In spite of copious literature investigating body dissatisfaction and its correlates in adolescents and young adult women, exploration of body image disturbances in adult women remains an underrepresented domain in the literature. Yet, there are many reasons to suspect that body image in adult women both may differ from and possibly be more complex than that of younger women. Adult women face myriad factors influencing body image beyond those delineated in the body image literature on adolescents and young adult women. For instance, aging-related physiological changes shift the female body further away from the thin-young-ideal, which is the societal standard of female beauty. Further, life priorities and psychological factors evolve with age as well. As such, adult women encounter changes that may differentially affect body image across the lifespan. This paper aims to provide an up-to-date review of the current literature on the relationship between body image and associated mental and physical health problems and behaviors in adult women. In addition, we explore factors that may influence body image in adult women. Lastly, we use this review to identify significant gaps in the existing literature with the aim of identifying critical targets for future research.

Background Eating Disorders (EDs) are serious psychiatric illnesses marked by psychiatric comorbidity, medical complications, and functional impairment. Research indicates that female athletes are often at greater risk for developing ED pathology versus non-athlete females. The Female Athlete Body (FAB) study is a three-site, randomized controlled trial (RCT) designed to assess the efficacy of a behavioral ED prevention program for female collegiate athletes when implemented by community providers. This paper describes the design, intervention, and participant baseline characteristics. Future papers will discuss outcomes. Methods Female collegiate athletes (N=481) aged 17–21 were randomized by site, team, and sport type to either FAB or a waitlist control group. FAB consisted of three sessions (1.3 hours each) of a behavioral ED prevention program. Assessments were conducted at baseline (pre-intervention), post-intervention (3 weeks), and six-, 12-, and 18-month follow-ups. Results This study achieved 96% (N = 481) of target recruitment (N = 500). Few group differences emerged at baseline. Total sample analyses revealed moderately low baseline instances of ED symptoms and clinical cases. Conclusions Health risks associated with EDs necessitate interventions for female athletes. The FAB study is the largest existing RCT for female athletes aimed at both reduction of ED risk factors and ED prevention. The methods presented and population recruited for this study represent an ideal intervention for assessing the effects of FAB on both the aforementioned outcomes. We anticipate that findings of this study (reported in future papers) will make a significant contribution to the ED risk factor reduction and prevention literature.

Objective To evaluate the efficacy of the Female Athlete Body project (FAB) in reducing eating disorder (ED) symptoms and risk factors. Method This study was a community participatory three‐site, two‐arm, cluster randomized controlled trial (RCT). Female collegiate athletes (N = 481) were randomly assigned by team to the FAB intervention, a behavioral ED risk factor reduction program, or a waitlist control condition. Primary analyses examined 18‐month effects for ED pathology. Secondary analyses examined risk factors and correlates (e.g., thin‐ideal internalization, negative mood, Female Athlete Triad knowledge, and body mass index [BMI]). Results Linear mixed effects models with team as a cluster level variable and study condition as a between‐subjects variable revealed significantly reduced dietary restraint in FAB teams relative to control teams. FAB teams also reported significantly fewer objective and subjective binge episodes than control teams. Finally, FAB teams showed significantly lower thin‐ideal internalization and increased BMI at 18‐months. No other significant differences were found. Discussion This RCT examined the effects of a short intervention on ED pathology and risk factors in female collegiate athletes through 18‐month follow‐up. This trial is one of only three trials with female athletes that have shown long‐term reductions in any ED symptoms or produced positive effects on ED risk factors. The present study is the first to find such effects with athletes using a brief (i.e., 4 hr) intervention at 18‐month follow‐up. Although small effects were found, the current trial provides valuable lessons about future design and implementation of similar trials with athletes. Trial Registration Clinical trials NCT01735994.

Background Although the link between body dissatisfaction and eating disorder (ED) pathology is well-established in general female samples, less is known about contextual body image (CBI) among female athletes. CBI refers to female athletes’ body image concerns in two contexts: sport and daily life. The Contextual Body Image Questionnaire for Athletes (CBIQA) measures four dimensions of body image (Appearance, Thin-Fat Self-Evaluation, Thin-Fat Others’ Evaluation, and Muscularity) in both contexts. In a sample of female collegiate athletes, this study sought to A) investigate the psychometric properties of the CBIQA, B) examine the cross-sectional relation of CBI with ED pathology and negative affect, and C) assess the degree to which CBI prospectively predicts ED pathology and negative affect. Method Using self-report data collected from a multi-site parent trial, we examined the psychometric properties of the CBIQA by confirmatory factor analysis. We assessed construct and criterion validity via cross-sectional bivariate correlation analyses with thin-ideal internalization, negative affect, and ED pathology. Using data from Time 1 and 6 months later (Time 2), we investigated the degree to which CBI prospectively predicted ED pathology and negative affect. Results Results from the CFA largely confirmed de Bruin et al.’s (2011) original factor analysis. Two CBIQA dimensions (Thin-Fat Self and Appearance) in both contexts correlated with ED pathology and negative affect. Thin-Fat Others also correlated with ED pathology in both contexts and negative affect in the sport context. The Muscularity dimension was predominantly orthogonal with other measures. CBIQA dimensions were uncorrelated with thin-ideal internalization. When controlling for BMI and Time 1 scores, daily life and sport appearance concerns predicted ED pathology, whereas perceived evaluation of thin-fat by others in the sport context predicted negative affect 6 months later. Conclusions Results support the psychometric validity of the CBIQA and suggest that it captures variance discrete from thin-ideal internalization. The Muscularity dimension largely was not related to other outcomes. Further, specific elements of perceived self- and other-evaluation in both contexts is relevant to risk for ED pathology and negative affect. Future research could examine the impact of dual body image between sports seasons and after transitioning out of sport. Clinical trials registration NCT01735994.

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