Role of Media and Peers on Body Change Strategies Among Adult Men: Is Body Size Important?

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1 RESEARCH ARTICLE Role of Media and Peers on Body Change Strategies Among Adult Men: Is Body Size Important? Marita P McCabe* & Shauna J McGreevy School of Psychology, Deakin University, Melbourne, Australia Abstract There has been limited previous research that has examined the role of sociocultural influences on body change strategies among adult men. The current study investigated the role of specific types of messages (encouragement, teasing and modelling) from peers and the media on the strategies to change weight among adult men. Differences were evaluated between 526 men aged from 18 to 60 years from three groups (normal weight, overweight and obese) on body image, body change strategies and messages about their body received from peers and the media. Men were primarily drawn from United States, Australia and Europe. Results showed that messages received by men regarding losing weight or increasing muscle size differed according to weight. Body image and media messages were the strongest predictors of losing weight, whereas body image importance and messages from peers were the strongest predictors of increasing muscles. These findings highlight the importance of sociocultural influences on body change strategies among adult males. Copyright # 2010 John Wiley & Sons, Ltd and Eating Disorders Association. Keywords body image; body weight; media; men; peers *Correspondence Marita P McCabe, PhD, FAPS, School of Psychology, Deakin University, 2221 Burwood Highway, Burwood, Victoria 3125 Australia. Tel: þ ; Fax: þ marita.mccabe@deakin.edu.au Published online 20 December 2010 in Wiley Online Library (wileyonlinelibrary.com) DOI: /erv.1063 Introduction A substantial amount of research has investigated the role of sociocultural influences in the development of body image disturbance among adolescent and adult women (Abrams & Cook Stormer, 2002; McCabe & Ricciardelli, 2001a) and adolescent boys (Ricciardelli & McCabe, 2004). Less work has been conducted with men, even though there is evidence to suggest that many men are dissatisfied with their bodies (Furnham & Calnan, 1998), and engage in harmful body change behaviours, such as over-exercising, the use of anabolic steroids (Pope, Phillips, & Olivardia, 2000; Thompson & Cafri, 2007), and disordered eating practices (Keel, Klump, Leon, & Fulkerson, 1998). Previous research with men has shown that they adopt strategies to lose weight and increase muscle tone (Davison & McCabe, 2005; Pope et al., 2000). Societal pressures and messages about the body received from parents, peers, partners and the media, in particular, are thought to have a significant influence in the development of body image dissatisfaction, a preoccupation with dieting, and a rise in the incidence of eating disorders (McCabe & Ricciardelli, 2001b; Stice, 2002). However, little is known about the specific components of these perceived messages and how they influence body change behaviours among adult men (Leit, Pope, & Gray, 2001; Ricciardelli & McCabe, 2007; Thompson & Cafri, 2007). Media images of ideal male bodies have been shown to impact on men s attitudes towards their appearance 438 Eur. Eat. Disorders Rev. 19 (2011) ß 2010 John Wiley & Sons, Ltd and Eating Disorders Association.

2 M. P. McCabe and S. J. McGreevy Body Image Among Men and play a role in body image disturbance in men (Leit, Gray, & Pope, 2002; Morgan & Arcelus, 2009). Men who are exposed to idealised male bodies in the media report dissatisfaction with their own bodies if they perceive a discrepancy between their actual body and the idealised male image (Agliata & Tantleff-Dunn, 2004; Baird & Grieve, 2006; Leit et al., 2002; Lorenzen, Grieve, & Thomas, 2004). However, little is known about the specific types of messages that men receive from the media, and how these messages influence their behaviours regarding their bodies. Similarly, very little is understood about the relationship between messages from friends and body image in men, specifically with regard to the types of messages that men receive about their bodies from friends. Research has demonstrated that adolescent boys and young men report being teased by peers when they perceived that their body did not fit the profile of the socially accepted male body ideal (Carlson Jones, Vigfusdottir, & Lee, 2004; Grogan & Richards, 2002; McCabe, Ricciardelli, & Finemore, 2002). However, very little research has focused on peer influences on body image in men. Body mass index (BMI) is thought to play an important role in the development of body image disturbances in both men and women (Kjelsås, Bjørnstrøm, & Götestam, 2004). Muth and Cash (1997) noted that there was a curvilinear relationship between body weight and body disturbance for men (larger men wanted to be thinner and smaller men wanted to be larger). It appears that men who do not believe that their bodies conform to the V-shaped profile of the normative male body want to change their body shape (Davison & McCabe, 2005). The above literature demonstrates a gap in the body image research in relation to the factors that impact on body image and body change strategies among adult men. The current study was designed to determine the major sociocultural predictors, and the types of messages from these sociocultural influences, of strategies to lose weight and increase muscles among adult men. It was decided to focus specifically on messages from the media and male and female friends, as it was expected from past research that these would be the most influential sources of feedback for adult men regarding their body. The role of BMI was also evaluated. It was hypothesised that men with a larger BMI would evidence lower body satisfaction and more strategies to lose weight. They were also expected to receive more messages to lose weight. Due to the limited research that has been conducted on messages about increasing muscle size among adult men, no hypothesised relationships were developed in relation to differences between BMI groups or sociocultural predictors of increasing muscles. Method Participants The sample consisted of 526 heterosexual adult male participants recruited from the internet. The majority of the participants were aged between 41 and 50 years (n ¼ 291; 55.4%), with 235 men aged between 18 and 40 (44.7%). Of the men who reported their relationship status (n ¼ 467), 166 (35.5%) were single, 147 were married (31.5%), 83 were in a steady relationship (17.8%), 66 were separated or divorced (14.1%) and 5 men were widowed (1.1%). Of the men who indicated their country of birth (n ¼ 522), the majority (n ¼ 333, 63.3%) listed US as their country of birth, 105 (20.0%) were born in Australia/Oceania and 84 (25.7%) were born in Europe, Asia or countries not listed on the questionnaire. Materials Demographic information The questionnaires contained demographic questions relating to age group, marital status, height, weight and country of birth. The body image satisfaction scale consisted of a 10- item scale designed to measure participants satisfaction with their weight, body shape, muscle size and different parts of their bodies (upper body ¼ 3 items, lower body ¼ 4 items; Ricciardelli & McCabe, 2002). Participants responded to a five point Likert scale (1 ¼ extremely dissatisfied; 5 ¼ extremely satisfied). Total scores ranged from 10 to 50; a in this study was.89. The body image importance scale consisted of a 10- item, self-report scale designed to measure the levels of importance participants place on the weight, shape and the size and strength of their muscles in different parts of their body (upper body ¼ 3 items, lower body ¼ 4 items; Ricciardelli & McCabe, 2002). Participants responded to a five point Likert scale (1 ¼ not at all important; 5 ¼ extremely important). Total scores ranged from 10 to 50; a in this study was.92. Eur. Eat. Disorders Rev. 19 (2011) ß 2010 John Wiley & Sons, Ltd and Eating Disorders Association. 439

3 Body Image Among Men M. P. McCabe and S. J. McGreevy The body change strategies to lose weight scale consisted of a 6-item scale designed to measure how often a participant eats less (3 items) or exercising more (3 items) to lose weight (Ricciardelli & McCabe, 2002). Participants responded to a five point Likert scale (1 ¼ never; 5 ¼ always). Total scores ranged from 6 to 30; a in this study was.89. The body change strategies to increase muscle size scale consisted of a 6-item scale designed to measure how often a participant uses strategies, such as eating more to increase muscles (3 items) and exercising more to increase muscles (3 items; Ricciardelli & McCabe, 2002). Participants responded to a five point Likert scale (1 ¼ never; 5 ¼ always). Total scores ranged from 6 to 30; a in this study was.91. The food supplements scale consisted of a 6-item scale designed to measure the use of food supplements such as the use of diet pills or steroids to lose weight (3 items) or to increase muscle size (3 items; Ricciardelli & McCabe, 2002). Participants responded to a five point Likert scale (1 ¼ never; 5 ¼ always). Total scores ranged from 6 to 30; a in this study was.88. The bingeing scale consisted of a 9-item scale designed to measure binge eating behaviours (Ricciardelli & McCabe, 2002). Participants responded to a five point Likert scale (1 ¼ never; 5 ¼ always). Total scores ranged from 9 to 45; a in this study was.89. Sub-scales from the sociocultural influences on body image and body change strategies scale (McCabe & Ricciardelli, 2001c) were used to evaluate messages from best male friend, best female friend and the media. The type of feedback from best male friend scale consisted of a 13-item scale to evaluate encouragement to lose weight, teasing to lose weight, modelling to lose weight, encouragement to increase muscles, teasing to increase muscles, modelling to increase muscles. Participants responded to a five point Likert scale (1 ¼ never; 5 ¼ always). Total scores ranged from 13 to 65; a in this study was.74. A similar 13-item scale was used to evaluate feedback from best female friend (a friend, not a romantic partner); a in this study was.61. The media influences questionnaire consisted of an 11-item scale designed to measure messages related to eating less to lose weight, exercising more to lose weight, eating less to be more muscular, eating more to be more muscular and exercising more to be more muscular (McCabe & Ricciardelli, 2001c). Participants responded to a five point Likert scale (1 ¼ never; 5 ¼ always). Total scores ranged from 11 to 55; a in this study was.82. The ideal body internalisation scale revised (Stice & Agras, 1998), designed to assess participants level of agreement with 10 statements concerning what attractive women look like, was modified to apply to men in the current study. The same items as those in the original scale were used, but they referred to men. The modified scale (the ideal body scale) consisted of a 10-item scale designed to measure men s perceptions of the ideal male body. Participants responded to a five point Likert scale (1 ¼ strongly disagree; 5 ¼ strongly agree). Total scores ranged from 10 to 50; a in this study was calculated at.91. Procedure Participants were recruited through the internet. Men s health and wellbeing, and sporting (e.g. golf, surfing and football) websites in Australia and overseas, were contacted via to invite them to participate in the study. Twelve websites in Australia, Great Britain and United Sates of America, agreed to link the questionnaire to their websites. The plain language statement indicated that to be eligible to participate in the study men were required to be heterosexual in their sexual orientation. Participants who were interested in completing the questionnaire read the plain language statement, clicked on the I Agree link and proceeded to the questionnaire. Results Participants were divided into three groups on the basis of their BMI. The categories were: normal weight, BMI < 25 (n ¼ 205); overweight, BMI 25,<30 (n ¼ 215); and Obese, BMI 30 (n ¼ 102). BMI was unable to be calculated for four participants and they were excluded from the study. Body satisfaction/body importance/ ideal body A one-way multivariate analysis of variance (MANOVA) was conducted to determine differences in body satisfaction, body importance and ideal body between the three BMI groups were body image satisfaction (upper and lower body), body image importance (see Table 1). A significant multivariate effect was found for BMI, F(10, 980) ¼ 2.57, p <.01; partial eta squared ¼.03. Univariate analysis demonstrated that there were significant effects for BMI for Satisfaction of Upper Body, F(2, 493) ¼ 5.15, p <.01; partial eta squared ¼.02 and satisfaction lower body, F(2, 493) ¼ 7.30, p <.01; 440 Eur. Eat. Disorders Rev. 19 (2011) ß 2010 John Wiley & Sons, Ltd and Eating Disorders Association.

4 M. P. McCabe and S. J. McGreevy Body Image Among Men Table 1 Mean and standard deviations for body image satisfaction and body image importance Variable BMI Group Normal weight Overweight Obese n ¼ 205 n ¼ 215 n ¼ 102 Mean SD Mean SD Mean SD Satisfaction with upper body N > Ob; Ov > Ob Satisfaction with lower body Ov > Ob Importance of upper body Importance of lower body Ideal body All contrasts significant at p <.01. partial eta squared ¼.03. The results of post hoc Scheffe s t tests are summarised in Table 1. p <.001; partial eta squared ¼.08. The results of post hoc Scheffe s t tests are summarised in Table 2. Body change strategies A one-way MANOVA was conducted to determine differences in body change strategies (eating and exercise practices including the use of food supplements and steroids) between the three BMI groups (see Table 2). There was a significant multivariate effect for BMI, F(14, 932) ¼ 8.40, p <.001; partial eta squared ¼.11. Univariate analysis demonstrated that there were significant effects for BMI for eating less to lose weight, F(2, 471) ¼ 30.18, p <.001; partial eta squared ¼.11; exercise more to lose weight, F(2, 471) ¼ 18.14, p <.001; partial eta squared ¼.07; eating less to increase muscle, F(2, 471) ¼ 7.60, p <.01; partial eta squared ¼.03; food supplements to increase muscles, F(2, 471) ¼ 5.55, p <.01; partial eta squared ¼.02; and bingeing, F(2, 471) ¼ 21.77, Sociocultural influences A one-way MANOVA was conducted to determine group differences across BMI categories regarding specific messages about losing weight from best male friend, best female friend and the media (see Table 3). There was a significant multivariate effect for BMI, F(18, 828) ¼ 8.30, p <.001; partial eta squared ¼.15. Univariate analysis demonstrated that there were significant effects for BMI for encouragement from best male friend to lose weight, F(2, 421) ¼ 27.52, p <.001; partial eta squared ¼.12; teasing from best male friend to lose weight, F(2, 421) ¼ 13.98, p <.001; partial eta squared ¼.06; encouragement from best female friend to lose weight, F(2, 421) ¼ 39.13, p <.001; partial eta squared ¼.16; teasing from best female friend to lose weight, F(2, 421) ¼ 9.65, p <.001; partial Table 2 Mean and standard deviations for body change strategies Variables BMI Group Normal weight Overweight Obese n ¼ 205 n ¼ 215 n ¼ 102 Mean SD Mean SD Mean SD Eating less to lose weight Ov > N; Ob> Ov Exercise more to lose weight Ov, Ob > N Eating more to increase muscle N > Ov, Ob Exercise more to increase muscle Food supplements to lose weight Food supplements to increase muscle N > Ob Bingeing Ob > Ov; Ob > N All contrasts significant at p <.01. Eur. Eat. Disorders Rev. 19 (2011) ß 2010 John Wiley & Sons, Ltd and Eating Disorders Association. 441

5 Body Image Among Men M. P. McCabe and S. J. McGreevy Table 3 Mean and standard deviations for reported messages to lose weight Variable BMI Group Normal weight Overweight Obese n ¼ 205 n ¼ 215 n ¼ 102 Mean SD Mean SD Mean SD Best male friend encouragement to lose weight Ob > Ov, N Teasing from best male friend to lose weight Ob > Ov, N Modelling from best male friend to lose weight Best female friend encouragement to lose weight Ob > Ov, N Teasing from best female friend to lose weight Ob > N Modelling from best female friend to lose weight Media messages to be slimmer Ov, Ob > N Media messages to eat less to lose weight Ob > N Media messages to exercise more to lose weight Ov, Ob > N All contrasts significant at p <.001. eta squared ¼.04; media messages to be slimmer, F(2, 421) ¼ 23.92, p <.001; partial eta squared ¼.10; media messages to eat less to lose weight, F(2, 421) ¼ 13.89, p <.001; partial eta squared ¼.04; and media messages to exercise more to lose weight, F(2, 421) ¼ 10.03, p <.001; partial eta squared ¼.04. The results of post hoc Scheffe s t tests are summarised in Table 3. A one-way MANOVA was conducted to determine BMI differences regarding messages to increase muscle from best male friend or best female friend, and the media (see Table 4). There was a significant main effect for BMI, F (20, 822) ¼ 2.56, p <.001; partial eta squared ¼.06. Univariate analysis demonstrated that there were significant effects for BMI for encouragement from best male friend to increase muscles, F(2, 419) ¼ 9.44, p <.001; partial eta squared ¼.04; and teasing from best male friend to increase muscles, F(2, 419) ¼ 8.82, p <.001; partial eta squared ¼.04. The results of post hoc Scheffe s t tests are summarised in Table 4. Hierarchical multiple regressions were conducted to determine which mechanisms (encouragement, teasing or modelling) and by whom (best male friend, best female friend or reported messages from the media), predicted strategies to lose weight or increase muscles. In order to control for the influence of other variables that have been shown to predict strategies to lose weight Table 4 Mean and standard deviations for reported messages to increase muscles Variable BMI Group Normal weight Overweight Obese n ¼ 205 n ¼ 215 n ¼ 102 Mean SD Mean SD Mean SD Best male friend encouragement to increase muscles 1.5 y N > Ov, Ob Teasing from best male friend to increase muscles N > Ov, Ob Modelling from best male friend to increase muscles Best female friend encouragement to increase muscles Teasing from best female friend to increase muscles Modelling from best female friend to increase muscles Media messages to be more muscular Media messages to eat less to be more muscular Media messages to eat more to increase muscles Media messages to exercise more to increase muscles All contrasts significant at p <.001. y As for all of the tables, N > Ov, Ob indicate that normal weight men experienced higher levels of messages than both overweight and obese men. 442 Eur. Eat. Disorders Rev. 19 (2011) ß 2010 John Wiley & Sons, Ltd and Eating Disorders Association.

6 M. P. McCabe and S. J. McGreevy Body Image Among Men and increase muscles, BMI, body image satisfaction and body image importance, were entered in the first step of all analyses. Step 1 variables predicted strategies to lose weight in men, F(3, 422) ¼ 36.89, p <.001. The inclusion of sociocultural mechanisms at Step 2 significantly increased the prediction of strategies to lose weight in men, F change(9, 413) ¼ 11.39, p <.001. The variables that were unique predictors of strategies to lose weight are summarised in Table 5. Step 1 variables predicted strategies to increase muscles in men, F(3, 420) ¼ 51.62, p <.001. The inclusion of sociocultural mechanisms of action at Step 2 significantly increased the prediction of strategies to increase muscles in men, F change(10, 410) ¼ 15.12, p <.001. The variables that were unique predictors of strategies to increase muscles are summarised in Table 6. Discussion Differences between BMI Groups: Body image and body change strategies The results indicate that men with lower BMIs were generally more satisfied with their bodies than men in higher weight categories. Previous studies with adolescent boys have reported similar findings (McCabe & Ricciardelli, 2004; Presnell, Bearman, & Stice, 2004). Research with men has found that men who are overweight or obese wanted to lose weight (Hatoum & Belle, 2004; McCabe & Ricciardelli, 2004; Muth & Cash, 1997). Men who are overweight or obese may recognise that they do not fit the narrow profile for the type of body that is considered attractive for men. Therefore, overweight or obese man would be more likely to use body change strategies, such as eating less or exercising more to lose weight, in order to bring them closer to the masculine ideal body (Thompson & Cafri, 2007). Men in the average BMI group were also found to be significantly more likely than obese men to use food supplements to increase the size of their muscles. Normal weight men may perceive that they are lacking the musculature expected of masculine men and may want to eat, and/or use food supplements to bulk up if they are dissatisfied with their actual body shape (O Dea & Abraham, 2002). Obese men were significantly more likely than overweight men to binge eat, and overweight men were significantly more likely than normal weight men to binge eat. Binge eating in men has been associated with problems in maintaining a stable body weight (Costanzo, Musante, Friedman, Lee, & Tomlinson, 1999; Barry, Grilo, & Masheb, 2002). Factors such as weight-related teasing, failed diets or emotional disregulation may have a negative impact on obese individuals attempts to change the shape of their Table 5 Summary of regression equations predicting strategies to lose weight Predictors B b R 2 R 2 change Step BMI Body image importance Body image satisfaction Step BMI Body image importance Body image satisfaction Encouragement from BMF to lose weight Teasing from BMF to lose weight Modelling from BMF to lose weight Encouragement from BFF to lose weight Teasing from BFF to lose weight Modelling from BFF to lose weight Media messages to be slimmer Media messages to eat less to lose weight Media messages to exercise more to lose weight BMF, best male friend; BFF, best female friend. p <.05; p <.01; p <.001. Eur. Eat. Disorders Rev. 19 (2011) ß 2010 John Wiley & Sons, Ltd and Eating Disorders Association. 443

7 Body Image Among Men M. P. McCabe and S. J. McGreevy Table 6 Summary of regression equations predicting strategies to increase muscles Predictors B b R 2 R 2 change Step BMI Body image importance Body image satisfaction Step BMI Body image importance Body image satisfaction Encouragement from BMF to increase muscles Teasing from BMF to increase muscles Modelling from BMF to increase muscles Encouragement from BFF to increase muscles Teasing from BFF to increase muscles Modelling from BFF to increase muscles Media messages to be increase muscles Media messages to eat less to increase muscles Media messages to eat more to increase muscles Media messages to exercise more to increase muscles BMF, best male friend; BFF, best female friend. p <.05; p <.01; p <.001. bodies, resulting in overeating behaviours and consequently the maintenance of a higher BMI. Consistent with this suggestion, the current study found that teasing was highest for obese men. Differences between the BMI groups: Feedback from peers and media The findings from the current study suggested that obese men may be more likely than men with a lower weight to be vulnerable to messages to lose weight, through encouragement and teasing by both male and female friends,due to the current focusinthemedia onobesityas a health hazard. Men who are overweight may be seen to be weak-willed or to have lost control (Grogan & Richards, 2002). Finally, obese men are more likely to be encouraged or teased to lose weight because they represent the BMI group that is furthest from the socially sanctioned ideal physique for men, i.e. a slim, taut, V- shaped and muscular body (Davison & McCabe, 2005). Obese men reported being significantly more likely to receive media messages to lose weight than men in the normal weight category. Studies with college-aged men have found than men who are exposed to images promoting the ideal physique report higher levels of body dissatisfaction after viewing the images (Agliata & Tantleff-Dunn, 2004; Baird & Grieve, 2006; Leit et al., 2002; Lorenzen et al., 2004). It is interesting that the importance a man placed on the appearance of his body, rather than his level of satisfaction with the appearance of his body, was more strongly related to strategies to change the shape of his body. Predictors of body change strategies Best female friend played a significant role, through encouragement, teasing and modelled behaviours, in conveying messages to increase muscle size. Perhaps because heterosexual men want to appear attractive to women, they were receptive to messages to increase the size of their muscles from their female friends as well as from their male friends. The findings demonstrated that more aspects of media messages to lose weight predicted body change strategies than media messages to increase muscles. It may be that the men in this study felt that losing weight, rather then increasing muscles, would bring them closer to the ideal male physique. Furthermore, since the majority of the men in this study were aged between 40 and 60, older men may be more concerned about the negative health aspects of being overweight (i.e. diabetes, cardiovascular disease and cancer), than they are about having a muscular body. They may, therefore, be attending less to media messages about increasing 444 Eur. Eat. Disorders Rev. 19 (2011) ß 2010 John Wiley & Sons, Ltd and Eating Disorders Association.

8 M. P. McCabe and S. J. McGreevy Body Image Among Men the size of their muscles and more to media messages about losing weight and staying healthy. Limitations, summary and future directions There are a number of limitations to the current study. The sample was limited to men who were computer literate, who used the internet, who were interested in male body image, and who were interested in completing the questionnaire. The majority of the men who answered the survey were aged years and of North American descent, indicating a particular bias towards older men who may have had similar socio-economic backgrounds. Further research needs to be conducted with men from more diverse backgrounds. A greater range of websites needs to be sampled, as well as recruiting men through other mechanisms (e.g. telephone calls, newspaper advertisements, etc.). Cronbach s Alpha for the feedback from best female friend was low (.61), and so the results using this scale need to be treated with caution. There are a number of relationships that need to be explored further. Data were not gathered on muscle mass for men in the current study. It would be interesting to explore the nature of the sociocultural influences on body change strategies for men with different levels of muscularity. In fact, it was not possible to determine in the current study if high BMI was due to high levels of adipose tissue or muscles. It is also important to determine men s motivations for adopting strategies to change their bodies. In particular, future research needs to determine the extent to which body change strategies are adopted for appearance related or health related reasons. References Abrams, L. S., & Cook Stormer, C. (2002). Socio-cultural variations in the body-image perceptions of urban adolescent females. Journal of Youth and Adolescence, 31, Agliata, D., & Tantleff-Dunn, S. (2004). The impact of media exposure on males body-image. Journal of Social and Clinical Psychology, 23, Baird, A. 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9 Body Image Among Men M. P. McCabe and S. J. McGreevy Pope, H. G., Phillips, K. A., & Olivardia, R. (2000). The adonis complex: The secret crisis of male body obsession. New York: The Free Press. Presnell, K., Bearman, S. K., & Stice, E. (2004). Risk factors for body dissatisfaction in adolescent boys and girls: A prospective study. International Journal of Eating Disorders, 36, Ricciardelli, L. A., & McCabe, M. P. (2002). Psychometric evaluation of the body-change inventory: An assessment of an instrument for adolescent boys and girls. Eating Behaviors, 2, Ricciardelli, L. A., & McCabe, M. P. (2004). A biopsychosocial model of disordered eating and the pursuit of muscularity in adolescent boys. Psychological Bulletin, 130, Ricciardelli, L. A., & McCabe, M. P. (2007). Pursuit of muscularity among adolescents. In J. K. Thompson, & G. Cafri (Eds.), The muscular ideal: Psychological, social, and medical perspective (pp ). Washington, DC: American Psychological Society. Stice, E. (2002). Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, Stice, E., & Agras, W. S. (1998). Predicting onset and cessation of bulimic behaviours during adolescence. A longitudinal grouping analysis. Behavioral Therapy, 29, Thompson, J. K., & Cafri, J. (2007). The muscular ideal. Washington, DC: American Psychological Society. 446 Eur. Eat. Disorders Rev. 19 (2011) ß 2010 John Wiley & Sons, Ltd and Eating Disorders Association.

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