An Insider’s Look at Our Newest Paper: Social Predictors of Daily Relations between College Women’s Physical Activity Intentions and Behavior

Standard

Note: This post features a discussion about the association between social comparison and physical activity.  If you are new to this topic or would like an in-depth overview, please read our previous posts on social comparison and its influences on health behaviors. Briefly, when we compare something about ourselves to that of another person, we’re making a social comparison. Take exercise, for example. We might make a comparison based on minutes of exercise between us and them. Further, we could compare ourselves to someone doing better (upward) or worse (downward) with exercise minutes. Past research has shown social comparison to be important for understanding changes in physical activity. However, more research is needed to understand how we can use social comparison to guide a person toward greater physical activity behavior–a key focus of this post and our paper.

One challenge to being physically active is that even when we set intentions to exercise, it’s difficult to follow through. This is called the “intention-behavior gap.” Though existing studies have shown that some people are better at the follow-through than others, and have smaller (or no) gaps between their exercise intentions and behavior. It’s possible that learning more about the people who don’t follow through could help us design and adapt exercise interventions to be more effective for them. For our most recent paper, our now in the Journal of Behavioral Medicine, we wanted to know whether a person’s social comparison tendencies or their perceptions of social support affect the link between their physical activity intentions and actual behaviors. For example, it’s possible that people who make comparisons more often or generally feel more supported by close others and have more confidence in their ability to follow through on their intentions, relative to people who are lower in these characteristics. This may be especially true for college women, as social experiences are more strongly connected to their health behaviors than in other groups.

We selected this topic because:

  • Women are generally less active than men, especially in college, and may face additional challenges in meeting their physical activity intentions.
  • Both social comparison and social support have been linked to health behaviors like physical activity, but their influences on the intention-behavior gap have rarely been studied.

What Were Our Research Questions and Expected Outcomes?

Question #1
First, we wanted to know more about college women’s exercise intentions (e.g., how often they were set) and behaviors (i.e., minutes in moderate + vigorous intensity activity). We selected women who were not already meeting exercise guidelines for health, to understand whether the intention-behavior gap was common for them. Based on existing evidence, we expected poor or moderate follow-through with exercise intentions.

Question #2
Second, we wanted to know whether college women’s perceptions of their social comparisons or social support is related to their  intention-behavior gap. We expected that greater social comparison and support would reduce the gap.

What Did We Do?

We conducted a 7-day observational study among 80 women students at a university in northeastern Pennsylvania (USA). Essentially, this design means that participants are asked to go about their normal activities while wearing monitors and responding to questions about their recent experiences; they didn’t participate in an intervention program or receive an experimental manipulation. Women interested in participation completed an initial online survey about demographics, social comparison, and social support. We reviewed responses and invited women to the study based on our eligibility criteria:

  •      No experience with wrist-worn/smartphone-based physical activity monitors
  •      <100 minutes/week moderate-to-vigorous physical activity
  •      2nd-year student or above (to avoid effects from the transition to college)

After attending a face-to-face orientation, we asked each participant to use an electronic diary to report daily exercise  intentions and wear a Fitbit to monitor their exercise behavior for 7 days. 

What Did We Find?

  • Exercise intentions were set on 36% of days – an average of 2-3 days a week, per person.
  • On days with set intentions, the average intention was 41 minutes of moderate + vigorous activity.
  • Based on Fitbit records, 26 minutes a day were spent in exercise, on average.
    • Minutes of exercise varied in participants from day to day.
  • Participants got about 12 more minutes of exercise on days with set intentions, versus those without; this difference was not statistically significant.
  • Social support did not affect the intention-behavior gap, but overall social comparison tendency did (i.e., greater interest in social comparison reduced the gap between intention and behavior).
    • The tendency to make downward comparisons (i.e., toward someone seen as worse-off) also reduced the gap, but the tendency to make upward comparisons (i.e., toward someone seen as better-off) had no effect.

What Does This Tell Us?

Unsurprisingly, low-active college women often do not set intentions to exercise. When they do set intentions, their increase in exercise is typically small and does not fulfill their intentions. This suggests a noticeable gap between college women’s exercise intentions and behavior. Social support was not linked to improvements in the intention-behavior gap, but social comparison was. Specifically, downward comparisons appear to help reduce the gap. In the future, targeting social comparison processes may improve the intention-behavior gap and reduce physical activity differences between women and men. This could help to improve women’s health during college and across the lifespan.

What Was it Like to Work on This Study?

“Dr. Arigo gave me the opportunity to learn about the research process from start to finish in the Clinical Health Psychology Lab at the University of Scranton. Through project CHASE, I had the ability to assist with participant recruitment, enrollment, technology troubleshooting, data collection, and finally manuscript writing. This broad skill set has strengthened my current research in medical school. Although writing a manuscript was intimidating, I learned how to write academically with the assistance of Leah Schumacher, Dr. Arigo, and Cole Ainsworth. It was great seeing the scientific process from start to finish, culminating in great results. I’m so proud to be a member of this team of researchers!”

Coco Thomas, Medical Student at Philadelphia College of Osteopathic Medicine

”I joined this project after the study had finished, as our team was preparing to write the paper. This topic was new to me, so it was a challenge at times to understand the ‘big picture’ of our results–how they fit into the existing literature and what value they provide. However, having a fresh perspective helped ensure that we didn’t gloss over any details needed for readers to fully grasp what this study was about. As a whole, this project is yet another example of the CHASE Lab’s dedication to improving women’s health, and it has been a pleasure working as part of that team.”

Dr. Cole Ainsworth, Postdoctoral Fellow with the CHASE Lab, Rowan University

“This project was a lot of fun to work on and was a true collaborative effort. The project team spanned institutions, experience levels, and disciplines. Over the course of working on the paper, I think that every single one of us also transitioned into a new professional role: Dr. Ainsworth and I started postdoctoral fellowships, Coco began medical school, and Dr. Arigo moved to a new institution. While this meant that progress was a bit slower at times and that the four of us never met together in a physical room, it was a real pleasure to work with such a fantastic group of people and to work so effectively as a team to get this project across the finish line. I am really thankful to have had the opportunity to work on this project and hope to work on many more projects together in the future!”

Dr. Leah Schumacher, Postdoctoral Research Fellow at Alpert Medical School, Brown University

I’ve been interested in the physical activity intention-behavior gap for a while, and always wanted an opportunity to study whether social comparison or social support were associated with this phenomenon. That wasn’t one of the original intentions of data collection, but that’s what’s great about secondary analyses – you already have the data and you can ask new questions. Like the rest of our team, I had a great experience working on this paper and I’m so impressed with everyone’s commitment to seeing it come together.

Dr. Dani Arigo, CHASE Lab Director

What Comes Next?

We’re pleased to be working with a team from UNC Greensboro to dig deeper into the physical activity intention-behavior gap. This time, we’re looking at it among women in midlife (ages 40-60) using smaller time blocks – chunks of 2-3 hours, rather than full days. Stay tuned!

Social Comparison Might Not Be As Bad As We’re Told

Standard

By Kristen Pasko, Cole Ainsworth, And Dr. Dani Arigo

“Don’t compare yourself to others” is frequently offered as advice for preventing spikes in anxiety and other negative emotions. This advice can be found on popular websites like Psychology Today, Healthline, and Medium. At face value, it seems like good advice – who wants to feel bad about themselves? But the perspective that “social comparisons are bad, don’t make them” is incomplete, and does not reflect the entire picture of social comparison as a basic human process. Forcing ourselves to avoid making comparisons is nearly impossible and might actually be harmful. Comparisons can also be positive, and some can be useful, even if they don’t make us happy in the moment. In this post, we want to offer another perspective on social comparison, with a special focus on how comparisons can be used to encourage health behaviors. 

What Do We Know about Social Comparison?

Social comparison has been of interest to psychologists for decades. Leon Festinger developed the first formal theory of social comparison in 1954. He proposed that we have a built-in drive to evaluate ourselves, and when objective standards (i.e., hierarchy of positions in a company)  aren’t available, we default to using social standards (other people). Later work showed that social comparison isn’t just a substitute for unavailable objective standards – even when these are available, people often prefer social standards!

Social comparison describes the process of a person noticing and evaluating something about themselves in relation to another person. This could be in domains such as work status, wealth, beliefs, health, or appearance. A person can see themselves as better off than, worse off than, or about the same as another individual in any of these domains. From Festinger’s work and others succeeding him, we know that comparison is one of our fundamental cognitive processes (how we make sense of, store, and apply information about other people and social situations). Making comparisons can help to increase cognitive accessibility of certain information. In other words, it reduces the time it takes to mentally sort and select information when thinking and talking about important topics. 

Key Terms

DIRECTION OF COMPARISON

Upward social comparison = perceiving that another person is doing better than we are in a given domain

  • Example: She is so much more attractive than I am. I really wish I had hair like hers.

Downward social comparison = perceiving that another person is doing worse than we are in a given domain

  • Example: I’m definitely healthier than he is, with all of his health symptoms. 

Lateral social comparison = perceiving that another person is doing about the same as we are in a given domain

  • Example: We’re performing about the same at work. 

COMPARISON TARGET: person that an individual compares themselves to; often similar to the individual making the comparison

Moderate target = selecting a person for comparison who seems “not too far off” from us

  • Example: This person is somewhat similar to me, even if they’re doing a little better/worse.

Extreme target = selecting a person for comparison who seems “pretty far off” from us 

  • Example: That person is nothing like me – they’re doing so much better/worse.

 Of these, upward comparisons have the worst reputation. These are the ones that websites tell us to avoid. But research suggests that upward comparisons (as well as downward and lateral comparisons) can have benefits. 

How Can Each Type of Social Comparison Be Beneficial? 

Let’s examine some examples from scientific literature. Upward comparisons can be useful for self-improvement related to job uncertainty (a stressor that could hinder achieving one’s career goals), as they might promote greater goal engagement. In other words, individuals who made upward comparisons more frequently were more likely to move towards their goals. Downward comparisons can be useful in romantic relationships, as individuals who engaged in more frequent downward comparisons about their relationships (compared to individuals who make lateral comparisons) later reported greater relationship satisfaction. Comparisons are even useful for a variety of populations. For example, they may work differently within the context of chronic illness, though still provide benefit. Specifically, individuals from the general population without chronic illness often prefer to see/hear about others that are doing worse than them (downward social comparison) to feel better about themselves. However, individuals with chronic illness tend to prefer contact with those who are doing about the same of better than them (lateral or upward comparison), as it provides reassurance about their current health or serves a picture of how they might look in the future (i.e., in better health). For example, adolescents with chronic illnesses who made lateral comparisons to other ill peers (vs. upward comparisons to well peers) reported greater feelings of social acceptance, happiness with their physical appearance, and global self-worth (personal value).

How are Social Comparisons and Health Behaviors Related?

Social comparisons may also have benefits for promoting healthy behavior. In general, social connections are increasingly recognized as useful in health behavior interventions. This might look like an intervention delivered on a social media platform to increase healthy eating or physical activity, where people are connected with a buddy or team and they can see each other’s progress (e.g., a leaderboard showing how many steps they took during the week vs. how many steps others took). Out of 3 top social strategies that are used to promote better health behavior (competition, comparison, cooperation), social comparison has been shown as the most effective. According to the authors of this study, the main strengths of social comparison include promotion of “subtle and empowering peer pressure.” Social media platforms have also induced social comparison by connecting people to one another to motivate medication management, allowing the sharing of calorie and nutrient consumption to promote a healthy diet, or ranking group members’ physical activity (i.e., steps) on a leaderboard.

A recent three-part study also showed that, regardless of direction (upward, downward, lateral), people who compared with moderate targets had greater physical activity motivation compared to those who compared with extreme targets (see definitions above). Therefore, if targets were moderate (close in activity engagement to the person making the comparison), physical activity motivation increased, as physical activity appeared more achievable. Conversely, targets that were extreme (farther away in activity engagement from the person making the comparison), physical activity motivation was decreased, as the same outcome appeared less achievable. This study suggests that the direction of comparison may not matter as much as whether our own performance is close to or far away from the performance of our targets.  

Food for Thought

Comparisons are quite natural and occur more often than some people would like to admit. Often they are automatic. Therefore, putting pressure on yourself to avoid making comparisons might be an unrealistic goal. Making comparisons is NOT something individuals need to be ashamed of! So, what are potential ways we can manage comparisons?

Try to be flexible about the way you are thinking about comparisons. Comparisons might provide us with examples of how other people are doing/viewing something, to save up our time and energy for future situations. In other words, they might be protective. You might ask yourself, “how can I use this person as a role model?” or “can I find a better (e.g., more realistic) role model?”. While comparing ourselves to these role models might make us feel a little bad at times, that little bit of negative emotion might motivate us to make some change!*

CHASE Lab’s Recent Work on Social Comparison

  • Methods to Assess Social Comparison Processes within Persons in Daily Life: A Scoping Review
    • What we learned: most available research on social comparison that assessed the same people multiple times were assessing: 1) women, 2) college students, and 3) social comparisons of appearance rather than other domains (i.e., wealth, health). Most studies signaled participants to report on their recent comparisons instead of asking participants to record them as they were happening. There was a lot of variability in the way the comparisons were assessed (i.e., how many times they were prompted per day, how “social comparison” was defined).
    • Future implications: we need to examine social comparisons using repeated assessment in a wider range of individuals, to better understand how the process affects us in daily life. See this article    See our blog post summary
  • Social Comparison Features in Physical Activity Apps: Scoping Meta-review
    • What we learned: social comparison processes were present in 31% of published articles that described behavior change techniques in mobile apps to promote physical activity. Though very few described what aspect of physical activity was compared (steps vs. active minutes). No studies identified social comparison features that were tailored to fit user preferences.
    • Future Implications: articles that describe social comparison features in apps should be more specific (i.e., about what is being compared or how comparison is being induced) and should consider individual differences in preferences and responses to social comparison. See this article   See our blog post summary
  • Daily Relations between Social Perceptions and Physical Activity among College Women
    • What we learned: college women engaged in less physical activity on the days that they reported making (vs. not making) comparisons – except comparisons in the health domain, which were on days with more physical activity (for a subset of women).
    • Future implications: days on which individuals report making comparisons (with exception of health comparisons) might be good days to intervene to prevent reductions in physical activity.  See this article    See our blog post summary

What We Have In the Works

  • Project WHADE – Read about our methods
  • Fitspiration Exposure Study – experimental manipulation of messaging that accompanies fitspiration posts, and its effects on body satisfaction, exercise motivation, and exercise behavior (more on this soon!)

*A little bit of negative emotion can signal to us that we want to make some changes, to avoid feeling this way in the future. But as many articles have pointed out by recommending that we avoid comparisons, we shouldn’t have to feel bad all the time, or even most of the time. If your comparisons are contributing to problems, please don’t hesitate to seek support. Visit https://www.7cups.com/ for free resources.

Social comparison opportunities in digital health interventions: Are we using theory and evidence effectively?

Standard

By Dr. Dani Arigo, Rowan University and Rowan University School of Osteopathic Medicine (reposted from UCL’s Center for Behavior Change Digi-Hub blog, published May 24, 2018)

As a clinical psychologist who studies the role of social process and perceptions in health behavior change, I’ve been both delighted and overwhelmed by our increasing ability to use digital tools that connect users to each other. So much of our daily lives are spent engaged in social interaction (or pondering social experiences), and there is huge potential to use the social environment to promote health. But it seems that we still have a long way to go before we can capitalize on this potential.

For instance, literature on intervention components of digital health tools – particularly work that describes mobile apps for physical activity and weight loss – indicates that a significant proportion of these tools uses “social comparison” to promote behavior change. (See here for an example.) Yet “social comparison” can mean a lot of different approaches or techniques. When researchers say that social comparison is used in an intervention, what does this mean in practice? Moreover, is this work maximizing the vast body of knowledge on social comparison theory and applications to health contexts?

Social comparison refers to the process of self-evaluation relative to another person or group. The ability to size ourselves up next to potential allies or competitors is thought to be innate and protective; it often happens quickly and implicitly, whenever we’re exposed to relevant information about other people. As a result, any digital health intervention that offers the opportunity to learn about others’ health behaviors could facilitate social comparison. This means that features such as message boards, direct messages, profiles/feeds, or anything else that lets users share text or photos with each other could be categorized as social comparison.

But simply providing information about others may not actually induce social comparison, as people (and therefore, users of digital health tools) differ in their tendencies to make comparisons or value the evaluations they provide. Here, concluding that comparison is a primary mechanism of action could lead us astray; other mechanisms such as social support and social reinforcement may be more powerful in these situations, or may interact with social comparison to produce behavior change. Features such as challenges (competitions) and leaderboards, which directly compare a user’s progress to that of other users, are more likely to induce the types of comparisons that could lead to behavior change.

Unfortunately, many existing reviews of digital health interventions do not specify what they categorize as “social comparison,” making it difficult to determine which features of a tool are most beneficial. To make things even more confusing, these reviews rarely indicate how users’ information is communicated to each other – via raw numbers (pounds lost or steps taken), data visualization (graphs), photos, videos, or avatars? Or some combination? Which of these is most effective for promoting behavior change?

But perhaps the most significant limitation of existing work in this space is the assumption that all opportunities for social comparison are created equal – specifically, that they will always have the desired positive effect. Social psychology theory and empirical work show that this is not accurate. As noted, people differ in their affinity for social comparison, meaning that facilitating or inducing this process via digital health tool won’t be very effective for some people. Even more importantly, for some people, comparison has negative effects. Anxiety, despondence, and frustration all are fairly common responses to comparison, and only some people are able to channel this negative affect into motivation for behavior change; many of us simply give up. (This could explain some users’ disengagement from digital health tools.)

Finally, differences in affinity for comparison or positive/negative response to a comparison opportunity do not exist just between people. Each of us fluctuates in our interest and response over time, depending on factors such as mood, stress level, and progress toward our behavioral goals. We’re continually improving the capacity for digital health tools to assess users’ dynamic preferences and needs, and respond to these in real time (e.g., JITAI designs), but this capacity has not yet been applied to tools’ social comparison features. We now have enormous potential to tailor social comparison features, which may provide more engaging and effective digital health interventions.

Questions:

  • What is the best approach to assessing social comparison preferences and needs, in order to inform social comparison tailoring in a digital health tool?
  • What steps are necessary in order to tease apart which social comparison intervention features and formats (e.g., text vs. photos) are most beneficial, for whom, and when?

@UofSHealthPsych at Healthier U Day (University of Scranton)

Standard

healthieruf161On Friday, September 16th, the Clinical Health Psychology Lab took part in the University of Scranton’s Healthier U Day event from 1:00-4:00 pm. Seven lab members introduced fellow students to the concept of health psychology, demonstrated its usefulness for behavior change, and provided information about ways to stay healthy on campus.

At 1:00, the line to enter Healthier U Day stretched the entire length of the Dionne Green. (If you’ve never been to our campus, this is about the size of a soccer field.) We were pleased to see so many students interested in learning more about health and wellness on campus. Our table was greeted with groups of 5 to 10 students at a time, who were eager to learn. To keep up with the flow of people, students were directed to start with our survey question and work their way through the rest of our table from there.

Our discussion began with the question, “What is your most common barrier to exercise?” We offered four options, and over 50 students responded: 64% said “I’m busy/have no time,” 18% said “I have no one to go with, ”18% said “The gym is too crowded/ I fear being judged,” and less than 1% said “I don’t know where to go.” These results demonstrate that time management seems to be the largest barrier to physical activity for college students. However, we observed the majority of students who reported fear of judgement or did not have anyone to go with were female, with the exception of males who were freshman. Such observations could lead us to new research questions about social support for exercise in these subgroups.

Based on the responses, students were directed to a visual web of solution stems, printed on a poster (pictured below). Solutions were recommended by lab members as methods that work for us in everyday life, so students got some insight into how we overcome the psychological barriers presented on the poster.

psychological-barriers-to-pa-healthier-u-day-2016We also introduced students to the types of studies and research questions that are conducted by our lab. We tried to make sure that the female students knew about Project CHASE, as we are recruiting for that study. We continued by giving students an overview of the field of health psychology. Students were given handouts, including exercise resources on and off campus and tips for healthy eating behaviors.

Our exercise resource sheet included information about off-campus resources and on-campus options other than the university’s gym. It included: The Jewish Community Center’s Group Exercise Classes, Yoga for Grief Relief, and Nay Aug Park, as well as  The Byron Center’s Open Swim and Intramural Teams. Students were surprised to see some of the options they had for physical activity in the area, and many seemed excited to take home a copy of the sheet. Some examples included in the healthy eating sheet included advice like “don’t eat and work” and “don’t completely take your favorite foods out of your diet”. These handouts were meant to increase convenience and thereby increase the likelihood of positive health behaviors.

healthieruf162

From Left: Team Members Zuhri Outland, Marissa DeStefano, Kerri Mazur, & Sabrina DiBisceglie

After guiding students through the survey and suggestions for positive health behaviors, several people were interested in taking the Health Psychology course offered in the spring semester (PSYC 228). Many students were unfamiliar with the concept of health psychology beforehand, and were curious to learn more after visiting our table. Overall, we were pleased with the feedback we received at the event, and we hope our presentation will allow students to make healthier choices!

Contributors to this post: Marissa DeStefano, Zuhri Outland, Kristen Pasko, Sabrina DiBisceglie, Kerri Mazur, and Dr. Arigo.

 

Our Social Brains: What’s In It for Health?

Standard

Originally posted on July 13, 2014 by Dr. Arigo

One of my recent projects was a small pilot study to test the feasibility of a new physical activity program. Although there are multiple components of my physical activity program, the novelty is its emphasis on social connections. As you can see from previous posts, understanding the effects of the social environment on health and health behavior change is central to my work; I believe that it’s central to overcoming ubiquitous barriers to healthy behaviors such as eating well and quitting smoking. We have decades of evidence to support the relationship between a person’s social environment and his or her health. For example, one of the most elegant and powerful studies on this relationship happened in the 1980s, when Sheldon Cohen and colleagues demonstrated that social support can protect a person from catching the common cold.

Advancements in statistical modeling techniques (as well as access to large data sets) led to findings on social network effects – in essence, we become more like close others in appearance (weight) and habits (smoking) over time. Although the math in the observational (i.e., no experimental manipulation, an thus no inference of causation) network studies has been questioned, FaceBook’s recent experimental manipulation of our News Feed content has delivered the same conclusion: we are affected by others, and we become more like “close” others over time. (For the record: ethical problems noted here, but important work and clever execution. I may return to this in another post.)

Neuroscientist Mattew Lieberman’s Social: Why Our Brains are Wired to Connect takes this concept several steps further. The goal of Lieberman’s work at UCLA is to determine the neural underpinnings of our social behaviors. In Social, he describes his (and other) research at length, integrates it with personal stories, and makes suggestions for how we might be able to use it to improve societal problems. The book is repetitive at times, but it hammers home a few critical points:

(1) The brain’s “default” network – what happens when we’re not actively focusing on anything in particular – is social. When we don’t have something to do, we default to thinking about our relationships and trying to figure out others’ motivations.

(2) The brain’s “mentalizing system” likely is responsible for our ability to connect with and understand others.

(3) We are hard-wired to prioritize our social connections – they likely kept us safe from predators and starvation as we evolved. Accordingly, we can improve failing institutions like the U.S. public education system by increasing the social connectivity of students around learning (rather than restricting their interactions in the classroom and allowing their social energies to be used elsewhere).

The third point is most interesting to me, as the same could be said for health promotion. But there are several ways to facilitate social connections – which is/are most effective remains an open and compelling question.

For me, reading this book not only underscored the importance of the work I do, but it encouraged me to return to blogging. Sharing my thoughts and my work with others is the only way to make them useful.

The Body Problem

Image

Originally posted on March 8, 2014 by Dr. Arigo

Around 2005, I decided to focus my work on disordered eating behavior and body image. Like many college women, I saw this broad topic everywhere. In addition to concerns among family and friends, body image, eating, and weight were plastered all over the media (and critiques of the media). During my gap year, I worked on an eating disorders unit at a psychiatric hospital, and I doubt that I could have been any more immersed in these issues.

Given the chasm between treatment and research in eating disorders, I was fortunate that the cultural interest in eating and weight included in the empirical literature. Professional journals do succumb to trends, and it seemed that body image research was fashionable at the time. Some of the classics include Crandall’s examination of social contagion of binge eating and Becker’s description of introducing disordered behavior to a population by giving them televisions. To me, some of the most interesting work was in mapping the temporal relationships between mood state, social and self-perceptions, and eating behavior, using electronic daily diaries. (I have yet to contribute to this area, though it is on the agenda for my first few years in my new position.)

Although there still is much to learn about these relationships, the fervor for body-related topics seems to have died down in the past few years. The first clue regarding this change came from my students in Abnormal Psychology, around 2010. Until then, I had been very much aware of the negative stereotype of young women with eating disorders (see Wasted and Skinny Bitch, for examples). When I asked my students to describe the stereotype, they surprised me: many of them seemed not to share this perception (including males), and expressed compassionate, considerate attitudes toward all people with these disorders. I suspect there were several reasons for this disconnect, including a high SES student population. But it seemed that times were a’changin, and I was behind in my own field.

Much has changed in the past ten years. Obesity is a bigger problem than ever, and the innovative work of Brian Wansink and Kelly Brownell has shifted attention to macro-level problems such as the food environment and public health policy. My own work has broadened to include the full spectrum of eating and weight disorders, with a heavier emphasis on obesity, diabetes, and weight loss than on body image and disordered eating. I’m also much more interested in the science of eating behavior – and how eating can be manipulated – than in collections of symptoms. But as I continue to write and publish in body image and disordered eating, I realize that I am farther from the pulse of these topics than ever. For example, I’m currently working with a student to revise her Master’s thesis for publication – a clever approach to help young women combat their immediate negative responses to thin media figures. Yet the Introduction to the “problem” of negative body image features a preponderance of references to literature from the 1980s and 90s, with virtually nothing newer than 2004.

Have we solved the body problem while I wasn’t looking? Or, have we come to accept it as such a part of our culture that we’re no longer doing interesting, novel research on it? Perhaps neither, or a little of both. In retrospect, part of the appeal of this research in the late 90s and early 2000s was its novelty; women were first starting to speak out about their experiences and disclose the severity of the consequences. We do have better treatments than ever (e.g., the Body Project, CBT for bulimia nervosa), though there is more to be done to optimize them. Members of our society are aware of the problem and talk more openly about it than they used to. And as obesity wreaks physical and psychological havoc, more of our resources go to understanding problems of excess weight and overeating (e.g., binge eating disorder).

I’m pleased to see the increasing unification of the eating disorders and obesity fields. From both research and clinical perspectives, what makes eating so interesting to me is that we cannot live without it (unlike heroin), but there are so many ways that it can go awry. And it’s entirely possible that each of the distinct problems I’ve noted stem from the same central disturbance. For example, a recent paper in Psychosomatic Medicine demonstrated that, in both healthy weight and overweight women, exposure to degrading treatment of overweight individuals in media clips led to increases in salivary cortisol (a stress hormone). Interpretations can and should vary, until further research is shared. It suggests to me that among women, there is something universally anxiety-provoking about the negative overweight stereotype. Some of us avoid the immediate distress of it by eating more, and some of us take drastic measures to prevent it from becoming reality. At present, too little is known about the development of truly healthy mindsets and habits. Let’s hope that’s the next trend.