All contributing authors wish to express their gratitude to the Spanish Red Cross, because without its support we could not have done this research. Also, we appreciate a lot of the feedback and help from the Committee on Scientific Conduct and Ethics of the Alfonso X el Sabio University.

The Committee reviewed the Protocol on Scientific Conduct and Ethics of the Alfonso X el Sabio University. Also, a group of scientists external to the research team checked and approved the complete experimental process. To allowing participation in the study, it was necessary to sign an informed consent accepting to enroll in the program, as recommended by the Declaration of Helsinki30. Before enrollment, it was ensured that none of the participants would suffer any psychological stress or harm r...

This experimental work supports the positive consequences of participating in a body satisfaction program in older people by examining satisfaction values before and after the intervention and comparing experimental and non-experimental groups. Also, the control of other intervening variables improves the reliability and validity of the results obtained.
The most critical step of the protocol was the selection of the program applied in the control group. It was necessary to replicate the same ...

In Western societies, looking good, healthy, and young is very important to feel right, fit in, interact with others, and be successful, becoming a core element of the self-concept and self-esteem. How satisfied one person is with her/his body depends on personal perception, specifically, with how s/he feels, perceives, imagines, and reacts to physical appearance and body functioning1,2. Following this definition, it is possible to identify two qualitatively different dimensions within this construct. On the one hand, there is the perceptive dimension, which depends on evaluating the size, shape, and proportions of the body itself; on the other hand, there is the cognitive-emotional domain (i.e., &#39;body satisfaction&#39;3), which is the subject of this research.
Essentially, body satisfaction is a person&#39;s degree of acceptance of his or her physical appearance4, which is bad if this assessment affects self-confidence negatively and positive when it increases personal confidence in interacting with others5,6. Traditionally, it has been considered that when a person ages and enters the last stage of life (taking age 50 as the cut-off point for middle age), body image concerns decrease substantially. In other words, it is believed that perceptual distortions about body image typical in adolescence and youth6,7,8&#160;are rare in older people9,10. The reason is that the focus of concern shifts from weight and fitness to other significant physical defects more associated with lack of health and physical decline.
In this line, the scientific literature has shown that the main concerns about the physical appearance of older people focus on the signs of aging, such as loss of fitness, wrinkling and aging skin, hair loss and grey hair, body odor, among others11,12. It has also been argued that the perception of these aging signs plays an evolutionary and adaptive role, since it allows people to become progressively aware of aging, thus helping to accept the transformation and deterioration of physical appearance. Although this may be right, it is no less true that aging awareness negatively influences body satisfaction. Not in vain, the widespread phenomenon of &#39;midlife crisis&#39; refers to a tipping point in which the person starts to realize that s/he is aging and, in some cases, this comes along with experiencing depressive symptoms which, if not properly addressed, can interfere with personal wellbeing and mental health11,13.
The psychological and emotional implications derived from the senescence awareness have been studied14. In that sense, the deterioration of the physical appearance has been considered the most unmistakable sign that someone can experience regarding the arrival of senescence15. This is coupled with the feeling of playing an irrelevant and undervalued social role 16. Therefore, self-identification as an &#39;older person&#39; is irremediably linked to a gradual acceptance of new limitations and unfavorable circumstances. Thus, the older person begins to experience difficulties and emotional problems, such as anxiety, stress, or depression. Shortly, the person may self-identify with negative social roles while poorly accepting the physical limitations associated with aging17,18.
In different age groups, such as adolescents and youth, it is known that satisfaction and body image can improve with intervention programs1,19. Examples of this are the well-known interventions of Cash (1997)20&#160;and PICTA (Preventive program on body image and eating disorders in Spanish) by Maganto, del R&#237;o and Roiz (2002)21, as well as some more recent programs (Kilpela et al., 2016)22, Halliwell et al. (2016)23, McCabe et al. (2017)24&#160;or Bailey, Gammage and Van Ingen (2019)25. However, none of them target mature people and focus mainly on females, except for the intervention developed by S&#225;nchez-Cabrero (2012)26&#160;called &#39;IMAGINA&#39; that this study aims to validate. Let us suppose that a therapeutic intervention on body image can contribute to self-acceptance and develop a positive self in young people. There is no reason for not applying it and intervening in older people who face radical changes in their bodies27,28,29.
The experimental design is the most effective methodology for determining causal relationships and evaluating whether a therapeutic intervention produces improvements. First, it is necessary to isolate the intervention effect from the rest of the intervening variables, something that in the social sciences is very costly and complex since the factors that can influence are almost innumerable. Second, it also requires a pre-post treatment comparison, comparisons between control and experimental groups, the randomization of the participants in the conditions of control and treatment, as well as the study of the most relevant intervening variables. Thus, this experiment follows two main objectives: (1) to analyze the improvement in body image satisfaction of persons over 50 years of age enrolling in a specific program of body satisfaction compared with the progress gained in a general program (non-specific); (2) to examine the relationship between body satisfaction and intervening variables such as age, gender, relationship status, time of year of participation, and living either in a metropolitan or countryside residence.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Body Shape Questionnaire (BSQ)</td>
			<td>International Journal of Eating Disorders</td>
			<td>1987</td>
			<td>Body Shape Questionnaire (BSQ) developed by Cooper, Taylor, Cooper, and Fairburn (1987), which was adapted and scaled to Spanish participants by Raich et al. (1996). This is a self-report of 34 items following a Likert scale that goes from 1 (never) to 6 (always). The final score ranges from 34 to 204 and scoring above 110 indicates dissatisfaction and discomfort with physical appearance (Cooper et al., 1987). It is a reliable instrument since several studies have reported Cronbach&#8217;s &#945; between 0.95 and 0.97. Also, the BSQ has good external validity, i.e., it is convergent with other similar tools, such as the Multidimensional Body Self-Relations Questionnaire, MBSRQ (Cash, 2015) and the body dissatisfaction subscale of the Eating Disorders Inventory, EDI (Garner, Olmstead, and Polivy, 1983).</td>
		</tr>
		<tr>
			<td>IMAGINA: programa de mejora de la autoestima y la imagen corporal para adultos</td>
			<td>Sinindice</td>
			<td>2012</td>
			<td>IMAGINA Program was meant to be a therapeutical tool to increase a body image satisfaction of older adults in Spain. It has eight group-sessions of 90-120 minutes duration each, aiming at entertaining and engaging participants. Body image and self-esteem are expected to improve through social participation, communication, body image workshops, and healthy nutrition information.</td>
		</tr>
		<tr>
			<td>Statistical Package for the Social Sciences (SPSS)</td>
			<td>IBM</td>
			<td>24</td>
			<td>Software package used in statistical analysis of data</td>
		</tr>
	</tbody>
</table>

validation of a psychosocial intervention on body image in older people: an experimental design

For most people, body satisfaction is crucial to develop both a positive self-concept and self-esteem, and therefore, it can influence mental health and well-being. This idea has been tested with younger people, but no studies explore whether body image interventions are useful when people age. This research validates a specific program designed for older people (IMAGINA Specific Body Image Program). This is done by employing a mixed experimental design, with between-subject and within-subject comparisons that focus on body satisfaction before and after experimental treatment, comparing two groups. Using this experimental methodology makes it possible to identify the effect of the intervention in a group of 176 people. The score obtained with the Body Shape Questionnaire (BSQ) was the dependent variable, and the IMAGINA program was the independent one. As for age, gender, relationship status, season, and residence environment, these were controlled variables. There were significant differences in body satisfaction between the two programs, obtaining better results with IMAGINA. The controlled variables had a much less significant effect than the treatment. Therefore, it is possible to improve body satisfaction in older adults through interventions similar to the one presented here.

The experimental research followed a mixed design, with between-subject measurements (experimental and control groups) and repeated measurements before and after treatment.
IMAGINA program by S&#225;nchez-Cabrero (2012)26&#160;was selected as the experimental therapeutical program to increase body image satisfaction of older adults in Spain. It has eight group-sessions of 90-120 minutes duration each, aiming at entertaining and engaging participants, using activities pr...

Watch this Scientific Journal Video about Validation of a Psychosocial Intervention on Body Image in Older People: An Experimental Design at JoVE.com

Validation of a Psychosocial Intervention on Body Image in Older People: An Experimental Design

This experimental intervention examines the body satisfaction of older people. The aim is to compare a specific intervention with another general program and determine which is more effective for improving body satisfaction in people over fifty years old.

For most people, body satisfaction is crucial to develop both a positive self-concept and self-esteem, and therefore, it can influence mental health and ...