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Examining an acute environmental trigger for dysfunctional eating
h [electronic resource] :
b measuring the immediate impact of fat disparagement media exposure and its effects on body dissatisfaction, negative affect, weight control practice intentions, and sub-clinical binge eating behavior in college women /
by Susan Himes.
[Tampa, Fla.] :
University of South Florida,
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Dissertation (Ph.D.)--University of South Florida, 2009.
Includes bibliographical references.
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ABSTRACT: Binge eating is a maladaptive eating practice associated with unhealthy weight control methods (vomiting, laxative abuse) and the development of weight gain and obesity. Isolating psychological and environmental variables that trigger binge eating can prevent or potentially moderate eating disturbance. Previous research implicates media exposure as an environmental contributor to psychological and eating disturbance. The current study sought to uncover whether fat stigmatization media exposure is an acute environmental trigger for psychological disturbance and binge initiation by dismantling fat media messages and experimentally manipulating messages. Undergraduate women (N=197) were assigned to one of four media message conditions: a fat negative interaction, fat comedy, control stigmatization, or control comedy condition. Psychological functioning and weight control variables were assessed at baseline, pre-test, and post-test.Results indicated that fat message exposure resulted in significantly greater post-test perceived pressure to lose weight, negative affect, guilt, and anger than control conditions. Participants exposed to fat messages were significantly more likely to restrict food intake. Two subjects engaged in an analogue binge. Weight control intentions were similar across conditions at post-test. BMI was found to moderate the relationship between fat message exposure and negative affect and hostility, with overweight and obese women more vulnerable to negative psychological consequences of fat media exposure. A history of weight related teasing moderated the relationship between fat message exposure and negative mood dependent variables (negative affect, guilt, sadness, fear), with those who had a history of teasing more vulnerable to negative mood induction. The primary significant mediator between fat message exposure and body dissatisfaction was appearance activation.Eating disorder theories were upheld, with suggested minor modifications specific to the context of fat media exposure. Findings are discussed in the context of weight loss and eating disorders treatment. Limitations of the study and directions for future research are discussed.
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Advisor: J. Kevin Thompson, Ph.D.
t USF Electronic Theses and Dissertations.
Examining an Acute Environmental Trigger for Dysfunctional Eating: Measuring the Immediate Impact of Fa t Disparagement Media Exposure and its Effects on Body Dissatisfaction, Negative Aff ect, Weight Control Practice Intentions, and Sub-Clinical Binge Eating Behavior in College Women by Susan Himes A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Psychology College of Arts and Sciences University of South Florida Major Professor: J. Kevin Thompson, Ph.D. Michael Brannick, Ph.D. Jonathan Rottenberg, Ph.D. William Sacco, Ph.D. Joseph Vandello, Ph.D. Date of Approval: May 11, 2009 Keywords: eating disorders, obesity television, movies, stigmatization Copyright 2009, Susan Himes
Acknowledgements This dissertation is dedicated to my pa rents, David and Betty Himes, who have always supported me in pursuing my goal to b ecome a clinical psychologist. I am very grateful to my sister, Amy Himes and my brother, Bria n Himes for their love and encouragement. My dissertation would not have been possible without my major professor, J. Kevin Thompson, Ph.D., and I am grateful for his guidance and support. Finally, I would like to thank my fellow memb ers of the Body Image Research Group for being such good colleagues.
i Table of Contents List of Tables ......................................................................................................... iv List of Figures ............................................................................................................... .......v Abstract ...................................................................................................................... ........ vi Chapter 1. Introduction ...................................................................................................... .1 Overview ..................................................................................................................1 Etiological Models of Eating Disturbance ...............................................................5 Media Consumption, Eating Disturbance, and Obesity .........................................11 Fat Stigmatization in Television and Movies ........................................................12 Preliminary Study ..................................................................................................13 Pilot Study 1: Development of the Stimuli ...........................................................14 Pilot Study 2: Pilot Investigation ..........................................................................16 Primary Study ........................................................................................................22 Chapter 2. Method ............................................................................................................ 27 Participants .............................................................................................................27 Measures ................................................................................................................28 Fat Stigmatization and Control Media Stimuli Items ................................28 Media Rating Form: Revised Version of the 3WD Humor Test ..............29 Demographic Information ..........................................................................29 Body Dissatisfaction ..................................................................................29 Thin Ideal Internalization ...........................................................................30 Sociocultural Pressure ................................................................................31 Drive for Thinness .....................................................................................32 Dieting........................................................................................................32 Negative Affect ..........................................................................................33 Bulimic Symptoms ....................................................................................34 Healthy Eating ...........................................................................................35 Exercise ......................................................................................................35 Study Credibility and Video Message Rating Form ..................................36 State Appearance Comparison Scale .........................................................37 Appearance-Related Teasing .....................................................................38 Cookie Taste Test Rating Form .................................................................38 Interpersonal R eactivity Index ...................................................................39 State Hunger...............................................................................................39
ii Procedure ...............................................................................................................40 Design and Analyses ..............................................................................................42 Chapter 3. Results ........................................................................................................... ..46 Preliminary Analyses .............................................................................................46 Planned MANCOVA and ANCOVA Analyses ....................................................52 2x2 MANCOVAs ......................................................................................52 2x2 ANCOVAs ..........................................................................................55 Moderation Analyses .............................................................................................63 Mediation Analyses ...............................................................................................66 Chapter 4. Discussion .......................................................................................................7 0 References .................................................................................................................... ......79 Appendices .................................................................................................................... .....96 Appendix A: Fat Stigmatization-Nega tive Interaction Stimuli Items .................97 Fat Stigmatization-Fat Comedy Stimuli ........................................98 Control Stigmatization-Negativ e Interaction Stimuli Items ..........99 Control Comedy Media Stimuli Items .........................................100 Appendix B: Media Rating Form: Revised Version of the 3WD Humor Test ...............................................................................................101 Appendix C: Demographic Information Form ..................................................103 Appendix D: Visual Analog Scales ...................................................................104 Appendix E: Positive and Negative Affect Scale Revised ................................105 Appendix F: Modified SATAQ-3 .....................................................................107 Appendix G: Video Message and Study Credibility Rating Form ....................108 Appendix H: Eating Diso rder Inventory-2 ........................................................109 Appendix I: Sociocultural A ttitudes Toward Appearance Questionnaire-3 ............................................................................110 Appendix J: Dutch Eating Behavior Questionnaire-Restraint Scale ................112 Appendix K: Eating Disorder Examination-Questionnaire ...............................114 Appendix L: Modified Eating Disord er Examination-Questionnaire ...............116 Appendix M: State Hunger Scale .......................................................................117 Appendix N: Multidimensional Health Behavior Inventory .............................118 Appendix O: State Appearance Comparison Scale ...........................................120 Appendix P: Physical Appearan ce-Related Teasing Scale ...............................121 Appendix Q: Cookie Taste Test Rating Form ...................................................123 Appendix R: Interpersonal Reactivity Index .....................................................124 Appendix S: Script for the Fat Stigmatization Media Exposure .......................127 Appendix T: Script for Control Media Exposure ..............................................129 Appendix U: Debriefing Form ...........................................................................131 Appendix V: Eating Disorder Descriptive Analyses .........................................132
iii Appendix W: Overweight and Ob esity Descriptive Analyses ...........................135 Appendix X: Repeated Measures ANOVAs .....................................................138 Appendix Y: Correlation Among Pre-test Measures .........................................140 Appendix Z: Correlation Am ong Post-test Measures .......................................141 About the Author ................................................................................................... End Page
iv List of Tables Table 1. Mean Scores a nd Standard Deviations for Pilot Study ................................21 Table 2. Means for Message Rating Form Items by Condition .................................49 Table 3. Means, F, P, and partial n Values for Planned MANCOVAs ...............54 Table 4. Means, F, P, and partial n Values for Planned ANCOVAs ........................60 Table 5. F, P, and partial n Values for Moderators ..................................................65 Table 6. Mediation Tests between Fat Message Exposure and DVs .........................68
v List of Figures Figure 1. The Tripartite Model of Influence ................................................................8 Figure 2. The Dual-Pathway Model of Bulimic Pathology .........................................9 Figure 3. The Rest raint Model of Binge Eating .........................................................10 Figure 4. Significant Media tion Models for the Tripartite Model .............................67
vi Examining an Acute Environmental Trigger for Dysfunctional Eating: Measuring the Immediate Impact of Fa t Disparagement Media Exposure and its Effects on Body Dissatisfaction, Negative Aff ect, Weight Control Practice Intentions, and Sub-Clinical Binge Eating Behavior in College Women Susan Himes ABSTRACT Binge eating is a maladaptive eating practice associated with unhealthy weight control methods (vomiting, laxative abuse) and the de velopment of weight gain and obesity. Isolating psychological and environmental vari ables that trigger binge eating can prevent or potentially moderate eating di sturbance. Previous resear ch implicates media exposure as an environmental contribu tor to psychological and eating disturbance. The current study sought to uncover whether fat stigma tization media exposure is an acute environmental trigger for psychological disturbance and binge initiation by dismantling fat media messages and experimentally mani pulating messages. Undergraduate women (N=197) were assigned to one of four media message conditions: a fat negative interaction, fat comedy, control stigmatiz ation, or control comedy condition. Psychological functioning and weight control variables were assesse d at baseline, pretest, and post-test. Results i ndicated that fat message exposur e resulted in significantly greater post-test perceived pressure to lose weight, negative affect, guilt, and anger than control conditions. Participants exposed to fa t messages were significantly more likely to
vii restrict food intake. Two subjects engage d in an analogue binge. Weight control intentions were similar across conditions at post-test. BMI was found to moderate the relationship between fat message exposure and negative affect and hostility, with overweight and obese women mo re vulnerable to negative psychological consequences of fat media exposure. A history of weight related teasing moderated the relationship between fat message exposure and negative m ood dependent variables (negative affect, guilt, sadness, fear), with those who had a history of teasing more vulnerable to negative mood induction. The primary significant medi ator between fat message exposure and body dissatisfaction was appearance activation. Eating disorder theories were upheld, with suggested minor modifications specific to the context of fat media exposure. Findings are discussed in the context of weight loss and eating disorders treatment. Limitations of the study and directions for future research are discussed.
1 Chapter 1 Introduction Overview Maladaptive eating practices are preval ent in western society, and precede a number of negative psychologi cal and health outcomes. Su stained food deprivation and starvation, and the consumption of large amount s of food in a short time span (binge eating) followed by purging behaviors, are dysfu nctional eating practices associated with a chronic course (Fairburn, Cooper, Doll, Norman, & OÂ’Conner, 2000), and high rates of mortality and morbidity (Reijonen, Pratt, Patel & Greydanus, 2003). Furthermore, the out-of-control consumption of large amounts of food in a short time span (binge eating) without compensatory behaviors, frequently paired in sporadic occurrences with daily overeating (Franko, Wonderlich, Little, Herzog, 2004), may be associated with weight gain and the development of overw eight and obesity (Grilo, 2002). Extreme dsyfunctional eating behavior is of ten manifested in eating disorder and obesity diagnoses. While rates of eating diso rders have remained approximately stable, obesity and overweight prevalence rates have doubled in the last 20 years (Centers for Disease Control [CDC], 2002; Flegal Carroll, Odgen, & Johnson, 1998; Thompson, 2004). Eating disorders disproportionately affect young adolescent and adult women, with a 0.5-1% prevalence rate for anorexia nervosa and a 1-3% prevalence rate for bulimia nervosa (American Psychiatric A ssociation, 2000; Streigel-Moore & Smolak,
2 2001; Thompson & Smolak, 2001). A societal tr end toward substantial weight gain was revealed in recent prevalence studies, indi cating a 65% prevalence rate for overweight and a 31% prevalence rate for obesity (F legal, Carroll, Ogden, & Johnson, 2002) among American adults. Obesity affects minority popu lations at a higher pr evalence rate than majority populations, particularly African Am erican and Hispanic women (Flegal et al., 2002). While most overweight or obese individu als do not meet criteria for a diagnosable eating disorder, a substantial minority of them do meet criteria for binge eating disorder with estimates ranging from 10-33% (G rilo, 2002; Grissett & Fitzgibbon, 1996; Yanovski, Nelson, Dubbet, & Spitzer, 1993). Disordered eating is conceptualized on a continuum, and eating disorders and obesity represent an extreme form of br oader dysfunctional eating practices. An additional 10-13% of adolescent and college fe males engage in subclinical disordered eating practices (Irving & Neumark-Sztainer, 2002). Overweight and obese adults and adolescents are more likely to engage in s ub-clinical levels of binge eating (Marcus, 1993) and unhealthy weight cont rol practices (i.e., diet pill s, laxatives, diuretics) ( Neumark-Sztainer, Story, Faulkner, Beuhri ng, & Resnick, 1999) than those who are not overweight. One dysfunctional eating practice that under lies both eating disorders and obesity is binge eating and sub-clini cal binge eating behavior. A binge is characterized by the consumption of a large amount of food in a di screte time period with a perceived loss of control; additional features include ra pid consumption of food, eating until uncomfortably full, and feeling depressed or guilty afterwards (Fairburn & Wilson, 1993). A binge is defined as one particular form of overeating (American Psychiatric
3 Association, 2000), and both clin ical and sub-clinical binge eating may lead to weight gain (Spitzer et. al, 1992). Binge eating is a central feature of bulim ia nervosa and occurs among one sub-type of anorexia nervosa (F airburn & Wilson, 1993). Furthermore, binge eating behavior may lead to the development and maintenance of overweight and obesity (Telch, Agras, & Rossiter, 1988). Etiological factors that contribute to binge behavior include sociocultural environment, pre-existing psyc hological traits, chronic beha vioral patterns (dieting and excessive exercise), and biologi cal dysregulation in the appetite control system (Blundell & Hill, 1993; Polivy & Herman, 1993). A number of preconditions are associated with vulnerability to binge eating: cultural pressu re to be thin (Poli vy, Garner, & Garfinkel, 1986; Silverstein, Peterson, & Perdue, 1986; Striegel-Moore, Silberstein, & Rodin, 1986), body dissatisfaction and drive for thinness (Miller et al., 1980; Rosen et al., 1987), chronic dieting (Abraham & Beumont, 1982; Garner, Rockert, Olmsted, Johnson, & Coscina, 1985; Hsu, 1990; Polivy & Herma n, 1985, 1987), food deprivation and restraint (Davis, Freeman, & Garner, 1988; Hawkins & Clement, 1980; Herman & Polivy, 1988), low self-esteem (Herman & Polivy, 1988; Johns on, Steinberg, & Lewis, 1988), irrational cognitive distortions (Garner & Bemis, 1985; Johnson & Connors, 1987), and a history of hostile, enmeshed family interaction pa tterns (Strober & Humphrey, 1987). Acute triggers for binge episodes include stre ss and negative affect (Davis et. al, 1988; Heatherton & Baumeister, 1991; Herman & Polivy, 1975), presence of fattening food cues (Johnson et al., 1987), hunger and food cr avings (Mitchell, Hatsukami, Eckert, & Pyle, 1985; Orleans & Barnett, 1984), the cons umption of forbidden foods, even in small amounts (abstinence violation effect) (J ohnson et al., 1987; Polivy & Herman, 1985,
4 1987, 1991; Schulndt & Johnson, 1990), alcohol i ngestion (Abraham & Beumont, 1982; Johnson et al., 1987), and privacy or isolation (De Castro, 1990) Polivy (1993) asserts that distal pre-conditions and immediate tri ggers for binge eating are both identified as binge antecedents, but that th e failure to discriminate ch ronic preconditions from acute triggers has muddled the unders tanding of binge etiology. Isolating psychological and environmental variables that trigger binge eating can prevent or potentially moderate eating dist urbance. It is important to identify environmental cues that contribute to binge onset; because of the extensive relationship between media exposure and eating distur bance, dismantling media messages and experimentally manipulating such messages wi ll illuminate whether fat stigmatization media exposure is an acute environm ental trigger for binge initiation. Therefore, the current study intends to experimentally manipulate fat stigmatization video messages and examine th e immediate and short-term effects on psychological functioning (i.e., perceived pres sure to be thin, body satisfaction, negative affect), intentions related to unhealthy wei ght control practices (i.e., dieting, use of laxatives), and eating behaviors (unrestrained/sub-clinical bi nge eating). The first section of this paper will discuss empirically supporte d etiological theories of eating disorders, with an emphasis on psychological and envir onmental contributing factors. The second section will discuss the role of media cons umption, specifically television viewing, and its relationship to eating disturbance a nd obesity, followed by an overview of fat stigmatization media content. Third, result s from a previous study that examined fat stigmatization video messages will be disc ussed. Fourth, results from a pilot study
5 conducted with the experimental media messa ges will be reviewed. Finally, hypotheses, analyses, and implications for the primary study will be offered. Etiological Models of Eating Disturbance Researchers concur that ea ting disorders develop through a complex interaction of genetic, cultural, social, behavioral, and psychological mechanisms (Brownell & Wadden, 1992; Bulik, 2004; Cope, Fernand ez, & Allison, 2004; Stein, OÂ’Byrne, Suminski, & Haddock, 2000). Many theories of eating disturbance have been proposed, but few have been consistently empirica lly supported. Three research supported etiological models that delineate the pathway to a binge or binge-pur ge behavior include the Tripartite Model, the Dual-Pathway Model, and the Restraint Model. The Tripartite Model of eating disturba nce (Thompson et al. 1999; van den Berg, Thompson, Obremski-Brandon, & Coovert, 2002; See Figure 1) posits that peers, media, and family are primary sources of cultural messages that influence eating behavior. When transmitted messages incorporate the glorif ication of thinness, it fosters thin-ideal internalization and heightened appearance comparison tendenc ies. Specifically, thin ideal internalization and app earance comparison mediate the effects of peer, family, and media influences on body dissatisfaction; body dissatisfaction directly precedes restriction and bulimic pathology. Furthermore, perfectionism influences the tendency to engage in social comparison. A cross-secti onal, structural equa tion modeling study on undergraduate females found broad support for the Tripartite Model (van den Berg et al., 2002). Additional studies with adolescents lend further support to the Tripartite Model (Keery, van den Berg, & Thompson, 2004; Shroff & Thompson, 2006.)
6 The Dual-Pathway model (Stice, 2001) is a synthesis of earlier sociocultural, dietary, and affect regulation eating disorder models (See Figure 2). The Dual-Pathway model posits that cultural glor ification of thinne ss is transmitted through messages from family, peers, and the media. Because thinness is virtually unattainable, it contributes to the development of body dissatisfaction. B ody dissatisfaction fost ers weight control behaviors (dieting) and negative affect, in creasing the risk of developing bulimic pathology. A cross-sectional, structural equation modeling st udy on undergraduate females (Stice et al, 1996), and a twenty-m onth prospective study of adolescent girls using random regression growth curve mode ls (Stice, 2001) have both provided support for the Dual-Pathway Model. The Restraint Model of eating disturba nce (Polivy & Herman, 1985) posits that sustained dieting produces we ight loss and a state of phys iological chronic hunger (See Figure 3). The ability to restrain eating wh en physically hungry is due to a cognitive restraint mechanism that supersedes physiolo gical controls. When cognitive restraint remains intact, dieting and weight loss be haviors are maintained. However, when cognitive restraint is suppressed or disi nhibited, usually by affective disturbance, abstinence violation, or alcohol excessive eating and binge eating occur. A series of experimental studies (Herman & Mack, 1975; Herman, Polivy, & Silver, 1979; Hibscher & Herman, 1977; Polivy, 1976; Polivy, Herman Hackett, & Kuleshnyk, 1983; Ruderman & Wilson, 1979; Spencer & Fremouw, 1979; W oody, Costanzo, Leifer, & Conger, 1981) support the Restraint Model. Despite early empirical support, the Restraint Model was criticized for numerous reasons: a) later studies were unable to replicate early findings of affect induced overeating or lab induced binge eating b) the original scale was a
7 unifactorial model of dieting, a nd more recent scales have supe rior ability to distinguish between chronic and acute dieting behavior c) overweight pe rsons did not respond according to the model and d) some experimental studies find that weight loss diets decrease binge eating (Lowe,1993; Stice, 2005). Also, in some studies, dieters maintained restraint when given a small forced high calor ie pre-load but were disinhibited by a large high calorie pre-load that led to the abs tinence violation effect (Herman & Mack, 1975; Herman & Polivy, 1980; Herman, Polivy, & Silv er, 1979). In contrast, some studies suggest that for those with higher levels of bulimic symptoms, a small quantity of forbidden food may suffice for inducing disi nhibition (Garner & Bemis, 1985; Polivy & Herman, 1993). Each model has unique components with re search support. The Tripartite Model highlights the importance of social comparis on as a mechanism that predicts body image dissatisfaction; in particular, social comparison mediates the influence of media messages on body dissatisfaction (van den Berg et al, 2002). The Dual-Pathway Model emphasizes the role of negative affect. When induced experimentally, negative affect predicts the onset of bulimic pathology (Stic e & Agras, 1998; Stice et. al., 1998a) and has triggered disinhibited eating among restrained eaters (Cools, Scho tte, & McNally, 1992; Ruderman, 1985). Finally, th e Restraint Model (Polivy & Herman, 1985) purports the central importance of cognitive restraint as a mechanism that maintains chronic dieting behavior. When cognitive restraint is intact eating remains inhibited; when cognitive restraint is suppressed or disi nhibited by negative affect or th e abstinence violation effect, overeating and binge eating occur. Each uni que component of the respective models will be tested in the primary study.
8 Figure 1. The Tripartite Model of Influence. Media Influences Parental Influences Peer Influences Comparison Internalization Body Dissatisfaction Restriction Bulimic Symptoms Global Psychological Functionin g
9 Figure 2. The Dual-Pathway Model of Bulimic Pathology. Pressure to be thin Thin-Ideal Internalization Body Dissatisfaction Dieting Negative Affect Bulimic Pathology
10 Figure 3. The Restraint Model of Binge Eating. Sustained Weight Loss Restraint Intact Dieting Chronic Hunger Loss of Restraint Binge Eating Disinhibitor Emotional Arousal Abstinence Violation
11 Media Consumption, Eating Disturbance, and Obesity Western media exposure and the presence of eating disorder symptoms have been strongly associated. Previous studies have observed a corr elational relationship between body satisfaction, eating disorder sympto ms, negative affect, and mass media consumption (Botta; 1999; Cusumano & Thompson, 1997; Harrison & Cantor, 1997; Stice, Shupak-Neuberg, Shaw, & Stein, 1994). Furthermore, many experimental studies of brief exposure to thin-ideal media images indicate increased body dissatisfaction postexposure to the images (see Groesz, Levine, & Murnen, 2002 for a meta-a nalytic review). Previous research shows that a robust correlation exists between television viewing and body-perception indices (poor body image and ED symptomatology) (Botta, 1999; Harrison, 1997; Levine and Smolak, 1996; Stice & Shaw, 1994.) In addition, research evidence demonstrates that television viewing a nd media exposure predict body dissatisfaction (Harrison & Cantor, 1997; Tiggemann & Pickering, 1996), bulimia symptoms (Harrison, 2001), disordered eat ing (Stice & Shaw, 1994), and negative mood (Harrison, 2001; Heinberg & Thompson, 1995). Research indicates that the relatio nship between television viewing and dysfunctional eating behaviors is not limited to those with classical eating disorder symptoms. Cross-sectional studies (Gortmaker, Must, Sobol, 1996; Utter, NeumarkSztainer, & Jeffery, 2003) and prospec tive studies (Dwyer, Stone, Yang, 1998; Obarzanek, Schrediber, & Crawford, 1994) have found a positive a ssociation between television viewing and obesity. One semi nal study found a dose -response relationship between hours of television viewed and obes ity, indicating that as television viewing behavior increases, so does weight gain (Dietz & Gortmaker, 1985). In addition,
12 considerable research supports the relationship between me dia usage (television, video games) and weight gain (Horgen, Choate, & Brownell, 2001; Hu, Li, Colditz, et al., 2003; Robinson, 1999). School-based ob esity intervention trials f ound that reducing television use predicted decreases in obesity preval ence and BMI (Gortmaker, Peterson, Wiecha, 1999; Robinson, 1999). Since then, studies examining the rela tionship between tele vision viewing and weight gain have found some s upport for three mechanisms of association: increases in sedentary behavior, increases in snacking while viewing, and food cues provided in advertisements elicit desire to eat (Gore, Foster, DiLillo, Kirk, & West, 2003; Halford et al., 2004; Henderson & Brownell, 2004; Va ndewater, Shim, & Caploritz, 2004). Although the relationship between weight gain and television viewing may be accounted for by previous explanations (snacking, less acti vity), it is also possible that dysfunctional eating precursors may be operating. Fat Stigmatization in Television and Movies Fat stigmatization is often presented in the form of commentary and humor through entertainment media. Content analys es indicate that overw eight characters are underrepresented on television (Fouts, 1999), an d overweight female characters receive more negative comments from male characters (Fouts, 2000; Himes & Thompson, 2007) while thin female characters simultaneously receive more positive commentary. Overweight characters are often targeted for social rejection and we ight-related verbal remarks (Himes & Thompson, 2007). Fat stigmatization in media influences ch ildren as well as adults. ChildrenÂ’s exposure to media that reinforces negative stereotypes about obes ity may contribute to
13 the development of childrenÂ’s body im age ideals (Herbozo, Tanteleff-Dunn, & Thompson, 2004). In a content analysis of childrenÂ’s popular movies, Herbozo et al. (2004) found that obesity was equated with ne gative traits (evil, unattractive, unfriendly, cruel) in 64% of the most popular childre nÂ’s videos. In a study by Harrison (2000) examining the relationship between fat stereotyping and television viewing among elementary school children, the frequency of television viewing predicted fat-girl stereotyping among males but not among females. Preliminary Study In a preliminary study, fat-specific mate rial was identified and quantified. A content analysis was conducted to meas ure and categorize fat-specific commentary (Himes & Thompson, 2007). Fat commentary vignettes were colle cted using four sampling methods, and 135 media clip scenes we re excised from movies and television programs. Scenes were edited using Avid Xpre ss Pro, and material was placed in random order. Media material was coded by trained ra ters. Inter-rater reliability indices were uniformly high for the seven categories (.66-.94). Results indicated that fat commentary and fat humor is often verbal, directed towa rd another person, and is often presented directly in the presence of the overweight target. Himes and Thompson (2007) also found that male characters were three times more likely to engage in fat commentary or fat humor than female characters. The experimental stimuli for the dissertati on investigation were selected from the media material collected and analyzed in the preliminary study (Himes & Thompson, 2007). All material was initially coded by the primary investigator, and the selected material has coding with high levels of inter-ra ter reliability agreement. A total of thirty
14 fat stigmatization media scenes were selected, with scenes from each content analysis category represented (gender of target, ge nder of commentator, di rect vs. indirect comment, verbal vs. nonverbal communication methods). Media clips are from culturally popular and prevalent movies a nd television programs; clips f eature characters from both genders and diverse racial backgrounds. The selected media clips represent actual commonplace fat stigmatization message exposure, and the use of the stimuli in the study enhances external validity by approximating as closely as possible real-world media experiences. Pilot Study 1: Development of the Stimuli The experimental stimuli material was se lected from an archive of material used for a previous content analysis of fat s tigmatization media (Himes & Thompson, 2006). Thirty media scenes of fat stigmatization we re divided into fat humor (16 items) and fat commentary-negative interaction (14 items) cat egories. Fat stigmatization clips were divided into the two experimental categor ies because the form of message delivery (humor comedy vs. negative interaction) may im pact mood state. In addition to the 2 fat stigmatization conditions, a control co medy condition (27 items) and a control stigmatization-negative interaction conditi on (19 items) were created using the same movie and television media. When possi ble, the same characters from the fat stigmatization conditions were used in the control conditions, in order to control for character likeability and show/m ovie familiarity. Each categ ory has media clips that are presented in a random order, with a 6 s econd blank screen dividing each clip. After the experimental stimuli were select ed, they were presented to an expert panel of researchers that sp ecialize in the study of body imag e and eating disturbances to
15 verify media audibility, to provide feedback about the ease of understanding the fat stigmatization messages, and to rate for each media clip the level of Â“funninessÂ” and Â“offensivenessÂ”. The expert panel consisted of one licensed clini cal psychologist, four doctoral students in clinical psychology, a nd two undergraduate research assistants. Feedback from the expert panel suggested th at one stimuli item was inaudible, and 2 items lost fat-specific meaning when removed fr om the larger film context. In addition, it was suggested that cartoon media was less disp araging, would be less likely to engender identification with fat targets, and might induce positive affect. Based on feedback from the expert panel, all cartoon items (2) were deleted, and items that lost fat-specific meaning (2) were removed. The stimulus set was reworked to amplify sound in segments with audibility problems (2). The expert panel ratings we re calculated for mean Â“funninessÂ” and Â“offensivenessÂ” of items, mirro ring the rating system to be used in the experimental study. The control stigmatiza tion-negative interaction condition had many items that included appearance-based mate rial, which might overlap with weight appearance and influence body image disturbance. Therefore, all appearance based items were removed (7), and items that had ratings of funniness>1 were removed (4), leaving a total of 8 stimuli clips for the control stig matizationnegative interaction condition. Within the fat stigmatization condition, items that contained additional non-fat related stigmatizing material were removed (1), items with ratings of funniness> 1 were removed (2), and items of self-fat talk (2) were rem oved. The 8 items with the highest ratings of offensiveness were included in the final set of 8 fat stigmatization stimuli. Within the fat comedy condition, items with ra tings of funniness>1 were in cluded, items having roughly equal funniness and offensiveness were include d (defined as funniness and offensiveness
16 means within a 1 point rating of each other), and items that cont ained material to counteract stigmatization were removed (1), l eaving a total of 8 items. For the control comedy condition, items with the highest ratin gs of funniness and lowest ratings of offensiveness were selected, and items with a rating of funniness <1 were removed (1). The final stimulus set was pruned from 76 items to 32 items, 8 clips for each condition. Please see Appendix A to review a list of media sources, fa t stigmatization and control messages, and time of exposure for each clip. Pilot Study 2: Pilot Investigation Prior to the primary stud y, a pilot study was conducted to determine whether exposure to the fat stigmatization negativ e interaction video messages resulted in negative affect mood induction, increases in body dissatisfaction, and sub-clinical binge behavior. The primary investigator recruited 9 unde rgraduate women between the ages of 18 and 23 ( M =19.89, SD =1.8). All women were assigne d to the fat stigmatization negative interaction media message conditi on because it was hypothesized that the stimuli would have the strongest impact on mood induction and body di ssatisfaction. The small sample was predominantly Caucasian ( 77.8%), with some mi nority participants (11.1% African American, 11.1% Hispanic); a ll participants were born in the United States. Self-reported height and weight estimates indicated that the majority of participants were normal weight (88.9%), and one participant wa s overweight (11.1%.) Within the sample, one participant wished to stay at her current weight; all others (88.9%) wished to lose weight rangi ng from 5lbs. to 40lbs. (M=14, SD=12.3). Participants were compensated with 3 extr a credit points in th eir psychology course.
17 In addition to demographic measures, st ate body dissatisfacti on and state negative affect were assessed pre-test with the Visual Analogue Scale (VAS; Heinberg & Thompson, 1995; see Appendix D) and the Posi tive and Negative Affect Scale-Revised (PANAS-X; Watson & Clark, 1992; see Appendix E). Following the pre-test measures, participants were asked to watch the fat stigmatization negative interaction message video and rate its Â“funninessÂ” and Â“offensivenessÂ” (Media Rating Form; Himes, 2007, Appendix B). After watching the video, subjec ts were asked to complete post-test VAS and PANAS-X measures. After completing mo od and body image measures, participants completed a Modified SATAQ-3 Pressures subscale (Thompson, van den Berg, Roehrig, Guarda, & Heinberg, 2004; Appendix F.) Following the completion of the scales, participants were given a Â“taste testÂ” in whic h they were instructed to eat as many minichocolate chip cookies as they needed to in order to determine the quality and desirability of the cookies. After the tast e test, participants filled out a Cookie Rating Form (Himes, 2007; see Appendix Q). Participants were th en debriefed. After the debriefing, subjects were asked to complete the 5-item modifi ed Message Rating Form (Sperry, Thompson, Roehrig, & Vandello, 2005; see Appendix G) Subjects were thanked for their participation and awarded th eir extra credit points. To identify any problems with video a udibility, video message understanding, or study cover-story credibility, the Message Ra ting Form was examined with each item analyzed separately. Mean scores were obtai ned, and results indica ted that the consumer cover story was convincing ( M =4.11), that the video messages were easy to hear ( M =4.67), and that the video messa ges were easy to understand ( M =4.67). If any of the above items exhibited a mean score of less than 4 (agree), it would have warranted
18 further subsequent action (del etion of media clip item, ch anges to the consumer study cover story.) However, no participants had di fficulty with the stimuli or with the cover story concept of a consumer study. Rating di fferences in the perceived media message applicability ( M =3.11) and influence ( M =3.33) were expected, and varied according to subjects. Descriptive sta tistics were conducted to examine frequency and range of responses. Overall, the Media Message Fo rm indicated that the cover story was convincing and that the video messages were accessible (easy to understand and easy to hear); see Table 1 for mean scor es and standard deviations. The SATAQ-3 Modified Pressures Subs cale was analyzed to assess whether subjects perceived pressure from the video to diet, to exercise, to lose weight, to change their appearance, or to be thin. Descriptive statistics were conducted to examine mean responses, frequencies, and response range. Re sults indicated that about half of the participants perceived no video message pr essure, and about half did perceive video message pressure to engage in various activitie s to be thin or to maintain an image of thinness/health (dieting, exercising, losi ng weight, changing appearance). Mean responses on the SATAQ-3 Modified Pressures Subscale range from 2.67-3.11, obscuring the diverging nature of the responses (see Table 1 for means and standard deviations.) Pre-post test analyses were conducted to assess for state changes in body dissatisfaction and negative affect. Six depe ndent t-tests were co mputed. A significant main effect for time was found, with si gnificant increases in PANAS-X negative emotional states hostility t (8)= -3.26, p<0.011 and guilt t(8)=-2.44, p<0.04, and significant increases in VAS st ate anger t(8)=-2.31, p<05. Furt hermore, mean levels of
19 overall PANAS-X negative affect increased from Time 1 ( M =12.1) to Time 2 ( M =13.0), though not meeting criteria for significance. After conducting dependent t-tests with an overall body dissatisfaction VAS index, as well as individual items re lated to weight and shape, results revealed no notable changes in body image disturbance. When examining pilot data, more than half of the sample expe rienced increases in state negative affect, and more than half of the sample reported slight increases in state body dissatisfaction. Based on the data indicating that a subset of the sa mple experienced increases in negative affect and increases in body dissatisfaction, with some negative emotional state changes meeting criteria for statistical significance, the rationale for the primary study hypotheses were supported. Correlations were conducted between the Fat Stigma tization Media Messages Rating Form Overall Offensiveness scores a nd changes in the state measures (affect, body dissatisfaction) to determine if ratings of offensiveness of the vignettes was related to mood and body image changes. None of the mood or body image difference variables were significantly correlated with the media offensiven ess scores. However, the relationship between anger and clip offens iveness ratings r=.58, p<.09 and between guilt and clip offensiveness ratings r= -.61, p<.07 approach significance. Implications from the pilot findings suggest that interpretations of the media messages as offensive is not related to body image changes. However, some subjects that interpreted the media messages as offensive have corresponding in creases in anger; other subjects who experienced increases in guilt after seeing the messages were more likely to interpret the media as non-offensive.
20 As subjects completed the taste test, ther e was an opportunity to examine whether an analogue binge behavior o ccurred (large amount of cookies consumed within a 3 minute time frame). Instead of binge eating, those with eating disorder compensatory symptoms (including BN) restricted the amount of cookies consumed instead of binge eating. The only overweight subj ect also restricted food in take (consuming 1 cookie.) Additionally, some subjects re ported high levels of hunger prior to the experiment, accounting for some noise variance in cookies consumed. Overall, findings from the pilot study supported the hypothesis that some subset of the undergraduate female population experien ces increases in negative affect, negative emotional states (anger, hostil ity, guilt), and experiences pe rceived pressure to lose weight and to diet following exposure to me dia messages of fat stigmatization in the context of a negative intera ction. There was not statisti cal support for increased body dissatisfaction following media exposure; rating s indicated that some women experienced slight increases in body dissati sfaction and others felt better about their bodies after comparison with obese/overwei ght targets. Media stimuli exposure was followed by some externalizing responses (anger) and by so me internalizing responses (guilt); these differing responses were associated with perc eptions of media offensiveness. However, media exposure did not affect all subjects, and the relationship be tween media exposure and perceptions of offensiveness was not statis tically significant. In stead of serving as a possible acute trigger for a binge episode, participants with eating disorder compensatory behaviors increased their rest riction of cookie intake, with various others engaged in unrestrained eating; this outco me directly contradicted ear lier hypotheses. Finally, the consumer cover story, the media message acc essibility (audibility and ability to
21 understand) were highly rated, wi th no subjects experiencing difficulty with the media or the credibility of the cover story. Table 1 Mean Scores and Standard Devi ations for Pilot Study Measure Fat Stigmatization Negative Interaction Media Video (N=9) Pre-VAS BD 10.03 (5.14) Post-VAS BD 10.15 (5.41) Pre-VAS Shape Dissatisfaction 4.98 (2.76) Post-VAS Shape Dissatisfaction 5.06 (2.76) Pre-VAS Anger 0.81 (1.46) Post-VAS Anger 2.34 (2.94) MRF-Cover Story Credible 4.11 (.33) MRF-Easy to Hear 4.67 (.70) MRF-Easy to Understand 4.67 (.50) MRF-Influential 3.33 (1.00) MRF-Applicable 3.11 (1.26) Pre-PANAS-X Negative Affect 12.11 (2.47) Post-PANAS-X Negative Affect 13.00 (3.00) Pre-PANAS-X Hostility 6.33 (0.70) Post-PANAS-X Hostility 7.66 (1.80) Pre-PANAS-X Guilt 8.00 (1.93) Post-PANAS-X Guilt 9.11 (2.71) SATAQ-3 Perceived Pressure to Lose Weight 2.67 (1.41) SATAQ-3 Perceived Pressu re to be Thin 3.00 (1.5) SATAQ-3 Perceived Pressure to Diet 2.67 (1.58) (Table Continues)
22 Table 1 (Continued) SATAQ-3 Perceived Pressure to Exercise 3.11 (1.45) SATAQ-3 Perceived Pressure to Change My Appearance 2.89 (1.45) Note VAS BD: Visual Analogue Scale-Body Dissatisfaction; MRF: Message Rating Form; PANAS-X: Positive and Negative Affect Scale-Revised; SATA Q-3: Sociocultural Attitudes Towards Appearance Scale-3 Primary Study In the primary study, media video messages were experimentally manipulated to directly examine the immediate and short-term effects of fat stigmatization media exposure on psychological functioning, weight control intentions, a nd subclinical binge eating behaviors in collegiate undergraduate women. Based on findings from the pilot study, the primary study was altered. First, an additional measure assessing state levels of hunger was added to control for variance in cookie consumption. Second, the pilot study results indicated that some subject s with eating disorder psychopathology and current binge behaviors increased or mainta ined levels of eating restraint following exposure to the media messages; these partic ipants ate the fewest number of cookies when compared to the total sample. Th erefore, decreases in cookie consumption (restraint), as well as possible binge i nduction, became the newly predicted set of possible outcomes. The rationale supporting the primary study is fourfold. First, it is important to examine whether fat stigmatization media exposure is a compone nt of the larger sociocultural pressure to be thin. Content analyses of weight-related material in media
23 found that overweight characte rs were underrepresented on te levision, and received more negative feedback from othe r characters (Fouts, 1999; F outs, 2000; Himes & Thompson, 2007). Fouts proposed the use of BanduraÂ’s so cial learning model to conceptualize weight-related media messages and their eff ects: a simultaneous modeling of thinness and vicarious reinforcement of positive feedback to thin characters, and modeling fat disparagement and negative feedback to overweight characters (Fouts, 1999). Whether these dismantled messages are both associated w ith sociocultural pressure to be thin has not been addressed. Second, it is important to consider whethe r fat stigmatization media exposure, as a possible separate component of thin-ideal sociocultural pressure, has psychological and behavioral consequences. In previous rese arch, western media exposure and the presence of eating disorder symptoms have been str ongly associated; televi sion viewing and media exposure have predicted body dissatisfaction a nd bulimia symptoms (Harrison & Cantor, 1997; Harrison, 2001; Stice & Shaw, 1994). Furthe rmore, experimental studies of brief exposure to thin-ideal media images indicate s that media exposure is a risk factor for eating pathology (Groesz, Levine, & Murne n, 2002; Stice, 2002) Although much previous research, both corre lational and experimental, has examined the role of thinideal media exposure on eating disorder deve lopment, only one study has examined the impact of viewing fat stigmatization media messages. Fat stigmatization video content within the experimental study c onsisted of one scene in whic h an obese adolescent girl was teased and rejected, and negative affect was induced among the viewers (Harrison, 2001). Limitations from that study include the absence of studying the direct effects of fat stigmatization media exposure on eati ng disturbance and body dissatisfaction
24 measures, the use of one indirectly conveyed fat stigmatization message, and the lack of clarity regarding whether the negative affect induction was a result of empathy or selfcomparison. Within the proposed study, the ro le of fat stigmatization media exposure as an acute trigger for mood disturbance, body image disturbance, and dysfunctional eating will be tested. Third, competing mechanisms may be res ponsible for the relationship between fat stigmatization media exposure and psychological outcomes. Ideal discrepancies often result in negative affect, and many of the par ticipants had weight-ide al discrepancies that may have been activated by fat commentary exposure. Furthermore, social comparison tendencies to video characters may lead to ne gative affect and body image disturbance if making an upward comparison, but if the target is perceived as less fortunate, downward comparisons made to unfortunate obese vide o characters may enhanc e participants own body image (Festinger, 1954; Tiggemann & Sl ater, 2003). The mechanism of thinking about oneÂ’s own appearance and social comparis on to other targets is highly correlated, complicating whether one mechanism is predom inant over the other or whether both are operating simultaneously (Tiggeman & Slater, 2 003). The role of social comparison and the role of activation of se lf-appearance schema with the presence of a weight ideal discrepancy will be examined as possible mediators associated with psychological outcomes. Fourth, a number of empirically supported eating disorder models will be tested, as components of each model will be analyzed (affective disturbance, social comparison, chronic restraint) in conjunction with psychological a nd behavioral study outcomes.
25 Specifically, the goals of the primary study ar e fourfold. First, it is designed to experimentally manipulate fat stigmatiz ation video messages and determine its immediate effects on (a) psychological f unctioning, including body dissatisfaction, negative affect, and perceived pressure to be thin, (b) dieting and weight control intentions, including unhealthy strategies for weight manage ment and (c) eating behavior, specifically binge eating, subclin ical binge eating, and restra ined or unrestrained eating. Second, the study will examine the relati onship between fat stigmatization media message exposure and perceived pressure to be thin. Third, the st udy will evaluate the possible mediational role of social compar ison and ideal-weight discrepancy on negative affect and body image disturbance, and the me ditational role of ne gative affect on cookie consumption. Finally, the investigation will te st whether the effects are consistent with components of prior eating pa thology models (e.g., affec tive, social comparison, and restraint.) Based on findings from the previous literature, the following hypotheses are proposed: (1) Subjects in the fat stigmatization and fat comedy media exposure conditions in comparison with the control conditions (a) will report highe r levels of state negative affect and state body dissatisfaction, (b) will feel more pressure to lose weight, and (c) will eat significantly more or si gnificantly less mini-chocolate chip cookies (engage in restraint or binge eating). Additionally, subjec ts in the fat comedy condition will report slightly less negative affect than subjects in the fat negative interaction condition, due to the mediating effects of hu mor exposure on mood. (2) Participants with bulimic symptoms, above average BMIs, a disc repancy between current and ideal weight, and a history of weight-related teasing w ill report higher levels of state body
26 dissatisfaction and state negative affect, experi ence more pressure to lose weight, and will eat more mini-chocolate chip cookies (engage in unrestrained eatin g). Subjects with high trait levels of restraint and low levels of bulimia symptoms will report similar psychological outcomes, but will be less likely to engage in unrestrained eating. (3) The findings will support the rela tionship between media fat stigmatization exposure and perceived pressure to be thin, such that fat stigmatization exposure will lead to increased perceived pressure to be thin when compared with subjects in the control conditions. (4) The results will indicate that pressure to be thin, activation of a self-appearance schema and a weight ideal discrepancy, and social appearance comparison to characters in the videos will be mediators of the relationship between fat stigmatization media exposure and body image disturbance and negative aff ect; negative affect will serve as a mediational link between exposure to the fa t stigmatization video messages and cookie consumption. (5) Components of eating disord er models indicati ng increased negative affect (SticeÂ’s Dual-Pathway Model), social comparison (ThompsonÂ’s Tripartite Model), and chronic trait restraint vi olation (PolivyÂ’s Restraint Model) preceding binge and subclinical binge eating will be supported.
27 Chapter 2 Method Participants The participants were 197 undergraduate wo men recruited from the University of South FloridaÂ’s Department of Psychology s ubject pool. Participants were primarily young adults, and ranged in age from 18 to 52 years ( M =21.6, SD =4.73). The sample was ethnically diverse with 13.3% African American ( N =26), 15.3% Hispanic American ( N =30), 65.8% Caucasian ( N =129), 3.6% Asian American ( N =7), and 2% Other ( N =4). The majority of the sample (86.8%) was from the United States ( N =169), with a notable number of internationa l participants (14.2%; N =28) from more than 20 foreign countries. Participants completed self-report measures of weight and height, wh ich revealed that the average body mass index (BMI) was in the normal range ( M =24.01, SD =5.35), with BMI scores ranging from 15 to 46. The sample exhi bited a wide range of weight status, with 5.8% underweight ( N =11; BMI 18.5 or lower), 61.6% average weight ( N =117; BMI 18.624.9), 20% overweight ( N =38; BMI 25-29.9), and 12.6% obese ( N =24; BMI over 30). When asked about the difference between th eir current weight and ideal weight, the majority of women reported a desire to lose anywhere from 5 to 15 pounds ( M =15.74, SD =21.22). Some participants reported eat ing disturbance symptoms; 2% reported symptoms of AN ( N =4; weight below 18.5 and feelings of fat/fear of weight gain), 7.1% reported symptoms of BED ( N =14; objective binge with no compensatory behaviors), and 6.6% reported symptoms of BN ( N =13; objective binge with some compensatory
28 behaviors.) Participants were compensated wi th extra credit points in their psychology course(s). Measures Fat stigmatization and cont rol media stimuli items. Study participants were exposed to one of four media videos; two of the videos contained fat messages (see Appendix A). The stimuli (as previously described, see above) were selected from ma terial collected for a cont ent analysis of media fat commentary (Himes & Thompson, 2007). Condition one video contains fat stigmatization commentary, exchanged during a negative interaction (fat stigmatization); the condition two video contains fat humor, often utilized in the comedy genre (fat humor). Condition three video contains control stigmatizat ion commentary, with similar characters from the condition one vide o engaging in non-weig ht related and nonappearance related negative interactions (contro l, non-fat, stigmatization). Condition four video contains neutral, non-weight relate d and non-appearance related control comedy interactions with the same characters fr om the fat humor video (control, non-fat humor)(see Appendix A). Each of the 8 medi a clips per condition (32 total) were extracted from popular movies and television shows. Fat s tigmatization materials were selected in order to ensure representation of both male and female targets, indirect and direct methods of negative we ight-related feedback, a range of ages and ethnicities, and both verbal and nonverbal communication met hods. In compliance with copyright law, no media clips from any movie or television show exceeded 3 minutes, and all materials were used for research purposes.
29 Media rating form: Revised ver sion of the 3WD Humor Test. Participants were asked to evaluate medi a stimuli. An adaptation of Form K of the 3WD Humour Test (Ruch, 1983) was admini stered to assess appreciation of humor containing fat commentary; it also assessed pe rceived offensiveness of the stimuli (see Appendix B). The original 3WD-K contains 50 jokes and cartoons, which are rated on Â“funninessÂ” and Â“aversivenessÂ” using two 7 poi nt scales ranging from Â“not at all funnyÂ”=0 to Â“very funnyÂ”=6 and Â“not at all aversiveÂ”=0 to Â“very aversiveÂ”=6. The 2 factors (aversiveness and funniness) emer ged from a factor analysis of humor appreciation, and can be applied to both comedic and dramatic commentary. In the adapted version of the Humor and Commenta ry Ratings Scale, original jokes were removed and replaced by media clip segments. After each clip was displayed, the participant circled how Â“funnyÂ” and Â“offensiv eÂ” the clip was to the corresponding item on the Media Rating Form. Demographic information. Participants were asked to provide de mographic information including age, race, height, weight, ideal weight, y ear in school, country of orig in, and number of years spent living in the United States (see Appendix C). Self-reported height in inches and weight in pounds were used to calculate Body Mass Index (BMI) [(weight in pounds/height in inches)2] x 703. Body dissatisfaction. Two measures of body dissa tisfaction were administer ed: one trait measure and one state measure. The Eating Disorder I nventory Body Dissatisfaction subscale (EDIBD, see Appendix H) (Garner, Olmsted, & Polivy, 1983) was employed as the trait
30 measure of body dissatisfaction. The EDI-BD is a 9-item scale that assesses overall satisfaction with various weight related body si tes. It has demonstrated good reliability (alphas above .80) across a variety of samples (Garner, 1991; Thompson, 1992). The EDI-BD was administered at baseline (a ) to ensure equal distribution of body dissatisfaction across conditions before the expe rimental manipulation and (b) to serve as a co-variate in analyses. CronbachÂ’s alpha was calculated for the EDI-BD within the current sample; results revealed that internal consistency was high at .92. The Visual Analogue Scales (VAS, see A ppendix D) was utilized to assess state dissatisfaction with body weight and shape (Heinberg & Thompson, 1995). Participants were asked to indicate thei r level of dissatisfaction on a 100 mm line, with the left-most point being "no weight/size di ssatisfaction" ("no overall a ppearance dissatis faction") and the right-most point being that of "extreme weight/size dissatisfaction" ("extreme overall appearance dissatisfaction"). The distance from the left-most point on the line (0) measured in millimeters indicates the level of distress (Thompson et al., 1999). The VAS has been found to correlate highly with the Eating Disorder Inventory-Body Dissatisfaction subscale (e.g., Heinberg & Thompson, 1995) and has been widely-used because it is brief and can be repeated with in a short time period without participants remembering their previous responses (T hompson, 2004). The VAS was used to assess state weight dissatisfaction, sh ape dissatisfaction, and overall body dissatisfaction before and after exposure to the experimental manipulation of the video messages. Thin-Ideal internalization. The Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3, see Appendix I)-Internalization s ubscales were used to measure trait levels of thin-ideal
31 internalization (Thompson et al., 2004). This measure focuses specifically on internalization of media messages regarding the thin-ideal, and ratings are made on a five-point Likert scale rangi ng from Â“Definitely AgreeÂ” to Â“Definitely Disagree.Â” The SATAQ-3 has two internalization subscales wi th excellent reliability: InternalizationGeneral (CronbachÂ’s alpha = .96) and Intern alization-Athlete (Cr onbachÂ’s alpha = .95) (Thompson et al., 2004). Within this sample, CronbachÂ’s alpha was .95 for Internalization-General and .86 for Internalizat ion-Athlete. Sociocultural pressure. A modified version of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3; Thompson et al., 2004) Pressures subscale was used to assess the extent to which the experimental stimuli apply pre ssure to lose weight and/or maintain a low body weight (see Appendix F). The original Pressure s subscale has been found to have excellent reliability (Cr onbachÂ’s alpha=.94) and has demonstrated convergent validity with a Â“gold standardÂ” measure of drive for thinness (Thompson et al., 2004). Items modified for this study re tained the SATAQ-3 stems but changed the cited source of perceived pr essure from TV, movies, and magazines to the fat stigmatization video message. For example, an original item on the Pressures subscale was modified from, Â“IÂ’ve felt pressure from TV or magazines to lose weight,Â” to Â“IÂ’ve felt pressure from this video to lose weight .Â” Items were summed to obtain a composite pressures score. The modified Pressures s ubscale was utilized in the primary study to assess perceived pressure from the video st imuli, and the standard SATAQ-3 Pressures subscale was administered as a trait measure at pre-test (see Appendix I). Within the
32 study sample, internal consistency for both the trait Pressures subscale (CronbachÂ’s alpha=.94.) and for the modified pressures subscale (CronbachÂ’s alpha=.93) was high. Drive for thinness. The Eating Disorder Inventory-Drive fo r Thinness (EDI-DT; See Appendix H, Garner et al., 1983) was used to assess drive fo r thinness. This scale measures restricting tendencies, desire to lose wei ght, and fear of weight gain. It has an internal consistency of .83 for a combined sample of eating di sordered individuals and .81-.91 for four samples of nonpatient female controls (Garne r, 1991). Directions were modified to assess usual drive for thinness, and the scale wa s administered at baseline to ensure equal distribution of eating distur bance across groups and as a co-variate in analyses. Reliability was excellent with an alpha of .92 in this sample. Dieting. The Dutch Eating Behavior Questionn aire-Restraint Scale (DEBQ-RS; see Appendix J, van Strien, Frijters, Bergers, & Defares, 1986) was used to measure current dieting behavior and intenti ons. This scale consists of ten-items that measure the frequency of dieting behaviors using a 5-point Likert scale, which ranges from Â“neverÂ” to Â“always.Â” The DEBQ has been shown to ha ve good internal consistency (CronbachÂ’s alpha=.95) and test-retest re liability (r=.92) (Allison, Kalinsky, & Gorman, 1992). Directions were modified to assess usual die ting behavior at baselin e and intended dieting behavior as an outcome vari able. Reliability of the DE BQ at baseline (CronbachÂ’s alpha=.94) and as an outcome intentions meas ure (CronbachÂ’s alpha=.91) was excellent.
33 Negative affect. The Positive Affect and Negative Affect Scale-Revised (PANAS-X; see Appendix E, Watson & Clark, 1992) was used to assess both state and trait negative affect and positive affect. In this scale, participants rate 30 negative emotional states (e.g., sadness, guilt, and fear/anxiety) and 20 posi tive emotional states (e.g., joyful, alert, cheerful) currently or usually. A 5-point Li kert scale, which range s from Â“very slightly or not at allÂ” to Â“extremely,Â” is used. This scale has been found to have adequate internal consistency, test-retest reliability, conve rgent and divergent validity, and predictive validity (Stice & Agras, 1998; Watson & Clark, 1992). Reliability in this sample was high for trait negative affect (CronbachÂ’s alph a=.96), for trait positive affect (CronbachÂ’s alpha=.95), for state negative affect at time 1 (CronbachÂ’s alpha=.93), for state positive affect at time 1 (CronbachÂ’s alpha=.96), for state negative affect at time 2 (CronbachÂ’s alpha=.93), and for state positive affect at time 2 (CronbachÂ’s alpha=.97). Visual Analogue Scales (VAS) related to affect were used primarily as filler questions to disguise the main purpos e of the VAS scalesÂ—to assess state body dissatisfaction (see Appendix D). However, previous research indicates that VAS variables anger and anxiety were highly correlated with the tension/anxiety and anger/hostility scales from the Profile of Mood States measure (Heinberg & Thompson, 1995.) Therefore, VAS anger and anxiety we re analyzed as state mood dependent variables. Following the same procedure de scribed above for the measurement of state weight and shape dissatisfaction, participants were asked to rate the ex tent of their current affect on several dimensions, including happi ness, anxiety, energy le vel, disappointment in self, anger, calmness, and irritability.
34 Bulimic symptoms. The Eating Disorder Examination-Qu estionnaire (EDE-Q; see Appendix K, Fairburn & Beglin, 1994) Bulimia Subscale was used to measure bulimic symptoms. The EDE-Q is derived from the Eating Disorder Examination (EDE; Fairburn & Cooper, 1993), which is a widely used and validated semistructured interview. The EDE-Q Bulimia Subscale consists of twelve items th at assess the frequency of binge eating and purging (i.e, vomiting, laxative a nd diuretic use, excessive ex ercising). The frequency is measured in terms of the number of days th at binging and/or purging occurred as opposed to the number of individual episodes. The internal consistency of the EDE-Q has been found to be adequate (CronbachÂ’s al pha=.84) (Fairburn & Beglin, 1994). In addition, the EDE-Q demonstrates acceptable criterion validity and convergen t validity (Black & Wilson, 1996). Because the Bulimia subscale of the EDE was discontinued due to its overlap with other EDE scales, the EDE wa s not calculated as a total Bulimia score (scoring criteria were unavailable after the scale was discontinued). The EDE within this sample was used to categorically divide some participants into eating disturbance cluster behaviors (AN, BN, BED) and to ensure th at such disturbances were equal across conditions at baseline. A modified version of the EDE-Q was u tilized to assess unhealthy weight control intentions (see Appendix L, Roehrig, 2006) EDE-Bulimia Items 10-12, which assess compensatory behavior frequency, were adap ted to measure intentions to vomit, use laxatives/diuretics, and excessive exercise to control weight on a five-point Likert scale. Additionally, items related to intentions to use diet pills, smoke, and employ meal skipping as weight control prac tices were added to the scale. Reliability of the modified
35 scale was adequate (CronbachÂ’s alpha=.72) but lower than the internal consistency of the original scale. Healthy eating. The Multidimensional Health Behavi or Inventory (MHB I; Kulbok, Carter, Baldwin, Gilmartin, & Kirkwood, 1999; see Ap pendix N) Diet subscale was used to measure healthy eating intentions and behavior s. The MHBI is a psychometrically sound instrument that was developed for use in adolescent and college-aged samples. The MHBI-Diet subscale consists of 13 items a ssessing frequency of healthy nutritional behaviors such as eating whol e grain foods and limiting suga r intake on a 5-point Likert scale ranging from Â“NeverÂ” to Â“Always.Â” Internal consiste ncy of the Diet subscale is very good (CronbachÂ’s alpha=.88) (Kulbok et al ., 1999). Directions will ask participants, Â“How often do youÂ….Â” to assess usual healthy ea ting habits, while participants will be asked Â“How often do you intend toÂ….Â” to meas ure intentions during the post-test. In addition to the original MHBI items, two questions regarding fruit and vegetable consumption were added using the MHBI st ems. CronbachÂ’s alpha was found to be .84 for the MHBI-Nutrition at baseline, and th e alpha level was .83 for MHBI-Nutrition Intentions. Exercise. The Multidimensional Health Behavior Inventory (MHBI; Ku lbok et al., 1999; see Appendix N) Exercise subscale was uti lized to assess exercise intentions and behaviors. The MHBI-Exercise subscale consis ts of four items on the same five-point Likert scale described above for the MHB I-Diet subscale. Items assess frequency of physical activity such as vigor ous exercise for at least 20 minutes a day, three times a
36 week. Kulbok et al. (1999) demonstrated th e scale has acceptable internal consistency (CronbachÂ’s alpha=.80) and cont ent and convergent validity. Test-retest reliability was not assessed. Directions were changed as i llustrated above to assess usual and intended exercise behavior. CronbachÂ’s alpha was .89 in this sample for usual exercise behavior, and alpha was .85 for intended exercise behavi or, indicating that bot h measures had good reliability. Study credibility and vi deo message rating form. A modified version of the Message Rating Form (Sperry et al., 2004; see Appendix G) was created to assess the extent to which the video messages were heard, easy to understand, applicable, a nd influential. A general ques tion about the cr edibility of the consumer study cover story was included. Al l items were rated on a five-point Likert scale ranging from Â“Definitely DisagreeÂ” to Â“Definitely Agree.Â” The Study Credibility and Video Message Rating Form was used duri ng pilot testing, and re sults indicated that all subjects endorsed the credib ility of the cover story and felt that media messages were easily heard and comprehended. Within the primary study sample, a very low alpha was obtained for the Video Message Rating Form (CronbachÂ’s alpha=.50). The items on the form addressed very different concerns (credibility of cover story, understanding messages, hearing messages, influence and a pplication of messages to the participantÂ’s life) and therefore, did not correlate highly with each othe r. Upon closer inspection of mean responses to each item, subj ects found the cover story credible ( M =4.15, SD =.83), the video easy to understand ( M =4.69, SD =5.72), and the video easy to hear ( M =4.85, SD =.47).
37 State Appearance Comparison Scale. The State Appearance Comparison Scale (see Appendix O) is a 3-item scale designed to index comparison prompted by e xposure to the experime ntal manipulation. The scale items are very similar to the items used in previous experimental studies examining state appearance comparison (e.g., Tiggeman & Slater, 2003; Tiggemann & McGill, 2004), which have demonstrated high internal consistency (CronbachÂ’s alpha = .91; Tiggemann & McGill, 2004). The scale consists of three items, and it assesses two constructs: participantsÂ’ appearance-related thoughts ( no thought to a lot of thought) and comparisons ( no comparison to a lot of comparison) while viewing video clips or magazine advertisements. In the current study, appearance processing was measured by asking respondents to indicat e the extent to which they thought about their own appearance over the past fifteen minutes (whi ch is the time period following exposure to fat stigmatization commentary). This item used a 7-point Likert scale ranging from no thought about my appearance to a lot of thought about my appearance. Similarly, appearance comparison was measured by asking respondents to indicate the extent to which they compared their overall appearance to that of the fat commentary target in the video. They were also asked to indicate th e extent to which they compared specific body parts to the fat commentary targetsÂ’ body pa rts. A 7-point Like rt scale ranging from no comparison to a lot of comparison was used for both comparison items. As in previous studies by Tiggemann and colleagues (2003, 2004), a composite measure of state appearance comparison was obtained by averaging the scores for all three items described above. The ratings on these items have been shown to be highly correlated (Tiggemann & McGill, 2004). The state measure of appearance schema activation and social
38 comparison (SACS) was administered after the post-test mood and body image measures. CronbachÂ’s alpha for the measure in this sample was .80, indicating good reliability; however, social comparison items were more hi ghly correlated to each other than either social comparison item was to the appearance schema activation item. Appearance-Related teasing. The Physical Appearance-Related T easing Scale (PARTS; see Appendix P, Thompson, Fabian, Moulton, Dunn, & Altabe, 1991) is an 18-item measure that assesses teasing history and consists of the Weight /Size Teasing and the General Appearance Teasing subscales. The Weight/Size Teasing and General Appearance Teasing subscales have demonstrated adequate internal consistency (CronbachÂ’s alpha = .91 and .71, respectively), and test-retest reliability (r = .86 and .87, respectively) for a sample of college females. The PARTS has also s hown moderate convergent validity with measures of eating disturbance, body dissati sfaction, social comparison, depression, and self-esteem (Thompson et al ., 1991). Within the samp le, the PARTS-Weight/Size Teasing subscale demonstrated excellent inte rnal consistency (Cr onbachÂ’s alpha=.92). Cookie taste test rating form. A modified version of the Message Rating Form (Sperry et al., 2004; see Appendix Q) with questions about cookie ev aluation was created to promote the face validity of the consumer study. All items were rated on a five-point Likert scale ranging from Â“Definitely DisagreeÂ” to Â“Definitely Agree.Â” In one sample item from the scale, participants were asked to rate their agreem ent with the statement, Â“The cookies were fresh, without any staleness.Â” Internal c onsistency of the cookie evaluation scale was rather poor (CronbachÂ’s alpha=.67).
39 Interpersonal Reactivity Index. The Interpersonal Reactivity Index (IRI ; see Appendix R, Davis, 1980) is a 28item measure that assesses di spositional empathy. The IRI assesses both cognitive and affective components of empathy, and consists of Perspective Taking, Empathic Concern, Personal Distress, and Fantasy subscales. Subjects report degree of agreement using a 5 point agreement/disagreement Likert scale. The IRI has demonstr ated sound internal consistency (CronbachÂ’s alpha = .70-.78 for each subscale). The IRI has also demonstrated test-retest reliability (.62.81 across subscales) with college student samples, and findings demonstrate converg ent validity with the emotional empathy research literature. Within the current sample, the Empathic Concern subscale was utilized to ensure trait empathy was even ly distributed across groups at baseline; CronbachÂ’s alpha was .74, indicating adequate reliability. State Hunger Scale. The State Hunger Scale (SHS; see Appe ndix M, Himes, 2008) is a 7-item measure that assesses which meals were consumed for the day, whether less food than usual has been consumed for the day, and incl udes 2 10-point scales that assess clinical ratings of hunger before and after the e xperiment. CronbachÂ’s alpha was poor (alpha=.47); however, items assessing meals co nsumed decreased the alpha level of the scale, with the 2 clinical hunger ratings highly correlated, and items assessing skipped meals and eating less than usual were somewh at correlated with hunge r levels. A clinical rating of hunger level pre-experiment was used as a co-variate for the dependent variable cookie consumption.
40 Procedure Participants enrolled in the primar y study through the USF Experiment Trak system. Eligible participants completed demographic information and trait measures (SATAQ-3, EDI-BD, PANAS-X, EDI-DT, PARTS, Dutch Restraint Scale, EDE-Q, IRI) online. Participants then enrolled in a complementary laboratory study, and were assigned to one of four condi tions: fat stigmatization-nega tive interaction experimental condition, fat stigmatization-comedy experi mental condition, cont rol stigmatizationnegative interaction condition, and control comedy condition. Although the experimenter was blind to subject charact eristics prior to condition assignment, assignment to conditions was not numerically randomized. Each day, subjects that arrived were assigned to a condition ba sed on a pre-assigned order (ex. 1,2,3,4 day one; 3,4,1,2 day two) so that all four conditions would be presented each day. Each of the 4 conditions were run daily in different orde rs to ensure that cells had equal numbers of participants and that condition would not be confounded with time. Participants were individually tested in a clinic observati on room. The testing room was located in the USF Ps ychological Services Center, and the primary investigator was able to observe subject responses a nd food consumption behaviors through a twoway mirror. After greeting resear ch subjects, participants were told that the primary study was a consumer behavior study examining Â“t he relationship between mood, personality characteristics, health behaviors, and th e evaluation of media and food products.Â” The participants first completed full informed consent procedures Afterwards, the subjects completed pre-test state assessment measures (VAS, PANAS-X.) Immediately after completion of the pre-test measures, particip ants watched the experimental or control
41 stimuli videos and filled out media evalua tion ratings (Media Rating Form) during the viewing process. Subjects then complete d the post-test measures (VAS, PANAS-X.) After measuring state body dissatisfaction and state negative affect, mediational measures were administered (Modified SATAQ-3 Me dia Pressures Scale, State Appearance Comparison Scale.) Subjects were then inform ed that their Â“ratings of media material provide feedback about their lik ely media consumption.Â” Then subjects were told, Â“The second product weÂ’ll need you to test is a br and of mini-chocolate chip cookies. Take your time and taste as many as you need to make a decision about the desirability and quality of the cookies.Â” During the tast e test, the primary investigator viewed participants through a two-way mirror. The investigator a) recorded latency of time before initial tasting b) noted whether participants complied (actually tasted the cookies) and c) noted whether particip ants absconded with cookies fo r future eating (as opposed to lab room tasting.) After the taste test, a C ookie Taste Test Rating Form was administered for study face validity. Following completion of the taste test and cookie ratings, participants handed in their completed rating form. Participants were told that Â“people who like to do certain health activities seem to like some foods more than other types of foodsÂ” and therefore, participan ts were asked to complete que stionnaires that asked them about their future health behaviors. At that time, measures assessing dieting and healthrelated intentions were ad ministered (EDE-Q Unhea lthy Weight Control Method Intentions, Dutch Restraint Scale-Intentions to Diet, and MHBI Intentions Scale.) Afterwards, participants were told that Â“sometimes, hunge r can affect whether you like certain foods or how much you like certain foods ;Â” they were then given the State Hunger Scale to complete. Subjects were debriefed, and then completed a short Study Credibility
42 and Video Message Rating Form to assess the extent to which media was clear, understood, influential, and whether the cover story of the consumer study was credible. After completing the form, participants were asked whether they had guessed the study hypotheses, and were asked about food allerg ies and other conditions that could have affected food consumption (religious fasting, di slike of sweets, new braces/tongue ring.) Once participants left the room, the total num ber of cookies consum ed were calculated and recorded. Participants were automatica lly credited with points for completing online trait measures, and were awarded additional points following completion of the experimental lab study. Design and Analyses Preliminary analyses were conducted to te st for any initial differences among the conditions on demographic va riables and baseline trait levels of body dissatisfaction (EDI-BD), thin-ideal internalization (SATAQ3), perceived pressure to be thin (SATAQ3), drive for thinness (EDI-DT), healthy ea ting behaviors (MHBI), exercise behaviors (MHBI), negative affect (PANAS-X), history of teasing (PARTS), dispositional empathy (IRI), dieting (Dutch Restraint Scale), eati ng disturbance symptoms (EDE-Q), and pretest state body dissatisfacti on (VAS) and negative affect (PANAS-X). 1 x 4 ANOVAs were conducted for each continuous variable, and 2 was used to compare categorical variables. If groups were found to differ on any variable, the trait measure from that variable was used in subseque nt tests as a covariate. Di fferences among ratings in the cover story credibility and accessibility of th e video message (MRF) were analyzed in separate one-way ANOVAs.
43 Hypothesis 1 stated that individuals in the fat st igmatization media exposure conditions would have higher le vels of state negative affect (PANAS-X), higher levels of state body dissatisfaction (VAS), would feel more pressure to lose weight (SATAQ-3 Modified Pressures subscale), and would eat more mini-chocolate ch ip cookies (engage in unrestrained eating) or less mini-chocolate ch ip cookies (restraint) than participants in the control conditions. A series of 2 x 2 MANCOVAs (fat condition: fat stigmatization media, no fat media) X (comedy condition: comedy, no comedy) procedures were performed for mood measures and body im age measures separately to examine differences between group centroids and mean vectors, with baseline and pre-test state mood and body image scores entered as co-variate s to control for pre-test levels of state body dissatisfaction and negative affect. Sinc e some dependent measures of mood and body image were uncorrelated, ANCOVAs were employed for dependent variables administered pre-test and pos t-test (VAS and PANAS-X va riables), with BMI, trait baseline, and pre-test state mood or pre-test state body imag e entered as co-variates. 2 x 2 ANCOVAs (fat condition: fat stigmatization media, no fat media) X (comedy condition: comedy, no comedy) were computed for the dependent variables administered at post-test only (modified SATAQ-3 perceived pressure to be thin subscale, intentions measures, and the numbe r/amount of cookies consumed.) SATAQ-3 Trait Perceived Pressure and BMI were ente red into the video state SATAQ-3 perceived pressure ANCOVA as co-variates, and hunger level at the beginning of the study, shape and weight concerns, compensatory behaviors, negative affect at post-test, BMI, ideal weight discrepancy, and history of weight teasing were ente red as covariates into the ANCOVA for cookie consumption. Unhealthy weight control intentions (EDE-Q-
44 Intentions), dieting intentions (Dutch Restraint Scale-Intentions), and intentions to eat healthy and engage in healthy exercise (M HBI) were evaluated in a series of 2 x2 ANCOVAs, with baseline levels of each a nd BMI entered as co-variates. When ANCOVAs were computed, a modified Bonferoni correction was employed to control for familywise Type 1 error. To examine moderator effects, ANCOVAs were used. Hypothesis 2 stated that level of bulimic symptoms, BM I, discrepancy between current and ideal weight, and a history of weight-related teasing would mode rate changes in state body dissatisfaction (VAS) and state negative affect (PANAS-X). Additionally, these trait measures could moderate perceived pressure to lose weight (SATAQ-3 Modifi ed Pressures subscale), and mini-chocolate chip cookie consumption. In or der to establish mode rator effects, there must be a significant interaction between the moderator and the independent variable (fat message exposure). Therefore, each potenti al moderator was entered into an ANCOVA to assess whether there we re interaction effects. Hypothesis 3 stated that exposure to me dia messages in the fat stigmatization experimental conditions would lead to significant post-test differences in perceived pressure to lose weight; the experimental cond itions would elicit great er pressure to lose weight than the control conditions. To test Hypothesis 3, a 2 x 2 ANCOVA was computed on the modified SATAQ-3 pressures scale with the baseline SATAQ-3 Pressures scale and BMI used as covariates. To examine mediator effects, the Pr eacher bootstrap method was used. Hypothesis 4 stated that pre ssure to be thin specific to the video (Modified SATAQ-3Pressures Subscale), an ideal-weight discre pancy (Wtdiscrep), activation of thinking
45 about oneÂ’s appearance (SACS question 1), and state appearance comparison (State Appearance Comparison Scale) would medi ate the relationship between fat media exposure and affective/body shape outcome variables (body dissatisfaction (VAS) and state negative affect (PANAS-X).) Furthermore, negativ e affect would serve as a mediator between fat message exposure and number of cookies consumed, with higher negative affect associated with higher cooki e consumption. Mediators were analyzed by using bootstrap macros in SPSS. Hypothesis 5 was tested by examining wh ether negative aff ect elicited binge behaviors and preceded increased cookie consum ption (tested in the mediational analysis of Hypothesis 4), and examining whethe r social comparison mediated body image disturbance and negative aff ect (tested in the mediationa l analysis of Hypothesis 4). There was a planned examination of whether high DRS trait restraint was violated by affective disturbance and was associated w ith higher cookie consumption. If abstinence violation had occurred and a binge ensued with a sizeable sample, the cognitive restraint model would have been tested with a pla nned regression analysis for restraint and negative affect at time 2 predicting binge. Skewness and kurtosis values were examin ed for all outcome variables. Boxplots were created to examine the pres ence of outliers. Pearson product Moment correlations were computed for all depende nt variables. The modified Bonferroni procedure was used on all comparisons to cont rol for Type 1 error, while having a higher degree of statistical power than the traditional very conservative Bonferroni correction (Kromrey & Dickinson, 1995; Simes, 1986). All analyses were performed using SPSS 15.0, SPSS 16.0, and SPSS 17.0.
46 Chapter 3 Results Preliminary Analyses A total of 197 participants were included in the final analyses for all dependent variables with the exception of number of cookies consumed. Cookie consumption was affected by some extraneous s ubject variables (religious fasti ng, allergy to nuts or gluten, new tongue ring, etc.). Extrane ous variables were identified in interv iews after the study, and were recorded in participant records and with in the electronic data set. A total of 17 participants had extraneous va riables that were identified; therefore, a sample of 181 participants was used to cal culate cookie consumption. Pa rticipants with extraneous variables were distributed across all c onditions, and no condition had significant differences in the proportion of partic ipants with extraneous variables 2 (24, N =197) =19.99, p>.05. Chi-square tests were utilized to examine demographic differences across conditions at pre-test. No significant differences were found among conditions for race, 2 (21, N =196) =22.86, p>.05, year in school 2 (12, N =197) =9.10, p>.05, or national origin 2 (63, N =197) =60.24, p>.05. Although participants with eating disturbances were spread throughout the conditions, a dispr oportionate number of individuals with AN symptoms were located in both control conditions 2 (3, N =197) =5.99, p<.05, and individuals with BED were di sproportionately located in the Fat Comedy and Control Comedy conditions 2 (3, N =197) =11.51, p<.01. Participants with BN were distributed
47 almost equally across conditions 2 (3, N =197) =.92, p>.05. Even though no significant differences were found among c onditions for weight status 2 (9, N =190) =11.84, p>.05, more overweight subjects were located in Fat Stigmatizati on and Control Comedy conditions, and more obese subjects we re located in Fat Comedy and Control Stigmatization conditions. A series of one-way ANOVAs confirmed there were no significant differences among conditions on age, F (3,193)=.91, p>.05 or BMI, F (3,192)=.77, p>.05. Separate one-way ANOVAs on each pre-test trait and state variable indi cated no significant differences among the conditions on body image or eating disorder measures. However, significant differences for state pre-test negative affect were found, both on the PANASX Negative Affect Time 1 F (3,193)=4.51, p<.01, and on a series of other state pre-test VAS negative mood variables (anxiety, ange r.) Follow-up post-hoc Tukey HSD tests revealed a significant difference between the Fat Stigmatization-Negative Interaction and the Fat Stigmatization-Comedy conditions, with the negative interaction condition having high levels of pre-manipulation negative affect and the fat comedy condition exhibiting lower levels of pre-manipulati on negative affect. Baseline nega tive affect scores, pre-test negative affect scores, and pre-test specific negative mood variable scores were used as covariates throughout the mood analyses. The Modified Study Credibility and Messa ge Rating Form items were analyzed separately in one-way ANOVAs to explore a) whether the quality of the message and the study cover story were endorsed by the sample and b) to assess differences in message perception and study credibility among condition s. The MRF items assessed whether the consumer cover story was credible, and wh ether video messages were easy to understand,
48 easy to hear, influential, and applicable A significant difference was found between 2 conditions for cover story credibility, F (3,193)=4.32, p<.02, with the Tukey HSD posthoc test revealing that the Fat Stigmatiz ation-Negative Interaction condition (M=3.9) perceived the credibility of the cover story significantly lower than the ControlStigmatization condition (M=4.4). However, a correlation between cookie consumption and study credibility indicated there was no significant relationship between perceived study credibility and amount of cookies consumed (r=.009, p=.897). Subsequent analyses in which subjects with a mean sc ore of 2 or below for study credibility were removed from the data and analyses re-run re vealed that perceptions of study credibility had no effect on significant results. Asid e from study credibilit y, examination of the mean values for each item by condition (see Ta ble 2) indicated similar responses across conditions for the media messages items. Ov erall mean responses indicated that the majority of the sample found the consumer cover story credible ( M =4.15), the media messages easy to understand ( M =4.69) and easy to hear ( M =4.85), though they did not perceive the media messages to be influential (M=2.43) nor applicable ( M =2.82) to them.
49 Table 2 Means and Standard Deviations for Mess age Rating Form Items by Condition Fat StigmatizationNegative Interaction Fat StigmatizationComedy Condition Control Stigmatization Condition Control Comedy Condition Study Credible 3.90 (.89)a 4.00 (.93) 4.40 (.63)a 4.31 (.74) Easy to Understand 4.80 (.49) 4.67 (.62) 4.52 (.64) 4.78 (.46) Easy to Hear 4.94 (.24) 4.82 (.52) 4.78 (.64) 4.86 (.35) Applicable 2.76 (1.21) 2.90 (1.19) 2.64 (1.19) 2.98 (1.14) Influential 2.69 (1.15) 2.49 (1.06) 2.20 (1.06) 2.35 (1.09) Note Letter subscripts indicate signifi cant differences across conditions. Correlations among the baseline trait vari ables completed online and the pre-test state measures were examined. The correla tion between trait negative affect and state negative affect was high (r=.40), and the correlations among measures of eating disturbance, body dissatisfaction, and internaliz ation was very high (r Â’s ranging from .39 to .82). The correlations between measures of mood and body dissatisfaction and eating disturbance were inconsistent; correlations between trait negative affect and eating disturbance indices were mode st. Correlations between stat e negative affect and eating disturbance were not statisti cally supported, with the exception of a small correlation for perceived pressure to be thin (r=.17). Findings are consiste nt with previous research, which suggest that the mood and eating dist urbance variables ofte n co-occur, but are modestly correlated. The correlations between the baseline trait variables completed online and the post-test variables (body dissa tisfaction, pressure to be thin, negative affect) were
50 reviewed for each dependent variable. All of the correlations were st atistically significant with an alpha level of p<.01. The relati onships between trait body dissatisfaction and post-test state body dissatisfaction (r=.70), betwee n trait pressure to be thin and state pressure to be thin (r=.42), and between tra it negative affect and pos t-test negative affect (r=.42) were fairly robust. The correlati on between trait negative affect and other PANAS negative mood scales assessed duri ng post-test (Hostili ty subscale, Fear subscale, Guilt subscale, Sadness subscale) wa s also considerable, ranging from .32-.39. Furthermore, the correlations between VAS state measures of ne gative mood (Anxiety, Anger) and trait negative affect were mode st (ranging from .24-.34). Because of the robust correlations between baseline and posttest scores, and because some conditions had significantly higher levels of negative affect present at pre-test, the baseline scores were included as co-variates in analyses. The primary purpose of using these co-variates is to reduce within-group error variance and increase the power to detect the effect of the independent variable, as well as to equalize the conditions on pre-existing trait variables. Finally, all of the dependent variables were correlated with one another to examine the strength of the relationships among them. Body dissatisfaction measures were highly correlated with one another (rÂ’s ranging from .90-.97) and mood measures were highly correlated with one another (rÂ’s ranging from .33-.80). However, some mood variables were significantly and robus tly correlated with body image and perceived pressure to be thin measures, while ot her mood indicators displayed no significant correlations. Because correlations were robus t and consistent within construct (mood vs. body dissatisfaction), but inconsistent in st rength between constructs, 2 separate MANCOVAs (one for mood, and one for body dissatisfaction) were conducted. Since
51 some dependent variables were uncorrelate d, separate ANCOVAs were performed as a follow-up after MANCOVA analyses. Before conducting analyses, the data were analyzed for violations of normality. Each dependent variable was examined for outliers, skewness, and kurtosis. Boxplots were created to visually inspect outlier s for each dependent variable. Frequency distributions, skewness and kur tosis values, standard erro r of skewness and kurtosis values, and bar graphs were created to ex amine whether the data violated normality assumptions. Outliers were present for mood de pendent variables, state pressure to be thin, and cookie consumption. There were no outliers for body dissatisfaction dependent variables. Outliers that were more than 3 standard deviations above the mean were identified; an average of 5-6 outliers was present for each DV (N=197.) Analyses were conducted with and without the outliers pres ent. Skewness and kurtosis were calculated with a formula (skewness va lue/stand. error of skewness 3.33; kurtosis value/stand. error of kurtosis 3.33). All DVs had skewness and kur tosis, with the exception of the body image dependent variables. To address the significant skewness and kurtosis, log transformations were used. Because data in a log transformation must remain above 1 (or the data will be undefined), a constant of 1 was added to all variables that included a response of zero or less than 1 (VAS anxiety, anger, cookie consumption.) Analyses were conducted with raw data for body image depende nt variables; analyses were conducted with both raw data and transformed data for all other dependent variables.
52 Planned MANCOVA and ANCOVA analyses 2 x 2 MANCOVAs. Two separate sets of MANCOVAs were computed to examine post-test differences in mood and body image disturba nce, with baseline covariates and BMI entered into the equation to control for pre-test differences. Because body image disturbance data contained no outliers, no skewness, and no kurtosis, body image data was computed with one raw data MANCOV A. Within the MANCOVA, trait body dissatisfaction, weight dissatisfaction and shap e dissatisfaction at pr e-test, and BMI were entered as covariates. However, mood da ta had significant outli ers, skewness, and kurtosis; therefore, mood data MANCOVAs were computed with outliers raw, without outliers raw, with outliers transformed, and without outliers transformed. Within the MANCOVA, trait negative affect, state negative affect at pre-test, and BMI were entered as covariates. All MANCOVA covariate adjust ed means and significance test results are displayed in Table 3. There were no significant main effe cts found for differences in state body dissatisfaction, although there wa s a directional trend toward increased dissatisfaction for participants exposed to fat messages ( =.97, F=2.616, p<.07). Follow-up contrast results indicated that the trend toward si gnificance was driven by dissatisfaction with body shape (F=2.9, p<.09). Covariate adjusted means indicate that dissatisfaction with body shape (M=3.6 ) is higher for those exposed to fat messages than for those exposed to the control conditions (M=3.3 ). Both Boxes M test of covariance matrices and LeveneÂ’s test of error vari ances were not significant, i ndicating that error was not significantly different ac ross matrices or groups.
53 Four mood MANCOVAs were computed (raw, raw with outliers removed, log transformed, log transformed w ith outliers removed), with similar results. Raw results are reported. There were no significant fat exposure main effects found for differences in overall mood across conditions ( =.94, F=1.606, p=.136). However, specific subtypes of negative mood (guilt, negative affect) we re significantly different across groups. Covariate adjusted means indica te that guilt (M=7.9 ) is si gnificantly higher for those exposed to fat media messages than for those exposed to control conditions (M=7.2 ). Covariate adjusted means indicate that nega tive affect (M=12.0) is significantly higher for those exposed to fat media messages th an for those exposed to control conditions (M=11.5 ). There was a significant main effect found for exposure to comedy, with comedy conditions eliciting lower negative mood ( =.92, F=2.42, p=.02). There were no significant interaction effects. Both Boxes M test of covari ance matrices and LeveneÂ’s test of error variances were significant, indicating that e rror was significantly different across matrices and groups.
54 Table 3 Covariate adjusted means, standard deviations, F, P, and partial n values for planned MANCOVAs _______________________________________________________________________ MANCOVAs Fat Negative Fat Comedy Control Negative Control Comedy p, partial n Adjusted M Adjusted M Adjusted M Adjusted M SE SE SE SE _____________________________________________________________________________________ Body Image Body Shape Dissatisfaction 3.6 (.21) 3.7 (.21) 3.3 (.21) 3.2 (.21) Body Weight Dissatisfaction 3.4 (.19) 3.5 (.19) 3.5 (.19) 3.5 (.19) Body Dissatisfaction Fat Expo =.97, F=2.6, p<.07, partial n=.027 Comedy =.99, F=.13, p=.87, partial n=.001 Fat E x C =.99, F=.29, p=.74, partial n=.003 Mood Negative Affect 12.2 (.24) 11.8 (.24) 11.7 (.24) 11.4 (.24) Fear 6.8 (.17) 6.8 (.17) 6.8 (.16) 6.8 (.16) Hostility 7.6 (.20) 6.8 20) 7.0 (.20) 6.6 (.20) Guilt 8.2 (.30) 7.5 (.30) 7.4 (.29) 7.0 (.29) Sadness 6.7 (.27) 6.2 (.27) 6.3 (.26) 6.0 (.26) Anxiety 2.8 (.25) 2.5 (.25) 2.9 (.24) 2.5 (.24) Anger 2.6 (.19) 1.9 (.18) 2.1 (.18) 1.7 (.18) Overall Negative Mood Fat Expo =.94, F=1.606, p=.136, partial n=.06 Comedy =.92, F=2.42, p=.02, partial n=.09* Fat E x C =.98, F=.41, p=.89, partial n=.02 ______________________________________________________________________________________ Note Fat Expo: Fat Message Exposure Main Effect; Comedy: Comedy Exposure Main Effect; Fat E X C: Fat Exposure x Comedy Exposure Interaction Effect *p<.05 **p<.01
55 2 x 2 ANCOVAs. Because MANCOVAs were not significan t for fat exposure main effects, but demonstrated significant findings for partic ular dependent variables, all dependent variables were subjected to additional i ndividual analyses. 2 x 2 ANCOVAs were computed for each variable, controlling for baseline, pre-test, and BMI variables. ANCOVAs for body dissatisfaction were analyzed with raw data, since the data had no outliers, no skewness, and no kurtosis. Sin ce all other variables demonstrated outliers, skewness, and kurtosis, the data was analyzed using ANCOVA with four data sets (raw data, raw data without outliers, transformed da ta, transformed data w ithout outliers.) See Table 4 for all ANCOVAs. The 2 x 2 ANCOVA for body shape dissatisfaction had BMI, body shape dissatisfaction pre-test, and trait body dissatisfaction entered into the equation as covariates. There were no signi ficant main effects or inte ractions. There was a slight trend toward increased body sh ape dissatisfaction for those pa rticipants exposed to fat messages (M=3.66 ) versus non-fat messages (M=3.32 ). For the body weight dissatisfaction ANCOVA, BMI, body weight dissatisfaction pretest, and trait body dissatisfaction were included as covariates. Ag ain, there were no significant main effects or interactions. For the mood variable of negative affect covariates were BMI, trait negative affect, and negative affect at pre-test. Ther e was a significant main effect found for fat message exposure, F(1,197)=3.78, p=.05, partial n=.02; the fat message conditions had a higher level of negative aff ect (M=12 ) than the two control conditions (M=11.55 ). When the results are re-run with outliers rem oved, with log transformations, and with log
56 transformations with outliers removed, the a bove results remain robust. The dependent variable guilt was entered into a 2 x 2 ANCOVA, with co-variates BMI, trait negative affect, pre-test negative affect, and pre-test guilt. There was a significant main effect found for fat message exposure, F(1,197)=8.9, p=.003, partial n=.05; this effect was robust across methods of ANCOVA comput ation (outliers, log transformed, log transformed minus outliers.) A 2 x 2 ANCOVA was computed for the dependent variable anger, with BMI, trait negative affect pre-test negative aff ect, and pre-test anger as co-variates. There was a significant main effect for fat message exposure F(1,197)=4.11, p=.04, partial n=.02; this find ing was supported using all other methods of ANCOVA computation (out liers removed, log transfor med, log transformed with outliers removed). Both guilt and anger were higher for participants exposed to fat messages. There were significant main effects found for comedy exposure on the dependent variables hostility F(1,197 )=10.2, p=.002, partial n=.05, sadness F(1,197)=10.1, p=.002, partial n=.05, guilt F(1,197)=3.8, p=.05, partial n=.02, and anger F(1,197)=15.9, p=.000, partial n=.08. Th ese negative mood variables were lower for participants exposed to comedy conditions as opposed to the negative interaction conditions. No other mood va riables were significant. A 2 x 2 ANCOVA was computed for the dependent variable perceived video pressure to lose weight. Co-variates en tered into the ANCOVA equation were trait SATAQ pressure (perceived pressure to lose weight) and BMI. There was a significant main effect found for fat message expos ure, F(1,197)=34.14, p=.000, partial n=.152, and a significant main effect for the co-var iate BMI F(1,197)=7.17, p=.008, partial n=.036. There was also a significant interaction effect for fat comedy message exposure,
57 F(1,197)=4.72, p=.03, partial n=.024. Partic ipants exposed to fat stigmatization messages or fat comedy messages experienced mo re perceived pressure to lose weight. The results were robust across computation methods. A 2 x 2 ANCOVA was computed for the de pendent variable number of cookies consumed. Compromised data due to subjec t error was removed (subjects acknowledged allergies to chocolate or glut en, fasting for religious reasons new braces or tongue rings that made eating painful), with a slightly sm aller sample remaining (N=181). Co-variates entered into the equation include BMI, idea l weight discrepancy, state negative affect post-test, eating concerns about body shap e and body weight, eating compensatory behaviors, history of weight teasing, and state hunger levels There was a significant main effect found for fat message exposure, F( 1,181)=4.58, p=.03, partial n=.026. Participants exposed to fat messages consumed signifi cantly fewer cookies. There were also significant main effects for 3 co-variate s: eating weight and shape concerns, F(1,181)=7.40, p=.007, partial n=.042, negative affect at post-test after the video, F(1,181)=4.43, p=.037, partial n=.026, and state levels of hunger, F(1,181)=16.71, p=.000, partial n=.09. Additi onal ANCOVA computation met hods solidified support for the significant main effect of fat exposure, and for significant main effects for co-variates eating and shape concer ns and state hunger. Some measures that assessed future intent ions rather than current behaviors were examined using 2 x 2 ANCOVAs; none were sign ificant (see Table 4 continued). A 2 x 2 ANCOVA was computed for the dependent vari able intentions to engage in healthy nutrition behaviors. Co-variates entered into the ANCOVA equation were trait MHBI Healthy Nutrition, EDESW and EDE Comp (ea ting disorder shape and weight concerns
58 and compensatory behaviors), and BMI. Th ere were no significan t main effects found for fat message exposure, F(1,197)=0.0, p= .945, partial n=.000, though there was a significant main effect for the co-variate BMI F(1,197)= 5.09, p=.02, partial n=.026. A 2 x 2 ANCOVA was computed for th e dependent variable intenti ons to engage in exercise behaviors. Co-variates entered into th e ANCOVA equation were trait MHBI Healthy Exercise Behaviors, EDESW and EDE Comp ( eating disorder shape and weight concerns and compensatory behaviors), and BMI. Th ere were no significan t main effects found for fat message exposure F(1,197)=0.897, p= .345, partial n=.005. A 2 x 2 ANCOVA was computed for the dependent variable re straint intentions (DRS-QI). Co-variates entered into the equation were DRS-Q Tra it, EDESW and EDE Comp (eating disorder shape and weight concerns and compensato ry behaviors), and BM I. There were no significant main effects for fat me ssage exposure F(1,197)=0.202, p=.653, partial n=.001. Finally, a 2 x 2 ANCOVA was comput ed for the dependent variable eating disorder compensatory behavior intentions (E DE-Q Intentions). Co-variates entered into the equation include EDESW and EDE Comp (ea ting disorder shape and weight concerns and compensatory behaviors), and BMI. Ther e were no significant main effects for fat message exposure F(1,197)=0.004, p=.952, partial n=.000. There was some concern that ANCOVAs ma y be significant due to the clinically eating disordered sample subset within the larger undergraduate sample. All individuals meeting criteria for an eating disorder (N= 31) (based on the EDE-Q) were removed and analyses were re-run with the raw data. There were two discre pancies that occurred when examining the non-clinical sub-sample. First, there was a significant main effect found for fat message exposure on body shape dissatisfaction in the non-clinical sub-
59 sample, F (1,166)=4.03, p=.046, partial n=.025. S econd, the main effect that had been found for fat message exposure on negative affect evaporated F (1, 166) = 1.31, p=.25, partial n=.008. Similar to original findings, there was a significant main effect for Fat Message Exposure on Guilt F(1, 166) = 3.86, p=.05, partial n=.024 and a significant interaction effect for the Fat x Co medy exposure on Guilt F (1, 166) = 3.81, p=.05, partial n=.023. Consistent with original fi ndings, there was a signi ficant main effect for Fat Message Exposure on Anger F(1, 166) = 3.8, p=.05, partial n=.023. All other mood variables and body dissatis faction variables were not signifi cant. In terms of perceived video pressure to lose weight, both fa t message exposure F (1, 166) = 28.98, p=.000, partial n=.153. and fat x comedy message exposure F (1, 166) = 7.4, p=.007, partial n=.044 were significant main and interacti on effects, which matched findings in the primary sample. For cookie consumption, prim ary findings were upheld in that there was a significant main effect for fat messa ge exposure F (1, 166) = 6.56, p=.011, partial n=.043. These findings suggest that the cl inical eating disorder subgroups are not entirely responsible for signifi cant findings in the study data. Due to the large number of ANCOVA an alyses conducted, a modified Bonferroni correction procedure was utilized to redu ce the likelihood of a Type I error while maintaining a higher degree of statistical power than the traditional, more conservative Bonferroni correction (Kromr ey & Dickinson, 1995; Simes, 1986). The application of the approach is .10/ total number of ANCOV A analyses conducted (15), which resulted in a new significance level of .006. Using this more conservative criteria, most of the ANCOVA results would not be considered sign ificant. However, main effects for fat message exposure on guilt and pressure and to be thin would remain supported.
60 Table 4 Covariate adjusted means, standard deviations F, P, and partial n values for planned ANCOVAs ________________________________________________________________________ ANCOVAs Fat Negative Fat Comedy Control Negative Control Comedy F p, partial n Adjusted M Adjusted M Adjusted M Adjusted M SE SE SE SE ______________________________________________________________________________________ Body Image Body Shape Dissatisfaction 3.6 (.23) 3.7 (.23) 3.3 (.22) 3.3 (.22) FE F(1, 197)=2.25, p=.13, partial n=.012 C F(1, 197)=.001, p=.97, partial n=.012 FxC F(1, 197)=.01, p=.89, partial n=.000 Body Weight Dissatisfaction 3.5 (.20) 3.6 (.20) 3.5 (.20) 3.5 (.20) FE F (1, 197)= .002, p=.96, partial n=.00 C F(1, 197)=.136, p=.71, partial n=.001 FxC F(1, 197)=.07, p=.79, partial n=.000 Mood Negative Affect 12.2 (.24) 11.8 (.24) 11.7 (.24) 11.4 (.24) FE F(1, 197)= 3.78, p=.05, partial n=.02 C F(1, 197)=3.03, p=.08, partial n=.016 FxC F(1, 197)=.01, p=.91, partial n=.000 Fear 6.8 (.15) 6.8 (.15) 6.7 (.15) 6.8 (.15) FE F(1, 197)= 0.15, p=.69, partial n=.001 C F(1, 197)=0.08, p=.77, partial n=.000 FxC F(1, 197)=0.01, p=.89, partial n=.000 Hostility 7.4 (.16) 6.8 (.16) 7.1 (.16) 6.7 (.16) FE F(1, 197)= 1.9, p=.17, partial n=.01 C F(1, 197)=10.2, p=.002,partial n=.05 ** FxC F(1, 197)=.02, p=.88, partial n=.000 Guilt 7.9 (.19) 7.7 (.19) 7.5 (.18) 7.0 (.18) FE F(1, 197)= 8.9, p=.003, partial n=.05 ** C F(1, 197)=3.8, p=.05, partial n=.02* FxC F(1, 197)=.48, p=.480, partial n=.003 Sadness 6.7 (.18) 6.1 (.18) 6.4 (.17) 5.9 (.18) FE F(1, 197)= 2.39, p=.12, partial n=.013 C F(1, 197)=10.1, p=.002, partial n=.05** FxC F(1, 197)=.08, p=.77, partial n=.000 ____________________________________________________________________________________________________________ (Table Continues)
61 Table 4 (Continued) Covariate adjusted means, standard deviations F, P, and partial n values for planned ANCOVAs ________________________________________________________________________ ANCOVAs Fat Negative Fat Comedy Control Negative Control Comedy F p, partial n Adjusted M Adjusted M Adjusted M Adjusted M SE SE SE SE ______________________________________________________________________________________ Anxiety 2.7 (.19) 2.7 (.19) 2.8 (.19) 2.4 (.19) FE F(1, 197)= 0.29, p=.59, partial n=.002 C F(1, 197)=0.95, p=.33, partial n=.005 FxC F(1, 197)=.69, p=.40, partial n=.004 Anger 2.6 (.17) 1.9 (.17) 2.3 (.16) 1.6 (.17) FE F(1, 197)= 4.11, p=.04, partial n=.02* C F(1, 197)=15.9, p=.00, partial n=.08 ** FxC F(1, 197)=.05, p=.81, partial n=.000 Video Induced Pressure to be Thin Video Pressure To be Thin 12.2 (.60) 10.0 (.60) 7.3 (.60) 7.8 (.60) FE F(1, 197)= 34.1, p=.00, partial n=.15 ** C F(1, 197)=1.93, p=.165, partial n=.010 FxC F(1, 197)=4.72, p=.03, partial n=.02 Number of Cookies Consumed # of Cookies 2.3 (.31) 2.4 (.30) 2.9 (.30) 3.1 (.30) FE F(1, 181)= 4.5, p=.034, partial n=.026 C F(1, 181)=.27, p=.602, partial n=.002 FxC F(1, 181)=.000, p=.98, partial n=.000 ____________________________________________________________________________________________________________ (Table Continues)
62 Table 4 (Continued) Covariate adjusted means, standard deviations F, P, and partial n values for planned ANCOVAs ________________________________________________________________________ ANCOVAs Fat Negative Fat Comedy Control Negative Control Comedy F p, partial n Adjusted M Adjusted M Adjusted M Adjusted M SE SE SE SE ______________________________________________________________________________________ Intentions Healthy Nutrition 41.3 (.72) 39.5 (.72) 40.0 (.71) 40.6 (.72) FE F(1, 197)=0.0, p=.945, partial n=.000 C F(1, 197)=.68, p=.40, partial n=.004 FxC F(1, 197)=2.6, p=.108, partial n=.014 Healthy Exercise 13.7 (.43) 14.1 (.43) 13.5 (.42) 13.6 (.43) FE F(1, 197)= 0.89, p=.345, partial n=.005 C F(1, 197)=.352, p=.554, partial n=.002 FxC F(1, 197)=.109, p=.74, partial n=.001 Restriction 27.7 (.89) 29.2 (.88) 28.4 (.86) 29.2 (.88) FE F(1, 197)= 0.20, p=.653, partial n=.001 C F(1, 197)=1.65, p=.20, partial n=.009 FxC F(1, 197)=.18, p=.67, partial n=.001 Compensatory Behaviors 8.6 (.41) 8.7 (.40) 9.1 (.40) 8.2 (.40) FE F(1, 197)= 0.00, p=.95, partial n=.000 C F(1, 197)=1.26, p=.26, partial n=.007 FxC F(1, 197)=1.3, p=.23, partial n=.007 ______________________________________________________________________________________ Note FE: Fat Message Exposure Main Effect; C: Come dy Exposure Main Effect; F X C: Fat Exposure x Comedy Exposure Interaction Effect *p<.05 **p<.01
63 Moderator Analyses To assess whether exposure to fat medi a messages results in greater negative affect, body dissatisfaction, higher perceived pr essure to be thin, and binge behavior among a sub-population of those with current binge behaviors, hi gh BMIs, discrepancy between ideal and current weight, and history of teasing, a series of moderation analyses were computed. All dependent variables we re separately entered into 2 x 2 ANCOVA SPSS Custom-Models to see if there were in teraction effects be tween the moderator variable and the factor fat me ssage exposure (see Table 5). For the dependent variables body we ight dissatisfaction, body shape dissatisfaction, and overall body dissatisfaction, there were no significant moderators for fat message exposure. A history of binge ea ting behavior, a discrepancy between current and ideal weight, and a history of teasing al l significantly impacted an individualÂ’s body shape satisfaction scores; furthermore, a di screpancy between curre nt and ideal weight, and a history of teasing were significant ma in effect co-variates that impacted an individualÂ’s body weight and ove rall body dissatisfaction scores. For the dependent variable perceived vide o pressure to lose weight, there were no significant interaction effects. However, a discrepancy between current and ideal weight, and a history of teasing both si gnificantly impacted an indivi dualÂ’s perceived pressure to lose weight. For the dependent variable number of cookies consumed, there were no significant interaction effects. However, a discrepancy between current and ideal weight significantly impacted food intake.
64 Significant moderation effects occurred within the domain of mood dependent variables. There was a significant interacti on effect for fat message exposure and the moderator BMI on Negative Affect at posttest Time 2, F(1, 197) = 3.77, p= .05, partial n=.021. Additionally, there was a significant interaction effect for fat message exposure and the moderator history of weight teasing on Negative Affect at post-test Time 2, F(1, 197) = 4.56, p= .03, partial n=.025. There was a significant interac tion effect for fat message exposure and the moderator BMI on Hostility at post-test Time 2 F(1, 197) = 6.71, p= .01, partial n=.03. For the dependent variable Guilt, th ere was a significant interaction effect for fat message exposure a nd the moderator history of weight teasing, F(1, 197) = 7.6, p= .006, partial n=.042. With rega rd to the dependent variable Sadness, there was a significant intera ction effect for fat message exposure and the moderator history of weight teasing, F(1, 197) = 4.2, p= .04, partial n=. 023. There was a significant interaction effect for fat message exposure a nd the moderator history of weight teasing for the dependent variable Fear F(1, 197) = 4.5, p= .03. All mood vari able inte ractions were plotted in graphs. Mood dependent vari ables and co-variates were consistent; fat message exposure yielded higher scores of di stressed mood as BMI increased and as a history of weight related teasing experiences increased.
65 Table 5 F, P, and partial n values for Moderaters between Fat Message Exposure and Dependent Variables ________________________________________________________________________ ANCOVAs F p, partial n values Dependent Variables ______________________________________________________________________________________ Body Shape Dissatisfaction NONE SIGNIFICANT Body Weight Dissatisfaction NONE SIGNIFICANT Overall Body Dissatisfaction NONE SIGNIFICANT Negative Affect FAT x BMI F(1, 197)= 3.77, p=.05, partial n=.021* FAT x PARTS F(1, 197)= 4.56, p=.03, partial n=.025* Hostility FAT x BMI F(1, 197)= 6.71, p=.01, partial n=.03** Guilt FAT x PARTS F(1, 197)= 7.6, p=.006, partial n=.042** Sadness FAT x PARTS F(1, 197)= 4.2, p=.04, partial n=.023* Fear FAT x PARTS F(1, 197)= 4.5, p=.03, partial n=.026* Pressure to be Thin NONE SIGNIFICANT # of Cookies NONE SIGNFICANT ______________________________________________________________________________________ Note Fat: Fat Message Exposure; BMI: Body Mass Index; PARTS: History of Weight Teasing *p<.05 **p<.01
66 Mediation Analyses To test empirically supported eating disord er models within the context of the fat media message exposure, a series of mediati on models were created and tested. The two primary types of media message exposure (fat media exposure vs. c ontrol exposure) were directly compared in the mediation analys es; fat media exposure was coded as Â“1Â” and control media exposure was coded as Â“0Â”. For each mediation te st, the covariate BMI and a pre-test covariate were included in th e model. To assess th e presence of mediation, significance tests were based on a bootstrapped estimate of th e indirect effects (product of a and b). This approach was selected because it does not require data normality, has higher power for smaller samples, and has shown reasonable control over the Type 1 error rate. An SPSS Macro was used to create bootstrap estimates based on 5,000 samples with 95% two-tailed bias corrected confidence intervals to control the familywise error rate for each of the mediator m odels tested (Preacher & Hayes, 2004; Preacher & Hayes, 2008). Figure 4 depicts the significant mediati on models assessed based on bootstrapped bias corrected confidence intervals of the indi rect effects that did not include zero. When examining the effects of various state soci al appearance comparison mediators on body dissatisfaction and negative affect, it becomes clear that the activation of thinking about self appearance has a significant mediation e ffect on body dissatisfac tion, and total social appearance comparison has a significant mediation eff ect on body dissatisfaction. Although components and relations hips of other eating disorder models were supported, additional mediation effects within the cont ext of exposure to fat media messages were not supported (see Table 6).
67 BMI, Body Dissatisfaction Time 1 controls Appearance Activation .76 a (Sa) 1.01 b (Sb) Fat Message Exposure Body Dissatisfaction Post .30 c (Sc) -.47 cÂ’ (ScÂ’) BMI, Body Dissatisfaction Time 1 controls Overall SACS score .54 a (Sa) .87 b (Sb) Fat Message Exposure Body Dissatisfaction Post .30 c (Sc) -.16 cÂ’ (ScÂ’) Figure 4. Significant Mediation Models for the Tripartite Model.
68 Table 6 Mediation Tests between Fat Message Exposure and Dependent Variables ________________________________________________________________________ Path Negative Body Coef. (SE) Affect Dissatisfaction ________________________________________________________________________ Tripartite Model-Appearance Acti vation (SACSQ1) as Mediator a(Sa) .76 (.22)* .76 (.22)* b(Sb) .14 (.14) 1.01 (.23)* c(Sc) .49 (.43) .30 (.74) cÂ’(ScÂ’) .38 (.45) -.47(.73) ab .11 .77* CI(lower, upper) [-.08,.39] [.31,1.49] ________________________________________________________________________ Tripartite Model-Appearance Comparison (AC) as Mediator a(Sa) .42 (.19)* .42 (.19)* b(Sb) .12 (.15) .39 (.27) c(Sc) .49 (.43) .30 (.74) cÂ’(ScÂ’) .44 (.44) .13 (.75) ab .05 .16 CI(lower, upper) [-.03,.25] [-.04,.63] ________________________________________________________________________ Tripartite Model-Total Com parison (SACS) as Mediator a(Sa) .54 (.17)* .54 (.17)* b(Sb) .18 (.17) .87 (.30)* c(Sc) .49 (.43) .30 (.74) cÂ’(ScÂ’) .39 (.44) -.16 (.75) ab .09 .47* CI(lower, upper) [-.03,.32] [.15,1.06] ________________________________________________________________________ Tripartite Model-State Vide o Pressure as a Mediator a(Sa) 3.49 (.59)* 3.5 (.60)* b(Sb) .07 (.02)* .04 (.04) c(Sc) .40 (.24) .31 (.36) cÂ’(ScÂ’) .13 (.25) .15 (.40) ab .27 .16 CI(lower, upper) [.06,.53] [-.06,.46] ________________________________________________________________________ (Table Continues)
69 Table 6 (Continued) Mediation Tests between Fat Message Exposure and Dependent Variables ________________________________________________________________________ Path Negative Body Coef. (SE) Affect Dissatisfaction ________________________________________________________________________ Exploratory Analyses-Ideal Wei ght Discrepancy as a Mediator a(Sa) 1.7 (2.9) 1.7 (2.9) b(Sb) .00 (.00) .16 (.01)* c(Sc) .39 (.24) .93 (.92) cÂ’(ScÂ’) .39 (.24) .64 (.78) ab .00 .29 CI(lower, upper) [-.02,.06] [-.62,1.29] ________________________________________________________________________ ________________________________________________________________________ Path # Cookies Coef. (SE) Consumed ________________________________________________________________________ Dual Pathway Model-Negative Affect as Mediator a(Sa) .42 (.26) b(Sb) .23 (.08)* c(Sc) -.59 (.30)* cÂ’(ScÂ’) -.69 (.30)* ab .09 CI(lower, upper) [-.00,.37] ________________________________________________________________________ Note : *p<.05
70 Chapter 4 Discussion The purpose of the primary study was to examine the immediate and short-term effects of fat stigmatization video messa ge exposure on psychological functioning, dieting and weight control inten tions, perceived pressure to be thin, and eating behaviors. It was hypothesized that subjec ts in the fat stigmatization media exposure conditions in comparison with the control conditions would report higher levels of state negative affect and state body dissatisfac tion, would feel more pressure to lose weight, and would eat significantly more or significantly le ss mini-chocolate chip cookies (engage in restraint or binge eating). Several of the body image hypotheses were partially supported. Upon examining whether there were significant differences in the dependent variable body image dissatisfaction for those participants exposed to fat messages, there were no statistically significant main factor effects found in the MANCOVA or follow-up ANCOVA analyses. Within MANCOVA and ANCOVA an alyses, a trend was found for higher levels of body shape dissatisfaction, but not body weight dissatisfaction, for those exposed to fat video messages. Upon examina tion of meditational da ta, there was support for appearance activation as a mediator of fat exposure effects on body dissatisfaction, but not social comparison as a mediator. With in the context of comparing appearance to a thin target, social comparison is a powerf ul mediator; however, when exposed to fat media messages, appearance activation, but not social comparison, plays a dominant role
71 in inducing body dissatisfaction. Therefore, depending on the type of media exposure, it is likely that 2 correlated but se parate constructs may be activat ed in a similar direction or in opposite directions, with th e dominant construct effect ing body image dissatisfaction. Hypotheses that negative mood would be hi gher for participants in the fat media exposure conditions were partially suppor ted. A MANCOVA examining negative mood state levels for those exposed to fat media messages vs. control messages indicated no significant differences between groups. Fo llow up ANCOVAs did indicate significantly higher levels of negative affect, feelings of guilt, and feeling angry at post-test in the experimental conditions, despite controlling for BMI, trait negative affect, pre-test negative affect, and a pre-test baseline of the specific negative mood variable. There were interaction effects found in the nega tive affect ANCOVA, with those who report high BMIs or a history of wei ght teasing more likely to experience negative affect when exposed to fat media messages. Dieting and weight control intention hypot heses were completely unsupported in the analyses. Hypotheses that exposure to negative fat media messages would result in higher levels of intentions to engage in healthy eating behaviors, healthy exercise behaviors, food restriction, and compensatory be haviors were not significant. While this may be due to no true effects of media messa ge exposure on future behavioral intentions, it is also possible that test sensitization o ccurred. Participants were given intentions measures after consuming cookies, and this cookie consumption may have had stronger effects on future eating intentions than medi a exposure. Although the decision to provide intentions measures post-cooki e consumption was undesirable from a design perspective, the investigators based the d ecision to measure actual ea ting behavior as a primary
72 outcome more important than future intentions since data suggests that intentions do not always correlate we ll with behavior. Perceived pressure to be thin hypothe ses were supported by study analyses. Pressure to be thin at post-test was found to be significantly higher for those participants in the fat media message exposure conditions. These results are consistent with findings from previous studies examining the impact of media messages on pressure to be thin, which indicates though it is not a causal risk factor for eat ing disorder psychopathology, it is a mediator for disordered ea ting (Roehrig, Thompson, & Cafri, 2008). With regard to dysfunctional eating, the pr imary analyses indicated a significant food restriction effect for those subjects in the experimental fat media exposure conditions. In addition, 3 co-varia tes that were controlled for in the analyses significantly affected cookie consumption: eating and weight/shape concer ns, negative affect at posttest, and state levels of hunge r. Only two participants met criteria for an analogous binge; binge behavior was defined as 1) eating consumption amount above the 3rd percentile of the bell curve, and 2) quick consumption of food. One participant had a BED diagnosis, and was an obese female dist ressed by the fat media message material. She consumed 14 of 30 cookies. The other participant was a thin underweight college freshman with no eating and shape concerns ; however, she had active binge eating and compensatory exercise behaviors. The part icipant was randomly assigned to the control comedy condition. The participant was upset by a clip that she felt was a sexual slur against women; she consumed 18 of 30 cooki es. Both participants during debriefing reported state hunger (neither had eaten any meals for the day), and negative affect increases, hostility increases, and anger in creases associated w ith the clips. Food
73 consumption for these two participants was qua litatively distinct (quick initiation) from the eating behavior of other participants. Overall, both eating disordered and non-eating disordered individuals exposed to fat media messages tended to s lightly restrict food intake when compared to those individuals in the control conditions ; the 2 subjects who engaged in an analogue binge are exceptions. It was also hypothesized th at the presence of particul ar moderaters (bulimic symptoms, above average BMIs, a discrepanc y between current and ideal weight, and a history of weight-related teasing) woul d result in higher le vels of state body dissatisfaction and state negative affect, in creased pressure to lose weight, and consumption of more mini-chocolate chip c ookies (engage in unrestrained eating) than subjects placed in control conditions. It was hypothesized th at subjects with AN symptoms (high trait levels of restraint and low levels of bulimia symptoms) would report similar psychological out comes, but would be less likel y to engage in unrestrained eating. Moderators were examined by entering each as a co-variate in teraction with fat message exposure into ANCOVAs with dependen t variables. There were no interaction effects between fat media message exposure and the moderators on food intake, body dissatisfaction, or perceived pr essure to lose weight. Ho wever, there were significant interaction effects for fat media message exposure and BMI on negative affect and hostility. There were significant interaction effects for fat media message exposure and a history of weight teasing on negative affect, guilt, sadness, and fear. Moderator analyses revealed that although each potential mode rator affected psychological and eating behaviors, only some of them were importa nt as moderators of mood (BMI, history of
74 weight teasing) in the context of exposure to fat media mess ages. Results indicate that overweight and obese individuals and women with histories of weight related teasing, are more vulnerable to negative psychologi cal consequences of fat media message exposure. Finally, the purpose of the study was to test the mediation effects of unique components of empirically supported eating di sorder models. Regarding the social comparison component of the Tripartite model, it was hypothesized th at activation of a self-appearance schema and a weight id eal discrepancy, and social appearance comparison to characters in the videos would be mediators of the rela tionship between fat stigmatization media exposure and body image disturbance and negative affect. To test the negative affect component of the Dual -Pathway Model, it was hypothesized that negative affect would serve as a mediat ional link between exposure to the fat stigmatization video messages and cookie consum ption. Finally, with regard to the Polivy and Herman restraint theory, it was hypothesized that cognitive dietar y restraint would be violated in the presence of mood disturbance and fattening fo ods, and that these factors (high trait restraint, abstinence violation) would precede binge and subclinical binge eating. A series of mediation analyses were employed using the Preacher bootstrap method to test models 1 and 2. A regressi on was planned to exam ine whether high trait dietary restraint and negative affect at time 2 predicte d binge eating in the study. Mediation analyses examining the social comparison component of the Tripartite model were deconstructed into a series of 6 analyses. First, the SACS measure was dismantled into appearance activation (Question1) and was used as a mediator of
75 negative affect and body dissatisfaction, and social comparison behavior (Questions 2 and 3) as a mediator of negative affect and body dissatisfaction. Second, the overall questionnaire SACS total score was used as a mediator of negative affect and body dissatisfaction. Analyses revealed that exposure to negative fat media messages was significantly associated with appearance activation, social co mparison behavior, and total SACS. However, appearance activ ation was the primary driver of significant increases in body dissatisfaction, with the total SACS scor e less significantly a ssociated with body dissatisfaction, and social comparison not associated with body dissatisfaction. Appearance activation may be activating fear of weight gain or negative body selfevaluation in the context of exposure to ne gative fat messages, and may be the primary process driver within the sp ecific situation. Therefore, it is possible that there are 2 separate processes that aff ect body dissatisfaction induction: social comparison and an unspecified mediator that occurs during a ppearance activation. The dominant process mediates improvements or increased dissatisfaction situationally. Mediation analyses testing the role of id eal weight discrepanc ies as a mediator between fat message exposure and body imag e dissatisfaction and negative mood were not supported. Additional analyses reviewing th e role of pressure to be thin from the video messages as a mediator between fat message exposure and body image dissatisfaction and negative m ood were also not supported. Mediation analyses examining the impact of negative affect as a mediator on cookie consumption yielded insi gnificant results. Negative fat message exposure was not significantly associated with negative affect, although messa ge exposure was associated with significant decreases in cookie consum ption. The relationship between negative
76 mood and cookie consumption was also positiv ely significant. This indicates that negative mood is associated with greater f ood intake, but that th e relationship was competing with a negative media message a bout overweight that re sulted in decreased food intake for the majority of participants. Therefore, negative affect is not the primary driver for food restriction beha viors. This is however not in consistent with SticeÂ’s DualPathway model, as it suggests that negative a ffect predicts bulimic behaviors instead of restriction. Finally, the regression analysis for th e components high cognitive restraint and negative affect at time 2 predicting abstinen ce violation in Polivy and HermanÂ’s theory could not be completed due to the lack of binge eating in the sample (N=2). Overall, study findings support and expand the Tripartite Model, which suggests that social comparison is an important tr igger for negative mood and body dissatisfaction when exposed to thin models, but is not a mediator for negative psychological consequences when exposed to fat stigmati zation media material. Appearance activation, which may induce fears of weight gain or trigger negative body self-evaluation, is activated among a subset of the women exposed to fat messages, resu lting in greater body dissatisfaction. With regard to SticeÂ’s Du al Pathway Model, the relationship between negative mood and increased food intake wa s supported by the mediation analyses. However, since only 2 subjects engaged in an analogue binge ep isode, there was not sufficient evidence to test the Dual-Pathway Model or the Restraint Model adequately. Although study results have interesting imp lications for existing eating disorder theories, there are important study limitations to consider.
77 One important limitation of the study is th e presence of possible test sensitization as a threat to internal valid ity. By administering social comparison and pressure to be thin measures prior to food taste-testing, and by administering the food taste-test prior to eating behavior intentions measures, there is a chance that the presence of earlier tests impact the measurement of the following te sts. Measurement error due to test sensitization cannot be eliminated. However, it was determined that measuring mediators of the relationship between mood, body image, and eating behavior, a nd therefore, testing eating disorder models, was important enough to introduce threats to internal validity. Furthermore, it was decided that measuring actual eating behavior was more important than measuring dieting intentions, which wa s worth the risk of increased measurement error. Another study limitation is the generali zability of the findings. Although the study was designed to maximize external va lidity, by incorporati ng popular real-world media clips, other important f actors affect food consumption. First, the presence of the mirror and concerns about being watched were identified by a sub-set of the experimental sample. It is likely that participants would incr ease restriction if they felt they were being watched. Second, in their home environments, subjects may be surrounded by family and friends, which alters eating patterns; subjects in the study were measured alone. Third, the sample consisted of female college st udents, limiting generalizability to young adult females. Future research should replicate study findings with olde r individuals, males, and non-college students. A third limitation of the study is the pr esence of statistical significance, but possibly not clinically signifi cant restriction effects. Fi ndings indicate that in the
78 negative interaction fat media exposure conditio n, participants consumed a mean of 2.3 cookies, while participants in the contro l comedy condition consumed a mean of 3.0 cookies. The difference between 2 and 3 mini -cookies could be viewed as minimal and not clinically significant in importance. Ho wever, it could be evaluated as though those participants in the experimental conditions consumed 23% fewer cookies than those in control media conditions. Interpretations about implications for future restriction should be cautious, and findings should be replicated. Study results have implications for eati ng disorder treatment. The presence of competing social comparison and appearan ce activation processes could impact body image disturbance in young women. Addressi ng each construct separately in treatment would allow clinicians to target which process is driving body dissatisfaction. Furthermore, women with particular demogra phic characteristics (high BMI, history of weight related teasing) are more vulnerabl e to mood disturbance following negative fat media message exposure. Because these women are more likely to seek treatment in weight management settings than traditiona l eating disorder settings, media literacy material and coping response (CBT, reduced media consumption) approaches may be more usefully disseminated in weight lo ss programs. Finally, women without eating disorders also engaged in food restrict ion following negative fat media message exposure. This indicates a continuum of re sponses to media messages that may lead to eating disturbance or sub-clinical eating di sturbance. Without directly addressing the internalization of media messages about we ight, and offering internal and external competing societal messages, women may remain at greater risk for eating disorders.
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97 Appendix A: Fat Stigmatization-Negativ e Interaction Media Stimuli Items Item # Program Comment Time Demographics Item 1 Victor Vargas Â“ThatÂ’s my sister, but sheÂ’s fat now.Â” 24 sec Male About Female Item 2 On Edge Â“Fat girls have no place in figure skating.Â” 49 sec Male About Female Item 3 Heavyweights Â“IÂ’m not going to camp with a bunch of fat loads.Â” 18 sec Male Child About Kids Item 4 She Devil Â“No wonder youÂ’re upset.Â” 26 sec Male to Female Item 5 Major Payne Â“Stop eating candy you fat pig.Â” 30 sec Male Adol to Male Adol Item 6 Camp Â“Rolls jiggling.Â” 46 sec Female Adol to Female Adol Item 7 Monsters Ball Â“Look at all this fat.Â” 1 min 10sec Female to Male Child Item 8 Bridget Jones Â“I thought you said she was thin.Â” 52 sec Female to Female
98 Appendix A (Continued): Fat Stigmatization-Fat Comedy Media Stimuli Items Item # Program Comment Time Demographics Item 1 Shallow Hal Â“I looked the other way while you banged a few fatties.Â” 27 sec Male about female targets Item 2 Summer Catch Â“Fat chicks are like mopeds.Â” 19 sec Males about female targets Item 3 Manhattan Â“Tote all that fat around.Â” 25 sec Male About Female Item 4 Dodge Ball Indirect face grimace 45 sec Male Adol to Female Adol Item 5 Friends Indirect sits on hand 8 sec Male to Female Item 6 Austin Powers Â“Take that you fatty.Â” 24 sec Female to Male Item 7 Nutty Professor Â“You fat tub of goo.Â” 28 sec Male to Male Item 8 King of Queens Â“You could stand to lose a few lbs.Â” 14 sec Male to Male
99 Appendix A (Continued): Control Stigmatizat ion-Negative Interaction Media Stimuli Items Item # Program Comment Time Demographics Item 1 She Devil Â“Ruth, you idiot!Â” 13 sec Male to Female Item 2 She Devil Â“YouÂ’re a bad mother.Â” 35 sec Male to Female Item 3 Tao of Steve Â“Asshole!Â” 17 sec Female to Male Item 4 Victor Vargas Â“YouÂ’re so stupid.Â” 33 sec Female Adol to Male Adol Item 5 Monsters Ball Â“YouÂ’re just like a woman.Â” 42 sec Male to Male Item 6 On Edge Â“SheÂ’s a complete b-it-c.Â” 12 sec Female Adol to Female Adol Item 7 On Edge Â“Stench of trailer trash.Â” 5 sec Female Adol to Female Adol Item 8 Camp Â“Get away from me you freak.Â” 1 min 27 sec Female Adol to Female Adol
100 Appendix A (Continued): Control Comedy Media Stimuli Items Item # Program Comment Time Demographics Item 1 Austin Powers Â“YouÂ’re not missing anything in the 70s and 80s.Â” 37 sec Male to Female Item 2 Dodge Ball Â“Joanie loves Chacie.Â” 13 sec Male to Male Item 3 Friends Â“His legs flail about as if independent from his body!Â” 27 sec Male to Male Item 4 Friends Turkey on head, dancing around and scaring Joey 1 min 14 sec Female to Males Item 5 King of Queens Â“Stop! IÂ’ll come around to other side of the car and let you in.Â” 32 sec Male to Male Item 6 Nutty Professor Â“I requested a Hugo but this is all they had.Â” 57 sec Male to Male Item 7 Summer Catch Â“IÂ’m still wearing your underwear so I canÂ’t give it back.Â” 1 min 6 sec Male to Female Item 8 Shallow Hal Â“If you mess up, IÂ’ll be on you like a tiger on a deer.Â” 54 sec Male to Male
101 Appendix B: Media Rating Form: Revise d Version of the 3 WD Humor Test 1. Media Clip 1 How funny was this segment? 0 1 2 3 4 5 6 Not funny at all Very funny How offensive was this segment? 0 1 2 3 4 5 6 Not offensive at all Very offensive 2. Media Clip 2 How funny was this segment? 0 1 2 3 4 5 6 Not funny at all Very funny How offensive was this segment? 0 1 2 3 4 5 6 Not offensive at all Very offensive 3. Media Clip 3 How funny was this segment? 0 1 2 3 4 5 6 Not funny at all Very funny How offensive was this segment? 0 1 2 3 4 5 6 Not offensive at all Very offensive 4. Media Clip 4 How funny was this segment? 0 1 2 3 4 5 6 Not funny at all Very funny How offensive was this segment? 0 1 2 3 4 5 6 Not offensive at all Very offensive 5. Media Clip 5 How funny was this segment? 0 1 2 3 4 5 6 Not funny at all Very funny How offensive was this segment? 0 1 2 3 4 5 6 Not offensive at all Very offensive
102 Appendix B (Continued) 6. Media Clip 6 How funny was this segment? 0 1 2 3 4 5 6 Not funny at all Very funny How offensive was this segment? 0 1 2 3 4 5 6 Not offensive at all Very offensive 7. Media Clip 7 How funny was this segment? 0 1 2 3 4 5 6 Not funny at all Very funny How offensive was this segment? 0 1 2 3 4 5 6 Not offensive at all Very offensive 8. Media Clip 8 How funny was this segment? 0 1 2 3 4 5 6 Not funny at all Very funny How offensive was this segment? 0 1 2 3 4 5 6 Not offensive at all Very offensive OVERALL: After viewing the eight clips above, how funny we re the clips overall? 0 1 2 3 4 5 6 Not funny at all Very funny After viewing the eight clips above, how offensive were the clips overall? 0 1 2 3 4 5 6 Not offensive at all Very offensive
103 Appendix C: Demographic Information Thank you for participating in this study. Pl ease read the directi ons for each group of questions and answer each one to the best of your ability. DEMOGRAPHIC INFORMATION Age: ____________ Height: __________ Weight: __________ Ideal weight: __________ Race/Ethnicity: (p lease circle one): Asian-American African-American Caucasian Hispanic Other: Please specify _______________________ Year in School: (p lease circle one) Freshman Sophomore Junior Senior Other: Please specify _______________________ Country of Origin: (please circle one) United States Jamaica Canada Mexico Puerto Rico Cuba Other: Please specify_______________________ If not a U.S. resident, the number of year s spent living/studying in the United States: One Two Three Four Five Six Seven Eight Nine Other: Please specify________________________
104 Appendix D: Visual Analog Scales Instructions: Place a mark through the area of the line that matches your feelings right now. 1. Happiness None Extreme 2. Anxiety None Extreme 3. Energetic None Extreme 4. Disappointed in Self None Extreme 5. Anger None Extreme 6. Calmness None Extreme 7. Dissatisfied with Weight/Size None Extreme 8. Healthy None Extreme 9. Irritability None Extreme 10. Dissatisfied with Body Shape None Extreme
105 Appendix E: Positive and Negative Affect Scale-Revised Please circle the response that indica tes how you feel currently/generally. not at all a little moderately a lot extremely 1. Disgusted with self . . 1 2 3 4 5 2. Sad. . . . . . . . . 1 2 3 4 5 3. Afraid . . . . . . . 1 2 3 4 5 4. Shaky. . . . . . . . 1 2 3 4 5 5. Alone. . . . . . . . 1 2 3 4 5 6. Blue. . . . . . . . 1 2 3 4 5 7. Guilty . . . . . . 1 2 3 4 5 8. Nervous. . . . . . 1 2 3 4 5 9. Lonely. . . . . . . 1 2 3 4 5 10. Jittery. . . . . . . 1 2 3 4 5 11. Ashamed . . . . . 1 2 3 4 5 12. Scared . . . . . . 1 2 3 4 5 13. Angry at self . . . . 1 2 3 4 5 14. Downhearted. . . . 1 2 3 4 5 15. Blameworthy. . . . 1 2 3 4 5 16. Frightened . . . . . 1 2 3 4 5 17. Dissatisfied with self. 1 2 3 4 5 18. Anxious. . . . . . 1 2 3 4 5 19. Depressed . . . . . 1 2 3 4 5 20. Worried . . . . . . 1 2 3 4 5 21. Angry . . . . Â…Â… 1 2 3 4 5 22. UpsetÂ…Â…Â…Â…Â…Â….. 1 2 3 4 5 23. Scornful. . . . . . 1 2 3 4 5 24. Distressed . . . . . 1 2 3 4 5 25. Irritable . . . . . . 1 2 3 4 5 26. Hostile. . . . . Â…Â… 1 2 3 4 5 27. DisgustedÂ…Â…Â…Â…Â… 1 2 3 4 5 28. Loathing. . . . . . 1 2 3 4 5 29. HappyÂ….. . . . . . 1 2 3 4 5 30. ProudÂ… . . . . . . 1 2 3 4 5 31. Attentive . . . Â…Â… 1 2 3 4 5 32. InspiredÂ…Â…Â…Â…Â…Â… 1 2 3 4 5 33. Determined. . . . . 1 2 3 4 5 34. JoyfulÂ….. . . . . . 1 2 3 4 5 35. Strong . . . . . . 1 2 3 4 5
106 Appendix E (Continued) Please circle the response that indica tes how you feel currently/generally. not at all a little moderately a lot extremely 36. AlertÂ…Â…Â…Â…Â….... . 1 2 3 4 5 37. Excited. .. . . . . . 1 2 3 4 5 38. BoldÂ…. . . . . . . 1 2 3 4 5 39. Concentrating. . . . 1 2 3 4 5 40. Delighted . . . . . 1 2 3 4 5 41. Active . . . . . . 1 2 3 4 5 42. Cheerful. . . . . . 1 2 3 4 5 43. Fearless. . . . . . 1 2 3 4 5 44. Lively. . . . . . . 1 2 3 4 5 45. Daring . . . . . . 1 2 3 4 5 46. Enthusiastic . . . . 1 2 3 4 5 47. Confident . . . . . .1 2 3 4 5 48. EnergeticÂ….. . . . . 1 2 3 4 5 49. InterestedÂ…Â…Â…Â…Â…..1 2 3 4 5
107 Appendix F: Modified SATAQ-3 You will be asked to rate your agreement with ma ny statements about the video you just viewed. Some of the questions will seem more relevant to the video you viewed than others. Please read each of the following items carefully and indicate the number that best reflects your agreement with the statement to the best of your ability. Definitely Disagree Mostly Disagree Ne ither Agree Nor Disagree Mostly Agree Definitely Agree 1 2 3 4 5 Pressures subscale 1. IÂ’ve felt pressure from this video to lose weight. 2. IÂ’ve felt pressure from this video to be thin. 3. IÂ’ve felt pressure from this video to diet. 4. IÂ’ve felt pressure from this video to exercise. 5. IÂ’ve felt pressure from this video to change my appearance.
108 Appendix G: Video Message and Study Credibility Rating Form You will be asked to rate your agreement with many statements about the study you just completed. Please read each of the following items carefully and indicate the number that best reflects your agreement with the statement to the best of your ability Definitely Disagree Mostly Disagree Neither Agree No r Disagree Mostly Agree Definitely Agree 1 2 3 4 5 Statement Level of Agreement The cover story of studying consumer behavior was convincing. The video was easy to understand. The video was easy to hear. The video messages were applicable to me. The video messages were influential to me.
109 Appendix H: Eating Disorder Inventory-2 Body Dissatisfaction subscale: 1 2 3 4 5 6 Always Usually Often Sometimes Rarely Never AlwaysÂ…Â…Â…Â….Never 1. I think that my stomach is too big. 1 2 3 4 5 6 2. I think that my thighs are too large. 1 2 3 4 5 6 3. I think that my stomach is ju st the right size. 1 2 3 4 5 6 4. I feel satisfied with the shape of my body. 1 2 3 4 5 6 5. I like the shape of my buttocks. 1 2 3 4 5 6 6. I think my hips are too big. 1 2 3 4 5 6 7. I think that my thighs are ju st the right size. 1 2 3 4 5 6 8. I think that my buttocks are too large. 1 2 3 4 5 6 9. I think that my hips are ju st the right size. 1 2 3 4 5 6 Drive For Thinness subscale: 1. I eat sweets and carbohydrates with out feeling nervous. 1 2 3 4 5 6 2. I think about dieting. 1 2 3 4 5 6 3. I feel extremely guilty after overeating. 1 2 3 4 5 6 4. I am terrified of gaining weight. 1 2 3 4 5 6 5. I am preoccupied with a desire to be thin. 1 2 3 4 5 6 6. If I gain a pound, I worry I wi ll keep gaining. 1 2 3 4 5 6
110 Appendix I: Sociocultural Attitudes Towards Appearance Questionnaire-3 1. _____ IÂ’ve felt pressure fr om TV or magazines to lose weight. 2. _____ I would like my body to look like the people who are on TV. 3. _____ I compare my body to the bodies of TV and movie stars. 4. _____ TV commercials are an im portant source of information about fashion and Â“being attractiveÂ”. 5. _____ IÂ’ve felt pressure from TV or magazines to look pretty. 6. _____ I would like my body to look like the models who appear in magazines. 7. _____ I compare my appearance to the appearance of TV and movie stars. 8. _____ IÂ’ve felt pressure from TV or magazines to be thin. 9. _____ I would like my body to look like the people who are in movies. 10. _____ I compare my body to the bodies of people who appear in magazines. 11. _____ IÂ’ve felt pressure from TV or magazines to have a perfect body 12. _____ I wish I looked like the models in music videos. 13. _____ I compare my appearance to the appearance of people in magazines. 14. _____ IÂ’ve felt pressure from TV or magazines to diet. 15. _____ I wish I looked as athletic as the people in magazines. 16. _____ I compare my body to that of people in Â“good shapeÂ”. 17. _____ IÂ’ve felt pressure from TV or magazines to exercise. 18. _____ I wish I looked as athletic as sports stars. 19. _____ I compare my body to that of people who are athletic.
111 Appendix I (Continued) 20. _____ IÂ’ve felt pressure from TV or magazines to change my appearance. 21. _____ I try to look like the people on TV. 22. _____ I try to look like the people in music videos. 23. _____ I try to look like sports athletes.
112 Appendix J: Dutch Eating Behavior Questionnaire-Restraint Scale Circle the best response to describe your usual behavior: NeverSeldomSometimesOften Always 1. Did you eat less than you normally would to lose weight? 1 2 3 4 5 2. Did you try to eat less at mealtimes than you would like to eat?. 1 2 3 4 5 3. How often did you refuse food or drink because you were concerned about your weight? 1 2 3 4 5 4. Did you watch exactly what you ate? 1 2 3 4 5 5. Did you deliberately eat foods that were slimming? 1 2 3 4 5 6. If you ate too much, did you eat less than usual the next day? 1 2 3 4 5 7. Did you deliberately eat less in order not to become heavier? 1 2 3 4 5 8. How often did you try not to eat between meals because you were watching your weight? 1 2 3 4 5 9. How often in the evenings did you try not to eat because you were watching your weight? 1 2 3 4 5 10. Did you take into account your weight in deciding what to eat? 1 2 3 4 5
113 Appendix J (Continued) Intentions Strongly Disagree Somewhat Disagree Neither Agree Nor Disagree Somewhat Agree Strongly Agree 1. Do you plan to eat less than you normally would to lose weight? 1 2 3 4 5 2. Do you plan to eat less at mealtimes than you would like to eat? 1 2 3 4 5 3. Do you plan to refuse food or drink to lose weight? 1 2 3 4 5 4. Do you plan to watch exactly what you eat? 1 2 3 4 5 5. Do you plan to deliberately eat foods that are slimming? 1 2 3 4 5 6. If you overeat one day, do you plan to eat less than usual the next day? 1 2 3 4 5 7. Do you plan to deliberately eat less in order to not become heavier? 1 2 3 4 5 8. Do you plan to try to not eat between meals because you plan on watching your weight? 1 2 3 4 5 9. Do you plan to eat less in the evenings to control your weight? 1 2 3 4 5 10. Do you plan to take your weight into account when deciding what to eat? 1 2 3 4 5
114 Appendix K: Eating Disorder Examination-Questionnaire Please circle the response that descri bes your behavior over the past week : No 1 2 3 4 5 6 7 On how many days during the past week ... days days daysdaysdays days days days 1. Have you felt fat? . . . . . . . . . .. 0 1 2 3 4 5 6 7 2. Have you had a definite fear that you might gain weight or become fat?. . . . . . . 0 1 2 3 4 5 6 7 Over the past week ... Not at all Slightly Moderately Extremely 3. Has your weight influenced how you think about (judge) yourself as a person? . . . . . . . . . 0 1 2 3 4 5 6 4. Has your shape influenced how you think about (judge) yourself as a person? . . . . . . . . . 0 1 2 3 4 5 6 1. During the past week have there been times when you felt you have eaten what other people would regard as an unusually large amount of food given the circumstances? YES NO 6. During the times when you ate an unusually large amount of food, did you experience a loss of control i.e. feel you couldn't stop eating or control what or how much you were eating? YES NO 7. How many times during the past week have you eaten an unusually large amount of food and experienced a loss of control ?____________ (please write in number or indicate zero) 8. During the past week have you had other times where you felt you uncontrollably ate a large amount of food, but the amount eaten would not have been considered large by most people? YES NO 9. How many times during the past week have you have uncontrollably eaten a large amount of food that others might not consider large?________________ (please write in number or indicate zero) 10. How many times during the past week have you made yourself sick in order to prevent weight gain or counteract th e effects of eating?________________ (write in number or indicate zero) 11. How many times during the past week have you used laxatives or diuretics in order to prevent weight gain or counteract th e effects of eating?__________ (write in number or indicate zero)
115 Appendix K (Continued) 12. How many times during the past week have you engaged in excessive exercise specifically for the purpose of c ounteracting overeating episodes?_______________ (write in number or indicate zero)
116 Appendix L: Modified Eating Diso rder Examination-Questionnaire Intentions Strongly Disagree Somewhat Disagree Neither Agree Nor Disagree Somewhat Agree Strongly Agree 1. I plan to make myself sick in order to prevent weight gain or counteract the effects of eating. 1 2 3 4 5 2. I plan to use laxatives or diuretics in order to prevent weight gain or counteract the effects of eating. 1 2 3 4 5 3. I plan to vigorously exercise for an hour or more in order to prevent weight gain or counteract the effects of eating. 1 2 3 4 5 4. I plan to use diet pills in order to prevent weight gain or help me lose weight. 1 2 3 4 5 5. I plan to smoke cigarettes in order to prevent weight gain or help me lose weight. 1 2 3 4 5 6. I plan to skip meals in order to prevent weight gain or help me lose weight. 1 2 3 4 5
117 Appendix M: State Hunger Scale SHS You will be asked some questions about th e food you have eaten today and about your current levels of hunger. Please respond as accurately as possible. 1. Did you eat breakfast to day? YES NO 2. Did you eat lunch today? YES NO 3. Did you eat dinner today? YES NO 4. Have you missed meals today? YES NO 5. Have you eaten less than usual today? YES NO On a scale of 1-10, please indicate how hungry you were at the beginning of todayÂ’s lab study by making an Â“XÂ” through the correct place in the line below. Not at all Hungry Very Hungry 1 2 3 4 5 6 7 8 9 10 _____________________________________________________________________ On a scale of 1-10, please indi cate how hungry you are right now by making an Â“XÂ” through the correct plac e in the line below. Not at all Hungry Very Hungry 1 2 3 4 5 6 7 8 9 10 _____________________________________________________________________
118 Appendix N: Multidimensional Health Behavi or Inventory Directions : The following statements describe a br oad range of health-related actions or behaviors that you may or may no t do. Read each behavior statement and circle the number following each stat ement that tells how often you usually do this behavior/plan to: NEVER RARELY SOMETIMES OFTEN ALWAYS 1. Limit red meat in your diet every day. 1 2 3 4 5 2. Limit fat in your diet every day. 1 2 3 4 5 3. Eat red meat more than two times a week. 1 2 3 4 5 4. Eat fewer calories to lose weight. 1 2 3 4 5 5. Eat at least one serving or more of red meat on most days (include beef, pork, ha m, 1 2 3 4 5 bacon, lamb, liver, and lunch meat not made from poultry). 6. Limit sugar in your diet every day. 1 2 3 4 5 7. Eat non-fat or low-fat dairy products. 1 2 3 4 5 8. Choose foods with whole grains every day, for exam ple, 1 2 3 4 5 whole wheat bread instead of white, br own rice instead of white, etc. 9. Participate in recreational physi cal activities as walking, biking, dancing 1 2 3 4 5 or sports regularly at least twice a week.
119 Appendix N (Continued) 10. Limit salt in your diet every day. 1 2 3 4 5 11. Limit intake of "sweets" in your diet. 1 2 3 4 5 12. Do stretching exercises every day. 1 2 3 4 5 13. Eat 2-3 servin gs of vegetables daily. 1 2 3 4 5 14. Exercise vigorously for at least 20 minutes 3 times a week. 1 2 3 4 5 15. Increase your physical activity to lose weight. 1 2 3 4 5 16. Run, jog, or swim for exercise at least 3 times per week. 1 2 3 4 5 17. Eat 2-3 serv ings of fruit per day. 1 2 3 4 5 18. Eat at least one or more servings of the following items every day: chips, 1 2 3 4 5 candy bars, cake, doughnuts, pastries, muffins, cookies, ice cream, pudd ing, chocolate.
120 Appendix O: State Appearance Comparison Scale In the past fifteen minutes to what extent did youÂ….. 1. Think about your own appearance? No thought A lot of thought about my appearanceÂ…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â….about my appearance 1 2 3 4 5 6 7 2. Compare your overall appearance to th at of the people in the video? No comparisonÂ…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…A lot of comparison 1 2 3 4 5 6 7 3. Compare your specific body parts to t hose of the people in the video? No comparisonÂ…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…A lot of comparison 1 2 3 4 5 6 7
121 Appendix P: Physical Appear ance-Related Teasing Scale Each question pertains to the time period of when you were growing up. Please respond by circling the appropriate number for the follo wing scale: Never (1), Frequently (5). 1. When you were a child, did you feel that your peers were staring at because you were overweight? Never Frequently 1 2 3 4 5 2. When you were a child, did you ever feel like people were making fun of you because of your weight? Never Frequently 1 2 3 4 5 3. Were you ridiculed as a child abou t being overweight? Never Frequently 1 2 3 4 5 4. When you were a child, did people make jokes about you being too big? Never Frequently 1 2 3 4 5 5. When you were a child, were you laughed at for trying out for sports because you were too heavy? Never Frequently 1 2 3 4 5 6. Did your brother(s) or other male relati ves call you names like Â“fatsoÂ” when they got angry at you? Never Frequently 1 2 3 4 5 7. Did your father ever make jokes that referred to your weight? Never Frequently 1 2 3 4 5 8. Did other kids call you derogatory names that related to your size or weight? Never Frequently 1 2 3 4 5
122 Appendix P (Continued) 9. Did you ever feel like people were pointing at you because of your size or weight? Never Frequently 1 2 3 4 5 10. Were you the brunt of family jokes because of your weight? Never Frequently 1 2 3 4 5 11. Did people point you out of a crowd because of your weight? Never Frequently 1 2 3 4 5 12. Did you ever hear your classmate snicker wh en you walked into the classroom alone? Never Frequently 1 2 3 4 5 13. When you were growing up, di d people say you dressed funny? Never Frequently 1 2 3 4 5 14. Did people say you had funny teeth? Never Frequently 1 2 3 4 5 15. Did kids call you funny looking? Never Frequently 1 2 3 4 5 16. Did other kids tease you about wearing clothes that didnÂ’t match or were out of style? Never Frequently 1 2 3 4 5 17. Did other kids ever make jokes about your hair? Never Frequently 1 2 3 4 5 18. When you were a child were you scoffed at fo r looking like a weakling? Never Frequently 1 2 3 4 5
123 Appendix Q: Cookie Taste Test Rating Form You will be asked to rate your agreement with the statements below. Please read each of the following items carefully and indicate the number that best reflects your agreement with the statement to the best of your ability. Definitely Disagree Mostly Disagree Neither Agree Nor Disagree Mostly Agree Definitely Agree 1 2 3 4 5 Statement Level of Agreement 1. The cookies were soft and chewy. 2. The cookies melted in my mouth. 3. The cookies had enough chocolate chips. 4. The cookies were fresh, without any staleness. 5. I would buy this brand of cookies at the grocery store.
124 Appendix R: Interpersonal Reactivity Index The following statements inquire about your thoughts and feelings in a variety of situations. For each item, indicate how well it describes you by choosing the appropriate letter on the scale at the top of the page: A, B, C, D, or E. When you have decided on your answer, fill in the letter on the answer sheet next to the item number. READ EACH ITEM CAREFULLY BEFORE RESPONDING. Answer as honestly as you can. Thank you. A B C D E Does not describe me well Describes me very well DisagreementÂ…Â…Â…Â….Agreement 1. I daydream and fantasize, with some regularity, about things that might happen to me. A B C D E 2. I often have tender, concerned feelings for people less fortunate than me. A B C D E 3. I sometimes find it difficult to see things from the Â“other guyÂ’sÂ” point of view. A B C D E 4. Sometimes I donÂ’t feel very sorry for other people when they are having problems. A B C D E 5. I get really involved with the feeli ngs of the characters in a novel. A B C D E 6. In emergency situations, I feel apprehensive and ill-at-ease. A B C D E 7. I am usually objective when I watc h a movie or play, and I donÂ’t often get completely caught up in it. A B C D E 8. I try to look at everybodyÂ’s side of a disagreement before I make a decision. A B C D E
125 Appendix R (Continued) 9. When I see someone being taken advantage of, I f eel kind of protective towards them. A B C D E 10. I sometimes feel helpless when I am in the middle of a very emotional situation. A B C D E 11. I sometimes try to understand my friends better by imagining how things look from their perspective. A B C D E 12. Becoming extremely involved in a good book or movie is somewhat rare for me. A B C D E 13. When I see someone get hurt, I te nd to remain calm. A B C D E 14. Other peopleÂ’s misfortunes do not usually disturb me a great deal. A B C D E 15. If IÂ’m sure IÂ’m right about something, I donÂ’t waste much time listening to other peopleÂ’s arguments. A B C D E 16. After seeing a play or movie, I have felt as though I were one of the characters. A B C D E 17. Being in a tense emotional situation scares me. A B C D E 18. When I see someone being treated unfairly, I sometimes donÂ’t feel very much pity for them. A B C D E 19. I am usually pretty effective in dealing with emergencies. A B C D E 20. I am quite often touched by things that I see happen. A B C D E
126 Appendix R (Continued) 21. I believe that there are two sides to every question a nd try to look at them both. A B C D E 22. I would describe myself as a pr etty soft-hearted person. A B C D E 23. When I watch a good movie, I can very easily put myself in the place of a leading character. A B C D E 24. I tend to lose control during emergencies. A B C D E 25. When IÂ’m upset at someone, I usually try to Â“put myself in his shoesÂ” for a while. A B C D E 26. When I am reading an interesting story or novel, I imagine how I would feel if the events in the story were happening to me. A B C D E 27. When I see someone who badly need s help in an emergency, I go to pieces. A B C D E 28. Before criticizing somebody, I try to imagine how I would feel if I were in their place. A B C D E
127 Appendix S: Script for the Fa t Stigmatization Media Exposure Hello. IÂ’m _________, and IÂ’m a research assistant in the psychology department. Today, weÂ’re conducting a consumer study to evaluate how you perceive certain products. We are particularly interested in how your personality traits and your mood state effect your evaluation of media and food products. First, youÂ’ll be asked to complete some questionnaires, then youÂ’ll watch a vide o and rate media clips, youÂ’ll complete more questionnaires, and later youÂ’ll be aske d to taste test a f ood product. We are interested in your honest fee dback about all the products. There are different types of media that wi ll be shown to research participants. Sometimes, the media will be from a certain genre (i.e., comedy or drama), and sometimes the media will have a theme. IÂ’ll be sure to prompt you when it is tim e for you to complete each questionnaire or consumer evaluation task. LetÂ’ s go ahead and get started. I know that you have already completed some questionnaires and an informed consent online. Remember that informed consent m eans that you are agreeing to participate in research in exchange for extra credit points; if at any time feel you cannot continue with the study, you are free to leave and will be gi ven points equal to the amount of time spent completing the experiment. Thank you again for coming. Please begin by filling out these questionnaires. Ok, now it is time to watch and rate media clip s. IÂ’ve given you a rating sheet to complete after you watch each media clip. Fo r the first clip, clip 1, youÂ’l l watch a short clip from a TV show or movie. Afterward, weÂ’d like you to rate how funny it is and how offensive it is. Note that sometimes, media can be funny a nd at other times, it can be offensive. Also, it can be both funny and offensive or neither f unny nor offensive. YouÂ’ll rate each clip as we go along, in order. I will leave the room while you complete your media rating task, and IÂ’ll return when youÂ’re finished. I see that youÂ’ve finished the media rating ta sk. Your ratings of me dia material provide feedback about your likely media consumption. Please complete these questionnaires, and let me know when you are finished. The second product weÂ’ll need you to test is a brand of mini-chocolat e chip cookies. Take your time and taste as many as you need to make a decision about the desirability and quality of the cookies. The goal is for you to evaluate the cookies, and youÂ’ll be given a rating form to complete after you finish ta sting them. I will leave the room while you complete your taste test, and IÂ’ll be back in a while to give you the rating form. Now that IÂ’ve given you a chance to taste test the cookies, please complete this rating sheet to let me know how you feel about the cookies.
128 Appendix S (Continued) At this time, IÂ’d like you to complete some questionnaires about your health behaviors; these behaviors interact with f ood product consumption and choices. Thank you again for your participation. At this time, IÂ’d like to provide a debriefing.
129 Appendix T: Script for Control Media Exposure Hello. IÂ’m _________, and IÂ’m a research assistant in the psychology department. Today, weÂ’re conducting a consumer study to evaluate how you perceive certain products. We are particularly interested in how your personality traits and your mood state effect your evaluation of media and food products. First, youÂ’ll be asked to complete some questionnaires, then youÂ’ll watch a vide o and rate media clips, youÂ’ll complete more questionnaires, and later youÂ’ll be aske d to taste test a f ood product. We are interested in your honest fee dback about all the products. There are different types of media that wi ll be shown to research participants. Sometimes, the media will be from a certain genre (i.e., comedy or drama), and sometimes the media will have a theme. IÂ’ll be sure to prompt you when it is tim e for you to complete each questionnaire or consumer evaluation task. LetÂ’ s go ahead and get started. I know that you have already completed some questionnaires and an informed consent online. Remember that informed consent m eans that you are agreeing to participate in research in exchange for extra credit points; if at any time feel you cannot continue with the study, you are free to leave and will be gi ven points equal to the amount of time spent completing the experiment. Thank you again for coming. Please begin by filling out these questionnaires. Ok, now it is time to watch and rate media clip s. IÂ’ve given you a rating sheet to complete after you watch each media clip. Fo r the first clip, clip 1, youÂ’l l watch a short clip from a TV show or movie. Afterward, weÂ’d like you to rate how funny it is and how offensive it is. Note that sometimes, media can be funny a nd at other times, it can be offensive. Also, it can be both funny and offensive or neither f unny nor offensive. YouÂ’ll rate each clip as we go along, in order. I will leave the room while you complete your media rating task, and IÂ’ll return when youÂ’re finished. I see that youÂ’ve finished the media rating ta sk. Your ratings of me dia material provide feedback about your likely media consumption. Please complete these questionnaires, and let me know when you are finished. The second product weÂ’ll need you to test is a brand of mini-chocolat e chip cookies. Take your time and taste as many as you need to make a decision about the desirability and quality of the cookies. The goal is for you to evaluate the cookies, and youÂ’ll be given a rating form to complete after you finish ta sting them. I will leave the room while you complete your taste test, and IÂ’ll be back in a while to give you the rating form. Now that IÂ’ve given you a chance to taste test the cookies, please complete this rating sheet to let me know how you feel about the cookies.
130 Appendix T (Continued) At this time, IÂ’d like you to complete some questionnaires about your health behaviors; these behaviors interact with f ood product consumption and choices. Thank you again for your participation. At this time, IÂ’d like to provide a debriefing.
131 Appendix U: Debriefing Form Previous research has demonstrated that television viewi ng and media exposure predict body dissatisfaction and bulimia sy mptoms (Harrison & Cantor, 1997; Harrison, 2001; Stice, 1994). Most studies in this area have primarily focused on the impact of viewing thin model images. Considerable evidence supports the findings that these thinideal media messages contribute to the sociocul tural pressure to be thin, which in turn predicts body dissatisfaction and eating dist urbance (Cattarin & Thompson,1994; Stice, 2001; Stice and Agras, 1998). However, very little is known about the impact of fat commentary presented in media. Specifically, there are still many unanswered questions regarding the interactio n of mood, personality traits, and th e viewing of fat weight-related media messages. The purpose of the present st udy is to examine the influence of various factors on how weight-related fat commentary in the media is processed and leads to later food evaluation and eating behaviors. It is important that you are aware that deception was used in this study; the study was not actually designed to analyze products and consumer behavior. Instead, the consumer evaluation portions of the study were designed for you to focus on the content of th e media and the food product, and to help examine our hypotheses about the impact of fat weight-related media commentary. Everyone who participated in the study was exposed to media and completed the consumer ratings; all participan ts were treated similarly. The findings of this study are likely to provide a better understanding of the manner in which weight-related fat commentary in media may contribute to body image and eating disturbances. Your participation in this study on the imp act of viewing media fat commentary is greatly appreciated. Sometimes, watchi ng fat comments in media or completing questionnaires about your physical appearance and eating history may temporarily result in distressing feelings and/ or thoughts. If you experience such negative outcomes for a prolonged period of time after this study or ha ve been experiencing them prior to this study, you may benefit from seeking therapy services. Contact the USF Counseling Center for Human Development at 974-2831 or the USF Psychological Services Center at 974-2496 if you are interested in learning more a bout their therapy services for students. If you have any questions about the study or th erapy services, feel free to ask one of the researchers. Suggested Readings: Brownell, K.D., Puhl, R.M, Schwartz, M.B., & Rudd, L. (2005). Weight Bias: Nature, Consequences, and Remedies. Guilford Press: New York. Groesz, L.M., Levine, M.P., & Murnen, S.K. (2002). The effect of experimental presentation of thin media images on body satisfaction: A meta-analytic review. International Journal of Eating Disorders, 31 1-16. Stice, E. (2002). Risk and maintenance f actors for eating pathology: A meta-analytic review. Psychological Bulletin, 128 (5), 825-848.
132 Appendix V: Eating Disorder Descriptive Analyses Eating Disorder Analyses: Descriptives and Means To assess psychological and eating behavi or outcomes for th e clinical eating disorder sub-set within the larger sample, m eans and standard deviations were calculated for those with AN (N=4), BN (N=13), and BED (N=14). Results (see Table ) sugges t that the AN subgroup, which was divided into the 2 control conditions, exhibited higher levels of mean Nega tive Affect (M=14.0, SD=4.5), Guilt (M=11.25, SD=7.5), perceived pressure from the video to lose weight (M=12.5, SD=7.5), State Body Dissatisfaction (M= 12.2, SD=8.5), and consumed less chocolate chip cookies (M=1.5, .57) than overall s ubjects in the control conditions. The BN subgroup exhibited higher levels of mean Negative Affect in the Fat Stigmatization Negative Interaction (M=14.7, SD =4.9) and Control Negative Interaction Conditions (N=15.0, SD=5), higher levels of Guilt in the Fat Stigmatization Negative Interaction (M=11.25, SD=4.3), Fat Comedy (M=9.2, SD=2.5), and Control Negative Interaction Conditions (M=13.3, SD=7.7), greate r perceived pressure from the video to lose weight in the Fat Stigmatization Ne gative Interaction Cond ition (M=15.2, SD=5.6), Fat Comedy Condition (M=14.5, SD=6.8), and C ontrol Negative Interaction Condition (M=11.0, SD=10.3), reported higher State Body Di ssatisfaction in the Fat Stigmatization Negative Interaction Condition (M=12.7, SD=5.1), Fat Comedy Condition (M=14.1, SD=5.5), and Control Negative Interaction Condition (M=18.1, SD=1.3), and consumed similar mean levels of chocolate chip cookies when compared to the rest of the sample for Fat Stigmatization Negative Interacti on (M=2.2, SD=1.5), Fat Comedy (M=2.5,
133 Appendix V (Continued) SD=1.7), and Control Comedy (M=2.5, SD=2.1) conditions. The BED subgroup reported more variable psychological outcomes. One subject with BED was located in the Fat Stigmati zation Negative Interaction Condition; she reported exceptionally high levels of Negative Affect (M=29), Hostility (M=23), Guilt (M=16), Sadness (M=11), perceived pre ssure to lose weight (M=19), Body Dissatisfaction similar to other eating diso rder levels (M=14.1), and qualitatively experienced a binge episode w ith an exceptional number of cookies consumed (M=14). For BED subjects in the C ontrol Comedy condition, similar levels of psychological variables were found (negative affect, guilt, perceived pressure to lose weight) when compared to the averages of the whole sample. BED subjects in the Control Comedy condition did express greater levels of body dissatisfaction (M=10.7, SD=6.2), and consumed less cookies (M=2.0, SD=1.3) than the overall sample. BED subjects in the Fat Comedy sample experienced similar levels of negative affect when compare to whole sample, but reported slightly higher Guilt (M=8 .3, SD=2.5) and perceived pressure to be thin (M=12.0, SD=7.7). BED subjects in the Fat Comedy condition consumed less cookies than the rest of the sample (M=1.7, SD=.8). Overall, AN subjects were placed with in both control conditions, and had high levels of psychological disturbance associated with eating disorders, and restricted their food intake when compared to the total sa mple. The BN subjects were spread across conditions, had high levels of ps ychological disturbance associat ed with eating disorders, and consumed food in similar amounts the to tal sample. Finally, the BED subjects
134 Appendix V (Continued) were disproportionately assigned to the Fat Comedy and Control Comedy conditions. They had higher levels of guilt and perceived pressure to lose weight when exposed to Fat Comedy media, but similar levels of psyc hological disturbance to the total sample in the Control Comedy condition. The BED sample differed in 2 primary ways: they had much higher levels of body dissatisfaction than the total sample, and either binged or restricted food intake when compared to the total sample.
135 Appendix W: Overweight and Ob esity Descriptive Analyses Overweight and Obese Analyses: Descriptives and Means To assess psychological and eating beha vior outcomes for the overweight and obese sub-set within the larger sample, means and standard deviations were calculated for those with BMIs between 2529.9 (overweight) (N=39) and with BMIs above 30 (obese) (N=24). Approximately 32% of the total unde rgraduate sample tested was overweight or obese, and subjects were spr ead across all 4 conditions. Results suggest that the overweight s ubgroup exhibited higher levels of mean Negative Affect (M=12.8, SD=3.6), Guilt (M=9.2, SD=3.9), and Hostility (M=8.0, SD=2.9) than the rest of the sample in the Fat Stigmatization-Negative Interaction condition. Overweight subj ects reported much greater levels of Body Weight Dissatisfaction, Body Shape Dissatisfaction, a nd Overall Body Dissatisfaction than the total sample, and this effect occurred across a ll conditions. Overweight subjects reported much higher levels of perceived pressure from the video to lose weight (M=12.5, SD=7.5) in the Fat Stigmatization-Negative In teraction condition; levels of perceived pressure to lose weight due to media messages was similar to the mean or below the mean for all other conditions. Overweight subjects consumption of chocolate chip cookies was highly variable. Consumption was similar to the mean of the total sample (M=2.3, SD=1.1) in the Fat StigmatizationNegative Interaction condition, somewhat higher than the mean in the Fat Comedy c ondition (M=3.0, SD=1.8), and less than the mean in the control conditions (M=2.8, SD=1.5) (M=1.9, SD= 1.0). This indicates that overweight subjects had consider able range in their cookie consumption responses, with
136 Appendix W (Continued) some subjects restricting and others eating double the mean amount. The obese subgroup exhibited higher leve ls of mean Negative Affect (M=16.7, SD=8.9), Fear (M=8.2, SD=2.8), Hostility (M=11, SD=8.12), Guilt (M=11.5, SD=6.4), Sadness (M=7, SD=2.8), Anxiety (M=3.2, SD=2.9) Irritability (M=3.8, 4.2), and feeling Disappointed in Self (M=4, SD=4.6) in th e Fat Stigmatization Negative Interaction condition than the overall sample. Levels of Guilt were higher across all conditions for the obese participants, and levels of Body Shape Dissatisfaction, Body Weight Dissatisfaction, and Overall B ody Dissatisfaction were significantly higher across all conditions when compared to the total sample. Perceived pressure from the video to lose weight in the Fat Stigmatization Negative Interaction Condition (M=17.2, SD=2.3), Fat Comedy Condition (M=14.12, SD=7.1), and C ontrol Negative Interaction Condition (M=10.8, SD=5.1), were substantially higher fo r obese participants than for the those participants in the overall sample. Chocol ate chip cookie consumption, when compared to the rest of the sample, was restricted (M=1.3, SD=1.0) or was a binge (M=14) for the obese subjects in the Fat Stigmatization Negative Interaction condition. Similarly, restriction tendencies when compared to the rest of the sa mple occurred in all conditions. However, slightly more restriction occurred in the fat message experimental conditions with Fat Comedy (M=1.3, SD=.75), Negativ e Control (M=2.2, SD =1.3) and Control Comedy (M=2.2, SD=.95). Overall, overweight and obe se subjects were placed w ithin all conditions. Both overweight and obese subjects had higher leve ls of body image dissatisfaction than the
137 Appendix W (Continued) overall sample across all conditions. The overweight subjects experienced greater negative affect, guilt, and hostility, as well as greater perceived pr essure to lose weight, in the Fat Stigmatization-Negative Interaction co ndition only. Obese subjects experienced similar affective disturbance for the Fat S tigmatization-Negative Interaction condition, but also experienced perceived pressure to lose weight across the 2 fat message experimental conditions and the negative in teraction control condition. One possible explanation for this finding is that overwei ght media characters in this control condition received negative comments for non-fat specifi c reasons, yet may have been perceived as still stigmatized negatively due to weight. Ob ese subjects reported much higher levels of guilt across all conditions. Overweight subjec ts had greater fluctuation in their cookie intake, with a larger range across conditions. Obese subjects however, tended to restrict across all conditions, with great er restriction present in the experimental fat media message conditions. However, one indivi dual in the Fat Stigmatization-Negative Interaction condition did enga ge in an analogue binge.
138 Appendix X: Repeated Measures ANOVAs Repeated Measures ANOVAs To assess psychological changes occurri ng within subjects, variables state negative affect and state body dissatisfaction were evaluated at pr e-video exposure and post-video exposure. A repeated measures 2 (Time: Pre-test, Po st-test) x 4 (Media Condition) ANOVA was computed for each psychol ogical variable, with trait levels of the variable (trait negative affect, trait body di ssatisfaction) entered into each respective model as a co-variate. For the variable state negative affect, there was no significant time by condition interaction F(3, 197) = 1.42, p= .236, partial n =.022. Within subjec ts, negative affect decreased slightly in every media conditio n; however, negative affect remained significantly higher in the fa t negative interaction medi a exposure condition when compared to all other experimental a nd control conditions F(3, 197) = 5.35, p<.001, partial n=.077 (see Table X). Repeated measures ANOVAs for body dissati sfaction revealed no significant time F(1, 197)= .012, p=.913, partial n=.000, condition F(3, 197)= .306, p=.821, partial n=.005, or time x condition interactions F(3, 197)= .231, p=.875, partial n=.004. Mean body dissatisfaction slightly decreased across all conditions. Similar to between subjects ANCOVAs that discovered no body dissatisfaction diffe rences between media conditions, there were no si gnificant findings for body image changes within subject.
139 Appendix X (Continued) Table X Means, standard deviations, F, P, and partial n values for planned Repeated Measures ANOVAs ________________________________________________________________________ Repeated Fat Negative Fat Comedy Control Negative Control Comedy F p, partial n values Measures Adjusted M Adjusted M Adjusted M Adjusted M ANOVAs SE SE SE SE Negative Affect Time 1 13.45 (.43) 11.35 (.43) 11.78 (.42) 12.30 (.43) Negative Affect Time 2 13.24 (.40) 11.17 (.40) 11.46 (.39) 11.44 (.40) Time: F(1, 197)= 1.27, p=.260, partial n=.007 Condition: F(3, 1 97)= 5.35, p=.001, partial n=.077 Time x Condition: F(3, 197)= 1.42, p=.236, partial n=.022 Body Dissatisfaction Time 1 7.58 (.59) 8.15 (.59) 7.51 (.58) 7.91 (.59) Body Dissatisfaction Time 2 7.03 (.66) 7.61 (.66) 6.69 (.65) 7.03 (.66) Time: F(1, 197)= .012, p=.913, partial n=.000 Condition: F(3, 1 97)= .306, p=.821, partial n=.005 Time x Condition: F(3, 197)= .231, p=.875, partial n=.004
140 Appendix Y: Correlation Among Pre-test Measures Table Y Correlations Among Pre-test Measures BMI State BD State NA Trait NA EDI-BD EDI-DT DEBQ SATAQGeneral SATAQTrait SATAQAthlete WTTeasing Empathy BMI 1 StateBD .54 ** 1 StateNA .03 .12 1 TraitNA .11 .29 .40 ** 1 EDIBD .59 ** .76 ** .08 .31 1 EDI-DT .44 ** .65 ** .13 .31 .69 ** 1 DEBQ .42 .55 .05 .22 .58 ** .80 ** 1 SATAQGeneral .03 .42 ** .13 .24 ** .48 ** .63 ** .51 ** 1 SATAQTrait Pressure .24 ** .46 ** .17 .26 ** .53 ** .68 ** .61 ** .82 ** 1 SATAQAthlete .15 .39 ** .06 .18 .39 ** .51 ** .43 ** .68 ** .66 ** 1 WTTeasing .40 ** .40 ** .07 .36 ** .46 ** .45 ** .42 ** .30 ** .41 ** .21 ** 1 Empathy .02 .06 .05 -.03 -.03 .01 -.00 .08 .14 .04 .081 Note : BMI: Body Mass Index; StateBD: VAS Body Dissatisfaction Index; StateNA: PANAS-X State Negative Affect Scale; TraitNA: PANAS-X Trait Negative Affect Scale; EDI-BD: Eating Disorder Inventory-Body Dissatisfaction subscale; EDI-DT: Eating Disorder Inventory-Drive for Thinness subscale; DEBQ: Dutch Eating Behavior Questionnaire-Restrain t subscale; SATAQ-General: Sociocultural Attitudes Towards Appearance Scale-General subscale; SATA Q-Trait Pressure: Socioc ultural Attitudes Towards Appearance Scale-Pressure subscal e; SATAQ-Athlete: Sociocultural Attitudes Towards Appearance ScaleAthlete subscale; WT Teasing: Physical Appearan ce Related Teasing-Weight subscale; Empathy: Interpersonal Reactivity Index-Empathetic Concern subscale *p<.05 **p<.01
141 Appendix Z: Correlation Am ong Post-test Measures Table Z Correlations Among Post-tes t Dependent Variables VAS-BD VAS-S VAS-W PAN-NA PAN-H PAN-G PAN-S VAS-Dis VAS-Ang VAS-Irrit Video P # Cookies VAS-BD 1 VAS-Shape .97** 1 VASWeight .97** .90** 1 PANAS-NA .14* .11 .16* 1 PANASHostility .14* .10 .16* .80** 1 PANASGuilt .52** .51** .52** .67** .54** 1 PANASSadness .19** .17* .19** .47** .54** .40** 1 VASDissapointed with Self .54** .51** .55** .43** .40** .76** .33** 1 VAS-Anger .08 .07 .09 .58** .39** .38** .47** .42** 1 VASIrritability .15* .12 .17* .61** .68** .40** .42** .40** .68** 1 Video Pressure .41** .42** .38** .34** .29** .55** .17* .46** .29** .18** 1 # Cookies -.10 -.11 -.09 .17* .20** .06 .05 -.03 .10 .11 .00 1 Note : VAS-BD: Visual Analogue Scale-Body Dissatisf action Index; VAS-Shape: Visual Analogue Scaleshape dissatisfaction item; VAS-Weight: Visual Analog ue Scale-weight dissatis faction item; PANAS-NA: Positive and Negative Affect ScaleNegative Aff ect subscale; PANAS-Hos tility: Positive and Negative Affect Scale-Hostility subscale; PANAS-Guilt: Positiv e and Negative Affect Scale-Guilt subscale; PANAS Sadness: Positive and Negative Affect Scale-Sadn ess subscale; VAS-Disappointed in Self: Visual Analogue Scale-disappointed in self item; VAS -Anger: Visual Analogue Scale-anger item; VAS Irritability: Visual Analogue Scale-irritability item; Video Pressure: Sociocultural Attitudes Towards Appearance Scale-modified Pressu res subscale; # Cookies Consumed *p<.05 **p<.01
About the Author Susan Himes received a Bachelor of Arts degree in Psychology from Oklahoma State University in 1997, and a Master s of Arts degree in Clinical Psychology from the University of South Florida in 2005. She is currently a docto ral candidate at the University of South Florida and a pre-doctoral intern in clinical psychology at Temple Health Sciences Center in July 2009. She w ill be a postdoctoral resident in the Obesity program at the Mayo Clinic from August 2009-August 2011. Her research is focused on measuring and testing factors that affect binge eating and obesity, and developing treatments to enhance bariatric surgery and weight loss outcomes. She has co-authored several peer-reviewed journal articles and book chapters in this field.