Attentional processing of body images in women with overweight and obesity

Attentional processing of body images in women with overweight and obesity | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Attentional processing of body images in women with overweight and obesity Julia Baur, Kerstin Krohmer, Eva Naumann, Jennifer Svaldi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1486031/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Purpose : Despite the claim to integrate body image interventions in obesity treatment, little is known about the mechanisms involved in maintaining body dissatisfaction in persons with overweight and obesity. Therefore, the present study sought to investigate attentional processing of body stimuli in women with overweight and obesity (OW). Methods : Women with OW ( n = 82) and normal weight controls (NW; n = 44) conducted two eye-tracking paradigms. In the first paradigm, fixation duration on the subjectively most beautiful and ugliest body part of one’s own and a weight-matched control body were analyzed. In the second paradigm, picture pairs including the own and a control body or object were presented and initial fixation orientation was measured. Automatic and intentional processing of the body pictures was manipulated by either indicating on which side which stimuli would appear or not. Results: Women with OW displayed a bias towards the ugliest as opposed to the most beautiful body part, whereas women with NW showed a balanced viewing pattern. Furthermore, both groups showed a preference for bodies relative to the object. However, only women with OW preferred their own relative to the control body during intentional processing. Conclusion: Taken together, results point towards a self-focused and deficit-oriented gaze pattern in women with overweight and obesity. Targeting these processes might help to improve obesity treatment outcomes. Level of Evidence: Level I, experimental study. obesity overweight attentional bias eye-tracking body image Figures Figure 1 Figure 2 Figure 3 What Is Already Known About This Subject? Attentional biases play an important role in the maintenance of body dissatisfaction Few studies have adressed this issue in overweight and obesity despite the negative impact body dissatisfaction has on psychological well-being and weight loss success in obesity What this study adds? Specificagtion of attentional processes underlying body dissatisfaction in overweight and obesity by using experimental eye-trakcing paradigms and adressing limitations of previous studies [e.g. including an inanimate control object] Demonstrating the clinical relevance of these attentional biases by including a control group The identified processes might be used in interventions to improve body dissatisfaction. Introduction Body dissatisfaction is markedly increased in individuals with overweight and obesity compared to normal weight persons [ 1 ]. Besides negative consequences on emotional well-being, numerous studies confirm the importance of body dissatisfaction for the etiology and maintenance of overweight which is why the integration of body image interventions in obesity treatment is discussed [ 2 – 4 ]. However, to effectively improve body dissatisfaction, a thorough understanding of the underlying mechanisms is warranted. According to cognitive-behavioral theories, increased body dissatisfaction results from and is maintained by dysfunctional body-related schemata, which distort different mental processes like e.g., memory, interpretation, and attention [ 5 ]. Therefore, two attentional biases have consistently been reported in individuals with eating disorders or high in body dissatisfaction: (I) a preferential processing of one’s own compared to a concurrently presented control body and (II) a negative bias towards subjectively disliked body parts [ 6 , 7 ]. However, only few studies have addressed these biases in overweight and obesity. Only one study so far has confirmed the preferential processing of one’s own body in obesity during intentional processing [ 8 ]. Processing of the pictures were manipulated by either giving information on which side which stimulus would appear (top-down) or not [bottom-up; 10]. Yet, a normal weight control group is missing to determine the clinical relevance of this bias in obesity. Second, it is unclear if the hypervigilance towards one’s own body results from an increased preference of the self or an avoidance of the control body. If the effect is driven by a prioritized processing of one’s own body, the latter should be preferred irrespective of whether a control body or object is present; if avoidance of the control body causes the hypervigilance, this avoidance should also be present during pairings with a control object. Concerning selective visual attention, two studies confirm the reported deficit-oriented gaze pattern in overweight and obesity [ 9 , 10 ], while another reported an attentional bias towards attractive body parts [ 11 ]. These contradicting results are difficult to integrate due to methodological differences [e.g., different definition of fixation duration]. Furthermore, significant sample characteristics like body dissatisfaction are missing which might however be crucial for subtyping individuals with overweight [ 12 ]. Hence, the evaluation of body-related attentional biases among those seeking treatment for body image is especially warranted. Taken together, evidence concerning attentional biases in individuals with overweight leaves several issues unanswered. Thus, the present study investigates attention allocation to specific body parts as well as attentional processing of concurrently presented (body) stimuli in treatment-seeking women with overweight and obesity (OW) compared to women with normal weight (NW). It is hypothesized, that relative to women with NW, treatment-seeking women with OW display a stronger attentional bias towards the self-rated ugliest compared to the most beautiful body part. For the second paradigm, we hypothesized that only during intentional processing, women with OW would show a preferred attention allocation towards one’s own body compared to the control body and object relative to women with NW. Materials And Methods Participants The present study was approved by the local ethics committee [614/2015BO2]. Inclusion criteria were (a) 18 ≤ age ≤ 69 years, (b) female gender, (c) corrected/normal vision, (d) fluent in German, and (e) no diagnosis of an eating disorder. Women with OW had to have a Body Mass Index [BMI] of ≥ 25 and women with NW between 18.5 ≤ BMI < 25 [ 13 ]. Exclusion criteria were (a) current presence of psychosis, suicidal ideation, manic episode, substance abuse or irregular intake of antidepressants, (b) pregnancy/lactation period, (c) borderline personality disorder, and (d) participation in eating- and weight-related interventions. An a-priori calculated power analysis (f = .035, α = 0.05, power of 0.90) resulted in a total sample size of n = 88 (44/ group). N = 82 women with OW and n = 44 women with NW participated in the study[1]. The presented results are part of a baseline assessment prior to an RCT on body image interventions (results will be presented elsewhere). The groups did not differ on age and marital status, however, education level was lower in OW [e.g. 18]. As expected, women with OW had higher scores on psychopathological variables (see Table 1). Stimuli Digitized black-and-white photos of one’s own body (self-body) and a BMI-and waist-to-hip-matched control body were used. Photos were taken in standardized positions (front, back, left side, right side; face omitted) in standardized underwear (nude panty and top). For the second paradigm, a drawing of an inanimate object (vase) served as control stimulus [ 15 ]. Eye Tracking Paradigms Eye-movements were measured using a desktop-mounted, video-based infrared remote eye-tracking system (RED250; angular resolution: ≤0.5°; temporal resolution: 250Hz) equipped with iViewXTM2 software (SensoMotoric Instruments). After a 9-point calibration to ensure gaze accuracy, pictures of the self-body and control body were presented in a free-viewing task with two blocks each including 16 trials in the first paradigm. In each block, every perspective of every stimulus was presented twice (left/right side) for 8 sec. The second paradigm consisted of two blocks each including 48 trials à 3 sec with 16 trials of each picture pair per block with counterbalanced stimulus location (self-body vs. control-body; self-body vs. vase; control-body vs. vase). Half of the trials were cued with information on which side which stimulus would appear (e.g.,“Your own body will be on the right side, the vase on the left side”), while the other half was not cued (e.g.,“You will see your own body and the vase”; see Fig. 1 ). Questionnaires and Interviews (1) Body dissatisfaction was assessed using the Body Shape Questionnaire [BSQ; 21] with higher scores reflecting higher body dissatisfaction (Cronbach’s α = .98 in the present sample]). (2) The BDI-II [ 22 ] was used to assess depressive symptoms over the last two weeks (α = .91). (3) The Positive and Negative Affect Scale [PANAS; 23] was used to assess negative affect prior to and after the first paradigm (α = .85 prior to [t0] and α = .92 after the experiment [t1]). (4) The Body Image State Scale [BISS; 24] assesses the evaluative experience of one’s own body with higher scores reflecting more favorable states (α = .90 [t0]; α = .96 [t1]) [ 5 ] After the paradigms, participants saw printed versions of the self and control body and indicated the perceived beauty of ten specified body parts (shoulders, cleavage, arms, hands, breast, back, buttocks, stomach, hips, thighs) on a 6-point Likert sale ( 1 = ugly; 6 = beautiful) to calculate a mean score for the overall beauty. Furthermore, participants self-reported their subjectively rated most beautiful and ugliest body part for both bodies (see Supplementary Material for more details). Procedure Participants were recruited via announcements in the local press, flyers, and the university’s mailing list. Trained psychologists performed a diagnostic assessment including the Eating Disorder Examination Interview [EDE; 16] and the Structured Clinical Interview for Mental Disorders [SCID, 17]. Informed written consent was obtained, relevant questionnaires (BSQ, BDI-II) were filled in via Unipark. On a separate day, body pictures were taken. Next, an appointment for the two eye-tracking paradigms was scheduled. Prior to and after the first paradigm, participants filled in the PANAS and BISS. At the end, participants saw printed versions of the self and control body to rate and rank the above-mentioned body parts. Afterwards, women with NW were reimbursed and debriefed concerning the study’s rationale[2], while another appointment was scheduled with women with OW participating in the RCT. Data processing A fixation was defined as maintaining visual gaze for ≥ 100ms [ 22 ]. For the first paradigm, Areas of Interests [AOIs] were defined in BeGaze 3.7 (SMI) separately for each participant [ugliest/most beautiful body part]. Relative fixation time on the relevant AOI compared to the overall fixation time on the body of all trials including this AOI were calculated. For the second paradigm, the frequency of the direction of the first fixation was analyzed. Statistical analysis Statistical analyses were made using IBM SPSS (Version 26). Mean substitution was used for missing questionnaire data ( n = 2 for each group). N = 3 women with OW dropped out after diagnostic assessment. One participant (first paradigm) and three participants (second paradigm) were excluded due to technical problems. Box plot analyses outlined by SPSS detected n = 1 outliers for each group for paradigm 1 and n = 1 women with OW resp. n = 2 women with NW for paradigm 2. Hypotheses of paradigm 1 were tested by means of a 2 (Group) ×2 (Body Part) x2 (Body) repeated-measures ANOVA for relative fixation time. A bias score (= fixation time most beautiful/ ugliest body part) for each body was used to calculate Pearson product-moment correlations. For Paradigm 2, three 2 (Group) x2 (Stimulus Combination) x2 (Cue) repeated-measures ANOVAs were used. Post-hoc ANOVAS and t-tests with Bonferroni correction for multiple testing were applied. If assumption of sphericity was not met (Mauchly’s Sphericity Test: p < 0.05), Greenhouse-Geisser correction was applied. Effect sizes of the ANOVAs are reported by partial eta squared (small: η p ² = 0.01; moderate: η p ² = 0.06;large: η p ² = 0.14) and for t-tests by Cohen’s d (small: d = 0.02; moderate: d = 0.5 large: d = 0.8;23). [1] Note: The presented unbalanced sample size is due to the accompanying RCT. Homogeneity of variance was therefore tested and if not given, non-parametric tests were applied [see Statistics]. [2] Prior to testing, participants were told a cover story [assessment of changes in pupil dilatation as an indicator of emotional arousal]. Results Paradigm 1 Relative Fixation Time : The 2 (Group: OW vs. NW) ×2 (Body: self-body vs. control body) ×2 (Body Part: most beautiful vs. ugliest) ANOVA revealed a significant main effect of Body Part [ F (1,118) = 78.026, p < .001, η p ² = .398), a significant Group × Body Part interaction [ F (1,118) = 28.615, p < .001, η p ² = .195) and a significant Body Part × Body interaction [ F (1,118) = 35.571, p < .001, η p ² = .232). All other effects were not significant [all F s(1,118) ≤ 1.734, p s ≥ .191, η p ² s ≤ 0.14]. Post-hoc t-tests separated for Group (see Fig. 2 ) showed, that women with OW spent more time looking at the ugliest compared to the most beautiful body part [ t (76) = 11.913, p < .001, d = 1.33], while women with NW showed a balanced viewing pattern [ t (42) = 2.153, p = .074, d = 0.296; see Fig. 2 ]. Questionnaires: For the PANAS, a significant main effect of Group [ F (1,117) = 25.604 p < .001, η p ² = .180], Time [ F (1,117) = 15.192, p < .001, η p ² = .115] and a significant interaction [ F (1,117) = 34.148, p < .001, η p ² = .226] were found. Post-hoc t-tests showed a decrease in negative affect in women with NW [ t (42) = 3.479, p = .001, d = 0.639] and an increase in women with OW [ t (75) = -6.635, p < .001, d = 1.315]. The same pattern was found for the BISS [Group: F (1,121) = 176.630, p < .001, η p ² = .593; Time: F (1,121) = 57.840, p < .001, η p ² = .323; Group × Time: F (1,121) = 15.462, p < .001, η p ² = .113]. Post-hoc t-tests revealed a significant decrease in body satisfaction over time, albeit stronger in women with OW [OW: t (78) = 8.982, p < .001, d = 1.121; NW: t (43) = 2.697, p = .020, d = 0.464]. Correlations : The bias score for the self-body was significantly correlated with the beauty rating of the self-body ( r = .432; p < .001), not the control body ( r = .172; p = .066). Significant correlations between changes in state body satisfaction and the bias score of the self-body ( r = .191; p = .042) and the control body ( r = .223; p = .017) were found. The same result pattern emerged for changes in mood (self-body: r = .276; p = .003; control body: r = .224; p = .017). Paradigm 2 Self-Body vs. vase : The 2 (Group: OW vs. NW) × 2 (Stimulus: self-body vs. VASE) × 2 (Cue: cue-condition vs. no-cue condition( ANOVA for the frequency of the first fixation revealed only a significant main effect of Stimulus [ F (1,117) = 287.801, p < .001, η p ² = .711; all other F s(1,117) ≤ 2.220, p s ≥ .139, η p ² s ≤ .019]. More first fixations were directed towards the self-body compared to the object. Control Body vs. vase : The same result pattern was found for this combination [Stimulus: F (1,118) = 255.831, p < .001, η p ² = .684; all other F s(1,118) ≤ 1.745, p s ≥ .189, η p ² s ≤ .015]. Self-Body vs. Control Body: A significant main effect of Stimulus [ F (1,116) = 7.549, p = .007, η p ² = .061] and a significant Cue × Stimulus × Group interaction were found [ F (1,116) = 7.274, p = .008, η p ² = .059; all other F s(1,116) ≤ 3.556, p s ≥ .062, η p ² s ≤ .030]. Post-hoc ANOVAs separated for Group revealed no significant effects for women with NW [all F s(1,41) ≤ 1.250, p s ≥ .270, η p ² s ≤ .030]. For women with OW, there was no main effect of Cue [ F (1,75) = 2.626, p = .109, η p ² = .034], but a significant main effect of Stimulus [ F (1,75) = 9.652, p = .003, η p ² = .114] and a Stimulus × Cue interaction [ F (1,75) = 13.383, p < .001, η p ² = .151]. Follow-up t-tests revealed a higher number of first fixations towards the self-compared to the control body [ t (75) = 4.363, p < .001, d = 0.500] in the cued condition, but not in the no-cue condition [ t (75) = 0.083, p = .934, d = 0.010; see Fig. 3 ]. Correlations: There was a negative correlation between the fixation frequency on the self-body in the cued condition and the perceived beauty rating of the self-body ( r = − .204; p = .027), but not with the control body ( r = − .143; p = .123). Discussion As biased information processing is theorized to be involved in the maintenance of body dissatisfaction [ 5 ], the aim of the present study was to investigate attentional processing of body pictures in women with overweight and obesity without an eating disorder compared to women with normal weight. As hypothesized, women with overweight and obesity displayed a negative bias towards the ugliest compared to the most beautiful body part, whereas women with normal weight showed a balanced viewing pattern. This is in line with previous studies in overweight and obesity [ 9 , 10 ] and in eating disorders [ 6 , 7 ]. The negative attentional bias has been related to body dissatisfaction [ 24 ], eating pathology [ 25 ], higher BMI and lower attractiveness ratings of one’s own body [ 26 ] in previous studies, all of these variables were significantly higher in the OW compared to the NW group in the present study. Interestingly, women with overweight and obesity not only explored their own, but also the control body in a deficit-oriented manner, which replicates findings of a recent study [ 27 ]. This deficit-oriented viewing pattern might be closely linked to the negative cultural views on obesity, [e.g. weight stigmatization] which are also internalized by the devalued subgroup itself [ 28 , 29 ] and play a prominent role in the etiology of body dissatisfaction [ 30 ]. Concerning the second paradigm, initial attentional orientation differed significantly between the groups: while participants with normal weight equally distributed their first fixation towards both bodies, women with overweight and obesity showed a preferred attention allocation towards their own body, but only during intentional processing. As in both groups, participants’ attention was captured by the body pictures in trials including the object, we can interpret this finding as a prioritized processing of one’s own rather than an avoidance of the control body. Hence, the hypervigilance found for one’s own body is of clinical relevance and presumably results from top-down processes involving the activation of underlying negative body-related self-schemata. This finding corroborates studies from eating disorder research [ 34 ] and a recent study in women with high body image concerns [ 32 ]. The latter found a significant correlation between the hypervigilance towards one’s own body and the tendency to evaluate the self-body as less attractive than a control body [ 32 ]. This self-deprecating discrepancy was also evident in the present sample. As the beauty rating of the self-body correlated significantly with the preferred processing of one’s own body, these variables might contribute to the emotional relevance of one’s own body for women with overweight and obesity [ 33 , 34 ]. To sum up, the present study provides evidence that women with overweight and obesity preferentially attend to and explore their own body in a deficit-oriented manner. As individuals with overweight and obesity show a reduced disengagement from obese compared to thin bodies [ 35 ], initial orientation towards one’s own body might start a vicious circle of deficit-oriented attention towards one’s own body. According to cognitive theories [ 5 ], this might contribute to the maintenance of negative body-related schemata. This assumption is supported by the self-reported deteriorations in negative mood and state body dissatisfaction following the paradigms and the significant correlations of these variables with the deficit-oriented attentional bias. As first experimental studies confirm the causal link between attentional biases and body dissatisfaction [ 36 ], future studies should examine whether these dysfunctional attentional biases are modifiable and whether such modifications improve body satisfaction in obesity. Strengths And Limitations The present study was able to provide a thorough insight into attentional processing of body pictures in women with overweight and obesity using an experimental approach and addressing limitation of previous studies (e.g., non-body control stimulus, normal weight controls, etc.). However, there are several limitations. First, a counterbalanced approach should be used, as familiarity with the pictures might have influenced results. Second, the external validity of our stimuli is limited as only static black-and-white pictures were used. Future studies should include colorful pictures or the confrontation with one’s own body in virtual reality or in vivo [ 37 , 38 ]. Third, during the second paradigm, we tried to disentangle automatic and intentional processing of body images by giving information about the localization. Even though, we were able to show differences in processing, other paradigms including one’s own body as task-irrelevant stimulus (e.g., visual probe task) might be more suitable to tap into bottom-up processing. To sum up, our results point towards a self-focused, deficit-oriented exploration of one’s own body in women with overweight and obesity without an eating disorder that might contribute to the maintenance of body dissatisfaction. As body dissatisfaction negatively influences psychological well-being and weight loss success [ 39 ], targeting these attentional biases might help to enhance obesity treatment outcomes. Declarations The authors received no funding for this study. The authors have no relevant financial or non-financial interests to disclose. The datasets of the current study are available from the corresponding author on reasonable request This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University of Tuebingen (614/2015BO2; 11.01.2016). Informed consent was obtained from all individual participants included in the study. Author Contributions : All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Julia Baur and Kerstin Krohmer. The first draft of the manuscript was written by Julia Baur and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. References Weinberger N, Kersting A, Riedel-Heller SG, Luck-Sikorski C (2016) Body image dissatisfaction in individuals with obesity compared to normal-weight individuals: A systematic review and meta-analysis. Obes Facts [Internet]. ;9:242. Available from: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L72316175%5 Cnhttp://dx.doi.org/10.1159/000446744 Jansen A, Vanreyten A, van Balveren T, Roefs A, Nederkoorn C, Havermans R Negative affect and cue-induced overeating in non-eating disordered obesity. Appetite [Internet]. 2008 Nov [cited 2015 Sep 9];51[3]:556–62. Available from: http://www.sciencedirect.com/science/article/pii/S0195666308001463 Haines J, Neumark-Sztainer D, Wall M, Story M (2007) Personal, behavioral, and environmental risk and protective factors for adolescent overweight. Obesity 1511:2748–2760 Legenbauer T, Vocks S, Betz S, Puigcerver MJB, Benecke A, Troje NF et al (2011) Differences in the nature of body image disturbances between female obese individuals with versus without a comorbid binge eating disorder: An exploratory study including static and dynamic aspects of body image. Behav Modif [Internet]. ;35[2]:162–86. Available from: https://doi.org/10.1177/0145445510393478 Williamson DA, White MA, York-Crowe E, Stewart TM (2004) Cognitive-Behavioral Theories of Eating Disorders. Behav Modif [Internet]. ;28[6]:711–38. Available from: http://bmo.sagepub.com/cgi/doi/10.1177/0145445503259853 Kerr-Gaffney J, Harrison A, Tchanturia K (2019) Eye-tracking research in eating disorders: A systematic review.International Journal of Eating Disorders. Jiang MYW, Vartanian LR (2018) A review of existing measures of attentional biases in body image and eating disorders research. Aust J Psychol 701:3–17 Svaldi J, Caffier D, Tuschen-Caffier B (2011) Automatic and intentional processing of body pictures in binge eating disorder. Psychother Psychosom 811:52–53 Svaldi J, Caffier D, Tuschen-Caffier B (2011) Attention to ugly body parts is increased in women with binge eating disorder. Psychother Psychosom 803:186–188 Gardner R, Morrell J, Watson D, Sandoval S (1990) Eye Movements and Body Size Judgements in the Obese. Int J Eat Disord 95:537–544 Warschburger P, Calvano C, Richter EM, Engbert R (2015) Analysis of attentional bias towards attractive and unattractive body regions among overweight males and females: An Eye-Movement Study. PLoS One [Internet]. ;10[10]:1–17. Available from: http://dx.doi.org/10.1371/journal.pone.0140813 Jansen A, Havermans R, Nederkoorn C, Roefs A Jolly fat or sad fat? Subtyping non-eating disordered overweight and obesity along an affect dimension. Appetite [Internet]. 2008 Nov [cited 2015 Sep 9];51[3]:635–40. Available from: http://www.sciencedirect.com/science/article/pii/S0195666308004844 WHO. Physical status: the use and interpretation of anthrpometry [Internet] (1995) p. 1–463. Available from: http://www.who.int/childgrowth/publications/physical_status/en/ Ogden CL, Fakhouri TH, Carroll MD, Hales CM, Fryar CD, Li X et al (2017) Prevalence of obesity among adults, by household income and education — United States, 2011–2014. Morb Mortal Wkly Rep 6650:1369–1373 Trampe D, Stapel DA, Siero FW (2007) On models and vases: Body dissatisfaction and proneness to social comparison effects. J Pers Soc Psychol 921:106–118 Pook M, Tuschen-Caffier B, Stich N (2002) Evaluation des Fragebogens zum Figurbewusstsein [FFB, deutsche version des Body Shape Questionnaire]. Verhaltenstherapie 122:116–124 Hautzinger M, Keller F, Kühner C (2006) Das Beck Depressionsinventar II. Deutsche Bearbeitung und Handbuch zum BDI II. Harcourt Test Services, Frankfurt Krohne HW, Egloff B, Kohlmann C-W, Tausch A (1996) Unterscuhungen mit einer deutschen Verion der “Positive and Negative Affect Schedule” [PANAS]. Diagnostica. Cash TF, Fleming T, Alindogan J, Steadman L, Whitehead A (2002) Beyond body image as a trait: The development and validation of the Body Image States Scale. Eat Disord 102:103–113 Hilbert A, Tuschen-Caffier B (2006) Eating Disorder Examination. Deutschsprachige Übersetzung. [Internet]. Available from: http://www.vpf-muenster.de/publikationen/online/EDE_VfP_1.pdf Wittchen H-U, Zaudig M, Fydrich T, SKID-I/II (1997) Strukturiertes Klinisches Interview für DSM-IV. Deutsche Version. Beltz Verlag, Weinheim Gao X, Li X, Yang X, Wang Y, Jackson T, Chen H (2013) I can’t stop looking at them: Interactive effects of body mass index and weight dissatisfaction on attention towards body shape photographs. Body Image [Internet]. ;10[2]:191–9. Available from: http://dx.doi.org/10.1016/j.bodyim.2012.12.005 Cohen J (1988) Statistical power analysis for the behavioral sciences. 2nd editio. Hilssdale, New Jersey: Erlbaum; Rodgers RF, DuBois RH (2016) Cognitive biases to appearance-related stimuli in body dissatisfaction: A systematic review. Clin Psychol Rev [Internet]. ;46:1–11. Available from: http://dx.doi.org/10.1016/j.cpr.2016.04.006 Jansen A, Nederkoorn C, Mulkens S (2005) Selective visual attention for ugly and beautiful body parts in eating disorders. Behav Res Ther 432:183–196 Roefs A, Jansen A, Moresi S, Willems P, van Grootel S, van der Borgh A (2008) Looking good. BMI, attractiveness bias and visual attention. Appetite 513:552–555 Leehr E, Giel KE, Schaeffeler N, Thiel A, Zurstiege G, Zipfel S et al (2018) Where Do You Look ? Visual Attention to Human Bodies across the Weight Spectrum in Individuals with Normal Weight or with Obesity. ;277–86 Baur J, Schmitz F, Naumann E, Svaldi J (2021) Implicit attitudes towards weight, one’s own body and its relation to food in women with overweight and obesity.Cognit Ther Res. ;1–12 Pearl RL, Puhl RM (2018) Weight bias internalization and health: a systematic review. Obes Rev 198:1141–1163 Puhl RM, Himmelstein MS, Pearl RL (2020) Weight stigma as a psychosocial contributor to obesity. Am Psychol 752:274–289 Kerr-Gaffney J, Harrison A (2019) Eye-tracking research in eating disorders: A systematic review. Int J Eat Disord 52:3–27 Voges MM, Giabbiconi CM, Gruber T, Andersen SK, Hartmann AS, Vocks S Sustained hypervigilance for one’s own body in women with weight and shape concerns: Competition effects in early visual processing investigated by steady-state visual evoked potentials [SSVEP]. Biol Psychol [Internet]. 2019;143[August 2018]:74–84. Available from: https://doi.org/10.1016/j.biopsycho.2019.02.010 Baur J, Krohmer K, Naumann E, Tuschen-Caffier B, Svaldi J (2020) Vocal arousal: a physiological correlate of body distress in women with overweight and obesity. Eat Weight Disord - Stud Anorexia, Bulim Obes [Internet]. Jul 23 [cited 2019 Sep 12];25[5]:1161–1169. Available from: http://link.springer.com/ 10.1007/s40519-019-00744-2 Calvo MG, Lang PJ (2004) Gaze patterns when looking at emotional pictures: Attention and affect. Motiv Emot 283:221–243 Lyu Z, Zheng P, Wang Z (2019) Time Course of Attentional Biases Toward Body Shapes in Women Who Are Overweight or Obese. Cognit Ther Res [Internet]. ;43[3]:594–602. Available from: http://dx.doi.org/10.1007/s10608-018-9978-6 Smeets E, Jansen A, Roefs A (2011) Bias for the [un]attractive self: on the role of attention in causing body [dis]satisfaction. Health Psychol 303:360–367 Tuschen-Caffier B, Bender C, Caffier D, Braks K, Klenner K, Svaldi J (2015) Selective visual attention during mirror exposure in anorexia and bulimia nervosa.PLoS One. Porras-Garcia B, Ferrer‐Garcia M, Ghita A, Moreno M, López‐Jiménez L, Vallvé‐Romeu A et al The influence of gender and body dissatisfaction on body‐related attentional bias: An eye‐tracking and virtual reality study. Int J Eat Disord. 2019;[November 2018]:1181–90 Teixeira PJ, Silva MN, Coutinho SR, Palmeira AL, Mata J, Vieira PN et al (2009) Mediators of Weight Loss and Weight Loss Maintenance in Middle-aged Women. Obesity [Internet]. ;18[4]:725–35. Available from: http://dx.doi.org/10.1038/oby.2009.281 Tables Table 1 Descriptive characteristics for women with overweight and obesity (OW) and normal weight controls (NW). OW [ n = 82] NW [ n = 44] Statistics Frequency n [%] Frequency n [%] Education level a χ 2 [1] = 4.707* low high 45 [54.9%] 37 [45.1%] 14 [31.8%] 27 [63.6%] Marital status a χ 2 [2] = 1.451 with partner single widowed/divorced SCID I diagnosis no yes SCID II diagnosis b no yes 49 [59.8%] 26 [31.7%] 7 [8.5%] 45 [54.9%] 37 [45.1%] 57 [69.5%] 21 [25.6%] 29 [65.9%] 9 [20.5%] 4 [9.1%] 34 [77.3%] 10 [22.7%] 44 [100%] 0 [0%] χ 2 [1] = 6.140* χ 2 [1] = 14.309** M [SD] M [SD] Age [years] 40.7 [15.9] 37.9 [9.7] F [1,124] = 1.166 BMI 31.7 [4.7] 21.8 [1.6] F [1,124] = 185.518** BDI 9.6 [8.1] 2.4 [4.4] F [1,124] = 30.270** EDE global 1.7 [0.8] 0.2 [0.3] F [1,124] = 155.649** BSQ 103.0 [27.8] 47.2 [15.5] F [1,124] = 151.635** OW [ n = 79] NW [ n = 44] M [SD] M [SD] Paradigm 1 – Questionnaire Data PANASneg c t0 1.39 [0.40] 1.27 [0.34] t1 1.92 [0.80] 1.17 [0.24] BISS t0 3.60 [1.29] 6.38 [1.10] t1 2.57 [1.51] 6.10 [1.33] Perceived Beauty - SB 2.83 [0.69] 4.53 [0.82] Perceived Beauty - CB 3.42 [0.79] 4.55 [0.79] Paradigm 2 – Frequency of first fixations d Self-Body Vase Self-Body Vase Cue Condition 5.9 [1.2] 2.1 [1.2] 5.9 [1.4] 2.1 [1.4] No Cue Condition 5.8 [1.3] 2.2 [1.3] 5.9 [1.3] 2.0 [1.3] Control Body Vase Control Body Vase Cue Condition 5.8 [1.4] 2.2 [1.4] 5.7 [1.4] 2.2 [1.3] No Cue Condition 5.7 [1.3] 2.3 [1.3] 5.9 [1.4] 2.0 [1.3] BDI = Beck Depression Inventory; BMI = Body Mass Index; BSQ = Body Shape Questionnaire; BISS = Body Image State Scale; CB = control body; EDE = Eating Disorder Examination; educational level: low ≤ secondary school; high = baccalaureate or university degree. PANASneg = negative affect subscale of the Positive and Negative Affect Scale; S B = self-body; t0 = prior to Paradigm 1, t1 = after Paradigm 1. * p < .05; ** p < .001. a n = 42 in the NW group due to missing data b n = 78 in the OW group due to missing data c n = 76 women with OW and n = 43 women with NW due to outlier analysis d n = 76 women with OW [resp. n = 75 for combination self-body – vase] due to outlier analysis Supplementary Files Supplements.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 28 Mar, 2022 Reviewers invited by journal 28 Mar, 2022 Editor assigned by journal 25 Mar, 2022 First submitted to journal 24 Mar, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1486031","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":94239489,"identity":"3fe9797e-9fea-4274-9ffa-08f94283a552","order_by":0,"name":"Julia Baur","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0002-5218-7757","institution":"Eberhard Karls Universitat Tubingen","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Julia","middleName":"","lastName":"Baur","suffix":""},{"id":94239490,"identity":"8184ef2f-27af-4303-90f3-395cbd3ab4be","order_by":1,"name":"Kerstin Krohmer","email":"","orcid":"","institution":"Eberhard Karls Universität Tübingen Mathematisch-Naturwissenschaftliche Fakultät: Eberhard Karls Universitat Tubingen Mathematisch-Naturwissenschaftliche Fakultat","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kerstin","middleName":"","lastName":"Krohmer","suffix":""},{"id":94239491,"identity":"523bf34c-285e-40ac-a101-30825f961d73","order_by":2,"name":"Eva Naumann","email":"","orcid":"","institution":"Eberhard Karls Universität Tübingen Mathematisch-Naturwissenschaftliche Fakultät: Eberhard Karls Universitat Tubingen Mathematisch-Naturwissenschaftliche Fakultat","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Eva","middleName":"","lastName":"Naumann","suffix":""},{"id":94239492,"identity":"4f9ef8bb-2c1d-4b09-a3e5-bfa14a6f62c5","order_by":3,"name":"Jennifer Svaldi","email":"","orcid":"","institution":"Eberhard Karls Universitat Tubingen Fakultat fur Mathematik und Physik: Eberhard Karls Universitat Tubingen Mathematisch-Naturwissenschaftliche Fakultat","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jennifer","middleName":"","lastName":"Svaldi","suffix":""}],"badges":[],"createdAt":"2022-03-24 15:25:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1486031/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1486031/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":19793230,"identity":"4839d1f5-5066-46f5-a0ca-a0dfb14527ee","added_by":"auto","created_at":"2022-03-30 19:39:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":34440,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic illustration of the eye-tracking experiments\u003c/p\u003e","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-1486031/v1/84cf6f9c54e2f5c0677ae5f6.png"},{"id":19792993,"identity":"cb572d2b-be90-4fd6-909c-4b181c7eae38","added_by":"auto","created_at":"2022-03-30 19:34:25","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":10292,"visible":true,"origin":"","legend":"\u003cp\u003eMean and standard error for the relative fixation time on the ugliest and most beautiful body part in women with overweight and obesity (OW) and normal weight (NW)\u003c/p\u003e","description":"","filename":"fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-1486031/v1/b932caa1eecfbf44ed59c692.png"},{"id":19792994,"identity":"6eb25c6f-d766-418e-8183-6d3e794cd4bb","added_by":"auto","created_at":"2022-03-30 19:34:26","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":14655,"visible":true,"origin":"","legend":"\u003cp\u003eMean and standard error for the frequency of first fixations on the self and the control body in women with overweight and obesity (OW) and normal weight controls (NW)\u003c/p\u003e","description":"","filename":"fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-1486031/v1/416b02f7cf3b4310c12e32e7.png"},{"id":19793231,"identity":"9f570fd1-99cf-4ebd-8722-ca785d519cad","added_by":"auto","created_at":"2022-03-30 19:39:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":368054,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1486031/v1/107494e6-477c-4f0e-af39-896581ccdaf0.pdf"},{"id":19792996,"identity":"0ae39cc6-239e-464d-85c3-8082331bc320","added_by":"auto","created_at":"2022-03-30 19:34:26","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":13170,"visible":true,"origin":"","legend":"","description":"","filename":"Supplements.docx","url":"https://assets-eu.researchsquare.com/files/rs-1486031/v1/bdcc8fec16935421ac1f973e.docx"}],"financialInterests":"","formattedTitle":"Attentional processing of body images in women with overweight and obesity","fulltext":[{"header":"What Is Already Known About This Subject?","content":"\u003cul\u003e\n \u003cli\u003eAttentional biases play an important role in the maintenance of body dissatisfaction\u003c/li\u003e\n \u003cli\u003eFew studies have adressed this issue in overweight and obesity despite the negative impact body dissatisfaction has on psychological well-being and weight loss success in obesity\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eWhat this study adds?\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eSpecificagtion of attentional processes underlying body dissatisfaction in overweight and \u0026nbsp;obesity by using experimental eye-trakcing paradigms and adressing limitations of previous studies [e.g. including an inanimate control object]\u003c/li\u003e\n \u003cli\u003eDemonstrating the clinical relevance of these attentional biases by including a control group\u003c/li\u003e\n \u003cli\u003eThe identified processes might be used in interventions to improve body dissatisfaction.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eBody dissatisfaction is markedly increased in individuals with overweight and obesity compared to normal weight persons [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Besides negative consequences on emotional well-being, numerous studies confirm the importance of body dissatisfaction for the etiology and maintenance of overweight which is why the integration of body image interventions in obesity treatment is discussed [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, to effectively improve body dissatisfaction, a thorough understanding of the underlying mechanisms is warranted.\u003c/p\u003e \u003cp\u003eAccording to cognitive-behavioral theories, increased body dissatisfaction results from and is maintained by dysfunctional body-related schemata, which distort different mental processes like e.g., memory, interpretation, and attention [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, two attentional biases have consistently been reported in individuals with eating disorders or high in body dissatisfaction: (I) a preferential processing of one\u0026rsquo;s own compared to a concurrently presented control body and (II) a negative bias towards subjectively disliked body parts [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, only few studies have addressed these biases in overweight and obesity. Only one study so far has confirmed the preferential processing of one\u0026rsquo;s own body in obesity during intentional processing [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Processing of the pictures were manipulated by either giving information on which side which stimulus would appear (top-down) or not [bottom-up; 10]. Yet, a normal weight control group is missing to determine the clinical relevance of this bias in obesity. Second, it is unclear if the hypervigilance towards one\u0026rsquo;s own body results from an increased preference of the self or an avoidance of the control body. If the effect is driven by a prioritized processing of one\u0026rsquo;s own body, the latter should be preferred irrespective of whether a control body or object is present; if avoidance of the control body causes the hypervigilance, this avoidance should also be present during pairings with a control object.\u003c/p\u003e \u003cp\u003eConcerning selective visual attention, two studies confirm the reported deficit-oriented gaze pattern in overweight and obesity [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], while another reported an attentional bias towards attractive body parts [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. These contradicting results are difficult to integrate due to methodological differences [e.g., different definition of fixation duration]. Furthermore, significant sample characteristics like body dissatisfaction are missing which might however be crucial for subtyping individuals with overweight [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Hence, the evaluation of body-related attentional biases among those seeking treatment for body image is especially warranted.\u003c/p\u003e \u003cp\u003eTaken together, evidence concerning attentional biases in individuals with overweight leaves several issues unanswered. Thus, the present study investigates attention allocation to specific body parts as well as attentional processing of concurrently presented (body) stimuli in treatment-seeking women with overweight and obesity (OW) compared to women with normal weight (NW). It is hypothesized, that relative to women with NW, treatment-seeking women with OW display a stronger attentional bias towards the self-rated ugliest compared to the most beautiful body part. For the second paradigm, we hypothesized that only during intentional processing, women with OW would show a preferred attention allocation towards one\u0026rsquo;s own body compared to the control body and object relative to women with NW.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cdiv class=\"Section2\" id=\"Sec3\"\u003e\n \u003ch2\u003eParticipants\u003c/h2\u003e\n \u003cp\u003eThe present study was approved by the local ethics committee [614/2015BO2]. Inclusion criteria were (a) 18\u0026thinsp;\u0026le;\u0026thinsp;age\u0026thinsp;\u0026le;\u0026thinsp;69 years, (b) female gender, (c) corrected/normal vision, (d) fluent in German, and (e) no diagnosis of an eating disorder. Women with OW had to have a Body Mass Index [BMI] of \u0026ge;\u0026thinsp;25 and women with NW between 18.5\u0026thinsp;\u0026le;\u0026thinsp;BMI\u0026thinsp;\u0026lt;\u0026thinsp;25 [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. Exclusion criteria were (a) current presence of psychosis, suicidal ideation, manic episode, substance abuse or irregular intake of antidepressants, (b) pregnancy/lactation period, (c) borderline personality disorder, and (d) participation in eating- and weight-related interventions.\u003c/p\u003e\n \u003cp\u003eAn a-priori calculated power analysis (f = .035, \u0026alpha; = 0.05, power of 0.90) resulted in a total sample size of \u003cem\u003en\u0026nbsp;\u003c/em\u003e= 88 (44/ group). \u003cem\u003eN\u003c/em\u003e = 82 women with OW and \u003cem\u003en\u003c/em\u003e = 44 women with NW participated in the study[1]. The presented results are part of a baseline assessment prior to an RCT on body image interventions (results will be presented elsewhere). The groups did not differ on age and marital status, however, education level was lower in OW [e.g. 18]. As expected, women with OW had higher scores on psychopathological variables (see Table 1).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eStimuli\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eDigitized black-and-white photos of one\u0026rsquo;s own body (self-body) and a BMI-and waist-to-hip-matched control body were used. Photos were taken in standardized positions (front, back, left side, right side; face omitted) in standardized underwear (nude panty and top). For the second paradigm, a drawing of an inanimate object (vase) served as control stimulus [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEye Tracking Paradigms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEye-movements were measured using a desktop-mounted, video-based infrared remote eye-tracking system (RED250; angular resolution: \u0026le;0.5\u0026deg;; temporal resolution: 250Hz) equipped with iViewXTM2 software (SensoMotoric Instruments).\u003c/p\u003e\n\u003cp\u003eAfter a 9-point calibration to ensure gaze accuracy, pictures of the self-body and control body were presented in a free-viewing task with two blocks each including 16 trials in the first paradigm. In each block, every perspective of every stimulus was presented twice (left/right side) for 8 sec.\u003c/p\u003e\n\u003cp\u003eThe second paradigm consisted of two blocks each including 48 trials \u0026agrave; 3 sec with 16 trials of each picture pair per block with counterbalanced stimulus location (self-body vs. control-body; self-body vs. vase; control-body vs. vase). Half of the trials were cued with information on which side which stimulus would appear (e.g.,\u0026ldquo;Your own body will be on the right side, the vase on the left side\u0026rdquo;), while the other half was not cued (e.g.,\u0026ldquo;You will see your own body and the vase\u0026rdquo;; see Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"Section2\" id=\"Sec6\"\u003e\n \u003ch2\u003eQuestionnaires and Interviews\u003c/h2\u003e\n \u003cp\u003e(1) Body dissatisfaction was assessed using the Body Shape Questionnaire [BSQ; 21] with higher scores reflecting higher body dissatisfaction (Cronbach\u0026rsquo;s \u0026alpha;\u0026thinsp;=\u0026thinsp;.98 in the present sample]). (2) The BDI-II [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e] was used to assess depressive symptoms over the last two weeks (\u0026alpha;\u0026thinsp;=\u0026thinsp;.91). (3) The Positive and Negative Affect Scale [PANAS; 23] was used to assess negative affect prior to and after the first paradigm (\u0026alpha;\u0026thinsp;=\u0026thinsp;.85 prior to [t0] and \u0026alpha;\u0026thinsp;=\u0026thinsp;.92 after the experiment [t1]). (4) The Body Image State Scale [BISS; 24] assesses the evaluative experience of one\u0026rsquo;s own body with higher scores reflecting more favorable states (\u0026alpha;\u0026thinsp;=\u0026thinsp;.90 [t0]; \u0026alpha;\u0026thinsp;=\u0026thinsp;.96 [t1]) [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e] After the paradigms, participants saw printed versions of the self and control body and indicated the perceived beauty of ten specified body parts (shoulders, cleavage, arms, hands, breast, back, buttocks, stomach, hips, thighs) on a 6-point Likert sale (\u003cem\u003e1\u003c/em\u003e\u0026thinsp;=\u0026thinsp;ugly; \u003cem\u003e6\u003c/em\u003e\u0026thinsp;=\u0026thinsp;beautiful) to calculate a mean score for the overall beauty. Furthermore, participants self-reported their subjectively rated most beautiful and ugliest body part for both bodies (see \u003cem\u003eSupplementary Material\u003c/em\u003e for more details).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eProcedure\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eParticipants were recruited via announcements in the local press, flyers, and the university\u0026rsquo;s mailing list. Trained psychologists performed a diagnostic assessment including the Eating Disorder Examination Interview [EDE; 16] and the Structured Clinical Interview for Mental Disorders [SCID, 17].\u003c/p\u003e\n\u003cp\u003eInformed written consent was obtained, relevant questionnaires (BSQ, BDI-II) were filled in via Unipark. On a separate day, body pictures were taken. Next, an appointment for the two eye-tracking paradigms was scheduled. Prior to and after the first paradigm, participants filled in the PANAS and BISS. At the end, participants saw printed versions of the self and control body to rate and rank the above-mentioned body parts. Afterwards, women with NW were reimbursed and debriefed concerning the study\u0026rsquo;s rationale[2], while another appointment was scheduled with women with OW participating in the RCT.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eData processing\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eA fixation was defined as maintaining visual gaze for \u0026ge;\u0026thinsp;100ms [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. For the first paradigm, Areas of Interests [AOIs] were defined in BeGaze 3.7 (SMI) separately for each participant [ugliest/most beautiful body part]. Relative fixation time on the relevant AOI compared to the overall fixation time on the body of all trials including this AOI were calculated. For the second paradigm, the frequency of the direction of the first fixation was analyzed.\u003c/p\u003e\n\u003cdiv class=\"Section2\" id=\"Sec9\"\u003e\n \u003ch2\u003eStatistical analysis\u003c/h2\u003e\n \u003cp\u003eStatistical analyses were made using IBM SPSS (Version 26). Mean substitution was used for missing questionnaire data (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2 for each group). \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3 women with OW dropped out after diagnostic assessment. One participant (first paradigm) and three participants (second paradigm) were excluded due to technical problems. Box plot analyses outlined by SPSS detected \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1 outliers for each group for paradigm 1 and \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1 women with OW resp. \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2 women with NW for paradigm 2.\u003c/p\u003e\n \u003cp\u003eHypotheses of paradigm 1 were tested by means of a 2 (Group) \u0026times;2 (Body Part) x2 (Body) repeated-measures ANOVA for relative fixation time. A bias score (=\u0026thinsp;fixation time most beautiful/ ugliest body part) for each body was used to calculate Pearson product-moment correlations. For Paradigm 2, three 2 (Group) x2 (Stimulus Combination) x2 (Cue) repeated-measures ANOVAs were used.\u003c/p\u003e\n \u003cp\u003ePost-hoc ANOVAS and t-tests with Bonferroni correction for multiple testing were applied. If assumption of sphericity was not met (Mauchly\u0026rsquo;s Sphericity Test: p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), Greenhouse-Geisser correction was applied. Effect sizes of the ANOVAs are reported by partial eta squared (small: \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003ep\u003c/sub\u003e\u0026sup2; = 0.01; moderate: \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003ep\u003c/sub\u003e\u0026sup2; = 0.06;large: \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003ep\u003c/sub\u003e\u0026sup2; = 0.14) and for t-tests by Cohen\u0026rsquo;s d (small: \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02; moderate: \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.5 large: d\u0026thinsp;=\u0026thinsp;0.8;23).\u003c/p\u003e\n \u003cp\u003e[1] Note: The presented unbalanced sample size is due to the accompanying RCT. Homogeneity of variance was therefore tested and if not given, non-parametric tests were applied [see Statistics].\u003c/p\u003e\n \u003cp\u003e[2] Prior to testing, participants were told a cover story [assessment of changes in pupil dilatation as an indicator of emotional arousal]. \u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv class=\"Section2\" id=\"Sec11\"\u003e\n \u003ch2\u003eParadigm 1\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eRelative Fixation Time\u003c/strong\u003e: The 2 (Group: OW vs. NW) \u0026times;2 (Body: self-body vs. control body) \u0026times;2 (Body Part: most beautiful vs. ugliest) ANOVA revealed a significant main effect of Body Part [\u003cem\u003eF\u003c/em\u003e(1,118)\u0026thinsp;=\u0026thinsp;78.026, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e = .398), a significant Group \u0026times; Body Part interaction [\u003cem\u003eF\u003c/em\u003e(1,118)\u0026thinsp;=\u0026thinsp;28.615, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e = .195) and a significant Body Part \u0026times; Body interaction [\u003cem\u003eF\u003c/em\u003e(1,118)\u0026thinsp;=\u0026thinsp;35.571, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e = .232). All other effects were not significant [all \u003cem\u003eF\u003c/em\u003es(1,118)\u0026thinsp;\u0026le;\u0026thinsp;1.734, \u003cem\u003ep\u003c/em\u003es\u0026thinsp;\u0026ge;\u0026thinsp;.191, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003es\u0026thinsp;\u0026le;\u0026thinsp;0.14].\u003c/p\u003e\n \u003cp\u003ePost-hoc t-tests separated for Group (see Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e) showed, that women with OW spent more time looking at the ugliest compared to the most beautiful body part [\u003cem\u003et\u003c/em\u003e(76)\u0026thinsp;=\u0026thinsp;11.913, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.33], while women with NW showed a balanced viewing pattern [\u003cem\u003et\u003c/em\u003e(42)\u0026thinsp;=\u0026thinsp;2.153, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.074, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.296; see Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eQuestionnaires:\u0026nbsp;\u003c/strong\u003eFor the PANAS, a significant main effect of Group [\u003cem\u003eF\u003c/em\u003e(1,117)\u0026thinsp;=\u0026thinsp;25.604 \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e = .180], Time [\u003cem\u003eF\u003c/em\u003e(1,117)\u0026thinsp;=\u0026thinsp;15.192, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e = .115] and a significant interaction [\u003cem\u003eF\u003c/em\u003e(1,117)\u0026thinsp;=\u0026thinsp;34.148, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e = .226] were found. Post-hoc t-tests showed a decrease in negative affect in women with NW [\u003cem\u003et\u003c/em\u003e(42)\u0026thinsp;=\u0026thinsp;3.479, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.639] and an increase in women with OW [\u003cem\u003et\u003c/em\u003e(75) = -6.635, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.315].\u003c/p\u003e\n \u003cp\u003eThe same pattern was found for the BISS [Group: \u003cem\u003eF\u003c/em\u003e(1,121)\u0026thinsp;=\u0026thinsp;176.630, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e = .593; Time: \u003cem\u003eF\u003c/em\u003e(1,121)\u0026thinsp;=\u0026thinsp;57.840, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e = .323; Group \u0026times; Time: \u003cem\u003eF\u003c/em\u003e(1,121)\u0026thinsp;=\u0026thinsp;15.462, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e = .113]. Post-hoc t-tests revealed a significant decrease in body satisfaction over time, albeit stronger in women with OW [OW: \u003cem\u003et\u003c/em\u003e(78)\u0026thinsp;=\u0026thinsp;8.982, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.121; NW: \u003cem\u003et\u003c/em\u003e(43)\u0026thinsp;=\u0026thinsp;2.697, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.020, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.464].\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelations\u003c/strong\u003e: The bias score for the self-body was significantly correlated with the beauty rating of the self-body (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.432; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), not the control body (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.172; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.066). Significant correlations between changes in state body satisfaction and the bias score of the self-body (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.191; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.042) and the control body (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.223; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.017) were found. The same result pattern emerged for changes in mood (self-body: \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.276; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.003; control body: \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.224; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.017).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eParadigm 2\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eSelf-Body vs. vase\u003c/strong\u003e: The 2 (Group: OW vs. NW) \u0026times; 2 (Stimulus: self-body vs. VASE) \u0026times; 2 (Cue: cue-condition vs. no-cue condition( ANOVA for the frequency of the first fixation revealed only a significant main effect of Stimulus [\u003cem\u003eF\u003c/em\u003e(1,117)\u0026thinsp;=\u0026thinsp;287.801, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e = .711; all other \u003cem\u003eF\u003c/em\u003es(1,117)\u0026thinsp;\u0026le;\u0026thinsp;2.220, \u003cem\u003ep\u003c/em\u003es\u0026thinsp;\u0026ge;\u0026thinsp;.139, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003es\u0026thinsp;\u0026le;\u0026thinsp;.019]. More first fixations were directed towards the self-body compared to the object.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eControl Body vs. vase\u003c/strong\u003e: The same result pattern was found for this combination [Stimulus: \u003cem\u003eF\u003c/em\u003e(1,118)\u0026thinsp;=\u0026thinsp;255.831, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e = .684; all other \u003cem\u003eF\u003c/em\u003es(1,118)\u0026thinsp;\u0026le;\u0026thinsp;1.745, \u003cem\u003ep\u003c/em\u003es\u0026thinsp;\u0026ge;\u0026thinsp;.189, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003es\u0026thinsp;\u0026le;\u0026thinsp;.015].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelf-Body vs. Control Body:\u0026nbsp;\u003c/strong\u003eA significant main effect of Stimulus [\u003cem\u003eF\u003c/em\u003e(1,116)\u0026thinsp;=\u0026thinsp;7.549, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.007, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e = .061] and a significant Cue \u0026times; Stimulus \u0026times; Group interaction were found [\u003cem\u003eF\u003c/em\u003e(1,116)\u0026thinsp;=\u0026thinsp;7.274, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.008, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e = .059; all other \u003cem\u003eF\u003c/em\u003es(1,116)\u0026thinsp;\u0026le;\u0026thinsp;3.556, \u003cem\u003ep\u003c/em\u003es\u0026thinsp;\u0026ge;\u0026thinsp;.062, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003es\u0026thinsp;\u0026le;\u0026thinsp;.030]. Post-hoc ANOVAs separated for Group revealed no significant effects for women with NW [all \u003cem\u003eF\u003c/em\u003es(1,41)\u0026thinsp;\u0026le;\u0026thinsp;1.250, \u003cem\u003ep\u003c/em\u003es\u0026thinsp;\u0026ge;\u0026thinsp;.270, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003es\u0026thinsp;\u0026le;\u0026thinsp;.030]. For women with OW, there was no main effect of Cue [\u003cem\u003eF\u003c/em\u003e(1,75)\u0026thinsp;=\u0026thinsp;2.626, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.109, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e = .034], but a significant main effect of Stimulus [\u003cem\u003eF\u003c/em\u003e(1,75)\u0026thinsp;=\u0026thinsp;9.652, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.003, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e = .114] and a Stimulus \u0026times; Cue interaction [\u003cem\u003eF\u003c/em\u003e(1,75)\u0026thinsp;=\u0026thinsp;13.383, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e = .151]. Follow-up t-tests revealed a higher number of first fixations towards the self-compared to the control body [\u003cem\u003et\u003c/em\u003e(75)\u0026thinsp;=\u0026thinsp;4.363, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.500] in the cued condition, but not in the no-cue condition [\u003cem\u003et\u003c/em\u003e(75)\u0026thinsp;=\u0026thinsp;0.083, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.934, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010; see Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelations:\u0026nbsp;\u003c/strong\u003eThere was a negative correlation between the fixation frequency on the self-body in the cued condition and the perceived beauty rating of the self-body (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.204; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.027), but not with the control body (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.143; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.123).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAs biased information processing is theorized to be involved in the maintenance of body dissatisfaction [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], the aim of the present study was to investigate attentional processing of body pictures in women with overweight and obesity without an eating disorder compared to women with normal weight.\u003c/p\u003e \u003cp\u003eAs hypothesized, women with overweight and obesity displayed a negative bias towards the ugliest compared to the most beautiful body part, whereas women with normal weight showed a balanced viewing pattern. This is in line with previous studies in overweight and obesity [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and in eating disorders [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The negative attentional bias has been related to body dissatisfaction [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], eating pathology [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], higher BMI and lower attractiveness ratings of one\u0026rsquo;s own body [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] in previous studies, all of these variables were significantly higher in the OW compared to the NW group in the present study. Interestingly, women with overweight and obesity not only explored their own, but also the control body in a deficit-oriented manner, which replicates findings of a recent study [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This deficit-oriented viewing pattern might be closely linked to the negative cultural views on obesity, [e.g. weight stigmatization] which are also internalized by the devalued subgroup itself [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and play a prominent role in the etiology of body dissatisfaction [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConcerning the second paradigm, initial attentional orientation differed significantly between the groups: while participants with normal weight equally distributed their first fixation towards both bodies, women with overweight and obesity showed a preferred attention allocation towards their own body, but only during intentional processing. As in both groups, participants\u0026rsquo; attention was captured by the body pictures in trials including the object, we can interpret this finding as a prioritized processing of one\u0026rsquo;s own rather than an avoidance of the control body. Hence, the hypervigilance found for one\u0026rsquo;s own body is of clinical relevance and presumably results from top-down processes involving the activation of underlying negative body-related self-schemata. This finding corroborates studies from eating disorder research [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and a recent study in women with high body image concerns [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The latter found a significant correlation between the hypervigilance towards one\u0026rsquo;s own body and the tendency to evaluate the self-body as less attractive than a control body [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This self-deprecating discrepancy was also evident in the present sample. As the beauty rating of the self-body correlated significantly with the preferred processing of one\u0026rsquo;s own body, these variables might contribute to the emotional relevance of one\u0026rsquo;s own body for women with overweight and obesity [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo sum up, the present study provides evidence that women with overweight and obesity preferentially attend to and explore their own body in a deficit-oriented manner. As individuals with overweight and obesity show a reduced disengagement from obese compared to thin bodies [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], initial orientation towards one\u0026rsquo;s own body might start a vicious circle of deficit-oriented attention towards one\u0026rsquo;s own body. According to cognitive theories [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], this might contribute to the maintenance of negative body-related schemata. This assumption is supported by the self-reported deteriorations in negative mood and state body dissatisfaction following the paradigms and the significant correlations of these variables with the deficit-oriented attentional bias. As first experimental studies confirm the causal link between attentional biases and body dissatisfaction [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], future studies should examine whether these dysfunctional attentional biases are modifiable and whether such modifications improve body satisfaction in obesity.\u003c/p\u003e"},{"header":"Strengths And Limitations","content":"\u003cp\u003eThe present study was able to provide a thorough insight into attentional processing of body pictures in women with overweight and obesity using an experimental approach and addressing limitation of previous studies (e.g., non-body control stimulus, normal weight controls, etc.). However, there are several limitations. First, a counterbalanced approach should be used, as familiarity with the pictures might have influenced results. Second, the external validity of our stimuli is limited as only static black-and-white pictures were used. Future studies should include colorful pictures or the confrontation with one\u0026rsquo;s own body in virtual reality or in vivo [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Third, during the second paradigm, we tried to disentangle automatic and intentional processing of body images by giving information about the localization. Even though, we were able to show differences in processing, other paradigms including one\u0026rsquo;s own body as task-irrelevant stimulus (e.g., visual probe task) might be more suitable to tap into bottom-up processing.\u003c/p\u003e \u003cp\u003eTo sum up, our results point towards a self-focused, deficit-oriented exploration of one\u0026rsquo;s own body in women with overweight and obesity without an eating disorder that might contribute to the maintenance of body dissatisfaction. As body dissatisfaction negatively influences psychological well-being and weight loss success [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], targeting these attentional biases might help to enhance obesity treatment outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors received no funding for this study. The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003eThe datasets of the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University of Tuebingen (614/2015BO2; 11.01.2016). Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e: All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Julia Baur and Kerstin Krohmer. The first draft of the manuscript was written by Julia Baur and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eWeinberger N, Kersting A, Riedel-Heller SG, Luck-Sikorski C (2016) Body image dissatisfaction in individuals with obesity compared to normal-weight individuals: A systematic review and meta-analysis. Obes Facts [Internet]. ;9:242. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.embase.com/search/results?subaction=viewrecord\u0026amp;from=export\u0026amp;id=L72316175%5\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003eCnhttp://dx.doi.org/10.1159/000446744\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eJansen A, Vanreyten A, van Balveren T, Roefs A, Nederkoorn C, Havermans R Negative affect and cue-induced overeating in non-eating disordered obesity. Appetite [Internet]. 2008 Nov [cited 2015 Sep 9];51[3]:556\u0026ndash;62. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.sciencedirect.com/science/article/pii/S0195666308001463\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHaines J, Neumark-Sztainer D, Wall M, Story M (2007) Personal, behavioral, and environmental risk and protective factors for adolescent overweight. Obesity 1511:2748\u0026ndash;2760\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLegenbauer T, Vocks S, Betz S, Puigcerver MJB, Benecke A, Troje NF et al (2011) Differences in the nature of body image disturbances between female obese individuals with versus without a comorbid binge eating disorder: An exploratory study including static and dynamic aspects of body image. Behav Modif [Internet]. ;35[2]:162\u0026ndash;86. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0145445510393478\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWilliamson DA, White MA, York-Crowe E, Stewart TM (2004) Cognitive-Behavioral Theories of Eating Disorders. Behav Modif [Internet]. ;28[6]:711\u0026ndash;38. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://bmo.sagepub.com/cgi/doi/10.1177/0145445503259853\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKerr-Gaffney J, Harrison A, Tchanturia K (2019) Eye-tracking research in eating disorders: A systematic review.International Journal of Eating Disorders.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eJiang MYW, Vartanian LR (2018) A review of existing measures of attentional biases in body image and eating disorders research. Aust J Psychol 701:3\u0026ndash;17\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSvaldi J, Caffier D, Tuschen-Caffier B (2011) Automatic and intentional processing of body pictures in binge eating disorder. Psychother Psychosom 811:52\u0026ndash;53\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSvaldi J, Caffier D, Tuschen-Caffier B (2011) Attention to ugly body parts is increased in women with binge eating disorder. Psychother Psychosom 803:186\u0026ndash;188\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eGardner R, Morrell J, Watson D, Sandoval S (1990) Eye Movements and Body Size Judgements in the Obese. Int J Eat Disord 95:537\u0026ndash;544\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWarschburger P, Calvano C, Richter EM, Engbert R (2015) Analysis of attentional bias towards attractive and unattractive body regions among overweight males and females: An Eye-Movement Study. PLoS One [Internet]. ;10[10]:1\u0026ndash;17. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1371/journal.pone.0140813\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eJansen A, Havermans R, Nederkoorn C, Roefs A Jolly fat or sad fat? Subtyping non-eating disordered overweight and obesity along an affect dimension. Appetite [Internet]. 2008 Nov [cited 2015 Sep 9];51[3]:635\u0026ndash;40. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.sciencedirect.com/science/article/pii/S0195666308004844\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWHO. Physical status: the use and interpretation of anthrpometry [Internet] (1995) p. 1\u0026ndash;463. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.who.int/childgrowth/publications/physical_status/en/\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eOgden CL, Fakhouri TH, Carroll MD, Hales CM, Fryar CD, Li X et al (2017) Prevalence of obesity among adults, by household income and education \u0026mdash; United States, 2011\u0026ndash;2014. Morb Mortal Wkly Rep 6650:1369\u0026ndash;1373\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eTrampe D, Stapel DA, Siero FW (2007) On models and vases: Body dissatisfaction and proneness to social comparison effects. J Pers Soc Psychol 921:106\u0026ndash;118\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePook M, Tuschen-Caffier B, Stich N (2002) Evaluation des Fragebogens zum Figurbewusstsein [FFB, deutsche version des Body Shape Questionnaire]. Verhaltenstherapie 122:116\u0026ndash;124\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHautzinger M, Keller F, K\u0026uuml;hner C (2006) Das Beck Depressionsinventar II. Deutsche Bearbeitung und Handbuch zum BDI II. Harcourt Test Services, Frankfurt\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKrohne HW, Egloff B, Kohlmann C-W, Tausch A (1996) Unterscuhungen mit einer deutschen Verion der \u0026ldquo;Positive and Negative Affect Schedule\u0026rdquo; [PANAS]. Diagnostica.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eCash TF, Fleming T, Alindogan J, Steadman L, Whitehead A (2002) Beyond body image as a trait: The development and validation of the Body Image States Scale. Eat Disord 102:103\u0026ndash;113\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHilbert A, Tuschen-Caffier B (2006) Eating Disorder Examination. Deutschsprachige \u0026Uuml;bersetzung. [Internet]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.vpf-muenster.de/publikationen/online/EDE_VfP_1.pdf\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWittchen H-U, Zaudig M, Fydrich T, SKID-I/II (1997) Strukturiertes Klinisches Interview f\u0026uuml;r DSM-IV. Deutsche Version. Beltz Verlag, Weinheim\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eGao X, Li X, Yang X, Wang Y, Jackson T, Chen H (2013) I can\u0026rsquo;t stop looking at them: Interactive effects of body mass index and weight dissatisfaction on attention towards body shape photographs. Body Image [Internet]. ;10[2]:191\u0026ndash;9. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.bodyim.2012.12.005\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eCohen J (1988) Statistical power analysis for the behavioral sciences. 2nd editio. Hilssdale, New Jersey: Erlbaum;\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eRodgers RF, DuBois RH (2016) Cognitive biases to appearance-related stimuli in body dissatisfaction: A systematic review. Clin Psychol Rev [Internet]. ;46:1\u0026ndash;11. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.cpr.2016.04.006\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eJansen A, Nederkoorn C, Mulkens S (2005) Selective visual attention for ugly and beautiful body parts in eating disorders. Behav Res Ther 432:183\u0026ndash;196\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eRoefs A, Jansen A, Moresi S, Willems P, van Grootel S, van der Borgh A (2008) Looking good. BMI, attractiveness bias and visual attention. Appetite 513:552\u0026ndash;555\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLeehr E, Giel KE, Schaeffeler N, Thiel A, Zurstiege G, Zipfel S et al (2018) Where Do You Look ? Visual Attention to Human Bodies across the Weight Spectrum in Individuals with Normal Weight or with Obesity. ;277\u0026ndash;86\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBaur J, Schmitz F, Naumann E, Svaldi J (2021) Implicit attitudes towards weight, one\u0026rsquo;s own body and its relation to food in women with overweight and obesity.Cognit Ther Res. ;1\u0026ndash;12\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePearl RL, Puhl RM (2018) Weight bias internalization and health: a systematic review. Obes Rev 198:1141\u0026ndash;1163\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePuhl RM, Himmelstein MS, Pearl RL (2020) Weight stigma as a psychosocial contributor to obesity. Am Psychol 752:274\u0026ndash;289\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKerr-Gaffney J, Harrison A (2019) Eye-tracking research in eating disorders: A systematic review. Int J Eat Disord 52:3\u0026ndash;27\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eVoges MM, Giabbiconi CM, Gruber T, Andersen SK, Hartmann AS, Vocks S Sustained hypervigilance for one\u0026rsquo;s own body in women with weight and shape concerns: Competition effects in early visual processing investigated by steady-state visual evoked potentials [SSVEP]. Biol Psychol [Internet]. 2019;143[August 2018]:74\u0026ndash;84. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.biopsycho.2019.02.010\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBaur J, Krohmer K, Naumann E, Tuschen-Caffier B, Svaldi J (2020) Vocal arousal: a physiological correlate of body distress in women with overweight and obesity. Eat Weight Disord - Stud Anorexia, Bulim Obes [Internet]. Jul 23 [cited 2019 Sep 12];25[5]:1161\u0026ndash;1169. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://link.springer.com/\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40519-019-00744-2\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eCalvo MG, Lang PJ (2004) Gaze patterns when looking at emotional pictures: Attention and affect. Motiv Emot 283:221\u0026ndash;243\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLyu Z, Zheng P, Wang Z (2019) Time Course of Attentional Biases Toward Body Shapes in Women Who Are Overweight or Obese. Cognit Ther Res [Internet]. ;43[3]:594\u0026ndash;602. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1007/s10608-018-9978-6\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSmeets E, Jansen A, Roefs A (2011) Bias for the [un]attractive self: on the role of attention in causing body [dis]satisfaction. Health Psychol 303:360\u0026ndash;367\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eTuschen-Caffier B, Bender C, Caffier D, Braks K, Klenner K, Svaldi J (2015) Selective visual attention during mirror exposure in anorexia and bulimia nervosa.PLoS One.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePorras-Garcia B, Ferrer‐Garcia M, Ghita A, Moreno M, L\u0026oacute;pez‐Jim\u0026eacute;nez L, Vallv\u0026eacute;‐Romeu A et al The influence of gender and body dissatisfaction on body‐related attentional bias: An eye‐tracking and virtual reality study. Int J Eat Disord. 2019;[November 2018]:1181\u0026ndash;90\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eTeixeira PJ, Silva MN, Coutinho SR, Palmeira AL, Mata J, Vieira PN et al (2009) Mediators of Weight Loss and Weight Loss Maintenance in Middle-aged Women. Obesity [Internet]. ;18[4]:725\u0026ndash;35. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1038/oby.2009.281\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003e\u003cem\u003eDescriptive characteristics for women with overweight and obesity (OW) and normal weight controls (NW).\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 24.3014%;\" valign=\"top\" width=\"28.220858895705522%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3226%;\" valign=\"top\" width=\"15.184049079754601%\"\u003e\n \u003cp\u003eOW\u003c/p\u003e\n \u003cp\u003e[\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 82]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4328%;\" valign=\"top\" width=\"16.717791411042946%\"\u003e\n \u003cp\u003eNW\u003c/p\u003e\n \u003cp\u003e[\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 44]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"24.69325153374233%\"\u003e\n \u003cp\u003eStatistics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 24.3014%;\" valign=\"top\" width=\"28.220858895705522%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3226%;\" valign=\"top\" width=\"15.184049079754601%\"\u003e\n \u003cp\u003e\u003cem\u003eFrequency\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003en [%]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4328%;\" valign=\"top\" width=\"16.717791411042946%\"\u003e\n \u003cp\u003e\u003cem\u003eFrequency\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003en [%]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"24.69325153374233%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 24.3014%;\" valign=\"top\" width=\"28.220858895705522%\"\u003e\n \u003cp\u003eEducation level\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3226%;\" valign=\"top\" width=\"15.184049079754601%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4328%;\" valign=\"top\" width=\"16.717791411042946%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"24.69325153374233%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e[1] = 4.707*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 24.3014%;\" valign=\"top\" width=\"28.220858895705522%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;low\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3226%;\" valign=\"top\" width=\"15.184049079754601%\"\u003e\n \u003cp\u003e45 \u0026nbsp; [54.9%]\u003c/p\u003e\n \u003cp\u003e37 \u0026nbsp; [45.1%]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4328%;\" valign=\"top\" width=\"16.717791411042946%\"\u003e\n \u003cp\u003e14 \u0026nbsp;[31.8%]\u003c/p\u003e\n \u003cp\u003e27 \u0026nbsp;[63.6%]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"24.69325153374233%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 24.3014%;\" valign=\"top\" width=\"28.220858895705522%\"\u003e\n \u003cp\u003eMarital status\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3226%;\" valign=\"top\" width=\"15.184049079754601%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4328%;\" valign=\"top\" width=\"16.717791411042946%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"24.69325153374233%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e[2] = 1.451\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 24.3014%;\" valign=\"top\" width=\"28.220858895705522%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;with partner\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;single\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;widowed/divorced\u003c/p\u003e\n \u003cp\u003eSCID I diagnosis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;no\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;yes\u003c/p\u003e\n \u003cp\u003eSCID II diagnosis\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;no\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3226%;\" valign=\"top\" width=\"15.184049079754601%\"\u003e\n \u003cp\u003e49 \u0026nbsp; [59.8%]\u003c/p\u003e\n \u003cp\u003e26 \u0026nbsp; [31.7%]\u003c/p\u003e\n \u003cp\u003e7 \u0026nbsp; \u0026nbsp; [8.5%]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e45 \u0026nbsp; [54.9%]\u003c/p\u003e\n \u003cp\u003e37 \u0026nbsp; [45.1%]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e57 \u0026nbsp; [69.5%]\u003c/p\u003e\n \u003cp\u003e21 \u0026nbsp; [25.6%]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4328%;\" valign=\"top\" width=\"16.717791411042946%\"\u003e\n \u003cp\u003e29 \u0026nbsp;[65.9%]\u003c/p\u003e\n \u003cp\u003e9 \u0026nbsp; \u0026nbsp; [20.5%]\u003c/p\u003e\n \u003cp\u003e4 \u0026nbsp; \u0026nbsp; [9.1%]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e34 \u0026nbsp;[77.3%]\u003c/p\u003e\n \u003cp\u003e10 \u0026nbsp;[22.7%]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e44 \u0026nbsp;[100%]\u003c/p\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; [0%]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"24.69325153374233%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e[1] = 6.140*\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e[1] = 14.309**\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 24.3014%;\" valign=\"top\" width=\"28.220858895705522%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3226%;\" valign=\"top\" width=\"15.184049079754601%\"\u003e\n \u003cp\u003e\u003cem\u003eM [SD]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4328%;\" valign=\"top\" width=\"16.717791411042946%\"\u003e\n \u003cp\u003e\u003cem\u003eM [SD]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"24.69325153374233%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 24.3014%;\" valign=\"top\" width=\"28.220858895705522%\"\u003e\n \u003cp\u003eAge [years]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3226%;\" valign=\"top\" width=\"15.184049079754601%\"\u003e\n \u003cp\u003e40.7 [15.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4328%;\" valign=\"top\" width=\"16.717791411042946%\"\u003e\n \u003cp\u003e37.9 [9.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"24.69325153374233%\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e[1,124] = 1.166\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 24.3014%;\" valign=\"top\" width=\"28.220858895705522%\"\u003e\n \u003cp\u003eBMI\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3226%;\" valign=\"top\" width=\"15.184049079754601%\"\u003e\n \u003cp\u003e31.7 [4.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4328%;\" valign=\"top\" width=\"16.717791411042946%\"\u003e\n \u003cp\u003e21.8 [1.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"24.69325153374233%\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e[1,124] = 185.518**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 24.3014%;\" valign=\"top\" width=\"28.220858895705522%\"\u003e\n \u003cp\u003eBDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3226%;\" valign=\"top\" width=\"15.184049079754601%\"\u003e\n \u003cp\u003e9.6 [8.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4328%;\" valign=\"top\" width=\"16.717791411042946%\"\u003e\n \u003cp\u003e2.4 [4.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"24.69325153374233%\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e[1,124]\u0026nbsp;= 30.270**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 24.3014%;\" valign=\"top\" width=\"28.220858895705522%\"\u003e\n \u003cp\u003eEDE\u003csub\u003eglobal\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3226%;\" valign=\"top\" width=\"15.184049079754601%\"\u003e\n \u003cp\u003e1.7 [0.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4328%;\" valign=\"top\" width=\"16.717791411042946%\"\u003e\n \u003cp\u003e0.2 [0.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"24.69325153374233%\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e[1,124] \u0026nbsp;= 155.649**\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 24.3014%;\" valign=\"top\" width=\"28.220858895705522%\"\u003e\n \u003cp\u003eBSQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3226%;\" valign=\"top\" width=\"15.184049079754601%\"\u003e\n \u003cp\u003e103.0 [27.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4328%;\" valign=\"top\" width=\"16.717791411042946%\"\u003e\n \u003cp\u003e47.2 [15.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"24.69325153374233%\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e[1,124] \u0026nbsp;= 151.635**\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.6846%;\" valign=\"top\" width=\"27.607361963190183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 13.816%;\" valign=\"top\" width=\"15.950920245398773%\"\u003e\n \u003cp\u003eOW\u003c/p\u003e\n \u003cp\u003e[\u003cem\u003en\u003c/em\u003e = 79]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8737%;\" valign=\"top\" width=\"17.33128834355828%\"\u003e\n \u003cp\u003eNW\u003c/p\u003e\n \u003cp\u003e[\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 44]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"31.901840490797547%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.6846%;\" valign=\"top\" width=\"27.607361963190183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 13.816%;\" valign=\"top\" width=\"15.950920245398773%\"\u003e\n \u003cp\u003e\u003cem\u003eM [SD]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8737%;\" valign=\"top\" width=\"17.33128834355828%\"\u003e\n \u003cp\u003e\u003cem\u003eM [SD]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"31.901840490797547%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 37.5007%;\" valign=\"top\" width=\"43.558282208588956%\"\u003e\n \u003cp\u003e\u003cem\u003eParadigm 1 \u0026ndash; Questionnaire Data\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8737%;\" valign=\"top\" width=\"17.33128834355828%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"31.901840490797547%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.6846%;\" valign=\"top\" width=\"27.607361963190183%\"\u003e\n \u003cp\u003ePANASneg\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 13.816%;\" valign=\"top\" width=\"15.950920245398773%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8737%;\" valign=\"top\" width=\"17.33128834355828%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"31.901840490797547%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.6846%;\" valign=\"top\" width=\"27.607361963190183%\"\u003e\n \u003cp\u003e\u003cem\u003et0\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 13.816%;\" valign=\"top\" width=\"15.950920245398773%\"\u003e\n \u003cp\u003e1.39 [0.40]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8737%;\" valign=\"top\" width=\"17.33128834355828%\"\u003e\n \u003cp\u003e1.27 [0.34]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"31.901840490797547%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.6846%;\" valign=\"top\" width=\"27.607361963190183%\"\u003e\n \u003cp\u003e\u003cem\u003et1\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 13.816%;\" valign=\"top\" width=\"15.950920245398773%\"\u003e\n \u003cp\u003e1.92 [0.80]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8737%;\" valign=\"top\" width=\"17.33128834355828%\"\u003e\n \u003cp\u003e1.17 [0.24]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"31.901840490797547%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.6846%;\" valign=\"top\" width=\"27.607361963190183%\"\u003e\n \u003cp\u003eBISS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 13.816%;\" valign=\"top\" width=\"15.950920245398773%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8737%;\" valign=\"top\" width=\"17.33128834355828%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"31.901840490797547%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.6846%;\" valign=\"top\" width=\"27.607361963190183%\"\u003e\n \u003cp\u003e\u003cem\u003et0\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 13.816%;\" valign=\"top\" width=\"15.950920245398773%\"\u003e\n \u003cp\u003e3.60 [1.29]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8737%;\" valign=\"top\" width=\"17.33128834355828%\"\u003e\n \u003cp\u003e6.38 [1.10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"31.901840490797547%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.6846%;\" valign=\"top\" width=\"27.607361963190183%\"\u003e\n \u003cp\u003e\u003cem\u003et1\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 13.816%;\" valign=\"top\" width=\"15.950920245398773%\"\u003e\n \u003cp\u003e2.57 [1.51]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8737%;\" valign=\"top\" width=\"17.33128834355828%\"\u003e\n \u003cp\u003e6.10 [1.33]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"31.901840490797547%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.6846%;\" valign=\"top\" width=\"27.607361963190183%\"\u003e\n \u003cp\u003ePerceived Beauty - SB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 13.816%;\" valign=\"top\" width=\"15.950920245398773%\"\u003e\n \u003cp\u003e2.83 [0.69]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8737%;\" valign=\"top\" width=\"17.33128834355828%\"\u003e\n \u003cp\u003e4.53 [0.82]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"31.901840490797547%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.6846%;\" valign=\"top\" width=\"27.607361963190183%\"\u003e\n \u003cp\u003ePerceived Beauty - CB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 13.816%;\" valign=\"top\" width=\"15.950920245398773%\"\u003e\n \u003cp\u003e3.42 [0.79]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8737%;\" valign=\"top\" width=\"17.33128834355828%\"\u003e\n \u003cp\u003e4.55 [0.79]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9313%;\" valign=\"top\" width=\"31.901840490797547%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 50.7102%;\" valign=\"top\" width=\"56.71406003159558%\"\u003e\n \u003cp\u003e\u003cem\u003eParadigm 2\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u0026ndash; Frequency of first fixations\u003csup\u003ed\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0521%;\" valign=\"top\" width=\"22.432859399684045%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.2121%;\" valign=\"top\" width=\"23.85466034755134%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003eSelf-Body\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003eVase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0521%;\" valign=\"top\" width=\"22.432859399684045%\"\u003e\n \u003cp\u003eSelf-Body\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003eVase\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.2121%;\" valign=\"top\" width=\"23.85466034755134%\"\u003e\n \u003cp\u003eCue Condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003e5.9 [1.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003e2.1 [1.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0521%;\" valign=\"top\" width=\"22.432859399684045%\"\u003e\n \u003cp\u003e5.9 [1.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003e2.1 [1.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.2121%;\" valign=\"top\" width=\"23.85466034755134%\"\u003e\n \u003cp\u003eNo Cue Condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003e5.8 [1.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003e2.2 [1.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0521%;\" valign=\"top\" width=\"22.432859399684045%\"\u003e\n \u003cp\u003e5.9 [1.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003e2.0 [1.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.2121%;\" valign=\"top\" width=\"23.85466034755134%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003eControl Body\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003eVase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0521%;\" valign=\"top\" width=\"22.432859399684045%\"\u003e\n \u003cp\u003eControl Body\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003eVase\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.2121%;\" valign=\"top\" width=\"23.85466034755134%\"\u003e\n \u003cp\u003eCue Condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003e5.8 [1.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003e2.2 [1.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0521%;\" valign=\"top\" width=\"22.432859399684045%\"\u003e\n \u003cp\u003e5.7 [1.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003e2.2 [1.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.2121%;\" valign=\"top\" width=\"23.85466034755134%\"\u003e\n \u003cp\u003eNo Cue Condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003e5.7 [1.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003e2.3 [1.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0521%;\" valign=\"top\" width=\"22.432859399684045%\"\u003e\n \u003cp\u003e5.9 [1.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7491%;\" valign=\"top\" width=\"16.429699842022117%\"\u003e\n \u003cp\u003e2.0 [1.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eBDI\u003c/em\u003e = Beck Depression Inventory; \u003cem\u003eBMI\u0026nbsp;\u003c/em\u003e= Body Mass Index; \u003cem\u003eBSQ\u003c/em\u003e = Body Shape Questionnaire;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBISS\u003c/em\u003e = Body Image State Scale;\u003cem\u003e\u0026nbsp;CB =\u0026nbsp;\u003c/em\u003econtrol body; \u003cem\u003eEDE\u003c/em\u003e = Eating Disorder Examination; \u003cem\u003eeducational level: low \u0026le;\u0026nbsp;\u003c/em\u003esecondary school; \u003cem\u003ehigh\u0026nbsp;\u003c/em\u003e= baccalaureate or university degree. \u003cem\u003ePANASneg\u003c/em\u003e = negative affect subscale of the Positive and Negative Affect Scale; S\u003cem\u003eB =\u0026nbsp;\u003c/em\u003eself-body; \u003cem\u003et0\u003c/em\u003e = prior to Paradigm 1, \u003cem\u003et1\u003c/em\u003e = after Paradigm 1. * p \u0026lt; .05; ** p \u0026lt; .001.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e \u003cem\u003en\u003c/em\u003e = 42 in the NW group due to missing data\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/sup\u003e\u003cem\u003en\u003c/em\u003e = 78 in the OW group due to missing data\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec\u003c/sup\u003e \u003cem\u003en\u003c/em\u003e = 76 women with OW and \u003cem\u003en\u003c/em\u003e = 43 women with NW due to outlier analysis\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ed\u003c/sup\u003en = 76 women with OW [resp. n = 75 for combination self-body \u0026ndash; vase] due to outlier analysis\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"eating-and-weight-disorders-studies-on-anorexia-bulimia-and-obesity","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"eawd","sideBox":"Learn more about [Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity](https://www.springer.com/journal/40519)","snPcode":"40519","submissionUrl":"https://submission.nature.com/new-submission/40519/3","title":"Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"obesity, overweight, attentional bias, eye-tracking, body image","lastPublishedDoi":"10.21203/rs.3.rs-1486031/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1486031/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: Despite the claim to integrate body image interventions in obesity treatment, little is known about the mechanisms involved in maintaining body dissatisfaction in persons with overweight and obesity. Therefore, the present study sought to investigate attentional processing of body stimuli in women with overweight and obesity (OW).\u003cem\u003e \u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003cem\u003e: \u003c/em\u003eWomen with OW (\u003cem\u003en\u003c/em\u003e = 82) and normal weight controls (NW; \u003cem\u003en\u003c/em\u003e = 44) conducted two eye-tracking paradigms. In the first paradigm, fixation duration on the subjectively most beautiful and ugliest body part of one’s own and a weight-matched control body were analyzed. In the second paradigm, picture pairs including the own and a control body or object were presented and initial fixation orientation was measured. Automatic and intentional processing of the body pictures was manipulated by either indicating on which side which stimuli would appear or not.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Women with OW displayed a bias towards the ugliest as opposed to the most beautiful body part, whereas women with NW showed a balanced viewing pattern. Furthermore, both groups showed a preference for bodies relative to the object. However, only women with OW preferred their own relative to the control body during intentional processing.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Taken together, results point towards a self-focused and deficit-oriented gaze pattern in women with overweight and obesity. Targeting these processes might help to improve obesity treatment outcomes.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eLevel of Evidence: \u003c/strong\u003eLevel I, experimental study.\u003c/p\u003e","manuscriptTitle":"Attentional processing of body images in women with overweight and obesity","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-03-30 19:34:24","doi":"10.21203/rs.3.rs-1486031/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2022-03-28T17:50:55+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-03-28T17:48:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-03-25T07:48:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity","date":"2022-03-24T11:12:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"eating-and-weight-disorders-studies-on-anorexia-bulimia-and-obesity","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"eawd","sideBox":"Learn more about [Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity](https://www.springer.com/journal/40519)","snPcode":"40519","submissionUrl":"https://submission.nature.com/new-submission/40519/3","title":"Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"1a7a2e08-598d-4c19-8e42-cde751846f8e","owner":[],"postedDate":"March 30th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2022-05-09T17:17:55+00:00","versionOfRecord":[],"versionCreatedAt":"2022-03-30 19:34:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1486031","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1486031","identity":"rs-1486031","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}