Exposure to westernization and dieting: a cross-cultural study

Eating Disorders and Disordered Eating Behaviors Among Undergraduate Students in Pakistan as Measured by Eating Disorder Examination Questionnaire (EDE-Q)

Objectives Eating disorders (ED) are an emerging public health issue globally, especially in young adults studying at the undergraduate level. This study aims to assess the frequency of eating disorders, their types, and disordered eating behaviors among such students. Moreover, it aims to identify factors like weight concern, shape concern, eating concern, and restraint, along with assessing the shifting trend of BMI impact on eating disorders using a standardized Eating Disorder Examination Questionnaire (EDE-Q). Methods In this cross-sectional study, 400 undergraduate students (aged 18-25) from four public universities participated from July 2022 to November 2023. Data was collected using the Eating Disorder Examination Questionnaire (EDE-Q). The frequency of eating disorders was computed using SPSS version 27. Results Among the participants, 21.75% (n=84) were identified as having a score surpassing the clinical cut-off. This group comprised 5.5% males (n=22) and 16% females (n=64). The highest prevalence among the four subscales was observed in the Shape Concern subscale (10.5%). Objective binge episodes (19.3%) emerged as the most notable disordered eating attitude. Atypical anorexia nervosa accounted for 13.8% of different eating disorders, while disordered eating was noted in 19.5% (n=78) of individuals. Discussion This study offers critical insights into eating disorders among Pakistan undergraduate students, utilizing the EDE-Q 6.0. Disordered eating behaviors, particularly shape concern and objective binge eating, exhibit significant correlations with these disorders. Weight dissatisfaction emerges as a prominent predictor, suggesting societal influence. The study also reveals a moderate correlation between BMI and eating disorders, challenging conventional assumptions. Furthermore, a changing trend in the prevalence of eating disorders is observed among the male population.

The Presentation of Eating Disorders in Saudi Arabia

Objective: There is lack of information on the presentation of eating disorders (EDs) in Saudi Arabia using gold standard clinical tools. The present study aimed to provide data on the presentation of EDs in Saudi Arabia using clinically validated measures.

Method: Hundred and thirty-three individuals (33 male) with a mean age of 22 years (2.63) completed three measures: the Eating Disorder Examination (EDE), a semi-structured interview, the Eating Disorder Examination Questionnaire (EDE-Q), a self-report measure, and the Depression Anxiety and Stress Scale (DASS-21) to measure comorbid symptoms.

Results: Individuals in Saudi Arabia reported higher levels of restraint, eating concern and shape concern and a higher global score, but lower levels of weight concern on the EDE-Q compared to the EDE. Female participants reported a higher global score, alongside significantly higher scores on the restraint, shape concern and weight concern subscales than males. The most common ED subtype was other specific feeding or ED. Compared with Western community samples, symptom severity in this purposive sample obtained from community settings was significantly higher in this sample.

Discussion: Individuals with eating, weight and shape concerns in Saudi Arabia may feel more comfortable expressing their symptoms on a self-report tool compared with a face to face interview. However, it is possible that a self-report measure may over-estimate the severity of symptoms. The data suggest that clinicians in Saudi Arabia should regularly screen for EDs in all genders. It is also important to note that ED symptoms are a cause for concern in young people in Saudi Arabia.

Female and male body image ideals among Arab immigrants and Germans in Germany

The current study explores cross-cultural differences of male and female body image ideals within a rapidly developing intercultural, immigration context that has garnered a considerable degree of popular and scholarly interest; recent Arab immigration to Germany. One hundred eighty participants (Arab immigrants or ethnic Germans) completed self-report online questionnaires (in either Arabic or German) regarding male and female body image ideals, as well as an assessment of their own body image perception. The data suggest cross-cultural differences in the body image ideals of, and held by, men and women of both groups. Slimmer ideals were held by Germans, especially German women, something that has repercussions for self-perceptions of being over- or under-weight by both Arabs and Germans. Culturally-bound body image ideals are important for the study of demographic changes in such socio-biological patterns as weight, weight-related health issues, and intergroup attraction and reproduction. The current study highlights the importance of psychological research on body image ideals for better understanding trends observed in "objective" measures of physiology (e.g., weight, weight-related health conditions) or relationship patterns (e.g., marriages, reproduction).

Overlaps and Disjunctures: A Cultural Case Study of a British Indian Young Woman's Experiences of Bulimia Nervosa

Eating disorder diagnoses are characterised by a pattern of disordered eating behaviour alongside symptoms such as body dissatisfaction and preoccupation with food, weight or shape (APA in Diagnostic and statistical manual of mental disorders, DSM-5, APA, Washington, DC, 2013). Incidence rates for eating disorders have increased during the last 50 years. However, epidemiological studies have suggested that such trends may not be a true representation of the occurrence of these illnesses in the general population, with figures underestimated due to reduced help seeking and poor access to care, particularly amongst ethnic minorities. This case study explores the experiences of a young British Indian woman with bulimia nervosa. Arising from an in-depth semi-structured interview, analysed with interpretative phenomenological analysis, her narrative offers a critical lens onto how diverse fragments of cultural practices and meanings come together to produce the clinical category of 'bulimia.' It thereby offers an alternative portrait of relationships between eating disorders and 'culture,' one that goes beyond a framing of these illnesses as culture inscribed on the body. Interrogating relationships between culture and the development, expression and maintenance of bulimia is suggested to be key to forging culturally-sensitive understandings of this illness; this paper begins to provide the evidence base for the design and development of appropriate support services, thereby aiming to contribute to a reduction in health inequalities and barriers to treatment.

Ethnic differences in eating disorder prevalence, risk factors, and predictive effects of risk factors among young women

Findings regarding ethnic differences in eating disorder diagnoses and risk factors have been mixed. This study evaluated whether there are ethnic differences in eating disorder prevalence, risk factors, and the predictive relations of the risk factors to future eating disorder onset. We used a large sample of young women followed longitudinally over three years to increase sensitivity to detect differences and to provide the first test of ethnic differences in the relation of risk factors to future onset of eating disorders. Females with body image concerns (N = 1177) were recruited from high schools and colleges for trials of a body acceptance eating disorder prevention program. They completed surveys and interviews at baseline and at 1-, 6-, 12-, 24-, and 36-month follow-up. Significant differences between ethnic groups were found for two of the 13 baseline risk factors: thin-ideal internalization and body mass index. No significant differences in later onset rates among ethnic groups were found. There were also no reliable ethnic differences in the relation of risk factors for future eating disorder onset. These findings suggest that eating disorders affect ethnic minorities as much as Whites and that there are more overlapping risk factors shared among various ethnic groups than differences.

The fit beauty ideal: A healthy alternative to thinness or a wolf in sheep's clothing?

Anecdotal testimony suggests the 'fit' female body ideal is 'healthier' than the thin ideal, because it simultaneously focuses on muscularity. However, statistical investigation into the outcomes associated with fit ideal internalisation is absent. Moderation analyses were used to investigate whether concurrent muscular internalisation mitigated the relationship between thin internalisation and; negative affect, body dissatisfaction, bulimic symptoms, and dieting. Further analyses were used to investigate whether concurrent thin internalisation amplified the relationship between muscular internalisation, compulsive exercise, and supplement use. No significant interaction was found on any of the outcome variables. Thus, the results suggest that incorporating muscularity into an ideal of thinness does not mitigate the detrimental eating and affective outcomes commonly associated with pursuing thinness. Equally, incorporating an ideal of thinness into one of muscularity does not appear to alter the detrimental behavioural outcomes commonly associated with pursuing muscularity. Such findings do not suggest fit internalisation is healthy for women.

The Effects of Immigration and Media Influence on Body Image Among Pakistani Men

This study examined the role of media influence and immigration on body image among Pakistani men. Attitudes toward the body were compared between those living in Pakistan ( n = 56) and those who had immigrated to the United Arab Emirates ( n = 58). Results of a factorial analysis of variance demonstrated a significant main effect of immigrant status. Pakistani men living in the United Arab Emirates displayed poorer body image than those in the Pakistan sample. Results also indicated a second main effect of media influence.Those highly influenced by the media displayed poorer body image. No interaction effect was observed between immigrant status and media influence on body image. These findings suggest that media influence and immigration are among important risk factors for the development of negative body image among non-Western men. Interventions designed to address the negative effects of the media and immigration may be effective at reducing body image disorders and other related health problems in this population.

Cross-cultural comparison of perspectives on healthy eating among Chinese and American undergraduate students

Background

Understanding views about what constitutes a healthy diet in diverse populations may inform design of culturally tailored behavior change interventions. The objective of this study was to describe perspectives on healthy eating among Chinese and American young adults and identify similarities and differences between these groups.

Methods

Chinese (n = 55) and American (n = 57) undergraduate students in Changsha, Hunan, China and Honolulu, Hawai’i, U.S.A. composed one- to two-paragraph responses to the following prompt: “What does the phrase ‘a healthy diet’ mean to you?” Researchers used content analysis to identify predominant themes using Dedoose (version 5.2.0, SocioCultural Research Consultants, LLC, Los Angeles, CA, 2015). Three researchers independently coded essays and grouped codes with similar content. The team then identified themes and sorted them in discussion. Two researchers then deductively coded the entire data set using eight codes developed from the initial coding and calculated total code counts for each group of participants.

Results

Chinese students mentioned physical outcomes, such as maintaining immunity and digestive health. Timing of eating, with regular meals and greater intake during day than night, was emphasized. American students described balancing among food groups and balancing consumption with exercise, with physical activity considered essential. Students also stated that food components such as sugar, salt and fat should be avoided in large quantities. Similarities included principles such as moderation and fruits and vegetables as nutritious, and differences included foods to be restricted and meal timing. While both groups emphasized specific foods and guiding dietary principles, several distinctions in viewpoints emerged.

Conclusions

The diverse views may reflect food-related messages to which participants are exposed both through the media and educational systems in their respective countries. Future studies may further examine themes that may not typically be addressed in nutrition education programs in diverse populations of young adults. Gaining greater knowledge of the ways in which healthy eating is viewed will allow for development of interventions that are sensitive to the traditional values and predominant views of health in various groups.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3680-y) contains supplementary material, which is available to authorized users.

Practice parameter for the assessment and treatment of children and adolescents with eating disorders

This Practice Parameter reviews evidence-based practices for the evaluation and treatment of eating disorders in children and adolescents. Where empirical support is limited, clinical consensus opinion is used to supplement systematic data review. The Parameter focuses on the phenomenology of eating disorders, comorbidity of eating disorders with other psychiatric and medical disorders, and treatment in children and adolescents. Because the database related to eating disorders in younger patients is limited, relevant literature drawn from adult studies is included in the discussion.

Disordered eating behaviors in university students in Hanoi, Vietnam

BACKGROUND

The aim of the study was to examine disordered eating behaviors in university students in Vietnam.

METHODS

A total of 244 female university students participated, and 203 data could be analyzed. The Body Mass Index, the SCOFF screening questionnaire and the Eating Disorder Inventory 2 were used to explore disordered eating behaviors.

RESULTS

45.3% of the participants were underweight, 53.2% were normal weight and 1.5% were overweight. 48.8% of students reported two or more yes-responses on the SCOFF screening questionnaire which indicates a high possibility of having eating disorder symptoms. The mean score for underweight subjects (M = 14.79, SD = 6.81) indicated a lower level on the drive for thinness scale of the EDI-2 compared to normal weight subjects (M = 24.65, SD = 6.86) and overweight subjects (M = 31.33, SD = 6.66). Additionally, underweight subjects (M = 27.24, SD = 7.57) were less dissatisfied with their body than normal weight subjects (M = 35.94, SD = 8.67) and overweight subjects (M = 43.33, SD = 11.24). A significant positive correlation appeared between the BMI and the EDI-2. The SCOFF questionnaire showed a statistically significant negative correlation with the BMI and the EDI-2.

CONCLUSIONS

Despite some limitations the current study shows a tendency in young females in urban Vietnam to be underweight and to develop disordered eating symptoms such as drive for thinness and body dissatisfaction. However, more studies using the SCOFF and the EDI-2 would be needed to verify these findings.

Body satisfaction and management in Iranian students

Purpose:

Despite the importance of body satisfaction on self concept and well being, there is little study about it or its consequences in Iranian populations, a part of Asian culture. The aim of this study was the assessment of body satisfaction and body management strategies in Iranian university students.

Work method:

This survey was performed based on a self-administrated questionnaire in 535 university and post graduate students.

Work results:

About 2/3rd of the students had moderate to severe body dissatisfaction and 40% of the students were using body management methods. Rhinoplasty and heavy exercise were the most frequent body management methods in women and men, respectively.

Conclusion:

Widespread research on body satisfaction prevalence and its management behaviors in the general population can be effective in reducing the negative health, social and economic consequences of harmful behaviors.

Westernization, Intuitive Eating, and BMI: An Exploration of Jordanian Adolescents

The purpose of this study was to validate the Arabic-version of the adapted Marin Bidimensional Acculturation Scale and investigate the relationship between Westernization, intuitive eating, and body mass index (BMI) in a sample of Jordanian female adolescents. A total of 199 subjects between the ages of 11–18 were surveyed. Participants who scored higher on the Arabic domain exhibited higher Intuitive Eating Scale (IES) intrinsic subscale scores ( r = 0.147, P = 0.048) suggesting that those who are more orientated toward Arabic culture may respond more naturally to physical hunger cues than their more Westernized counterparts. Reinforcing intuitive eating attitudes and behaviors and emphasizing body ideals resonant with the Arabic culture may propagate the continuation of intuitive eating in this population, potentially reducing the risk of obesity and other nutrition-related non-communicable diseases.

The influence of sociocultural factors on the eating attitudes of Lebanese and Cypriot students: a cross-cultural study

BACKGROUND

The present comparative cross-cultural study aimed to explore the relationship between eating behaviour and sociocultural influences with respect to appearance and body image in female university students from two cultural contexts, namely Cyprus and Lebanon.

METHODS

The Dutch Eating Behavior questionnaire (DEBQ) and the Perceived Sociocultural Influences on Body Image and Body Change Questionnaire were used to assess sociocultural influences and body image, respectively, in 200 students from each country.

RESULTS

The results indicated that the Lebanese students were more likely to engage in emotional and external eating and their body image was impacted to a larger extent by sociocultural agents, including media influences, compared to the Cypriot students. Also, a positive relationship was found between emotional and external eating in both cultures. Finally, sociocultural influences correlated positively with external eating only in the Cypriot sample.

CONCLUSIONS

Culture-specific factors, such as the societal values and norms, as well as the Westernisation history of each country, are discussed as underpinnings for the differences found. These findings are significant for understanding the rise of eating pathology in these two cultures and provide evidence for a need to consider cultural environment when designing public health policies addressing the negative aspects of nutrition transition.

Obesity and body size preferences of Jordanian women

The nutrition transition is associated with increased obesity rates and increased desire to be thin. This study evaluates the relationship between actual body size and desired body size among a representative sample of 800 Jordanian women. Using Stunkard's body silhouettes, women were asked to identify their current and ideal body sizes, healthy body size, and their perception of the body size preferred by men. Body mass index (BMI) calculations indicate that 53.8% of the women were overweight or obese. Their mean current body size was 5, which is consistent with the mean BMI of 26 in the sample. Although 66% of the women were dissatisfied with their body size, the desired weight loss was not extreme. Pearson correlation was positive (.858, p <.0001) between measured BMI and body silhouettes chosen as an indicator of current body size. Jordanian women seemed pulled between the traditional and Westernized body preferences. Possible cultural explanations are explored.

Nutritional knowledge, eating attitudes and chronic dietary restraint among men with eating disorders

We compared nutritional knowledge, eating attitudes and chronic dietary restraint scores among 17 men (10 with bulimia nervosa and 7 with anorexia nervosa) and 50 women (20 with bulimia nervosa and 30 with anorexia nervosa), who were consecutive patients at a major treatment center in Brazil. There were no differences in nutritional knowledge and concern with food between men and women. For both genders, chronic dietary restraint scores were higher among bulimics. Men with eating disorders had better eating attitudes scores than women. Anorexic men tended to have worse eating attitudes scores than bulimic men, while the opposite was observed for women, suggesting an interaction between gender and diagnosis.

Eating Attitudes, Self-Dissatisfaction and Emotional Distress Among Early Adolescents in Hawai'i: A Gender Comparison

The present study examines whether there are gender differences in eating attitudes among a sample of early adolescents in Hawai'i. A total of 79 female and 65 male 7th graders completed a survey that included measures of eating attitudes and other psychological constructs. Contrary to our prediction, males reported higher levels of disordered eating attitudes and body dissatisfaction than females. However, there were no gender differences in symptom levels of anxiety and depression. Eating attitudes were associated with symptoms of depression, anxiety and self-dissatisfaction among females, while only self-dissatisfaction was associated with eating attitudes among males. The findings fail to support past studies that suggest females report more disordered eating attitudes than males.

The correlation of Chinese mothers' eating attitudes and psychological characteristics with their children's eating attitudes, as well as the gender effect on eating attitudes of children

OBJECTIVE

No study has examined the connection between the mothers' weight concerns, their psychological characteristics as well as their educational level and their children's weight concerns in China. Nor has the gender effect on the eating attitudes of pre- to post-pubertal Chinese children been explored (aged 10-13).

METHOD

The children (girls N=138, boys N=103) were given a Chinese version of the EDI-C. Their mothers completed a Chinese version of the EDI-2. The Bivariate's (Pearson) correlation was used to examine the relationship between the mothers' weight concerns, psychological characteristics and educational level with their children's weight concerns. An Independent-Samples Ttest was conducted to comparing the EDI-C subscales of the girls and boys groups.

RESULTS

Regarding the mothers' and children's eating attitudes, there was a significant correlation between the mothers' weight concerns as well as their psychological characteristics with their children's eating attitudes. No significant relationship was found between the mothers' educational level and the children's eating attitudes. According to the scores of the EDI-C questionnaire, there was no general significant gender difference between Chinese children (aged 10-13). However, a differential gender effect on the body dissatisfaction of children was found for the subgroup of elders (aged 13) indicating a differential developmental dynamic.

CONCLUSIONS

The Chinese mothers' weight concerns and their psychological characteristics correlated with their children's eating attitudes. A gender effect on the Chinese children's eating attitudes (aged 13) was established.

Restraint and eating concern in North European and East Asian women with and without eating disorders in Australia and Singapore

OBJECTIVE

To investigate eating disorder psychopathology, restraint and eating concern in young women with and without an eating disorder from two different ethnic groups in Australia and Singapore.

METHOD

The relationship of Eating Disorder Examination Questionnaire Global, Restraint and Eating Concern scores to cultural orientation and sociocultural factors was analysed in 154 women with and without an eating disorder. Participants were from the following backgrounds: North European Australian, East Asian Australian, Singaporean Chinese and North European expatriates in Singapore.

RESULTS

Women with eating disorders had similar psychopathology across the cultural groups. Among controls, Singaporean Chinese reported significantly greater overall eating disorder psychopathology than other cultural groups and greater restraint than North European Australians/expatriates. Eating concern was not associated with cultural group overall or acculturation to Western culture. Dissatisfaction with family functioning, socioeconomic status and education level were not significantly associated with any of the eating disorder measures.

CONCLUSION

In eating disorder psychopathology, the specific symptom of eating concern may transcend cultural influences.

The impact of body mass index and Western advertising and media on eating style, body image and nutrition transition among Jordanian women

OBJECTIVES

To identify the impact of body mass index (BMI) and Western advertising and media on the stage of the nutrition transition among Jordanian women, and to evaluate their impact on eating styles and body image.

DESIGN

A randomised cross-sectional survey that included a variety of culturally measured Likert-type scales and body size images. In addition, BMI was calculated based on measured height and weight.

SETTING

In the homes of the participants. The data were collected by female interviewers who worked for the Jordan Department of Statistics.

SUBJECTS

The sample was based on a random and representative selection of 800 mostly urban Jordanian women. A pre-test sample of 100 women was also used to validate the instruments.

RESULTS

Women tended to agree that they ate based on emotional cues. They had high levels of disordered eating attitudes and behaviours and 42.1% were considered restrained eaters. However, these women also had higher than expected body esteem levels and desired a healthy body size. As expected, being obese was associated with a desire to lose weight, being a restrained and emotional eater, and having more disordered eating attitudes and behaviours. Similarly, Western advertising and media were associated with restrained and emotional eating, desired weight loss, and disordered eating attitudes and behaviours.

CONCLUSIONS

There is a need to develop health education materials that explain the influence of obesity on health and the negative psychological and physical consequences of restrained and emotional eating, building on the current cultural preferences of healthy body size. Further implications and suggestions for future research are discussed.

Religion, weight perception, and weight control behavior

Religion's relationships with weight perception and weight control behavior were examined using data (3032 adults aged 25-74) from the National Survey of Midlife Development in the United States. Religion was conceptualized as denomination, religious attendance/practice, religious social support, religious commitment, religious application, and religious identity. Weight perception was conceptualized as underestimating body weight, overestimating body weight, and accurately assessing body weight. Respondents also reported whether they had engaged in any intentional weight loss (yes/no) in the last 12 months. Logistic regression was used, with significant results being set at a p-values of <.01 and <.05. Accurately assessing body weight was the reference category for all weight perception analyses. Women with greater religious commitment and men with greater religious application had greater odds of underestimating their body weight. This relationship remained significant, controlling for age, race/ethnicity, education, and income. Jewish women had greater odds of overestimating their body weight. There were no relationships between religion and weight control behavior. Relationships between religion, weight perception, and weight control behavior illustrate religion's multidimensionality.

Validation of the Sociocultural Attitudes Towards Appearance Questionnaire-3 among a random sample of Jordanian women

Measuring the impact of westernization on body image is an important element in understanding body dissatisfaction and eating disorders in countries undergoing cultural transitions. The purpose of this study was to evaluate the validity and reliability of the Sociocultural Attitudes Towards Appearance Questionnaire-3, a measure of societal and media impacts on body image, in a non-western population. Factor analyses identified the same four subscales found in the original validation with high Cronbach's alpha coefficients and Guttman split-half coefficients, and low item cross-loadings. Furthermore, mean score comparisons by demographic variables on each subscale indicated that subscale scores were only affected by age. The results suggest that the Sociocultural Attitudes Towards Appearance Questionnaire-3 is a valid and reliable instrument for Jordanian women. The high level of validity and reliability for this population lends support for the possible use of this scale in other non-western populations after appropriate pretesting.

Urbanization and obesity in The Gambia: a country in the early stages of the demographic transition

OBJECTIVE

To investigate the distribution of overweight and obesity and its relationship with socio-economic and behavioural factors in a developing-country population undergoing rapid nutritional transition.

DESIGN

Cross-sectional house-to-house survey in urban Gambia.

SUBJECTS

Four groups of 50 subjects were sampled as follows: young men (YM, 14-25 years), young women (YW, 14-25 years), older men (OM, 35-50 years) and older women (OW, 35-50 years).

MEASUREMENTS

Several socio-economic and behavioural factors were investigated. Composite indices for socio-economic status, education, healthy lifestyle and western influences were created. Body weight, height, waist and hip circumferences were measured and body mass index (BMI) was calculated. Body composition was assessed by leg-to-leg bioimpedance. Overweight was defined as BMI=25.0-29.9 kg/m(2) and obesity as BMI>or=30.0 kg/m(2).

RESULTS

There were highly significant gender and age differences in overweight (YM=0%, YW=10%, OM=6% and OW=34%) and obesity (YM=0%, YW=4%, OM=6% and OW=50%). Only 16% of OW were neither overweight nor obese compared to 88% of OM. OW had a higher fat mass percent (38.4%) than other groups, while fat-free mass (kg) was significantly higher in males than females with YW having the lowest value. Young generations were more educated and more influenced by western ideals than OM and OW. Weight gain was not always associated with weight concern and many overweight/obese subjects did not perceive themselves as overweight.

CONCLUSION

Social and behavioural changes are already creating a perceptible 'generational gap' among this population undergoing rapid transition. The improved education and current lean status of the younger adults offers opportunities for preventative interventions. These need to be specially targeted at women.

Time trends in eating disturbances in young Greek migrants

OBJECTIVE

The study intends to measure time trends in eating disorder psychopathology in Greek adolescents in Veria (Greece) and migrant Greek adolescents in Munich (Germany). For this purpose, large samples of students were assessed at both locations in the 1980s and about two decades later. Our research question was whether the frequency of eating disorder-related psychopathology had changed over time and that there were differences between migrants and nonmigrants. The present-day prevalence of eating disorders in the Greek population was established.

METHOD

Greek adolescents were assessed in Munich and Veria in the 1980s (N = 2,631) and almost two decades later (N = 2,920). At both times, the Anorexia Nervosa Inventory for Self-Rating (ANIS) was used to assess eating disorder pathology and the General Health Questionnaire (GHQ-28) was used to assess mental health status. In the second wave, persons at risk for an eating disorder were interviewed using the Structured Interview for Anorexic and Bulimic Syndromes (SIAB-EX).

RESULTS

At both times and both locations, adolescent girls in comparison to boys had higher, more pathologic scores on the GHQ-28 and on all ANIS self-rating subscales. Females in Munich reported an increase over time in figure consciousness and their fear of negative effects of meals. In the 1980s, significantly higher scores of bulimic behavior were found in Veria as compared with Munich. In the second wave, bulimic behavior was considerably decreased in Veria for both girls and boys, and for bulimic behavior no significant differences were found between locations. The percentage of girls with a low body weight (<5th percentile) increased significantly over time in Veria and Munich. In the second wave, the current prevalence for girls with anorexia nervosa was 0.00% in Munich and 0.59% in Veria (lifetime 1.26% and 1.18%, respectively). For bulimia nervosa, current prevalence was 1.89% in Munich and 1.18% in Veria.

CONCLUSION

Differences between locations diminished over time. Bulimic syndromes are prevalent in both locations.

Westernization of the nutritional pattern of Chinese children living in France

This paper reports an analysis of dietary habits of children (aged 0-5 years) born to Chinese immigrant parents living in France. The nutritional investigation was made by face-to-face interviews with the mothers. Data were exploited using the general table of food composition. Chinese newborns are practically never breastfed (10%, compared with 55% of French babies). After 12 months of age, they consume a traditional diet but eat few dairy products (only once per day) and fresh fruits (33% never). They consume many soft drinks (85%). Daily calcium and vitamin C intakes are lower than the recommended intakes for preschool children. Dietary habits of the children of first-generation Chinese immigrants are still traditional in terms of the late introduction of new food and the composition of meals, but we observed Westernization of dietary habits such as reduced breastfeeding and high consumption of soft drinks.

Weight satisfaction and self-esteem among teenagers in Helsinki, Moscow and Tallinn

OBJECTIVE

Information on weight satisfaction in Eastern Europe is limited. This study compares relative weight, weight satisfaction and self-esteem of teenagers living in two post-Soviet capitals, Moscow and Tallinn, and a western capital Helsinki.

METHOD

Classroom surveys including data about weight and height, weight satisfaction and self-4 esteem among 15-18-year-old girls (n = 911) and boys (n = 650) collected in 1994-95.

RESULTS

Body mass index and self-esteem were highest in Helsinki. Nevertheless, feelings of over-weight were most common among Tallinn girls and feelings of over- and underweight among Muscovite girls. Boys were mostly satisfied with their current weight with no differences between cities. Low self-esteem was associated with feelings of overweight among girls and underweight among boys.

DISCUSSION

Somewhat unexpectedly, girls grown in non-western cultures were more dissatisfied with their weight than girls in Helsinki. These findings may partly be attributable to rapid economic and cultural transformations that were occurring in these countries during the study period.

A large-scale survey of eating disorder symptomatology among female adolescents in the People's Republic of China

OBJECTIVES

This study was designed to document comprehensively the prevalence of the signs, symptoms, and associated features of anorexia nervosa and bulimia nervosa among schoolgirls in the People's Republic of China.

METHODS

Female participants were recruited from both junior and senior high schools with varying levels of academic performance in six cities (Beijing, Shanghai, Guangzhou, Zunyi, Xin Xiang, and Yinchuan) that are representative of different geographical regions in China (North East, Central East, South East, South West, North West, and North). In each school, girls were recruited across all grades, in order to cover ages 12-19 years. The final sample comprised 1,246 participants whose mean age was 15.76 years. The questionnaire, developed specifically for the purpose of this research, assessed the diagnostic criteria and associated features of anorexia nervosa and bulimia nervosa outlined in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders.

RESULTS AND DISCUSSION

Our results have shown a surprisingly high level of weight-related concerns among schoolgirls across mainland China. There would seem to be few cases of anorexia or bulimia, although some girls satisfy criteria for partial diagnoses. Our findings highlight the difficulty of identifying girls who are underweight, at least by applying the standard Western procedure for categorizing body mass index.

Presence and severity of anorexia and bulimia among male and female Omani and non-Omani adolescents

OBJECTIVE

The population of Oman is a heterogeneous mix of nationalities providing a natural setting for studying the cross-cultural differences in the presence and severity of eating disorders as well as an opportunity for evaluating the performance of measurement instruments for these disorders.

METHOD

Disordered eating screening instruments (the Eating Attitude Test and the Bulimic Investigatory Test) were administered to Omani teenagers, non-Omani teenagers, and Omani adults.

RESULTS

On the Eating Attitude Test, 33% of Omani teenagers (29.4% females and 36.4% males) and 9% of non-Omani teenagers (7.5% of males and 10.6% females) showed a propensity for anorexic-like behavior. On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). Among the non-Omani teenagers, 18.4% showed a tendency toward bulimia, with females showing a slightly greater tendency than males. In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food.

CONCLUSION

Omani teenagers scored significantly higher than other ethnic groups and Omani adults. This finding is discussed in the light of emerging evidence from many parts of the world suggesting that cultural transition, compounded by demographic constraints, plays a significant role in abnormal eating attitudes.