The Mediator Role of Social Physique Anxiety on Orthorexia among Women in a Province in the Mediterranean Region of Turkey

Abstract

The Mediator Role of Social Physique Anxiety on Body Image and Orthorexia among Adult Women in a Province in the Mediterranean Region of Turkey

Abstract

Purpose: Orthorexia nervosa (ON) has garnered increasing attention in the literature as a relatively new eating disorder characterized by an excessive preoccupation with healthy eating, which can result in malnutrition and other health problems. While studies have established a link between body image and ON, the role of social physique anxiety (SPA) as a mediator in this relationship remains unclear. The present study aimed to address this gap by examining the mediating role of SPA in the relationship between body image and ON in women. Material and Methods: A total of 647 women aged 18 to 65 years were recruited from a Province in the Mediterranean Region of Turkey. The causal steps approach (Baron and Kenny method) was used in the statistical evaluation of the mediation model and the realization of the steps testing the mediation model was evaluated. The hypothesized mediation model was tested with the PROCESS macro for SPSS models in Model 4 using a bootstrapping approach to assess the significance of indirect effects. Results: After controlling for the effects of age, education, marital status, employment status, body mass index (BMI), and weight perception for consistency with BMI, the results of regression analyses supported the mediating effect of SPA on the relationship between body image and ON. Conclusion: It follows from these findings that the inclusion of strategies aimed at reducing negative body image perception and SPA may contribute to improved prevention efforts aimed at reducing ON among Turkish women.

Keywords

• Body image
• eating disorders
• social interaction
• women’s health
• mediator variable

References

1. Crow S. The economics of eating disorder treatment. Current Psychiatry Reports 2014; 16:14-16.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders V. 5th ed. Washington, DC: American Psychiatric Association; 2013.
3. Dell'Osso L, Abelli M, Carpita B, Pini S, Castellini G, et al. Historical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism, and obsessive-compulsive spectrum. Neuropsychiatric Disease and Treatment 2016;12:1651-1660.
4. Vandereycken W. Media hype, diagnostic fad or genuine disorder? Professionals' opinions about night eating syndrome, orthorexia, muscle dysmorphia, and emetophobia. Eating Disorders 2011;19:145-155.
5. Bratman S. Orthorexia vs. theories of healthy eating. Eating and Weight Disorders 2017;22:381-385.
6. Chaki B, Pal S, Bandyopadhyay A. Exploring scientific legitimacy of orthorexia nervosa: A newly emerging eating disorder. Journal of Human Sport and Exercise 2013;8:1045-1053.
7. Koven NS, Abry AW. The clinical basis of orthorexia nervosa: Emerging perspectives. Neuropsychiatric Disease and Treatment. 2015; 11:385-394.
8. Duran S, Cicekoglu P, Kaya E. Relationship between orthorexia nervosa, muscle dysmorphic disorder (bigorexia), and self-confidence levels in male students. Perspectives in psychiatric care 2020;56:878-884.

9. Schilder P. The Image and appearance of the human body. 1st ed. London: Routledge; 1999.
10. Murray S. In The Fat Female Body. 1st ed. London: Palgrave Macmillan; 2008.
11. Tylka TL. Positive psychology perspectives on body image. Encyclopedia of Body Image and Human Appearance 2012;2:657-663.
12. Bailey KA, Cline LE, Gammage KL. Exploring the complexities of body image experiences in middle age and older adult women within an exercise context: The simultaneous existence of negative and positive body images. Body Image. 2016; 17:88-99.
13. Osa ML, Calogero RM. Orthorexic eating in women who are physically active in sport: a test of an objectification theory model. Body Image 2020; 35:154-60.
14. Jackson AM, Cox AE, Sano Y, Parker L, Laniga, J. Body image and eating behaviors: a latent profile analysis. Body Image 2022;41:396-405.
15. White M, Berry R, Rodgers RF. Body image and body change behaviors associated with orthorexia symptoms in males. Body Image 2020;34:46-50.
16. Barnes MA, Caltabiano ML. The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity 2017;22:177-184.
17. Barthels F, Meyer F, Pietrowsky R. Orthorexic eating behavior: A new type of disordered eating. Ernahrungs Umschau 2015; 62:156-161.
18. Lantz C, Hardy C, Ainsworth B. Social physique anxiety and perceived exercise behavior. Journal of Sport Behavior 1997;20:83-93.
19. Schlenker BR, Leary MR. Social anxiety and self-presentation: a conceptualization model. Psychological Bulletin 1982;92:641-669.
20. Hart EA, Leary MR, Rejeski WJ. Tie measurement of social physique anxiety. Journal of Sport and Exercise Psychology 1989;11:94-104.
21. Eriksson L, Baigi A, Marklund B, Lindgren EC. Social physique anxiety and sociocultural attitudes toward appearance impact on orthorexia test in fitness participants. Scandinavian Journal of Medicine and Science in Sports 2008;18:389-394.
22. Thompson AM, Chad KE. The relationship of social physique anxiety to risk for developing an eating disorder in young females. Journal of Adolescent Health 2002;31:183-189.
23. Alcaraz-Ibáñez M, Sicilia Á, Díez-Fernández DM, Paterna A. Physical appearance comparisons and symptoms of disordered eating: The mediating role of social physique anxiety in Spanish adolescents. Body Image 2020;32:145-149.
24. Pan H, Liu S, Miao D, Yuan Y. Sample size determination for mediation analysis of longitudinal data. BMC Medical Research Methodology 2018;18:32.
25. Secord PF, Jourard SM. The appraisal of body-cathexis: body-cathexis and the self. Journal of Consulting Psychology 1953;17:343-347.
26. Hovardaoglu, S. Body image scale. Psychiatry Psychology Psychopharmacology 3P 1993;1:26-27.
27. Balli O, Asci H. Reliability and validity of social physique anxiety scale. Hacettepe Journal of Sport Sciences 2006;17:11-19.
28. Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. Orthorexia nervosa: validation of a diagnosis questionnaire. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity 2005;10:e28-e32.
29. Arusoglu G, Kabakci E, Koksal G, Merdol TK. Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turkish Journal of Psychiatry 2008; 19:283-291.
30. World Health Organization (WHO). Obesity: preventing and managing the global epidemic: report of a who consultation on obesity Geneva 3-5 June 1997 (Repr. 2004).
31. Hayes A. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. 3rd ed. New York, NY: The Guilford Press; 2022.
32. Baron M, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology 1986;51:1173-1182.
33. Cepikkurt F, Coskun F. Social physique anxiety and body image satisfaction levels of collegian dancers. Pamukkale Journal of Sport Sciences 2010;1:17–24.
34. Thompson AM, Chad KE. The relationship of pubertal status to body image, social physique anxiety, preoccupation with weight and nutritional status in young females. Canadian Journal of Public Health 2000;91:207-211.
35. Puhl RM, King KM. Weight discrimination and bullying. Best Practice Research Clinical Endocrinology Metabolism 2013;27:117-127.
36. Calogero RM, Tylka TL, Mensinger JL, Meadow A, Daníelsdóttir S. Recognizing the fundamental right to be fat: a weight-inclusive approach to size acceptance and healing from sizeism. Woman Therapy 2019;42:22–44.