BACKGROUND
Disordered eating behaviour (DEB) is an unhealthy eating pattern that includes body dissatisfaction, inappropriate food intake and desire to control body weight by dieting or self-induced vomiting, purging and intensive sports (Bryla, 2003). It has been observed that DEB usually occurs in adolescence and predicts the further development of the DEB or eating disorders that correspond to the clinical diagnosis (Keel & Forney, 2013). Studies show that DEB occurs in up to one-third of men and as many as two-thirds of women (Griffiths et al., 2017; Neumark-Sztainer et al., 2011); a similar prevalence of DEB also exists in Lithuania (Aleksė & Žardeckaitė-Matulaitienė, 2021), where research about the development of DEB is insufficient (Paluckaitė, 2021). Additionally, it is argued that the prevalence of DEB will increase over time because of the lean body cult in Western culture (Jankauskienė et al., 2010; Val-Laillet et al., 2015). DEB is associated with negative consequences for both physical and mental health: slower metabolism (Bryla, 2003), obesity (Pinto-Bastos et al., 2016), inferior quality of life (Wade et al., 2012), depression (Neumark-Sztainer et al., 2011) and use of psychoactive substances (Bryla, 2003).
Biological, psychological, social, and interpersonal factors associated with DEB are studied in the scientific literature. However, they do not adequately explain the development of DEB, and many researchers state that new factors may be sought to supplement existing ones (Sanchez-Ruiz et al., 2019). One of them is appearance comments, which are described as negative and positive comments about a person’s physical appearance, weight and body shape (Carriere & Kluck, 2014). Parents, peers and romantic partners provide appearance comments; however, their impact on DEB is ambiguous and insufficiently researched.
It has been found that those young women whose parents make negative comments about their daughters’ appearance have higher levels of general (Fortesa & Ajete, 2014) and bulimia-specific DEB (Kluck, 2010; Rodgers et al., 2009) and occurrence of overeating and self-induced vomiting (Field et al., 2008). Another longitudinal study showed that those who heard negative comments about their physical appearance from parents in childhood and adolescence have higher DEB levels when they are adults (Eisenberg et al., 2011). It is also known that mothers’ negative comments about physical appearance are related to all types of DEB (Shomaker & Furman, 2009); however, the significance of fathers’ comments on DEB has not been studied separately. It is thought that positive comments about appearance by parents could act as a protective factor against the development of DEB (Gross & Nelson, 2000). However, Rodgers et al. (2009) found that positive comments may lead to social comparison and thin-ideal internalization, which may affect eating behaviour.
Although negative comments about physical appearance are provided mainly by peers (Helfert & Warschburger, 2013) and mostly for young women with higher body mass index (BMI; Haines et al., 2006), the importance of these comments for DEB is mixed. Those young women who receive negative comments about weight from their peers tend to be twice as likely to engage in unhealthy weight control methods as those who do not (Neumark-Sztainer et al., 2002; Shomaker & Furman, 2009). Additionally, negative comments about physical appearance by peers have been found to predict overeating and self-induced vomiting (Field et al., 2008; Haines et al., 2006; Wertheim et al., 2001). However, previous research by Gardner et al. (2000) found no relationship between these variables. Meanwhile, in the scientific literature, no attention was given to the relationship between positive comments about physical appearance by peers and DEB. Also, it has not been investigated whether the association between peers’ comments on physical appearance and DEB differs depending on the gender of the peers making those comments. Possibly comments about physical appearance made by peers of different genders may not have the same significance for DEB as mothers’ and fathers’ comments.
It has been stated that romantic partners often make comments about physical appearance; however, their impact in the context of DEB is undeveloped. Carriere and Kluck (2014) assessed the significance of both negative and positive comments about appearance for female students’ eating behaviour. It was found that negative comments about body shape and weight from romantic partners were associated with higher levels of anorexia-specific DEB, while positive comments were related to lower levels of that DEB type. Meanwhile, another similar study found that they were not related (Shomaker & Furman, 2009).
The scientific literature attempts to explain how significant others – peers, parents and romantic partners – can affect a person’s attitudes and beliefs. According to Carriere and Kluck (2014), persons tend to make the comments to maintain emotionally warm relations. When hearing comments about physical appearance that do not match a person’s opinion of themselves, the cognitive dissonance becomes important: individuals tend to change their beliefs in order to reduce the perceived discomfort due to a discrepancy between their own and others’ opinions (Wood, 2000). Thus, hearing negative comments about physical appearance can lead a person to accept these comments, which in the long run can affect DEB. On the other hand, a person who is dissatisfied with their body image, but hears positive comments about physical appearance, due to cognitive dissonance may become less involved in such an eating pattern, which is considered as disordered (Wood, 2000).
Sociocultural Theory ideas are also beneficial in understanding the relations between significant others’ comments about physical appearance and DEB. It is argued that individuals tend to internalise the ideal body image prevalent in society into their body image (Tiggemann, 2012). Thin-ideal internalisation is a process by which the prevailing standards of appearance in the community are accepted as personal, and one of them is a slim body (Jones et al., 2004). Vartanian et al. (2016) stated that the extent to which a body meets societal standards determines whether a person is satisfied with their body or not. Standards of appearance are adopted through social reinforcement, the process by which individuals accept the attitudes and behaviours of significant others as their own, thus changing their beliefs and behaviours (Thompson et al., 2012). One of the most well-known, the Tripartite Influence Model, states that the media, family, and peers play a crucial role in communicating the prevailing standards of appearance in society. One of the main ways appearance standards are conveyed is through verbal comments received directly from parents or peers (Nerini et al., 2016). A person who hears comments about their physical appearance evaluates how these conform to the internalised body ideal. If a person has internalised the ideal of a lean body but hears negative comments about their physical appearance from significant others, they can lead to DEB; conversely, if such a person hears positive comments about their appearance, they may act as a protective factor reducing the risk of DEB development. As it can be seen, the Tripartite Influence Model does not include the impact of romantic partners, although their influence on both body image and eating behaviour has recently become more investigated in scientific literature.
In contrast, it is argued that positive comments about physical appearance should not necessarily be associated with lower levels of DEB. According to Objectification Theory, the implicit or explicit sexualization of a woman’s body in Western culture encourages self-objectification, a phenomenon in which women value their appearance based on what others think of it (Fredrickson & Roberts, 1997). According to this theory, it is fundamentally irrelevant what kind of comments a woman hears, as both negative and positive comments about appearance are equally objectifying and can lead to DEB (Calogero et al., 2009).
Based on theoretical assumptions and research findings, it can be stated that the association of the comments about physical appearance with DEB is ambiguous. This study aimed to investigate the relationship between eating behaviour and appearance comments by parents, peers, and romantic partners in a sample of young Lithuanian women. It was hypothesized that more frequent negative comments about physical appearance by parents, peers and partners would be related to higher young women’s DEB, while more frequent positive comments about physical appearance would be related to lower DEB. Although the theoretical implications and previous studies’ results suggest that positive comments might be related to higher levels of young women’s DEB, this relationship has still not been analysed and confirmed in more detail.
PARTICIPANTS AND PROCEDURE
PARTICIPANTS
The study involved 285 Lithuanian women between the ages of 19 and 27 (Mage = 21.8, SD = 2.14). As can be seen in Table 1, the majority of respondents reported having a romantic partner (73.3%) and both a mother (98.2%) and a father (77.5%). The duration of young women’s relationships with a romantic partner ranges from 1 month to 10 years (Mwith partner = 2.75, SD = 2.21). The vast majority (73.3%) of the study respondents are normal weight (MBMI = 22.13, SD = 3.92).
MATERIALS
Participant information form. Study participants were asked to provide their age, height, and weight. The information about maintaining a relationship with the mother, father and a romantic partner was also asked. If the participant reported having a romantic partner when they completed the survey, it was also asked about the duration of this relation. BMI was calculated with the formula: weight (in kg)/height (in m2). The World Health Organization (2000) has established BMI norms: the underweight category consists of those with a body mass index of less than 18.5, the normal weight category is between 18 and 25. The overweight category includes persons with a body mass index in the range of 25 to 30, while persons scoring 30 and more are classified as obese. All of the questionnaires below were translated into Lithuanian, using a double translation procedure.
Eating Attitudes Test (EAT-26; Garner et al., 1982) is a set of 26 questions designed to measure the risk or presence of DEB. A Likert scale from 1 (always) to 6 (never) is used to evaluate the questionnaire’s statements. For higher scores on the questionnaire to show a higher risk or presence of DEB, the questions (except 26) were inverted. The questionnaire is divided into three scales. The Dieting Scale consists of 13 questions, which assess how much a person is concerned about their slimming and avoids foods that could fatten, e.g., “Aware of the calorie content of foods that I eat”. The Bulimia Scale is composed of 6 questions, which measure overrating and self-induced vomiting, e.g., “Have gone on eating binges where I feel that I may not be able to stop”. The Oral Control Scale consists of 7 questions that measure the perceived social pressure to gain weight and shows how much a person is inclined to control food consumption, e.g., “Avoid eating when I am hungry”. The original scale has demonstrated a Cronbach’s α varying from .72 to .82, while the current study indicates .90 for Dieting Scale, .79 for Bulimia and .63 for Oral Control.
Verbal Commentary on Physical Appearance Scale (VCOPAS; Herbozo & Thompson, 2006) is a questionnaire consisting of 21 questions, which is appropriate to measure the frequency of appearance comments by these groups of significant others – parents, peers and romantic partners (Carriere & Kluck, 2014; Herbozo & Thompson, 2006). The subscales below measured the appearance comments’ frequency made separately by romantic partners, separately by parents (fathers and mothers), and separately by peers (female and male). A Likert scale from 1 (never) to 5 (always) is used to estimate the frequency of comments. The questionnaire consists of three subscales. The Negative Weight/Shape subscale (NWS) consists of 9 items, which show how often a person receives negative comments about body shape and weight, e.g., “You need to start watching what you eat”. The Positive Weight/Shape subscale (PWS) consists of 6 items measuring the frequency of positive comments about body shape and weight, e.g., “You are in great shape”. The Positive General Appearance subscale (PGA) is composed of 6 questions, which assess the frequency of positive comments about general appearance such as hair, facial features and clothing, e.g., “Your facial skin looks good”. The original scale offered a Cronbach’s α varying from .84 to .92. The current study indicates from .92 to .93 for NWS, from .87 to .90 for PWS and from .85 to .92 for PGA when assessing separately for each group of significant others.
DESIGN AND PROCEDURE
The quantitative correlation study design was used to investigate the relationship between appearance comments by significant others and eating behaviour in young women. The research was carried out by convenience sampling, inviting young Lithuanian women to fill in an online survey questionnaire placed on closed female groups in a social network. Survey data were collected in February-March of 2020 by the Google Docs platform. The respondents completed the survey in 20 to 30 minutes. Before filling the survey, the informed consent form of the study was presented. It provided information about the interviewers, the purpose, the procedure of the study, the conditions of voluntary participation and withdrawal from the study at any time without retention of data. Before completing the questionnaire, subjects had to express their consent to participate in the study – the research aligned with the ethical standards of the 1964 Helsinki Declaration and its later amendments.
ANALYSIS
Statistical data processing was performed using IBM SPSS version 23. The statistical significance level of data analysis was .05. In order to evaluate the reliability of EAT-26 and VCOPAS, Cronbach’s α was used. The Shapiro-Wilk test showed that EAT-29 and VCOPAS scales’ changes had a normal distribution, so multivariate linear regression by the enter method was used when analysing the relationship between appearance comments by significant others and eating behaviour in young Lithuanian women. Before making regression models, multivariate outliers were analysed and excluded from the data. The fact that the survey data were collected electronically ensured that there were no missing values.
RESULTS
Significant correlations varying from weak to medium emerged among mostly comments by significant others and DEB types, so linear regression models were made to better express the relationship between these variables. Additionally, BMI is one of the most important variables related to DEB (Loth et al., 2015), so it was included as a control variable in the regression models. The data from this study also showed that higher BMI is related to higher dieting (r = .42, p < .001) and bulimia-specific DEB (r = .29, p < .001), while lower BMI is related to higher levels of oral control (r = –.31, p < .001). Also, strong correlations emerged between comments by significant others (e.g., positive comments about body shape and weight by mother and father, r = .67, p ≤ .001), so in order to prevent a multicollinearity problem, the regression models on DEB were made separately for all groups of significant others – mother, father, romantic partner and peers.
APPEARANCE COMMENTS BY MOTHER ON EATING BEHAVIOUR
The relationship between appearance comments by mother with young women DEB are presented in Table 2. The findings reveal that more frequent negative comments about body shape and weight by mother predict higher young women’s dieting, R2 = .22, F(4, 273) = 19.43, p < .001, bulimia-specific DEB, R2 = .16, F(4, 273) = 13.10, p < .001 and oral control, R2 = .10, F(4, 273) = 7.93, p = .022. Additionally, more frequent positive comments about body shape and weight by mother are related to higher levels of oral control, R2 = .10, F(4, 273) = 7.93, p = .017, but more frequent positive comments about general appearance are related to lower oral control, R2 = .10, F(4, 273) = 7.93, p = .033.
Table 2
Regression coefficients of appearance comments by mother on eating behaviour
APPEARANCE COMMENTS BY FATHER ON EATING BEHAVIOUR
Table 3 presents the relationship between appearance comments by the father with young women’s DEB. More frequent negative comments about body shape and weight by the father predict higher young women’s dieting, R2 = .17, F(4, 213) = 10.51, p = .001 and bulimia-specific DEB, R2 = .13, F(4, 213) = 7.81, p = .001.
Table 3
Regression coefficients of appearance comments by father on eating behaviour
APPEARANCE COMMENTS BY ROMANTIC PARTNER ON EATING BEHAVIOUR
Table 4 presents the importance of appearance comments by a romantic partner on young women’s DEB. The findings reveal that frequent negative comments about body shape and weight by a romantic partner predict higher young women’s dieting, R2 = .20, F(4, 201) = 12.88, p = .001 and bulimia-specific DEB, R2 = .17, F(4, 201) = 10.35, p < .001.
Table 4
Regression coefficients of appearance comments by romantic partner on eating behaviour
APPEARANCE COMMENTS BY FEMALE PEERS ON EATING BEHAVIOUR
The relationship between appearance comments by female peers with young women’s DEB are presented in Table 5. More frequent negative comments about body shape and weight by female peers predict higher young women’s dieting, R2 = .18, F(4, 274) = 14.98, p < .001, bulimia-specific DEB, R2 = .11, F(4, 274) = 8.77, p < .001 and oral control, R2 = .11, F(4, 274) = 8.67, p = .032. However, more frequent positive comments about body shape and weight by female peers are related to higher levels of young women’s dieting, R2 = .18, F(4, 274) = 14.98, p = .016.
Table 5
Regression coefficients of appearance comments by female peers on eating behaviour
APPEARANCE COMMENTS BY MALE PEERS ON EATING BEHAVIOUR
Table 6 presents the relationship between appearance comments by male peers with young women’s DEB. The findings reveal that more frequent negative comments about body shape and weight by male peers predict higher young women’s dieting, R2 = .14, F(4, 273) = 11.11, p = .002 and bulimia-specific DEB, R2 = .10, F(4, 273) = 7.50, p = .001. Additionally, more frequent positive comments about body shape and weight by male peers are related to higher levels of oral control, R2 = .10, F(4, 273) = 8.59, p = .043.
Table 6
Regression coefficients of appearance comments by male peers on eating behaviour
DISCUSSION
The current study aimed to investigate the relationship between eating behaviour and appearance comments by significant others in a sample of young Lithuanian women. The results indicate that negative comments are negatively related to young women’s eating behaviour, while positive comments about physical appearance may impact it both ways – negatively and positively.
It was assessed whether the more frequent negative comments about body shape and weight by parents, peers and romantic partners are associated with higher DEB levels among young women. It was found that more frequent negative comments about body shape and weight provided by all groups of significant others were associated with greater young women’s dieting and bulimia-specific DEB. The literature analysis revealed that negative comments about young women’s body shape and weight by mothers, fathers, and peers predict bulimia-specific DEB (Field et al., 2008). Additionally, Shomaker and Furman (2009) found that mothers’ negative comments about body shape and weight were associated with all three types of DEB; the same correlations were found in the current research. Expanding the above, the results of this study showed that negative comments about body shape and weight by significant others were relevant not only for bulimia-specific DEB behaviour but also for dieting. We assume that negative comments about body shape and weight are associated with higher levels of young women’s bulimia-specific DEB and dieting, regardless of by whom these comments are provided. According to the social psychology concepts, young women who receive negative comments about body shape and weight from significant others may eventually begin to accept these comments and assess their bodies more negatively, which would affect eating behaviour (Wood, 2000). It can also be assumed that young women who receive negative comments about their body shape and weight begin to pursue a socially acceptable lean body ideal by dieting or engaging in bulimia-specific DEB.
Only negative comments about body weight and shape by mothers and female peers were significantly associated with higher levels of oral control. To date, only negative comments about body shape and weight by romantic partners (Carriere & Kluck, 2014) and mothers (Shomaker & Furman, 2009) are relevant to this type of DEB. The current study results are consistent with the study by Shomaker and Furman (2009), but do not confirm the results obtained by Carriere and Kluck (2014). As discussed, higher levels of oral control are more prevalent between young women with lower BMI; on this basis we can assume that for young women’s oral control, only negative comments about weight and shape by mothers and female peers matter – those made by romantic partners, fathers, or male peers are likely to have less impact. It is likely that negative comments about physical appearance provided by mothers and female peers, but not others, could encourage thin-ideal internalization, leading to higher levels of oral control (Thompson et al., 2012). Thus, for practitioners working with the treatment of young women’s DEB, it may be important to pay attention to the influence of appearance comments by significant others.
We also assessed whether more frequent positive comments about physical appearance by significant others are related to lower DEB levels in young women. The results indicate that more frequent positive comments about body weight and shape by female peers predict lower young women’s dieting, while positive comments about general appearance by mothers are related to lower levels of oral control. Other studies have found that positive comments about body shape and weight by romantic partners are associated with lower female oral control (Carriere & Kluck, 2014), while Rodgers et al. (2009) found no relation between positive comments about physical appearance by parents and eating behaviour. As can be seen in this research, only positive comments about physical appearance by mothers and female peers are significant, so we hypothesise that compliments about physical appearance from individuals of the same gender are more important to young women. Ideas of Sociocultural Theory can explain this: a young female who hears positive comments about her general physical appearance from her mother and about her body shape and weight from female peers may begin to accept their opinion and, as a result, have lower levels of DEB (Wood, 2000). It is also not ruled out that young women, hearing positive comments from people of the same gender, feel in tune with society’s beauty standards, thus reducing the risk of engaging in harmful weight control practices.
However, we found that more frequent positive comments about body shape and weight provided by mothers and male peers are related to young women’s oral control. Although similar relations have not been found in any previous studies, Objectification Theory helps to understand them. According to it, both negative and positive comments about body shape and weight encourage women to view themselves as objects and therefore engage in unhealthy behaviours (Calogero et al., 2009). It might be that young women who hear positive comments about body shape and weight seek to maintain what they are praised for by ways that are harmful to their health, in this case, oral control. The study results also highlighted that the significance of positive comments about physical appearance provided by mothers for oral control is ambiguous: more frequent positive comments about general appearance predict lower levels of oral control; in contrast, more frequent positive comments about body shape and weight are related to higher oral control. We assume that positive comments about general appearance are not associated with body shape; in that case, they are not interpreted as an objectifying message. Thus, we argue that the significance of positive comments about physical appearance by significant others for DEB and, in particular, for oral control remains unclear and needs further research.
When analysing the methodological limitations of the research, it is essential to take into account the method of sample selection, the age of the respondents, the time of filling in the questionnaire and the respondents’ subjectively provided height and weight. The subjects were selected by convenience sampling in a limited age category, so the sample of this study should not be considered representative for all young women. The long time taken to complete the study questionnaire (20-30 minutes) may have affected the inaccuracies of the subjects’ answers to the questionnaire, and the fact that the subjects indicated their height and weight in the questionnaire may have led to errors in the subjects’ calculated body mass index.
Further research about appearance comments by significant others should be carried out in young women and other age groups. When assessing the significance of both negative and positive comments about physical appearance made by significant others for eating behaviour, it may be essential to consider their frequency and effects (what emotions they cause). To better understand the importance of comments about physical appearance for eating behaviour, it is vital to assess the intermediate significance of various social or personal factors that determine body weight and shape assessment (e.g., social comparison, thin-ideal internalisation, self-esteem).
CONCLUSIONS
Negative comments about physical appearance from significant others are undeniably related to the DEB of young women, so it may be essential to consider their importance in the DEB prevention and treatment processes.
Positive comments about physical appearance in the process of DEB prevention and treatment should be considered with extreme caution as their importance for eating behaviour is ambiguous. Further research is needed to better understand the significance of positive appearance comments.
