Abstract

The Tripartite Influence Model posits that sociocultural influences mediated by internalization and social comparison are predictors of disordered eating and body change behaviours. This study aimed to test the Tripartite Influence Model among Brazilian male university students, which has not been tested yet. 707 undergraduate students of the five Brazilian regions, completed measures of sociocultural influences, internalization, social comparison, body and muscularity dissatisfaction, disordered eating and body change behaviours. Structural equation modelling analyses showed good model-fitting. Parental influence was related to internalization, while peer influence with social comparison. Media influences were related to both internalization and social comparison. Internalization and social comparison are mediating variables that are related to body dissatisfaction and muscularity dissatisfaction. Finally, muscularity dissatisfaction was associated with body change behaviours.

Key words
Body image; Feeding and eating disorders; Men’s health; Risk factors

Resumo

O modelo de influência dos três fatores indica que as influências socioculturais, mediadas pela internalização e a comparação social, são preditoras de comportamentos de risco para transtornos alimentares e comportamentos de mudança corporal. O estudo objetivou testar o Modelo de Influência dos Três Fatores para jovens adultos brasileiros, uma vez que o mesmo ainda não foi testado neste contexto. 707 homens, jovens universitários das cinco regiões brasileiras, responderam a instrumentos de avaliação das influências socioculturais, internalização, comparação social, insatisfação com o corpo e com a muscularidade, comportamentos de risco para transtornos alimentares e comportamentos de mudança corporal. Análise por meio de Modelagem de Equações Estruturais demonstrou adequados índices de ajustamento do modelo. As influências dos pais foram associadas com a internalização, enquanto as influências dos pares com a comparação social. Influência da mídia demonstrou associação tanto com a internalização quanto com a comparação social. A internalização e a comparação social são variáveis mediadoras que se relacionam com a insatisfação corporal e insatisfação com a muscularidade. Por fim, a insatisfação com a muscularidade esteve associada com os comportamentos de mudança corporal.

Palavras-chave
Imagem corporal; Transtornos da alimentação e da ingestão de alimentos; Saúde do homem; Fatores de risco

Introduction

Research has demonstrated an array of negative consequences associated with body image disturbance and eating pathology such as poor self-esteem and unhealthy weight control practices¹1 Stice E. A prospective test of the dual-pathway model of bulimic pathology: Mediating effects of dieting and negative affect. J Abnorm Psychol 2001; 110(1):124-135.^,22 Stice E. Risk and maintenance factors for eating pathology: a meta-analytic review. Psychol Bull 2002; 128(5):825-848., poor impulse control and social anxiety³3 Dakanalis A, Zanetti AM, Riva G, Colmegna F, Volpato C, Madeddu F, Clerici M. Male body dissatisfaction and eating disorder symptomatology: Moderating variables among men. J Health Psychol 2015; 20(1):80-90., and abuse of anabolic androgenic steroids⁴4 Cafri G, Thompson JK, Ricciardelli L, McCabe M, Smolak L, Yesalis C. Pursuit of the muscular ideal: Physical and psychological consequences and putative risk factors. Clin Psychol Rev 2005; 25(2):215-239.^,55 Pope HG, Khalsa JH, Bhasin S. Body image disorders and abuse of anabolic-androgenic steroids among men. JAMA 2017; 317(1):23-24.. Researchers have consequently sought to understand the aetiology and maintenance of these disorders to illuminate potential points of intervention²2 Stice E. Risk and maintenance factors for eating pathology: a meta-analytic review. Psychol Bull 2002; 128(5):825-848.^,66 Cash TF, Smolak L. Body image: a handbook of science, practice, and prevention. 2nd ed. New York: Guilford Press; 2011..

To assess the risk factors associated with the development of disordered eating among women, Thompson et al. ⁷7 Thompson JK, Heinberg LJ, Altabe M, Tantleff-Dunn S. Exacting beauty: theory, assessment, and treatment of body image disturbance. Worcester: American Psychological Association; 1999. developed the Tripartite Influence Model, which is based on sociocultural theories of body image disturbances and disordered eating⁸8 Carvalho PHB, Alvarenga MS, Ferreira MEC. An etiological model of disordered eating behaviors among Brazilian women. Appetite 2017; 116:164-172.^,99 Tiggemann M. Sociocultural perspectives on human appearance and body image. In: Cash TF, Smolak L, editors. Body image: a handbook of science, practice, and prevention. 2nd ed. New York: Guilford Press; 2011. p. 12-9.. This model posits that individuals are pressured by powerful social agents (e.g. , parents, peers, and the media) to adhere to culturally sanctioned appearance ideals, which is mediated by the internalization of social body-ideal and appearance social comparison behaviours. Internalization is the process of adopting a body ideal created by society as one’s own standards and body goal⁷7 Thompson JK, Heinberg LJ, Altabe M, Tantleff-Dunn S. Exacting beauty: theory, assessment, and treatment of body image disturbance. Worcester: American Psychological Association; 1999.^,1010 Karazsia BT, van Dulmen MH, Wong K, Crowther JH. Thinking meta-theoretically about the role of internalization in the development of body dissatisfaction and body change behaviors. Body Image 2013; 10(4):433-441., whereas social comparison denotes the frequent behaviour of self-evaluation using other individuals as a basis of comparison¹¹11 Festinger L. A theory of social comparison processes. Hum Relations 1954; 7(2):117-140.^,1212 Karazsia BT, Crowther JH. Sociocultural and psychological links to men’s engagement in risky body change behaviors. Sex Roles 2010; 63(9-10):747-756..

There is a historical relationship between studies on body image disturbance and eating disorders in the female population, which has contributed to the belief that men would be free from these disorders¹³13 Cafri G, Thompson JK. Measuring male body image: A review of the current methodology. Psychol Men Masculinity 2004; 5(1):18-29.^,1414 Thompson JK, Cafri G. The muscular ideal: psychological, social, and medical perspectives. Worcester: American Psychological Association; 2007.. Strother et al. ¹⁵15 Strother E, Lemberg R, Stanford SC, Turberville D. Eating disorders in men: underdiagnosed, undertreated, and misunderstood. Eat Disord 2012; 20(5):346-355. argue that eating disorders in males are underdiagnosed, undertreated, and misunderstood.

However, in recent years there has been a considerable increase in the number of research studies on body image and eating disorders in men. Researchers have shown that body image disturbances are also present in men, and they are concerned with acquiring more muscle mass and attaining a more defined body¹⁶16 Edwards C, Tod D, Molnar G. A systematic review of the drive for muscularity research area. Int Rev Sport Exerc Psychol 2014; 7(1):18-41.^,1717 McCreary DR, Sasse DK. An exploration of the drive for muscularity in adolescent boys and girls. J Am Coll Health 2000; 48(6):297-304.. The drive for muscularity appears to be the major male body image concern¹³13 Cafri G, Thompson JK. Measuring male body image: A review of the current methodology. Psychol Men Masculinity 2004; 5(1):18-29.^,1414 Thompson JK, Cafri G. The muscular ideal: psychological, social, and medical perspectives. Worcester: American Psychological Association; 2007.^,1616 Edwards C, Tod D, Molnar G. A systematic review of the drive for muscularity research area. Int Rev Sport Exerc Psychol 2014; 7(1):18-41.. However, both women and men may be concerned with both body weight and muscularity. The drive for thinness and the drive for muscularity are not mutually exclusive constructs¹⁸18 Kelley CCG, Neufeld JM, Musher-Eizenman DR. Drive for thinness and drive for muscularity: Opposite ends of the continuum or separate constructs? Body Image 2010; 7(1):74-77.^,1919 Murray SB, Rieger E, Hildebrandt T, Karlov L, Russell J, Boon E, Dawson RT, Touyz SW. A comparison of eating, exercise, shape, and weight related symptomatology in males with muscle dysmorphia and anorexia nervosa. Body Image 2012; 9(2):193-200..

Although male body image has received considerably less research attention, extant studies indicate that internalization of the muscular-ideal is significantly associated with increased body dissatisfaction, negative affect, and unhealthy behaviours aimed at increasing muscle size¹²12 Karazsia BT, Crowther JH. Sociocultural and psychological links to men’s engagement in risky body change behaviors. Sex Roles 2010; 63(9-10):747-756.^,1616 Edwards C, Tod D, Molnar G. A systematic review of the drive for muscularity research area. Int Rev Sport Exerc Psychol 2014; 7(1):18-41.^,2020 Karazsia BT, Crowther JH. Social body comparison and internalization: Mediators of social influences on men’s muscularity-oriented body dissatisfaction. Body Image 2009; 6(2):105-112.. In turn, social comparison is significantly associated with muscularity dissatisfaction and body change behaviours¹²12 Karazsia BT, Crowther JH. Sociocultural and psychological links to men’s engagement in risky body change behaviors. Sex Roles 2010; 63(9-10):747-756.^,2020 Karazsia BT, Crowther JH. Social body comparison and internalization: Mediators of social influences on men’s muscularity-oriented body dissatisfaction. Body Image 2009; 6(2):105-112.. Body change behaviours may be understood as adopted strategies in an attempt to achieve an idealized physical appearance, such as the abuse of anabolic androgenic steroids and food supplements, and excessive practice of physical exercise with the goal of increasing muscle mass⁴4 Cafri G, Thompson JK, Ricciardelli L, McCabe M, Smolak L, Yesalis C. Pursuit of the muscular ideal: Physical and psychological consequences and putative risk factors. Clin Psychol Rev 2005; 25(2):215-239.^,55 Pope HG, Khalsa JH, Bhasin S. Body image disorders and abuse of anabolic-androgenic steroids among men. JAMA 2017; 317(1):23-24.^,1717 McCreary DR, Sasse DK. An exploration of the drive for muscularity in adolescent boys and girls. J Am Coll Health 2000; 48(6):297-304.^,2121 Smolak L, Murnen SK, Thompson JK. Sociocultural influences and muscle building in adolescent boys. Psychol Men Masculinity 2005; 6(4):227-239..

In view of this discussion, it is necessary to evaluate specific theoretical models to understand body image disturbance, disordered eating and body change behaviours in men. It reiterates the fact that male body image and eating disorders in the population must be investigated. Moreover, the Tripartite Influence Model was also evaluated with adolescent men²²22 Halliwell E, Harvey M. Examination of a sociocultural model of disordered eating among male and female adolescents. Br J Health Psychol 2006; 11(2):235-248.^,2323 Jones DC, Bain N, King S. Weight and muscularity concerns as longitudinal predictors of body image among early adolescent boys: A test of the dual pathways model. Body Image 2008; 5(2):195-204. and young adults¹²12 Karazsia BT, Crowther JH. Sociocultural and psychological links to men’s engagement in risky body change behaviors. Sex Roles 2010; 63(9-10):747-756.^,2020 Karazsia BT, Crowther JH. Social body comparison and internalization: Mediators of social influences on men’s muscularity-oriented body dissatisfaction. Body Image 2009; 6(2):105-112.^,2424 Van den Berg P, Paxton SJ, Keery H, Wall M, Guo J, Neumark-Sztainer D. Body dissatisfaction and body comparison with media images in males and females. Body Image 2007; 4(3):257-268..

Van den Berg et al. ²⁴24 Van den Berg P, Paxton SJ, Keery H, Wall M, Guo J, Neumark-Sztainer D. Body dissatisfaction and body comparison with media images in males and females. Body Image 2007; 4(3):257-268. posit that the model is valid to understand body image disturbance in men; however, the authors highlighted the need to further examine processes that are involved in the development of body dissatisfaction in males. Methodological concerns should be considered with respect to the evaluation of the Tripartite Influence Model in men, such as the use of specific measurement instruments for the male population²⁰20 Karazsia BT, Crowther JH. Social body comparison and internalization: Mediators of social influences on men’s muscularity-oriented body dissatisfaction. Body Image 2009; 6(2):105-112.. Moreover and according to Karazsia and Crowther²⁰20 Karazsia BT, Crowther JH. Social body comparison and internalization: Mediators of social influences on men’s muscularity-oriented body dissatisfaction. Body Image 2009; 6(2):105-112., the Tripartite Influence Model is a robust aetiological model, particularly when constructs are assessed in ways that are reliable and valid for this population.

More recently, Karazsia and Crowther¹²12 Karazsia BT, Crowther JH. Sociocultural and psychological links to men’s engagement in risky body change behaviors. Sex Roles 2010; 63(9-10):747-756. re-evaluated the Tripartite Influence Model, including a new variable: body change behaviours. In this study, body change behaviours were conceptualized as the practice of excessive physical exercise to the point of causing muscular injury and behaviours oriented towards muscular gain, such as the use of dietary supplements and high protein intake. The final model was similar to the original model proposed by Thompson et al. ⁷7 Thompson JK, Heinberg LJ, Altabe M, Tantleff-Dunn S. Exacting beauty: theory, assessment, and treatment of body image disturbance. Worcester: American Psychological Association; 1999., which included a relational path between Internalization and Social Comparison. It should also be noted that a direct relational path between social influence factors and body change behaviours was verified, which indicates that parents, peers and the media may exert a strong influence on these behaviours, regardless of the influence of internalization or social comparison¹²12 Karazsia BT, Crowther JH. Sociocultural and psychological links to men’s engagement in risky body change behaviors. Sex Roles 2010; 63(9-10):747-756..

The Tripartite Influence Model has been evaluated in different countries with various cultural backgrounds, including Brazilian adolescents²⁵25 Fortes LS, Filgueiras JF, Oliveira FC, Almeida SS, Ferreira MEC. Modelo etiológico dos comportamentos de risco para os transtornos alimentares em adolescentes brasileiros do sexo feminino. Cad Saude Publica 2016; 32(4):e000024115. and young adult women⁸8 Carvalho PHB, Alvarenga MS, Ferreira MEC. An etiological model of disordered eating behaviors among Brazilian women. Appetite 2017; 116:164-172.; however, the model validity has not been tested with Brazilian male university students. The model’s validation by the previously cited studies does not exempt it from testing for use with the Brazilian male population. The incidence and extent of body dissatisfaction and disordered eating are culturally specific and has gender bias; therefore, specific attention should be paid to cultural and gender characteristics in evaluating these variables²⁶26 Rodgers R, Chabrol H, Paxton SJ. An exploration of the tripartite influence model of body dissatisfaction and disordered eating among Australian and French college women. Body Image 2011; 8(3):208-215..

A population-based study conducted in Brazil²⁷27 Silva DAS, Nahas MV, Sousa TF, Del Duca GF, Peres KG. Prevalence and associated factors with body image dissatisfaction among adults in southern Brazil: a population-based study. Body Image 2011; 8(4):427-431. indicated a prevalence of 60.5% of body dissatisfaction in men. Risk behaviours for eating disorders are present in 15.4% of Brazilian male university students²⁸28 Reis JAD, Silva Júnior CRR, Pinho LD. Factors associated with the risk of eating disorders among academics in the area of health. Rev Gaucha Enferm 2014; 35(2):73-78.. A perfect, athletic and young body is the main ideological concern in the Brazilian population²⁹29 Rocha E, Frid M. In perfect shape media representations of women’s health in Brazil. Mediterr J Soc Sci 2013; 4(9):474-481.. Edmonds³⁰30 Edmonds A. ‘The poor have the right to be beautiful’: cosmetic surgery in neoliberal Brazil. J R Anthropol Inst 2007; 13(2):363-381. suggested that physical appearance is an essential element in the construction of a national Brazilian identity.

Considering the importance of physical appearance for Brazilian men and the influence of cultural aspects on body image disturbance and disordered eating, the present study aimed to evaluate a revised version of the Tripartite Influence Model of disordered eating and body change behaviours among Brazilian male university students. In general, we hypothesized that the proposed model would be valid and reliable for use with Brazilian male university students.

Method

Participants

An online calculator that consisted of implementing the guidelines of Westland³¹31 Westland JC. Lower bounds on sample size in structural equation modeling. Electronic Commerce Res Appl 2010; 9(6):476-487. was used to determine sample size. The effect size was estimated at .10 based on previous sociocultural model among Brazilian female university students⁸8 Carvalho PHB, Alvarenga MS, Ferreira MEC. An etiological model of disordered eating behaviors among Brazilian women. Appetite 2017; 116:164-172.. With this effect size, power of .80, nine latent variables and 82 observed variables, and 5% significance level³¹31 Westland JC. Lower bounds on sample size in structural equation modeling. Electronic Commerce Res Appl 2010; 9(6):476-487., the minimal sample size to detect an effect was calculated to be equal to 666 individuals.

Seven hundred seven (N = 707) Brazilian male university students, aged 21-35 years (M_age = 23.98, standard deviation (SD) = 4.07), participated in this study. Thus, our sample size was sufficient to test the hypothesized model. As a basic assumption for applying the statistical method to test the theoretical model (Structural Equation Modelling)³²32 Kline RB. Principles and practice of structural equation modelling. 3rd ed. New York: Guilford Press; 2011., a heterogenic sample was used. Participants were recruited by convenience after being contacted by associated researchers (research groups, co-workers, past partnerships) in higher education institutions from Brazil’s five regions (South, Southeast, Centre-West, North, and Northeast).

Male university students enrolled in Mathematical, Human, Applied Social and Health Sciences participated in the study. In total, individuals from 15 states (Acre, Amapá, Bahia, Espírito Santo, Goiás, Minas Gerais, Pará, Pernambuco, Rio de Janeiro, Rio Grande do Sul, Rondônia, Santa Catarina, São Paulo, Sergipe and Tocantins) distributed in 20 Brazilian cities from 35 different undergraduate courses took part in the present study.

Measures

Sociodemographic data. In order to characterize the sample, a sociodemographic questionnaire was used, which investigates the information on racial/ethnic background, anthropometry (self-reported stature and body mass for the calculation of body mass index) and socioeconomic family status. Regarding the classification of racial/ethnic background, the categories suggested by the Brazilian Institute of Geography and Statistics³³33 Instituto Brasileiro de Geografia e Estatística (IBGE). Características étnico-raciais da população: Classificações e identidades. Rio de Janeiro: IBGE; 2013. was used, and for the anthropometric nutritional status the categories suggested by the World Health Organization³⁴34 World Health Organization (WHO). Body mass index classification: Report of a WHO consultation on obesity. Geneva: WHO; 1995. was used. The socioeconomic family status was evaluated by the Brazilian Economic Classification Criterion³⁵35 Associação Brasileira de Empresas de Pesquisa (ABEP). Critério de Classificação Econômica Brasil 2014 [Internet]. São Paulo: ABEP; 2014 [cited 2014 Feb 5]. Available from: http://www.abep.org/criterio-brasil
http://www.abep.org/criterio-brasil... .

Sociocultural influences. The Brazilian validated version of the Tripartite Influence Scale (TIS)³⁶36 Amaral ACS, Ferreira MEC, Scagliusi FB, Costa LS, Cordas TA, Conti MA. Psychometric evaluation of the Tripartite Influence Scale. Psicol Reflex Crit 2013; 26(2):213-221. was used to assess the influences of parents, peers, and the media on body image. The TIS consists of 39 items with a 5-point Likert scale (1 = always to 5 = never) and total scores that range from 39 to 195. Three separate subscales were also used: parental influences, peer influences and media influences. The scores for the subscales were inverted to bring them in line with the other scales applied in the present study (i.e. , a higher score indicated a greater influence of the “phenomenon” in question).

Internalization. The general internalization and athletic internalization subscales of the Brazilian validated version of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3)³⁷37 Amaral ACS, Ribeiro MS, Conti MA, Ferreira CS, Ferreira MEC. Psychometric evaluation of the Sociocultural Attitudes Towards Appearance Questionnaire-3 among Brazilian young adults. Span J Psychol 2013; 16(e94):1-10. were used to evaluate internalization of the social body-ideal. These two subscales total 11 self-reported items rated on a 5-point Likert scale (1 = totally disagree to 5 = totally agree) and total scores that range from 11 to 55, with higher scores indicating higher internalization.

Social comparison. The relative items (seven) of the Brazilian version of the Male Body Checking Questionnaire (MBCQ)³⁸38 Carvalho PHB, Conti MA, Ribeiro MS, Amaral ACS, Ferreira MEC. Psychometric assessment of the Male Body Checking Questionnaire (MBCQ). Psicol Reflex Crit 2014; 27(4):700-709. were used to evaluate social comparison. Items are rated on a 5-point Likert scale (1 = never to 5 = very often), and total scores range from 7 to 49. A higher score indicates a higher frequency of social comparison.

Body dissatisfaction. The Brazilian validated short version of the Body Shape Questionnaire (BSQ)³⁹39 Silva WR, Dias JCR, Maroco J, Campos JADB. Confirmatory factor analysis of different versions of the Body Shape Questionnaire applied to Brazilian university students. Body Image 2014; 11(4):384-390. was used to evaluate concern with weight and shape. The short version of the BSQ consists of eight items rated with a 6-point Likert scale (1 = never to 6 = always) and total scores that range from 8 to 48. A greater score indicates a greater level of body dissatisfaction.

Muscularity dissatisfaction. The oriented body image factor of the Brazilian version of the Drive for Muscularity Scale (DMS)⁴⁰40 Campana ANNB, Tavares MCGCF, Swami V, Silva D. An examination of the psychometric properties of Brazilian Portuguese translations of the Drive for Muscularity Scale, the Swansea Muscularity Attitudes Questionnaire, and the Masculine Body Ideal Distress Scale. Psychol Men Masculinity 2013; 14(4):376-388. was used to evaluate muscularity dissatisfaction. The five items are rated on a 6-point Likert scale (1 = always and 6 = never), and total scores range from 5 to 30. The scores of each item were inverted to calculate the final score, in which a greater score indicates greater muscularity dissatisfaction.

Body change behaviours. The muscularity oriented-behaviour factor of the Brazilian version of the DMS⁴⁰40 Campana ANNB, Tavares MCGCF, Swami V, Silva D. An examination of the psychometric properties of Brazilian Portuguese translations of the Drive for Muscularity Scale, the Swansea Muscularity Attitudes Questionnaire, and the Masculine Body Ideal Distress Scale. Psychol Men Masculinity 2013; 14(4):376-388. was used to assess body change behaviours. Seven items are rated on a 6-point Likert scale (1 = always and 6 = never), and total scores range from 7 to 42. As performed for the oriented body image factor of the DMS, the scores for each item were inverted to calculate the final score.

Disordered eating. A simplified self-reporting questionnaire, adapted and tested for the Brazilian context, was used to evaluate disordered eating⁴¹41 Ferreira JEDS, Veiga GVD. Test-retest reliability of a simplified questionnaire for screening adolescents with risk behaviors for eating disorders in epidemiologic studies. Rev Bras Epidemiol 2008; 11(3):393-401.. The questionnaire is composed of two questions and investigates the frequency of overeating/binge eating and the use of methods to control weight gain and potential compensatory mechanisms for excessive food intake such as induced vomiting, use of laxatives and diuretics, and restrictive diet and fasting⁴¹41 Ferreira JEDS, Veiga GVD. Test-retest reliability of a simplified questionnaire for screening adolescents with risk behaviors for eating disorders in epidemiologic studies. Rev Bras Epidemiol 2008; 11(3):393-401.. The construct was standardized by transforming the answer options into a 4-point Likert scale⁴²42 Ortega-Luyando M, Alvarez-Rayón G, Garner DM, Amaya-Hernández A, Bautista-Díaz ML, Mancilla-Díaz JM. Systematic review of disordered eating behaviors: Methodological considerations for epidemiological research. Rev Mex Transtornos Alimentarios 2015; 6(1):51-63. to enable screening of disordered eating against the other questionnaires used in this study, which are ordinal (Likert scale): never = 1; less than once a week = 2; once a week = 3; twice a week or more = 4.

Procedures

After evaluating institutions that were potentially interested in participating in this research (as previously mentioned by contacting associated researchers), the academic departments of the respective universities were contacted, the research objectives were outlined, and professors were invited to participate in data collection. Data collection was performed during class time. The participants were informed of the study objectives and all data acquisition procedures. The author’s Institutional Research Ethics Committee approved the study, and all participants signed an informed consent form.

Data analysis

Data regarding racial/ethnic background, socioeconomic status and anthropometric data were expressed as relative frequencies. Scores obtained from the questionnaires were presented as means and standard deviations. Analyses of the skewness and kurtosis were performed to determine the univariate and multivariate distributions³¹31 Westland JC. Lower bounds on sample size in structural equation modeling. Electronic Commerce Res Appl 2010; 9(6):476-487.. Mahalanobis distance (D²) and VIF (Variance Inflation Factor) values were used to test for the presence of outliers and multicollinearity, respectively³¹31 Westland JC. Lower bounds on sample size in structural equation modeling. Electronic Commerce Res Appl 2010; 9(6):476-487.^,4343 Maroco J. Análise de Equações Estruturais: Fundamentos teóricos, softwares e aplicações [Analysis of Structural Equations: Theoretical foundations, software and applications]. 2nd ed. Pêro Pinheiro: Report Number; 2014.. The Pearson correlation coefficient was used to test the association between variables (r_pearson), while the internal consistency was determined using Cronbach’s alpha coefficient (α), where a coefficient of .70 or greater is considered acceptable⁴⁴44 Nunnally JC. Psychometric theory. 2nd ed. New York: McGraw-Hill; 1978.. Correlations of .20, .40, and .60 were considered small, moderate, and strong, respectively⁴⁵45 Tabachnick BG, Fidell LS. Using multivariate statistics. 5th ed. Boston: Allyn & Bacon; 2007..

The proposed model (Figure 1) was evaluated using Structural Equation Modelling with the Maximum Likelihood estimation method³¹31 Westland JC. Lower bounds on sample size in structural equation modeling. Electronic Commerce Res Appl 2010; 9(6):476-487.. Goodness of fit was determined using the following tests³¹31 Westland JC. Lower bounds on sample size in structural equation modeling. Electronic Commerce Res Appl 2010; 9(6):476-487.^,4343 Maroco J. Análise de Equações Estruturais: Fundamentos teóricos, softwares e aplicações [Analysis of Structural Equations: Theoretical foundations, software and applications]. 2nd ed. Pêro Pinheiro: Report Number; 2014.: Chi-Square (χ²), Corrected Chi-Square (χ²/df), Comparative Fit Index (CFI), Parsimony Comparative Fit Index (PCFI), and Root Mean Square Error of Approximation (RMSEA). The following values were considered acceptable⁴³43 Maroco J. Análise de Equações Estruturais: Fundamentos teóricos, softwares e aplicações [Analysis of Structural Equations: Theoretical foundations, software and applications]. 2nd ed. Pêro Pinheiro: Report Number; 2014.: χ² (the lower, the better; p > .05), χ²/df (less than 5), CFI (greater than .80), PCFI (greater than .60), and RMSEA (between .05 and .10).

The model was refined by respecifying it using modification indices (Lagrange Multipliers) with values greater than 11³¹31 Westland JC. Lower bounds on sample size in structural equation modeling. Electronic Commerce Res Appl 2010; 9(6):476-487.^,4343 Maroco J. Análise de Equações Estruturais: Fundamentos teóricos, softwares e aplicações [Analysis of Structural Equations: Theoretical foundations, software and applications]. 2nd ed. Pêro Pinheiro: Report Number; 2014.. The local goodness of fit was determined via factor weighting (λ) and assessing the reliability of individual items, whereas the significance of causal paths was measured by performing a Z-test of critical ratios³¹31 Westland JC. Lower bounds on sample size in structural equation modeling. Electronic Commerce Res Appl 2010; 9(6):476-487.^,4343 Maroco J. Análise de Equações Estruturais: Fundamentos teóricos, softwares e aplicações [Analysis of Structural Equations: Theoretical foundations, software and applications]. 2nd ed. Pêro Pinheiro: Report Number; 2014.. Non-significant paths were not referenced in the final model.

A descriptive and inferential analysis was performed using the Statistical Package for Social Sciences version 21.0 (SPSS Inc. , Chicago, United States), adopting a 5% significance level (p < .05). Structural Equation Modelling was performed using the statistical software package Analysis of Moment Structures (AMOS) version 21.0.

Results

Seven hundred seven (N = 707) Brazilian male university students participated in this study. The racial/ethnic background of the participants was 54.46% white, 33.56% dark skinned, 8.91% black and 3.07% multi-racial. Approximately two thirds of the sample (61.67%) were normal weight, 29% overweight, 6.08% obese and only 3.25% underweight. In terms of socioeconomic family status, most participants reported being middle class (76.81%), whereas 10.18% and 13.01% reported they were upper and lower class, respectively.

Means, SDs, and internal consistencies of the applied instruments are presented in Table 1. All measuring instruments exhibited satisfactory internal consistency. Analyses of the skewness and kurtosis indicated multivariate normality of the data. The VIF values were less than five, which indicates an absence of multicollinearity.

All latent variables were correlated (Table 2). Significant moderate correlations (r_pearson ≥ .40) were identified between: Parental influences and Peer influences, Media influences and Internalization, Internalization and Body change behaviours, Internalization and Muscularity dissatisfaction, Social comparison and Muscularity dissatisfaction, Social comparison and Body change behaviours, Muscularity dissatisfaction and Body change behaviours, and Body dissatisfaction and Disordered eating. A strong correlation was identified between Internalization and Social comparison (r_pearson = .65, p = .001).

Structural Equation Modelling indicated a poor fit of the proposed model (χ² (3177) = 11789.509, p = .0001, χ²/df = 3.71, CFI = .77, PCFI = .74, RMSEA = .063 [90%CI = .062-.064]). In addition, in analysing the causal paths, three were not statistically significant: Parental influences → Social comparison, Peer influences → Internalization and Body dissatisfaction → Disordered eating. The model was re-specified, removing non-significant paths. After analysis, the adjustment indexes indicated an improvement in the model fit (χ² (2790) = 10548.421; p = .0001; χ²/df = 3.78; CFI = .79; PCFI = .75; RMSEA = .064 [90%CI = .062-.065]). The χ² value decreased, and increases in the CFI and PCFI were identified. The χ²/df value and RMSEA remained adequate⁴³43 Maroco J. Análise de Equações Estruturais: Fundamentos teóricos, softwares e aplicações [Analysis of Structural Equations: Theoretical foundations, software and applications]. 2nd ed. Pêro Pinheiro: Report Number; 2014.. All causal paths were significant (Table 3). The local goodness of fit was adequate, with all λ greater than .40³¹31 Westland JC. Lower bounds on sample size in structural equation modeling. Electronic Commerce Res Appl 2010; 9(6):476-487.^,4343 Maroco J. Análise de Equações Estruturais: Fundamentos teóricos, softwares e aplicações [Analysis of Structural Equations: Theoretical foundations, software and applications]. 2nd ed. Pêro Pinheiro: Report Number; 2014.. The Fitted Tripartite Influence Model with regression weights among Brazilian male university students are presented in Figure 2.

Discussion

This study aimed to evaluate the Tripartite Influence Model for Brazilian male university students. The importance of this study is emphasized by the need to better understand the aetiology and maintenance of body image disturbance and disordered eating to illuminate potential intervention points²2 Stice E. Risk and maintenance factors for eating pathology: a meta-analytic review. Psychol Bull 2002; 128(5):825-848.^,66 Cash TF, Smolak L. Body image: a handbook of science, practice, and prevention. 2nd ed. New York: Guilford Press; 2011.. The importance attributed to physical appearance in the Brazilian population must be highlighted²⁷27 Silva DAS, Nahas MV, Sousa TF, Del Duca GF, Peres KG. Prevalence and associated factors with body image dissatisfaction among adults in southern Brazil: a population-based study. Body Image 2011; 8(4):427-431.^,2929 Rocha E, Frid M. In perfect shape media representations of women’s health in Brazil. Mediterr J Soc Sci 2013; 4(9):474-481.^,3030 Edmonds A. ‘The poor have the right to be beautiful’: cosmetic surgery in neoliberal Brazil. J R Anthropol Inst 2007; 13(2):363-381., as well as the need to consider cultural aspects regarding body image disturbances and eating disorders²⁶26 Rodgers R, Chabrol H, Paxton SJ. An exploration of the tripartite influence model of body dissatisfaction and disordered eating among Australian and French college women. Body Image 2011; 8(3):208-215.^,4646 Swami V, Frederick DA, Aavik T, Alcalay L, Allik J, Anderson D, Andrianto S, Arora A, Brännström A, Cunningham J, Danel D, Doroszewicz K, Forbes GB, Furnham A, Greven CU, Halberstadt J, Hao S, Haubner T, Hwang CS, Inman M, Jaafar JL, Johansson J, Jung J, Keser A, Kretzschmar U, Lachenicht L, Li NP, Locke K, Lönnqvist J-E, Lopez C, Loutzenhiser L, Maisel NC, McCabe MP, McCreary DR, McKibbin WF, Mussap A, Félix Neto, Nowell C, Alampay LP, Pillai SK, Pokrajac-Bulian A, Proyer RT, Quintelier K, Ricciardelli LA, Rozmus-Wrzesinska M, Ruch W, Russo T, Schütz A, Shackelford TK, Shashidharan S, Simonetti F, Sinniah D, Swami M, Vandermassen G, van Duynslaeger M, Verkasalo M, Voracek M, Yee CK, Zhang EX, Zhang X, Zivcic-Becirevic I. The attractive female body weight and female body dissatisfaction in 26 countries across 10 world regions: Results of the International Body Project I. Pers Soc Psychol Bull 2010; 36(3):309-325..

Our results indicated that the proposed model is adequate. Nearly all indexes exhibited satisfactory values. The re-specified model showed an adequate fit with substantial improvements in the adjustment indexes, and all causal paths were significant. However, the χ² test was also significant, and the CFI value was slightly less than .80 (CFI = .79).

With regards to the χ² test, it has been established that this test is sensitive to the sample size³¹31 Westland JC. Lower bounds on sample size in structural equation modeling. Electronic Commerce Res Appl 2010; 9(6):476-487.^,4343 Maroco J. Análise de Equações Estruturais: Fundamentos teóricos, softwares e aplicações [Analysis of Structural Equations: Theoretical foundations, software and applications]. 2nd ed. Pêro Pinheiro: Report Number; 2014.. Therefore, we used the absolute index (χ²/df), which indicated an adequate value (less than 5)⁴³43 Maroco J. Análise de Equações Estruturais: Fundamentos teóricos, softwares e aplicações [Analysis of Structural Equations: Theoretical foundations, software and applications]. 2nd ed. Pêro Pinheiro: Report Number; 2014.. Regarding the CFI, its parsimony index (PCFI) was taken into account. It performs a correction of the relative index (CFI) by a penalty factor associated with the complexity of the proposed theoretical model⁴³43 Maroco J. Análise de Equações Estruturais: Fundamentos teóricos, softwares e aplicações [Analysis of Structural Equations: Theoretical foundations, software and applications]. 2nd ed. Pêro Pinheiro: Report Number; 2014.. The CFI is independent of the sample size; however, it is penalized by the model’s complexity⁴³43 Maroco J. Análise de Equações Estruturais: Fundamentos teóricos, softwares e aplicações [Analysis of Structural Equations: Theoretical foundations, software and applications]. 2nd ed. Pêro Pinheiro: Report Number; 2014., which is high in the case of the present research. Thus, the use of the PCFI corrects the reduction in the CFI, taking into account the degrees of freedom of the test model and the independent model. Therefore, based on this discussion, the fitted Tripartite Influence Model of disordered eating and body change behaviours among Brazilian male university students was considered adequate.

Similar to the original model proposed by Thompson et al. ⁷7 Thompson JK, Heinberg LJ, Altabe M, Tantleff-Dunn S. Exacting beauty: theory, assessment, and treatment of body image disturbance. Worcester: American Psychological Association; 1999. and the model proposed by Karazsia and Crowther²⁰20 Karazsia BT, Crowther JH. Social body comparison and internalization: Mediators of social influences on men’s muscularity-oriented body dissatisfaction. Body Image 2009; 6(2):105-112., the model tested in the present study is considered a full mediation model. The conducted analyses did not indicate improvements in the model adjustment through the inclusion of direct paths between sociocultural influences (parental, peer and media) and Body dissatisfaction, Muscularity dissatisfaction or Body change behaviours. In this sense, Internalization and Social comparison are full mediating variables. In other words, they explain “how” or “why” sociocultural influences predict or cause body dissatisfaction and muscularity dissatisfaction.

Regarding Peer influences, a non-significant pathway of this variable with Internalization was identified. The way in which peers lead to Internalization occurs indirectly through the Social comparison. Carvalho et al. ⁸8 Carvalho PHB, Alvarenga MS, Ferreira MEC. An etiological model of disordered eating behaviors among Brazilian women. Appetite 2017; 116:164-172. reported a similar result in a study with Brazilian women. According to the authors, this result indicates a specific characteristic in relation to the way in which Brazilian women internalize social ideals.

The authors also suggest the influence of the measurement tool used to assess Internalization⁸8 Carvalho PHB, Alvarenga MS, Ferreira MEC. An etiological model of disordered eating behaviors among Brazilian women. Appetite 2017; 116:164-172.. The SATAQ-3³⁷37 Amaral ACS, Ribeiro MS, Conti MA, Ferreira CS, Ferreira MEC. Psychometric evaluation of the Sociocultural Attitudes Towards Appearance Questionnaire-3 among Brazilian young adults. Span J Psychol 2013; 16(e94):1-10. internalization index was developed with a focus on media influence on body image. Thus, a greater association between Media influences and Internalization is justified in relation to the other sociocultural variables. Moreover, our results showed a higher correlation between Media influences and Internalization (r_pearson = .40, p = .001) than the correlations between Internalization and Parental influences (r_pearson = .24, p = .001) and Peer influences (r_pearson = .28, p = .001). Thus, we believed that the phenomenon observed in Brazilian women in relation to Internalization⁸8 Carvalho PHB, Alvarenga MS, Ferreira MEC. An etiological model of disordered eating behaviors among Brazilian women. Appetite 2017; 116:164-172. also occurs among male university students in this country.

Another non-significant causal pathway was identified between Parental influences and Social Comparison. The reasons this causal path was not significant in the Brazilian population remain unclear. Again, it is possible that the measurement instrument contributed to this result. The parental influences subscale of the Tripartite Influence Scale³⁶36 Amaral ACS, Ferreira MEC, Scagliusi FB, Costa LS, Cordas TA, Conti MA. Psychometric evaluation of the Tripartite Influence Scale. Psicol Reflex Crit 2013; 26(2):213-221. has items that refer to the direct and indirect influences of parents on the need for weight loss and diets. Considering that the ideal body for men is featured by a figure with a muscular body, it is possible that these parental messages do not interfere in the way Brazilian male university students adhere to Social comparison. To confirm these hypotheses future studies should invest in implementing instruments with greater ability to capture the male peculiarities with respect to their bodies. For example, the SATAQ-4⁴⁷47 Schaefer LM, Burke NL, Thompson JK, Dedrick, RF, Heinberg, LJ, Calogero RM, Bardone-Cone AM, Higgins MK, Frederick DA, Kelly M, Anderson DA, Schaumberg K, Nerini A, Stefanile C, Dittmar H, Clark E, Adams Z, Macwana S, Klump KL, Vercellone AC, Paxton SJ, Swami V. Development and validation of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4). Psychol Assess 2015; 27(1):54-67. is a promising instrument in this context. However, it still has not had its validity and reliability confirmed for the Brazilian population.

An important aspect to consider is the finding that previous studies¹²12 Karazsia BT, Crowther JH. Sociocultural and psychological links to men’s engagement in risky body change behaviors. Sex Roles 2010; 63(9-10):747-756.^,2020 Karazsia BT, Crowther JH. Social body comparison and internalization: Mediators of social influences on men’s muscularity-oriented body dissatisfaction. Body Image 2009; 6(2):105-112. have evaluated sociocultural influences as a unique latent variable. Specifically, parents, peers and media were used together to create the latent variable “sociocultural influences”. The assertion that sociocultural factors lead to Internalization and Social comparison may not be true if the operationalization of the variables is performed jointly. For example, it is possible that Parental influences and Media influences act incisively on Internalization when evaluated together, and Peer influences do not contribute to the causal path. However, if “sociocultural influence” is operationalized by joining the items of the three factors, the non-influence of the peers may be hidden. For this reason, the three sociocultural factors were used separately in the present research to enable evaluating the influence of each factor on the Internalization and Social comparison.

However, of all the obtained results, what is most striking is the finding that the Body dissatisfaction remained in the fitted model. It is highlighted that (to the best of our knowledge) this investigation is the first study that included both Body dissatisfaction → Disordered eating and Muscularity dissatisfaction → Body change behaviour paths in a single theoretical model based on the Tripartite Influence Model. According to some authors, male body image concerns have been neglected for years, and after accepting the fact that these subjects suffer body image disturbances, the focus was exclusively on muscularity⁴4 Cafri G, Thompson JK, Ricciardelli L, McCabe M, Smolak L, Yesalis C. Pursuit of the muscular ideal: Physical and psychological consequences and putative risk factors. Clin Psychol Rev 2005; 25(2):215-239.^,1313 Cafri G, Thompson JK. Measuring male body image: A review of the current methodology. Psychol Men Masculinity 2004; 5(1):18-29.. However, the amount of adipose tissue, as well as body shape are important aspects for men because in order to reach a defined body, it is necessary to reduce the amount of body fat¹³13 Cafri G, Thompson JK. Measuring male body image: A review of the current methodology. Psychol Men Masculinity 2004; 5(1):18-29.. As previously discussed, the drive for thinness and the drive for muscularity are not mutually exclusive constructs¹⁸18 Kelley CCG, Neufeld JM, Musher-Eizenman DR. Drive for thinness and drive for muscularity: Opposite ends of the continuum or separate constructs? Body Image 2010; 7(1):74-77.. Therefore, our results indicate that body dissatisfaction is an important issue for Brazilian male university students because it is potentially linked to the pursuit of a muscular body.

Nevertheless, there was a non-significant path between Body dissatisfaction and Disordered eating; thus, the latter latent variable was removed from the final model. Strother et al. ¹⁵15 Strother E, Lemberg R, Stanford SC, Turberville D. Eating disorders in men: underdiagnosed, undertreated, and misunderstood. Eat Disord 2012; 20(5):346-355. noted that male eating disorders remain misunderstood. In order to better understand the development of eating disorders in men, it is necessary to move away from the logic of what occurs in women¹⁵15 Strother E, Lemberg R, Stanford SC, Turberville D. Eating disorders in men: underdiagnosed, undertreated, and misunderstood. Eat Disord 2012; 20(5):346-355.. The relationship between men and food appears to be different from that observed in women¹⁵15 Strother E, Lemberg R, Stanford SC, Turberville D. Eating disorders in men: underdiagnosed, undertreated, and misunderstood. Eat Disord 2012; 20(5):346-355.. Our results reinforce the idea that the phenomenon of eating disorders in men is complex and therefore requires measurement instruments capable of capturing the peculiarities of individuals of this sex in relation to disordered eating behaviours associated with the pathology of eating disorders.

The present research provides important information and expands the debate regarding body image disturbances, disordered eating and the body change behaviours among men. It is also worth noting that the study is important for providing a specific theoretical model for Brazilian male university students. For example, the results indicate that Parental influences do not lead to Social comparison and Peer influences do not lead to Internalization. Internalization and Social comparison are important factors for the development of body dissatisfaction and muscularity dissatisfaction among men. Furthermore, Body dissatisfaction proves to be important for Brazilian young men, even though it has not led to disordered eating. Intervention programmes should consider these associations.

There are limitations to this study that are important to acknowledge. First, the cross-sectional design does not enable a causality analysis. It is possible to delineate hypothetical causal relationships between the independent (exogenous) and dependent (endogenous) variables³¹31 Westland JC. Lower bounds on sample size in structural equation modeling. Electronic Commerce Res Appl 2010; 9(6):476-487.^,4343 Maroco J. Análise de Equações Estruturais: Fundamentos teóricos, softwares e aplicações [Analysis of Structural Equations: Theoretical foundations, software and applications]. 2nd ed. Pêro Pinheiro: Report Number; 2014. through Structural Equation Modelling. Thus, the method simulates the causal relationship through the combination of statistical techniques such as factor analysis and path analysis; however, it does not allow for classic causal analyses, such as those verified in longitudinal designs. Second, although male university students from different regions of Brazil were evaluated, we employed a sample selection by convenience. Finally, measurement instruments, although mostly psychometrically evaluated for the Brazilian male population, remain focused on the drive for thinness, such as the Tripartite Influence Scale³⁶36 Amaral ACS, Ferreira MEC, Scagliusi FB, Costa LS, Cordas TA, Conti MA. Psychometric evaluation of the Tripartite Influence Scale. Psicol Reflex Crit 2013; 26(2):213-221. and SATAQ-3³⁷37 Amaral ACS, Ribeiro MS, Conti MA, Ferreira CS, Ferreira MEC. Psychometric evaluation of the Sociocultural Attitudes Towards Appearance Questionnaire-3 among Brazilian young adults. Span J Psychol 2013; 16(e94):1-10.. However, the SATAQ-3, for example, has been used in other studies with the male population³3 Dakanalis A, Zanetti AM, Riva G, Colmegna F, Volpato C, Madeddu F, Clerici M. Male body dissatisfaction and eating disorder symptomatology: Moderating variables among men. J Health Psychol 2015; 20(1):80-90.^,1212 Karazsia BT, Crowther JH. Sociocultural and psychological links to men’s engagement in risky body change behaviors. Sex Roles 2010; 63(9-10):747-756.^,2020 Karazsia BT, Crowther JH. Social body comparison and internalization: Mediators of social influences on men’s muscularity-oriented body dissatisfaction. Body Image 2009; 6(2):105-112..

Given the complexity and multifaceted nature of body image and disordered eating, further research is merited to test different models that include explanatory variables which were not considered in this study. The specificities of men with respect to these two constructs may have other intervening variables which have not been previously tested.

References

Publication Dates

History