The Effects of Gender and Family,Friend, and Media Influences on Eating Behaviors and Body Image During Adolescence

The current study expands upon body image research to examine how gender, self-esteem, social support, teasing, and family, friend, and media pressures relate to body image and eating-related attitudes and behaviors among male and female adolescents (N = 177). Results indicated that adolescents were dissatisfied with their current bodies: males were concerned with increasing their upper body, whereas females wanted to decrease the overall size of their body. Low self-esteem and social support, weight-related teasing, and greater pressures to lose weight were associated with adolescents’ negative body esteem, body image, and eating attitudes. Females displayed more high risk eating behaviors—which were associated with more psychosocial risk factors—than males, whose high risk attitudes and behaviors were only associated with low parental support and greater pressure to be muscular. Reducing adolescents’ perceptions of appearance-related pressure from family and friends may be key for enhancing body image and decreasing links between low self-esteem and negative eating behaviors and weight-related perceptions. Rheanna N. Ata is currently a research assistant at the Weight Control and Diabetes Research Center, Miriam Hospital/Brown University. She is interested in body image and eating disorders and completed this research during her undergraduate studies at the College of the Holy Cross. Alison Bryant Ludden is a developmental psychologist whose research focuses on social relationships and problem behaviors during adolescence, with a special interest in school as a developmental context. She is an assistant professor of psychology at the College of the Holy Cross. Megan M. Lally is currently a graduate student in psychology at Pepperdine University. She completed this research during her undergraduate studies at the College of the Holy Cross.     

Weighing in on the Issue: A Longitudinal Analysis of the Influence of Selected Individual Factors and the Sports Context on the Developmental Trajectories of Eating Pathology Among Adolescents

Eating disorders, and related issues (e.g., body dissatisfaction, weight control behaviors), represent pressing and prevalent health problems that affect American adolescents with alarming frequency and potentially chronic consequences. However, more longitudinal research is needed to elucidate the developmental processes that increase or maintain risk for, and that protect against, eating- and weight-related problems among adolescents. Accordingly, the current study used longitudinal data from 1,050 male and female (68.0 %) adolescents (Grades 9–11)—the majority of whom were European Americans (72.2 %)—who participated in the 4-H Study of Positive Youth Development to (a) describe trajectories of adolescents’ eating pathology and body dissatisfaction, (b) identify individual and contextual correlates of these pathways, (c) examine whether trajectories of eating pathology and body dissatisfaction related to adolescents’ depressive symptoms, and (d) elucidate whether sports participation moderated associations between specific trajectories of eating pathology and body dissatisfaction and adolescents’ depressive symptoms. Results suggest that the diverse pathways of eating pathology and body dissatisfaction that exist across middle adolescence, in combination with adolescents’ sports participation, have important implications for the positive and problematic development of our youth. In addition, the findings underscore the need to evaluate the interindividual differences that exist in regard to how sports participation may relate positively and negatively to developmental outcomes.     

Gender Differences Among Adolescents in Family,and Peer Influences on Body Dissatisfaction,Weight Loss,and Binge Eating Behaviors

The present study examined perceived family and peer influences on body dissatisfaction, weight loss, and binge eating behaviors in adolescents. Three hundred and six girls aged 11 to 17 years (M = 13.66, SD = 1.12) and 297 boys aged 11 to 18 years (M = 13.89, SD = 1.13) completed a questionnaire that examined the direct influence and quality of family and peer relationships on body dissatisfaction and disordered eating. Direct influences of family and peers, rather than the quality of these relationships, predicted body dissatisfaction and disordered eating in adolescent boys and girls. Interesting differences were found between girls and boys in the nature of the influences and in the way they were expressed. In particular, parental and peer discussion and encouragement of weight loss predicted disordered eating behaviors in girls, while maternal and peer encouragement predicted binge eating and weight loss behaviors in boys. Fathers played a salient role in the expression of more severe forms of eating problems, while siblings played a small yet significant role in cognitive restraint among girls. The findings highlight gender differences in the importance of significant others in the expression of body dissatisfaction and disordered eating in adolescence.     

Future Orientation, School Contexts, and Problem Behaviors: A Multilevel Study

The association between future orientation and problem behaviors has received extensive empirical attention; however, previous work has not considered school contextual influences on this link. Using a sample of N = 9,163 9th to 12th graders (51.0 % females) from N = 85 high schools of the National Longitudinal Study of Adolescent Health, the present study examined the independent and interactive effects of adolescent future orientation and school contexts (school size, school location, school SES, school future orientation climate) on problem behaviors. Results provided evidence that adolescent future orientation was associated independently and negatively with problem behaviors. In addition, adolescents from large-size schools reported higher levels of problem behaviors than their age mates from small-size schools, controlling for individual-level covariates. Furthermore, an interaction effect between adolescent future orientation and school future orientation climate was found, suggesting influences of school future orientation climate on the link between adolescent future orientation and problem behaviors as well as variations in effects of school future orientation climate across different levels of adolescent future orientation. Specifically, the negative association between adolescent future orientation and problem behaviors was stronger at schools with a more positive climate of future orientation, whereas school future orientation climate had a significant and unexpectedly positive relationship with problem behaviors for adolescents with low levels of future orientation. Findings implicate the importance of comparing how the future orientation-problem behaviors link varies across different ecological contexts and the need to understand influences of school climate on problem behaviors in light of differences in psychological processes among adolescents.     

Individual and Sociocultural Influences on Pre-Adolescent Girls’ Appearance Schemas and Body Dissatisfaction

Appearance schemas, a suggested cognitive component of body image, have been associated with body dissatisfaction in adolescent and adult samples. This study examined girls’ weight status (BMI), depression, and parent, sibling, peer, and media influences as predictors of appearance schemas in 173 pre-adolescent girls. Hierarchical regression results indicated that appearance schemas scores were associated with girls’ level of depression, perceptions of parental influence on weight concerns, appearance related interactions with other girls, and awareness of media messages; perceptions of sibling influence on weight concerns and BMI were not independent predictors. In addition, appearance schemas were associated with girls’ level of body dissatisfaction. One implication of these findings is for prevention programs to focus on reducing the importance and value that girls place on appearance by targeting social influences, particularly parental influence, in order to reduce risk for adolescent body dissatisfaction and related risk behaviors.Doctoral candidate in Human Development and Family Studies at the Pennsylvania State University. Her research interests are the development of disordered eating and body dissatisfaction from middle childhood through adolescence.Distinguished professor of Human Development and Family Studies at the Pennsylvania State University. Her research interests are child and adolescent eating behavior.     

Gender-related Risk and Protective Factors for Depressive Symptoms and Disordered Eating in Adolescence: A 4-year Longitudinal Study

The interplay between intrapersonal risk (low self-esteem, perfectionism and body dissatisfaction) and interpersonal protection (social support) appears relevant for delineating gender-specific pathways that lead to both depressive and eating psychopathology. The aims of this longitudinal study were to examine gender differences in the levels of depressive symptoms, disordered eating and the co-occurrence of both problems from preadolescence to mid-adolescence and to identify gender-specific risk and protective factors of depressive symptoms and disordered eating. A Spanish community-based sample initially comprising 942 early adolescents (49% females) was assessed at baseline (T1; X _age = 10.8 years) and at 2 and 4-year follow-up (T2 and T3). Gender differences emerged at T2 for disordered eating and at T3 for depressive symptoms and for co-occurring depressive symptoms and disordered eating. Predictors of depressive symptoms were body dissatisfaction, low self-esteem and fear of getting fat, for girls, and body dissatisfaction and low self-esteem, for boys. Predictors of disordered eating were body dissatisfaction, depressive symptoms, BMI and perfectionism, for girls, and low social support and BMI, for boys. In addition, for boys only, social support moderated the effect of body dissatisfaction on depressive symptoms and the effect of depressive symptoms on disordered eating. The hypotheses of the study were partially supported. Clinical implications are derived regarding the components that should be included in programs for preventing depression and eating disorders in both girls and boys.     

Body image satisfaction,dieting beliefs,and weight loss behaviors in adolescent girls and boys

Body image and weight loss beliefs and behaviors were assessed in 341 female and 221 male high school students. Estimates of body dissatisfaction varied depending on the measurement strategy used. Despite having similar weight distributions around the expected norm, girls were significantly more dissatisfied with their bodies than boys. Body Mass Index was positively related to body dissatisfaction in girls and boys, while higher exercise levels were related to higher body satisfaction in boys. Nearly two-thirds of girls and boys believed being thinner would have an impact on their lives, but the majority of girls believed this would be positive while the majority of boys believed this would be negative. Thirteen percent of female subjects reported using one or more extreme weight loss behavior at least weekly. Beliefs regarding the effectiveness of different weight loss measures were assessed. Weight loss behaviors in this Australian sample appear similar to comparable U.S. samples.Received Ph.D. from University of Tasmania. Main research interest in body image, weight loss behaviors, and eating disorders.Received Ph.D. from University of Connecticut. Main research interest in body image, eating disorders and weight loss behaviors.Dietitian degree from Melbourne University, Melbourne. Main research interest in eating practices and clinical outcome.M.D. from University of Melbourne, D.P.M. from U.K. FRC Psych. Main research interests in eating disorders.B.B.Sc.(Hons.) received from La Trobe University, Melbourne, B.A. received from University of Minnesota, Duluth. Main research interest in attitudes and attributions.B.A. Received from University of Minnesota, Duluth. Main research interest in adolescence and eating disorders.     

Gender Differences in Peer and Parental Influences: Body Image Disturbance,Self-Worth,and Psychological Functioning in Preadolescent Children

The connections between body image disturbance and psychological functioning have been well established in samples of older adolescent girls and young women. Little is known, however, about body image in younger children. In particular, little is known about possible gender differences in preadolescent children. The current study explored self-reported body image disturbance and psychological functioning in relation to peer and parental influences in 141 elementary school-aged girls and boys aged 8–11. Results suggest that girls are more concerned about dieting and are more preoccupied with their weight than are boys. Girls also reported a greater drive for thinness and a higher level of family history of eating concerns than did boys. Correlations suggested that girls' experiences of body image concerns (body dissatisfaction, bulimia, and drive for thinness) were related to a number of factors (such as family history of eating concerns, peer influences, teasing, depression, and global self-worth) whereas boys' experiences of body image concerns were related to fewer factors. On the basis of these findings, the assessment and treatment of body image concerns in preadolescent children (especially girls) are of great importance. Implications for intervention and prevention programs are discussed.     

Longitudinal Predictors of Restrictive Eating and Bulimic Tendencies in Three Different Age Groups of Adolescent Girls

This study examined longitudinal predictors of future eating problems in 435 female adolescents in Grades 7, 8, and 10, who were tested at two time points 8 months apart. Restrictive eating and bulimic tendencies were found to be relatively stable from Time 1 to Time 2, particularly in older grade levels. Partial correlations predicting Time 2 restrictive eating and bulimic tendencies indicated a role of body dissatisfaction, depression, and weight-related teasing, with findings being most clear in Grade 7. Path analyses indicated that the relationships among predictors were more complex and that some of the relationships were mediated by other variables.     

Body Dissatisfaction and Physical Development Among Ethnic Minority Adolescents

The present study examined the association between body dissatisfaction and adjustment, and the role physical development plays in this association, in an ethnically diverse sample of over 1100 urban, ninth grade boys and girls (M age = 14). More similarities than differences were found across ethnic groups: Caucasian, African American, Latino, Asian, and multiethnic boys reported similar areas of body dissatisfaction, levels of body dissatisfaction, and associations between body dissatisfaction and psychosocial maladjustment. For girls, only mean level differences were found with African American girls reporting lower levels of body dissatisfaction than girls from other ethnic backgrounds. Higher levels of body dissatisfaction predicted more psychological and social maladjustment for both boys and girls. For boys, faster development predicted stronger associations between feeling overweight and peer victimization. Feeling too small only predicted victimization if boys were actually low in physical development. For girls, physical development directly predicted less peer victimization, while perceived faster development predicted more victimization. Thus, it appears that physical development can protect both girls (directly) and boys (buffering against the negative effects of body dissatisfaction) from peer victimization, whereas perceived faster timing of development can exacerbate peer victimization.Adrienne Nishina conducted this research as an NIH postdoctoral fellow in the UCLA Department of Education. She is currently an Assistant Professor in the Department of Human and Community Development at UC Davis. She received her PhD in clinical psychology from UCLA. Her major research interests include mental health in schools, adolescent peer relations, and ethnic diversity.Natalie Y. Ammon is a graduate student in the Department of Human Development and Family Sciences at the University of Texas, Austin. Her major research interests are at-risk youth and academic achievement.Amy D. Bellmore is an American Psychological Association/Institute of Educational Sciences Postdoctoral Education Research Training fellow at the University of California, Los Angeles. She received her PhD in developmental psychology from the University of Connecticut. Her research interests include peer-directed aggression, ethnicity and ethnic contexts, and the development of interpersonal perception.Sandra Graham is a Professor in the Department of Education at the University of California, Los Angeles. She received her PhD degree in educational psychology from UCLA. Her major research interests are the academic motivation and social behavior of ethnically diverse adolescents in urban schools.     

A Biopsychosocial Model of Body Image Concerns and Disordered Eating in Early Adolescent Girls

Body image and eating concerns are prevalent among early adolescent girls, and associated with biological, psychological and sociocultural risk factors. To date, explorations of biopsychosocial models of body image concerns and disordered eating in early adolescent girls are lacking. A sample of 488 early adolescent girls, mean age = 12.35 years (SD = 0.53), completed a questionnaire assessing depressive symptoms, self-esteem, body mass index (BMI), sociocultural appearance pressures, thin-ideal internalization, appearance comparison, body image concerns and disordered eating. Structural equation modelling was conducted to test a hypothetical model in which internalization and comparison were mediators of the effect of both negative affect and sociocultural influences on body image concerns and disordered eating. In addition, the model proposed that BMI would impact body image concerns. Although the initial model was a poor fit to the data, the fit was improved after the addition of a direct pathway between negative affect and bulimic symptoms. The final model explained a large to moderate proportion of the variance in body image and eating concerns. This study supports the role of negative affect in biopsychosocial models of the development of body image concerns and disordered eating in early adolescent girls. Interventions including strategies to address negative affect as well as sociocultural appearance pressures may help decrease the risk for body image concerns and disordered eating among this age group.     

Psychosocial Correlates of Shape and Weight Concerns in Overweight Pre-Adolescents

Shape and weight concerns among overweight pre-adolescents heighten risk for eating disorders and weight gain. Treatment and prevention efforts require consideration of psychosocial factors that co-occur with these concerns. This study involved 200 overweight pre-adolescents, aged 7–12 years (M age = 9.8; SD = 1.4), presenting for family-based weight control treatment. Hierarchical regression was used to examine the influence of pre-adolescents’ individual characteristics and social experiences, and their parents’ psychological symptoms, on shape and weight concerns as assessed by the Child Eating Disorder Examination. Findings revealed that higher levels of dietary restraint, greater feelings of loneliness, elevated experiences with weight-related teasing, and higher levels of parents’ eating disorder symptoms predicted higher shape and weight concerns among overweight pre-adolescents. Interventions addressing overweight pre-adolescents’ disordered eating behaviors and social functioning, as well as their parents’ disordered eating behaviors and attitudes, may be indicated for those endorsing shape and weight concerns.     

Eating Attitudes and Weight-Loss Attempts in Female Adolescents and Their Mothers

This study examined the relationship between mothers' eating attitudes and weight-loss attempts and their adolescent daughters' body dissatisfaction and weight-loss attempts. Two modes of transmission of mother's values to the daughter (modeling and encouragement) and two forms of weight-loss behavior (moderate and extreme) were examined. Female 10th and llth graders and their mothers completed eating attitudes and behaviors questionnaires. Daughter's moderate weight-loss attempts (e.g., dietary restraint and exercising) and its associated body dissatisfaction were significantly associated with mother's encouraging her daughter to lose weight. In contrast, daughter's more extreme weight-loss behaviors (e.g., fasting, crash dieting, and skipping meals) were predicted by mother's reports of her own body dissatisfaction and mother's use of extreme weight-loss behaviors herself. These effects were not simply an artefact of daughter's body weight. Implications for theory and prevention were noted.     

Psychosocial Aspects of Body Mass and Body Image Among Rural American Indian Adolescents

This study examines the psychosocial risks associated with body weight (BMI) and body image in a southeastern, rural Lumbee American Indian community. A total of 134 adolescents (57% female) were surveyed over 2 years at ages of 13 and 15 years. On average, boys (55%) were more likely to be overweight or obese than were girls (31%). BMI was related to a variety of weight control efforts including onset and frequency of smoking, dieting, and body dissatisfaction. Body dissatisfaction was associated with peer relations, self-esteem, anxiety, depression, and somatization in adolescence. Longitudinally, psychological health, peer competence, and ethnic identity were associated with positive body image. In boys, early ethnic identification was associated with the development of later body image. Implications of findings for ethnic- and gender-specific interventions are discussed.On faculty at Tulane University. Received PhD in clinical and developmental psychology from the University of Minnesota. Major research interests are developmental psychopathology and personality, and diverse topics in American Indian mental health.Department of Psychology, University of Florida, Gainesville, Florida. A graduate student in the developmental psychology. Received BS in psychology from Tulane University in 2004. Major research interests include developmental psychopathology, emotion regulation, and biological responses to stress.Department of Psychology, Tulane University, New Orleans, Louisiana. A doctoral student in developmental and school psychology at Tulane University. Received MS in psychology from Tulane University and BA in psychology from CUNY Hunter College. Major research interests are social and personality development, developmental psychopathology, minority mental health, and the impact of hearing loss on social and cognitive development.     

Body Dissatisfaction Among Adolescent Boys and Girls: The Effects of Body Mass,Peer Appearance Culture and Internalization of Appearance Ideals

Body image dissatisfaction is a significant risk factor in the onset of eating pathology and depression. Therefore, understanding predictors of negative body image is an important focus of investigation. This research sought to examine the contributions of body mass, appearance conversations with friends, peer appearance criticism and internalization of appearance ideals to body dissatisfaction among adolescents. The sample was comprised of 239 (54% female) adolescents, with a mean age of 16 years. Self-report questionnaires were completed on body dissatisfaction, peer appearance conversations and criticism, internalization of appearance ideals, height and weight. For girls and boys, body mass, appearance conversations with friends, peer appearance criticism and internalized appearance ideals emerged as significant predictors of body dissatisfaction. Gender moderated the effect of body mass on body dissatisfaction. Internalization mediated the relationship between peer appearance conversations and criticism, and body dissatisfaction. These findings suggest that while body mass exerts a differential risk for body dissatisfaction among boys and girls, internalisation may represent a key psychological process that underpins body dissatisfaction among both boys and girls.     

The effects of delayed menarche in different contexts: Dance and nondance students

The premise that effects of maturational timing are mediated by social context is explored by comparing adolescent girls in dance and nondance schools. Because the dance student must maintain a relatively low body weight, being a late maturer (who is often leaner than an on-time maturer) is expected to be more advantageous to the dancer than to the student not required to meet a weight standard. Girls aged 14 to 18 were seen; 276 attended private schools and 69 attended national ballet company schools. AllSs were weighed and measured and asked questions about their secondary sexual development, weight-related concerns, eating concerns, adult sex-role expectancies, body image, emotional functioning, and family relationships. Menarcheal age was used to classify girls as early (before 11.5 years of age), on time (between 11.5 and 14 years), and late maturers (after 14 years). More dance than non-dance school students were late maturers (55% versus 29%). The dance students weighed less and were leaner, had higher eating scores, and had lower family relationship and impulse control scores than the comparison sample. Across groups, late maturing students weighed less, were leaner, and had lower diet and higher oral control scores than on-time maturers, with the differences more pronounced in the dance than nondance students. In addition, the on-time dancers had higher psychopathology, perfection, and bulimia scores and lower body image scores than the late maturing dancers. The findings are discussed in terms of a goodness of fit between the requirements of a social context and a person's physical and behavioral characteristics.This paper was prepared with the support of grants from the W. T. Grant Foundation and the National Institutes of Health.Ph.D. from the University of Pennsylvania. Research Interests: Girls' psychological adaptation to pubertal change, biosocial aspects of female reproductive events, development in at-risk children and adolescents.     

Strategies to Address Weight-Based Victimization: Youths’ Preferred Support Interventions from Classmates,Teachers, and Parents

Weight-Based Victimization is a frequent experience for adolescents who are overweight or obese, and is associated with numerous psychosocial and physical consequences for those who are targets of victimization. Assessing targets` preferences for different types of support and intervention has been absent in the context of weight-based victimization, but is needed to help inform potential interventions, motivate action, and identify strategies to help adolescents cope with experiences of weight-related teasing or bullying. Adolescents (14–18 years, N = 361, 40 % female, 71 % Caucasian) enrolled in national weight-loss camps completed an on-line survey. Participants who reported previous experiences of weight-based victimization were surveyed about their preferred interventions from peers, friends, teachers, Physical Education (PE) teachers/coaches, and parents. Participants indicated their preferences for specific strategies pertaining to target support, bullying intervention and prevention (e.g., inclusion in peer activities, confronting the bully, telling an adult, and improving anti-bullying policies). Friends (66 %) and peers (58 %) were the most highly preferred intervention agents followed by teachers (55 %), PE teachers/coaches (44 %), and parents (43 %). Participants who experienced more weight-based victimization expressed increased desire for intervention. The frequency of victimization, social support from friends and family, and perceived likelihood and helpfulness of intervention significantly influenced participant preferences for certain types of intervention, although preferences were generally consistent across participants’ characteristics. The current study is the first to document youth’s preferences for interventions in response to weight-based victimization. The findings have important implications for encouraging appropriate intervention and informing bystanders, which may help to reduce the prevalence, recurrence, and consequences for youth who are targets of weight-based teasing or bullying.     

The Effect of “Thin Ideal” Television Commercials on Body Dissatisfaction and Schema Activation During Early Adolescence

The purpose of the study was to investigate the effect of viewing televised images of female attractiveness on the body dissatisfaction of young adolescent girls and boys. Adolescents (160 females and 197 males) aged 13–15 years viewed either 20 commercials containing idealized female thin images or 20 nonappearance television commercials. Body dissatisfaction was measured before (Time 1), immediately following (Time 2), and 15 min after (Time 3) commercial viewing. Appearance-schema activation was assessed using a word-stem completion task. Girls, but not boys, who viewed the appearance commercials reported significantly higher body dissatisfaction at both Times 2 and 3 compared with the nonappearance condition. Participant age had no effect. Both girls and boys in the appearance condition reported greater schema activation, but appearance schematicity did not moderate the commercial effect. The results support the general hypothesis that televised images of attractiveness lead to increased body dissatisfaction and schema activation for girls as young as 13 years old.     

Weight-Based Victimization Among Adolescents in the School Setting: Emotional Reactions and Coping Behaviors

Weight-based victimization is a frequent experience for adolescents, but little is known about their emotional reactions and coping strategies in response to weight-based teasing and bullying. The present study examined the ways that adolescents cope with experiences of weight-based victimization at school. An initial sample of 1,555 students from two high schools in central Connecticut completed a comprehensive battery of self-report measures to assess their experiences of weight-based teasing and bullying at school, affective responses to these experiences, and coping strategies used to deal with incidents of weight-based victimization. Only those students who reported experiencing weight-based victimization (N = 394) were included for the purposes of the present study. Of this sub-sample, 56% were females, 84% were Caucasian, and the mean age was 16.4 years. Weight-based victimization resulted in 40–50% of adolescents feeling sad and depressed, worse about themselves, bad about their body, angry, and some feeling afraid. Gender differences emerged with respect to how boys and girls react to experiences of weight-based victimization. However, structural equation model estimates demonstrated that both boys and girls who reported negative affect in response to weight-based victimization were more likely to use coping strategies of avoidance (e.g., avoiding gym class), increased food consumption, and binge eating. Binary logistic regressions showed that the odds of students skipping school or reporting that their grades were harmed because of weight-based teasing increased by 5% per teasing incident, even after controlling for gender, age, race, grades, and weight status. To our knowledge, this study is the first systematic examination of affective reactions and coping strategies among overweight adolescents in response to weight-based victimization. These findings can inform efforts to assist overweight youth to cope adaptively with weight-based victimization.     

Disordered Eating Precursors in Pre- and Early Adolescent Girls and Boys

First- and second-year findings from a study of the development of disordered eating in pre- and early adolescents are presented. Fifth- and sixth-grade girls (n = 80) and boys (n = 85) were assessed on depression, body image, self-esteem, and eating behaviors and attitudes in Year 1 and again one year later. Weight, height, and pubertal development were also evaluated in Year 1 and Year 2. Gender differences existed on all measures in Year 2 and indicated consistently poorer scores for girls compared to boys. For girls, Year 1 Body Mass Index and pubertal development predicted Year 2 disordered eating. For boys, poor body image in Year 1 predicted Year 2 disordered eating. The importance of identifying early risk factors for eating disorders is discussed.