Sarah L. Weinberger-Litman

Psychosocial Perspectives and the Issue of Prevention in Childhood Obesity

A dramatic increase in childhood overweight/obesity has been recognized globally over the past 50 years. This observed increase may reflect genetic, as well as psychological, environmental, and socio-cultural influences. In the first part of this review, we present an updated summary of the psychosocial factors associated with this change and discuss possible ways in which they operate. Among these factors, lower socio economic status (in both industrialized and non-industrialized countries), being female, belonging to a minority group, and being exposed to adverse life events may all be associated with a greater risk of childhood overweight/obesity. These influences may be mediated via a variety of mechanisms, in particular above-average food intake of low nutritional quality and reduction in physical activity. Other important psychosocial mediators include the influence of the family and peer environment, and exposure to the media. In the second part of the review, we discuss the potential of psychosocial prevention programs to intervene in the processes involved in the rise of childhood overweight/obesity. Two points are emphasized. First, prevention programs should be multidisciplinary, combining the knowledge of experts from different professions, and taking into consideration the important role of the family environment and relevant influential social organizations, particularly school. Second, effective change is unlikely to occur without large-scale programs carried out on a public policy level.

Mobile Exercise Apps and Increased Leisure Time Exercise Activity: A Moderated Mediation Analysis of the Role of Self-Efficacy and Barriers

Background There are currently over 1000 exercise apps for mobile devices on the market. These apps employ a range of features, from tracking exercise activity to providing motivational messages. However, virtually nothing is known about whether exercise apps improve exercise levels and health outcomes and, if so, the mechanisms of these effects. Objective Our aim was to examine whether the use of exercise apps is associated with increased levels of exercise and improved health outcomes. We also develop a framework within which to understand how exercise apps may affect health and test multiple models of possible mechanisms of action and boundary conditions of these relationships. Within this framework, app use may increase physical activity by influencing variables such as self-efficacy and may help to overcome exercise barriers, leading to improved health outcomes such as lower body mass index (BMI). Methods In this study, 726 participants with one of three backgrounds were surveyed about their use of exercise apps and health: (1) those who never used exercise apps, (2) those who used exercise apps but discontinued use, and (3) those who are currently using exercise apps. Participants were asked about their long-term levels of exercise and about their levels of exercise during the previous week with the International Physical Activity Questionnaire (IPAQ). Results Nearly three-quarters of current app users reported being more active compared to under half of non-users and past users. The IPAQ showed that current users had higher total leisure time metabolic equivalent of task (MET) expenditures (1169 METs), including walking and vigorous exercise, compared to those who stopped using their apps (612 METs) or who never used apps (577 METs). Importantly, physical activity levels in domains other than leisure time activity were similar across the groups. The results also showed that current users had lower BMI (25.16) than past users (26.8) and non-users (26.9) and that this association was mediated by exercise levels and self-efficacy. That relationship was also moderated by perceived barriers to exercise. Multiple serial mediation models were tested, which revealed that the association between app use and BMI is mediated by increased self-efficacy and increased exercise. Conclusions Exercise app users are more likely to exercise during their leisure time, compared to those who do not use exercise apps, essentially fulfilling the role that many of these apps were designed to accomplish. Data also suggest that one way that exercise apps may increase exercise levels and health outcomes such as BMI is by making it easier for users to overcome barriers to exercise, leading to increased self-efficacy. We discuss ways of improving the effectiveness of apps by incorporating theory-driven approaches. We conclude that exercise apps can be viewed as intervention delivery systems consisting of features that help users overcome specific barriers.

The relationship between body image, age, and distress in women facing breast cancer surgery.

OBJECTIVES Research suggests that the strength of the relationship between body image and emotional distress decreases with age. Past research has focused on expected aging-related body changes, and has not yet examined unexpected body changes (e.g., breast cancer surgery). The present post-hoc study assessed relationships between age, body image, and emotional distress in women facing breast cancer surgery. METHODS Older (≥ 65 years, n = 40) and younger (<65 years, n = 40) women were matched on race/ethnicity, marital status, and surgery type. Within one week prior to surgery, participants completed measures of demographics, aspects of body image, and emotional distress (general and surgery-specific). RESULTS Results indicated that: (1) body image did not differ by age (p > 0.999); (2) older women reported less pre-surgical emotional distress than younger women (ps < 0.01); and, (3) age moderated the relationship between body image and emotional distress (ps < 0.06). SIGNIFICANCE OF RESULTS The results suggest that younger women, particularly those with poor body image, are at an increased risk for pre-surgical emotional distress. These women may benefit from pre-surgical interventions designed to improve body image or to reduce pre-surgical emotional distress.

Negative Religious Coping Predicts Disordered Eating Pathology Among Orthodox Jewish Adolescent Girls.

Recent research suggests the importance of exploring religious and spiritual factors in relation to the continuum of disordered eating. This continuum ranges from mild disordered eating behaviors and attitudes to moderate levels of disordered eating pathology (DEP) through full-blown clinical levels of eating disorders (EDs). The current study is the first to explore the role that religious coping (both positive and negative) plays in the development DEP, which is considered a risk factor for the development of EDs. In addition, the study aims to describe levels of DEP among a non-clinical sample of 102 Orthodox Jewish adolescent females. Participants completed a questionnaire measuring religious coping strategies, DEP and self-esteem. Results indicated that greater use of negative religious coping was associated with higher levels of DEP. Mediation analyses suggested that greater negative religious coping is related to lower levels of self-esteem, which accounts for higher levels of DEP. Furthermore, findings revealed relatively lower overall levels of DEP among this sample, compared to similar populations in Israel and the USA. These results suggest that a strong religious and spiritual identity may serve as a protective factor against DEP.

Both Intrinsic and Extrinsic Religious Orientation are Positively Associated with Attitudes Toward Cleanliness: Exploring Multiple Routes from Godliness to Cleanliness

In the present study, we explore how intrinsic and extrinsic religious orientations are associated with cleanliness attitudes. We find that reported importance of religion is associated with increased cleanliness concerns and interest in cleanliness. Attitudes toward cleanliness were also associated with both intrinsic religious orientation and extrinsic religious orientation. Together, religiosity and religious orientation account for 14.7% of cleanliness attitudes and remained significant in the presence of personality, socioeconomic status, age, education, obsessive–compulsive attitudes toward cleanliness, and other covariates. These results show that religiosity is associated with cleanliness via multiple routes. We suggest that intrinsic religious orientation leads to increased interest in cleanliness due to the link between physical and spiritual purity. Extrinsic religious orientation may be linked with cleanliness because of the secondary benefits, including health and the facilitation in communal cohesiveness, that cleanliness rituals offer. The implications of these findings for the relationship between religion and health are discussed.

Extrinsic Religious Orientation and Disordered Eating Pathology Among Modern Orthodox Israeli Adolescents: The Mediating Role of Adherence to the Superwoman Ideal and Body Dissatisfaction

The role of religious and spiritual factors has been recognized with regard to risk factors for disordered eating pathology (DEP). Specifically, religious orientation, or underlying religious motivation, has been associated with DEP among a variety of religious groups. Extrinsic religious orientation has consistently been found to be associated with increased levels of DEP among Christians and Jews in the USA. However, this paradigm has not been investigated cross-culturally. The current study is the first to examine the association of extrinsic religious orientation and DEP among Modern Orthodox Israeli adolescents. Furthermore, the mediating mechanisms of adherence to the Superwoman Ideal and body dissatisfaction are explored to further elucidate the mechanisms generating the association between religious orientation and DEP. A sample of 120 Modern Orthodox Israeli adolescent females participated in an anonymous survey which asked about DEP, body dissatisfaction, adherence to the Superwoman Ideal and religious orientation. Mediation models revealed a significant association between extrinsic religious orientation and DEP. Furthermore, adherence to the Superwoman Ideal and body dissatisfaction serially mediated the association between religious orientation and DEP. Findings suggest that a pathway through which extrinsic orientation influences DEP is through greater adherence to the Superwoman Ideal which leads to higher levels of body dissatisfaction, which is known to be a proximal risk factor for DEP. This finding is discussed in light of specific cultural pressures within the Modern Orthodox population and related clinical implications.

The Interplay Between Eating and Sleeping Behavior in Adolescence: Normative and Disordered Trajectories

The present chapter deals with the relation between eating and sleeping patterns among adolescents. The first part describes both normative and pathological changes in eating and sleeping behavior. In the second part, studies that examine sleep-wake patterns among adolescents suffering from eating disorders are presented. Finally, the importance of maintaining a balance between adolescents’ needs for autonomy and the supervision and support of parents as providers of healthy nutrition and sleeping habits is discussed.

Body Dissatisfaction and Disordered Eating Among Jewish Women: The Role of Religious Orientation and Spiritual Well-Being

Numerous psychological, cultural, and biological variables have been investigated in the etiology of eating disorders (EDs) and their risk factors such as body dissatisfaction and a preoccupation with weight and appearance. Despite its historical link to EDs, the role of religion has largely been ignored. Most studies investigating religious influences on ED symptoms use the terms religion and spirituality interchangeably and do not include Jewish women. Studies that have included Jewish women used a single variable (e.g., attendance at religious service) to measure religiosity, which does not adequately capture the nature of one’s religious beliefs and practices. In a sample of 301 adolescent and young Jewish women, this study assessed participants’ religious orientation and spiritual beliefs to elucidate the possible differential influences of these variables on body dissatisfaction and disordered eating. Results revealed that participants with an intrinsic religious orientation had consistently lower scores (indicating less pathology) on measures of body dissatisfaction and eating disturbance as compared to those with an extrinsic, pro-religious, or anti-religious orientation. High levels of spiritual well-being were moderately associated with lower levels of body dissatisfaction but showed no association with disordered eating. Overall, these findings suggest that having an intrinsic religious orientation may confer protection from eating and body image disturbance.