Exteroception, the processing of environmental sensory information, may be relevant to eating disorder (ED) symptoms, but limited research has examined its associations across specific ED symptom dimensions. This study primarily examined whether self-reported exteroceptive sensibility was associated with dietary restraint, eating concern, weight concern, shape concern, avoidant/restrictive eating symptoms, binge-eating symptoms, and orthorexia-related symptoms. Secondary analyses investigated sociodemographic differences in self-reported exteroceptive sensibility and whether sociodemographic variables moderated associations between self-reported exteroceptive sensibility and ED symptom dimensions. A non-clinical community sample of 221 Australian adults completed self-report measures of ED symptoms and exteroceptive sensibility. Spearman correlations assessed associations between exteroceptive sensibility and ED symptom dimensions. Group comparisons assessed sociodemographic differences in exteroceptive sensibility, and regression-based moderation models examined whether sociodemographic variables (e.g. sex assigned at birth, gender identity, and age) moderated associations between exteroceptive sensibility and ED symptom dimensions. Self-reported exteroceptive sensibility was positively associated with dietary restraint, eating concern, weight concern, shape concern, avoidant/restrictive eating symptoms, and binge-eating symptoms. Associations with orthorexia-related symptoms were weaker and did not remain statistically significant after Holm–Bonferroni correction. Associations were strongest for avoidant/restrictive eating symptoms. Exteroceptive sensibility differed across several sociodemographic variables, but moderation analyses provided limited evidence that these variables altered associations between exteroceptive sensibility and ED symptom dimensions. Self-reported exteroceptive sensibility was positively associated with multiple ED symptom dimensions, with the strongest associations observed for avoidant/restrictive eating symptoms. Findings support consideration of sensory experiences in ED assessment and care. Level of evidence: Level III, cross-sectional analytic study.
Orthorexia nervosa refers to a pathological preoccupation with healthy eating characterized by rigid dietary rules, excessive concern about food purity, and distress when these rules are violated. Despite growing clinical interest, validated instruments for assessing orthorexic tendencies in children and adolescents remain limited. This study aimed to evaluate the validity and reliability of the Turkish version of the ORTO-R Scale in a clinical sample of adolescents and to examine its associations with eating-related and anxiety symptoms. A total of 132 participants aged 12–17 years were recruited from a child and adolescent psychiatry outpatient clinic. Participants completed the ORTO-R Scale, the Eating Attitudes Test-26, the Orthorexia Nervosa Inventory, and the Revised Child Anxiety and Depression Scale, and psychiatric diagnoses were assessed using a semi-structured clinical interview. The ORTO-R demonstrated good internal consistency, with Cronbach’s α and McDonald’s ω coefficients of 0.77. Confirmatory factor analysis identified a three-factor structure with favorable overall model fit. Total ORTO-R scores showed moderate positive correlations with orthorexic and eating disorder symptoms and low-to-moderate correlations with anxiety symptoms. The Turkish version of the ORTO-R showed promising preliminary psychometric properties in this psychiatric outpatient sample, including acceptable internal consistency and meaningful associations with related measures. Further studies in larger, more diverse, and community-based samples are needed to confirm its validity, reliability, and clinical utility.
Spontaneous pneumomediastinum (SPM) is a rare but significant complication of anorexia nervosa (AN). While historically linked to Valsalva maneuvers, a growing body of evidence implicates severe malnutrition as an associated risk factor, challenging traditional etiologic models. To describe a case of SPM in a patient with profound weight loss and malnutrition without classic triggers and review the literature on malnutrition as a contributing factor. We present the case of a 23-year-old male with rapid weight loss (80 kg over 7 months) and a body mass index (BMI) of 17 kg/m2 (DSM-5 mild severity) who developed exertional dyspnea and subcutaneous emphysema in the absence of vomiting, coughing, trauma, or evidence of covert purging. Computed tomography confirmed isolated SPM; a CT of the abdomen performed at an outside center was normal, excluding intra-abdominal pathology. Symptoms resolved completely with eight days of conservative management and intensive nutritional rehabilitation, during which he gained 1.5 kg. Male cases of AN are statistically rare, which further increases the clinical interest of this presentation. This case reinforces the association between rapid weight loss/malnutrition and SPM pathogenesis. A narrative review of the literature reveals a broad clinical spectrum, ranging from benign, self-limited presentations to a more severe presentation characterized by multi-compartmental air leaks and cardiopulmonary compromise. The patient's BMI of 17 kg/m2 (mild severity) contrasts with most prior cases (BMI 10–14), suggesting that the rate of weight loss ( 11 kg/month) may be more pathophysiologically relevant than absolute BMI. SPM is a critical complication of rapid weight loss and malnutrition that can occur without classic triggers. Clinicians should recognize its potential for recurrence and, rarely, for severe progression. This report synthesizes current evidence to provide a framework for diagnosis, risk stratification, and comprehensive management. Future research should focus on identifying biomarkers of tissue fragility, including prealbumin, rate of weight loss, and low BMI.
Body image disturbance is a common characteristic of eating and body dysmorphic disorders that can manifest through three theorized dimensions: evaluative, behavioral, and perceptual. Despite this, the perceptual aspect of body image disturbance is not well understood, nor how it relates to the evaluative and behavioral dimensions. This study investigates the relationship between the perceptual and other dimensions of body image disturbance, as well as its potential to predict symptoms of eating disorders and body dysmorphic disorder. Two hundred and sixty-two female undergraduate students between the ages of 17 and 25 completed various assessment measures of body image disturbance, along with clinical measures for eating disorder and body dysmorphic disorder symptoms. The findings revealed strong relationships overall between most perceptual measures and evaluative and behavioral measures. Additionally, multiple regression analyses showed that several perceptual measures were significant, unique predictors of symptoms related to eating disorders and, to a lesser extent, body dysmorphic disorder. These results provide valuable insight into the relationship between the three dimensions of body image disturbance as well as reinforce the importance of the perceptual dimension in understanding body image disturbance. We discuss the study's implications for understanding and addressing eating disorders and body dysmorphic disorder. Level of Evidence: Level I, evidence obtained from experimental studies.
Autonomous motivation and self-compassion may potentially influence outcomes in eating disorder treatment. Self-compassion may reduce criticism and shame, which have been implicated in the maintenance of anorexia nervosa. This study examined whether baseline autonomous motivation and self-compassion, and their interaction, were associated with changes in eating disorder symptoms in women with anorexia nervosa receiving inpatient treatment. Participants were 56 women (M age = 23.8, range = 16–52 years) diagnosed with anorexia nervosa and admitted to an inpatient eating disorder programme. Eating disorder symptoms (Eating Disorder Examination-Questionnaire; EDE-Q), autonomous motivation (Autonomous and Controlled Motivation for Treatment Questionnaire; ACMTQ), and self-compassion (Self-Compassion Scale-Short Form (SCS-SF) were measured at pre- and post-treatment. Latent change score models indicated that higher baseline autonomous motivation was associated with greater reductions in eating disorder symptoms across treatment. Baseline self-compassion and the interaction between autonomous motivation and self-compassion were not associated with changes in eating disorder symptoms. Post hoc Monte Carlo simulations indicated that the models were adequately powered to detect effects of the observed magnitude. The findings are consistent with Self-Determination Theory in eating disorder populations and suggest that higher autonomous motivation is associated with greater reductions in eating disorder symptoms. Future research should examine whether interventions targeting autonomous motivation may be associated with improved treatment outcomes in women with anorexia nervosa. Level III: Evidence obtained from well-designed cohort or case–control analytic studies.
Growing popularity of restrictive dietary practices exists among young women; however, their effects on health and factors driving adoption of restrictive dietary practices among young Indian women remain underexplored. The study assessed prevalence, awareness, and effects of perceived restrictive dietary practices among young adult Indian women (18–30 years). A cross-sectional pilot study using online survey was performed pan-India using a pre-tested questionnaire. A total of 230 young women who provided consent and met eligibility criteria completed the study. Information on socio-demographics, nutrition knowledge, dietary habits, and perceived effects of restrictive dietary practices were collected. Descriptive statistics and chi-square/Fisher’s exact tests were performed to investigate associations between age, education attainment status, and outcomes. The study reported a prevalence of adoption of restrictive dietary practices was 20.9
Binge eating disorder (BED) represents a significant public health concern due to its multifaceted physical, psychological, and economic consequences, all of which substantially impair the quality of life of affected individuals. Individuals with BED often experience persistent body dissatisfaction, emotional distress, anxiety, depression, chronic stress, and social prejudice. Fear of judgment, stigmatisation, and discrimination frequently leads to delays in, or complete avoidance of, seeking medical or psychological support. Although BED remains largely underdiagnosed, existing literature indicates a higher prevalence among females. Nevertheless, the factors contributing to its onset remain insufficiently explored, despite the well-documented vulnerability of women throughout various life stages. Specifically, gendered social roles and ongoing hormonal fluctuations are known to influence emotional regulation, potentially triggering and sustaining binge eating behaviours. This narrative review explores the prevalence and associated factors of BED in the female population across the lifespan, including childhood, adolescence, pregnancy, and menopause. It also considers the transgender population, acknowledging how gender identity, stigma, discrimination, and hormonal treatments can influence BED risk and presentation. Moreover, studies highlighted that the risk and maintenance of BED are exacerbated at various life stages by biological changes associated with sex, as well as by sociocultural influences related to gender roles and socially constructed ideals of femininity. Understanding these diverse factors is essential for developing targeted prevention and treatment strategies that address the specific psychological and biological, as well as social challenges faced by women and individuals assigned female at birth. Importantly, further research is warranted to reduce disparities in healthcare access and to dismantle structural barriers and stigma. Both clinical practice and research must embrace inclusive frameworks that acknowledge the unique vulnerabilities of marginalised populations, while also enhancing healthcare professionals’ training to ensure equitable, culturally competent, and effective care.
Interoception has been reported to be impaired in patients with restrictive eating disorders (REDs), while its role in patients with borderline personality disorder (BPD) is more controversial. We set out to conduct a clinical study to explore the relationship between interoception, eating disorders, and BPD. We recruited a sample of 75 female adolescents affected by REDs, of whom 21 received a diagnosis of comorbid BPD. In addition to collecting demographic and clinical data, we administered measures of interoceptive awareness (MAIA-2), the scale for eating symptomatology (EDI-3), and alexithymia (TAS-20) to all patients. Patients with REDs and comorbid BPD reported lower scores on the MAIA-2 Not-Distracting (p = 0.046) and Trusting (p = 0.023) subscales, reflecting decreased focus and reliance on bodily sensations of pain or discomfort compared to patients with REDs only. Lower scores on the MAIA-2 Trusting subscale were associated with higher scores on all EDI-3 subscales and on the total TAS-20 scale (p = 0.005), whereas lower scores on the MAIA-2 Not-Worrying subscale were associated with higher scores on the EDI-3 Interpersonal Problems composite subscale (p = 0.049), and higher scores on the MAIA-2 Noticing subscale were associated with higher scores on the EDI-3 Affective Problems composite subscale (p = 0.003). Interoceptive dysfunction appears to be a key vulnerability factor for eating disorder psychopathology in female adolescents with REDs, with comorbid BPD potentially further exacerbating these impairments. Targeting interoceptive processes may represent a promising therapeutic approach to improve emotion regulation and clinical outcomes, particularly in patients with co-occurring BPD, and warrants further investigation in this clinical population. Level III Evidence obtained from cohort or case–control analytic studies.
To investigate the relationships between Intuitive Eating and maladaptive eating behaviors among Brazilian university students. A cross-sectional quantitative study was conducted among technical, undergraduate, and postgraduate students aged 18 years or above, between 2020 and 2021. Participants completed an online survey comprising sociodemographic questions, the Intuitive Eating Scale-2 (IES-2), and the Three-Factor Eating Questionnaire-Revised 21 (TFEQ-R21), both validated for the Brazilian population. Spearman’s correlation and MANCOVA tests were used to assess associations between study variables. The study included 1,237 participants (82.6
Body mass index (BMI) standard deviation scores (SDS) are essential for age- and sex-adjusted assessments in pediatric populations, including growth trajectories. Their accuracy depends on the use of population-specific reference data, as BMI distributions vary substantially across countries. Despite the availability of internationally recognized growth standards, no accessible computational tool tailored to Italian normative data has been previously described. This paper describes the development and validation of an interactive, freely accessible web-based calculator for deriving BMI-SDS in Italian children and adolescents, based on the nationally representative Cacciari et al. (2006) growth reference dataset. BMI-SDS computation is based on the LMS parameterization of Italian reference curves, which provide sex-specific L (skewness), M (median), and S (coefficient of variation) values at half-year age intervals from 2 to 20 years for a nationally representative Italian sample of approximately 70,000 children and adolescents. The tool was implemented in R using the Shiny web application framework and is hosted at https://turius.shinyapps.io/BMI_SDS_IT/. Given user-entered weight, height, age, and sex, the tool computes BMI (kg/m2), derives the corresponding BMI-SDS and returns i) age- and sex-adjusted BMI-SDS; ii) the corresponding percentile; iii) a graphical representation of the individual's position on the reference distribution. The tool offers a straightforward, clinician- and researcher-friendly interface for computing age- and sex-standardized BMI scores using Italian-specific references, supporting more accurate weight-status classification in both clinical practice and epidemiological research.
Sexual minoritized men (SMM) exhibit high rates of thinness- and muscularity-oriented eating and body image disturbances, possibly due to sexual minority and intraminority stressors. Yet, existing research has largely employed variable-centered methods (e.g., correlation- and regression-based analyses), which limit understanding of within-group heterogeneity and symptom-to-symptom connections. We applied a three-prong analytical approach (variable-centered, person-centered, and network analyses) to examine relations among sexual minority and intraminority stressors and eating and body image disturbances among SMM (N = 255; Mage = 25.79). Variable-centered analyses revealed that, after adjusting for covariates and other stressors, internalized heterosexism, heterosexist discrimination, and intraminority body stigma were uniquely and positively associated with both thinness- and muscularity-oriented disordered eating. Intraminority body stigma was uniquely associated with more thinness- and muscularity-oriented body image disturbances, and internalized heterosexism was a unique, positive correlate of muscularity-oriented body image disturbances. Person-centered analysis revealed three profiles: Low Sexual Minority Intraminority Stress (70
Although kleptomania is frequently observed in patients with eating disorders, research on its causes is scarce, and no scale exists to assess it. This pilot study was done to develop such a scale and to evaluate its validity and reliability. Forty-six female patients with anorexia nervosa incarcerated at the Kitakyushu Medical Prison completed our newly developed questionnaire that is based on the DSM-5 diagnostic criteria for kleptomania. All participants had developed an eating disorder prior to their initial incarceration in a correctional facility, had no history of stimulant abuse, and were incarcerated for theft. Factor analysis (principal axis method, Promax rotation) identified three significant factors: “Elation/Pleasure”, “Material/Monetary Desire”, and “Impulsivity.” The test–retest correlation coefficients for each item were generally high, confirming test–retest reliability. While the Cronbach’s alpha coefficients for items with high factor loadings on each factor were moderate, the correlations between factors were low, suggesting that each factor represents an independent construct. The “Elation/Pleasure” factor aligned with DSM diagnostic criteria B and C, the “Impulsivity” factor aligned with Criterion A, and the “Material/Monetary Desire” factor contradicted Criterion A. These preliminary findings suggest the validity and reliability of this questionnaire, which indicates that it may be useful as a foundational resource and contribute to the advancement of this field. Level of evidence III: Retrospective observational study.
Eating disorders (EDs) are a growing global health concern and are increasingly associated with negative body-image perceptions linked to social-media exposure, particularly among adolescents. Early identification and screening of individuals at risk can influence effective patient management and care. AI models, such as machine learning, natural language processing, or wearables, have shown early promise as potential screening tools, offering early prediction, improved accuracy, reduced reporting bias, and better user compliance than conventional methods. Literature from PubMed, Scopus, and Web of Science (2015–July 2025) produced 606 records after applying Boolean operators “OR” for synonyms and “AND” to link core concepts. 23 studies were included using the PICOT framework. Data extraction examined predictors, algorithms, metrics, and limitations. The findings on predicting EDs highlight six major domains: traditional machine-learning (ML) models, sensor-based systems, mobile and wearable technologies, natural language processing (NLP), questionnaire-based models, and integrated risk prediction frameworks. Among all the domains, sensor-based and wearable systems, along with NLP from social-media data, demonstrated the highest accuracy. While traditional questionnaire-based models integrating validated tools with AI/ML have shown moderate performance, they remain limited by small sample sizes, standardised settings, and a lack of validation in low-resource settings, such as India. AI-based predictive models demonstrate promising early potential for scalable, likely less biased, and non-stigmatising detection of EDs. Despite the promising performance demonstrated across multiple AI-based approaches, certain challenges remain, including generalizability, ethical considerations, and real-world implications. Although most AI-based eating-disorder research has been conducted in high-income countries, evidence from developing and culturally diverse settings remains limited, where cultural variations and social stigma co-exist. In such contexts, the use of multimodal systems can support early prediction of eating disorders. Future research should be culturally diverse, integrate multimodal approaches with social and peer factors, and use validated frameworks for effective practice. Level of Evidence: Level V. Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
Abstract Objectives The present study explored affective touch in anorexia nervosa (AN) by: (a) comparing patients with AN and healthy control subjects (HCs) on the quality and quantity of affective-touch experiences across the lifespan; (b) investigating the association between affective touch and body-image-related symptoms; (c) assessing the link between affective touch and interpersonal space (IPS). Methods Participants (76 patients with AN and 77 HCs) completed self-report questionnaires measuring eating-related symptoms, anxiety, depression, and affective-touch experiences. IPS was assessed with a computer-based stop-distance task with different social conditions. Results Patients with AN had higher general (i.e., anxiety and depression), and body-image-related (e.g., body checking, body dissatisfaction) symptoms than HCs; moreover, they reported lower quantity of affective touch both in childhood and adulthood and less comfort with affective touch, with a medium to large effect size; more frequent negative affective-touch experiences were also observed in patients than in HCs, with a medium effect size. In patients, lower experienced affective touch, both in childhood and adulthood, and reduced touch-related comfort were associated with larger IPS, independent of anxiety and depression, and with a high effect size after statistical adjustment. No associations with IPS emerged in HCs. Conclusions The results highlighted a link between negative and reduced affective touch and social difficulties and avoidance in AN. The study remarks the relevance of affective-touch experiences and their relation with implicit body-related mechanisms, suggesting addressing early tactile experiences and interpersonal functioning in clinical interventions. Level of evidence Level III, case–control study based on self-report questionnaires and a behavioral task.
Abstract Purpose The lives of people with eating disorders (EDs) habitually revolve around food and diet, and they exhibit disturbances in attitudes and feelings about their bodies and appearance. Both aspects are also described in people at risk of orthorexia nervosa (ON). Social support plays an important role in the treatment of EDs, but less is known about the role of social support in ON. Therefore, the study aimed to estimate the levels of ON risk, perceived social support, body esteem (BE), and diet quality among students by biological sex, body mass index (BMI) group, and current education stage and program; and evaluate the associations between the levels of ON risk, perceived social support, BE, and diet quality. Methods Data were collected from 2022 to 2025 through a cross-sectional quantitative survey among 261 Polish high school students (aged 16–19 years) and university students (aged 18–23 years). Students completed the Polish version of the Düsseldorf Orthorexia Scale (PL-DOS), the Multidimensional Scale of Perceived Social Support (MSPSS), the Body Esteem Scale for Adolescents and Adults (BESAA), and the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN). Pearson Chi-squared test, the Mann–Whitney U test, the Kruskal–Wallis rank ANOVA, and quantile regression analysis were used for further analyses. Results Females exhibited a significantly higher ON risk than males. University students from nutrition-related majors demonstrated a significantly higher ON risk than those from non-nutrition-related majors. No significant association was found between ON risk and BMI. An increased risk of ON was significantly associated with lower social support from friends, lower BE weight, and a lower intensity of harmful dietary characteristics for health. Meanwhile, higher BE attribution and a higher intensity of beneficial dietary characteristics for health were significantly associated with increased ON risk. Conclusions Overall, the findings suggest that ON risk is associated with selected psychosocial characteristics, such as perceived social support and body weight-related self-esteem. These findings highlight the need for greater integration of psychological aspects of eating and body image into school and university education programs, as well as interventions aimed at enhancing support from friends to reduce the risk of ON and EDs. Level of evidence : Level III. Evidence obtained from a cross-sectional quantitative study.
Abstract Purpose This multicenter study aims to investigate associations between body mass index (BMI) and sociodemographic and clinical characteristics in a clinical sample of individuals with obsessive–compulsive disorder (OCD). Methods Data were analyzed from 947 adults diagnosed with OCD, recruited through the Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders. BMI was calculated from self-reported weight and height and categorized according to WHO definitions. Sociodemographic and clinical data were obtained using standardized instruments. Associations between BMI and sociodemographic/clinical variables were examined using linear regression models. Results The mean BMI in the sample was 24.55 kg/m2 (SD = 4.65), with 5.5% of participants classified as underweight, 58% as normal weight, 25% as overweight, and 11.5% as obese. In the multivariate linear regression model, higher BMI was significantly associated with older age (β = 0.09, p < 0.001), current psychiatric treatment (β = 1.4, p < 0.001), and binge eating disorder (β = 4.4, p < 0.001). Lower BMI was significantly associated with female sex (β = – 1.6, p < 0.001) and body dysmorphic disorder (β = – 1.2, p = 0.005). No significant associations were found with educational level, OCD severity, comorbid depression, anxiety, bulimia, or anorexia. Conclusion Although BMI was unrelated to OCD severity, it was associated with demographic, clinical, and treatment-related variables, underscoring the need for evaluation beyond symptom-based assessment. Level of evidence: III, as it is based on an observational analytic design using a large cross-sectional multicenter sample.
Bariatric surgery might impact the thyroid function test and, in hypothyroid patients, the dose of levothyroxine (LT4), but data are not univocal. We evaluated changes in thyroid function during the first year following bariatric surgery in patients without pre-existing thyroid disease, as well as adjustments in LT4 dosage in those with thyroid disorders, comparing the effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). A retrospective observational study including 69 patients on LT4 therapy (Tr) and 85 patients with normal thyroid function (Nt) at pre-surgical work-up and at regular follow-up at 45 days, 3–6 months and 1-year visits after surgery. The mean body weight reduction for the entire cohort was in 31.4 ± 0.7
Internalized weight stigma (IWS) is a known correlate of reduced quality of life (QoL) in individuals with obesity or overweight. However, few studies have examined whether this association differs across different recruitment settings. This study aimed to assess the association between IWS and obesity-related QoL in adults with obesity or overweight recruited from clinical settings or from the community, while adjusting for established psychological and demographic predictors. A total of 313 individuals with obesity were recruited from six obesity treatment centers, and 139 with obesity (n = 72) or overweight (n = 67) were recruited from the community via online survey. Participants completed self-report measures of IWS (Weight Bias Internalization Scale), obesity-related QoL (Laval Questionnaire), depressive symptoms (BDI-II), binge eating (BES), and attitudes toward people with obesity (ATOP). Multiple regression models tested the effect of IWS across QoL domains, with interaction terms by recruitment setting and adjustment for covariates. First exploratory analyses revealed some significant differences across clinical centers in both predictors and QoL domains, which warranted the adjustment of the alpha level to 0.005 for all subsequent regression models. IWS significantly predicted poorer QoL in emotional, social, and sexual domains across all groups, including individuals with overweight from the community. It was also associated with lower hygiene-related QoL, but only among individuals with obesity from clinical centers. No direct effect of IWS was found on physical functioning or symptom burden. Depressive symptoms and BMI were strong covariates in most regression models. IWS is independently associated with psychological and interpersonal aspects of QoL across clinical and community settings. These findings underscore the importance of addressing internalized weight stigma in both therapeutic interventions and public health efforts. Level III: Evidence obtained from well-designed cohort or case–control analytic studies.
Abstract Purpose This research aimed to address existing methodological limitations in research on mindful eating behaviours in children, to enhance future research in this area. This manuscript presents the development and the assessment of the validity and reliability of a Mindful Eating Behaviour Scale for children and parents across five studies. Methods Study 1 assessed the scale's content validity using ratings from experts in the field. Study 2 evaluated the internal consistency of the scales. Study 3 explored temporal stability using a test–retest design with a 2-week interval. Studies 4 and 5 examined the criterion-related validity of the scales. Results Study 1 demonstrated that the items reflected the definition of mindful eating behaviour and were suitable for children. Study 2 showed that the scale and the subscales, “ sensory attention ” and “ non-judgemental awareness ” demonstrated good internal consistency. Using exploratory factor analysis, the scale supported the presence of two factors, “sensory attention” and “non-judgemental awareness”. Study 3 showed that the scale was a reliable measure over time. Studies 4 and 5 showed that the scales are suitable measures for mindful eating behaviour. The scales demonstrated correlations between mindfulness and other eating behaviours, but further research is required, as only limited associations were observed. Conclusions The current research presents new psychometric scales for mindful eating in children. The studies show that the scale is valid and reliable. Level of evidence No level of evidence: basic science.
Internalization of appearance ideals and sociocultural pressures contribute to body dissatisfaction and eating disorders. Japanese adolescents report high levels of body dissatisfaction despite relatively low body mass index compared to peers in other countries, highlighting potential cultural influences. However, the Sociocultural Attitudes Towards Appearance Questionnaire-4-Revised (SATAQ-4R) has not been validated in Japan. This study aimed to develop a Japanese version of the SATAQ-4R and examine its psychometric properties among Japanese adolescents. A nationwide population-based study was conducted in 2023 among 1,368 adolescents aged 11–17 years (girls: n = 694; boys: n = 674). Participants completed self-reported questionnaires. The factor structure of the SATAQ-4R was evaluated using exploratory and confirmatory factor analyses (EFA and CFA), internal consistency was assessed using Cronbach’s alpha, and convergent validity was examined using eating-related measures. EFA suggested a five-factor 23-item structure for girls and a seven-factor 23-item structure for boys. CFA showed suboptimal fit for the female model and comparatively better fit for the male model. Most subscales showed acceptable internal consistency, although one female pressure-related subscale showed inadequate reliability. Correlations with external measures provided partial evidence of convergent validity, with associations varying by sex and subscale. These findings provide preliminary evidence for psychometric properties of the Japanese SATAQ-4R. However, suboptimal female model fit, inadequate reliability of one female subscale, and mixed convergent validity evidence indicate that the resulting Japanese models should be used with caution. Level III, cross-sectional observational study.
