Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Gary_Fine_-_Honours_Thesis_2011 FINAL VERSION

Related Audiobooks

Free with a 30 day trial from Scribd

See all
  • Be the first to comment

  • Be the first to like this

Gary_Fine_-_Honours_Thesis_2011 FINAL VERSION

  1. 1. Running Head: INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES Influences of the Muscular Body Ideal on Weight Status, Dietary Restraint and Body Esteem in a Large Community Sample of Adolescent Males Gary A. Fine Carleton University 2011 A THESIS PRESENTED TO THE DEPARTMENT OF PSYCHOLOGY IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE B.A. WITH HONOURS DEGREE
  2. 2. Abstract Objective: To assess the relationship between internalization of the sociocultural prevalent standard for the ideal body, and weight status; and determine the predictive role of internalization of such standard with respect to restrictive dietary behaviour, general feelings about appearance and weight satisfaction in middle and high school males. Method: As part of a larger longitudinal study examining eating behaviour and adolescent lifestyles, 1014 males completed self-report questionnaires including demographic questions, the Internalization subscale of the Sociocultural Attitudes Toward Appearance Questionnaire (SATAQ), the Dietary Restraint subscale of the Dutch Eating Behaviour Questionnaire (DEBQ), and the Appearance and Weight Satisfaction subscales of the Body Esteem Scale for Adolescents and Adults (BESAA). Objective measures of height and weight were used to calculate body mass index (BMI) and classify participants as underweight, normal weight or overweight using international age- and sex-specific centile curves. Results: No relationship was found between internalization of the muscular ideal and BMI. Significant differences were found between weight groups on dietary restraint, feelings about appearance and weight satisfaction such that overweight males scored higher on restrained eating and had significantly less positive feelings about their general appearance compared to normal weight and underweight males; the only significant difference between the normal and underweight group was a lower score for weight satisfaction in the underweight group. For normal weight and overweight males, internalization scores on the SATAQ appeared to be a significant positive predictor of dietary restraint behaviours, and a significant negative predictor of general feelings about appearance and weight satisfaction. Discussion: These results give insight into predictors of dietary restraint behaviours and low ii
  3. 3. self-esteem associated with general appearance and weight satisfaction in male adolescents, which may aid in the development of preventative programs for at risk youth in Canada. iii
  4. 4. Acknowledgements First and foremost I would like to thank the entire Research on Eating and Adolescent Lifestyles (REAL) team including but not limited to Dr. Katherine Henderson and Dr. Annick Buchholz, with special thanks to Dr. Martine Flament, Dr. Gary Goldfield, Meagan Birmingham and Marisa Murray for their assistance and guidance in the completion of this paper. I would also like to thank Dr. Hymie Anisman for taking on the task of being my on-campus co-advisor on short notice, due to unforeseeable events which rendered me without a Carleton advisor. Lastly, I would like to thank my friends and family for supporting me during the completion of this thesis. iv
  5. 5. Table of Contents Abstract …………………………………………………………………………………….. ii Acknowledgements …………………………………………………….…………………….. iv Table of Contents …………………………………………………………………………….. v List of Tables …………………………………………………...……………………………… vii List of Appendices …………………………………………………………………………..… viii Introduction ……………………………………………………………………………….……. 1 Gender-Based Trends ………………………………………………………………...…. 1 Sociocultural Pressures ……………………………………………………………...….. 2 Relationships with Serious Health Outcomes ………………………………………..…. 3 Critical Times in Body Image Development ……………………………………….….. 4 Internalization of the Muscular Ideal …………………………………………..……… 4 The Current Study …………………………………………………………...…………. 5 Methods …………………………………………………………………………………………. 7 Participants ………………………………………………...……………………….…… 7 Procedure ……………………………………………………………………………….. 7 Measures ……………………………………………………………………...………… 8 v
  6. 6. Analytic Plan ………………………………………………...………………………… 12 Results …………………………………………………………………………………………. 14 Descriptive Statistics ……………………………………..……………………………. 14 Correlations Between Study Variables……………………...………………………….. 17 ANOVA’s ………………………………………………………..…………………….. 19 Regression Analyses …………………………………………………………………… 21 Discussion ……………………………………………………………………………………… 27 References ……………………………………………………………………………….……. 34 vi
  7. 7. List of Tables Table 1. Frequency Table of Weight Classes According to International Guidelines for BMI Categories for Children and Adolescents ………………………………………………...…… 15 Table 2. Frequency Distribution Showing Highest Level of Education Received for Mothers…16 Table 3. Frequency Distribution Showing Highest Level of Education Received for Fathers.… 16 Table 4. Pearson Correlations (Bivariate) Assessing the Associations Between Participant Variables and Subscales ………………………….………………………………………….…. 18 Table 5. Descriptive Statistics for all Variables with Participants Grouped Into Separate Weight Categories …………………………………………………………………………………….... 20 Table 6. Simple Regression Analysis Results Predicting Dietary Restraint Behaviours from Internalization Scores in Male Adolescents…………………………………………………….. 22 Table 7. Simple Regression Analysis Results Predicting General Feelings About Appearance from Internalization Scores in Male Adolescents………………………………………………. 24 Table 8. Hierarchical Regression Analysis Results Predicting Weight Satisfaction from Internalization Scores in Male Adolescents, While Controlling for Age ……………………… 26 vii
  8. 8. List of Appendices Appendix A. Male Portion of The Sociocultural Attitudes Toward Appearance Questionnaire (SATAQ) ……………………………………………………………………………………….. 42 Appendix B. The Dutch Eating Behaviour Questionnaire Items ………………………………. 43 Appendix C. The Body Esteem Scale for Adolescents and Adults ………………………….… 45 viii
  9. 9. Influences of the Muscular Body Ideal on Weight Status, Dietary Restraint and Body Esteem in a Large Community Sample of Adolescent Males Gary A. Fine To date, research on the development of body image and eating disorders has focused primarily on female sample populations (Smolak, Levine & Thompson, 2001), with very little to no focus on men (Daniel & Bridges, 2010). This bias may be attributed to the fact that there has been substantial empirical evidence to show that girls elicit greater body dissatisfaction than boys (Knauss, Paxton & Alsaker, 2007; Eisenberg, Neumark-Sztainer & Paxton, 2006; Barker & Galambos, 2003) and therefore, are far more likely to suffer from eating disorders and disturbances in self-esteem associated with appearance and weight. As a result, it is possible that researchers have traditionally focused more on females, simply because findings show that men exhibit less risk. The tendency of researchers to focus on the female population has resulted in an extensive body of literature pertaining to body image and eating disorders that is almost void of males, inevitably understating the reality of the male population. Research shows that men are at risk of developing eating and body image disorders, albeit to a lesser extent than females, necessitating the need to study male populations. Neglecting to study male populations prevents the discovery of important information that may aid in the detection and prevention of body image and eating disorders in men, the mental and physical well-being of which is no less important than females. Gender-Based Trends Recent body image research has revealed several disturbing trends in males pertaining to body image, eating behaviours, exercise patterns and anabolic steroid use in youth and adults
  10. 10. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 2 (Smolak et al., 2001), provoking an increased interest in the study of male populations. Historically, many body image measures have focused on the desire to be thinner (Smolak et al., 2001), thus neglecting a quintessential gender-based sociocultural trend in North America; the desire of men to be more muscular. Men are more likely to want to be heavier and gain more muscle, while women generally desire to be thin (Petrie, Greenleaf & Martin, 2010; Daniel & Bridges, 2010; McVey, Tweed & Blackmore, 2005). Men are also more likely than women to use supplements (Petrie et al., 2010) and even abuse steroids (Smolak et al., 2001). These tendencies may be related to muscle dysmorphia, a disorder in which a person becomes obsessed with the idea that they are not muscular enough and in some instances suffer from delusions that they are too skinny or too small (Pope & Katz, 1994; Pope, Katz & Hudson, 1993), highlighting the fact that men are indeed affected by body image concerns and that there are differences between men and women in the way they experience body image disorders. Sociocultural Pressures Societal pressures are believed to be a major contributor to the high levels of body dissatisfaction in North America across genders. Although the mass majority of literature focuses on women, many studies have found direct links between media images of muscular men and male body image issues (Pope, Olivardia, Gruber & Borowiecki, 1999). Furthermore, research has shown that both men and women experience strong pressure to be attractive in North America (Petrie et al., 1996). According to Austin & Smith (2008), the sociocultural model of eating disorders is one of the most thoroughly tested and validated models of body dissatisfaction, and in accordance with sociocultural theories, research has shown that low level body satisfaction is a primary risk factor in the development of eating disorders, dietary restraint, depressive symptoms, binge eating and the pursuit of muscularity (Neumark-Sztainer, Paxton,
  11. 11. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 3 Hannan, Haines & Story, 2006; Stice, 2002; Stice & Bearman, 2001; Stice & Shaw, 2002). To further the clinical importance of such findings, dietary restraint has been linked directly to the onset of obesity in childhood and adolescence (Stice, Presnell, Shaw & Rohde, 2005; Petrie et al., 2010; Field et al., 2003) and to the development of maladaptive eating behaviours and eating disorders (Edmunds & Hill, 1999; Hsu, 1997). In addition, obesity has been linked to cardiovascular disease risk factors in adulthood as well as increased mortality (Petrie et al., 2010). Such findings suggest a link between body dissatisfaction, and more serious health outcomes such as cardiovascular disease and depression. Relationships with Serious Health Outcomes The leading cause of mortality in Canada is cardiovascular disease, claiming 76,321 lives in 2000 (35% of all deaths in the country) costing the Canadian health care system over 24 billion dollars (Mirolla, 2004). Based on previous findings, body dissatisfaction is thus one of many precursors to the leading cause of mortality in Canada. Depression is also associated with body dissatisfaction and is considered to be a danger to the mental and physical well-being of those who suffer from it (Bares et al., 2009; Yiend et al., 2009). In Canada, approximately 26,874 people were hospitalized for depression between 2005 and 2006 at an average cost of 5,368 dollars per person to the health care system, not including physician compensation (Canadian Institute for Health Information, 2008). The preceding evidence cultivates a need for research that helps to better understand the factors associated with body dissatisfaction and disordered eating, to allow educators, interventionists and clinicians to target those individuals at risk before they develop more severe diseases and disorders such as depression or cardiovascular disease, especially in populations that are understudied (e.g., males).
  12. 12. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 4 Critical Times in Body Image Development In order to understand the development of body image disturbances, researchers must study people at critical time points in their life when they are the most easily influenced and receptive to outside pressures. Adolescence is a decisive period in the development of body image (Lawler & Nixon, 2011), with massive amounts of physical, cognitive and psychological changes occurring at this time, thus contributing to a heightened awareness of one’s own body image and weight in adolescent males and females (Ata, Ludden & Lally, 2007). Adolescents partake in what Jones (2004) refers to as “appearance training” wherein everyday conversations centered around body image, looks and attractiveness are focused on and subsequently, come to be valued. Adolescence thus marks an important time to investigate the factors which may be indicative of, and associated with, negative body image in order to gain a better understanding of the development of negative self esteem and to provide knowledge essential to the creation and implementation of preventative programs that aim to identify at-risk individuals before they engage in risky behaviours (e.g., unhealthy dieting or steroid consumption) or even develop more severe disorders such as depression, anorexia nervosa, bulimia nervosa, binge eating disorder or muscle dysmorphia at later ages. Internalization of the Muscular Ideal As stated earlier, adolescence is a period of time marked by substantial amounts of physiological and psychological changes, and is a critical time in the development of body image. As males adopt the socially defined image of muscularity as attractiveness, they begin to internalize it as a standard of attractiveness. The internalization of social standards of appearance that are virtually unattainable promotes body dissatisfaction due to inevitable discrepancies
  13. 13. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 5 between one’s own shape and the physical ideal (Lawler & Nixon, 2011). Findings have shown that high internalization of the muscular ideal in males is associated with low weight esteem and appearance esteem (Frisen & Holmqvist, 2010) and high body dissatisfaction (Lawler & Nixon, 2011; Knauss et al., 2007). In addition to body esteem, dietary behaviours are linked to the way we feel about our bodies as the food we consume inevitably affects our body weight and in turn, our appearance. Coincidentally, while internalization of the muscular ideal is linked with higher body dissatisfaction, it has been found that body dissatisfaction is associated with maladaptive dieting behaviours (Cafri et al., 2005) and dietary restriction (Smolak, Murnen, & Thompson, 2005), creating a link between internalization and eating behaviours that affect body weight. A study by McVey, Tweed & Blackmore (2005) found that, in a community sample, males engaged significantly more often in the use of laxative/diuretics and vomiting in order to lose weight than females, although the prevalence was low. The Current Study The current study is one of few that focus on males and was conducted in an attempt to establish the nature of the relationship between the internalization of the ideal body and weight status in male adolescents. Only two studies were found briefly addressing the relationship between internalization of the muscular body ideal and body mass index (BMI) in males, with one showing a very low positive correlation between the two (Knauss et al., 2007) and the other showing no correlation (Petrie et al., 2010). Other research has shown that high internalization scores are predictive of muscle gaining behavior in both male adolescents (McVey et al., 2005) and college students (Daniel & Bridges, 2010), which may or may not affect BMI. Objectives of the current study were to establish if internalization of the muscular ideal predicts (1) weight status (BMI), (2) general feelings about appearance, (3) weight esteem or (4) dietary restraint
  14. 14. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 6 behaviours. Due to the paucity of research in the field, hypotheses with respect to the relationship between internalization and BMI in males were not made. However, based on previous research, it was hypothesized that the more males internalize the muscular body ideal: (a) the less happy they will be with their overall appearance, (b) the less satisfied they will be with their weight, and (c) the more they will engage in restrictive dietary behaviours.
  15. 15. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 7 Methods Participants There were a total of 1014 English speaking male participants in this study (M age= 13.99, SD= 1.65), recruited from schools in Ottawa and the surrounding areas in grades seven to twelve. Data were collected between November 2004 and May 2008. This study is part of a larger longitudinal study referred to as REAL (Research on Eating and Adolescent Lifestyles) examining risk factors for eating and weight disorders in adolescents. The research team established firm liaisons with several school boards (i.e., Ottawa-Carleton District and Catholic School Boards, Upper Canada District School Board) and a few private schools dispersed among and around the city of Ottawa in urban, sub-urban and rural areas. Participants were students from various ethnicities, religious backgrounds and socioeconomic status. The diversity of the sample population and school locations which generated this data set warrants its ability to accurately represent the average male youth population in the Ottawa region. Procedure Ethics approval was obtained from the Research Ethics Board of the Royal Ottawa Health Care Group and the Children's Hospital of Eastern Ontario. The study protocol was also approved by the Research Advisory Committee of the Ottawa-Carleton District School Board and the Catholic School Board. Upon receiving ethical approval, the research team met with the administrative staff of each participating school and established a list of participating classrooms. Each participating classroom was approached by members of the research team at which point the study was described, any questions answered and consent forms were distributed that required signatures from both the parents and students in order to participate in the study. At
  16. 16. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 8 about two weeks later, each classroom was approached again and, upon obtention of appropriate consent forms, slef-report questionnaires were administered to all consenting students. Administration of the questionnaires was performed by trained research assistants and research staff in the school setting. The questionnaire took between 50 and 70 minutes to complete, after which each participant was weighed and measured by a research team member in a separate, private area. Upon completion of the survey and objective measurement of weight and height, participants were verbally debriefed and provided with a ‘thank-you’ letter which contained the name and contact information of at least one member of the research team; this was provided in the event that the participant and/or a parent needed to contact the research team for any reason. Measures Demographic Characteristics Demographic data were collected from each participant and entailed questions regarding age, gender, grade, ethnic origin, language spoken at home as well as parental education. Pubertal Status The Pubertal Development Scale (PDS) (Petersen, Crockett, Richards, & Boxer, 1988; Carskadon & Acebo, 1993) was used to assess pubertal status. The PDS is a 5-item self rating scale of pubertal development designed to be used when more direct measures of puberty are not possible (i.e., in a school setting). Three items are common to boys and girls, two items are specific to each gender, and each item is rated 1 through 4 (or 0 = does not know). The PDS allows researchers to classify adolescents into five categories, from prepubertal to postpubertal (1 = pre-, 2 = early-, 3 = mid-, 4 = late-, and 5 = post-pubertal). The PDS score has acceptable
  17. 17. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 9 internal consistency (α = .71) and correlates well with physician ratings (r = .61-.67) (Brooks- Gunn, Warren, Rosso, & Gargiulo, 1987). Predictor Variable Internalization of the Ideal Body In order to assess the degree to which each participant adopted the ideal body image portrayed in North American media, the internalization subscale of the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) (Heinberg, Thompson, & Stormer, 1995) was used. The SATAQ consists of two separate 14-item scales, one for males (See Appendix A) and one for females, where each question is answered on a 5-point scale (from 1 = completely disagree, 3 = neither agree or disagree to 5 = completely agree). The scale is set up so that higher scores always represent greater internalization. For males, the SATAQ measures awareness of and attitudes about sociocultural images of muscularity and the internalization of these attitudes. The scale has been validated in male sixth and seventh graders (Smolak et al., 2001). The internalization subscale of the SATAQ has shown high convergence with five other measures of body image as measured by correlation values (range = .36-.61) (Heinberg et al., 1995). Cashel, Cunningham, Landeros, Cokley & Muhammad (2003) successfully demonstrated construct validity for the internalization subscale of the SATAQ as well as significant internal consistency (α = .79). The SATAQ has been widely used in research as a measure of sociocultural attitudes toward body image in several languages (Lawler & Nixon, 2011; Daniel & Bridges, 2010; Frisen & Holmqvist, 2010; Heinberg et al., 2008; Vaughan, Sacco, & Beckstead, 2008; Knauss et al., 2007; Forbes, Jobe, & Revak, 2006; McVey et al., 2005; Vartanian, Herman, & Polivy, 2005; Smolak et al., 2001). In the current study it was provided in English.
  18. 18. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 10 Outcome Variables Dietary Restraint Dietary restraint was measured by the Dutch Eating Behaviour Questionnaire (DEBQ) (Van Strien, Frijters, Bergers, & Defares, 1986), a 33-item, 5-point Likert scale that measures multiple aspects of eating, specifically restrictive, emotional and external eating with answers ranging from 1 = never to 5 = very often (See Appendix B). Higher scores always represent a greater degree of the eating aspect measured. The restrictive eating subscale was used to measure dietary restraint utilizing 10 of the 33 questions which ask participants about the extent to which they engage in behaviours that are indicative of food intake conscientiousness and dietary restriction (i.e., monitoring what and how much they eat as well as purposefully restricting what and when they eat). For the dietary restraint subscale, the maximum score achievable is 50 and the lowest is 5. Halversson & Sjödén (1998) found high internal consistency (α = 0.84) for the restrained eating subscale of the DEBQ and showed a high degree of correlation with the Children’s Eating Attitudes Test (ChEAT) (Maloney, McGuire, Daniels & Specker, 1989) dieting subscale. The DEBQ Restrictive Eating subscale has been used effectively by Wardle (1987) to measure conscious regulation of eating in obese women placed into different experimental groups, and more applicably, has been used successfully in male and female children and adolescents (Lattimore & Butterworth, 1999). Body Esteem The Body Esteem Scale for Adolescents and Adults (BESAA) (Mendelson, Mendelson, & White, 2001; Cecil & Stanley, 1997) was used to measure participants’ body esteem, specifically their attitudes and feelings about their bodies and appearance (See Appendix C). The
  19. 19. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 11 BESAA is comprised of 23-items measured on a 5-point scale ranging from never (0) to always (5), and examines three distinct areas of body esteem (a) appearance esteem, (b) weight esteem, and (c) attribution (i.e., perception of others’ evaluations about one’s body and appearance). The scale has been adapted for ages 12-25 years and negative items are reversed so that a high score always reflects positive judgment of one’s own body. Factor analysis of the three subscales by Mendelson, Mendelson & White (2001) showed high internal consistency across all ages: BE- appearance (α = .92, item–total r(1,306) = .56–.79 (M = .71), p < .01), BE-weight (α = .94, item– total r(1,310) = .72–.85 (M = .78), p < .01) and BE-attribution (α = .81, item–total r(1,281) = . 48–.72 (M = .62), p < .01). These findings are corroborated by Cecil & Stanley (1997) who found high internal consistency with Cronbach alpha values ranging from .82 to .94. Weight Status Weight status is represented by individual Body Mass Index’s (BMI’s). Each participant was asked to take off his/her shoes and any extra pieces of clothing, after which the individual’s height and weight was recorded in private. Height measurements were taken using a stadiometer and were recorded in centimeters to the nearest 0.1cm. Weight measurements were collected using a standardized digital scale and recorded in kilograms to the nearest 0.1kg. Body Mass Index was calculated by dividing the participants’ weight in kilograms by their height squared (kg/m2). The resulting BMI value was recorded at the end of each participant’s questionnaire booklet. Justification for the use of BMI as opposed to alternative measures of weight status, are provided by Cole, Faith, Pietrobelli & Heo (2005) in a study which compared BMI, BMI percentile, BMI z-score and BMI centile measures kindergarten students. This study was the only one found comparing the different measures of BMI and despite using a sample population younger than that of the current study, their findings suggest that BMI is a reliable measure of
  20. 20. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 12 adiposity on a single-occasion and is affected less by the within-child variability of adiposity changes over time than BMI z-scores and BMI centile scores (Cole et al., 2005). In this study, participants were divided into weight categories according to international guidelines for BMI categories for children and adolescents (Cole, Bellizzi, Flegal & Dietz, 2000; Cole, Flegal, Nicholls & Jackson, 2007) whereby the participants’ age, gender and BMI are combined to place them into one of five ordinal categories: (1) thinness grade 2, (2) thinness grade 1, (3) normal weight, (4) overweight, and (5) obese. Due to the small number of participants in the extreme weight categories (See Table 1), the below normal weight categories were grouped together and the above normal weight categories were also grouped together to make three categories: (1) underweight (4.4% of the sample population, comprised of the thinness grade 1 and 2 categories), (2) normal weight (67.1% of the sample population) and (3) overweight (28.5% of the sample population, comprised of the overweight and obese categories). Grouping participants into these weight categories was done in order to assess whether there were any between group differences in outcome variables, while increasing statistical power by combining previously separate and smaller groups. Analytic Plan The relationships between ideal muscular body internalization and age, weight status, restrictive dietary behaviours, general feelings about appearance and weight satisfaction were tested using Pearson correlations (bivariate). Scale scores for the predictor and dependant variables were explored individually using one-way ANOVA in order to establish if outcomes differed between weight classes. Post hoc analyses were run on variables which showed significant differences between weight classes in order to determine the exact pattern of
  21. 21. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 13 relationships. Regression analyses were completed with participants split into weight categories, using internalization as the predictor variable separately for BMI, dietary restraint, general feelings about appearance and weight satisfaction as the dependent variables. Simple regression analyses were completed for dietary restraint behaviours and general feelings about appearance. Since weight satisfaction was significantly correlated with age, a hierarchical regression analysis was completed predicting weight satisfaction from internalization, while controlling for the effects of age in a two step model.
  22. 22. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 14 Results Before all analyses, descriptive statistics on the make-up of the study population showed that the average age of participants was 13.99 years (SD = 1.65), with the majority being in grade seven (38.9%), followed by grade nine (31.3%), grade eight (15.5%), grade ten (7.9%), grade twelve (5.0%) and grade eleven (1.6%). Of the population, 14.1% claimed they were born outside of Canada. Responses to demographic questions about ethnic origin showed that 49.1% of participants described themselves “North American” and 25.2% described themselves as being of European background. The language spoken most at home was English (82.8%). With respect to sexual maturity, answers from the pubertal rating scale showed that 70.4% of the sample population were in late puberty, followed by 16.5% which were mid-pubertal, 8.3% pre- pubertal and 4.7% were post-pubertal. The majority of students were in the normal weight range (67.1%) with a large amount in the overweight categories (28.5%) and a small amount in the underweight categories (4.4%) (See Table 1). Analysis of the highest parental education obtained showed that for mother education level 67.5% obtained a college degree or higher (See Table 2 for complete breakdown) and for highest parental education obtained by father 67.7% obtained a college degree or higher (See Table 3 for complete breakdown).
  23. 23. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 15 Table 1 Frequency Table of Weight Classes According to International Guidelines for BMI Categories for Children and Adolescents. Frequency Percent Valid Percent Cumulative Percent Valid Thinness Grade 2 5 .5 .5 .5 Thinness Grade 1 38 3.7 3.9 4.4 Normal Weight 659 65.0 67.1 71.5 Overweight 211 20.8 21.5 93.0 Obese 69 6.8 7.0 100.0 Total 982 96.8 100.0 Missing 32 3.2 Total 1014 100.0 Table 2 Frequency Distribution Showing Highest Level of Education Received for Mothers. Frequency Percent Valid Percent Cumulative Percent
  24. 24. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 16 Valid Didn’t finish high school 24 2.4 2.4 2.4 High school diploma 92 9.1 9.2 11.6 College degree or higher 684 67.5 68.3 79.8 Don’t know 202 19.9 20.2 100.0 Total 1002 98.8 100.0 Missing 12 1.2 Total 1014 100.0 Table 3 Frequency Distribution Showing Highest Level of Education Received for Fathers. Frequency Percent Valid Percent Cumulative Percent Valid Didn’t finish high school 25 2.5 2.5 2.5 High school diploma 91 9.0 9.1 11.6 College degree or higher 686 67.7 68.7 80.3 Don’t know 197 19.4 19.7 100.0 Total 999 98.5 100.0 Missing 15 1.5 Total 1014 100.0 Correlations Between Study Variables Exploratory data analysis on the cronbach’s alpha levels for each of the four dependant variable subscales revealed satisfactory internal consistency for the BESAA Appearance subscale (α = .741) and BESAA Weight subscale (α = .718), good internal consistency was found for the DEBQ Restrained Eating subscale (α = .867) and excellent internal consistency was established for the SATAQ Internalization subscale (α =.915). In order to identify the relationships between (a) internalization of appearance ideals and (b) age, (c) BMI, (d) dietary restraint behaviours, (e) feelings about appearance and (f) weight satisfaction, a Pearson product- moment correlation matrix was utilized (See Table 4). The results from this table show no correlation between internalization and BMI, a significant positive correlation between restrained
  25. 25. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 17 eating and BMI, and significant negative correlations between general feelings about appearance, weight satisfaction and BMI. With respect to the subscale relationships, there was a significant negative correlation between internalization of the muscular ideal and general feelings about appearance, r(872) = -.350, p < .01; a significant negative correlation was also found between internalization of the muscular ideal and weight satisfaction, r(872) = -.215, p <.01. A significant positive correlation between internalization of the muscular ideal and dietary restraint behaviours was revealed, r(872) = .135, p <.01. These findings suggest several things. Firstly, they suggest that internalization of the muscular ideal is not linearly related to BMI, but is related to dietary restraint, general feelings about appearance and weight satisfaction. Secondly, they suggest that as internalization of the muscular ideal rises, feelings about appearance and weight satisfaction decrease, and lastly, as internalization rises restrained eating behaviours increase. Table 4 Pearson Correlationsa (Bivariate) Assessing the Associations Between Participant Variables and Subscales. Variable 1 2 3 4 5 6 1. Age in Years 1 .270** -.063 -.084* -.025 .100** 2. BMI 1 -.137** -.291** .362** .027 3. BESAA Subscale: General Feelings About Appearance 1 .656** -.299** -.350** 4. BESAA Subscale: Weight Satisfaction 1 -.387** -.215** 5. DEBQ subscale: Restrained Eating 1 .136** 6. SATAQ Subscale: Internalization 1 Note. **p < .01, 2-tailed. *p < .05, 2-tailed. a. Listwise N=874
  26. 26. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 18 BMI = Body Mass Index BESAA = Body Esteem Scale for Adolescents and Adults DEBQ = Dutch Eating Behaviour Questionnaire SATAQ = Sociocultural Attitudes Toward Appearance Questionnaire. In order to establish if differences existed between weight classes on individual measures (See Table 5), one-way ANOVA’s were performed on each subscale with participants grouped into three categories: (1) underweight, (2) normal weight or (3) overweight. Results for the SATAQ Internalization subscale revealed no significant differences between groups F(2,882) = 1.05, p = .351. For the DEBQ Restrained Eating subscale there was a significant difference between groups F(2,976) = 57.14, p < .001. A Tukey post-hoc test revealed that restrained eating behaviour was significantly lower for the normal weight (1.39 ± .47, p <.001) and underweight (1.36 ± .34, p <.001) groups compared to the overweight group (1.78 ± .66). In other words, the normal and underweight categories did not engage in restrained eating behaviours nearly as much as the overweight category. There were no significant differences between the underweight and normal weight groups (p = .281). Analysis of the BESAA Appearance subscale using a one- way ANOVA showed a significant difference between groups F(2,955) = 7.44, p <.001. Tukey post-hoc test results showed that feelings about appearance were significantly lower for the overweight group (1.78 ± .66, p <.001) compared to the normal weight group (1.39 ± .47), with
  27. 27. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 19 no differences between the underweight group (1.26 ± .34) and the normal weight or overweight groups. That is to say, the overweight group showed far more negative feelings about their general appearance than the normal and underweight groups. Results for the BESAA Weight subscale also showed significant differences between groups F(2,953) = 48.20, p <.001, and a Tukey post-hoc analysis revealed that scores were significantly lower for the underweight (3.85 ± .79, p =.002) and overweight (3.77 ± .77, p < .001) groups compared to the normal weight group (4.21 ± .58), with no differences between the underweight and overweight groups (p = . 727). Put more simply, both underweight and overweight males were far less satisfied with their weight than the normal weight males. These findings revealed that differences existed between
  28. 28. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 20 Table 5 Descriptive Statistics for all Variables with Participants Grouped Into Separate Weight Categories. Underweight Males Normal Weight Males Overweight Males Males Overall Variable N M SD N M SD N M SD N M SD Age 43 14.32 2.20 659 13.92 1.53 279 14.02 1.82 1009 13.99 1.65 BMI 43 15.77 1.03 659 19.44 1.81 279 25.68 2.89 985 21.05 3.70 BESAA Subscale: General Feelings About Appearance 40 3.79 0.75 648 3.83 0.62 270 3.65 0.72 989 3.78 0.66 BESAA Subscale: Weight Satisfaction 40 3.85 0.79 646 4.21 0.57 270 3.76 0.76 987 4.06 0.67 DEBQ Subscale: Restrained Eating 43 1.26 0.34 659 1.39 0.46 277 1.77 0.66 990 1.50 0.55 SATAQ Internalization Subscale 29 14.36 6.25 606 13.00 5.56 250 13.37 6.01 897 13.19 5.72 BMI = Body Mass Index BESAA = Body Esteem Scale for Adolescents and Adults DEBQ = Dutch Eating Behaviour Questionnaire SATAQ = Sociocultural Attitudes Toward Appearance Questionnaire
  29. 29. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 21 weight groups on all three dependent variable subscales and as a result, subsequent regression analyses were performed with participants split into weight categories. Internalization of the Muscular Ideal as a Predictor of Dietary Restraint Results from the original Pearson correlations (See Table 4) did not reveal a correlation between the DEBQ Retrained Eating Subscale and age; because BMI was controlled for as a result of dividing the participants into weight groups, no other control variables were included in the regression analysis. Results from a simple regression analysis predicting restrained dietary behaviour in males (See Table 6) was not significant for the underweight group (p > .05), but was significant for the normal weight group F(1,604) = 11.58, p = .001 and overweight group F(1,245) = 5.28, p = .022. Internalization was a significant positive predictor of restrictive dietary behaviour in the normal weight group (B = .01, p = .001) and the overweight group (B = . 02, p = .022). However, only 2% of the variance in restrained dietary behaviour scores was accounted for by internalization of the muscular ideal scores in both groups (adjusted-R2 = .02).
  30. 30. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 22 Table 6 Simple Regression Analysis Results Predicting Dietary Restraint Behaviours from Internalization Scores in Male Adolescents. Weight Group Variable F Adjusted-R2 B Underweight Males Internalization 0.66 .05 -.01 Normal Weight Males Internalization 11.58** .02 .01** Overweight Males Internalization 5.28* .02 .02* Note. * p < .05, 2-tailed. ** p < .01, 2-tailed. Internalization of the Muscular Ideal as a Predictor of Feelings About Appearance Results from a simple regression analysis predicting male adolescents’ feelings about appearance from their SATAQ Internalization scores (See Table 7) was not significant for the
  31. 31. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 23 underweight group (p > .05), but was significant for the normal weight group F(1,600) = 81.38, p < .001, and the overweight group F(1,247) = 40.48, p < .001. Internalization was found to be a significant negative predictor of appearance satisfaction for the normal weight group (B = -.04, p <.001), accounting for 12% of the variability in BESAA Appearance scores (adjusted-R2 = 0.12). Internalization was also found to be a significant negative predictor of appearance satisfaction among males in the overweight group (B = -.04, p < .001), accounting for 14% of the variance in BESAA Appearance scores (adjusted-R2 = .14). Based on the results, it appears as if internalization has an inverse relationship with appearance satisfaction in normal weight and overweight males, whereby more internalization predicts lower feelings about general appearance. No significant results were found for the underweight group however, this may be due to the low sample size of underweight males (See Table 1). Table 7
  32. 32. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 24 Simple Regression Analysis Results Predicting General Feelings About Appearance from Internalization Scores in Male Adolescents Weight Group Variable F Adjusted-R2 B Underweight Males Internalization 2.48 .05 -.03 Normal Weight Males Internalization 81.38* .12 -.04* Overweight Males Internalization 40.48* .14 -.04* Note. * p < .001, 2-tailed. Internalization of the Muscular Ideal as a Predictor of Weight Satisfaction Due to a significant correlation between the BESAA Weight Satisfaction subscale and participant age, r = -.08 p < .05 (See Table 4), age was controlled for in a hierarchical regression analysis examining internalization of the muscular ideal as a predictor of weight satisfaction among male adolescents (See Table 8). In step one of the model, participants’ age was used to
  33. 33. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 25 predict weight satisfaction yielding non-significant results for all three weight categories. With respect to weight satisfaction scores, age accounted for: 2% of the variance in underweight males (adjusted-R2 = .02), 2% of the variance in normal weight males (adjusted-R2 = .02), and -0.1% of the variance in overweight males (adjusted-R2 = -.001). The negative adjusted-R2 finding for the overweight category is important and will be addressed in the discussion section. In step two of the model, SATAQ Internalization scores were used to predict weight satisfaction scores while controlling for age. Significant results were found for the normal weight group F(2,598) = 20.24, p < .001, and the overweight group F(2,245) = 6.64, p = .002. Internalization appeared to be a significant negative predictor of weight satisfaction for the normal weight group (B = -.02, p < . 001), accounting for 6% of the variance in weight satisfaction (adjusted-R2 = .06) with an increase of 4% from stage one (R2 change =.04). Internalization also appeared to be a significant negative predictor of weight satisfaction for the overweight group (B = -.03, p < .001), accounting for 4% of the variance in the weight satisfaction scores (adjusted-R2 = .04) with an increase of 5% from stage one (R2 change = .05). Internalization of the ideal body appears to be inversely related to weight satisfaction for normal and overweight males. Results for the underweight group were not significant, F(2,25) = 3.09, p =.063, although the trend appears to be consistent with the normal weight and overweight groups such that internalization as a predictor appears to be negatively related to weight satisfaction (B = -.05, p = .045). Table 8 Hierarchical Regression Analysis Results Predicting Weight Satisfaction from Internalization Scores in Male Adolescents, While Controlling for Age Predictor Variable R2 F ∆R2 B Underweight Males
  34. 34. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 26 Step 1 .06 1.51 Age -.08 Step 2 .20 3.10 .14 Internalization -.05* Normal Weight Males Step 1 .02 12.59** Age -.05** Step 2 .06 20.24** .04 Internalization -.02** Overweight Males Step 1 .00 .67 Age .02 Step 2 .05 6.63** .05 Internalization -.03** Note. * p < .05, 2-tailed. ** p < .001, 2-tailed. Discussion This study examined the relationship between adolescents’ internalization of the muscular body ideal and weight status as well as internalization’s ability to predict restrictive dietary behaviour, general feelings about appearance and weight satisfaction in a large community sample of adolescent males. There was no relationship found between internalization of the muscular ideal and BMI, this finding suggests that weight does not affect whether adolescent males internalize the socially defined ideal muscular body (or vice versa). This concept is supported by Petrie et al. (2010) who found that the SATAQ Internalization subscale did not correlate with BMI. However, the present finding contradicts that of Knauss et al. (2007) who found that internalization subscale scores in adolescent males were positively correlated with BMI, r = .07, p < .05, albeit an extremely low correlation. These were the only two studies found that examined the relationship between internalization and BMI directly in males, thus
  35. 35. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 27 suggesting that more research be performed in order to establish whether a significant relationship exists between weight and the degree to which males internalize the ideal muscular body. Internalization of socially idealized images (i.e. the muscular body ideal) is most likely influenced by an array of biopsychosocial factors. Research has shown evidence for possible relationships between certain biopsychosocial factors (e.g., weight, ethnicity and culture) and internalization scores, but the majority of studies are on females and findings are conflicting. In order to shed some light on possible relationships in males, discussing the findings from studies using female samples is important. For instance, Vaughan, Sacco & Beckstead (2008) found that Caucasian women evidenced significantly greater levels of thin ideal internalization than African-American women. However, this study was done on female undergraduates, making these findings un-applicable to adolescent males. Shannon Snapp (2009) found that internalization did not differ between groups based on ethnicity or weight categorization, but this study was done using low-income ethnic minority adolescent girls only. Austin & Smith (2008) found that SATAQ Internalization scores were significantly higher in at-risk/overweight girls than in normal weight girls. Research has thus shown that internalization may be influenced by ethnicity, culture and possibly weight, but sample populations are vastly different and often include females only. Research on similar relationships should be done using male participants, with larger sample sizes of underweight males. Significant differences between weight groups were found for the DEBQ Restrained Eating subscale, such that overweight males scored higher on restrained eating than normal weight or underweight, with no differences between the normal and underweight groups; this finding suggests that for male adolescents, being overweight increases the likelihood that one
  36. 36. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 28 will engage in dietary restriction. These findings are supported by past research which found increased dietary restriction (Goldfield et al., 2010) and more weight loss attempts (Frisen & Holmqvist, 2010) in overweight males. General feelings about appearance were also found to differ based on weight status. Significant differences emerged wherein overweight males had significantly more negative feelings about their general appearance compared to normal weight and underweight males, with no differences between underweight and normal weight males; this finding suggests that overweight males are more likely to have negative feelings about their appearance, creating the possibility that weight status may act as a risk factor for low self-esteem in adolescent males. This current result is corroborated by past research on adolescent males which shows that as BMI increases: body dissatisfaction (Lawler & Nixon, 2011; Knauss et al., 2007) and negative feelings about appearance (Frisen & Holmqvist, 2010; Goldfield et al., 2010) increase. Weight status also had a moderating effect on the BESAA Weight Satisfaction subscale, wherein significant differences were revealed between weight groups. Specifically, overweight and underweight males had significantly lower scores for weight satisfaction than normal weight males, with no difference between the overweight and underweight groups; this finding suggests that being overweight or underweight increases the probability that male adolescents will possess negative feelings about their weight, compared to normal weight males. This finding is supported by past research which has shown that as weight increases BESAA Weight Satisfaction subscale scores decrease (Goldfield et al., 2010). With respect to the predictive utility of the SATAQ Internalization subscale, several findings emerged from the regression analyses with differences between weight groups. For
  37. 37. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 29 normal weight and overweight males, SATAQ Internalization scores appeared to be a significant predictor of dietary restraint behaviours, general feelings about appearance and weight satisfaction. In addition, the standardized Beta values suggest that for dietary restraint and feelings about appearance, internalization scores serve as a stronger predictor in overweight males than in normal weight and underweight males. A finding occurred in the regression analysis predicting weight satisfaction, where the adjusted-R2 finding for the overweight category produced a negative value (-.001). This finding suggests that for overweight males the achieved R2 value is less than that which would be expected by chance, fostering the possibility that age is useless in its ability to predict weight satisfaction, but only in overweight adolescent males. Overall, internalization of the muscular ideal appears to predict all three outcome variables of interest with statistical significance for normal weight and overweight adolescent males. For underweight males, SATAQ Internalization was not a significant predictor of dietary restraint, general feelings about appearance or weight satisfaction. Past research has shown that SATAQ Internalization is a significant positive predictor of body dissatisfaction as measured by the Negative Body Evaluation subscale of the Body Image Questionnaire (Knauss et al., 2007) and a significant negative predictor of general feelings about appearance and weight satisfaction as measured by the BESAA (Frisen & Holmquvist, 2010). Similarly, Lawler & Nixon (2011) found that internalization, as measured by The Sociocultural Internalization of Appearance Questionnaire for Adolescents (SIAQ-A) (Keery, Shroff, Thompson,Wertheim & Smolak, 2004), was a significant predictor of body dissatisfaction, as measured by The Contour Drawing Rating Scale (CDRS) (Thompson & Gray, 1995). None of these studies focused solely on males rather their regression analyses divided their sample populations between male and female participants. The current study focused only and males and divided participants into weight classes using
  38. 38. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 30 SATAQ Internalization scores to predict body esteem and dietary restraint behaviours, a model which to date, has not been duplicated in any other study. It is important to note that upon the division of participant data into weight groups the sample size for underweight males (n = 42) became very small after listwise deletions, such that the sample size for any given regression analysis was less than 30. Such low sample sizes inevitably hindered the ability of both ANOVA and regression analyses to yield significant results for underweight males. For example, based on the mean scores for all dependant variables (See Table 5) and the one-way ANOVA results, underweight males scored significantly lower than normal weight males on weight satisfaction, with a mean comparable to overweight males. Despite the similarity between the underweight and overweight groups the regression analysis using internalization to predict weight satisfaction was significant for overweight but not underweight males. The observed trend of internalization being non-significant in its ability to predict any dependent variable, but only in the underweight group, contradicts the general finding from other studies, that suggest internalization predicts weight satisfaction in males (regardless of weight). Had the sample of underweight males been larger, it is possible that more statistically significant relationships may have emerged for this group. Limitations While the sample population utilized was large and representative of male, middle and high school students in Ontario, the findings may not be applicable to other provinces and are not generalizable to students in other countries. The data used were cross-sectional in nature and as a result, causality cannot be inferred; therefore longitudinal research is needed to better ascertain the directionality of findings over time. Future research should incorporate more variables such as ethnic, genetic and personality measures in order to see how these measures impact the
  39. 39. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 31 relationships between the variables of interest as well as the efficacy of internalization to predict dietary restraint behaviours and body esteem. By studying more variables a better understanding of all the factors associated with internalization, dietary restraint and body esteem may be achieved, aiding in the ability to create effective preventative programs. In order to measure weight status, BMI was used, but the medical community acknowledges that BMI does not distinguish from fat-free mass such as muscle and bone, making it a less accurate measure of adiposity. Furthermore, BMI serves as a less accurate measure for males because muscle tissue contributes to overall weight and males tend to be more muscular than females (Burkhauser & Cawley, 2008). Despite its shortcomings, BMI does serve as one of the most reliable and cost- effective means of measuring weight status and is the most widely used measure of weight in many fields of research; however, when attempting to measure adiposity, more accurate measures of body-fat content should be explored. Most importantly, the sample size of underweight participants was low, fostering the possibility that the non-significant results obtained in the underweight group were due to a lack of statistical power, and not necessarily indicative of an absence of relationship. Future research should attempt to acquire larger sample sizes of underweight males to see if internalization becomes a significant predictor of dietary restraint and body esteem in male adolescents. Conclusions The current study has several methodological strengths which include a large and diverse sample, representative of English speaking adolescent males attending urban, suburban and rural middle and high schools in Ontario, objective measurements of height and weight and a questionnaire that boasts a multitude of strong, validated scales and measures thus supporting their use. The findings from this community sample show significant differences between weight
  40. 40. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 32 groups on different measures of body esteem and unhealthy eating behaviours, and a strong predictive utility of internalization of the muscular ideal to predict dietary restraint behaviours and body esteem in normal weight and overweight male adolescents. Inferences of causality cannot be made due to the cross-sectional nature of the data, thus longitudinal studies are needed in order to see if the observed differences between weight groups persist over time as individual weight status’ change and also to examine whether internalization of the muscular ideal predisposes adolescents to unhealthy bahaviours and low body esteem at later ages. Implications for Prevention Strategies Findings from the current study have several implications regarding prevention strategies. Understanding predictors of low body esteem and unhealthy eating behaviours may contribute to the development of awareness and prevention programs for at-risk adolescent males as well as health promotion programs. Such information may be used by staff of schools or other youth communities in order to be more cognizant about which students may be at-risk allowing them to intervene if necessary and when possible before problematic behaviours develop. In addition, health promotion programs that educate youth on the biological and sociocultural factors that contribute to both obesity and thinness, and the reality of the idealistic body type presented in North American media may help students reduce cognitive dissonance resulting from comparisons between their own bodies and an unrealistic ideal body. The current findings suggest that both overweight and underweight male students have lower body esteem related to their weight, that overweight males are far more likely to engage in unhealthy restrictive dietary behaviours and have low self esteem regarding their overall appearance, and that high SATAQ Internalization scores predict low body esteem and increased dietary restriction in normal and overweight youth. Although the media indoctrinates the minds of youth with images of
  41. 41. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 33 perfection, it is the field of academia that controls the curriculum in our schools. Educating youth and their parents about media influence, social psychology, the reality of unrealistic ideals, and healthy eating and exercise practices may help reduce the desire to achieve unrealistic goals, or at the very least, provide youth with the ability to go about achieving their goals in a healthier fashion. References Ata, R. N., Ludden, A. B., & Lally, M. M. (2007). The effects of gender and family, friend, and media influences on eating behaviors and body image during adolescence. Journal of Youth and Adolescence, 36, 1024-1037. Austin, J. L. & Smith, J. E. (2008). Thin ideal internalization in Mexican girls: a test of the sociocultural model of eating disorders. International Journal of Eating Disorders, 41, 448-457. Bares, M., Kopecek, M., Novak, T., Stopkova, P., Sos, P., Kozeny, J. et al. (2009). Low frequency (1-Hz), right prefrontal repetitive transcranial magnetic stimulation (rTMS) compared with venlafaxine ER in the treatment of resistant depression: a double-blind, single-centre, randomized study. Journal of Affective Disorders, 118, 94-100.
  42. 42. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 34 Barker, E. T. & Galambos, N. L. (2003). Body dissatisfaction of adolescent girls and boys: risk and resource factors. Journal of Early Adolescence, 23, 141-165. Brooks-Gunn, J., Warren, M. P., Rosso, J., & Gargiulo, J. (1987). Validity of self-report measures of girls' pubertal status. Child Development, 58, 829-841. Burkhauser, R. V. & Cawley, J. (2008). Beyond BMI: the value of more accurate measures of fatness and obesity in social science research. Journal of Health Economics, 27, 519-529. Cafri, G., Thompson, J. K., Ricciardelli, L., McCabe, M., Smolak, L., & Yesalis, C. (2005). Pursuit of the muscular ideal: Physical and psychological consequences and putative risk factors. Clinical Psychology Review, 25, 215-239. Canadian Institute for Health Information (2008). The cost of hospital stays: why costs vary. Ottawa: CIHI. Retrieved from http://secure.cihi.ca/cihiweb/products/2008hospcosts_report_e.pdf Carskadon, M. A. & Acebo, C. (1993). A self-administered rating scale for pubertal development. Journal of Adolescent Health, 14, 190-195. Cashel, M. L., Cunningham, D., Landeros, C., Cokley, K. O., & Muhammed, G. (2003). Sociocultural attitudes and symptoms of bulimia: evaluating the SATAQ with diverse college groups. Journal of Counseling Psychology, 50, 287-296. Cecil, H. & Stanley, M. A. (1997). Reliability and validity of adolescents' scores on the body esteem scale. Educational and Psychological Measurements, 57, 340-357.
  43. 43. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 35 Cole, T. J., Bellizzi, M. C., Flegal, K. M., & Dietz, W. H. (2000). Establishing a standard definition for child overweight and obesity worldwide: international survey. British Medical Journal, 320, 1240-1243. Cole, T. J., Faith, M. S., Pietrobelli, A., & Heo, M. (2005). What is the best measure of adiposity change in growing children: BMI, BMI %, BMI z-score or BMI centile? European Journal of Clinical Nutrition, 59, 419-425. Cole, T. J., Flegal, K. M., Nicholls, D., & Jackson, A. A. (2007). Body mass index cut offs to define thinness in children and adolescents: international survey. British Medical Journal, 335, 194. Daniel, S. & Bridges, S. K. (2010). The drive for muscularity in men: media influences and objectification theory. Body Image, 7, 32-38. Edmunds, H. & Hill, A. J. (1999). Dieting and the family context of eating in young adolescent children. International Journal of Eating Disorders, 25, 435-440. Eisenberg, M. E., Neumark-Sztainer, D., & Paxton, S. J. (2006). Five-year change in body satisfaction among adolescents. Journal of Psychosomatic Research, 61, 521-527. Field, A. E., Austin, S. B., Taylor, C. B., Malspeis, S., Rosner, B., Rockett, H. R. et al. (2003). Relation between dieting and weight change among preadolescents and adolescents. Pediatrics, 112, 900-906.
  44. 44. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 36 Forbes, G. B., Jobe, R. L., & Revak, J. A. (2006). Relationships between dissatisfaction with specific body characteristics and the Sociocultural Attitudes Toward Appearance Questionnaire-3 and Objectified Body Consciousness Scale. Body Image, 3, 295-300. Frisen, A. & Holmqvist, K. (2010). Physical, sociocultural, and behavioral factors associated with body-esteem in 16-year-old Swedish boys and girls. Sex Roles, 63, 373-385. Goldfield, G. S., Moore, C., Henderson, K., Buchholz, A., Obeid, N., & Flament, M. F. (2010). Body dissatisfaction, dietary restraint, depression, and weight status in adolescents. Journal of School Health, 80, 186-192. Halvarsson, K. & Sjödén, P. O. (1998). Psychometric properties of the Dutch Eating Behaviour Questionnaire (DEBQ) among 9-10-year-old Swedish girls. European Eating Disorders Review, 6, 115-125. Heinberg, L. J., Thompson, J. K., & Stormer, S. (1995). Development and validation of the Sociocultural Attitudes Towards Appearance Questionnaire. International Journal of Eating Disorders, 17, 81-89. Heinberg, L. J., Coughlin, J. W., Pinto, A. M., Haug, N., Brode, C., & Guarda, A. S. (2008). Validation and predictive utility of the Sociocultural Attitudes Toward Appearance Questionnaire for Eating Disorders (SATAQ-ED): internalization of sociocultural ideals predicts weight gain. Body Image, 5, 279-290. Hsu, L. K. (1997). Can dieting cause an eating disorder? Psychological Medicine, 27, 509-513.
  45. 45. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 37 Jones, D. (2004). Body image among adolescent girls and boys: a longitudinal study. Developmental Psychology, 40, 823-835. Keery, H., Shroff, H., Thompson, J. K., Wertheim, E., & Smolak, L. (2004). The Sociocultural Internalization of Appearance Questionnaire - Adolescents (SIAQ-A): psychometric analysis and normative data for three countries. Eating and Weight Disorders, 9, 56-61. Knauss, C., Paxton, S. J., & Alsaker, F. D. (2007). Relationships amongst body dissatisfaction, internalisation of the media body ideal and perceived pressure from media in adolescent girls and boys. Body Image, 4, 353-360. Lattimore, P. J. & Butterworth, M. (1999). A test of the structural model of initiation of dieting among adolescent girls. Journal of Psychosomatic Research, 46, 295-299. Lawler, M. & Nixon, E. (2011). Body dissatisfaction among adolescent boys and girls: the effects of body mass, peer appearance culture and internalization of appearance ideals. Journal of Youth and Adolescence, 40, 59-71. Maloney, M. J., McGuire, J., Daniels, S. R., & Specker, B. (1989). Dieting behavior and eating attitudes in children. Pediatrics, 84, 482-489. McVey, G., Tweed, S., & Blackmore, E. (2005). Correlates of weight loss and muscle-gaining behavior in 10- to 14-year-old males and females. Preventive Medicine, 40, 1-9. Mendelson, B. K., Mendelson, M. J., & White, D. R. (2001). Body-esteem scale for adolescents and adults. Journal of Personality Assessment, 76, 90-106.
  46. 46. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 38 Mirolla, M. (2004). The cost of chronic disease in Canada. The Chronic Disease Prevention Alliance of Canada. Retrieved from http://www.gpiatlantic.org/pdf/health/chroniccanada.pdf Neumark-Sztainer, D., Paxton, S. J., Hannan, P. J., Haines, J., & Story, M. (2006). Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. Journal of Adolescent Health, 39, 244- 251. Petersen, A. C., Crockett, L., Richards, M., & Boxer, A. (1988). A self-report measure of pubertal status: reliability, validity, and initial norms. Journal of Youth and Adolescence, 17, 117-133. Petrie, T. A., Austin, L. J., Crowley, B. J., Helmcamp, A., Johnson, C. E., Lester, R. et al. (1996). Sociocultural explanations of attractiveness for males. Sex Roles, 35, 581-602. Petrie, T. A., Greenleaf, C., & Martin, S. (2010). Biopsychosocial and physical correlates of middle school boys' and girls' body satisfaction. Sex Roles, 63, 631-644. Pope, H. G., Jr., Katz, D. L., & Hudson, J. I. (1993). Anorexia nervosa and "reverse anorexia" among 108 male bodybuilders. Comprehensive Psychiatry, 34, 406-409. Pope, H. G., Jr. & Katz, D. L. (1994). Psychiatric and medical effects of anabolic-androgenic steroid use. A controlled study of 160 athletes. Archives of General Psychiatry, 51, 375- 382.
  47. 47. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 39 Pope, H. G., Jr., Olivardia, R., Gruber, A., & Borowiecki, J. (1999). Evolving ideals of male body image as seen through action toys. International Journal of Eating Disorders, 26, 65-72. Smolak, L., Levine, M. P., & Thompson, J. K. (2001). The use of the sociocultural attitudes towards appearance questionnaire with middle school boys and girls. International Journal of Eating Disorders, 29, 216-223. Smolak, L., Murnen, S. K., & Thompson, J. K. (2005). Sociocultural influences and muscle building in adolescent boys. Psychology of Men and Masculinity, 6, 227-239. Snapp, S. (2009). Internalization of the thin ideal among low-income ethnic minority adolescent girls. Body Image, 6, 311-314. Stice, E. & Bearman, S. K. (2001). Body-image and eating disturbances prospectively predict increases in depressive symptoms in adolescent girls: a growth curve analysis. Developmental Psychology, 37, 597-607. Stice, E. & Shaw, H. E. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: a synthesis of research findings. Journal of Psychosomatic Research, 53, 985-993. Stice, E. (2002). Risk and maintenance factors for eating pathology: a meta-analytic review. Psychological Bulletin, 128, 825-848.
  48. 48. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 40 Stice, E., Presnell, K., Shaw, H., & Rohde, P. (2005). Psychological and behavioral risk factors for obesity onset in adolescent girls: a prospective study. Journal of Consulting and Clinical Psychology, 73, 195-202. Thompson, M. A. & Gray, J. J. (1995). Development and validation of a new body-image assessment scale. Journal of Personality Assessment, 64, 258-269. Van Strien, T., Frijters, J. E. R., Bergers, G. P. A., & Defares, P. B. (1986). The Dutch Eating Behaviour Questionnaire (DEBQ) for assessment of restrained, emotional and external eating behaviour. International Journal of Eating Disorders, 5, 747-755. Vartanian, L. R., Peter, H. C., & Polivy, J. (2005). Implicit and explicit attitudes toward fatness and thinness: The role of the internalization of societal standards. Body Image, 2, 373- 381. Vaughan, C. A., Sacco, W. P., & Beckstead, J. W. (2008). Racial/ethnic differences in Body Mass Index: the roles of beliefs about thinness and dietary restriction. Body Image, 5, 291-298. Wardle, J. (1987). Eating style: a validation study of the Dutch Eating Behaviour Questionnaire in normal subjects and women with eating disorders. Journal of Psychosomatic Research, 31, 161-169. Yiend, J., Paykel, E., Merritt, R., Lester, K., Doll, H., & Burns, T. (2009). Long term outcome of primary care depression. Journal of Affective Disorders, 118, 79-86.
  49. 49. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 41 Appendix A Male Portion of The Sociocultural Attitudes Toward Appearance Questionnaire (SATAQ). Please read each of the following items and circle the number between 1 and 5 that best reflects YOUR AGREEMENT WITH THE STATEMENT Completely Neither agree Completely disagree or disagree agree 1. Men who appear in TV shows and movies have the type of appearance that I see as my goal………………………………………………. 1 2 3 4 5 2. I believe that clothes look better on muscular men……………………………..1 2 3 4 5 3. Music videos that show muscular men make me wish that I were muscular..1 2 3 4 5 4. I would like to look like the muscular men who model clothing………………..1 2 3 4 5 5. I tend to compare my body to people in magazines and on TV……………….1 2 3 4 5 6. In our society, fat people are regarded as unattractive………………………...1 2 3 4 5 7. Photographs of muscular men make me wish I were muscular……………… 1 2 3 4 5 8. Attractiveness is very important if you want to get ahead in our culture……..1 2 3 4 5 9. It’s important for people to work hard on their figures/physiques if they want to succeed in today’s culture………………………………………………..1 2 3 4 5 10. Most people believe that the more muscular you are, the better you look…1 2 3 4 5 11. People think that the more muscular you are, the better you look in clothes……………………………………………………………………………..1 2 3 4 5 12. In today’s society, it is important to always look attractive…………………...1 2 3 4 5 13. I wish I looked like a body builder……………………………………………….1 2 3 4 5 14. I often read magazines like Muscle & Fitness, Sport Illustrated, and CG,
  50. 50. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 42 and compare my appearance to the male models in the magazine……..….1 2 3 4 5
  51. 51. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 43 Appendix B The Dutch Eating Behaviour Questionnaire Items. WHEN AND HOW DO YOU EAT? Circle the number that shows how often the statement is true for you Never Seldom Some- Often Very . times often 1. If you have put on weight, do you eat less than you usually do?.....…..........................1 2 3 45 2. Do you try to eat less at mealtimes than you would like to eat?....................……….....1 2 3 45 3. How often do you refuse food or drink offered because you are concerned about your weight?........................................................................................................ 1 2 3 45 4. Do you watch exactly what you eat?............................................................................. 1 2 3 45 5. Do you deliberately eat foods that are slimming?..........................................................1 2 3 45 6. When you have eaten too much, do you eat less than usual the following days?........ 1 2 3 45 7. Do you deliberately eat less in order not to become heavier?.......................................1 2 3 45 8. How often do you try not to eat between meals because you are watching your weight?.. 1 2 3 45 9. How often in the evening do you try not to eat because you are watching your weight?. …1 2 3 45 10. Do you take into account your weight with what you eat?...........................................1 2 3 45 11. Do you have the desire to eat when you are irritated?............................................... 1 2 3 45 12. Do you have a desire to eat when you have nothing to do?........................................1 2 3 45 13. Do you have a desire to eat when you are depressed or discouraged?..................... 1 2 3 45 14. Do you have a desire to eat when you are feeling lonely?..........................................1 2 3 45 15. Do you have a desire to eat when somebody lets you down?.....................................1 2 3 45 16. Do you have a desire to eat when you are cross?.......................................................1 2 3 45 17. Do you have a desire to eat when you are approaching something unpleasant to happen? …………………………………………………………………………………. 1 2 3 45 18. Do you have a desire to eat when you are anxious, worried or tense?.......................1 2 3 45 19. Do you have a desire to eat when things are going against you or when things have gone wrong?.......................................................................................................1 2 3 45
  52. 52. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 44 20. Do you have a desire to eat when you are frightened?...............................................1 2 3 45 21. Do you have a desire to eat when you are disappointed?...........................................1 2 3 45 22. Do you have a desire to eat when you are emotionally upset?...................................1 2 3 45 23. Do you have a desire to eat when you are bored or restless?.....................................1 2 3 45 24. If food tastes good to you, do you eat more than usual?.............................................1 2 3 45 25. If food smells and looks good, do you eat more than usual?...................................... 1 2 3 4 5 26. If you see or smell something delicious, do you have the desire to eat it?..................1 2 3 4 5 27. If you have something delicious to eat, do you eat it straight away?...........................1 2 3 4 5 28. If you walk past the bakery, do you have a desire to buy something delicious?.........1 2 3 4 5 29. If you walk past a snack bar or a café, do you have a desire to buy something delicious?.....................................................................................................................1 2 3 4 5 30. If you see others eating, do you also have a desire to eat?.........................................1 2 3 4 5 31. Can you resist eating delicious foods?........................................................................1 2 3 4 5 32. Do you eat more than usual when you see others eating?..................................…....1 2 3 4 5 33. When preparing a meal, are you inclined to eat something?...................................... 1 2 3 4 5
  53. 53. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 45 Appendix C The Body Esteem Scale for Adolescents and Adults. Indicate HOW OFTEN YOU AGREE with the following statements ABOUT YOURSELF by circling the appropriate number Never Seldom Sometimes Often Always 1. I like what I look like in pictures…………………………………..….………0 1 2 3 4 2. Other people consider me good looking……………………………………0 1 2 3 4 3. I’m proud of my body…………………………………………………..…...…0 1 2 3 4 4. I am preoccupied with trying to change my body weight ………………...0 1 2 3 4 5. I think my appearance would help me get a job……………………………0 1 2 3 4 6. I like what I see when I look in the mirror…………………………………..0 1 2 3 4 7. There are lots of things I’d change about my looks if I could………..……0 1 2 3 4 8. I am satisfied with my weight ………………………………………………..0 1 2 3 4 9. wish I looked better ………………………………………………………… 0 1 2 3 4 10. I really like what I weigh……………………………………………………..0 1 2 3 4 11. I wish I looked like someone else………………………………………….0 1 2 3 4 12. People my own age like my looks…………………………………….……0 1 2 3 4 13. My looks upset me…………………………………………………….........0 1 2 3 4 14. I’m as nice looking as most people………………………………………..0 1 2 3 4 15. I’m pretty happy about the way I look………………………………..........0 1 2 3 4 16. I feel I weigh the right amount for my height…………………………….. 0 1 2 3 4 17. I feel ashamed of how I look…………………………………………….....0 1 2 3 4 18. Weighing myself depresses me……………………………………………0 1 2 3 4 19. My weight makes me unhappy……………………………………………. 0 1 2 3 4 20. My looks help me to get dates……………………………………………..0 1 2 3 4 21. I worry about the way I look…………………………………………….…..0 1 2 3 4
  54. 54. INTERNALIZATION DIETARY RESTRAINT AND BODY ESTEEM IN ADOELSCENT MALES 46 22. I think I have a good body…………………………………………….…….0 1 2 3 4 23. I’m looking as nice as I’d like to……………………………………….……0 1 2 3 4

×