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OBJECTIVE: Gay and bisexual men are at an increased risk for eating disorders (EDs) and muscle dysmorphia (MD) compared with their heterosexual counterparts. Existing dissonance-based (DB) EDs prevention programs for this population have been evaluated in the United States; however, these programs have not been evaluated in the Brazilian context. Thus, we investigated the feasibility, acceptability, and efficacy of a DB ED prevention program (i.e., the PRIDE Body Project) among Brazilian cisgender gay and bisexual men. METHOD: Eligible men were randomly assigned to either a DB intervention (n = 74) condition or an assessment-only control (AOC) condition (n = 75). Participants completed measures assessing ED and MD risk and protective factors at baseline, post-intervention, 1-month, 6-month, and 1-year follow-up. Those in the intervention condition also completed acceptability measures. RESULTS: Feasibility and acceptability ratings were highly favorable. Regarding efficacy, post-intervention results were not significant, except for self-objectification, which showed a significantly greater decrease in the DB condition compared with the AOC condition at all time-points of follow-ups (Cohen's d = -0.31 to -0.76). At follow-up, the DB condition showed significantly greater decreases in appearance-ideal internalization, drive for muscularity, self-objectification, ED and MD symptoms at 1-month, 6-month, and 1-year follow-ups (d = -0.33 to -0.92) compared with the AOC condition. Significant increases were observed in the DB compared with the AOC condition for body appreciation at 1-month, 6-month, and 1-year follow-ups (d = 0.31-0.81). DISCUSSION: Results support the feasibility, acceptability, and efficacy of the PRIDE Body Project up to 1-year in Brazilian cisgender gay and bisexual men. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC; available at http://www.ensaiosclinicos.gov.br/) number of registration: RBR-62fctqz.

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Despite high levels of muscularity concerns among sexual-minority men, most of the existing literature on the drive for muscularity and muscle dysmorphia focuses on heterosexual men and has mainly been conducted in Western and English-speaking regions. The present study aimed to evaluate the psychometric properties of the Drive for Muscularity Scale (DMS) and the Muscle Dysmorphic Disorder Inventory (MDDI) in Brazilian cisgender gay and bisexual adult men who were 18-50 years old. We evaluated the factor structure of both measures using a two-step, split-sample exploratory (EFA; n = 704) and confirmatory (CFA; n = 705) factor-analytic approach, which supported the original three-factor structure of the MDDI and resulted in a reduced two-factor solution with 13 items for the DMS. Convergent validity was supported through associations of the DMS and the MDDI with eating disorder symptoms, body-ideal internalization, self-objectification beliefs and behaviors, and body appreciation measures. Additionally, we found good internal consistency, and test-retest reliability of both measures. Results support the validity and reliability of the DMS and the MDDI in Brazilian cisgender gay and bisexual adult men and will support future studies exploring these constructs in Brazilian sexual-minority men.

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OBJECTIVE: The Muscularity-Oriented Eating Test (MOET) is a 15-item unidimensional scale, designed to assess eating practices that occur in the pursuit of a muscular body. The aim of the present study was to describe the translation and cultural adaptation of the MOET to Brazilian Portuguese, to explore its factor structure and measurement invariance, and to evaluate its internal consistency, three-week test-retest reliability, and convergent validity in a community sample of Brazilian men and women. METHOD: After the back-translation procedure, the Brazilian MOET was administered online to a sample of 1246 adults (634 men and 612 women), along with measures of drive for muscularity, muscle dysmorphia symptoms, muscular/athletic-ideal internalization, disordered eating behaviors, and exercise dependence. RESULTS: Findings from an exploratory factor analysis and a confirmatory factor analysis revealed a one-factor structure and adequate internal consistency for men (ω = 0.86; α = 0.86) and women (ω = .84; α = .83). Measurement invariance across gender was supported. In addition, the scale demonstrated good three week test-retest reliability for both men (ICC = .96; p < .001) and women (ICC = .92; p < .001), and the subscales revealed moderate to large associations with drive for muscularity, muscle dysmorphia symptoms, muscular/athletic-ideal internalization, disordered eating, and exercise dependence. CONCLUSION: This study supports the validity and reliability of the MOET in a community sample of Brazilian men and women and represents an advance in measures of muscularity-oriented disordered eating in Brazilian adults, allowing for future cross-cultural studies in this field. PUBLIC SIGNIFICANCE: The Muscularity-Oriented Eating Test (MOET) is a measure of muscularity-oriented disordered eating, which assess strict adherence to diet rules, including the food's macronutrient content, regulation of protein intake, and eating less or more to influence muscle gain. This study evaluated the validity and reliability of the MOET in a community sample of Brazilian men and women. Our findings represent an advance in measures of muscularity-oriented disordered eating in Brazilian adults.

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Abstract Introduction Adolescents are the group with the highest risk of developing disordered eating behaviors (DEB). Preventing this problem is of the utmost importance due to the physical and psychological consequences. Objective To evaluate the effects of a universal prevention program for disordered eating behaviors (DEB), thin ideal internalization (TII), drive for muscularity (DM), and sedentary lifestyle among Mexican adolescents. Method A quasi-experimental study with repeated measures (pre-test, post-test, six-month, and one-year follow-up) was carried out in a non-probabilistic sample of 523 adolescents (46.7% of females) aged 15-19 years (Mage = 16.07). We worked in two private high schools, one of them was designed as control group (CG), and the other as intervention group (IG). For both, female and male adolescents', data were collected using the Brief Questionnaire for Disordered Eating Behaviors (BQDEB) and the short form of the International Physical Activity Questionnaire (IPAQ). To evaluate TII the Attitudes toward Body Figure Questionnaire was applied in females, while in males Drive for Muscularity Scale (DMS) was used. Results After one-year, repeated measures analyses of variance (ANOVAs) revealed a significant reduction of the mean DEBs scores both in female (p = .01) and male (p = .03) adolescents of the IG with respect to CG. In IG, females decreased significantly the mean TII score as well as the mean DM score in males. Physical Activity increased in IG females from pre-test to posttest; however, the effect was not maintained over time. Discussion and conclusion These findings have important implications for future interventions with Mexican adolescents. We must take sex differences into account to choose activities and strategies that will enhance the effects of the program.

Resumen Introducción Los adolescentes constituyen el grupo con mayor riesgo de desarrollar conductas alimentarias de riesgo (CAR). Prevenirlas es de suma importancia debido a las consecuencias físicas y psicosociales. Objetivo Evaluar los efectos de un programa de prevención universal en conductas alimentarias de riesgo (CAR), interiorización del ideal de delgadez (IID), obsesión por la musculatura (OM) y sedentarismo en adolescentes mexicanos. Método Estudio cuasi-experimental con medidas repetidas (pre-test, post-test, seguimiento a seis meses y un año) en una muestra no probabilística de 523 adolescentes (46.7% mujeres) de 15-19 años de edad (Medad = 16.07). Se trabajó en dos escuelas preparatorias privadas, una como grupo control (GC) y otra como grupo intervenido (GI). Para mujeres y hombres, los datos se recolectaron usando el Cuestionario Breve para Conductas Alimentarias de Riesgo (CBCAR) y la versión corta del Cuestionario Internacional de Actividad Física (IPAQ). Para evaluar el IID en mujeres, se utilizó el Cuestionario de Actitudes hacia la Figura Corporal (CAFC) y en hombres la Escala para Obsesión por la Musculatura (DMS). Resultados Después de un año, el ANOVA de medidas repetidas mostró una reducción significativa en la media de CAR, tanto en mujeres (p = .01) como en hombres (p = .03) del GI respecto al GC. En el GI, la media de IID en mujeres disminuyó significativamente, así como la media de OM en hombres. La actividad física aumentó en las mujeres del GI desde el pre-test hasta el post-test; sin embargo, el efecto no se mantuvo en el tiempo. Discusión y conclusión Estos hallazgos tienen implicaciones para futuras intervenciones con adolescentes mexicanos. Se deben tomar en cuenta las diferencias por sexo para elegir las actividades y las estrategias que potenciarían los efectos del programa.

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PURPOSE: The aim of this study was to develop an instrument to identify disordered eating behaviors (DEB) in college men (hereafter, DEBM-Q). METHODS: A two-stage project consisting of a diagnostic scale construction (n1 = 9 for interviews, n2 = 9 for cognitive laboratory) and a validation study with a cross-sectional sample (N = 570) was carried out. Both semi-structured interviews and a cognitive laboratory with nine participants were conducted to obtain DEBM-Q items. DEBM-Q was applied to 570 freshmen male in Mexico City. Psychometric characteristics and internal consistency (Cronbach's alpha) were analyzed. An item-total correlation value greater than 0.30 was determined, and factor loads greater than 0.40 were considered valid. Exploratory factor analysis (EFA, n1 = 297) and confirmatory factor analysis (CFA, n2 = 273) were performed. RESULTS: Two fixed factors explaining 55.08% of the total variance were extracted. Factor 1, "Drive for Thinness" (8 items), explained 30.84% of the variance, whereas factor 2, "Drive for Muscularity" (8 items), explained 24.23% of the variance. Cronbach's alpha for the whole questionnaire was 0.84. DEBM-Q was correlated with the Dutch Food Restriction Scale (RS) (r = 0.52, p < 0.001), Eating Disorder Examination-Questionnaire (EDE-Q) (r = 0.46, p < 0.001), Emotional Eating Scale (EES) (r = 0.18, p < 0.001), and Negative Affect Subscale (PANAS-X) (r = 0.11, p < 0.005). CONCLUSION: DEBM-Q is a valid and practical short screening tool (16 items) allowing early identification of disordered eating in young men, thereby facilitating clinical management. LEVEL OF EVIDENCE: Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

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RESUMEN Es cada vez más frecuente la exposición de los adultos emergentes a prácticas socioculturales que afectan su salud mental, cumpliendo un papel importante en la manifestación de la obsesión por la delgadez y la musculatura. Por ello, el propósito del estudio fue comparar la obsesión por la delgadez y la musculatura entre mujeres adultas emergentes universitarias de Chile y España respecto a factores socio-culturales, satisfacción corporal y variables psicológicas vinculadas a la imagen corporal. De esta forma, la presente investigación se realizó desde un enfoque cuantitativo, con un diseño no experimental transversal, de alcance correlacional, con una muestra compuesta por 230 participantes (n chilenas= 155; n españolas= 75). Los resultados evidenciaron una diferencia significativa entre ambos grupos en la obsesión por la musculatura, siendo mayor en España. El modelo predictivo de obsesión por la delgadez estuvo compuesto por las variables de perfeccionismo, satisfacción corporal en forma negativa, presión social de la familia, de los medios de comunicación y nacionalidad española, explicando así el 45% de la varianza, mientras que el modelo explicativo para obsesión por la musculatura permite predecir un 16% de su varianza a partir de la nacionalidad española, la obsesión por la delgadez, la presión social de la familia y la actividad física regular. Finalmente, se plantea la necesidad de fomentar indagaciones futuras y profundizar más en las temáticas que permitan prevenir en las jóvenes mujeres con mayor riesgo de padecer alguna de estas problemáticas.

ABSTRACT Exposure of emerging adults to sociocultural practices that affect their mental health is more and more frequent, playing an important role in the manifestation of a drive for thinness and muscularity. The purpose of the study was to compare the drive for thinness and drive for muscularity, among emerging adult university women from Chile and Spain. We evaluated socio-cultural factors, body satisfaction and psychological variables linked to body image using a quantitative approach, with a non-experimental cross-sectional design. We used a correlational-causal scope, with a sample of 230 participants (n Chileans= 155; n Spanish= 75). The results evidenced a significant difference between the two groups in drive for muscularity, being higher in Spain. The predictive model of drive for thinness was made up of the variables of perfectionism, negative body satisfaction, social pressure from the family, the media and Spanish nationality, explaining 45% of the variance. The model for drive for muscularity predicted 16% of the variance based on Spanish nationality, drive for thinness, social pressure from the family and regular physical activity. Finally, there is a need to encourage future inquiries and delve deeper into the issues that allow young women at higher risk of suffering from any of these problems to be prevented.

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Resumen Para comprender la forma en que piensan y actúan las personas excesivamente preocupadas por su musculatura, es importante contar con instrumentos de medición apropiados. Por esto, el objetivo de este estudio fue examinar la literatura publicada sobre las propiedades psicométricas de las medidas desarrolladas para evaluar la imagen corporal masculina, la motivación por la musculatura y la dismorfia muscular. Para la inclusión de los instrumentos a analizar, se aplicaron los criterios propuestos por Cafri y Thompson (2004). Los instrumentos fueron clasificados en tres grandes grupos: insatisfacción muscular, motivación por la musculatura y dismorfia muscular. Para describir los instrumentos, se consideró la descripción de la escala, sus datos psicométricos obtenidos por los desarrolladores y evidencia psicométrica adicional, con énfasis en poblaciones hispanas y latinas. De los 14 instrumentos que existen para medir insatisfacción muscular, motivación por incrementar la musculatura o sintomatología de dismorfia muscular, solo siete han sido evaluados psicométricamente en muestras hispanas o latinas. En general, todos los instrumentos poseen adecuadas propiedades psicométricas para evaluar los constructos insatisfacción muscular, motivación por la musculatura y dismorfia muscular.

Abstract To understand how people who are overly concerned about their musculature think and act, it is important to have appropriate measuring instruments. Therefore, the objective of this study was to examine the published literature on the psychometric properties of the measures developed to assess male body image, drive for muscularity and muscle dysmorphia. For the inclusion of the measures to analyze, the criteria proposed by Cafri and Thompson (2004) were applied. The instruments were classified into three main groups: muscle dissatisfaction, drive for muscularity and muscle dysmorphia. To describe the instruments, we considered the description of the scale, their psychometric data obtained by the developers, and additional psychometric evidence, with emphasis on Hispanic and Latino populations. Of the 14 instruments that exist to measure muscular dissatisfaction, drive for muscularity or symptomatology of muscular dysmorphia, only seven have been evaluated psychometrically in Hispanic or Latin samples. In general, all instruments have adequate psychometric properties to evaluate the constructs muscle dissatisfaction, muscle motivation and muscle dysmorphia.

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PURPOSE: This study aimed to evaluate the psychometric properties of the Drive for Muscularity Scale (McCreary and Sasse, J Am Coll Health 48(6): 297-304, 2000) (DMS) among a sample of Jamaican male weightlifters. METHODS: 205 weightlifters (Mage = 28.49, SD = 9.61) from rural and urban areas in Jamaica, completed the DMS, the Depression, Anxiety and Stress Scale-21 Items (DASS-21) and the Body Areas Satisfaction Scale (BASS) in a cross-sectional design. Confirmatory factor analysis was performed on the DMS and conventional fit indices used to determine model fit. Measurement invariance was examined for urban and rural participants. Correlations between the DMS scores and the DASS-21 and BASS were determined to examine the validity of the scale. RESULTS: Confirmatory factor analysis of the original 2-factor model (muscularity-oriented body image and muscularity behaviors) resulted in overall good fit (CFI = .94, TLI = 0.93, RMSEA = 0.06 [0.05, 0.08], SRMR = 0.08). Also, measurement invariance was observed between weightlifters from rural and urban areas. The DMS was principally correlated with specific body areas previously associated with male's body dissatisfaction (muscle tone, upper torso and weight) (rs = 0.17 to .47). The DMS showed significant weak to moderate negative correlations with the DASS-21 (rs = - 0.16 to - 0.32). Adequate levels of internal consistency were observed (omega = 0.75-0.88). CONCLUSION: The DMS showed to be a valid instrument to evaluate the drive for muscularity in Jamaican weightlifters and has utility in informing further research, diagnosis and treatment of body image-related pathologies. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

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OBJECTIVE: Few prevention programs have been developed and empirically evaluated to address eating disorder (ED) and muscle dysmorphia (MD) symptoms in men. Furthermore, new strategies for the broad implementation of available programs are needed. We investigated the acceptability and efficacy of a dissonance-based (DB) intervention for Brazilian undergraduate men with body dissatisfaction to target risk and protective factors for ED and MD symptoms (the Body Project: More Than Muscles) after an online training for facilitators. METHOD: Participants were randomized to a two-session DB-intervention (n = 89) or assessment-only control (AOC) (n = 91), and completed validated measures assessing ED and MD risk and protective factors pre-intervention, post-intervention, and at 4- and 24-week follow-up post-intervention. RESULTS: Acceptability ratings were highly favorable. Regarding efficacy, the DB condition demonstrated significantly greater decreases in ED and MD risk factors compared to AOC from pre-intervention to 4-week (p-values <.05, between-condition Cohen's d = 0.35-1.10) and 24-week follow-up (p-values <.05, between-condition Cohen's d = 0.33-0.78). Results at post-intervention were not significant, with the exception that body appreciation showed significantly greater improvements in the DB condition (post-intervention: p < .01, between-condition Cohen's d = 0.40; 4-week: p < .001, between-condition Cohen's d = 0.80; and 24-week follow-up: p < .001, between-condition Cohen's d = 0.58). DISCUSSION: Results support the acceptability and efficacy of a DB-intervention delivered in-person after an online training for facilitators up to 24-week follow-up in Brazilian men.

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PURPOSE: Adolescent men have been identified as a risk population to develop eating disorders and other psychopathologies as drive for muscularity (DM) recently considered as muscularity-oriented disordered eating. It is important to identify risk factors as precursors of these pathologies. The aim of this study was to determine the risk of developing disordered eating behaviors (DEB) and DM and its relationship with anthropometric indicators and physical activity (PA) in adolescent men (high-school students, age 15-19) from Hidalgo, Mexico. METHODS: A cross sectional, descriptive, and correlational field study was carried out in a non-probabilistic sample of 267 Mexican adolescents aged 15-19 years. Participants completed measures of DM, DEB, and PA. Each subject was weighted and heighted to calculate body mass index (BMI), body fat percentage, and fat-free mass index (FFMI). RESULTS: Adolescents in the DM risk category (OR 8.28, CI 2.71-25.22) had significantly greater odds of developing DEB, while adolescents with higher BMI scores (OR 1.28, CI 1.14-1.45) tended to be more likely of developing DEB. The results showed that DEB and moderate PA were associated with DM; adolescents who engaged in DEB had an 8.64 times (CI 3.05-24.52) higher risk of developing DM. Participants classified in the category of highest moderate PA (OR 2.66, CI 1.26-5.59) had significantly greater odds of developing DM. CONCLUSION: Important percentages of the risk of developing DEB and DM were determined in Mexican adolescent men. In agreement with other findings, there were no associations between anthropometric indicators and DM. LEVEL OF EVIDENCE: V, descriptive cross-sectional study.

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There is a lack of psychometric studies on scales aiming to evaluate the drive for muscularity in women. This study aimed to test whether the Drive for Muscularity Scale (DMS) yielded reliable and valid scores for assessing the drive for muscularity construct in young adult women. A cross-sectional study was conducted among 242 Brazilian adult women. Exploratory factor analysis, convergent validity, estimated internal consistency, and test-retest reliability of the DMS's scores were examined. The results of the exploratory factor analysis upheld the original unidimensional structure of the DMS for Brazilian women. The scale presented a significant but weak association with body mass index and risk behaviors for eating disorders. Adequate internal consistency and 2-week test-retest reliability were found. Future psychometric analyses (convergent and discriminant validity) of the DMS are encouraged to further our understanding of drive for muscularity in women, especially to confirm its unidimensional factor structure. Future research avenues also include examining the reliability and validity of the DMS's scores among women from various cultures.

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Several studies have demonstrated that men express body dissatisfaction differently than women. Although specific instruments that address body dissatisfaction in men have been developed, only a few have been validated in Latin-American male populations. The aim of this study was to reassess the factor structure of the Spanish versions of the Drive for Muscularity Scale (DMS-S) and the Male Body Attitudes Scale (MBAS-S) in an Argentinian sample. A cross-sectional study was conducted among 423 male students to examine: the factorial structure (confirmatory factor analysis), the internal consistency reliability, and the concurrent, convergent and discriminant validity of both scales. Results replicated the two factor structures for the DMS-S and MBAS-S. Both scales showed excellent levels of internal consistency, and various measures of construct validity indicated that the DMS-S and MBAS-S were acceptable and valid instruments to assess body dissatisfaction in Argentinian males.

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A la fecha, pocos estudios han evaluado la relación entre las medidas antropométricas y la obsesión por la musculatura (OM). Por lo anterior, el propósito de este estudio fue examinar los correlatos antropométricos de la OM. 76 varones universitarios contestaron la Escala de Obsesión por la Musculatura e individualmente se midió su peso, su talla y cuatro panículos adiposos (biceps, triceps, supraescapular y suprailiaco). No se observaron correlaciones significativas entre la puntuación total de la OM y los indicadores antropométricos (índice de masa corporal, densidad corporal, porcentaje de grasa, índice de masa libre de grasa e índice cintura cadera). Los índices antropométricos no se relacionaron con la OM, lo cual sugiere que la composición corporal actual de los participantes no se relaciona con la OM. El hecho de que el índice de masa libre de grasa no se relacionó con la OM es notable porque se esperaría mayor OM en los hombres con musculatura media. Una posible explicación es que la OM podría asociarse con la figura corporal, más que con la masa muscular corporal. Los hallazgos del presente estudio incrementan nuestro conocimiento de la OM en varones y pueden contribuir en el diseño de intervenciones enfocadas a disminuir la OM.

To date, few studies have assessed the relationship between anthropometric measures and drive for muscularity (DM). Therefore, the purpose of this study was to examine anthropometric correlates of DM. 76 college men answered the Drive for Muscularity Scale, and individually their weight, height and four skinfolds (biceps, triceps, suprascapular, and suprailiac) were measured. There were no significant correlations between DMS total score and anthropometric indicators (body mass index, body density, body-fat percentage, fat-free mass index, and waist to hip ratio). Anthropometric indices were not related to the DM, suggesting that the current body composition of participants was not related to the DM. The fact that the fat-free mass index was not associated with DM is significant because we expect more DM in men with average muscularity. One possible explanation is that the DM could be associated with body shape, rather than lean body mass. The findings of this study increase our understanding of the DM in men and may help in designing interventions to decrease the DM.