional" and culturally-influenced factors are important to consider when conceptualizing eating pathology and body image in young SA American women.

What are you losing it for? Weight suppression motivations in undergraduates.

PURPOSE: Accumulating evidence suggests weight suppression (WS) is related to disordered eating and eating disorder (ED) risk in non-clinical samples; however, research to-date has not examined the intentionality of, or motivations for, WS. The purpose of this study was to: (1) qualitatively assess WS motivation in undergraduates, and (2) explore differences in body image and eating behaviors across motivation categories. METHODS: In the first study, responses from 192 undergraduates were evaluated using inductive content analysis; four primary motivation categories emerged: appearance, functional, sports/military, and unintentional. In a second study, 1033 undergraduates indicated their primary WS motivation, if applicable, and completed body image and eating behavior measures. Separate analyses were run by gender; covariates included current body mass index (BMI) and WS. RESULTS: Differences in body image and eating behaviors emerged across motivation categories for both men (p < 0.001) and women (p < 0.001). Appearance-motivated WS in men, and appearance and sports/military-motivated WS in women, were related to greater body dissatisfaction, restraint, thin-ideal internalization, and ED risk. Undergraduates with intentional WS demonstrated higher body dissatisfaction and eating pathology than undergraduates with unintentional or no WS (all ps < 0.05). CONCLUSIONS: Assessing weight history and WS motivations could be a brief, low-cost intervention to improve identification of undergraduates at greatest risk for EDs. This information could be integrated into campus marketing campaigns promoting wellness. LEVEL OF EVIDENCE: Cross-sectional descriptive study, Level V.

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.