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Body Image, Dissatisfaction and Eating Disorders: A Healthcare Perspective

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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Mental Health and Psychosocial Well-being".

Deadline for manuscript submissions: 30 September 2026 | Viewed by 21345

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Special Issue Editors

Dr. Rosendo Berengüí

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Guest Editor

Faculty of Education, Universidad Católica de Murcia (UCAM), 30107 Murcia, Spain
Interests: psychology; mental health; sport, exercise and health
Special Issues, Collections and Topics in MDPI journals

Dr. María Ángeles Castejón

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Guest Editor Assistant

Faculty of Education, Universidad Católica de Murcia (UCAM), 30107 Murcia, Spain
Interests: psychology; mental health; pedagogy

Special Issue Information

Dear Colleagues,

Eating disorders are a real challenge for public health and healthcare providers. Their high prevalence in recent decades calls for a more in-depth analysis of their causes and development. Current research should continue to study clinical patterns in their evolution, but more information is also needed on maladaptive eating behaviors and the cognitive, emotional, and social factors associated with the perception of inadequate body image.

The aim of this Special Issue is to provide the latest advances on correlates and risk factors for the development of eating disorders in order to detect the most vulnerable individuals and carry out appropriate prevention interventions. In addition, more data are needed on the symptomatology presented by patients and the existing lines of treatment in order to facilitate the efforts of the professionals who care for them.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

Studies of risk factors and variables related to body image, body dissatisfaction, and eating disorders.
Treatment studies.
Prevention studies.
Systematic reviews and meta-analyses.
Epidemiologic studies.
Validation studies of existing assessment tools and introduction of new instruments.

We look forward to receiving your contributions.

Dr. Rosendo Berengüí
Guest Editor

Dr. María Ángeles Castejón
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

eating disorders
body image
body dissatisfaction
mental health
prevention
diagnosis
treatment
health assessment

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Published Papers (7 papers)

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Research

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15 pages, 303 KB

Open AccessArticle

Physical Activity Enjoyment and Orthorexic Eating Behaviours in Turkish Adults: A Cross-Sectional Study

by Bekir Erhan Orhan, Hussain Yasin, Aydın Karaçam, Umut Canlı and Mehdi Ben Brahim

Healthcare 2026, 14(5), 677; https://doi.org/10.3390/healthcare14050677 - 7 Mar 2026

Viewed by 425

Abstract

Background: Orthorexic eating reflects a rigid preoccupation with healthy eating that often co-occurs with health-oriented lifestyles, yet the affective experience of physical activity has received little attention. This study examined whether enjoyment of physical activity is associated with orthorexic tendencies in adults and whether it explains variance beyond age, body mass index (BMI), physical activity status, and self-rated diet. Methods: Adults (N = 434; M_age = 27.55) recruited online in Türkiye completed a survey including the Physical Activity Enjoyment Scale (PACES), the Orthorexia Nervosa Inventory (ONI), and sociodemographic, BMI, physical activity, and diet items. Pearson correlations and one-way ANOVAs assessed bivariate associations, and hierarchical regressions tested whether PACES added incremental variance to ONI total and domain scores beyond covariates. Results: PACES scores showed a near-zero correlation with ONI total (r ≈ 0.02) and did not add variance in regression models (ΔR² ≈ 0.00). Higher BMI and identifying one’s diet as “healthy and balanced” were linked to modestly higher ONI total and Impairments/Emotions scores, while differences in physical activity status were small and mainly limited to the Behavioural domain. Conclusions: In this non-clinical sample of Turkish adults, enjoyment of physical activity was not meaningfully associated with orthorexic tendencies. These findings suggest that enjoyment-focused physical activity promotion can be encouraged without increasing orthorexic symptoms, while replication in clinical/high-risk groups (e.g., elite/professional athletes and clinical eating disorder patients) and longitudinal designs is warranted. Full article

(This article belongs to the Special Issue Body Image, Dissatisfaction and Eating Disorders: A Healthcare Perspective)

23 pages, 338 KB

Open AccessArticle

Cyberbullying and Problematic Internet Use as Correlates of Eating-Disorder Symptomatology and Health-Related Quality of Life in Women Under Specialized Care

by Isabel Panea-Pizarro, Sonia Prieto-de Benito, Andrés Ignacio García-Notario, María Aranzazu Sánchez-Calabuig, Carmen López-Sánchez, Virginio García-López and Fidel López-Espuela

Healthcare 2026, 14(4), 476; https://doi.org/10.3390/healthcare14040476 - 13 Feb 2026

Viewed by 672

Abstract

Background/Objectives: Digital environments have intensified exposure to interpersonal stressors and appearance-related evaluation, raising concerns about cyberbullying and problematic internet use among women with eating disorders (EDs). This study examined whether cyberbullying exposure and problematic online use are associated with health-related quality of life in women receiving specialized outpatient care for eating disorders in Spain. Methods: We conducted a cross-sectional analysis of baseline data collected between 2018 and 2019 from a clinical cohort of 124 women in specialized ED treatment. ED symptoms were assessed using the SCOFF and the Bulimic Investigatory Test, Edinburgh (BITE). Problematic online use was measured with the Internet Addiction Test (IAT) and the Bergen Facebook Addiction Scale (BFAS), and cyberbullying exposure was summarized using a composite index. HRQoL was assessed with the EQ-5D index and visual analogue scale (EQ-VAS). Associations were examined using correlation analyses, group comparisons, and exploratory multiple linear regression models adjusting for age, body mass index (BMI), diagnosis, and comorbidity. Results: Cyberbullying exposure was strongly positively correlated with problematic internet and social media use (IAT and BFAS). Its bivariate associations with ED symptom measures were small and not statistically significant. Participants with physical or mental health comorbidities reported lower HRQoL on both the EQ-5D index and EQ-VAS scores (p < 0.01). In the exploratory adjusted regression model predicting EQ-5D, coefficients for cyberbullying exposure, IAT, and BITE severity were small and imprecisely estimated, whereas diagnosis category showed between-group differences (with the “other ED” category reporting lower EQ-5D scores relative to the reference group). The overall model explained approximately 26.7% of the variance in EQ-5D (adjusted R² = 0.22). Conclusions: In this clinical sample, digital-use measures co-occurred strongly with one another, and comorbidity was associated with poorer HRQoL at the bivariate level. In exploratory adjusted models, estimated associations of cyberbullying and problematic online use with HRQoL were imprecise, supporting cautious interpretation. Prospective and intervention studies are needed to determine whether digital interpersonal stressors contribute to HRQoL trajectories in women receiving specialized ED care and whether targeting these stressors improves patient-reported outcomes. Full article

(This article belongs to the Special Issue Body Image, Dissatisfaction and Eating Disorders: A Healthcare Perspective)

18 pages, 1122 KB

Open AccessArticle

Brief Mindfulness Meditation Protects Chinese Young Women’s Body Image from Appearance-Focused Social Media Exposure: An Online Randomized Controlled Trial

by Xiaoxiao Zhang and Zixuan Zhang

Healthcare 2026, 14(1), 120; https://doi.org/10.3390/healthcare14010120 - 4 Jan 2026

Viewed by 1088

Abstract

Objectives: Exposure to appearance-focused social media often leads to body image disturbance among young women. One promising intervention to lessen this negative impact is mindfulness meditation. This study aimed to determine whether a brief mindfulness meditation intervention could mitigate the adverse effects of exposure to appearance-focused social media content on body image and mood in young Chinese women. Methods: In an online randomized controlled trial, 168 women aged 18–35 years were randomly assigned to either an intervention group (n = 86) that listened to a ten-minute mindfulness meditation audio or to a control group (n = 82) that listened to a ten-minute recorded natural history text. After listening to the audio, participants viewed idealized body images on Xiaohongshu and compared themselves to these images. Outcome measures included state body dissatisfaction and negative mood. Data were collected at baseline (T0), post-intervention (T1), and post-exposure to images (T2). Results: At T0, groups did not differ in age, BMI, education, body dissatisfaction, or negative mood (all p > 0.05). From T0 to T1, both groups showed significant improvements in body dissatisfaction and mood. The intervention group’s scores decreased significantly (p = 0.008; p < 0.01), and the control group also showed significant improvements on both outcome measures (both p < 0.001). However, when exposed to the idealized images, only the intervention group maintained its improvements, with no significant change in body dissatisfaction or mood (p = 0.178 and p = 0.310, respectively) from T1 to T2, whereas the control group’s scores worsened significantly on both outcome measures (p < 0.001 for both). Conclusions: These findings suggest that even a brief mindfulness meditation intervention may buffer against the negative effects of idealized social media content on body image and mood. Full article

(This article belongs to the Special Issue Body Image, Dissatisfaction and Eating Disorders: A Healthcare Perspective)

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15 pages, 1611 KB

Open AccessArticle

Perception Versus Actual Weight: Body Image Dissatisfaction as a Stronger Correlate of Anxiety and Depression than BMI Among Romanian Health Sciences Students

by Catalin Pleșea-Condratovici, Vlad Dionisie, Lavina-Alexandra Moroianu, Petrut-Stefan Serban, Victor Plesea-Condratovici and Manuela Arbune

Healthcare 2025, 13(23), 3118; https://doi.org/10.3390/healthcare13233118 - 1 Dec 2025

Cited by 2 | Viewed by 1686

Abstract

Background: The high prevalence of anxiety and depression among young adults constitutes a significant public health concern, with body image identified as a key psychological factor. However, the interplay between subjective metrics (perceived body image) and objective measures (Body Mass Index) remains insufficiently explored within specific populations, such as health sciences students in Eastern Europe. Methods: An observational, cross-sectional study was conducted on a sample of 137 medical and nursing students from a Romanian university. Validated instruments were employed: the Hospital Anxiety and Depression Scale (HADS) and the Eating Disorder Examination Questionnaire (EDE-Q). BMI was calculated from self-reported height and weight. Spearman’s correlation analyses and Mann–Whitney U tests were performed. Results: Subjective body image concerns, particularly those related to shape, weight, and eating, were found to be positively and significantly correlated with symptoms of anxiety and depression (all p < 0.05). In contrast, BMI exhibited no significant correlation with either of the HADS subscales. Although nursing students presented a higher mean BMI, no significant differences were recorded between the student groups with respect to psychological symptoms or body image concerns. Conclusions: Subjective dissatisfaction with body image is a more salient correlate of emotional distress than objective body mass in this cohort. Although the sample size was moderate, the observed associations were robust and statistically significant, underscoring the importance of subjective body image over objective metrics such as BMI in this academic population. These findings underscore the necessity for mental health interventions within university settings to focus on the perceptual and cognitive-affective aspects of body image, rather than exclusively on weight management. Full article

(This article belongs to the Special Issue Body Image, Dissatisfaction and Eating Disorders: A Healthcare Perspective)

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13 pages, 2400 KB

Open AccessArticle

Social Media Exposure and Muscle Dysmorphia Risk in Young German Athletes: A Cross-Sectional Survey with Machine-Learning Insights Using the MDDI-1

by Maria Fueth, Sonja Verena Schmidt, Felix Reinkemeier, Marius Drysch, Yonca Steubing, Simon Bausen, Flemming Puscz, Marcus Lehnhardt and Christoph Wallner

Healthcare 2025, 13(14), 1695; https://doi.org/10.3390/healthcare13141695 - 15 Jul 2025

Viewed by 3916

Abstract

Background and Objectives: Excessive social media use is repeatedly linked to negative body image outcomes, yet its association with muscle dysmorphia, especially in athletic youth, remains underexplored. We investigated how social media exposure, comparison behavior, and platform engagement relate to muscle dysmorphia symptomatology in young German athletes. Materials and Methods: An anonymous, web-based cross-sectional survey was conducted (July–October 2024) of 540 individuals (45% female; mean age = 24.6 ± 5.3 years; 79% ≥ 3 h sport/week) recruited via Instagram. The questionnaire comprised demographics, sport type, detailed social media usage metrics, and the validated German Muscle Dysmorphic Disorder Inventory (MDDI-1, 15 items). Correlations (Spearman’s ρ, Kendall’s τ) were calculated; multivariate importance was probed with classification-and-regression trees and CatBoost gradient boosting, interpreted via SHAP values. Results: Median daily social media time was 76 min (IQR 55–110). Participants who spent ≥ 60 min per day on social media showed higher MDDI scores (mean 38 ± 7 vs. 35 ± 6; p = 0.010). The strongest bivariate link emerged between perceived social media-induced body dissatisfaction and felt pressure to attain a specific body composition (Spearman ρ = 0.748, Kendall τ = 0.672, p < 0.001). A CatBoost gradient-boosting model out-performed linear regression in predicting elevated MDDI. The three most influential features (via SHAP values) were daily social media time, frequency of comparison with fitness influencers, and frequency of “likes”-seeking behavior. Conclusions: Intensive social media exposure substantially heightens muscle dysmorphia risk in young German athletes. Machine-learning interpretation corroborates time on social media and influencer comparisons as primary drivers. Interventions should combine social media literacy training with sport-specific psychoeducation to mitigate maladaptive comparison cycles and prevent downstream eating disorder pathology. Longitudinal research is warranted to clarify causal pathways and to test targeted digital media interventions. Full article

(This article belongs to the Special Issue Body Image, Dissatisfaction and Eating Disorders: A Healthcare Perspective)

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12 pages, 703 KB

Open AccessArticle

The Relationship and Effects of Self-Esteem and Body Shape on Eating Disorder Behavior: A Cross-Sectional Survey of Chinese University Students

by Zeng Gao, Jingyi Zhao, Sanying Peng and Han Yuan

Healthcare 2024, 12(10), 1034; https://doi.org/10.3390/healthcare12101034 - 16 May 2024

Cited by 11 | Viewed by 4773

Abstract

Background: Eating disorders (EDs) have become a global public health concern among adolescents and young adults. However, Chinese university students exhibit a high prevalence of eating disorders. This study aims to investigate the effects of self-esteem (SE) and body shape (BS) on ED behaviors among Chinese university students. Methods: Using random sampling, 946 Chinese university students (aged 18 to 24, M = 19.94, SD = 1.04) participated in a survey comprising the Sick, Control, One, Fat, and Food Questionnaire (SCOFF-Q), the Body Shape Questionnaire (BS-Q), and the Rosenberg Self-Esteem Scale (RS-S) to assess their eating disorder or non-eating disorder (NED) behavior. Results: There was a significant positive correlation between body shape and eating disorder behaviors (r = 0.19, p < 0.01), while there was a significant negative correlation between self-esteem and eating disorder behaviors (r = −0.14, p = 0.001 < 0.01). Gender was a moderating factor in the relationship between body shape and eating disorder behaviors (t = 3.14, p = 0.002 < 0.01), while parents’ marital status was a moderating factor in the relationship between self-esteem and eating disorder behavior (t = 2.72, p = 0.007 < 0.01). Body shape (z = 6.47, p = 0.001 < 0.01), self-esteem (z = −2.81, p = 0.005 < 0.05), and gender (z = 3.06, p = 0.002 < 0.01) significantly influenced eating disorder behavior among Chinese university students aged 18–24 years. Conclusions: There was a direct effect between body shape and self-esteem and eating disorder behaviors among Chinese university students aged 18–24 years. Alarmingly, female university students are becoming susceptible to external influences on self-esteem and body shape, leading to eating disorder behaviors at an increasingly younger age in China. Full article

(This article belongs to the Special Issue Body Image, Dissatisfaction and Eating Disorders: A Healthcare Perspective)

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Review

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21 pages, 369 KB

Open AccessReview

Cultural Determinants of Body Image: What About the Menopausal Transition?

by Coralie Vincent, Alixe Ménard and Isabelle Giroux

Healthcare 2025, 13(1), 76; https://doi.org/10.3390/healthcare13010076 - 3 Jan 2025

Cited by 7 | Viewed by 7228

Abstract

Body image is an important aspect of psychological well-being that is influenced by several biological and psychosocial risk factors. Cultural determinants of body image include the patterns of shared beliefs, values, practices, and social norms within a group that can act as a lens through which a person perceives, compares, and evaluates their body. Women tend to experience higher rates of body dissatisfaction than men, with reproductive milestones such as puberty, pregnancy, and postpartum being windows of vulnerability for body image concerns. The menopausal transition is another reproductive stage of women’s lives that involves major physical changes, psychological challenges, and social pressures that can impact body image negatively. However, the literature on the influence of cultural determinants on the body image of menopausal women is limited. Therefore, this perspective review paper aims to discuss the potential role of cultural determinants in influencing body image satisfaction in women undergoing the menopausal transition. To this end, the relationships between different cultural perspectives and body image around the world are first discussed. Sociocultural influences on body image throughout women’s lifespan and reproductive stages are then presented. Finally, cultural perspectives on menopause and aging and their potential influence on the body image of menopausal women are explored. This paper underscores the importance of considering culture and sociocultural factors when studying body image and highlights the need for further research on the cultural determinants of body image during the menopausal transition. Full article

(This article belongs to the Special Issue Body Image, Dissatisfaction and Eating Disorders: A Healthcare Perspective)

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