Revisiting the Postulates of Etiological Models of Eating Disorders: Questioning Body Checking as a Longer-Term Maintaining Factor

Body checking (BC) is not only inherent to the maintenance of eating disorders but is also widespread among healthy females. According to etiological models, while BC serves as an affect-regulating behavior in the short term, in the longer term it is assumed to be disorder-maintaining and also produces more negative affect. The present study therefore aimed to empirically examine the proposed longer-term consequences of increased BC. In an online study, N = 167 women tracked their daily amount of BC over a total of 7 days: Following a 1-day baseline assessment of typical BC, participants were asked to check their bodies in an typical manner for 3 days and with a 3-fold increased frequency for 3-days. Before and after each BC episode, the impact of BC on affect, eating disorder symptoms, general pathology and endorsement of different functions of BC was assessed. Participants showed longer-term consequences of increased BC in terms of increased negative affect and general pathology, while eating disorder symptoms remained unaffected. In the case of typical BC, participants showed decreased general pathology and anxiety. Furthermore, the endorsement of a higher number of BC functions led to increased negative affect and an increased amount of typical BC. The findings support the theoretically assumed role of maladaptive BC in maintaining negative emotion in the longer term. However, though requiring replication, our finding of positive effects of typical BC calls into question the overall dysfunctionality of BC among non-clinical women who are not at risk of developing an eating disorder.

Drawings or 3D models: Do illustration methods matter when assessing perceived body size and body dissatisfaction?

Research has reported that both men and women experience body dissatisfaction. Among other instruments, a widely used method to assess perceived body size and body dissatisfaction are figure rating scales. Although a variety of illustration methods (e.g., three-dimensional, or 3D, models and line-drawing models) have been used to create these figure rating scales, to date, they have not been directly compared to one another. Thus, in the first study, which includes 511 participants at a mean age of 46 years old (range: 20–70), the present research work aims to assess how the line-drawing and 3D model scales, representing different body illustration methods, relate to each other. Furthermore, the first study assesses the validity of the indication of body dissatisfaction measured using these figure rating scales by comparing them to body checking or scrutinizing behavior and body appreciation levels. The project’s second study examines the two figure rating scales using objectively measured anthropometric data. In total, 239 participants at a mean age of 54 years (range: 18–94) were included. The results show that figure rating scales can be considered tools that measure perceptual body image due to their positive correlations with body checking behavior (for women) and their negative correlations with body appreciation. The 3D model and line-drawing scales show good to excellent inter-scale reliability, and both scales agree equally well with body mass index (BMI) measurements. Thus, the 3D model and line-drawing scales both seem well suited for assessing perceived body size and perceptual body dissatisfaction, suggesting that neither illustration method is superior to the other.

The Association of Muscle Dysmorphia, Social Physique Anxiety, and Body Checking Behavior in Male College Students With Weight Exercise

Objectives: To investigate the association between muscle dysmorphia (MD), social physique anxiety, and body-checking behavior in male college students with weight exercise, and to reveal the association between them.Methods: A total of 492 male college students with weight exercise from 18 Fitness Clubs or bodybuilding centers in Chengdu, China, participated in this study.Results: First, the social physique anxiety scores, body checking frequency, and weight exercise behavior (i.e., frequency, time, and intensity) in male college students with MD were significantly higher than those without MD; it indicated that the higher the exercise frequency they had, the longer the exercise time they cost, and the higher exercise intensity carried out, and the higher the social physique anxiety scores tended to be, the higher the frequency of body checking on “global muscles,” “chest and shoulder muscles,” “comparison with others” and “posture measurement” they did. Second, the mediating effect of the social physique anxiety on MD and body checking was established in the “MD → global muscle checking,” “MD → chest and shoulder muscle checking,” “MD → comparison with others,” and “muscle dysmorphia → posture measurement.”Conclusion: Male college students with MD not only have a higher social physique anxiety, but also a higher frequency of body-checking behavior than the ordinary individuals. Social physique anxiety is one of the important mediating factors to those with MD which affects the body-checking behavior.

Therapist Materials for the Three Parts of Emotions (3-Component Model)

The session covered in this chapter looks at the three components of emotions, which are thoughts, physical sensations, and behaviors/urges. These components interact and unfold over time. With regard to thoughts, clients frequently know that they have thoughts, but they have difficulty putting the thoughts into specific words. With regard to physical sensations, clients are often least familiar with thinking about physical sensations as a part of emotion. With regard to behaviors, it is useful to think of urges as well as behaviors, and also to broaden thinking to a wide range of behaviors, including not doing certain things. It is particularly useful to identify the three components of emotion in different, recent situations where they experienced strong emotion or behavioral symptoms, such as binge eating, compensatory behavior, driven exercise, body checking, or skipping a meal.

Reality Check 2: The Cost-Effectiveness of Policy Disallowing Body Checking in Non-Elite 13- to 14-Year-Old Ice Hockey Players

Sport-related injuries are the leading cause of injury in youth and are costly to the healthcare system. When body checking is disallowed in non-elite levels of Bantam (ages 13–14 years) ice hockey, the injury rate is reduced, but the impact on costs is unknown. This study compared rates of game injuries and costs among non-elite Bantam ice hockey leagues that disallow body checking to those that did not. Methods: An economic evaluation was conducted alongside a prospective cohort study comparing 608 players from leagues where body checking was allowed in games (Calgary/Edmonton 2014–2015, Edmonton 2015–2016) with 396 players from leagues where it was not allowed in games (Vancouver, Kelowna 2014–2015, Calgary in 2015–2016). The effectiveness measure was rate of game injuries per 1000 player-hours. Costs were estimated based on associated healthcare use within the publicly funded healthcare system as well as privately paid healthcare costs. Probabilistic sensitivity analysis was conducted using bootstrapping. Results: Disallowing body checking reduced the rate of injuries by 4.32 per 1000 player-hours (95% CI −6.92, −1.56) and reduced public and total healthcare system costs by $1556 (95% CI −$2478, −$559) and $1577 (95% CI −$2629, −$500) per 1000 player-hours, respectively. These finding were robust in over 99% of iterations in sensitivity analyses in the public healthcare and the total healthcare system perspectives. There was no statistically significant difference in privately paid healthcare costs (−$65 per 1000 player-hours (95% CI −$220, $99)). Interpretation: Disallowing body checking in non-elite 13–14-year-old ice hockey nationally would prevent injuries and reduce public healthcare costs.

An Economic Evaluation of Disallowing Body Checking in 11- to 12-Year-Old Ice Hockey Leagues

Background: After a national policy change in 2013 disallowing body checking in Pee Wee ice hockey games, the rate of injury was reduced by 50% in Alberta. However, the effect on associated health care costs has not been examined previously. Hypothesis: A national policy removing body checking in Pee Wee (ages 11-12 years) ice hockey games will reduce injury rates, as well as costs. Study Design: Cost-effectiveness analysis alongside cohort study. Level of Evidence: Level 3. Methods: A cost-effectiveness analysis was conducted alongside a cohort study comparing rates of game injuries in Pee Wee hockey games in Alberta in a season when body checking was allowed (2011-2012) with a season when it was disallowed after a national policy change (2013-2014). The effectiveness measure was the rate of game injuries per 1000 player-hours. Costs were estimated based on associated health care use from both the publicly funded health care system and privately paid health care cost perspectives. Probabilistic sensitivity analysis was conducted using bootstrapping. Results: Disallowing body checking significantly reduced the rate of game injuries (−2.21; 95% CI [−3.12, −1.31] injuries per 1000 player-hours). We found no statistically significant difference in public health care system (−$83; 95% CI [−$386, $220]) or private health care costs (−$70; 95% CI [−$198, $57]) per 1000 player-hours. The probability that the policy of disallowing body checking was dominant (with both fewer injuries and lower costs) from the perspective of the public health care system and privately paid health care was 78% and 92%, respectively. Conclusion: Given the significant reduction in injuries, combined with lower public health care system and private costs in the large majority of iterations in the probabilistic sensitivity analysis, our findings support the policy change disallowing body checking in ice hockey in 11- and 12-year-old ice hockey leagues.

Body checking in non-elite adolescent ice hockey leagues: it is never too late for policy change aiming to protect the health of adolescents

ObjectivesThe objective of this study is to evaluate the effect of policy change disallowing body checking in adolescent ice hockey leagues (ages 15–17) on reducing rates of injury and concussion.MethodsThis is a prospective cohort study. Players 15–17 years-old were recruited from teams in non-elite divisions of play (lower 40%–70% by division of play depending on year and city of play in leagues where policy permits or prohibit body checking in Alberta and British Columbia, Canada (2015–18). A validated injury surveillance methodology supported baseline, exposure-hours and injury data collection. Any player with a suspected concussion was referred to a study physician. Primary outcomes include game-related injuries, game-related injuries (>7 days time loss), game-related concussions and game-related concussions (>10 days time loss).Results44 teams (453 player-seasons) from non-body checking and 52 teams (674 player-seasons) from body checking leagues participated. In body checking leagues there were 213 injuries (69 concussions) and in non-body checking leagues 40 injuries (18 concussions) during games. Based on multiple multilevel mixed-effects Poisson regression analyses, policy prohibiting body checking was associated with a lower rate of injury (incidence rate ratio (IRR): 0.38 (95% CI 0.24 to 0.6)) and concussion (IRR: 0.49; 95% CI 0.26 to 0.89). This translates to an absolute rate reduction of 7.82 injuries/1000 game-hours (95% CI 2.74 to 12.9) and the prevention of 7326 injuries (95% CI 2570 to 12083) in Canada annually.ConclusionsThe rate of injury was 62% lower (concussion 51% lower) in leagues not permitting body checking in non-elite 15–17 years old leagues highlighting the potential public health impact of policy prohibiting body checking in older adolescent ice hockey players.

Factors Associated With Clinical Recovery After Concussion in Youth Ice Hockey Players

Background: The identification of factors associated with clinical recovery in youth after sports-related concussion could improve prognostication regarding return to play (RTP). Purpose: To assess factors associated with clinical recovery after concussion in youth ice hockey players. Study Design: Cohort study; Level of evidence, 2. Methods: Participants were part of a larger longitudinal cohort study (the Safe to Play study; N = 3353). Included were 376 ice hockey players (age range, 11-17 years) from teams in Calgary and Edmonton, Canada, with 425 physician-diagnosed ice hockey–related concussions over 5 seasons (2013-2018). Any player with a suspected concussion was referred to a sports medicine physician for diagnosis, and a Sport Concussion Assessment Tool (SCAT) form was completed. Time to clinical recovery was based on time between concussion and physician clearance to RTP. Two accelerated failure time models were used to estimate days to RTP clearance: model 1 considered symptom severity according to the SCAT3/SCAT5 symptom evaluation score (range, 0-132 points), and model 2 considered responses to individual symptom evaluation items (eg, headache, neck pain, dizziness) of none/mild (0-2 points) versus moderate/severe (3-6 points). Other covariates were time to physician first visit (≤7 and >7 days), age group (11-12, 13-14, and 15-17 years), sex, league type (body checking and no body checking), tandem stance (modified Balance Error Scoring System result ≥4 errors out of 10), and number of previous concussions (0, 1, 2, and ≥3). Results: The complete case analysis (including players without missing covariates) included 329 players (366 diagnosed concussions). The median time to clinical recovery was 18 days. In model 1, longer time to first physician visit (>7 days) (time ratio [TR], 1.637 [95% confidence interval (CI), 1.331-1.996]) and greater symptom severity (TR, 1.016 [95% CI, 1.012-1.020]) were significant predictors of longer clinical recovery. In model 2, longer time to first physician visit (TR, 1.698 [95% CI, 1.399-2.062]), headache (moderate/severe) (TR, 1.319 [95% CI, 1.110-1.568]), and poorer tandem stance (TR, 1.249 [95% CI, 1.052-1.484]) were significant predictors of longer clinical recovery. Conclusion: Medical clearance to RTP was longer for players with >7 days to physician assessment, poorer tandem stance, greater symptom severity, and moderate/severe headache at first visit.