The distinct role of body image aspects in predicting eating disorder onset in adolescents after one year

Recent research suggests specific body image aspects, namely weight/shape dissatisfaction, overvaluation of weight/shape, weight/shape preoccupation, and fear of weight gain, have distinct roles in eating disorder (ED) onset and maintenance. The aim of this study was to investigate unique associations between these body image aspects and ED onset, distress, and quality of life in a community sample of adolescents prospectively after 1 year. Adolescents (n = 1,327; 51% female; age range 11–19 years) who completed Waves 1 and 2 of the EveryBODY Study and did not meet criteria for an ED at Wave 1 completed measures of ED symptoms, distress, and quality of life impairment. Results showed that 18.2% of participants (70% female) met criteria for an ED at Wave 2. Only weight/shape dissatisfaction was prospectively associated with onset of any ED. No other body image aspect was uniquely associated with greater distress nor lower quality of life in longitudinal analyses. However, all body image aspects were independent correlates of ED diagnosis within Wave 2. These findings suggest that dissatisfaction might operate as a risk factor for ED development in adolescence, whereas overvaluation, preoccupation, and fear of weight gain could be more proximal markers of ED psychopathology. Therefore, these body image phenomena should be assessed as separate constructs as they may play unique roles in ED onset and classification. ED prevention efforts in adolescence may need to target dissatisfaction first, whereas a focus on other aspects of body image may be more important for early intervention programs. (PsycInfo Database Record (c) 2021 APA, all rights reserved) <strong xmlns:lang="en">General Scientific Summary—We found that adolescents, both boys and girls, who were more dissatisfied with weight/shape were more likely to develop eating disorder symptoms after 1 year than those who were less dissatisfied with weight/shape. This was in contrast to other body image concerns, such as weight/shape preoccupation, overvaluation of weight/shape, and fear of gaining weight. All of the mentioned body image concerns could distinguish between adolescents with eating disorder issues and those without when examined at the same time point (after 1 year), but from a prevention perspective, dissatisfaction appears to be the key.