Is Orthorexia Nervosa the newest media induced health hazard? : an experimental study of the relationship between fitspiration and women’s intention to engage in excessive exercising and healthy eating

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Is Orthorexia Nervosa the newest media induced health hazard?

An experimental study of the relationship between fitspiration and women’s intention to engage in excessive exercising and healthy eating.

Master’s Thesis Graduate School of Communication Entertainment Communication Master’s program

Anne-Margreet Jonkman (Uva-ID: 11205946) Supervisor: Sindy Sumter

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Abstract

Fitspiration has recently received a lot of attention regarding its alleged relationship to disordered behaviors, such as excessive exercising and healthy eating. The present study aimed to investigate the relationship between direct short-term exposure to fitspiration and intention to engage in compulsive behaviors and the individual characteristics that are

proposed to moderate it. To investigate this relationship an online experiment was conducted among women from Dutch origin between the ages of 18 and 58 (N = 109). Intention to engage in excessive exercising (IEE) and healthy eating (IHE) were included as proximate measures of the disorder Orthorexia Nervosa (ON).

Although fit-ideal internalization was associated with both IEE and IHE, the

experiment showed no direct effect of short-term exposure to fitspiration images on IEE and IHE. In contrast to what was expected, fit-ideal internalization and appearance-related self-esteem did not moderate the relationship between exposure to fitspiration and both IEE and IHE. Based on the current study, the concerns about the relationship between fitspiration and disordered eating cannot yet be confirmed. Longitudinal research is needed to draw more definitive conclusions about long-term effects of exposure to fitspiration on intention to engage in excessive exercising and healthy eating.

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Is Orthorexia Nervosa the newest media induced health hazard?

There have always been concerns about the negative effects of the media on body image satisfaction (e.g., Grabe, Ward & Hyde, 2008; Levine & Murnen, 2009; Groesz, Levine & Murnen, 2002; Want, 2009). Recently the main focus of these concerns has been gravitating towards the potential effects of the use of social networking sites specifically (Tiggeman & Zaccardo, 2015). Although there are numerous factors that can influence body image (Thompson, Heinberg, Altabe & Tantleff-Dunn, 1999), substantial research shows that the media are one of the strongest and most influential contributors (Grabe et al., 2008; Groesz et al., 2002; Levine & Murnen, 2009; Thompson et al., 1999; Tiggemann, 2011; Want, 2009). In an age where social networking sites occupy an increasing part of our daily lives (Nationale Social Media Onderzoek, 2015), it is no wonder that they play a substantial role in the way we view ourselves and others. Several studies have linked the use of social networking sites to body image related issues, but also to more severe conditions such as eating disorders (Holland & Tiggemann, 2016).

Concerns about the effect of social media on body image and eating concerns have been especially prevalent since the rise in popularity of thinspiration. The word

‘thinspiration’ is an aggregation of the words ‘thin’ and ‘inspiration’ (Tiggemann & Zaccardo, 2015), and can be defined as online content that promotes thinness by showing images to inspire weight loss (Borzekowski, Schenk, Wilson & Peebles, 2010; Ghaznavi & Taylor, 2015). Now that fitspiration has become a popular theme on social media too, similar concerns have been expressed (Tiggemann & Zaccardo, 2015). Fitspiration can be described as online content that promotes a healthy lifestyle by excessive exercising and healthy eating. Both thinspiration and fitspiration promote an ideal that highlights the discrepancies between the ‘ideal self’ and the actual self; awareness of these discrepancies might eventually cause body image disturbances (Goldstraw & Keegan, 2016). The fit-ideal is very similar to the thin ideal, but in addition it is also extremely muscular and toned (Tiggemann & Zaccardo, 2015). While one might argue that fitspiration evokes a more positive outcome by

encouraging health and fitness, it often emphasizes attractiveness as a motivator to engage in behaviors to attain the fit-ideal (Simpson & Mazzeo, 2015). Thereby fitspiration advocates body image standards that are related to appearances instead of health (Simpson & Mazzeo, 2015; Willis & Knobloch-Westerwick, 2014).

Although fitspiration content might be considered a positive influence to maintain a healthy lifestyle, it has also been associated with similar problematic behaviors as

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Liu, Tortomasi, Greene & Bowles, 2016). Content analyses show that fitspiration praises weight management behaviors to attain a beauty ideal that is both unrealistically thin and extremely toned (Boepple, Ata, Rum & Thompson, 2016; Tiggemann & Zaccardo, 2015; Simpson & Mazzeo, 2015). This implies that only thin and toned bodies are presented as healthy, yet they are unachievable for a large population of women and pursuing these ideals can present serious health risks. Internalization of these ideals, i.e. thin-ideal internalization and fit-ideal internalization, teaches women to appreciate their outward appearance rather than their inner qualities (Fredrickson & Roberts, 1997).

Findings from a review of 67 qualitative, correlational and experimental studies support the relationship between exposure to appearance-focused social media and body image and eating concerns (Rodgers & Melioli, 2016). This is worrisome, as body

dissatisfaction is a key predictor of eating disorders (Smolak & Thompson, 2001). Although the existence of a relationship between social media use and body image has been

demonstrated (for a review see Rodgers & Melioli, 2016), little is known about the negative consequences of fitspiration content on social media specifically. Because fitspiration is all about promoting a healthy lifestyle by both exercising and healthy eating, a possible negative consequence could be extreme healthism, which is known as Orthorexia Nervosa (ON), a condition that is characterized by disordered eating generated by a pathological drive to eat healthful (Missbach, Dunn & König, 2016; Moroze, Dunn, Holland, Yager & Weintraub, 2015). ON is characterized by a restrictive diet in which specific foods that are believed to be unhealthy are avoided (Dunn & Bratman, 2016; Vandereycken, 2011). Several studies

suggest that social networking sites might accelerate extreme healthism (McBride, 2010; Spence, Okajima, Cheok, Petit & Michel, 2015), but although that is alarming a causal relationship has not yet been found.

The present study aims to investigate whether exposure to fitspiration imagery could potentially result in ON, by looking at the relationship between short-term exposure to fitspiration and two proximate measures of ON, namely the intention to engage in excessive exercising and healthy eating to attain the goals set by fitspiration (Dunn & Bratman, 2016; Moroze et al., 2015). In sum, the question this study will try to answer is the following: RQ: To what extent is short-term exposure to fitspiration associated with women’s intentions to engage in excessive exercising and healthy eating?

Social Comparison

Several studies already demonstrated the role of social comparison in body

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traditional media (Tiggemann & Polivy, 2010; Bessenoff, 2006; Engeln-Maddox, 2005). The reason why social media can have such a profound impact on body image – maybe even more so than magazines – is the fact that people on social media are more relatable. Fitspiration accounts often feature ‘normal’ women instead of models or celebrities. People generally tend to make self-comparisons that are relevant to their own identity (Wood & Taylor, 1991). These self-relevant comparisons are processed more deeply and are more easily accessible, causing their psychological impact to be stronger (Wood & Taylor, 1991). This means that upward comparisons – comparisons in which individuals value themselves to be the lesser attractive party – with attractive peers have a more significant effect than upward comparisons with attractive models or celebrities. The latter group is perceived as less similar and therefore not as suitable for social comparisons (Cash, Cash & Butters, 1983). Thus upward social comparisons with peers on social media are more likely to result in negative affect and body image disturbances.

According to Corning, Krumm and Smitham (2006), engaging in body-related social comparisons predicts the presence of eating disorder symptoms. Since fitspiration does not only potentially cause negative affect and body image disturbances induced by upward social comparisons among women, but also simultaneously inspires them to engage in healthy behaviors by stressing the appearance-related benefits (Boepple et al., 2016), we can argue that women who are exposed to fitspiration are more likely to report a higher intention to engage in excessive exercising and healthy eating than women who are not exposed to fitspiration. We therefore propose the following hypothesis: Women who are exposed to fitspiration are expected to report a higher intention to engage in excessive exercising and healthy eating than women who are exposed to neutral images (H1).

Fit-ideal internalization

In addition to investigating the relationship between exposure to fitspiration and intention to engage in excessive exercising and healthy eating, the current study will also investigate how individual characteristics, i.e. fit-ideal internalization and appearance related self-esteem, operate as moderators of the relationship between short-term exposure to fitspiration and excessive exercising and healthy eating. According to several contemporary models about media effects it is important to consider the role of individual characteristics. For example, the Transactional Model of Social Media Effects (Perloff, 2014) demonstrates that exposure to social media alone will not cause body image disturbances, but rather that social media in combination with certain individual characteristics can have serious psychological implications. Perloff (2014) argues that there exists a reciprocal transaction

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between the media and individuals and that the interaction between the media and individual characteristics is a more accurate prediction of the outcome. With regard to fitspiration social media use, it is expected that fit-ideal or thin-ideal internalization and appearance-related self-esteem will put women at risk for body image problems (Perloff, 2014).

The desire to be thin is an indicator that the thin ideal has been internalized (Thompson & Stice, 2001). Similarly, fit-ideal internalization reflects the extent to which fitness is incorporated as a personal standard of attractiveness and is a motivator to engage in behaviors to reach this ideal (Thompson & Stice, 2001). Typically, the internalization of attitudes is a result of perceived approval by peers (Kandel, 1980). However, the

internalization of ideal body beliefs is also reinforced by the media, where the ideal is supported and maintained through comments.

Several studies demonstrate that fit-ideal internalization is often related to excessive exercising. Thin-ideal internalization on the other hand is often related to disordered eating and body dissatisfaction (e.g., Dittmar & Howard, 2004; Myers & Crowther, 2007; Homan, 2010; Homan, McHugh, Wells, Watson & King, 2012). The reason why fit-ideal

internalization is thought to produce higher body dissatisfaction, resulting in excessive exercising and disordered eating, is because the ideal is unattainable for most women (Stice, Schupak-Neuberg, Shaw & Stein, 1994; Thompson et al., 1999). Social media do not only pressure women to conform to the fit or thin ideal via appearance-related images (Clark & Tiggemann, 2006), but fit-ideal and thin-ideal internalization can also work as a moderator: women who have internalized the fit-ideal or the thin-ideal perceive it as a desirable goal and are therefore more susceptible to its influence (Anschutz, Engels & van Strien, 2012).

We can therefore argue that women who report high on the fit-deal internalization are more likely to be affected by exposure to fitspiration. Despite insufficient research on the topic of fitspiration, it demonstrates striking similarities with thinspiration; namely displaying one particular body shape (e.g. thin and toned) (Tiggeman & Zaccardo, 2015). Although the bodyshape that is displayed in fitspiration can be argued to be less thin than ideals displayed in thinspiration, it is still unattainable for most women and will therefore presumably have a similar effect (Krane, Stiles-Shipley, Waldron, & Michalenok, 2001). Bearing this in mind, we have derived at the second hypothesis: Women who have internalized the fit-ideal report higher intentions to engage in excessive exercising and healthy eating after exposure to fitspiration images than women have not internalized the fit-ideal (H2).

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A second important individual difference variable that makes women more vulnerable to the negative effects of exposure to fitspiration imagery is appearance-related self-esteem (Perloff, 2014). According to Crocker, Luhtanen, Cooper and Bouvrette (2003), people’s self-worth can depend upon different self-identified contingencies. Women whose appearance is central to their self-concept, define their self-worth by their attractiveness. Self-esteem can be decreased when setbacks or failures in the areas of the contingencies occur, resulting in drops in their self-esteem (Crocker et al., 2003). This means that when people negatively evaluate themselves in the domains of their self-esteem, they will experience negative affect. In general, it can also be said that external contingencies – contingencies that are dependent upon other people or contingencies that represent superficial aspects of the self – are

associated with lower levels of psychological well-being (Crocker et al., 2003). People who base their self-esteem on their appearance, which is an external and thus unstable aspect of the self, will therefore likely experience fluctuations as their self-esteem is built up by downward comparisons and torn down by upward comparisons.

Especially women are often evaluated based on their physical appearance in the media (Crocker et al., 2003). This objectification of the female body encourages women to value their own self-worth based on their attractiveness. Several studies have demonstrated that when appearance is a key component of self-esteem, upward social comparisons can lead to a drop in self-esteem (Patrick, Neighbors & Knee, 2004; Bailey & Ricciardelli, 2010; Crocker et al., 2003). As a result, self-objectification occurs; the notion that a women’s body is an object that exists to be looked at (Fredrickson & Roberts, 1997).

One very prevalent form of self-objectification is posting photos of oneself online for others to see (Tiggemann & Zaccardo, 2015), as is the case with fitspiration. Exposure to images in which women’s bodies are objectified might lead viewers to self-objectify (Harper & Tiggemann, 2008) and thus let their self-esteem depend on appearance-related

contingencies. When met by more attractive peers, the self-concept is threatened and upward social comparisons result in decreased self-esteem. It can thus be argued that women who believe their body exists to be looked at and report high on appearance-related self-esteem experience more negative outcomes of exposure to fitspiration. We therefore propose the final hypothesis: Women who report high on appearance-related self-esteem report higher

intentions to engage in excessive exercising and healthy eating after exposure to fitspiration images than women who have not internalized the fit-ideal (H3).

Thus, in short the present study aims to investigate to what extent exposure to fitspiration influences the intention to engage in excessive exercising and healthy eating

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among women between 18 and 58 of years of age. In line with recent thinking about media effects, the moderating effect of two individual difference variables will also be investigated. First, the relationship between characteristics of ON, i.e. commitment to healthy eating and excessive exercising, and time spent on fitspiration will be investigated within the control group, to establish whether the findings match previous research. Furthermore, it is expected that women who report high on fit-ideal internalization and appearance-related self-esteem will be more strongly affected by exposure to fitspiration and consequentially report the highest intention to engage in excessive exercising and healthy eating.

Methods Sample and Procedure

The sample consisted of 109 Dutch women between 18 and 58 years old, with a mean age of 24.33 years (SD=5.29). The majority of the respondents (66.1%) had completed the highest level of education in the Netherlands.

Data were collected through Qualtrics, online survey software. The respondents were recruited using convenience sampling. The link to the survey was distributed in the

researcher’s personal network through a post on Facebook and personal emails. In addition, the survey was posted to several pages dedicated to the recruitment of respondents for academic research (e.g., ‘Respondenten Gezocht’ and ‘Survey Sharing 2016/2017’). The first page of the survey consisted of information about the goal of the study as well as the researching institution, assured the respondents of their anonymity and asked for their consent before participating. The respondents were also informed that they could quit the survey at any given point in time by closing their browser window and that they could withdraw consent afterwards should they change their minds about participating. The respondents could continue to the survey by stating that they were willing to proceed. The procedure was approved by the Ethical committee of the University of Amsterdam.

Research Design

The direct effect of short-term exposure to fitspiration on intention to engage in excessive exercising and healthy eating was assessed in a between-subjects design with two conditions. The respondents were randomly assigned to either the experimental condition or the control condition. The experimental condition consisted of 20 fitspiration images, which were selected by the researcher from Instagram. The images all showed women with a slim and muscular body while working out or in workout gear. All images were pretested by five

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people, who evaluated whether the images could be identified as fitspiration. Women in the control condition were exposed to 20 interior design images that did not feature any people, which were also selected by the researcher from Instagram. This method was derived from a previous study by Tiggemann & Zaccardo (2015).

The respondents believed that the objective of the study was to investigate the use of filters on social media. They were given a cover story to ensure that they were unaware of the true purpose of the study. However, in reality the questions that they received about the use of filters on social media were control questions. At the end of the experiment they were

debriefed and informed about the true objective of the study.

Measures

Average fitspiration use (AFU). To assess how often respondents used fitspiration in the three months prior to the experiment, they were asked how often they visited fitspiration accounts or pages on average during the week (see Scale A1). The response scale ranged from 1 (never) to 9 ((I check the pages continuously throughout the day). High scores reflected high average weekly use of fitspiration.

Intention to engage in excessive exercising (IEE). The intention to engage in excessive exercising was measured using the Intention for Exercise and Healthy Eating scale from a similar study from Psouni, Chasandra and Theodorakis (2016). Intention to engage in excessive exercising was measured via 3 questions, such as ‘I intend to exercise’. Responses were given on a 5-point scale, with answering categories ranging from 1 (completely

disagree) to 5 (completely agree) (see Scale A2). The questions were structured so that higher scores indicated higher intentions to engage in excessive exercising. A measure for the mean score on intention to engage in excessive exercising was created by calculating the average on the three items. The reliability of the scale for IEE was good with a Cronbach’s alpha of .74. Intention to engage in healthy eating (IHE). To assess the intention to engage in healthy eating was measured using the Intention for Exercise and Healthy Eating scale from a similar study from Psouni et al. (2016). Intention to engage in healthy eating was measured via three questions, such as ‘I intend to eat healthy’. Responses were given on a 5-point scale, with answering categories ranging from 1 (strongly disagree) to 5 (strongly agree) (see Scale A3). The questions were structured so that higher scores indicated higher intentions. A measure for the mean score on intention to engage in healthy eating was created by

calculating the average on the three items. The reliability of the scale for IHE was good with a Cronbach’s alpha of .76.

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Appearance-related self-esteem (ARSE). To assess appearance-related self-esteem appearance-related items from the Contingencies of Self-Worth Scale by Crocker et al. (2003) were used. Appearance-related esteem was measured by six items, such as ‘My self-esteem is unrelated to how I feel about the way my body looks’. Responses were given on a 5-point scale, with answering categories ranging from 1 (strongly disagree) to 5 (strongly agree) (see Scale A4). High scores indicated high levels of appearance-related self-esteem. A measure for the mean score on appearance-related self-esteem was created by calculating the average on the five items. The reliability of the scale for ARSE was good with a Cronbach’s alpha of .72.

Fit-ideal internalization (FII). To assess fit-ideal internalization the Muscular/Athletic subscale of the Sociocultural Attitudes Towards Appearance

Questionnaire-4 was used (Schaefer, Burke, Thompson, Dedrick, Heinberg, Calogero & Anderson, 2015). The subscale consists of five statements that measure the extent to which the respondents has internalized a muscular/athletic physique, such as ‘It is important for me to look athletic’ (see Scale A5). Responses were given on a 5-point scale, with answering categories ranging from 1 (completely disagree) to 5 (completely agree). High scores indicated high levels of fit-ideal internalization. A measure for the mean fit-ideal

internalization was created by calculating the average on the five items. The reliability of the Muscular/Athletic subscale was high with a Cronbach’s alpha of .90.

Commitment to healthy Eating (CHE). To assess the extent to which respondents suffer from ON, the proximate measures of healthy eating were measured. First, the criteria for ON proposed by Moroze et al. (2015) were used to assess healthy eating. The scale consists of 7 statements, such as ‘I feel guilty when I consume foods that I think are

unhealthy’. Responses were given on a 5-point scale, with answering categories ranging from 1 (strongly disagree) to 5 (strongly agree) (see Scale A6). High scores indicated high levels of ON, as proposed by Moroze et al. (2015). A measure for the mean score on CHE was created by calculating the average on the six items, after the item ‘I do not agree with other people’s ideas about food’ was deleted for the purpose of reliability. The reliability of the scale for CHE with the remaining six items was good with a Cronbach’s alpha of .76.

Commitment to excessive exercising (CEE). Commitment to Exercise Scale (Davis, Brewer & Ratsuny, 1993) was used to assess the respondent’s psychological commitment to exercising. The original 8 questions of the Commitment to Exercising Scale were altered into statements, such as: ‘It upsets me if for some reason I’m unable to exercise’. Responses were given on a 5-point scale, with answering categories ranging from 1 (strongly disagree) to 5

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(strongly agree) (see Scale A7). High scores indicated more psychological commitment to exercising, the second proximate measure of ON. A measure for the mean score on CEE was created by calculating the average on the eight items. The reliability of the scale for CEE was good with a Cronbach’s alpha of .84.

Data Analysis Plan

To answer the main research question and the hypotheses, several statistic analyses will be conducted. First, to determine the correlations between the variables a reliability analysis will be conducted. Secondly, although the relatively small sample size a regression analysis of the control group will be conducted to test whether previous findings are

duplicated. Whether short-term exposure to fitspiration is associated to an increased intention to engage in excessive exercising and the intention to engage healthy eating, a multivariate analysis of covariance will be conducted that controls for age. Finally, to test whether the effect of fitspiration exposure is moderated by appearance-related self-esteem and fit-ideal internalization a moderation analysis will be conducted in PROCESS, a macro developed by Andrew Hayes (Hayes, 2013).

Results Descriptives

As a first step the means and standard deviations were calculated and bivariate correlations between the main variables of the study for the whole sample and the control sample separately were conducted. These descriptives can be found in Table B1. Correlations for the whole sample are presented above the diagonal (top right) and the correlations for the control sample are presented below the diagonal (bottom left). The table shows that the intention to engage in excessive exercising (IEE) is significantly related to self-reported commitment to excessive exercising (CEE) for both the control group and the whole sample. In addition, the intention to healthy eating (IHE) is significantly related to self-reported commitment to healthy eating (CHE) both the control group and the whole sample as well. In line with previous research, average fitspiration use was significantly related to IEE and IHE for the whole sample, but average fitspiration use was only significantly related to IHE for the control group. This means that except for a significant relationship between average

fitspiration use and intention to engage in excessive exercising, the control group was representative for the whole sample.

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Is time spent on fitspiration related to commitment to excessive exercising and healthy eating? To assess whether the average time spent on fitspiration in the three months prior to the survey was related to self-reported ON, a linear regression analysis was

conducted. The analysis included average fitspiration use as an outcome variable, and age as a covariate. In addition, CEE and CEE were included as the main predictors. For this analysis only the control group was used, n = 56. See Table B2 for an overview of the results.

The analysis showed that average time spent on fitspiration was not significantly related to self-reported CEE (b = .37, p = .42). This means that more time spent on fitspiration was not related to commitment to excessive exercising in this sample. This

finding is not in line with previous research that states that fitspiration has a positive effect on commitment to excessive exercising.

In addition, the analysis demonstrated a significant positive relationship between average time spent on fitspiration and CHE (b = .96, p = 0.04). This means that more time spent on fitspiration was associated with higher scores on commitment to healthy eating, which is in line with previous findings. Finally, the analysis showed that time spent on fitspiration is not significantly related to age (b = -.08, p = .07).

Effects of Short-term Exposure to Fitspiration Images

Does exposure to fitspiration affect the intention to engage in excessive

exercising and healthy eating? To investigate whether exposure to fitspiration was related to women’s intentions to engage in excessive exercising and healthy eating a multivariate analysis of covariance (MANCOVA) was conducted that controlled for age. Exposure to fitspiration images will be referred to as condition to enhance readability of the results section (0 = control and 1 = experimental). The average scores on IEE and IHE in healthy eating per condition can be found in Table B3 and the means and standard deviations per condition (experimental vs control) can be found in Table B4. Although age was significantly related to IEE and IHE, Wilk’s Lambda = .91, F(2, 105) = 5.09, p = 0.01, there was no significant effect of condition on IEE or IHE, Wilk’s Lambda = 0.10, F(2, 105) = .12, p = .89.

Does appearance-related self-esteem moderate the effect of exposure to

fitspiration? To test the moderating effect of appearance related self-esteem (ARSE) model 1 of the PROCESS macro developed by Hayes (2013) was used. The model was used to test whether ARSE moderated (1) the effect of condition on IEE and (2) the effect of condition

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on IHE. Both models will be discussed successively, see Table B5 for an overview of the results.

The first analysis showed that there was no main effect of ARSE on IEE (b = -.12, p = .52), nor was there a moderating effect between condition and ARSE, (b = -.13, p = .72). The second analysis showed that there was no main effect of ARSE on IHE, (b = .01, p = .98), nor was there a moderating effect between condition and ARSE, (b = 3.34, p = .58). This means that appearance-related self-esteem does moderate the relationship between exposure to fitspiration and intention to engage in excessive exercising or healthy eating, nor is it related to intention to engage in excessive exercising or healthy eating directly.

Does fit-ideal internalization moderate the effect of exposure to fitspiration? To test the moderating effect of fit-ideal internalization model 1 of the PROCESS macro developed by Hayes (2013) was used. The model was used to test whether fit-ideal

internalization (FII) moderated (1) the effect of condition on intention to engage in excessive exercising and (2) the effect of condition on intention to engage in healthy eating. Both models and their significance will be discussed successively, see Table B6 for an overview of the results.

The first analysis showed that there was a main effect of FII on IEE (b = .61, SE = .12, t = 5.20, p = .00), but there was no moderating effect between condition and FII, (b = .11, p = .64). The second analysis showed that there was a main effect of FII on IHE (b = .37, SE = .11, t = 3.44, p = .00), but there was no moderating effect between condition and FII (b = -.11, p = .61). This means that fit-ideal internalization is not a moderator of the relationship between exposure to fitspiration and intention to engage in excessive exercising and healthy eating, but it is related to intention to engage in excessive exercising and healthy eating directly.

Discussion

The present study aimed to gain more insight into the effect of exposure to fitspiration accounts on women. Based on a large body of research on body image concerns and the internet (for a review see Rodgers & Melioli, 2016), fitspiration was expected to have a negative effect on body image by promoting an unrealistic body ideal. Following recent research on a new problem, Orthorexia Nervosa (ON), the main aim of the current study was to look at how fitspiration use was related to ON and whether short-term exposure to

fitspiration images would result in a higher intention to engage in excessive exercising and healthy eating. These two outcome variables are conceptualized as precursors of ON, which translates into an increased intention to engage in excessive exercising and healthy eating.

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Remarkably, the time that women spent on fitspiration on average during a three month period was related to higher intentions to engage in excessive exercising and healthy eating, which was in turn related to commitment to compulsive behaviors, i.e. commitment to excessive exercising and healthy eating. However, in contrast to what was expected the experiment demonstrated that there was no effect of short-term exposure to fitspiration on women. Women who were exposed to fitspiration did not differ in their intention to engage in excessive exercising and healthy eating directly afterwards from women who were not

exposed to fitspiration at all. This means that singular short-term exposure to fitspiration content can not be associated with an immediate shift in women’s behaviors.

The absent effect of the experimental manipulation can be explained using the theoretical model of Perloff (2014). Perloff argues that women who are predisposed to the effects of the media will experience aggravated body image disturbances by repeated exposure to alleviate the negative effect. Singular short-term exposure to fitspiration might therefore not result in noticeable changes in women’s intentions to engage in exercising and healthy eating, but repeated exposure could. Therefore, future research should focus on long-term exposure to better understand the relationship between fitspiration and disordered behaviors.

A second explanation could be that no effect of exposure to fitspiration on intention to engage in excessive exercising and healthy eating occurred because the content was not self-selected by the respondents. Perloff (2014) also argues that the relationship that people have with the media is transactional: they select media based on their individual preferences and therefore are affected by the media differently. Because the respondents in the sample did not select the fitspiration images based on their own preferences, this could explain the absence of a relationship. To take this into account research on fitspiration should pay more attention to the preferences of the respondents instead of assuming that all fitspiration content is equal. A second aim of the study was to investigate the role of two individual difference variables as potential moderators of the effect of exposure to fitspiration on intention to engage in excessive exercising and healthy eating. Based on previous research (Perloff, 2014) it was expected that appearance-related self-esteem and fit-ideal internalization would

moderate the relationship between exposure to fitspiration and intention to engage in excessive exercising and healthy eating. The results indicate that this is true for neither fit-ideal internalization nor for appearance-related self-esteem.

However, fit-ideal internalization did appear to be positively related to intention to engage in compulsive behaviors, meaning that the more the fit-ideal is internalized the higher

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the intention to engage in excessive exercising and healthy eating is reported. This finding is in line with previous research that fitspiration is associated with body image concerns by promoting an ideal that is unattainable by most women (Stice, Schupak-Neuberg, Shaw & Stein, 1994; Thompson et al., 1999). It also supports the notion that fitspiration, similar to thinspiration, encourages women to take measures to meet the unrealistic standards that they set (Clark & Tiggemann, 2006). The reason that appearance-related self-esteem was not related to exposure to engage in excessive exercising and healthy eating could be that it merely causes social comparisons that result in negative affect (Crocker et al., 2003). Fit-ideal internalization however encourages women to engage in healthy behaviors to reap the

appearance-related benefits (Boepple et al., 2016).

The results indicate that the relationship between fit-ideal internalization on

compulsive behaviors was stronger for excessive exercising than it was for healthy eating. A possible explanation for this finding could be that fitspiration more often features content with thin and toned women than with healthy foods. Findings by Antonis (2016) illustrate that different types of fitspiration do have different effects on women. For example, pages related to healthy eating are known to be related to higher body dissatisfaction, excessive exercising and lower self-esteem (Antonis, 2016). It is important to know the distinctions between the different types of fitspiration to better understand the relationship between exposure to fitspiration and disordered behavior.

Limitations and future research

The current study contributes to the growing body of research on the effects of fitspiration, specifically shedding light on the role of individual characteristics and the

transaction between the media and the individual. It demonstrates that short-term exposure to fitspiration is not associated with a noticeable change in women’s intentions to engage in excessive exercising and healthy eating, but that a long-term effect cannot be ruled out. It also demonstrates that fit-ideal internalization is associated with compulsive behaviors, i.e.

excessive exercising and healthy eating, two proximate measures of ON.

Despite the strengths of this study, there also are at least four limitations that should be mentioned. First, due to the choice of the design, no statements can be made about long-term effects of exposure to fitspiration social media. Based on the current study it can be concluded that fitspiration exposure is related to commitment to engage in healthy eating, however longitudinal research will have to point out whether this relationship is causational. However, it is important to note that intention to engage in healthy eating does not necessarily imply the presence of a disorder. For the current study it was assumed that intention to engage in

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healthy eating was a characteristic of compulsive behavior, but fitspiration could also merely be the source of inspiration for a healthier lifestyle. Future research should make the

distinction between healthy eating and compulsive healthy eating to better understand the relationship between fitspiration and Orthorexia Nervosa.

The second limitation is that intention to engage in and commitment to excessive exercising and healthy eating were self-reported by the respondents. Although intentions are usually good predictors of future behavior (Ajzen, 1985), we cannot know for certain whether they represent actual behavior. Also, a common limitation of self-reported measures is social desirability bias. For a better understanding future research should elaborate further on the relationship between exposure to fitspiration and behavior, rather than intentions.

Furthermore, the sample in the present study consisted of respondents from the researcher’s own network that were selected using convenience sampling. Therefore, the majority of the respondents had completed the highest level of education in the Netherlands and had a mean age of 24. To generalize findings to a larger population, future research should replicate these findings in a sample with with a more diverse educational and social economic background and with a wider range of ages. Also, it would be interesting to test whether these findings can be replicated among teenagers.

Finally, future research should investigate whether the thin-ideal also plays a role in fitspiration. Because both the thin-ideal and the fit-ideal feature thin women, the relationship between fitspiration and compulsive behaviors could partly be explained by the incorporation of the thin-ideal. By completely separating the thinspiration and fitspiration in an experiment, an answer could be given on the question whether they are mutually exclusive.

Conclusion

The effects of the media have been heavily debated over the years, but only recently concerns about fitspiration have been raised. Because of its popularity, it is highly relevant to clarify the relationship between exposure to fitspiration and body image and eating disorder concerns. Despite the growing body of research, there is very little evidence that exposure to fitspiration can contribute to the development of disordered behaviors. This study identifies the threats that exposure to fitspiration poses to certain individuals. Specifically, it

demonstrates that short-term exposure is not associated with compulsive behaviors. Against expectations, fit-ideal internalization and appearance-related self-esteem did not operate as moderators between exposure to fitspiration and the intention to engage in compulsive behaviors. Fit-ideal internalization was associated with both intention to engage in excessive exercising and healthy eating. However, there is a need for more research about the individual

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differences that play a role in the transaction between the media and the individual to better answer the question under which conditions fitspiration is related to Orthorexia Nervosa.

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Appendices Appendix A. Measures and scales

Scale A1

Average Fitspiration Use

Hoe vaak bezocht je gemiddeld accounts/pagina's gerelateerd aan fitness in de afgelopen 3 maanden?

Nooit 1

Bijna nooit 2

Ongeveer 1 keer per maand 3

Meerdere keren per maand 4

Ongeveer 1 keer per week 5

Meerdere keren per week 6

Ongeveer 1 keer per dag 7

Meerdere keren per dag 8

Ik check(te) de pagina's de hele dag door 9

Scale A2

Intention to engage in excessive exercising 1 Ik ben van plan om te sporten.

Helemaal mee oneens 1

Mee oneens 2

Een beetje mee eens, een beetje mee oneens 3

Mee eens 4

Helemaal mee eens 5

2 Ik ben vastberaden om te sporten.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

3 Ik zal proberen om te sporten.

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Mee oneens 2

Mee eens 4

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Scale A3

Intention to engage in healthy eating 1 Ik ben van plan om gezond tee ten.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

2 Ik ben vastberaden om gezond tee ten.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

3 Ik zal proberen om gezond te eten.

Mee oneens 2

Mee eens 4

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Scale A4

Appearance-related self-esteem

1 Mijn zelfvertrouwen hangt niet af van hoe aantrekkelijk ik me voel.

Helemaal mee eens 1

Mee eens 2

Mee oneens 4

2 Mijn zelfvertrouwen wordt beïnvloed door hoe aantrekkelijk ik mijn gezicht of gezichtskenmerken vind.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

3 Mijn gevoel van zelfwaarde daalt wanneer ik denk dat ik er niet goed uit zie.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

4 Mijn zelfvertrouwen is niet gerelateerd aan hoe ik me voel over mijn lichaam.

Helemaal mee eens 1

Mee eens 2

Mee oneens 4

5 Wanneer ik denk dat ik er aantrekkelijk uit zie, voel ik me goed over mezelf.

Mee oneens 2

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Helemaal mee eens 5

Scale A5

Fit-ideal internalization

1 Ik vind het belangrijk om er athletisch uit te zien.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

2 Ik denk veel na over er gespierd uit zien.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

3 Ik besteed veel tijd aan activiteiten om er atletischer uit te zien.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

4 Ik denk veel na over er atletisch uit zien.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

5 Ik besteed veel tijd aan activiteiten om er gespierder uit te zien.

Mee oneens 2

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Scale A6

Commitment to healthy eating

1 Ik besteed veel tijd aan het lezen over, verwerven van en bereiden van eten dat in mijn ogen gezond en puur is.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

2 Ik voel me schuldig wanneer ik een keer iets eet wat in mijn ogen ongezond of niet puur is.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

3 Ik besteed relatief veel geld aan eten dat in mijn ogen gezond en puur is.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

4 Ik vermijd eten dat in mijn ogen ongezond is.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

5 Ik ben bang dat ik ongezond of niet puur eten consumeer, dit een negatief effect heeft op mijn lichaam en gezondheid.

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Mee eens 4

Helemaal mee eens 5

6 Ik eet alleen eten dat ik als gezond en puur beschouw.

Mee oneens 2

Mee eens 4

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Scale A7

Commitment to excessive exercise

1 Het is belangrijk voor mijn algemene gezondheid dat ik geen enkele sportsessie mis.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

2 Ik voel me rot wanneer ik om één of andere reden geen tijd heb voor mijn sportsessie

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

3 Als ik één of meerdere sportsessies mis, dan probeer ik dit goed te maken door de volgende keer meer tijd in mijn sportsessie te investeren.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

4 Ik heb een vaste routine voor mijn sportsessies.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

5 Ik ga wel eens sporten als ik me moe of onwel voel.

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Mee eens 4

Helemaal mee eens 5

6 Ik ga wel eens sporten ondanks dat ik een sportgerelateerde blessure heb opgelopen.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

7 Ik voel me schuldig wanneer ik een sportsessie oversla.

Mee oneens 2

Mee eens 4

Helemaal mee eens 5

8 Soms sla ik een uitnodiging voor een interessante sociale activiteit af, omdat het samenvalt met een geplande sportsessie.

Mee oneens 2

Mee eens 4

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Appendix B. Tables and figures

Table B1

Correlations between the variables and the mean

Variables M (SD) 1 2 3 4 5 6 7

1 Average fitspiration use 3.66 (2.19) - .46** .37** .42 .39** .33* .30* 2 Intention to engage in excessive exercise 4.63 (1.07) .46** - .55** -.04 .48** .28* .51* 3 Intention to engage in healthy eating 4.70 (0.93) .34** .57** - -.01** .34** .36** .30** 4 Appearance-related self-esteem 33.71 (0.58) .02 -.03 -.06 - -.11 .09 -.21* 5 Fit-ideal internalization 2.50 (0.86) .38** .46** .37** -.14 - .40** .61** 6 Commitment to healthy eating 2.58 (0.64) .31* .22 .46** -.03 .40** - .38** 7 Commitment to excessive exercising 2.57 (0.73) .21 .49** .40** -.25 .52** .42** - * p < .05, ** p < .01

Note. Correlations above the diagonal correlation for the whole sample (n = 109) and below the diagonal correlations for the control sample (n =56)

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Table B2

Result of the regression analysis examining the relationship between average fitspiration use and ON (n = 56) Average fitspiration use

Model variabels b SE t p Constant 2.19 1.57 1.39 .17 CEE .37 .46 .81 .42 CHE .96 .45 .21 .04* Age -.08 .05 -1.85 .07 * p < 0.05 Table B3

Average scores per condition on IEE and IHE

Experimental Control M (SD) M (SD) IEE 4.71 (1.03) 4.57 (1.10) IHE 4.74 (.81) 4.66 (1.04) Age 23.89 (3.85) 24.75 (6.37) n 53 56

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Table B4

Results of the multivariate analysis of covariance (MANCOVA) examining the relationship between condition and IEE and IHE

IEE IHE Sum of Squares df Mean Square F P Sum of Squares Df Mean Square F P Intercept 178.41 1 178.41 169.04 .00* 129.68 1 129.68 149.38 .00* Age 10.34 1 10.34 9.79 .00* 1.12 1 1.12 1.29 .26 Condition .24 1 .24 .23 .63 .11 1 .11 .13 .72 Error 111.88 106 1.06 92.02 106 .87 Total 2465.56 109 2501.44 109 * p < 0.05

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Table B5

Result of the moderated-regression analysis in PROCESS examining the interaction effect between appearance-related self-esteem (ARSE) and condition on IEE and IHE (n = 109)

IEE IHE b SE t p b SE t p Constant 4.64 .10 46.94 .00** 4.69 .09 51.54 .00** Condition .17 .20 .86 .39 .08 .18 .44 .66 ARSE -.12 .18 -.64 .52 .01 .17 .03 .98 ARSE x EF -.13 .37 -.36 .72 .19 3.34 .56 .58 * p < 0.05 Table B6

Result of the moderated-regression analysis in PROCESS examining the interaction effects of fit-ideal internalization (FII) and condition on IEE and IHE (n = 109) IEE IHE b SE t p b SE t p Constant 4.63 .10 48.24 .00** 4.71 .09 53.71 .00** Condition .-.03 0.19 -.15 .88 .-.02 .18 -.12 .90 FII .61 0.12 5.20 .00** .37 .11 3.44 .00** FII x EF .11 .24 .47 .64 -.11 .21 -.52 .61 * p < 0.05, ** p < 0.01