Christine Sundgot-Borgen

• Sundgot-Borgen, Christine; Daus, Stephan; Poornikoo, Mehdi; Pedersen, Cathrine; Besche, Torstein de & Vestad, Lene [Show all 10 contributors for this article] (2026). Embargoed OSF preregistration; Validation of questionnaires measuring multi-level implementation of a health promotive school reform. Open Science Framework (OSF). doi: https:/osf.io/t3b5f/overview?view_only=5187f0f6454647319ea37f150cdb1c72. Full text in Research Archive Show summary

  This preregistration describes a cross-sectional observational validation study of four newly developed questionnaires assessing the implementation of Health and Life Skills (HLS) in Norwegian schools. The questionnaires target school owners, school leaders, and teachers, and are designed to capture implementation determinants, processes, and outcomes across levels of the school system. The study combines theory-driven item categorisation based on CFIR, Proctor’s Implementation Outcomes Framework, and Fixsen’s Implementation Drivers Framework with empirical analyses of factor structure and psychometric properties. The preregistered analyses include confirmatory and exploratory factor analyses, CFA of EFA-derived models, reliability and validity analyses, measurement invariance testing, and assessment of school- and municipality-level variation. The aim is to evaluate whether the questionnaires provide valid and reliable measures of implementation in a complex, cross-curricular school reform.

• Edvoll, Maud Clemson; Poornikoo, Mehdi; Klomstén, Anne Torhild; Sundgot-Borgen, Christine; Ystrom, Eivind & Røysamb, Espen [Show all 11 contributors for this article] (2026). OSF Embargoed Preregistrering; A Norwegian School Reform: The Effects of ‘Health and Life Skills’ for the Socioemotional School Climate. Open Science Framework (OSF). doi: https:/osf.io/tfrqu/overview. Full text in Research Archive
• Sundgot-Borgen, Christine; Sundgot-Borgen, Jorunn & Mathisen, Therese Fostervold (2026). Appearance Pressure, Body Image, and Nutrition Practices in Youth Athletes: Implications for Performance. International Journal of Sports Physiology and Performance (IJSPP). ISSN 1555-0265. doi: 10.1123/ijspp.2025-0687. Full text in Research Archive Show summary

  Elite youth sport (12–19 y of age) exists at the intersection of increasing performance demands, rapid biological development, and growing appearance pressures. For many adolescent athletes, this convergence blurs the distinction between fueling to support performance and manipulating food intake to conform to perceived physique ideals. As cultural and digital body norms intensify through social media engagement, leanness is frequently misconstrued as a marker of success—despite clear evidence that inadequate fueling undermines the physiological and psychological systems required for athletic development.1 A recalibration is needed: nutrition in youth sport must be reframed as a biological prerequisite for growth, adaptation, resilience, sustained enjoyment of sport, and the sustainable development of athletic performance across the developmental years.

• Bond, Dale S.; Wu, Yin; Baillot, Aurélie; Lillis, Jason; Sundgot-Borgen, Christine & Papasavas, Pavlos K. (2025). The Role of Physical Activity in Minimizing Recurrence of Weight Gain Following Metabolic and Bariatric Surgery: Current Evidence and Suggestions for Advancing Future Research. Current Obesity Reports. 14(1). doi: 10.1007/s13679-025-00658-4. Full text in Research Archive
• Sundgot-Borgen, Christine; Bårdstu, Silje Kvam; Bond, D. S.; Sniehotta, F. F.; Bergh, Irmelin & Mala, Tom [Show all 8 contributors for this article] (2025). Longitudinal associations between self-regulation and physical activity behavior following metabolic bariatric surgery; an exploratory study. International Journal of Behavioral Nutrition and Physical Activity. 22. doi: 10.1186/s12966-025-01739-2. Full text in Research Archive Show summary

  Background Low adherence to moderate-to-vigorous physical activity (MVPA) recommendations among patients undergoing metabolic bariatric surgery (MBS) is common. However, understanding of psychosocial factors that contribute to low adherence levels is limited. Self-regulation plays a key role in MVPA adherence. Still, the longitudinal and bidirectional associations between self-regulation and MVPA in the MBS patient population remains unexplored. This study aimed to investigate how self-regulatory processes of action- and coping planning, and action control, developed over a 1–5-year post-surgery period, and explore longitudinally the direct, indirect, and bidirectional associations between this development in self-regulation and MVPA assessed at 1- and 5-years after surgery. Methods Participants from the Oslo Bariatric Surgery Study (OBSS) completed MVPA-specific self-regulation questionnaires at 1-, 3-, and 5-years post-surgery and wore ActiGraph monitors for seven days at 1- and 5-years to assess daily MVPA. Second-order latent growth curve modeling examined changes in the three self-regulation constructs, followed by path analysis to explore direct, indirect, and bidirectional associations between baseline levels and changes in self-regulation, and MVPA at 1- and 5-years post-surgery. Results A total of 205 (82.8%), 195 (64.6%), and 79 (26.2%) male and females (77%) participated at 1-, 3-, and 5-years after surgery, respectively. Action- and coping- planning decreased with.52 and.30 sd, respectively, over 1–5 years post-surgery. This indicates a moderate effect size. Action control remained relatively stable. Indirect and bidirectional path analyses showed that only higher levels of action control at 1-year were indirectly associated with higher MVPA at 5-years through their impact on MVPA at 1-year, whereas there were no indications of bidirectional associations from MVPA levels at 1-year to changes in any of the self-regulation constructs over time. Conclusions After MBS, patients exhibited low self-regulation 1-year post-surgery, and many participants faced growing difficulties in self-regulating over time. Self-regulation at 1-year was positively linked to MVPA, with action control only, being associated with MVPA at 5-years. However, no bidirectional associations from MVPA to self-regulation were found. These findings suggest further research is needed to test interventions targeting action control to improve MVPA adherence and optimize surgical outcomes and overall health after MBS.

• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn; Macnaughton, Lindsay; Rustaden, Anne Mette; Løkkevik, Inger Johanne & Lundberg, Helge Einar [Show all 7 contributors for this article] (2025). Knowledge of low energy availability in biathlon: Why coaches need more targeted education. Results from a national, cross-sectional study. International journal of sports science & coaching. ISSN 1747-9541. doi: 10.1177/17479541251407845. Full text in Research Archive Show summary

  This study explores the knowledge of coaches working with adolescent biathletes regarding eating disorders (ED), low energy availability (LEA), and Relative Energy Deficiency in Sport (REDs). METHODS: Recruited coaches completed a questionnaire assessing self-reported knowledge (scale 0–10) of ED, LEA and REDs, and secondly by articulating their knowledge (scored by three experts, scale 0–2). RESULTS: Thirty-three coaches participated (mean age 40.6 ± 12.2 years), most without formal coach education (n = 25, 75.8%), and 13 (39.4%) were female. Self-reported knowledge of LEA/REDs was lower than ED knowledge (4.75 ± 2.9 vs. 5.74 ± 2.5; p = 0.02, g = 0.4), with a similar pattern in expert-rated scores (0.72 ± 0.6 vs. 1.12 ± 0.6; p < 0.01, g = 0.8). A regression model explained 45% of variance in self-reported LEA/REDs knowledge, with education level and course participation positively associated, while sex had no significant effect. For expert-rated scores, the model explained 33% of variance, with only course participation significant. For knowledge of guidelines on addressing LEA/REDs concerns self-reported scores were 3.6 ± 2.9, and 4.5 ± 2.9 for ED concerns (p = 0.04, g = 0.4); and expert-assessed scores were 0.7 ± 0.7 and 0.9 ± 0.8 (p = 0.11), respectively. Regression models did not significantly explain variability in these scores CONCLUSION: Biathlon coaches are less aware of LEA/REDs symptoms and less confident in addressing them than symptoms of ED. Importantly, education and course attendance raised knowledge scores, and preferred learning methods were virtual or physical courses with experts over scientific papers.

• Kvalem, Ingela Lundin; Soest, Tilmann von; Sundgot-Borgen, Christine & Dahlgren, Anna Maria Camilla Lindvall (2025). Kosmetisk kirurgi blant kvinner – en tverrsnittsstudie. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(1). doi: 10.4045/tidsskr.24.0218. Full text in Research Archive Show summary

  Bakgrunn Undersøkelser fra 2003 og 2008 indikerte at 7–8 % av voksne kvinner i Norge hadde gjennomgått kosmetisk kirurgi. Det foreligger lite oppdatert kunnskap om dette, og hovedmålet med studien var å kartlegge bruk av, ønske om og sosial aksept for kosmetisk kirurgi, samt forskjeller i demografiske og psykososiale faktorer mellom kvinner som har gjennomgått, de som ønsker, og de som ikke ønsker kosmetisk kirurgi. Materiale og metode Et utvalg på 3 071 kvinner i alderen 18 til 60 år ble rekruttert fra panelet til meningsmålingsinstituttet Ipsos/MMI, hvorav 3 055 kvinner ble inkludert i studien. Strukturerte telefonintervjuer ble utført i desember 2022. Resultater Blant deltakerne svarte 526 (17 %) at de hadde gjennomført én eller flere kosmetiske operasjoner. 1 588 (52 %) rapporterte at det var sannsynlig at de ville gjennomføre kosmetisk kirurgi, og 535 (18 %) hadde selv blitt anbefalt kosmetisk kirurgi. Kvinnene som hadde gjennomført eller ønsket kosmetisk kirurgi, hadde lavere utdanningsnivå, var mindre fornøyde med egen kropp og utseende, hadde oftere blitt anbefalt kosmetisk kirurgi, og var oftere på utseendefokuserte sosiale medier, sammenlignet med dem som ikke ønsket kosmetisk kirurgi. Fortolkning Studien indikerte en økning i bruk av kosmetisk kirurgi blant voksne kvinner de siste 20 årene, fra 8 % til 17 %, samt en økning i både ønske om og sosial aksept for kosmetisk kirurgi.

• Sundgot-Borgen, Christine; Sundgot-Borgen, Jorunn; Sølvberg, Nina; Torstveit, Monica Klungland; Mountjoy, Margo & Mathisen, Therese Fostervold (2025). Factors predicting disordered eating and the prevalence of eating disorders in adolescent elite athletes, trained athletes and a reference group: a prospective controlled two-step study. British Journal of Sports Medicine. ISSN 0306-3674. 59(15), p. 1043–1054. doi: 10.1136/bjsports-2024-108808. Full text in Research Archive Show summary

  Abstract Objective To prospectively examine the prevalence of diagnosed eating disorders (ED-diagnosis), ED-symptoms and factors predicting ED-symptoms in three male and female high school student groups: elite athletes, trained athletes and a non-athlete reference group at baseline (T1) and 1-year follow-up (T2). Methods A survey was administered at baseline (T1) (n=1186) and 1-year follow-up (T2) (n=1144) (step-one). Participants classified with ED-symptoms by the Eating Disorder Examination Questionnaire (EDEQ 6.0) at T2 were invited to a diagnostic interview (step-two). Results Prevalence of ED-diagnosis for males and females were 6.9% and 9.3% in elite athletes, 5.9% and 11.2% in trained athletes and 3.0% and 11.9% in references, respectively. No group differences were statistically significant. Male references had more ED-symptoms compared with elite and trained male athletes (EDEQ-global score 0.81 vs <0.55), while elite female athletes had fewer ED-symptoms compared with trained female athletes and female references (EDEQ-global score 1.14 vs >1.59). Trained female athletes increased ED-symptoms over time, whereas elite female athletes consistently had fewer ED-symptoms in comparison. High ED-symptom presentation was predicted by high body mass index and more psychological distress in males, whereas for females, ED-symptoms were predicted by lower resilience, more psychological distress and being a non-athlete reference. Conclusion No statistically significant group differences in the prevalence of ED-diagnosis were observed between elite athletes, trained athletes and a non-athlete reference group. Female elite athletes had fewer ED-symptoms compared with other female groups, and male references had more ED-symptoms compared with male athlete groups. Preventive measures that address psychological resilience and distress should be considered.

• Swami, Viren; Tran, Ulrich S.; Voracek, Martin; Aavik, Toivo; Ranjbar, Hamed Abdollahpour & Adebayo, Sulaiman Olanrewaju [Show all 253 contributors for this article] (2025). Self-Compassion Around the World: Measurement Invariance of the Short Form of the Self-Compassion Scale (SCS-SF) Across 65 Nations, 40 Languages, Gender Identities, and Age Groups. Mindfulness. ISSN 1868-8527. 16, p. 1569–1596. doi: 10.1007/s12671-025-02560-5. Full text in Research Archive Show summary

  Objectives The 12-item Self-Compassion Scale–Short Form (SCS–SF) is a widely used instrument for the assessment of self-compassion. To date, there have been few examinations of this instrument’s psychometric properties, particularly across nations and languages. Therefore, we used data from the Body Image in Nature Survey (BINS) to assess measurement invariance of the SCS–SF across nations, languages, gender identities, and age groups. Methods Participants (N = 56,968) from 65 nations completed the SCS–SF in 40 languages. Using these data, we tested various hypothesised models of the SCS–SF in the total sample and, using multi-group confirmatory factor analysis, tested for invariance of the optimal model across national groups, languages, gender identities, and age groups. Results In the total dataset, we found that an 11-item, 2-factor model (i.e., SCS-11) provided best fit to the data, with the two factors tapping distinct constructs of compassionate and uncompassionate self-responding. The SCS-11 was found to be partially scalar invariant across national groups and languages, and fully scalar invariant across gender identities and age groups. There was wide variation in latent means for the two factors, particularly across national groups and languages. Further analyses showed negligible associations between the two factors and sociodemographic variables, including marital status, financial security, and urbanicity. Conclusions Our results suggest that it may be possible to derive a stable 2-factor model of the SCS–SF for use in crosscultural research, but also highlight the likelihood of cross-national and cross-linguistic variations in the way that selfcompassion is understood.

• Swami, Viren; Stieger, Stefan; Voracek, Martin; Aavik, Toivo; Ranjbar, Hamed Abdollahpour & Adebayo, Sulaiman Olanrewaju [Show all 253 contributors for this article] (2025). Life satisfaction around the world: Measurement invariance of the Satisfaction With Life Scale (SWLS) across 65 nations, 40 languages, gender identities, and age groups. PLOS ONE. 20(1), p. 1–34. doi: 10.1371/journal.pone.0313107. Full text in Research Archive Show summary

  The Satisfaction With Life Scale (SWLS) is a widely used self-report measure of subjective well-being, but studies of its measurement invariance across a large number of nations remain limited. Here, we utilised the Body Image in Nature (BINS) dataset–with data collected between 2020 and 2022 –to assess measurement invariance of the SWLS across 65 nations, 40 languages, gender identities, and age groups (N = 56,968). All participants completed the SWLS under largely uniform conditions. Multi-group confirmatory factor analysis indicated thatconfigural and metric invariance was upheld across all nations, languages, gender identities, and age groups, suggesting that the unidimensional SWLS model has universal applicability. Full scalar invariance was achieved across gender identities and age groups. Based on align- ment optimisation methods, partial scalar invariance was achieved across all but three national groups and across all languages represented in the BINS. There were large differences in latent SWLS means across nations and languages, but negligible-to-small differences across gender identities and age groups. Across nations, greater life satisfaction was significantly associated with greater financial security and being in a committed relationship or married. The results of this study suggest that the SWLS largely assesses a common unidimensional con- struct of life satisfaction irrespective of respondent characteristics (i.e., national group, gender identities, and age group) or survey presentation (i.e., survey language). This has important implications for the assessment of life satisfaction across nations and provides information that will be useful for practitioners aiming to promote subjective well-being internationally.

• Dahlgren, Anna Maria Camilla Lindvall; Sundgot-Borgen, Christine; Kvalem, Ingela Lundin; Wennersberg, Anne Louise & Wisting, Line (2024). Further evidence of the association between social media use, eating disorder pathology and appearance ideals and pressure: a cross-sectional study in Norwegian adolescents. Journal of Eating Disorders. 12. doi: 10.1186/s40337-024-00992-3. Full text in Research Archive Show summary

  Background Few studies have investigated how the plethora of contemporary social media (SM) platforms relate to, and influence eating disorder (ED) pathology, appearance ideals and pressure to conform to these ideals in youth. Methods In this study, 1558 girls (53%) and boys (47%), predominantly within the 16–19 age range, completed an online questionnaire assessing SM use and perceived influence on appearance, ED pathology, internalization of appearance ideals and perceived appearance pressure. Results Results showed that ED pathology was common, particularly in girls, and that internalization of body ideals was gender specific, a thin ideal being more prevalent in girls, and a muscular ideal being more common in boys. Results also showed a strong association between ED pathology and perceived pressure to conform to these appearance ideals. One fourth of the participants reported spending four hours or more on SM daily, and 80% of girls reported that SM, particularly Instagram and TikTok, had a negative influence on how they felt about their appearance. These girls had significantly higher levels of ED pathology and reported higher levels of appearance pressure from the media. Conclusion A clear pattern of associations between photo- and video specific SM platforms, ED pathology, internalization of body ideals and perceived pressure was found in this study. Adolescent girls appeared to be particularly at risk. The results illustrate an imperative need to keep addressing the potential risks of SM use in adolescents, and to continue monitoring the effect of SM on young people’s view of themselves, their appearance, and their eating habits. Future studies should attempt to identify aspects of SM use that may be particularly detrimental for girls and boys in their formative years, but also those that may enhance adolescents’ satisfaction and appreciation of their body and appearance. Trial registration: The study is registered in the Open Science Framework (Identifier: 10.17605/OSF.IO/5RB6P https://doi.org/10.17605/OSF.IO/5RB6P).

• Lie, Selma Øverland; Bastos, Rafael Valdece Sousa; Sundgot-Borgen, Christine; Wisting, Line & Dahlgren, Anna Maria Camilla Lindvall (2024). Sociocultural attitudes towards appearance questionnaire-4-revised (SATAQ-4R): validation in a community sample of Norwegian adolescents. Journal of Eating Disorders. 12(1). doi: 10.1186/s40337-024-01151-4. Full text in Research Archive Show summary

  Background Negative body image and disordered eating are common among adolescents and young adults. The Sociocultural Attitudes Towards Appearance Questionnaire-4-Revised (SATAQ-4R) captures the internalization of societal appearance ideals and perceived pressures from others but has not been validated in a Norwegian adolescent population. Methods The current study explored the factor structure of SATAQ-4R in a sample of adolescent Norwegian males and females (n = 1558, mean age 17.04 ± 0.95) using confirmatory factor analysis (CFA) for a 6- and 7-factor structure in females, and a 7-factor structure in males. Correlations between subscales, internal consistency and reliability, and comparisons with convergent measures (disordered eating, body mass index, negative influence of social media) were explored. Results The CFA supported a 7-factor structure of the SATAQ-4R for both males and females. Internal consistency and reliability were acceptable. SATAQ-4R subscales largely correlated with disordered eating and additional convergent measures. Conclusions Results confirm the structure and reliability of the SATAQ-4R in a Norwegian adolescent population. The subscales showed good convergent validity, and high scores on internalization and societal pressures were related to higher levels of disordered eating and negative social media influence. The Norwegian version of the SATAQ-4R thus demonstrates good psychometric properties in adolescent males and females, and is well suited to capture internalization and sociocultural pressures that particularly affect adolescents. Results highlight the need to continue working towards reducing adverse internalization and improving body image among adolescents.

• Kvalem, Ingela Lundin; Soest, Tilmann von; Sundgot-Borgen, Christine & Dahlgren, Anna Maria Camilla Lindvall (2024). Kosmetisk kirurgi - en tverrsnittstudie blant kvinner 18 - 60 år. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.24.0218. Full text in Research Archive
• Sundgot-Borgen, Christine; Wisting, Line Norøm; Sundgot-Borgen, Jorunn; Lied, Karoline Steenbuch; Skrede, Jenny Vik & Nilsen, Karoline [Show all 8 contributors for this article] (2024). The “Young Athlete Body Project”—A pilot study evaluating the acceptability of and results from an eating disorder prevention program for adolescent athletes. International Journal of Eating Disorders. ISSN 0276-3478. 57(3), p. 568–580. doi: 10.1002/eat.24140. Full text in Research Archive Show summary

  Background: The high frequency of eating disorders (EDs) in sports speaks of a need for early-stage preventive measures. Objectives: This study evaluated the acceptability of an age, sex, and sports adapted version of the “Body Project” and changes in mental health symptoms. Methods: This noncontrolled pilot study included a class of athletes from 18 sports (N = 73, 13–14 years) at a sport-specialized junior high school in six small-group workshops. We interviewed 34 athletes on program acceptability, and all athletes responded to questionnaires at pretest, posttest, and 6-month follow-up including the Body Appreciation Scale 2–Children, Social Attitudes towards Appearance Questionnaire-4 revised, Eating Disorder Examination Questionnaire Short form-12 modified, and questions about body appearance pressure (BAP). Results: Athletes found the program acceptable and beneficial, but some missed physically oriented activities or did not identify with the focus, particularly boys. There were acceptable levels in mental health constructs before the workshops. There were temporary changes in the percentage of boys experiencing “BAP in society” by −14.8% points (95% CI: −.6 to .0, p = .04), % in total group experiencing “BAP at school” by +11% points (95% CI: .0–.2, p = .05), thinness idealization by girls (g = .6, p = .002) and total group (g = .4, p = .006), and muscularity idealization by boys (g = .3, p = .05) and total group (g = .23, p = .04). Discussion: Athletes experienced benefits from the Young Athlete Body Project. Seeing stabilization in outcomes may mean a dampening of the otherwise expected worsening in body appreciation and ED symptoms over time. Public Significance: Adolescent athletes are at risk for developing EDs. Due to lack of prevention programs for this group, we adapted and evaluated a well-documented effective program, the Body Project, to fit male and female athletes

• Swami, Viren; White, Mathew P.; Voracek, Martin; Tran, Ulrich S.; Aavik, Toivo & Ranjbar, Hamed Abdollahpour [Show all 253 contributors for this article] (2024). Exposure and connectedness to natural environments: An examination of the measurement invariance of the Nature Exposure Scale (NES) and Connectedness to Nature Scale (CNS) across 65 nations, 40 languages, gender identities, and age groups. Journal of Environmental Psychology. ISSN 0272-4944. 99, p. 1–23. doi: 10.1016/j.jenvp.2024.102432. Full text in Research Archive Show summary

  Detachment from nature is contributing to the environmental crisis and reversing this trend requires detailed monitoring and targeted interventions to reconnect people to nature. Most tools measuring nature exposure and attachment were developed in high-income countries and little is known about their robustness across national and linguistic groups. Therefore, we used data from the Body Image in Nature Survey to assess measurement invariance of the Nature Exposure Scale (NES) and the Connectedness to Nature Scale (CNS) across 65 nations, 40 languages, gender identities, and age groups (N = 56,968). While multi-group confirmatory factor analysis (MG-CFA) of the NES supported full scalar invariance across gender identities and age groups, only partial scalar invariance was supported across national and linguistic groups. MG-CFA of the CNS also supported full scalar invariance across gender identities and age groups, but only partial scalar invariance of a 7-item version of the CNS across national and linguistic groups. Nation-level associations between NES and CNS scores were negligible, likely reflecting a lack of conceptual clarity over what the NES is measuring. Individual-level associations between both measures and sociodemographic variables were weak. Findings suggest that the CNS-7 may be a useful tool to measure nature connectedness globally, but measures other than the NES may be needed to capture nature exposure cross-culturally.

• Swami, Viren; Tran, Ulrich S; Stieger, Stefan; Aavik, Toivo; Ranjbar, Hamed Abdollahpour & abedayo, sulaiman [Show all 51 contributors for this article] (2023). Body appreciation around the world: Measurement invariance of the Body Appreciation Scale-2 (BAS-2) across 65 nations, 40 languages, gender identities, and age. Body image. ISSN 1740-1445. 46, p. 449–466. doi: 10.1016/j.bodyim.2023.07.010. Full text in Research Archive Show summary

  The Body Appreciation Scale-2 (BAS-2) is a widely used measure of a core facet of the positive body image construct. However, extant research concerning measurement invariance of the BAS-2 across a large number of nations remains limited. Here, we utilised the Body Image in Nature (BINS) dataset – with data collected between 2020 and 2022 – to assess measurement invariance of the BAS-2 across 65 nations, 40 languages, gender identities, and age groups. Multi-group confirmatory factor analysis indicated that full scalar invariance was upheld across all nations, languages, gender identities, and age groups, suggesting that the unidimensional BAS-2 model has widespread applicability. There were large differences across nations and languages in latent body appreciation, while differences across gender identities and age groups were negligible-to-small. Additionally, greater body appreciation was significantly associated with higher life satisfaction, being single (versus being married or in a committed relationship), and greater rurality (versus urbanicity). Across a subset of nations where nation-level data were available, greater body appreciation was also significantly associated with greater cultural distance from the United States and greater relative income inequality. These findings suggest that the BAS-2 likely captures a near-universal conceptualisation of the body appreciation construct, which should facilitate further cross-cultural research.

• Borgen, Christine Sundgot; Bond, D.S.; Sniehotta, F.F.; Kvalem, Ingela Lundin; Hansen, Bjørge Hermann & Bergh, Irmelin [Show all 8 contributors for this article] (2023). Associations of changes in physical activity and sedentary time with weight recurrence after bariatric surgery: a 5-year prospective study. International Journal of Obesity. ISSN 0307-0565. 47, p. 463–470. doi: 10.1038/s41366-023-01284-7. Full text in Research Archive Show summary

  Background Increasing physical activity and limiting sedentary time may minimize weight recurrence after bariatric surgery. However, few studies have evaluated potential associations of objectively-measured physical activity and sedentary time with post-surgical weight recurrence over time. Aims To evaluate associations of change in physical activity and sedentary time with weight recurrence after bariatric surgery. Methods Participants from the Oslo Bariatric Surgery Study, a prospective cohort study, wore an ActiGraph monitor for seven days at 1- and 5 years after surgery to assess daily physical activity and sedentary time. Participants’ weight was measured at in-person clinic visits. Chi-square Test and Paired-samples T-test evaluated group differences and change over time, while Pearson’s Correlation, multiple logistic and linear regression investigated associations between variables. Results Five years after surgery 79 participants (70.5% response rate, 81% female) (mean (sd) age: 54.0 (±9.3), BMI: 32.1 (±4.7)) had valid monitor data. Participants increased their sedentary time (71.4 minutes/day (95% CI: 54.2–88.6, p = <0.001)) and reduced daily steps (−1411.1 (95% CI: 737.8–208.4), p = <0.001), light physical activity (−54.1 min/day (95% CI: 40.9–67.2, p = <0.001)), and total physical activity (−48.2 (95% CI: 34.6–63.3), p = <0.001) from 1- to 5 years after surgery. No change was found for moderate-to-vigorous intensity physical activity. No associations were found between changes in steps, physical activity or sedentary time and weight recurrence. Conclusion Participants increased sedentary time and decreased light- and total physical activity between 1- and 5 years post-surgery. Overall, changes in physical activity and sedentary time were not associated with weight recurrence. Interventions to help patients increase physical activity and limit sedentary time after bariatric surgery are needed.

• Otterbring, Tobias; Borgen, Christine Sundgot; Bratland-Sanda, Solfrid & Trangsrud, Lise Katrine Jepsen (2023). Siblings, shopping, and sustainability: Birth-order differences in green consumption. Frontiers in Psychology. 14. doi: 10.3389/fpsyg.2023.1105072. Full text in Research Archive Show summary

  Several studies have examined the role of birth order in shaping human personality, but fewer have tested this variable in relation to other pressing issues. We conducted a birth-order study on green consumption, which enabled us to detect a small-to-moderate effect size equivalent to r = 0.15 or d = 0.30 with sufficient statistical power (N = 335). To capture green consumption, participants indicated their tendency to express the value of environmental protection through purchases and consumption behaviors. Firstborns (vs. laterborns) consistently expressed lower concerns linked to environmental protection in their purchase patterns. While the effect size of this finding was small-to-moderate by conventional standards and in direct contrast to the findings from a recent article on the same topic, these results could still be informative to address challenges associated with climate change considering the number of individuals with siblings in the world and the ease with which birth-order data can be collected.

• Sundgot-Borgen, Christine; Bond, Dale S.; Rø, Øyvind; Sniehotta, Falko F.; Kristinsson, Jon Adalsteinn & Kvalem, Ingela Lundin (2023). Associations of adherence to physical activity and dietary recommendations with weight recurrence 1–5 years after metabolic and bariatric surgery. Surgery for Obesity and Related Diseases. ISSN 1550-7289. doi: 10.1016/j.soard.2023.11.014. Full text in Research Archive Show summary

  Background Little is known about longer-term adherence to recommended physical activity (PA) and dietary behaviors after metabolic and bariatric surgery (MBS) and whether adherence is associated with weight recurrence. Objectives To explore (1) changes in and associations between adherence to PA and general dietary recommendations after MBS and (2) whether PA and dietary behaviors interact to predict weight recurrence. Setting University hospital; public practice. Methods Participants completed ActiGraph PA monitoring, dietary questionnaire, and weighing 1 and 5 years after surgery. Parametric and non-parametric tests evaluated changes in and associations between adherence to PA and dietary recommendations. Multiple linear regression explored associations of adherence and weight recurrence 5 years post-surgery. Results A total of 73 participants (66% loss to follow-up, 80.8% females) were included. From 1 to 5 years after surgery, adherence to PA recommendations did not change (23.5% versus 20.5%, P = .824), whereas adherence to dietary recommendations decreased (P = <.001). Adherence to PA recommendations is positively associated with eating fruits and vegetables and limiting intake of sugar and fat at 1 year (P < .05) and negatively associated with choosing meat with less fat at 5 years (P = .018). Adherence to PA and dietary behaviors did not independently contribute or interact to predict weight recurrence. Conclusions Adherence to recommendations was poor. Dietary adherence decreased from 1 to 5 years post-surgery, whereas PA adherence remained stable. PA adherence was positively associated with adherence to some dietary recommendations at 1 year but not at 5 years. Neither behavioral adherences were associated with weight recurrence. Additional research is needed to understand how to improve adherence and its relationship with other health outcomes after MBS.

• Sundgot-Borgen, Christine; Mathisen, Therese Fostervold; Torstveit, Monica Klungland & Sundgot-Borgen, Jorunn (2022). Explanations for use of dietary- and muscle enhancing dietary supplements among university students: a national cross-sectional study. BMC Nutrition. 8. doi: 10.1186/s40795-022-00510-1. Full text in Research Archive Show summary

  Background: Use of dietary supplements (DS) and muscle enhancing dietary supplements (MEDS) is frequent among students despite the lack of evidence of effects and health risks related to consumption. We need to increase our understanding of students’ motivation, examine potential gender differences, and explore explanatory factors, to address preventive measures related to use. Therefore, this study aimed to explore the frequency of, and the reasons for, DS use among university students, as well as explanatory factors for use of MEDS. Method: Male and female students from nine Norwegian universities participated in this cross-sectional study. Participants responded to questions about demographics, DS and MEDS use, internalization of body ideals, physical activity- and exercise level, motives for exercise, and exercise context. Independent t-test, Chi-square test, Pearson’s correlation, and logistic regression were used to investigate between group differences, associations, and explanatory factors for use, respectively. P-values ≤ 0.05 were defined as significant. Results: A total of 1001 males (34%) and females, with a mean(sd) age of 24.21(4.76) years, participated. The frequency of DS use was 42% and 40% (p = .414) in males and females, respectively, in which more males than females used DS to improve physical or mental performance (p =  < .001), increase muscle mass (p =  < .001) and weight for health (p = .014), and improve appearance (p =  < .001). In males and females, respectively, 25% and 10% used MEDS (p =  < .001). In males, being a fitness center member (OR:3.80), exercising to improve muscle mass (OR:1.96), and a higher physical activity level (OR:1.09) positively explained MEDS use, while exercising to increase endurance (OR:0.49) and being an exercise science student (OR:0.47) negatively explained MEDS use. In females, internalizing the athletic body ideal (OR:1.78) and exercising to improve muscle mass (OR:1.74) positively explained MEDS use. Conclusions: Our main findings indicate that a surprisingly high percentage of male and female Norwegian students use DS and MEDS, and that reasons for use, and variables explaining the variability in frequency of use, differ between genders. Longitudinal studies to investigate direction of associations are needed in future research.

• Mathisen, Therese Fostervold; Sundgot-Borgen, Christine; Anstensrud, Beate & Sundgot-Borgen, Jorunn (2022). Mental health, eating behaviour and injuries in professional dance students. Research in Dance Education. ISSN 1464-7893. 23(1), p. 108–125. doi: 10.1080/14647893.2021.1993171. Full text in Research Archive Show summary

  A high frequency of mental health challenges and injuries in professional dancers necessitate a better understanding of the complexity of such symptoms, and to explore differences according to sex, academic year and performance levels. Professional dance students were recruited to evaluate symptoms of depression and anxiety (SCL-10), resilience (RSA), self-esteem (RSS), perfectionism (CAPS), body appreciation (BAS-2), and symptoms of low energy availability (LEA, LEAF-q) and eating disorders (ED) (EDE-q). Totally 20–54% of the dancers had symptoms of anxiety or depression, LEA (in females), ED and/or injuries, and 12% had a self-reported history with ED. In females, 44% of the variability in SCL-10 was explained by CAPS and RSS; 15% of variability in LEA was explained by EDE-q and training volume; while BMI, academic year and LEA increased the odds ratio of an injury. In all, BAS-2 reduced the odds ratio of EDE-q by -3.33. Totally 50% reported that they could identify personal mental health problems, still <45% would consult a health professional. Enhanced body acceptance may reduce the frequency of mental health challenges in dancers, and improved knowledge of nutrition and body weight regulation may reduce the high frequency of LEA, disordered eating behaviour, and injuries.

• Mathisen, Therese Fostervold; Sundgot-Borgen, Christine; Anstensrud, Beate & Sundgot-Borgen, Jorunn (2022). Intervention in professional dance students to increase mental health- and nutrition literacy: A controlled trial with follow up. Frontiers in Sports and Active Living. 4. doi: 10.3389/fspor.2022.727048. Full text in Research Archive Show summary

  Introduction: There is a need to change the culture within the art of dance, as it has been associated with injuries and mental health consequences. This study evaluates an intervention designed to increase mental health literacy, enhance nutritional knowledge, reduce symptoms and effects of low energy availability, and strengthen understanding of sports nutrition and recovery strategies, in dance students of mixed genders. Material and methods: A total of 125 dance students received three workshops, with 39 arts and crafts students serving as references. The results were evaluated by the Eating Disorder Examination questionnaire, the Low Energy Availability in Females questionnaire, the Hopkins Symptom Check List, and questions on mental health literacy, sports nutrition, and recovery knowledge. Results: Dance students achieved sustained improvements in mental health and nutrition knowledge and temporary improvements in driven exercise (i.e., performing exercise because of a compulsive drive). No other benefits were identified from the intervention. Conclusion: Our findings indicate the need for an ongoing education program to reduce the occurrence and development of negative mental health outcomes and low energy availability in professional dance students. Such approaches may not only improve the mental health of dance students but also potentially prevent the high frequency of injuries.

• Sundgot-Borgen, Christine; Trangsrud, Lise Katrine Jepsen; Otterbring, Anders Emil Tobias & Bratland-Sanda, Solfrid (2022). Hiking, indoor biking, and body liking: a cross-sectional study examining the link between physical activity arenas and adults’ body appreciation. Journal of Eating Disorders. 10. doi: 10.1186/s40337-022-00705-8. Full text in Research Archive Show summary

  Background Body appreciation might serve as a protective factor for developing eating disorders and is associated with participation in physical activity. Less is known about whether various arenas for physical activity may be linked to body appreciation. Therefore, the current study sought to (1) identify potential associations between physical activity level and arenas for physical activity, connectedness with nature, self-compassion, and body appreciation in adults, and (2) explore physical activity level and arenas, connectedness with nature, and self-compassion as explanatory factors for body appreciation. Methods A total of 360 adult Norwegian inhabitants (75% women, mean (SD) age 42.58 (12.30) yrs) responded to an online questionnaire. Instruments included the Body Appreciation Scale, the Connectedness with Nature Scale, and the Self-Compassion Scale. Results The percentage of participants who engaged in various physical activity arenas were 98.5% for nature, 57.5% for fitness centers, and 43.0% for organized sports. Small, positive associations were found between body appreciation and the frequency of using fitness centers and nature as physical activity arenas. Self-compassion, connectedness with nature, and frequency of using fitness centers and nature as physical activity arenas explained 39% of the variance in body appreciation. Discussion The importance of both fitness centers and nature as arenas for physical activity to explain body appreciation was surprising and might reflect different use of fitness centers among adults compared to younger age groups. Conclusion Physical activity at fitness centers and in nature were positively associated with body appreciation in adults. Self-compassion, connectedness with nature, and using fitness centers and nature as arenas for physical activity, were found to explain variation in body appreciation in adults.

• Svantorp-Tveiten, Kethe Marie Engen; Ivarsson, Andreas; Torstveit, Monica Klungland; Sundgot-Borgen, Christine; Mathisen, Therese Fostervold & Bratland-Sanda, Solfrid [Show all 10 contributors for this article] (2022). The Healthy Body Image Intervention and Reduction in Eating Disorder Symptomatology and Muscle Building Supplement Use in High School Students: A Study of Mediating Factors. Frontiers in Psychology. 13. doi: 10.3389/fpsyg.2022.803654. Full text in Research Archive Show summary

  Background: Mediation analysis is important to test the theoretical framework underpinning an intervention. We therefore aimed to investigate if the healthy body image (HBI) intervention’s effect on eating disorder (ED) symptomatology and use of muscle building supplements was mediated by the change in risk and protective factors for ED development and muscle building supplement use. <p> <p>Methods: This study used data from the HBI intervention: a cluster randomized controlled universal intervention aiming to promote positive body image and embodiment and reduce the risk for ED development including 30 schools in Norway. A total of 1,713 (37% boys) participants were included in the analyses. Conditional latent growth curve analyses were performed to test for indirect effects on ED symptomatology and weekly frequency of protein and creatine supplement use measured at the 12-month follow-up via change in the proposed mediators. Results: In girls, the reduction in ED symptomatology was mediated by positive changes in protective factors (self-esteem and body image flexibility) and reductions in risk factor scores (perceived media pressure and thin appearance internalization). Comparable changes in protective and risk factors among boys played no mediating role. <p> <p>Conclusion: Interventions aiming to reduce the risk of ED development in girls may benefit from aiming to enhance self-esteem and body image flexibility and reduce perceived media pressure and thin appearance internalization. Future studies should investigate the casual relationship between muscle building supplement use and risk and protective factors for ED development in both girls and boys.

• Haakstad, Lene Annette Hagen; Jakobsen, Charlotte; Solberg, Runar Barstad; Sundgot-Borgen, Christine & Gjestvang, Christina (2021). Mirror, mirror - Does the fitness club industry have a body image problem? Psychology of Sport And Exercise. ISSN 1469-0292. 53. doi: 10.1016/j.psychsport.2020.101880. Full text in Research Archive Show summary

  The primary aim of the present study was to report longitudinal data on body image across the first year of gym engagement. Second, we aimed to compare body image among those who reported regular use of the fitness club (≥2 sessions/week) with those who did not (≤1exercise session/week or no exercise/dropout), as well as between genders and Body Mass Index groups (BMI<25 and BMI≥25) at membership start-up. Novice exercisers (n = 250) from 25 fitness clubs in Oslo (Norway) responded to an online questionnaire at start-up, three, six and 12-months follow-up, with a high response rate (100%, 89.6%, 85.2% and 74.8%). The questionnaire covered background/health information and exercise involvement. A modified Multidimensional Body Self Relations Questionnaire Appearance Scales (MBSRQ-AS), comprising five subscales (appearance satisfaction, appearance investment, weight-related attitude, self-classified weight and Body Areas Satisfaction Scale (BASS), was used to gather repeated measures of body image. Data were analysed separately for each subscale and as a body image total score, using a linear mixed model adjusted for baseline, gender and BMI. We found differences in body image total score reported at six months when compared with onset (0.04, 95% CI 0.005–0.078, p = 0.024), whereas the subscale appearance satisfaction was different at three (0.08, 95% CI 0.015–0.164, p = 0.018), six (0.11, 95% CI 0.039–0.197, p = 0.003) and twelve (0.10, 95% CI 0.021–0.179, p = 0.013) months when compared with onset. Also the subscale BASS was different at three (0.17, 95% CI 0.009–0.255, p < 0.001), six (0.21, 95% CI 0.127–0.301, p < 0.001) and twelve (0.26, 95% CI 0.143–0.388, p < 0.001). Participants adhering to regular exercise (≥2 times weekly) had better outcomes on total body image than those who exercised less frequently or irregularly (three: 2.94 vs. 2.83, p = 0.027 and 12-months: 2.97 vs. 2.85, p = 0.028). At membership start-up, being male (p < 0.001) and having a BMI<25 (p = 0.003), were the strongest factors associated with reporting a higher score on total body image. In conclusion, we found improved body area and appearance satisfaction in novice exercisers across the first year of fitness club membership.

• Sundgot-Borgen, Christine; Sundgot-Borgen, Jorunn; Bratland-Sanda, Solfrid; Kolle, Elin; Torstveit, Monica Klungland & Svantorp-Tveiten, Kethe Marie Engen [Show all 7 contributors for this article] (2021). Body appreciation and body appearance pressure in Norwegian university students comparing exercise science students and other students. BMC Public Health. 21. doi: 10.1186/s12889-021-10550-0. Full text in Research Archive Show summary

  Body image is considered a core issue for public health and associates with university students’ overall health. Due to positive associations between exercise and body image, it has been suggested that students within an exercise science program might be more body appreciative compared to other students. On the other hand, the strong societal idealization of the athletic body may expose them to a pressure of having a specific body appearance, which may result in unfavorable health consequences. Nevertheless, studies investigating these hypotheses are lacking. We therefore aimed to explore the level and associations of body appreciation, body appearance pressure, body image related mental health constructs, physical activity, and exercise, in Norwegian university exercise science and non-health reference students.

• Svantorp-Tveiten, Kethe Marie Engen; Torstveit, Monica Klungland; Rosenvinge, Jan H; Sundgot-Borgen, Christine; Friborg, Oddgeir & Bratland-Sanda, Solfrid [Show all 8 contributors for this article] (2021). Effect of A Healthy Body Image intervention on risk- and protective factors for eating disorders: A cluster randomized controlled trial. Mental health & prevention. 24. doi: 10.1016/j.mhp.2021.200225. Full text in Research Archive Show summary

  Objective: To investigate the immediate and 12-months effects of a school-based intervention aiming to reduce risk and enhance protective factors for eating disorder development in high school boys and girls. Method: In total, 4,149 adolescents from 30 high schools were eligible for inclusion and 2,446 consented to participate and were randomly allocated to the Healthy Body Image (HBI) intervention or a control group (classes as usual). The HBI intervention is multicomponent consisting of three workshops targeting body image, social media usage and lifestyle. Linear mixed model and intention-to-treat analyses were applied to investigate the effects of group, time, and gender at posttest, 3-, and 12-months follow-up. The main outcome variable was weight and shape concerns, and secondary outcome variables were self-esteem, mental distress, body image flexibility, thin internalization, muscular internalization, drive for leanness, perceived media pressure, protein- and creatine supplement use, and diet aid use. Results: The HBI intervention significantly reduced eating disorder risk factor scores related to ED pathology, thin internalization and perceived pressure from media, which was particularly pronounced in girls. Positive intervention effects on body image flexibility were only observed at posttest for boys but grew increasingly larger for girls across the 12-month follow-up time span. Favorable intervention effects on protein and creatine supplement use were only present at 3-months follow-up in boys solely. A general favorable intervention effect was observed for self-esteem, mental distress, muscular internalization, and drive for leanness. Conclusion: The HBI intervention produced consistent reductions in risk factors and enhancements in protective factors associated with eating disorder development in adolescents.

• Svantorp-Tveiten, Kethe Marie Engen; Friborg, Oddgeir; Torstveit, Monica Klungland; Mathisen, Therese Fostervold; Sundgot-Borgen, Christine & Rosenvinge, Jan H [Show all 9 contributors for this article] (2021). Protein, creatine and dieting supplements among adolescents: Use and associations with eating disorder risk factors, exercise- and sports participation, and immigrant status. Frontiers in Sports and Active Living. 3. doi: 10.3389/fspor.2021.727372. Full text in Research Archive Show summary

  Objective: This study aimed to estimate the number of weekly users of protein, creatine, and dieting supplements and to explore whether weekly use was related to eating disorder (ED) risk factors, exercise, sports participation, and immigrant status.<p><p> Methods: In total, 629 and 1,060 high school boys and girls, respectively, self-reported weekly frequency of protein, creatine, and dieting supplement use, and weight and shape concerns, appearance internalization and pressure, self-esteem, mental distress, physical activity level, exercise context, and the type and weekly frequency of sport played. Multiple hierarchical regression analyses were performed to investigate explanatory factors for supplement use.<p> Results: More boys than girls used protein and creatine supplements. Immigrant boys had more frequent use of all supplements than non-immigrant boys, and immigrant girls used creatine supplements more frequently than non-immigrant girls. In total, 23–40 and 5–6% of the variation in the weekly frequency of supplement use in boys and girls, respectively, was explained by immigrant status, ED risk factors, and exercise and sports participation. More frequent use of protein, creatine and dieting supplements in boys was significantly explained by more weight and shape concerns, fitness center exercise, and weight-sensitive sports participation. Depending on the type of supplement, more frequent use of supplements in girls was significantly explained by lower self-esteem, more engagement in weight-sensitive sports, and less engagement in general sport and exercise activities. Conclusion: Weekly supplement use was common and more frequent among boys than girls. The weekly use of protein, creatine, and dieting supplements was related to ED risk factors, exercise and sports participation, and immigrant status in boys but not in girls.

• Mathisen, Therese Fostervold; Sølvberg, Nina; Sundgot-Borgen, Christine & Sundgot-Borgen, Jorunn (2021). Sexual Harassment in Fitness Instructors: Prevalence, Perpetrators, and Mental Health Correlates. Frontiers in Psychiatry. 12. doi: 10.3389/fpsyt.2021.735015. Full text in Research Archive Show summary

  Introduction: This paper explores frequency of experiences of sexual harassment (SH) among fitness instructors, outlines the typical perpetrator, and explores associated mental health symptoms. Design: Cross-sectional survey. Materials and Methods: A total of 270 Norwegian fitness instructors, recruited in social media, responded to an electronic questionnaire in 2019/2020 on experiences of body appearance pressure, SH, and mental health symptoms. Outcomes included in this publication are experiences of SH, and symptoms of mental health issues based on the Hopkins symptom checklist, SCL-10; Beck Depression Inventory, BDI-1a; and Eating Disorder Examination Questionnaire, EDE-q. Results: The frequencies of SH experiences were 30% among 211 women and 22% among 59 men, respectively, with customers being the most frequent source of such approaches and personal trainers (PTs) more often reporting such experiences compared to group instructors (GIs) and to those operating as both PT and GI. Women having experienced SH had significantly higher scores in symptoms of depression, anxiety, and eating disorders compared to women with no such experience. Conclusion: The high frequency of SH experiences among fitness instructors, with customers emerging as perpetrators and typically in the context of personal training, necessitates increased awareness of SH in the fitness industry. To reduce the occurrence of SH, the fitness centers need to communicate countermeasures with high level of compliance.

• Sundgot-Borgen, Christine; Stenling, Andreas; Rosenvinge, Jan H; Pettersen, Gunn; Friborg, Oddgeir & Sundgot-Borgen, Jorunn [Show all 10 contributors for this article] (2020). The Norwegian healthy body image intervention promotes positive embodiment through improved self-esteem. Body image. ISSN 1740-1445. 35, p. 84–95. doi: 10.1016/j.bodyim.2020.08.014. Full text in Research Archive Show summary

  We examined both direct and indirect effects of the Healthy Body Image (HBI) intervention on positive embodiment among Norwegian high school students. In total, 2446 12th grade boys (43 %) and girls (mean age 16.8 years) from 30 schools participated in a cluster-randomized controlled study with the HBI intervention and a control condition as the study arms. We tested mediation models using path analysis and found that among several hypothesized mediators, only self-esteem mediated a positive intervention effect on positive embodiment for both boys and girls. A direct effect of the intervention on positive embodiment was only found in girls. The study provides novel findings indicating that health promotion interventions to address a positive embodiment should focus on enhancing adolescent’s self-esteem. Serial mediation modeling might reveal more complex explanations of change mechanisms and could further evolve current knowledge.

• Mathisen, Therese Fostervold; Aambø, Jenny Malene; Bratland-Sanda, Solfrid; Sundgot-Borgen, Christine; Svantorp-Tveiten, Kethe Marie Engen & Sundgot-Borgen, Jorunn (2020). Body figure idealization and body appearance pressure in fitness instructors. Frontiers in Psychology. 11:585901(2020), p. 1–11. doi: 10.3389/fpsyg.2020.585901. Full text in Research Archive Show summary

  Purpose: The fitness centers are settings for health promotion, yet may serve as a stage for counterproductive figure idealization. Such idealization may take the form of a drive toward the thin, the muscular, or lean body figure ideal, which all hold the potential to impel an experience of body appearance pressure (BAP) and body dissatisfaction. The aim of this study was to explore figure idealization, body dissatisfaction, and experience of BAP in fitness instructors. Materials and Methods: Fitness instructors, 70 (23%) males and 236 (77%) females, were recruited through their facility chief executive officer and social media for a digital survey on mental health. Results are presented for body appreciation (BAS-2), body dissatisfaction (EDI-BD), drive for muscularity (DM), drive for leanness (DLS), questions on BAP, symptoms of eating disorders (EDE-q), and history of weight regulation and eating disorders (EDs). Results: Attempts to gain body weight were reported by 17% of females and 53% of males, whereas ∼76% of males and females, respectively, reported to have attempted weight reduction. Reasons for body weight manipulation were predominantly appearance related, and 10–20% reported disordered eating behavior. Mean BAS-2 and EDI-BD were acceptable, but 28% of females were above clinical cutoff in EDI-BD, and mean DLS were high in both sexes. In total, 8% of females were above clinical cutoff in EDE-q, which corresponded well with the self-reported ED. Approximately 90% of the sample perceived BAP to be a societal issue and reported predominantly customers and colleagues to be the cause of their personal experience of BAP. Fewer than 50% knew of any actions taken by their employer to reduce BAP. There were few differences according to profession or educational level. Conclusion: Fitness instructors report BAP to affect them negatively, which may put them at risk of impaired mental health. Educational level did not protect against figure idealization and BAP. To care for their employees and to optimize their position as a public health promoter, the fitness industry should target BAP in health promotion programs.

• Bratland-Sanda, Solfrid; Mathisen, Therese Fostervold; Sundgot-Borgen, Christine; Sundgot-Borgen, Jorunn & Tangen, Jan Ove (2020). The Impact of Covid-19 Pandemic Lockdown during spring 2020 on Personal Trainers’ Working and Living Conditions. Frontiers in Sports and Active Living. 2(2020). doi: 10.3389/fspor.2020.589702. Full text in Research Archive Show summary

  Purpose: The aim of this study was to map changes in working and living conditions of Norwegian personal trainers (PTs) during the Covid-19 lockdown spring 2020. Methods: A total of 150 PTs (mean (SD) age 35.5 (8.4) years, with 6.5 (5.3) years of experience as PT, and 61% female) in Norway responded to an online survey. Results: Number of PT sessions per week was reduced during the lockdown and the majority of the respondents reported loss of clients and negative impact on their working conditions. The official restrictions and guidelines were considered difficult to interpret and somewhat discriminatory compared to restrictions and guidelines for other comparable exercise occupational groups. The lockdown period provided more PTs to offer online and outdoor training. Living conditions were also affected with reported impairments in private economy and reduced vitality (p < 0.05), and with vitality being lower in female compared to male respondents during, but not before, the lockdown period. Discussion: The reported negative impact of the Covid-19 lockdown period on PTs' working and living conditions are discussed with focus on the reported gender differences and considering the previously reported poor reputation of the fitness industry.

• Sundgot-Borgen, Christine; Friborg, Oddgeir; Kolle, Elin; Torstveit, Monica Klungland; Sundgot-Borgen, Jorunn & Engen, Kethe Marie Elgesem [Show all 9 contributors for this article] (2019). Does the Healthy Body Image program improve lifestyle habits among high school students? A randomized controlled trial with 12-month follow-up. Journal of International Medical Research. ISSN 0300-0605. doi: 10.1177/0300060519889453. Full text in Research Archive Show summary

  <i>Objectives</i> - Positive embodiment and healthy lifestyle habits seem to be related; therefore, stimulating positive embodiment should promote healthy lifestyle habits. In the current study, we delivered the Healthy Body Image (HBI) intervention among Norwegian high school students and examined the effects on healthy lifestyle habits.<p> <p><i>Methods</i> - The HBI intervention comprises three interactive workshops, with three overarching themes related to body image, social media literacy, and lifestyle. A total of 2446 boys (43%) and girls in grade 12 (mean age 16.8 years) from 30 high schools participated in this cluster-randomized controlled study. Schools were randomized to the HBI intervention or control study arm. Data on physical activity, eating habits, and sleep were collected at baseline, post intervention, and 3- and 12-month follow-up and analyzed using linear mixed regression models.<p> <p><i>Results</i> - The intervention had a minor negative effect on physical activity levels in boys at 12-month follow-up and short-term small-to-moderate positive effects on consumption of breakfast and fruit and vegetables, and sleep duration on school days.<p> <p><i>Conclusions</i> - In future, the lack of satisfactorily long-term effects might be better addressed using a combination of cognitive and behavioral approaches to more optimally integrate positive embodiment and lifestyle changes in the daily life of adolescents.

• Sundgot-Borgen, Jorunn; Sundgot-Borgen, Christine; Myklebust, Grethe; Sølvberg, Nina & Torstveit, Monica Klungland (2019). Elite athletes get pregnant, have healthy babies and return to sport early postpartum. BMJ Open sport & exercise medicine. 5(1). doi: 10.1136/bmjsem-2019-000652. Full text in Research Archive Show summary

  Objectives: To enhance knowledge on pregnancy and return to sport in the postpartum period in elite female athletes. Methods: 34 Norwegian elite athletes (33.1 years) and 34 active controls (31.5 years) were asked about training and competitive history, pregnancy-related issues, injuries, body dissatisfaction (BD), drive for thinness (DT), eating disorders (ED) and practical experiences, through a questionnaire and interview. Independent samples T-tests or χ² tests for between-group differences and paired-samples T-tests and repeated measures analysis of variance for within group differences were used. Results: No group differences in fertility problems, miscarriage, preterm birth or low birth weight were found. Both groups decreased training volume all trimesters and the first two postpartum periods compared with prepregnancy, and more athletes returned to sport/exercise at week 0–6 postpartum. We found no group differences in complications during pregnancy and delivery, but athletes reported fewer common complaints. Four athletes experienced stress fracture postpartum. Athletes had higher BD and DT postpartum, while controls reduced DT score. Number of athletes with clinical ED was reduced postpartum, while constant in controls. Athletes were not satisfied with advice related to strength training and nutrition during pregnancy. Conclusion: Elite athletes and active controls get pregnant easily, deliver healthy babies and decrease training during pregnancy and the first postpartum periods compared with prepregnancy. Most athletes and every third control returned to sport or exercise at week 0–6 postpartum. Athletes report stress fractures and increased BD and DT, but decreased ED postpartum. However, since relatively few athletes were included these findings need further investigation.

• Sundgot-Borgen, Christine; Friborg, Oddgeir; Kolle, Elin; Engen, Kethe Marie Elgesem; Sundgot-Borgen, Jorunn & Rosenvinge, Jan H [Show all 10 contributors for this article] (2019). The healthy body image (HBI) intervention: Effects of a school-based cluster-randomized controlled trial with 12-months follow-up. Body image. ISSN 1740-1445. 29, p. 122–131. doi: 10.1016/j.bodyim.2019.03.007. Full text in Research Archive Show summary

  We examined the effects of the Healthy Body Image (HBI) intervention on positive embodiment and health-related quality of life among Norwegian high school students. The intervention comprised three interactive workshops, with body image, media literacy, and lifestyle as main themes. In total, 2,446 12th grade boys (43%) and girls (mean age 16.8 years) from 30 high schools participated in a cluster-randomized controlled study with the HBI intervention and a control condition as the study arms. Data were collected at baseline, post-intervention, 3- and 12-months follow-up, and analysed using linear mixed regression models. The HBI intervention caused a favourable immediate change in positive embodiment and health-related quality of life among intervention girls, which was maintained at follow-up. Among intervention boys, however, weak post-intervention effects on embodiment and health-related quality of life vanished at the follow-ups. Future studies should address steps to make the HBI intervention more relevant for boys as well as determine whether the number of workshops or themes may be shortened to ease implementation and to enhance intervention effects.

• Sundgot-Borgen, Christine; Bratland-Sanda, Solfrid; Engen, Kethe Marie Elgesem; Pettersen, Gunn; Friborg, Oddgeir & Torstveit, Monica Klungland [Show all 10 contributors for this article] (2018). The Norwegian healthy body image programme: Study protocol for a randomized controlled school-based intervention to promote positive body image and prevent disordered eating among Norwegian high school students. BMC Psychology. 6(8). doi: 10.1186/s40359-018-0221-8. Full text in Research Archive Show summary

  Background: <br>Body dissatisfaction and disordered eating raise the risk for eating disorders. In the prevention of eating disorders, many programmes have proved partly successful in using cognitive techniques to combat such risk factors. However, specific strategies to actively promote a positive body image are rarely used. The present paper outlines a protocol for a programme integrating the promotion of a positive body image and the prevention of disordered eating.<br> Methods and design:<br> Using a cluster randomized controlled mixed methods design, 30 high schools and 2481 12th grade students were allocated to the Healthy Body Image programme or to a control condition. The intervention comprised three workshops, each of 90 min with the main themes body image, media literacy, and lifestyle. The intervention was interactive in nature, and were led by trained scientists. The outcome measures include standardized instruments administered pre-post intervention, and at 3 and 12 months follow-ups, respectively. Survey data cover feasibility and implementation issues. Qualitative interviews covers experiential data about students’ benefits and satisfaction with the programme.<br> Discussion:<br> The present study is one of the first in the body image and disordered eating literature that integrates a health promotion and a disease prevention approach, as well as integrating standardized outcome measures and experiential findings. Along with mediator and moderator analyses it is expected that the Healthy Body Image programme may prove its efficacy. If so, plans are made with respect to further dissemination as well as communicating the findings to regional and national decision makers in the education and health care services.

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• Pedersen, Cathrine; Nygaard, Egil; Sundgot-Borgen, Christine & Daza, Viviana (2026). Refleksjonsopplegg om FoL – HeaLS og LIFE: Folkehelse og livsmestring i skolen. Full text in Research Archive
• Kvalem, Ingela Lundin; Borgen, Christine Sundgot & Dahlgren, Anna Maria Camilla Lindvall (2024). Social Media Use and Self-Presentation: Predictors for Experience with and Consideration of Cosmetic Treatment in Adult Women. Full text in Research Archive
• Dahlgren, Anna Maria Camilla Lindvall; Borgen, Christine Sundgot; Kvalem, Ingela Lundin; Wennersberg, Anne Louise & Wisting, Line (2024). Social media use, eating disorder pathology and appearance ideals and pressure: A cross-sectional study in adolescent boys and girls. Full text in Research Archive
• Brevik, Lisbeth M.; Sundgot-Borgen, Christine; Pedersen, Cathrine; Daus, Stephan; Gjerustad, Cay & Vestad, Lene [Show all 9 contributors for this article] (2024). Folkehelse og livsmestring – Hvordan få best mulig effekt for elevene. Skolelederen. ISSN 0802-2062. 3, p. 52–55. Full text in Research Archive
• Wisting, Line Norøm; Dahlgren, Anna Maria Camilla Lindvall; Kvalem, Ingela Lundin; Borgen, Christine Sundgot & Wennersberg, Anne Louise (2023). Further evidence of the association between social media use, eating disorder pathology and appearance ideals and pressure: a cross-sectional study in Norwegian adolescents. Full text in Research Archive
• Borgen, Christine Sundgot; Kvalem, Ingela Lundin; Wennersberg, Anne Louise; Wisting, Line Norøm & Dahlgren, Anna Maria Camilla Lindvall (2023). Social media use, eating disorder pathology and appearance ideals and pressure: a cross-sectional study in adolescent boys and girls. Full text in Research Archive
• Mathisen, Therese Fostervold; Sundgot-Borgen, Christine; Anstensrud, Beate & Sundgot-Borgen, Jorunn (2021). Symptomer og kunnskap om psykisk helse og restitusjon hos profesjonelle dansestudenter: en kartlegging og intervensjonsstudie. Full text in Research Archive
• Sundgot-Borgen, Christine (2020). The Healthy Body Image intervention: A school-based, cluster-randomized controlled trial in high school students. Norges idrettshøgskole. ISSN 9788250205765. Full text in Research Archive Show summary

  Paper I: Sundgot-Borgen, C., Bratland-Sanda, S., Engen, K. M., Pettersen, G., Friborg, O., Torstveit, M. K., Kolle., E., Piran, N., Sundgot-Borgen, J. & Rosenvinge, J. H. (2018). The Norwegian healthy body image programme: study protocol for a randomized controlled school-based intervention to promote positive body image and prevent disordered eating among Norwegian high school students. BMC Psychology, 6(1), 8.

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