Body Image 10 (2013) 191199

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Body Image
j our nal homepage: www. el sevi er . com/ l ocat e/ bodyi mage
I cant stop looking at them: Interactive effects of body mass index and weight
dissatisfaction on attention towards body shape photographs
Xiao Gao
a,b,,1
, Xiaojing Li
a,b,1
, Xiaoying Yang
c
, Yang Wang
a,b
, Todd Jackson
a,b
, Hong Chen
a,b
a
Faculty of Psychology, Southwest University, Chongqing, China
b
Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
c
School of Pre-school Education, Chongqing Second Normal College, Chongqing, China
a r t i c l e i n f o
Article history:
Received 12 April 2012
Received in revised form
22 December 2012
Accepted 22 December 2012
Keywords:
Attentional bias
Disengagement
Body dissatisfaction
BMI
Inhibition of return
a b s t r a c t
Although attentional biases toward body-related information contribute to the etiology and maintenance
of body dissatisfaction (BD) and eating disorders (EDs), attentional disengagement in women with BD
and EDs is not clear. The present study investigated the association between weight dissatisfaction and
attentional disengagement from body-related pictures and the possible moderating effect of body mass
index (BMI) on this relation. Two hundred and four undergraduate women engaged in an experiment
using a pictorial spatial cueing paradigm including fat/thin bodies and neutral household photos. Partial
correlations and simple slopes regression analyses were conducted with attentional disengagement index
scores of each category of cues. Findings suggested that independent of BMI, weight dissatisfaction was
directly associated with attentional disengagement from both fat and thin pictures. In addition, among
women with low and medium BMIs, the more they were dissatised with their bodyweight, the more
difculty they had disengaging their attention from fat body pictures.
2013 Elsevier Ltd. All rights reserved.
There is an abundant literature on information processing pre-
ferences related to body size, body shape and food cues, some of
which suggest that attentional biases toward such cues contribute
to the etiology and maintenance of body dissatisfaction and eat-
ing disorders (EDs; Cash & Strachan, 2002; Lee & Shafran, 2004).
According to Vitousek and Hollons (1990) cognitive theory of EDs,
attentional biases toward weight-related information arise as a
result of underlying maladaptive schemata associated with shape,
weight and self. Individuals with maladaptive schemata differ from
those without in several ways, including enhanced attention to
and enhanced memory for schema-consistent information (e.g., fat
stimuli) and resistance to schema-inconsistent information (e.g.,
thin stimuli). Two approaches have emerged within this liter-
ature. The rst examines how body dissatised or ED samples
process information about their own body (e.g., Blechert, Ansorge,
& Tuschen-Cafer, 2010; Janelle, Hausenblas, Ellis, Coombes, &
Duley, 2008; Jansen, Nederkoorn, & Mulkens, 2005; Roefs, Jansen,
Moresi, Willems, van Grootel, & van der Borgh, 2008; Smeets,
Jansen, & Roefs, 2011; Smeets, Tiggemann, et al., 2011), and the
second focuses on how these samples process body-, weight- and

Corresponding author at: Faculty of Psychology, Southwest University, No. 1,

Tiansheng Road, BeiBei, Chongqing 400715, China. Tel.: +86 13627639919;
fax: +86 23 68253629.
E-mail address: gaoxiaox@swu.edu.cn (X. Gao).
1
They are co-rst authors.
shape-related information in their general environment (e.g., Chen
& Jackson, 2005; Chen & Jackson, 2006; Gao, Deng, et al., 2011;
Glauert, Rhodes, Fink, & Grammer, 2010; Rieger, Schotte, Touyz,
Bemont, Grifths, & Russell, 1998; Shafran, Lee, Cooper, Palmer, &
Fairburn, 2007). In the rst approach, consistent evidence indicates
that body dissatised and ED samples are highly self-critical when
looking at their own bodies (Jansen et al., 2005; Roefs et al., 2008;
Smeets, Jansen, et al., 2011; Smeets, Tiggemann, et al., 2011). Con-
versely, research on the second approach has been less consistent.
Therefore, the nature of attentional biases toward external body,
weight, and shape stimuli are not well understood.
Early studies often used modied Stroop color naming tasks
to study attentional bias in ED samples, and most of the results
indicated that ED samples were often slower to name the color of
disorder-relevant stimuli than neutral cues (Davidson & Wright,
2002; Lee & Shafran, 2004; Perpina, Leonard, Treasure, Bond,
& Banos, 1998; Sackville, Schotte, Touyz, Grifths, & Beaumont,
1998). However, there are conceptual ambiguities and method-
ological issues when using modied Stroop color naming task;
namely, it cannot distinguish different attentional components
(Dobson & Dozois, 2004; Lee & Shafran, 2004). Attentional
biases corresponding to disturbance-relevant stimuli (e.g., anx-
iety related stimuli, depression related stimuli, or ED related
stimuli) can include facilitated attention, disengagement difculty,
or attentional avoidance (see Cisler & Koster, 2010). Facilitated
attention refers to the relative ease or speed with which atten-
tion is drawn to a disturbance-relevant stimulus (i.e., attentional
1740-1445/$ see front matter 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.bodyim.2012.12.005
192 X. Gao et al. / Body Image 10 (2013) 191199
orienting). Disengagement difculty refers to the degree to which
a disturbance-relevant stimulus captures attention and impairs
switching attention away from it to another stimulus. Attentional
avoidance refers to the phenomenon in which attention is pref-
erentially allocated towards locations opposite the location of the
disturbance-relevant cue, thus indicatingavoidanceof this cue(e.g.,
Cisler & Koster, 2010; Gao, Wang, Jackson, Zhao, Liang, & Chen,
2011; Glauert et al., 2010; Koster, Verschuere, Crombez, & Van
Damme, 2005). Recently, researchers haveturnedtotwo maintasks
(the dot probe task and odd-one-out visual search task) to dis-
tinguish different attentional components to clarify the nature of
attentional biases in body dissatised and ED samples.
The dot probe task was originally developed by MacLeod,
Mathews, and Tata (1986). In this task, a pair of stimuli (e.g., a
body-related stimulus and a neutral stimulus) are briey presented
on a screen, one above the other or one beside the other, and are
immediately followed by a dot (the probe) in the location of one
of the stimuli. Participants are required to respond to the probe as
quickly as possible. The reaction time to probe would be reduced
if participants were attending to the region of the screen. This
task is possible to distinguishengagement anddisengagement sub-
components of attention, either by manipulating the presentation
duration (Mogg, Bradley, Miles, & Dixon, 2004) or by including
neutral trials (Koster, Crombez, Verschuere, & De Houwer, 2004).
The odd-one-out visual search task was introduced by Hansen and
Hansen (1988) and later modied by other researchers. In this task,
a group of words/pictures stimuli are simultaneously presented on
the screen, and they are often presented in the shape of a 22,
33 or 54 matrices. Participants are asked to indicate whether
one of the stimuli is different fromothers on a predened dimen-
sion by pressing the corresponding key. For example, the matrix
might contain a single body-related target word (e.g., fat) among
eight distractor or neutral words (e.g., box, bed, cot) in a 33
matrix. In this case, the participants would have to react to the
body-related word. The odd-one-out task can be used to assess
attentional engagement by evaluating response latencies in detec-
ting disturbance-relevant targets (e.g., body-relatedstimuli) versus
neutral targets (e.g., car-related stimuli) among other kind of neu-
tral distractors (e.g., furniture-related stimuli). Disengagement can
be evaluated by comparing response latencies in detecting a neu-
tral target (e.g., car-related stimuli) among disturbance-relevant
distractors (e.g., body-related stimuli) versus latencies for detec-
ting a neutral target (e.g., car-related stimuli) fromanother neutral
stimulus category (e.g., furniture-related stimuli; Rinck, Reinecke,
Ellwart, Heuer, &Becker, 2005; Smeets, Jansen, et al., 2011; Smeets,
Roefs, van Furth, & Jansen, 2008; Smeets, Tiggemann, et al., 2011).
Using an odd-one-out task, Smeets et al. (2008) found that
patients with EDs were faster detecting body words in arrays of
neutral words thanindividuals without EDs. These ndings suggest
attentional engagement towards body information was speeded
in patients with EDs. However, because valences of body words
were not specied, it was not clear whether the effect reected
a bias towards negative, positive, or general body information.
Dot probe studies suggest ED and body dissatised samples dis-
played facilitated attention towards negative body cues (e.g., fat,
obese, or tubby). Rieger et al. (1998) reported that patients
with EDs were faster at responding to probes in the location of
previously-presented words denoting a large physique and slower
responding toprobes inthe locationof previously-presentedwords
denoting thinness. Shafran et al. (2007) found that relative to thin
body shape pictures, ED samples were faster at responding to
probes in the same location as overweight or neutral body shape
pictures. Recently, using the dot probe paradigm combined with
eye-tracking technology, Gao, Wang, et al. (2011) reported that
womenwithbody dissatisfactionshowed initial orienting, speeded
detection, and initial maintenance biases towards fat body words
(e.g., fat or plump) inadditiontoa speededdetection-avoidance
patternof biases inrelationto thinbody words (e.g., slim or slen-
der). Together, these ndings suggest that individuals with EDs or
body dissatisfaction preferentially process negative body informa-
tion and/or resist or avoid thin body information as proposed by
Vitousek and Hollon (1990).
To our knowledge, fewpublished studies have focused onatten-
tional disengagement among womenwithbody dissatisfactionand
EDs. The importance of inhibited disengagement from threat in
individuals with anxiety has been highlighted in anxiety disorder
studies, withmodels of anxiety-basedattentional biases suggesting
that inhibited disengagement has a signicant role in the etiology
and maintenance of anxiety disorders (e.g., Amir, Elias, Klumpp,
& Przeworski, 2003; Fox, Russo, Bowles, & Dutton, 2001; Ouimet,
Gawronski, & Dozois, 2009). Given that patterns of attentional bias
toward food or body-related information among individuals with
body dissatisfaction or EDs are similar to those linked to anxiety
disorders (Lee & Shafran, 2004; Rieger et al., 1998), attentional
disengagement difculties warrant serious consideration as a cog-
nitive vulnerability to exacerbations in body dissatisfaction and ED
risk.
Recently, two odd-one-out studies assessed attentional bias
in ED or body dissatised samples (Smeets et al., 2008; Smeets,
Jansen, et al., 2011; Smeets, Tiggemann, et al., 2011). Neither of
them showed any indication of attentional distraction by body-
related stimuli. However, this paradigmmay not be the best option
for investigating attentional disengagement. In the studies from
Smeets et al. (2008), Smeets, Jansen, et al. (2011), and Smeets,
Tiggemann, et al. (2011), the 54 stimuli matrix was presented
on the screen until a response was made or for a maximumof 20s.
The mean behavioral response latencies were around 4s, during
which engagement, disengagement, and re-engagement of visual
attention could occur several times.
Toillustrate, Gao, Wang, et al. (2011) assessedeyemovements of
women with and without body dissatisfaction within a dot probe
task and found that women with body dissatisfaction had com-
paratively longer initial xations on fat words and shorter initial
xations onthinwords. Theauthors suggestedthat followingatten-
tional capture by fat stimuli in very early stage of information
processing (i.e., less than one second), women with body dissatis-
factionhadmoredifculty, at least initially, disengagingfromthem.
In contrast, shorter initial xations on thin words among this group
may have reected rapid disengagement of overt attention from
these stimuli (Garner, Mogg, & Bradley, 2006). Although tracking
of eye movements may illuminate subtle biases in visual attention
that arise soon after stimulus presentations, opinions differ when
choosing appropriate eye movement indices for evaluating disen-
gagement. For example, in a free-viewing task, Giel, Friederich,
Teufel, Hautzinger, Enck, and Zipfel (2011) used total gaze duration
to evaluate attentional engagement and disengagement and found
that patients withanorexianervosademonstratedmoreattentional
disengagement to food pictures than did controls, whereas Gao,
Wang, et al. (2011) used rst xation duration, nding attentional
disengagement difculty fromfat words and disengagement facil-
ity from thin words. Moreover, the dot probe paradigm may not
be ideal for evaluating disengagement, because the pairs of stimuli
are simultaneously presented on the screen and attention could
be easily implicitly captured by the unattended one, which could
involve covert eye movements such as saccades (for a review, see
Simons, 2000). Therefore, it remains an issue as to how the atten-
tional disengagement obtained from the dot probe paradigm can
be understood or explained.
To investigate disengagement, researchers have used a mod-
ied spatial cueing paradigm (Posner, 1980). The task is widely
used because the direction and disengagement of attention can
be observed clearly (e.g., Dai & Feng, 2009; Fox et al., 2001; Fox,
X. Gao et al. / Body Image 10 (2013) 191199 193
Russo, &Dutton, 2002; Verkuil, Brosschot, Putman, &Thayer, 2009;
Waters, Nitz, Craske, & Johnson, 2007; Yiend & Mathews, 2001).
In this task, a visual cue is presented in one of the two locations
followed by a target, either at the same location as the target (a
valid trial) or at the opposite location (an invalid trial). Participants
were required to respond to the target as quickly and accurately as
possible. Response latencies of the valid trails are typically shorter
than those of invalid trials when the time lag between the onset of
the cue and the target is relatively short, which is called cue-target
stimulus onset asynchrony (SOA). However, as the SOAgets longer,
response latencies of the valid trials often turn longer than those
of invalid trials. This phenomenon is called inhibition of return
(IOR) and enables individuals to disengage attention away from
a searched location to a new location. Modest inhibition of return
effects may reect a reduced capacity to disengage attention from
cued locations (Fox et al., 2002; Verkuil et al., 2009). Inhibition of
return effects can be modulated by cues having emotional valence
(Fox et al., 2002). Specically, participants took longer to respond
to a target when the cue was angry or happy relative to neutral.
Inhibition of return effects for disturbance-relevant stimuli may
also be reduced by trait anxiety (Fox et al., 2002; Verkuil et al.,
2009; Waters et al., 2007; Yiend & Mathews, 2001) and depression
(Dai & Feng, 2009; Karparova, Kersting, & Suslow, 2005).
Another issue salient to this research is the impact of body
mass index (BMI) on the relation between body dissatisfaction and
attentional bias. For example, Roefs et al. (2008) measured eye
movements in 51 normal-weight (BMI range: 18.525) female stu-
dents who were successively shown pictures of their own body
and a control body for 30s each. Attention directed towards ones
self-identied least attractive body part and the controls most
attractive bodypart was associatedwithhigher BMI andlower level
of self-rated attractiveness. Later, using pictorial dot probe task,
Glauert et al. (2010) found undergraduate women were faster to
discriminatethedirectionof acuethat appearedinthelocationpre-
viously occupied by thin rather than fat body gures. This bias was
weakest for women who had a higher BMI and elevated body dis-
satisfaction. Signicant correlations between attentional bias and
either BMI or body dissatisfaction were eliminated if either of these
two variables was controlled. However, using 500ms and 150ms
cue presenting time, Glauert et al.s (2010) study only assessed
attentional engagement, while attentional disengagement can not
bemeasuredintheir study, becauseneutral trials werenot included
in their dot probe task (Koster et al., 2004). Furthermore, the sta-
tistical methods used in their study only allowed for testing the
covariate effects of BMI and body dissatisfaction on attentional
bias to body-related cues, but other effects could not be analyzed.
For example, Glauert et al. (2010) could not determine whether
BMI moderated the relationship between body dissatisfaction and
attentional bias, and more specically, whether the effects of body
dissatisfaction on attentional bias differed between samples with
high and low BMI. The present study added to the literature by
addressing these questions.
Finally, of additional interest for the present study is the atten-
tional disengagement course over time. In view of Yiend and
Mathews (2001) ndings, attentional disengagement fromthreats
was greater for individuals high in anxiety than individuals low in
anxiety at 500ms, while group differences in disengagement dis-
appeared by 2000ms. Later, using 300ms SOA condition, Fox et al.
(2002) found that emotionally-valenced facial expressions (angry
or happy) produced delayed disengagement in people high in trait
anxiety but not in people low in trait anxiety. However, the group
differences diminished on SOA 960ms conditions, such that both
groups showed delayed attentional disengagement from angry
faces. Theauthors suggestedthat althoughanSOAof 960ms is fairly
standard in the IOR literature, using a SOA of 960ms might miss
differences in disengagement between groups. For example, if low
anxious participants take about 300ms to disengage froman initial
threat stimulus while high anxious participants take about 600ms
to disengage from the same stimulus, this pattern would be con-
sistent with the theoretical hypothesis but would not be reected
in any IOR differences with an SOA of 960ms (Fox et al., 2002,
p. 370). Therefore, in the current study, SOA was varied (760ms
and 1160ms) to allow for a more thorough investigation of atten-
tional disengagement over time. The rationale for these changes is
as follows: SOA760ms is more powerful than SOA960ms in detec-
ting attentional disengagement effects from body-related stimuli
if the difference in attentional disengagement magnitude between
high and low weight dissatisfaction groups is relatively low or the
attentional disengagement difference between two groups occurs
relativelyearlyduringstimulus processing. Then, if thedifferencein
attentional disengagement magnitude between two groups is rel-
atively large or the attentional disengagement difference between
two groups occurs relatively late during stimulus processing, SOA
1160ms could detect it.
Based on the preceding review, this study used a modied spa-
tial cueing paradigmto investigate the association between weight
dissatisfaction and attentional disengagement from body-related
pictures and the potential moderating effect of BMI on this rela-
tionship. Based on Vitousek and Hollons cognitive model (1990)
and previous ndings (Gao, Wang, et al., 2011; Glauert et al.,
2010), three hypotheses were generated: First, weight dissatisfac-
tionwouldbepositivelyassociatedwithdifcultydisengagingfrom
pictures denoting fat body shape/parts relative to neutral pictures:
participants with greater weight dissatisfaction would be slower
than those with less weight dissatisfaction to disengage attention
from fat pictures. Second, weight dissatisfaction could be related
to facilitated disengagement from pictures denoting thin body
shape/parts relative to neutral pictures: participants with greater
weight dissatisfaction would be faster than those with less weight
dissatisfaction to disengage attention from thin pictures. Finally,
it was expected that BMI would moderate associations between
weight dissatisfaction and attentional disengagement from body
shape-related information. To be exact, these effects of weight
dissatisfaction on attentional disengagement would be stronger
among participants with higher BMIs than those with lower BMIs.
Method
Participants
The sample included 204 women drawn from undergraduate
classes at Southwest University (SWU), Chongqing, China. The
women ranged from 18 to 25 years of age (M=20.89, SD=1.44).
One hundred and ninety six students were Han nationality, three
were Uygur nationality, two were Zang nationality, two were Hui
nationality, and one was Yi nationality. BMIs ranged from16.02 to
26.17 (M=19.99, SD=2.08). All were right-handed non-smokers,
with no current or previous neurological or psychiatric illness, had
normal or corrected-to-normal vision, and had normal color vision
as assessed by several basic color tests.
Materials
Body image measure. The Negative Physical Self Scale (NPS;
Chen, Jackson, & Huang, 2006) is a 38-itemmeasure of body image
concerns developedinMainlandChinese samples. The measure has
subscales that assess specic concerns related to Fatness, Stature,
and Facial Appearance as well as a General Appearance Concern
dimension. Eachitemis ratedona 5-point scale of agreement. Chen
et al. (2006) found that the NPS has a stable factor structure among
college women fromChina.
194 X. Gao et al. / Body Image 10 (2013) 191199
In this study, the 11-item Fatness Concern subscale (NPS-F)
assessing thoughts, feelings, and behaviors related to fatness and
overweight concerns was used to measure weight dissatisfaction.
Sample items include When I weigh myself, I feel depressed, I
have tried many ways to lose weight, and I think I amfat in oth-
ers eyes. Each item was rated between 0 (not at all like me) and
4 (very much like me), with total scores reecting the average of
summed responses. The NPS-F yields internally consistent scores
(=.88), as well as stable scores over three weeks (r =.89) among
female and male middle and high school students and undergrad-
uates (Chen, 2006) and nine months (r =.70) among middle school
and high school girls (Chen & Jackson, 2007). It has satisfactory
convergent and predictive validity (Chen et al., 2006; Chen, Gao, &
Jackson, 2007; Chen &Jackson, 2008; Jackson &Chen, 2008) among
samples of adolescents andyoung adults. Inthe current sample, the
NPS-F had an alpha of .90, its scores ranged from 0.09 to 3.18 on
a converted 04 scale (M=1.31, SD=0.79), and its correlation with
BMI was r =.45, p<.001.
Apparatus and picture stimuli. Stimuli were presented on
a 19-in., 85-Hz monitor connected to a Pentium IV 3.2-GHz
computer. Participants sat 70cmfromthe monitor screen. The pho-
tographic stimuli consisted of 30 fat body pictures, 30 thin body
pictures, and 30 neutral household pictures adapted from recent
work (Gao, 2010; Gao, Wang, Chen, Wang, &Zhang, 2012). Initially,
these images were downloaded from free sites on the Internet.
Then, they were cropped and sized into uniformsize. The two sets
of body shape pictures featuredthe whole body excluding the head.
Fat versus thin pictures of different body parts such as arms, waists,
thighs or stomachs were matched for gestures. Also, sets of body
shape pictures and household pictures were closely matched for
physical properties such as color and visual complexity and pre-
tested for valence and arousal by female undergraduates. There
was no signicant difference among the three kinds of pictures
on valence, F(2, 106) =2.54, p=.087, or arousal, F(2, 106) =1.82,
p=.170. Examples of stimuli are presented in Appendix A.
The Modied Spatial Cueing Paradigm
The modied spatial cueing paradigm procedure was pro-
grammed with E-Prime v1.2 software (Schneider, Eschman, &
Zuccolotto, 2002). The main trial events in the current modied
spatial cueing paradigmare illustrated in Fig. 1. At the beginning of
each trial, the xation point and two empty boxes were displayed
for 8001000ms. The two boxes were 5cm high and 3cm wide
and were displayed 2.25cm to the left and the right of the cen-
tral xation point. Shortly thereafter, a body or a household cue
was presented for 300ms in either the left or right box (Verkuil
et al., 2009). The cue pictures were 3.75cm high and 2.4cm wide.
Then the cue was blanked out, and 200ms later the central xation
point was presented in bold type for either 100ms (SOA=760ms)
or 500ms (SOA=1160ms). The initial xation point was then pre-
sented for 160ms. Following this, the target (O or C) appeared
in the lower half of the same box as the cues (valid trials) or in the
box opposite to the cues (invalid trials) until a response was made
or for a 5s maximum. Participants were required to identify the
target as quickly and accurately as possible, with left index nger
pressing the key C if the target was a C and right index nger
pressing the key O if the target was an O. During the task, they
were instructed to keep the left index nger on key C and the
right index nger on key O. The diameter of the target was about
0.8cm.
Each participant completed a total of 24 practice trials and 360
experimental trials. Similar to the procedure used by Fox et al.
(2002) andVerkuil et al. (2009), 50%(180trials) of the experimental
trials werevalid, and50%trials wereinvalid. Theformal experiment
phase consisted of four blocks with 90 trials in each block, and
the trials were blocked by SOA condition. Two blocks were SOA
760ms condition and the other two were SOA 1160ms condition.
Each block consisted of fat body cues-valid, fat body cues-invalid,
thinbody cues-valid, thinbody cues-invalid, neutral cues-validand
neutral cues-invalid trials, and each category of trials appeared 15
times inevery block. That is, fat body, thinbody andhouseholdcues
appeared 60 times each on valid trials and 60 times each on invalid
trials, half of which were on SOA 760ms condition and the other
half were on SOA 1160ms condition. Every picture was presented
four times during the whole experiment, and each was presented
twice on invalid and valid trials on SOA 760ms and 1160ms condi-
tion, respectively. The order of presentation of the 90 trials within
each block was randomized, and the sequence of four blocks was
counterbalanced across participants.
Procedure
Following ethics approval from SWU, participants were
recruitedvia on-campus advertisements. Subsequently, 204under-
graduate women engaged in the initial and follow-up phases of
the study. They were told the experiment focused on determining
spatial locations of stimuli and would last for about 60 minutes.
After reading a general overview of the research and signing an
informed consent sheet, participants completed the individually-
administered self-report measures noted above as well as color
vision tests. Participants reported their height and weight, and this
information was used to calculate their BMI. There was a 1-month
delay between the initial and follow-up phases of the study to
attempt to mask the true purpose of the study and reduce demand
characteristics during the experiment (Gao, Wang, et al., 2011).
Participants were asked to consume their regular meals. To
avoid the inuence of caffeine on the participants attention
and cognitive performance, they were also required to refrain
from drinking caffeinated beverages for 12 hours before the
experiment. Individual testing sessions were scheduled between
9:0011:00amand 2:305:30pmin a quiet and soundproof room.
Following their session, women were debriefed and paid 20 Yuan
as compensation for their time.
Data Preparation
Trials with errors and response time exceeding two standard
deviations of each individuals mean reaction time were excluded
fromanalyses (Ratcliff, 1993). The number of errors ranged from0
to 16 times (M=10.27, SD=4.68).
Design and Statistical Analyses
The statistical analyses followedEllenbogenandSchwartzmans
(2009) and Verkuil et al.s (2009) studies. A 322 within-group
design assessed effects of Cue (Fatness, Thinness, and Neutral),
SOA (760ms vs. 1160ms) and Validity (valid trials vs. invalid
trials) on probe reaction time, measured in milliseconds. To inves-
tigate whether weight dissatisfaction, BMI, and their interaction
were associated with delayed disengagement from body cues,
but not from neutral cues, weight dissatisfaction, BMI and their
interaction were used as continuous between-subjects variables
while Cue, SOA, and Validity were within-subjects variables in
a repeated measures analysis of variance (ANOVA). To minimize
the number of post hoc tests conducted, only main effects and
interactions relevant to the studys hypotheses were examined.
Similar to EllenbogenandSchwartzmans (2009) andVerkuil et al.s
(2009) studies, when a signicant interaction emerged, disengage-
ment index scores for two categories of body-related cues were
calculated to further examine the signicant interactions using
X. Gao et al. / Body Image 10 (2013) 191199 195
Fig. 1. The modied spatial cueing paradigm(one complete invalid cue condition of thin body cues).
partial correlations and simple slopes regression analyses (Koster
et al., 2005; Verkuil et al., 2009; Waters et al., 2007). For all
within-subjects analyses, p-values were corrected for deviations
according to the GreenhouseGeisser correction (Greenhouse &
Geisser, 1959). A p-level of .05 was used for determining statistical
signicance.
Results
Inhibition of Return Effects
After excluding trials with errors and response times exceed-
ing two standard deviations of each individuals mean reaction
time, reaction times on the different trials were analyzed. Descrip-
tive statistic results of reaction time data are presented in Fig. 2.
A 3 (Cue) 2 (SOA) 2 (Validity) repeated measures ANOVA on
reaction time data revealed a signicant main effect of Validity,
F(1, 203) =14.42, p<.001, with longer reaction times on valid tri-
als (M=576.10ms, SD=98.62) than on invalid trials (M=565.42ms,
SD=99.53). The main effect of SOA was also signicant, F(1,
203) =6.40, p=.012. Participants had shorter reaction times for
the SOA 760ms condition (M=567.49ms, SD=100.09) than the
SOA 1160ms condition (M=574.03ms, SD=95.81). These effects
were qualied by a signicant SOAValidity interaction, F(1,
203) =19.28, p<.001. Simple effects analyses indicated that the
inhibitionof returneffects onthe760ms SOAconditionweresignif-
icant (p<.001), while no inhibition of return effects were observed
on the 1160ms SOA condition. Other main effects or interactions
were not signicant.
Effects of Weight Dissatisfaction, BMI, and Their Interaction
on Attentional Disengagement
A 3 (Cue) 2 (SOA) 2 (Validity) within-subjects repeated
measures ANOVA was conducted with BMI, weight dissatis-
faction, and their interaction as continuous between-subjects
variables. Signicant interactions emerged for Cue BMI,
F(2, 400) =3.27, p=.040, Cue BMIWeight Dissatisfaction
interaction, F(2, 400) =3.64, p=.028, Cue Validity, F(2,
400) =4.72, p=.010, Cue ValidityWeight Dissatisfaction,
F(2, 400) =3.35, p=.036; Cue ValidityBMI, F(2, 400) =4.28,
p=.015, Cue ValidityBMIWeight Dissatisfaction interac-
tion, F(2, 400) =3.21, p=.042, as well as marginally signicant
interactions between SOACue Validity, F(2, 400) =2.94,
p=.055, and SOACue ValidityBMI, F(2, 400) =2.90, p=.057.
In addition, relevant to the studys predictions, the four-way
Cue SOAValidityBMIWeight Dissatisfaction interaction
was signicant, F(2, 400) =3.48, p=.032.
To further analyze the 4-way interaction, the cue validity factor
and valid trials were dropped fromfurther analyses (Ellenbogen &
Schwartzman, 2009). Datafor invalidtrials wereconvertedintodis-
engagement index scores by subtracting reaction times for invalid
trials with neutral picture cues fromthe reaction times for invalid
trials with fat or thin picture cues, respectively. A positive score
indicates longer reaction time followed by an invalid fat or thin pic-
ture cue than a neutral cue, which is consistent with the delayed
disengagement from fat or thin-related stimuli. A negative score
indicates shorter reaction time followed by an invalid fat or thin
picture cue than a neutral cue, which suggests the rapid disengage-
ment from fat or thin-related stimuli. As indicated by Ellenbogen
and Schwartzman (2009), a further advantage of using index scores
is that they control for overall group differences in reaction times.
A repeated measures ANOVA on disengagement index scores
with Cue type as the within-subject variable and BMI, weight
dissatisfaction, and their interaction as continuous between-
subjects variables were assessed regarding each SOA condition.
To further test the rst and second hypotheses that weight dis-
satisfaction would be associated with attentional disengagement
from body-related cues, partial correlations between weight
dissatisfaction and disengagement index scores of fat and thin
picture cues were conducted while controlling for BMI and the
BMIweight dissatisfaction interaction when the main effect of
weight dissatisfaction or the Cue Weight Dissatisfaction inter-
action was signicant. Then, to test the nal hypothesis that BMI
would moderate the relationship between weight dissatisfaction
and attentional disengagement, partial correlations between the
BMIweight dissatisfaction interaction and index scores of each
cue type were conducted, while controlling for BMI and weight
dissatisfaction, when the main effect of BMIweight dissatisfaction
interaction or the Cue BMIWeight Dissatisfaction interaction
196 X. Gao et al. / Body Image 10 (2013) 191199
0.00
100.00
200.00
300.00
400.00
500.00
600.00
700.00
Fat Thin Neutral Fat Thin Neutral
Valid trials Invalid trials
SOA760ms SOA1160ms
M
e
a
n

r
e
a
c
t
i
o
n

t
i
m
e

(
m
s
)
Fig. 2. Mean reaction time on each condition within the modied spatial cueing task.
was also signicant. If partial correlations betweenthe BMIweight
dissatisfaction interaction and index scores of each cue type were
signicant, simple slopes analyses were conducted to explore how
BMI moderated the relation between weight dissatisfaction and
attentional disengagement.
SOA760ms condition. For indexscores, therepeatedmeasures
ANOVA indicated signicant main effects of weight dissatisfaction,
F(1, 200) =36.31, p<.001, andthe BMIweight dissatisfactioninter-
action, F(1, 200) =8.82, p=.003. Other main effects or interactions
were not signicant.
Since the main effect of weight dissatisfaction was signi-
cant, partial correlations betweenthefat/thindisengagement index
scores and weight dissatisfaction were conducted respectively
while controlling for BMI and the BMIweight dissatisfaction inter-
action, which was aimed to test Hypotheses 1 and Hypothesis
2. Signicant associations between weight dissatisfaction and fat
disengagement index scores, r =.28, p<.001, as well as weight dis-
satisfaction and thin disengagement index scores, r =.28, p<.001,
were observed. These ndings showed independent effects of
weight dissatisfaction on attentional disengagement fromboth fat
and thin pictures that the more women were dissatised with their
body weight, the more difcult it was for them to disengage their
attention fromboth fat and thin body pictures. Therefore, the nd-
ings on the SOA 760ms condition were consistent with Hypothesis
1, but contrary to Hypothesis 2.
To test Hypothesis 3, the signicant main effect of BMIweight
dissatisfaction interaction found in the repeated measures ANOVA
was further examined by inspecting partial correlations between
disengagement index scores and the BMIweight dissatisfaction
interaction while controlling for BMI and weight dissatisfac-
tion. Partial correlation analyses revealed signicant associations
between the BMIweight dissatisfaction interaction and fat disen-
gagement index scores, r =.16, p=.025, as well as a marginally
signicant correlation between BMIweight dissatisfaction inter-
action and thin disengagement index scores, r =.13, p=.066. Next,
simple slopes regression analyses on the fat and thin disengage-
ment indexscores wereconductedrespectively, usingstandardized
variables. The simple slopes regression analyses on the fat dis-
engagement index scores conrmed that coefcients for weight
dissatisfaction(=.25, p=.001) andthe BMIweight dissatisfaction
interaction (=.18, p=.007) were signicant. Signicance tests
on the separate regression slopes showed that the slopes of the
low (=.43, p<.001) and middle (=.25, p=.001) BMI line were
signicant (see Fig. 3). The simple slopes regression analyses on
the thin disengagement index scores showed that only the main
-1.2
-0.6
0
0.6
1.2 BMI: -1 SD
BMI: Mean
BMI: +1 SD
NPS-F: -1 SD NPS-F: +1 SD
(Z scores)
D
i
s
e
n
g
a
g
e
m
e
n
t

i
n
d
e
x

s
c
o
r
e
s

f
o
r

f
a
t

c
u
e
s
Fig. 3. Regressionlines onSOA760ms for the relationship betweenweight dissatis-
faction and the disengagement index scores for fat picture cues, moderated by body
mass index (BMI). The y-axis was presented in Z scores of disengagement index
scores for fat picture cues. Mean=6.44ms, SD=86.39ms; NPS-F =Negative Physical
Self-Fatness Concern subscale.
effect of weight dissatisfaction (=.30, p<.001) was signicant.
Because the main effect of the BMIweight dissatisfaction interac-
tiononthindisengagement indexscores was not signicant, further
analysis was not conducted. Therefore, Hypothesis 3 was partly
supportedonthe SOA760ms conditioninthat BMI only moderated
the relationship between weight dissatisfaction and attentional
disengagement from fat body pictures but not thin body pictures,
and the effects of weight dissatisfaction on attentional disengage-
ment from fat body pictures were only signicant for individuals
at lowor mediumBMI levels.
SOA 1160ms condition. A signicant Cue Weight Dissatis-
faction interaction, F(1, 200) =4.61, p=.033, Cue BMI interaction,
F(1, 200) =4.77, p=.031 and Cue BMIWeight Dissatisfaction
interaction, F(1, 200) =4.47, p=.036, were obtained.
To further analyze the Cue Weight Dissatisfaction interaction,
partial correlations betweenweight dissatisfactionandfat/thindis-
engagement index scores were conducted respectively, controlling
for BMI and the BMIweight dissatisfaction interaction. However,
no signicant correlation was obtained.
The signicant Cue BMIWeight Dissatisfaction interaction
was further examined by conducting partial correlations between
disengagement index scores and the BMIweight dissatisfaction
interaction while controlling for BMI and weight dissatisfaction.
X. Gao et al. / Body Image 10 (2013) 191199 197
A marginally signicant correlation between thin disengagement
index scores and the BMIweight dissatisfaction interaction was
obtained, r =.12, p=.090. Other correlations were not signicant.
The simple slopes regression analyses on the thin disengagement
index scores showed that no signicant main effect of weight
dissatisfaction or the BMIweight dissatisfaction interaction was
observed. Therefore, none of the three hypotheses was supported
for the SOA 1160ms condition.
Discussion
This is therst experimental studytoexamineattentional disen-
gagement fromimages of fat and thin body shapes in a non-clinical
sample that varied in degree of weight dissatisfaction. First, results
demonstrated that independent of BMI, weight dissatisfaction was
associated with delayed attentional disengagement from both fat
and thin body pictures only within the SOA 760ms condition.
Second, BMI only moderated the relation between weight dissat-
isfaction and attentional disengagement from fat body pictures
within the SOA 760ms condition. Specically, weight dissatisfac-
tion was associated with delayed attentional disengagement from
fat body pictures only among individuals at a lowor mediumlevel
of BMI.
The current results suggest a positive relationship between
weight dissatisfactionanddelayedattentional disengagement from
general body information. Attentional disengagement difculties
among women with elevations in weight dissatisfaction were con-
sistent with eye movement research indicating that women high
in weight dissatisfaction had longer initial xations on fat body
words (Gao, Wang, et al., 2011) and fat body images (Gao et al.,
2012) than did controls as well as ndings indicating anxiety is
associated with difculty disengaging attention from spatial loca-
tions of threat cues (Fox et al., 2001; Yiend & Mathews, 2001). Fat
body pictures may serve as ego threats to women who feel dis-
contented with their own body weight and shape, and assimilation
effects might be induced between fat body parts described in the
pictures and their own bodies. Perhaps such processing involves
self-reection or rumination on perceived unattractive parts of
their own bodies. Assessments of salient variables such as anxi-
ety, downwardsocial comparison, andself-reectioninducedbyfat
body images are needed in future work to test this interpretation.
Contrary to predictions, weight dissatisfaction was also inde-
pendently associated with delayed attentional disengagement
from thin body pictures within the SOA 760ms condition. These
results suggest womenwithhighlevels of weight dissatisfaction, in
particular, had difculty disengaging from pictures denoting thin
body shape relative to images of neutral household images. The
mechanismunderlying this effect might differ fromthe disengage-
ment bias related to fat body images. Women with high weight
dissatisfaction may engage in an automatic upward appearance
social comparison process whereby they compare their bodies to
thin bodies (Posavac, Posavac, & Posavac, 1998; Schutz, Paxton, &
Wertheim, 2002). Women high in weight dissatisfaction also focus
attention more heavily on the attractive body parts of the compar-
ison targets (Jansen et al., 2005; Roefs et al., 2008). As indicated
by Friederich et al. (2007), anxiety ratings in response to thin body
images among women average in BMI and who do not have an eat-
ing disorder are positively correlated with brain activation related
to anxiety processing, fear processing, emotional regulation, self-
reection, self-judgment, and cognitive conict monitoring. On
this basis, similar brain mechanisms may underlie inhibited dis-
engagement from thin body images in the current study among
women with elevated weight dissatisfaction. The reduced capacity
to disengage from thinness cues may aggravate body dissatisfac-
tionandcontribute toother negative consequences suchas anxiety,
depressed mood, and even increases in disordered eating behav-
iors.
Regarding the moderating inuence of BMI on association
between weight dissatisfaction and attentional disengagement,
effects were observed in the SOA760ms condition only for fat body
pictures. Notably, weight dissatisfaction was positively associated
withsloweddisengagement fromfat body pictures only whenBMIs
were at a low or mediumlevel. Conversely, no signicant associa-
tionbetweenweight dissatisfactionandattentional disengagement
from fat body pictures was observed when BMI was high. Previ-
ously, Roefs et al. (2008) found a positive association between BMI
and the amount of attention focusing on ones own perceived most
unattractive body part and anothers perceived most attractive
body part. In Glauert et al.s study (2010), a signicant correla-
tion between attentional engagement and body dissatisfaction was
eliminated when BMI was controlled. Together, these studies sug-
gest that BMI has an effect on attention towards body information.
The nonsignicant ndings of women high in BMI in the current
study may result from a ceiling effect. Specically, women high
in BMI might show inhibited attentional disengagement from fat
body images, independent of self-reported weight dissatisfaction.
Because societyadvocates thinbodies as ideal andstigmatizes large
bodies, women high in BMI would likely internalize societal ideals
and have more negative implicit attitudes toward their own body
weight and shape, regardless of the extent they explicitly report
weight dissatisfaction. Hence, women with a higher BMI may be
more sensitive to body-relevant stimuli in a similar manner to
women with negative body image.
With respect to the time course of attentional disengagement,
weight dissatisfaction was associated with slowed disengagement
from both fat and thin body pictures, but only in the SOA 760ms
condition. In other words, women high in weight dissatisfaction
were less able to disengage from body images during a shorter
interval between the cue and the target but could shift attention
and focus on locations opposite to body cues as quickly as their
healthier counterparts did during a relatively longer interval. Dis-
engagement difcultyamongwomen highinweight dissatisfaction
during the shorter intervals may be based on automatic schema
related processing (Vitousek & Hollon, 1990), while later disen-
gagement from fat and thin body images may help them escape
awareness of their perceived unattractive bodies or from the dis-
comfort or anxiety induced by the images.
The current ndings contrast with those provided by Glauert
et al. (2010), who found that undergraduate women showed an
attentional bias toward thin bodies, which was weakest for women
who had a higher BMI and elevated body dissatisfaction. However,
methodological differences betweenthe twostudies may have con-
tributed to the discrepant ndings. Specically, while a spatial
cueing paradigmwas utilized to assess attentional disengagement
in the present study, a modied dot probe task was used by Glauert
et al. (2010) to investigate attentional engagement. Attentional
disengagement and engagement are two subcomponents of atten-
tion that do not always complement one another. Second, images
of actual human bodies were stimuli in this study compared to
computer-generated nude female bodies having emaciated BMIs of
11.7 and 15.1 in that study. Skeletally-thin nude bodies may arouse
negative emotion for many women and override effects of weight
dissatisfaction that may be observed in more realistic depictions of
thinness.
Findings from the present study were relatively novel and
require replication in nonclinical high-risk samples (e.g., females
with body dissatisfaction) and clinical ED samples. Nonetheless,
this study has potential implications for research questions perti-
nent to intervention. For example, since weight dissatisfaction was
related to delayed attentional disengagement from body stimuli,
will interventions that reduce absorption in body-related cues
198 X. Gao et al. / Body Image 10 (2013) 191199
Fig. A1.
reduce body dissatisfaction and, possibly, promote body esteem
among college women? Furthermore, will degree of changes in dis-
engagement inhibition following treatment serve as a measure of
successful outcome and/or a marker for post-treatment prognosis
and relapse risk?
Although this research provided potential insights regarding
links between weight dissatisfaction, BMI, and attentional disen-
gagement related to body-related environmental cues, its main
limitations warrant mention to guide future work. First, because
generalizations cannot be made to clinical ED samples, future
research should test the hypothesis that disengagement difcul-
ties are even more entrenched among women with EDs. On a
related note, ndings do not necessarily generalize to groups that
are demographically dissimilar vis--vis gender, age, and culture.
Second, reaction time is a relatively crude index of attentional
disengagement that fails to elucidate visual attention during stim-
ulus presentations. In order to measure disengagement with more
precision, use of a spatial cueing paradigm combined with eye
movement indices such as saccade latency could be adopted in
future research (Hooge & Frens, 2000). Furthermore, participants
weight dissatisfactioncouldhave beenalteredduring the relatively
long time lag between the assessment of weight dissatisfaction and
experimental task, due to body image state uctuations (Melnyk,
Cash, & Janda, 2004). In order to reduce body image variability,
future studies should include a shorter time lag.
In conclusion, this study is the rst that uses a pictorial spa-
tial cueing paradigm which presents fat and thin body image
cues in order to study whether an association exists between
weight dissatisfactionanddelayedattentional disengagement from
these images in a nonclinical sample. Specically, undergradu-
ate women who experienced high levels of dissatisfaction with
their body weight were slower to disengage from both fat and
thin body images in a relatively early processing stage. As well,
BMI moderated the association between weight dissatisfaction and
attentional disengagement. Specically, whenparticipants hadlow
or medium levels of BMI, the more they were dissatised with
their body weight, the more difcult it was for them to disen-
gage their attention from fat body pictures. Overall, difculties in
disengaging frombody-related environmental stimuli may be one
cognitive bias that co-occurs with weight dissatisfaction among
young women.
Acknowledgements
This research was supported by The Chinese National Natural
Science Foundation (31100758) grant to Xiao Gao. We thank two
anonymous reviewers who extensively commented on an earlier
version of this article. Special gratitude goes to Dr. Tracy L. Tylka for
her enthusiasmand thoughtful comments to improve this article.
Appendix A.
See Fig. A1.
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