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BODY DISSATISFACTION AS A MEDIATOR OF THE RELATIONSHIP BETWEEN DISORDERED EATING AND COSMETIC SURGERY ACCEPTANCE AMONG COLOMBIAN UNIVERSITY STUDENTS

Vol XI, No. 2, 2011 Comments (0)

Carmen CARRION*1, Laura A. RABIN2,
Sarah L. WEINBERGER-LITMAN3, Joshua FOGEL2

1Roosevelt University, Chicago, USA

2Brooklyn College of the City University of New York, New York, USA

3Marymount Manhattan College, New York, USA

 

Abstract

Body dissatisfaction has consistently been linked to disordered eating and recently to the endorsement of cosmetic surgery procedures. In the current study, we examined body dissatisfaction as a potential mediating variable between disordered eating behaviors and the acceptance of cosmetic surgery in a university sample of 179 Colombian women aged 18 to 34. Participants completed a demographics questionnaire and Spanish versions of the Three-Factor Eating Questionnaire (TFEQ), Acceptance of Cosmetic Surgery Scale (ACSS), and Body Shape Questionnaire (BSQ). We controlled for age and body mass index (BMI). Results revealed that the Disinhibition and Restraint subscales of the TFEQ were significant predictors of the Social subscale of the ACSS. However, when the BSQ was included as a predictor, the Disinhibition and Restraint Scales were no longer significant, suggesting that body dissatisfaction mediates the relationship between disordered eating and the acceptance of cosmetic surgery. Results are discussed in relation to cultural and social aspects that may be driving this association and also the applied implications for these findings.

 

Keywords: disordered eating, cosmetic surgery, body dissatisfaction, Colombia, mediation
Introduction

 

Body dissatisfaction occurs commonly across cultures and affects women of all ages. Some studies suggest that young women are particularly vulnerable (C.N. Markey & P.M. Markey 2005; Striegel-Moore & Franko 2002; Tiggerman & Slater, 2003). Stice and Shaw (2002) define body dissatisfaction as a negative evaluation of one’s body, or specific body features such as weight, figure, stomach, and hips. Traditionally, body dissatisfaction has been associated with disordered eating behavior and eating disorders (EDs) (Mora-Giral, Raich-Escursell, Segues, Torras-Claraso, & Huon, 2004; Shaw, Stice, & Springer, 2004; Stice & Shaw, 2002), and has demonstrated prognostic significance in disordered eating development (Keel, Fulkerson, & Leon, 1997; Killen et al., 1996; Patton, Johnson-Sabine, Wood, Mann, & Wakeling, 1990). Studies on body dissatisfaction and its relation to disordered eating behaviors in developing countries are not as widespread as those conducted in Westernized societies. This may be due to findings suggesting that disordered eating behaviors may be culture-bound and typically occur in Westernized societies (Keel & Klump, 2003; Markey, 2004). However, a study by Angel and colleagues (1997) suggested that EDs are prevalent among Colombian women. In this study, prevalence rates in Colombia were found to be similar to those commonly observed in developed countries, such as the United States (Angel et al., 2008). Although body dissatisfaction is usually associated with disordered eating behaviors (Mora-Giral et al., 2004; Shaw, Stice, & Springer, 2004; Stice & Shaw, 2002), few studies have been conducted in Colombia to determine the prevalence and psychological correlates of body dissatisfaction.

Recent investigations link body dissatisfaction to an increased likelihood of considering cosmetic surgery among non-clinical samples of U.S. men and women (Brown, Furnham, Glanville, & Swami, 2007; Swami et al., 2008). Women with body dissatisfaction tend to experience a greater acceptance of cosmetic surgery, particularly if they feel they do not have socially accepted standards of beauty (Henderson-King & Henderson-King, 2005). There exist specific cultural and social pressures among Colombian women to attain an ideal body type consisting of an hourglass figure, with a slender waist and large breasts (Ochoa Hoyos, 2007; Taussig, 2008). This premise is consistent with previous findings that body dissatisfaction is largely socioculturally determined (Dittmar, 2005; Grogan, 2007; McCabe & Ricciardelli, 2003; Smolak, Murnen, & Thompson, 2005; Stormer & Thompson, 1996; Striegel-Moore, Silberstein, & Rodin, 1986). Beauty pageants in Colombia are abundant and are known to encourage a beauty ideal that is often unattainable without the help of surgical procedures (Taussig, 2008). Thus, it is possible that beauty pageants have to some extent contributed to the acceptance of cosmetic surgery among Colombian women.

We recently reported a relationship between disordered eating behaviors and the acceptance of cosmetic surgery in a cross-cultural study examining young women in the United States and Colombia (Carrión, Weinberger-Litman, Rabin, & Fogel, in press). However, the mechanism mediating these behaviors was unclear. It is possible that the shared feature of body dissatisfaction associated with both disordered eating (Mora-Giral, Raich-Escursell, Segues, Torras-Claraso, & Huon, 2004; Shaw, Stice, & Springer, 2004; Stice & Shaw, 2002) and the endorsement of cosmetic surgery (Brown, Furnham, Glanville, & Swami, 2007; Swami et al., 2008) contributes to the observed relationship between disordered eating and endorsement of cosmetic surgery. Although previous studies suggest that body dissatisfaction leads to EDs (Attie & Brooks-Gunn, 1989; Killen et al., 1996), it is possible that for some individuals there is a different pattern of symptom development.

In the current study, we investigated the possibility that body dissatisfaction serves as a mediating factor between disordered eating behavior and endorsement of cosmetic surgery in female college students from Colombia. We sampled college students, as they are known to be vulnerable to experimentation with new dietary methods and exposure to Western media ideals (Fogel & Shlivko, 2010; Haberman & Luffey, 1998; Pan, Dixon, Himburg, & Huffman, 1999; Silliman, Rodas-Fortier, & Neyman, 2004). We sampled women, as they have traditionally shown a greater acceptance of cosmetic surgery (Brown, Furnham, Glanville, & Swami, 2007; Frederick, Lever, & Peplau, 2007; Swami et al., 2008) and higher prevalence of disordered eating behaviors (National Eating Disorders Association, 2009) than men. We also assessed body mass index (BMI) and included this variable along with age in our analytic models, as these variables may be linked to disordered eating behaviors (Clinton, Button, Norring, & Palmer, 2004; Gralen, Levine, Smolak, & Murnen, 1990).

 

Method

 

Participants

Participants were 179 female undergraduate students from an urban private university in the city of Cartagena, Colombia. Data from one participant over age 35 was excluded from the analyses to allow for a similar young adult age profile. Prior to completing the Spanish-language questionnaires, students were provided with instructions regarding the nature and duration of the study and the informed consent process. Participation was voluntary and confidential, and all data were collected as part of an IRB-approved protocol. All participants provided written informed consent and the study took approximately 45 minutes to complete. The questionnaires were administered in classrooms, the school cafeteria, or library. Students were not compensated for their participation.

Participants provided basic demographic information and completed measures of disordered eating, body dissatisfaction, and acceptance of cosmetic surgery. For the purpose of the present study, a group of bilingual students from the United States translated demographic questions, the Acceptance of Cosmetic Surgery Scale (ACSS; Henderson-King & Henderson-King, 2005), and the Three-Factor Eating Questionnaire (TFEQ; Stunkard & Messick, 1985) into Spanish. One student performed the initial translation into Spanish, and a second student independently back translated the Spanish questions/items into English. Lastly, a committee of two students assisted the primary investigator with revisions to the Spanish questionnaires to achieve semantic equivalence with the original English version. The independent translators were unfamiliar with the nature of the study and did not participate beyond the translation/back translation process. The version of the Body Shape Questionnaire (Cooper, Taylor, Cooper, & Fairburn, 1987) used in this study was previously translated into Spanish and validated in a Colombian sample (Castrillon, Luna, Avendaño, & Perez-Acosta, 2007).

 

Measures

Demographics. Participants provided information about their age and sex. Additionally, participants provided their weight (kilograms) and height (centimeters). Height and weight values were converted to inches and pounds to calculate Body Mass Index (BMI) using the following formula: (703*weight (in lbs.)/height (in inches)2). Approximately 8% of participants did not provide usable information about their weight and/or height.

Acceptance of Cosmetic Surgery Scale (ACSS). The ACSS is a 15-item scale that measures the acceptance of cosmetic surgery for social and intrapersonal reasons (Henderson-King & Henderson-King, 2005). The ACSS has three subscales: (1) Intrapersonal, which assesses whether an individual would have cosmetic surgery for its self-oriented benefits, e.g., “Cosmetic surgery can be a big benefit to people’s self-image;” (2) Social, which measures whether an individual would undergo cosmetic surgery for social reasons, e.g., “I would seriously consider having cosmetic surgery if my partner thought it was a good idea;” and (3) Consider, which assesses whether an individual would consider undergoing surgery for general reasons under various scenarios, e.g., “If I could have a surgical procedure done for free I would consider trying cosmetic surgery.” Responses are reported on a Likert-type scale that range from “strongly disagree” = 1 to “strongly agree” = 7; higher scores indicate greater endorsement of cosmetic surgery. Subscale scores are computed by taking the mean of items associated with each subscale. The ACSS has demonstrated high internal consistency, and Cronbach’s alpha across four validation studies has ranged from .84 to .92 (Henderson-King & Henderson-King, 2005). As noted above, the ACSS was translated into Spanish for purposes of the current study and scored in the same manner as the English version. Cronbach’s alpha for the current study was .88 for the Intrapersonal subscale, .89 for the Social subscale, and .89 for the Consider subscale. Approximately 1% of participants did not provide complete responses for the ACSS.

Body Shape Questionnaire (BSQ). The BSQ is a 34-item scale that measures concerns about body shape and weight (Cooper, Taylor, Cooper, & Fairburn, 1987). The Spanish version of the BSQ was utilized in the present study and was previously validated in a Colombian population (Castrillon, Luna, Avendaño & Perez-Acosta, 2007). Sample items include: “Have you felt ashamed of your body?” or “Have you not gone out to social occasions (e.g. parties) because you have felt bad about your shape?” Participants rate responses on a Likert-type scale ranging from “never” = 1 to “always” = 6. A total score is calculated, which ranges from 34 to 204; higher scores indicate greater body dissatisfaction. The BSQ has demonstrated high internal consistency in previous studies (Castrillon et al., 2007; Cooper et al., 1987). Cronbach’s alpha for the current study was .97. Approximately 2% of our sample did not provide complete responses for the BSQ scale.

Three Factor-Eating Questionnaire (TFEQ) The TFEQ is a 51-item measure of eating behaviors that consists of three subscales (Stunkard & Messick, 1985). The Restraint subscale consists of 21 items that measure restrictive eating as well as the intention to restrain eating, and includes items such as, “I deliberately take small helpings as a means of controlling my weight.” The Disinhibition subscale consists of 16 items that measure the ability to stop eating and to resist emotional or social cues when no longer hungry, and includes items such as, “While on a diet, if I eat food that is not allowed, I often then splurge and eat other high calorie foods.” The Hunger subscale consists of 14 items that measure the ability to cope with the sensation of hunger, and includes items such as, “I am always hungry enough to eat at any time.” The first 36 items are true/false responses that are scored as 0 (false) or 1 (true). The remaining items ask about the frequency of, difficulty with, and extent of agreement with certain behaviors and are answered with Likert-type scales with responses ranging from 1 to 4. The scoring of these items is dichotomized such that responses of 1 and 2 are scored as 0 and responses of 3 and 4 are scored as 1. Accordingly, total scores ranged from 0 to 51 with higher scores indicating greater dietary disorder. As noted above, the TFEQ was translated into Spanish for purposes of the current study and scored in the same manner as the English version. The scale has demonstrated good validity and reliability. Cronbach’s alpha for the Restraint, Disinhibition, and Hunger subscales are .93, .91, and .85, respectively (Stunkard & Messick, 1985). Cronbach’s alpha for the current study was .87, .68, and .73 for the Restraint, Disinhibition, and Hunger subscales, respectively. Approximately 15% of our sample did not provide complete answers for the Disinhibition subscale, followed by 32% for the Restraint subscale, and 7% for the Hunger subscale.

 

Statistical Analyses

Descriptive statistics were used to describe the sample. As age had a skewed distribution, it was logarithmically transformed and this transformed variable was used in the analyses. Separate linear regression analyses were used to determine the relationship of the three TFEQ subscales (Disinhibition, Restraint, Hunger) to each of the ACSS subscales (Intrapersonal, Social, Consider). Each of the TFEQ subscales served as predictor variables while the ACSS subscales served as outcome variables. We adjusted for age and BMI in these analyses. The significant predictors from the above analyses were further analyzed with a mediation analysis to determine if the BSQ was a mediator. First, two separate linear regression analyses were conducted with BSQ scores as the outcome variable. One analysis had Disinhibition as a predictor variable and the other had Restraint as a predictor variable. Second, two separate mediation analyses were conducted with the ACSS Social subscale as the outcome variable (Figure 1). One analysis had both Disinhibition and the BSQ as predictor variables and the other had both Restraint and the BSQ as predictor variables. All the linear regression analyses adjusted for age and BMI. Finally, we conducted Sobel and Goodman mediation tests. SPSS Statistics Version 18 (SPSS, 2009) and Stata/SE Version 11.0 (Stata, 2009) were used for the analyses.

 

Figure 1. Mediation Model for Body Shape Questionnaire (BSQ) as a Mediator of the Relationship between the Three-Factor Eating Questionnaire (TFEQ) and Acceptance of Cosmetic Surgery (ACSS). Variables with lines through them represent subscales that were not significant in the regression analyses and therefore not included in the mediation models

Figure 1. Mediation Model for Body Shape Questionnaire (BSQ) as a Mediator of the Relationship between the Three-Factor Eating Questionnaire (TFEQ) and Acceptance of Cosmetic Surgery (ACSS). Variables with lines through them represent subscales that were not significant in the regression analyses and therefore not included in the mediation models

 

Results

 

Table 1 presents the descriptive statistics. The 179 female participants had ages ranging from 18 to 34, with an average age of 21. BMI scores ranged from 16 to 33 with an average of 21.1. Average BMI for the present sample fell within the normal range, as determined by the Centers for Disease Control & Prevention (2010). At present, there are no published clinical norms on the TFEQ, ACSS, or BSQ, to determine whether the sample fell within the “normal” range.

 

Table 1. Descriptive Statistics of the Sample of Colombian College Students

 

Variable

N

Mean

SD

Age

179

21.01

2.58

BMI

164

21.14

3.09

Disinhibition – TFEQ

152

4.88

2.69

Restraint – TFEQ

121

7.64

4.57

Hunger – TFEQ

166

5.75

3.05

ACSS – Intrapersonal

178

3.89

1.68

ACSS – Social

177

3.46

1.74

ACSS – Consider

178

4.17

1.66

BSQ

176

59.49

25.60

Note: SD=Standard Deviation, BMI=Body Mass Index, TFEQ=Three-Factor Eating Questionnaire, ACSS=Acceptance of Cosmetic Surgery Scale, BSQ=Body Shape Questionnaire, age was skewed and the logarithmic transformed value was used in the analyses.

 

Table 2. Linear Regression Analyses for the Subscales of the Acceptance of Cosmetic Surgery Scale

 

Variable

B (SE)

B (SE)

B (SE)

Intrapersonal Subscale

(n=140)

(n=113)

(n=152)

Constant

-1.59 (3.98)

-5.83 (4.61)

0.22 (4.22)

Age

3.75 (3.06)

7.05 (3.44)*

2.23 (3.15)

BMI

0.03 (0.05)

0.01 (0.06)

0.04 (0.05)

Disinhibition-TFEQ

-0.002 (0.06)

Restraint-TFEQ

0.04 (0.04)

Hunger-TFEQ

<0.001 (0.05)

///////////////////////////////////

Social Subscale

(n=139)

(n=112)

(n=151)

Constant

-3.72 (4.06)

-4.60 (4.72)

-1.22 (4.37)

Age

5.00 (3.11)

6.57 (3.52)

2.87 (3.27)

BMI

-0.004 (0.05)

-0.06 (0.06)

0.03 (0.05)

Disinhibition-TFEQ

0.12 (0.06)*

Restraint-TFEQ

0.09 (0.04)*

Hunger-TFEQ

0.06 (0.05)

///////////////////////////////////

Consider Subscale

(n=140)

(n=113)

(n=152)

Constant

-0.49 (4.02)

-5.92 (4.58)

0.56 (4.11)

Age

2.62 (3.09)

6.73 (3.42)

1.31 (3.07)

BMI

0.04 (0.05)

0.05 (0.06)

0.08 (0.05)

Disinhibition-TFEQ

0.07 (0.06)

Restraint-TFEQ

0.02 (0.04)

Hunger-TFEQ

0.05 (0.04)

Note: B=beta, SE=standard error, BMI=Body Mass Index, TFEQ=Three-Factor Eating Questionnaire, age was skewed and the logarithmic transformed value was used in the analyses.

*p<0.05

 

Table 2 shows the linear regression analyses for the subscales of the ACSS. None of the TFEQ subscales of Disinhibition, Restraint, or Hunger were significantly associated with the Intrapersonal subscale. In the analysis including the Restraint subscale, only increasing age was significantly associated with the Intrapersonal subscale. With regard to the Social subscale, increased scores on the Disinhibition and Restraint subscales both showed a significant association with increased scores on the Social subscale. None of the TFEQ subscales of Disinhibition, Restraint, or Hunger were significantly associated with the Consider subscale.

Table 3 shows the linear regression analyses for the BSQ. In the analysis including Disinhibition, both increasing levels of BMI and Disinhibition were significantly associated with increasing scores on the BSQ. In the analysis including Restraint, increasing levels of Restraint were significantly associated with increasing scores on the BSQ.

 

Table 3. Linear Regression Analyses for the Body Shape Questionnaire

 

Variable

B (SE)

(n=139)

B (SE)

(n=112)

Constant

60.73 (54.71)

70.66 (55.54)

Age

-36.89 (41.98)

-32.98 (41.46)

BMI

1.73 (0.70)*

0.46 (0.69)

Disinhibition-TFEQ

2.19 (0.75)**

Restraint-TFEQ

3.02 (0.44)***

Note: B=beta, SE=standard error, BMI=Body Mass Index, TFEQ=Three-Factor Eating Questionnaire, age was skewed and the logarithmic transformed value was used in the analyses.

*p<0.05, **p<0.01, ***p<0.001

 

 

Table 4. Mediation Analyses for the Social Subscale of the Acceptance of Cosmetic Surgery Scale

 

Variable

B (SE)

B (SE)

Social Subscale

(n=138)

(n=111)

Constant

-5.16 (3.88)

-6.29 (4.62)

Age

5.91 (2.97)*

7.36 (3.43)*

BMI

-0.05 (0.05)

-0.07 (0.06)

Disinhibition-TFEQ

0.07 (0.06)

Restraint-TFEQ

0.02 (0.04)

BSQ

0.02 (0.01)***

0.02 (0.01)**

Note: B=beta, SE=standard error, BMI=Body Mass Index, TFEQ=Three-Factor Eating Questionnaire, BSQ=Body Shape Questionnaire, age was skewed and the logarithmic transformed value was used in the analyses.

*p<0.05, **p<0.01, ***p<0.001

 

Table 4 shows the mediation analyses for the Social subscale. These analyses included the significant TFEQ predictors determined above of Disinhibition and Restraint, as well as the BSQ as the mediating variable. In the analysis including both Disinhibition and the BSQ, increasing levels of the BSQ and age were significantly associated with the Social subscale while Disinhibition was no longer significantly associated. In the analysis including both Restraint and the BSQ, increasing levels of the BSQ and age were significantly associated with the Social subscale while Restraint was no longer significantly associated.

Table 5 shows the Sobel and Goodman mediation tests. In the mediation analysis for Disinhibition, all Sobel and Goodman mediation tests were significant. In addition, 43.16% of the association between Disinhibition and the Social subscale was mediated by the BSQ. In the mediation analysis for Restraint, all Sobel and Goodman mediation tests were significant. Also, 76.64% of the association between Restraint and the Social subscale was mediated by the BSQ.

 

Table 5. Sobel and Goodman Tests of Mediation

 

 

Disinhibition & BSQ

Restraint & BSQ

Sobel

p=0.02

p=0.01

Goodman 1

p=0.02

p=0.01

Goodman 2

p=0.02

p=0.01

Percent of Total Effect that is Mediated

43.16%

76.64%

Note: BSQ=Body Shape Questionnaire

 

 

Discussion and conclusions

 

To our knowledge, this study is the first to investigate whether body dissatisfaction mediates the relationship between disordered eating behavior and endorsement of cosmetic surgery. In a sample of female university students in Colombia, we first established a significant relationship between higher levels of the disordered eating behaviors of disinhibition and restraint and the acceptance of cosmetic surgery (for primarily social reasons). We subsequently confirmed a significant relationship between higher levels of both disinhibition and restraint and greater body dissatisfaction. Finally, we carried out mediation analyses with the acceptance of cosmetic surgery for social reasons as the outcome and disinhibition and restraint in eating as predictors with level of body satisfaction serving as the mediating variable. These analyses suggested that body dissatisfaction mediates the relationship between disordered eating behaviors and the acceptance of cosmetic surgery for social reasons. Body dissatisfaction has consistently been linked to disordered eating (Mora-Giral, Raich-Escursell, Segues, Torras-Claraso, & Huon, 2004; Shaw, Stice, & Springer, 2004; Stice & Shaw, 2002) and recently to the acceptance of cosmetic surgery (Brown, Furnham, Glanville, & Swami, 2007; Swami et al. 2008). Pressure to be thin, and subsequent body dissatisfaction, may lead to disordered eating behavior to alter one’s shape; failure to achieve a desired physical outcome through diet modifications may lead to greater body dissatisfaction, which in turn may result in the belief that cosmetic surgery is the answer. This seems to be particularly salient for women who feel the need to meet societal standards of physical beauty. It is important to note that women in our sample tended to endorse cosmetic surgery for social reasons (e.g., if a partner would find it attractive or if it would benefit one’s career), and therefore our mediation analyses only utilized this subscale of the ACSS. This finding may be related to the age of our sample and the possibility that young adults feel a strong need to conform to aesthetic societal standards in an attempt to gain acceptance.

In the particular case of Colombia, societal standards of beauty are likely determined by the appearance of women in beauty pageants. Models who participate in these pageants are often given celebrity status (Taussig, 2008). A study from Europe (Swami, Taylor, & Carvalho, 2009) reported that high celebrity worship among undergraduate college women was associated with a greater acceptance of cosmetic surgery. The beauty pageants held in Colombia may lead young women to develop some form of celebrity worship toward the pageant contestants. If body dissatisfaction is present, it is possible that this type of celebrity emulation leads to a greater acceptance of cosmetic surgery among Colombian women.

Underlying psychopathology might also be a relevant variable, as previous studies have reported high levels of perfectionism, depression, anxiety, and obsessive compulsive disorder in women who suffer from EDs (Hinz & Williamson, 1987; Strober & Katz, 1988) and women who undergo cosmetic surgery (Bradbury, 2009; Crerand, Franklin, & Sarwer, 2006). Although not analyzed in this study, it is possible that disordered eating and cosmetic surgery endorsement are not disparate tendencies but rather representations of an underlying psychopathological mechanism with body dissatisfaction as a core feature. If this is the case, then clinicians evaluating cosmetic surgery candidates might consider screening for body dissatisfaction and related attitudes before giving clearance and/or providing counsel prior to and after surgery. Depending on the severity and rigidity of the body dissatisfaction, longstanding negative beliefs and feelings may return subsequent to surgery leading to negative outcomes (e.g., repeated surgical procedures, worsening of ED symptomatology, etc.) (McIntosh, Britt, & Bulik, 1994; Yates, Shisslak, Allender, & Wolman, 1988).

Overall, the present findings support previous research that links disordered eating and acceptance of cosmetic surgery with body dissatisfaction (summarized above). The observed association between disordered eating and acceptance of cosmetic surgery may stem from high levels of body dissatisfaction, which in turn may relate to various sociocultural or psychological factors. Future studies may clarify these results by considering the effects of the media, or unique aspects of Colombian culture on a tendency to endorse cosmetic surgery. For example, some have observed that a feature of Colombian culture is that younger members tend to conform to the ideals of their elders. This family dynamic might lead young women to be influenced by family expectations of thinness (Ochoa Hoyos, 2007), which can place undue pressure among young women to change their bodies through surgical measures. Further investigation into the specific aspects of social life, such as family, peer relations, and romantic relationships, might reveal which factors are most likely to impact disordered eating, body dissatisfaction, and the acceptance of cosmetic surgery.

It is important to mention our study limitations. Findings were based on self-report data, which are subject to certain biases (e.g., tendency to give socially desirable responses) and may limit the extent to which our results can be applied to the actual behavior of those undergoing cosmetic surgery. Additionally, we did not assess a sample of women meeting clinical criteria for eating disorders, and future research may determine whether the observed relationships hold in such individuals. Conversely, the present study can be extended to include a sample of actual cosmetic surgery patients to determine if body dissatisfaction and symptoms of disordered eating are present and to what degree. Also, although our overall sample included 179 individuals, many of the analyses were for a smaller sample as there were items not completed on these scales. Specifically, a greater number of participants failed to complete items on the TFEQ relative to items completed on the ACSS and BSQ. This might be due to issues with the translation of this measure, though participants did not actually report any such difficulties. Lastly, regarding our findings for the Disinhibition subscale, some may argue that it had a relatively low internal consistency (alpha = .68), which may affect interpretation of the findings related to disinhibited eating.

Despite the aforementioned limitations, these study results suggest that level of body satisfaction mediates the relationship between disordered eating (specifically a tendency toward disinhibited eating and restrictive eating to control weight) and the acceptance of cosmetic surgery for primarily social reasons. Body dissatisfaction, which may arise or become exacerbated after failed attempts to achieve thinness through certain eating behaviors, may drive young women to consider surgical procedures as a viable option. It therefore may behoove physicians and counselors to address body dissatisfaction and/or disordered eating symptoms with patients directly prior to any surgical procedures. This might lead to safer and better outcomes for women of all ages who struggle with issues related to eating and body perception.

 


Acknowledgements

This research was completed as part of fulfillment of the requirement for the Master of Arts degree at Brooklyn College of The City University of New York.

 

This research was funded, in part, by the New York City Louis Stokes Alliance for Minority Participation (LS-AMP). The authors thank Melba Lopez and Karla Felix for their help with instrument translation. They also thank Carmen Elena Meza Estrada, Ana Milena Batista Caneda, and the Research and Psychology Departments at Universidad de San Buenaventura for granting access to their community of students. Lastly, the authors thank all the students who graciously agreed to participate and Dr. Claude Brathwaite for providing the opportunity to conduct an international study.

 

REFERENCES

 

Ángel, L., Vásquez, R., Chavarro, K., Martínez, L.M., & García, J. (1997). “Prevalencia de trastornos del comportamiento alimentario en estudiantes de la Universidad Nacional de Colombia entre julio de 1994 y diciembre de 1995” Información extraída del Acta                 Médica Colombiana, Sección Trabajos originales, pag. 112, Vol. 22 No. 3- mayo-junio.

Attie, I., & Brooks-Gunn, J. (1989). Development of eating problems in adolescent girls: A longitudinal study. Developmental Psychology, 25, 70-79.

Baron, R. M. & Kenny, D. A. (1986). The moderator-mediator distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182.

Bradbury, E. (2009). Clinical risk in cosmetic surgery. Aesthetic Surgery, 15, 227-231.

Brown, A., Furnham, A., Glanville, L., & Swami, V. (2007). Factors that affect the likelihood of undergoing cosmetic surgery. Aesthetic Surgery Journal, 27, 501-508.

Carrión, C., Weinberger-Litman, S., Rabin, L. A., & Fogel, J. (in press). Predictors of attitudes toward cosmetic surgery among U.S. & Colombian college women: the roles of eating behaviors & demographic variables. Avances en Psicología Latinoamericana.

Castrillón, D., Luna, I., Avendaño, G. & Pérez-Acosta, A. M. (2007). Validación del Body Shape Questionnaire (cuestionario de la figura corporal) BSQ para la población Colombiana. Acta Colombiana de Psicología, 1, 15-23.

Centers for Disease Control & Prevention. Interpretation of BMI for adults. Retrieved July 13,        2010 from http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html.

Clinton, D., Button, E., Norring, C., & Palmer, R. (2004). Cluster analysis of key diagnostic variables from two independent samples of eating-disorder patients: Evidence for a         consistent pattern. Psychological Medicine, 34, 1035-1045.

Cooper, P. J., Taylor, M. J., Cooper, Z., & Fairburn, C. G. (1987). The development and validation of the Body Shape Questionnaire. International Journal of Eating Disorders, 6, 485-494.

Crerand, C. E., Franklin, M. E., & Sarwer, D. B. (2006). Body dysmorphic disorder and cosmetic surgery. Plastic and Reconstructive Surgery, 118, 167e-180e.

Dittmar, H. (2005). Vulnerability factors and processes linking sociocultural pressures and body dissatisfaction. Journal of Social and Clinical Psychology, 24, 1081–1087.

Fogel, J., & Shlivko, S. (2010). Weight problems and spam e-mail for weight-loss products. Southern Medical Journal, 103, 31-36.

Frederick, D. A., Lever, J., & Peplau, L. A. (2007). Interest in cosmetic surgery and body image:      Views of men and women across the lifespan. Plastic and Reconstructive Surgery, 120, 1407-1415.

Garner, D. M., & Garfinkel, P. E., (1979). The eating attitudes test: An index of the symptoms of anorexia nervosa. Psychological Medicine, 9, 273-279.

Gralen, S. J., Levine, M. P., Smolak, L., & Murnen, S. K. (1990). Dieting and disordered eating during early and middle adolescence: Do the influences remain the same? International Journal of Eating Disorders, 9, 501-512.

Grogan, S. (2007). Body image: Understanding body dissatisfaction in men, women and children (2nd ed.). London: Routledge.

Haberman, S, & Luffey, D. (1998). Weighing in college students’ diet and exercise behaviors. Journal of American College Health, 46, 189-191.

Henderson-King, D., & Henderson-King, E. (2005). Acceptance of cosmetic surgery: Scale development and validation. Body Image, 2, 137-149.

Hinz, L. D., & Williamson, D. A. (1987). Bulimia and depression. A review of the affective variant hypothesis. Psychological Bulletin, 102, 150-158.

Keel, P. K., Fulkerson, J. A., & Leon, G. R. (1997). Disordered eating precursors in pre- and early adolescent girls and boys. Journal of Youth and Adolescence, 26, 203–216.

Keel, P. K., & Klump, K. L. (2003). Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology. Psychological Bulletin, 5, 747-769.

Killen, J. D., Taylor, C. B., Hayward, C., Haydel, K. F., Wilson, D. M., Hammer, L., Kraemer, H., Blair-Greiner, A., & Strachowski D. (1996). Weight concerns influence the development of eating disorders: A 4-year prospective study. Journal of Consulting and Clinical Psychology, 64, 936-940.

Markey, C. N. (2004). Culture and the development of eating disorders: A tripartite model.              Eating Disorders: The Journal of Treatment and Prevention, 12, 139-156.

Markey, C. N., & Markey, P. M. (2005). Relations between body image and dieting behaviors: An exploration of gender differences. Sex Roles, 53, 519-530.

McCabe, M. P., & Ricciardelli, L. A. (2003). Sociocultural influences on body image and body changes among adolescent boys and girls. Journal of Social Psychology, 143, 5-26.

McIntosh, V. V., Britt, E., & Bulik, C. M. (1994). Cosmetic breast augmentation and eating disorders. The New Zealand Medical Journal, 107, 151-2.

Mora-Giral, M., Raich-Escursell, R. M., Segues, C. V., Torras-Claraso, J., & Huon, G. (2004).            Bulimia symptoms and risk factors in university students. Eating and Weight          Disorders, 9, 163-169.

National Eating Disorders Association. Statistics: Eating disorders and their precursors. Retrieved November 9, 2009, from www.nationaleatingdisorders.org.

Ochoa Hoyos, A. M. (2007). Body image: Differences and similarities between Colombian and      Dutch teenagers. Perspectivas en Nutricion Humana, 2, 109-122.

Pan, Y., Dixon, Z., Himburg, S., & Huffman, F. (1999). Asian students change their eating                patterns after living in the United States. Journal of the American Dietetic     Association, 99, 54-57.

Patton, G. C., Johnson-Sabine, E., Wood, K., Mann, A. H., & Wakeling, A. (1990). Abnormal eating attitudes in London schoolgirls: A prospective epidemiological study. Outcome at twelve-month follow-up. Psychological Medicine, 20, 383.

Shaw, H. E., Stice, E., & Springer, D. W. (2004). Perfectionism, body dissatisfaction, and

self-esteem in predicting bulimic symptomatology: Lack of replication. International Journal of Eating Disorders, 36, 41-47.

Silliman, K., Rodas-Fortier, K., & Neyman, M. (2004). A survey of dietary and exercise habits and perceived barriers to following a healthy lifestyle in a college population. Californian Journal of Health Promotion, 2, 10-19.

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.

Stice, E., & Shaw, H. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: A synthesis of current findings. Journal of Psychosomatic Research, 53, 985-993.

Stormer, S. M., & Thompson, J. K. (1996). Explanations of body image disturbance: A test of maturational status, negative verbal commentary, social comparison, and sociocultural hypotheses. International Journal of Eating Disorders, 19, 193-202.

Striegel-Moore, R. H., & Franko, D. L. (2002). Body image issues among girls and women. In T. F. Cash & T. Pruzinsky (Eds.), Body image: A handbook of theory, research, and clinical practice (pp. 183-191). New York: Guilford Press.

Striegel-Moore, R. H., Silberstein, L. R., & Rodin, J. (1986). Toward an understanding of risk factors for bulimia. American Psychologist, 41, 246-263.

Strober, M. & Katz, J. (1988). Depression in the eating disorders: A review and analysis of  descriptive, family, and biological factors. In D. M. and P. E. Garfinkel (Eds.), Diagnostic issues in anorexia nervosa and bulimia nervosa (pp. 80-111), New York: Brunner/Mazel.

Stunkard, A. J., & Messick, S. (1985). The Three-Factor Eating Questionnaire to measure dietary    restraint, disinhibition, and hunger. Journal of Psychosomatic Research, 29, 71-83.

Swami, V., Arteche, A., Chamorro-Premuzic, T., Furnham, A., Stieger, S., Haubner, T., & Voracek, M. (2008). Looking good: Factors affecting the likelihood of having cosmetic surgery. European Journal of Plastic Surgery, 30, 211-218.

Swami, V., Taylor, R., & Carvalho, C. (2009). Acceptance of cosmetic surgery and celebrity worship: Evidence of associations among female undergraduates. Personality and       Individual Differences, 47, 869-872.

Taussig, M. (2008). La bella y la bestia. Antípoda. Revista de Antropología y Arqueología, 6, 17-40.

Tiggerman, M., & Slater, A. (2003). Thin ideals in music television: A source of social comparison and body dissatisfaction. International Journal of Eating Disorders, 1, 48-58.

Yates, A., Shisslak, C. M., Allender, J. R., & Wolman, W. (1988). Plastic surgery and the bulimic      patient. International Journal of Eating Disorders, 7, 4, 557-560.



* Correspondence concerning this article should be addressed to:

E-mail: CCarrion01@mail.Roosevelt.edu

Pages: 143-156

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