Eating problems in female Japanese high school students: a prevalence study

Potential Triggers for Risking the Development of Eating Disorders in Non-Clinical Higher-Education Students in Emerging Adulthood

Nowadays, eating disorders (ED) among individuals during emerging adulthood have become a crucial challenge to public health, taking into account the fact that the global prevalence of the ED risk in student-aged populations already stands at 10.4% and has been sharply increasing during the COVID-19 pandemic. In all, from 50% to 80% of all the ED cases go undetected or are not correctly diagnosed; moreover, these individuals do not receive specialized treatment. Therefore, early diagnosis detected via screening questionnaires for ED is highly recommended. This study aimed to identify the triggers for ED risk development in emerging-adulthood individuals and to reveal the factors significant not only for ED prevention but also for assessing individuals with subthreshold symptoms. This cross-sectional study provides the results for the ED symptom screening in 1716 Lithuanian higher-education students aged 21.2 ± 3.9, during emerging adulthood. According to the results of this study, 19.2% of students were at risk for ED. Potential risk factors such as sex (odds ratio (OR): 3.1, 95% CI: 1.9-4.9), body weight (self-reported body mass index) (adjusted (A) OR: 1.4; 95% CI: 1.2-1.7) and comorbidities such as smoking (AOR: 2.1; 95% CI: 1.6-2.8), and perceived stress during the pandemic (AOR: 1.4; 95% CI: 1.1-1.8) are involved in anticipating the symptomatology of ED during emerging adulthood. Regular initial screenings with universally adopted questionnaires and further referral to a psychiatrist must be applied to promote both the diagnosis of early-onset symptomatology and the treatment of these ED in student-aged populations. Preventive programs for reducing the prevalence of overweight or obesity among students during emerging adulthood should focus on integration directions for the development of a positive body image.

Real beauty: Effects of a body-positive video on body image and capacity to mitigate exposure to social media images

OBJECTIVE

Recent industry-created social marketing campaigns have targeted positive body image; however, research investigating the effects of such social media campaigns on body image has largely neglected non-Western English-speaking groups. This study explored the effects on body image of a video produced by Dove for a Japanese audience 'Real Beauty ID', and its capacity to modify the effects of subsequent exposure to celebrity social media images of young women.

METHOD

Young women from Japan (n = 568), mean age (SD) = 25.38 (3.52) years, were randomly allocated to view either the Dove Real Beauty ID video, or a control video, followed by exposure to celebrity social media images (female celebrities or landscapes). Finally, participants reported on state and trait appearance-based comparisons, thin ideal internalization, body appreciation, and media similarity scepticism.

RESULTS

Among participants with high levels of thin ideal internalization, those who viewed the Dove Real Beauty ID video reported significantly lower satisfaction with body and facial features, as well as more negative mood (p < .05) compared with the control video. Little support emerged for the capacity of the Dove Real Beauty ID video to modify the effects of exposure to celebrity social media images, nor were these effects moderated by risk and resilience factors.

CONCLUSIONS

In sum, no usefulness emerged for the Dove Real Beauty ID video in promoting positive body image, and limited usefulness was seen in buffering the effects of exposure to celebrity social media images among Japanese young women. Given the reach of such interventions, exploring whether interventions that are culturally adapted and theoretically driven are more helpful is warranted.

A battery of self-screening instruments and self-reported body frame could not detect eating disorders among college students

Objective

Although studies have shown inconsistent results in terms of prevalence of eating disorders, the Eating Attitudes Test (EAT-26) was used to screen students for abnormal eating behaviors. The results of the self-reported EAT-26 and body frame, as well as the efficacy of using self-administered questionnaires (SAQs) were examined to detect eating disorders in new college students.

Results

An anonymous questionnaire (EAT-26) was provided to 7738 new students; 4552 (58.8%) responders were included in the final analysis. Semi-structured interviews were conducted for 131 (1.7%) students. Among them, 6 students showed a high EAT-26 score, but were not diagnosed with an eating disorder based on the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Three students were diagnosed with an eating disorder using SCID-I, but their EAT-26 scores were below the threshold. From these results, in a non-clinical population, findings on EAT-26 do not agree with those on SCID-I in terms of the diagnosis of eating disorders, and this battery is not appropriate for detecting eating disorders.

Cross-cultural, population-based study on adolescent body image and eating distress in Japan and Finland

This cross-sectional population-based survey compares the prevalence of self-reported body image and eating distress symptoms among adolescents in Japan and Finland, and associations between emotional/behavioral problems, body image and eating distress from a cross-cultural perspective. The study included 1,840 Japanese and 1,135 Finnish 8th grade students. The self-reported questionnaire included the Body Image and Eating Distress Scale and Strengths and Difficulties Questionnaire (SDQ). The female adolescents from both Finland and Japan reported much greater dissatisfaction with, and concern about, their bodies than the males and Japanese females expressed even higher distress than Finnish females. High levels of body image and eating distress were associated with psychiatric problems measured with the SDQ. There was a significant three-way interaction effect of body image and eating distress, gender and country with SDQ peer problems and prosocial behavior.

Eating disorder symptoms in Brazilian university students: a systematic review and meta-analysis

Objective:

To synthesize the risk of eating disorder (ED) symptoms in Brazilian university students through a systematic review and meta-analysis. Secondary goals were to analyze whether any specific majors were related to higher ED risk and whether any regions of Brazil had higher proportions of college students at risk of ED.

Methods:

The procedures followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, and a search was conducted in three electronic databases (MEDLINE, LILACS, and SciELO).

Results:

Thirty-three studies were included in the analysis, of which 14 were included in the meta-analysis. All included studies used self-report questionnaires, the most frequent of which was the Eating Attitudes Test (EAT-26). None of the studies used a structured interview to diagnose ED. A meta-analysis of studies with a cutoff ≥ 20 for the EAT-26 (n=5) found 14.9% (95%CI 12.8-17.2%) positive screenings, while those with a cutoff of t ≥ 21 (n=9) found 13.3% (95%CI 11.3-15.6%) positive screenings. There was a significantly higher proportion of positive screenings among nutrition majors than all other majors combined (26.5 and 20.5%, respectively).

Conclusion:

Nutrition students seem to be at higher risk of ED. Further research should investigate whether positive screenings translate to actual ED diagnoses.

Adolescents and Eating Disorders:

Little is known about the incidence and prevalence of eating disorders among adolescents of color who are poor or identify themselves as gay or lesbian. Among American women, eating disturbances are equally as common among Native, Asian, or Hispanic Americans as they are among Caucasians. African Americans were at higher risk of developing eating disorders than were Hispanic and Asian Americans. Media and gender-role body stereotype and body dissatisfaction are strongly linked and have been shown to be the strongest predictors of disordered eating. As these youth adopt Western values about beauty, they may be at increased risk for developing eating disorders.

The relationship between distorted body image and lifestyle among Japanese adolescents: a population-based study

Background

Distorted body image plays a significant role in the development of obesity, eating problems, and eating disorders. The aim of this study was to investigate the relationship between distorted body image and lifestyle among Japanese adolescent boys and girls.

Methods

Subjects were 1731 seventh graders (age 12–13 years) from the Ina-town’s junior high schools, Japan, from 2005–2009. The height and weight of each subject were measured. Childhood underweight, overweight, and obesity were defined using the body mass index cutoff points proposed by the International Obesity Task Force. Information regarding the self-perceived weight status and lifestyles (exercise, snacking after dinner, breakfast, wakeup time, bedtime) of each subject was collected using a self-administered questionnaire. Self-perceived weight status was categorized into three groups (thin, normal, or heavy), and compared with the subjects’ actual weight status. Body image perception was categorized into the following three groups: an underestimated own weight status group (underestimated group), a correct own weight status group (correct group) and an overestimated own weight status group (overestimated group).

Results

The proportion of boys in the underestimated group was higher than that of girls, while the opposite was true for the overestimated group (P < 0.001). There were no statistically significant differences in lifestyle between the underestimated group and the correct group regardless of sex. In contrast, there were statistically significant differences between the overestimated group and the correct group in the lifestyle factors of exercise among boys and snacking after dinner among girls. The adjusted odds ratio (OR) in boys who exercised daily significantly decreased (OR: 0.35, 95 % CI: 0.16–0.77), while a significantly increased OR was observed in girls who snacked after dinner (OR: 1.53, 95 % CI: 1.07–2.19).

Conclusion

Adolescent boys tended to underestimate their body weight, whereas adolescent girls were likely to overestimate their body weight. Furthermore, lifestyle factors associated with distorted body image differed by sex, with exercise affecting body image perception among boys and snacking after dinner affecting body image perception among girls. Thus, lifestyle may lead to distorted body image among adolescents.

[Prevalence of eating disorders assessed using eating attitudes test-26 and their relevant factors in Japanese working women]

OBJECTIVE

The purpose of the present study was to investigate the prevalence of eating disorders and their relevant factors in Japanese women.

METHODS

Anonymous self-administered questionnaire surveys of 3023 working women aged 20-39 were conducted during health checkups in Tokyo, Nagoya, Osaka, and Fukuoka in 2012. Eating disorders were assessed using Eating Attitudes Test-26 (EAT-26). The factors related to EAT-26 scores ≥20 were analyzed by multiple logistic regression.

RESULTS

The prevalences of eating disorders among the participants with EAT-26 scores ≥20 were 2.4% [95% confidence interval (95% CI): 1.8-2.9%] of all the participating women aged 20-39, 3.4% (95% CI: 2.5%-4.3%) of women in their 20s, and 1.2% (95% CI: 0.6%-1.8%) of women in their 30s. Logistic regression analysis showed that EAT-26 scores of ≥20 were associated with the following variables: perceived ideal BMI ≤17.5 kg/m(2) (OR: 4.55, 95% CI: 2.08-9.93), change in body weight in the previous six months (OR: 2.83, 95% CI: 1.61-4.95), being 20-29 years of age (OR: 2.64, 95% CI: 1.42-4.89), and the perception of being fat (OR=2.54, 95% CI: 1.24-5.18).

CONCLUSIONS

The prevalence of eating disorders with EAT-26 scores ≥20 was 2.4% (95% CI: 1.8%-2.9%) among Japanese working women aged 20-39. EAT-26 scores ≥20 were most closely associated with a perceived ideal BMI of ≤17.5 kg/m(2). Eating disorders may be more prevalent among women who want to lose weight to achieve a BMI of ≤17.5 kg/m(2), and these women should be carefully monitored.

Social insecurity in relation to orbitofrontal activity in patients with eating disorders: a near-infrared spectroscopy study

BACKGROUND

Functional neuroimaging techniques are widely used to elucidate changes in brain activity, and various questionnaires are used to investigate psychopathological features in patients with eating disorders (ED). It is well known that social skills and interpersonal difficulties are strongly associated with the psychopathology of patients with ED. However, few studies have examined the association between brain activity and social relationships in patients with ED, particularly in patients with extremely low body weight.

METHODS

In this study, 22-channel near-infrared spectroscopy was used to quantify regional hemodynamic changes during a letter fluency task (LFT) in 20 female patients with ED with a mean body mass index of 14.0 kg/m(2) and 31 female controls (CTLs). Symptoms were assessed using the Eating Disorder Inventory-2 and Beck Depression Inventory. We hypothesized that frontal activity in patients with ED would be lower than in CTLs and would show different correlations with psychopathological features compared with CTLs.

RESULTS

The LFT performance and score on the social insecurity subscale of the Eating Disorder Inventory-2 were significantly higher in the ED group than in the CTL group. The mean change in oxygenated hemoglobin (oxy-Hb) in bilateral frontal regions during the LFT was significantly smaller in the ED group than in the CTL group. Social insecurity score was positively correlated with the concentration of oxy-Hb in the bilateral orbitofrontal cortex in the ED group but not in the CTL group.

CONCLUSIONS

These results suggest that activity of the orbitofrontal cortex is associated with social insecurity and disturbed in patients with ED. Therefore, disturbed orbitofrontal cortex activity may underlie the lack of insight and social isolation that is characteristic of patients with ED.

Changes in eating attitudes, eating disorders and body weight in Chinese medical university students

BACKGROUND

Eating disorders is a particular problem for university students. However, little is known about this problem among medical students who often have high stress.

AIMS

The aims of this study were to describe the changes in eating attitudes and eating disorders from 2006 to 2008 in a medical student sample, and to compare the gender differences of eating attitudes and body mass index (BMI, kg/m(2)) with this sample.

METHODS

This study was conducted in Changsha city, Mainland China. Self-reported questionnaires, including the Eating Attitudes Test (EAT) and Eating Disorders Assessment Questionnaire (CETCA), were employed to examine the changes in eating attitudes and eating disorders from 2006 to 2008 in a medical student sample (N = 500).

RESULTS

Self-reported findings suggest that tentative eating disorders prevalence was 0.90% (anorexia nervosa (AN): 0; bulimia nervosa (BN): 4 females) in 2006 and 1.44% (AN: 1 male; BN: 1 male and 3 females) in 2008 of the full sample. The present data showed that 2.26% (2 males and 9 females) in 2006 and 2.47% (4 males and 6 females) in 2008 of all students obtained scores greater than 20 on the EAT-26 indicative of distorted eating attitudes and behaviour. Male students kept lower distorted eating attitudes and behaviours than female students, while female students kept a lower BMI than male students in both 2006 and 2008. However, there were no statistically significant changes in eating attitudes, distorted eating attitudes and CETCA in either male or female students from 2006 to 2008.

CONCLUSIONS

The results of this study suggest that there were no statistically significant changes from 2006 to 2008 in eating attitudes, distorted eating attitudes and CETCA. However, females showed significantly higher eating disorders and distorted eating attitudes compared to males in both 2006 and 2008. This study is furthering our understanding of eating disorders in a Chinese cultural context.

Relationship of a desire of thinness and eating behavior among Japanese underweight female students

OBJECTIVE

We conducted a questionnaire survey among Japanese female students to explore the influence of a desire for thinness and dietary behaviors on the development of eating disorders.

METHODS

Self-reported measures of socio-demographic characteristics, body weight perception, height and weight, and dietary and exercise behavior were completed by 631 female university students at 6 universities in Kyoto, Japan.

RESULTS

Many students had a desire for thinness (underweight students, 51.7 %; normal-weight students, 88.8 %), whereas ideal weight and body mass index were lower in the students with a desire for thinness than the students without a desire for thinness, and were also lower in the underweight students than the normal-weight students. The eating attitude test (EAT-26) scores of underweight students with a desire for thinness were higher than those of the normal-weight students with a desire for thinness. As a result of a logistic regression analysis, underweight, desire for thinness, and experience with weight control were positively associated with eating problems. Further, the association of eating problems increased along with the increase in the number of factors (underweight, desire for thinness, and experience with weight control).

CONCLUSIONS

These results indicate that underweight females have strong associations with eating problems.

Disordered Eating Attitudes and Their Correlates among Iranian High School Girls

BACKGROUND

Disordered eating attitudes are contributing factors to the development of eating disorders. Adolescent girls are at high risk for eating diseases. In Iran, there is few data on the subject, especially in Azarian adolescent girls, so we did this study for assessing disordered eating attitudes and their correlates among Iranian Azarbaijani high school girls.

METHODS

In a cross-sectional study, 1887 high school girls were selected. Eating Attitude Test-26 (EAT-26) and socio economical questionnaires were used. The EAT-26 score of 20 or higher defined as disordered eating attitudes. Data were analyzed using the Statistical Program for Social Sciences, by using from descriptive and analytical statistics.

RESULTS

Reliability and validity of the translated EAT-26 were 0.80, 0.76, respectively. In studied subjects, mean (SD) of EAT-26 was 11.71(8.48). Totally, 16.7% (C.I with 95%: 15.1- 18.3%) of students had disordered eating attitudes. About half of the participants were unhappy with their body weight and considered themselves as obese. Mean of EAT-26 was higher in this group. Groups, who intent to weight loss, were smoker, and who had age of menarche less than 11 years, also had higher EAT-26 scores. Parent's literacy or job, birth order, family size or income and house ownership had not any significant effect on EAT-26 score.

CONCLUSIONS

Persian version of EAT-26 has good reliability and validity for assessing disordered eating attitudes in Azarian girl adolescents. Prevalence of disordered eating attitudes among Azarian adolescent girls are in the range of some studies, but are less than Arabian countries, and some European ones. In adolescent girls, body weight dissatisfaction, smoking and early menarche has important role in eating attitudes.

Prevalence and correlates of self-induced vomiting as weight-control strategy among adolescents in Taiwan

AIMS

This study was designed to assess the prevalence and correlates of self-induced vomiting to control body weight among adolescents in Taiwan.

BACKGROUND

Over the past decades, the rate of obesity among children in Taiwan has nearly tripled. Educational authorities have devoted considerable effort to prevent the increase in childhood obesity.

DESIGN

An observational exploratory design to investigate the problem of using unhealthy weight-reduction strategy.

METHODS

This study consists of a cross-sectional study aimed at collecting national representative data. We chose 120 representative schools using a three-stage stratified systematic sampling design with probability proportionate to the size of the population in Taiwan. Participants consisted of 8673 girls and 7043 boys, aged 10-18 old.

RESULTS

Of the participants, 13% reported using self-induced vomiting, the prevalence being highest in participants aged 10-12 (15·9%) and lowest in participants aged 16-18 (7·5%). Several factors were significantly and positively associated with the use of self-induced vomiting as a weight-loss strategy, specifically subjects who (1) watched television, used computer, surfed the Internet or played video games for greater than or equal to two hours/day, (2) consumed fried food every day and (3) ate night-time snacks every day (odds ratio = 1·55, 2·10 and 1·51, respectively; p < 0·05). Eating breakfast every day and sleeping for more than eight hours a day were both protective factors against the use of self-induced vomiting to control body weight (odds ratio = 0·43 and 0·86, respectively; p < 0·05).

CONCLUSIONS

Self-induced vomiting was prevalent among adolescents who had tried to lose weight; sedentary lifestyle, shorter sleep length and unhealthy eating habits may contribute significantly to this behaviour among these adolescents.

RELEVANCE TO CLINICAL PRACTICE

School nurses who are helping adolescents lose weight should also pay attention to the possibility they are using self-induced vomiting as a weight-control strategy.

Factors associated with abnormal eating attitudes among Greek adolescents

OBJECTIVE

To estimate the prevalence of abnormal eating attitudes among Greek adolescents and identify possible risk factors associated with these attitudes.

DESIGN

Cross-sectional, school-based study.

SETTING

Six randomly selected schools in Patras, southern Greece.

PARTICIPANTS

The study population consisted of 540 Greek students aged 13-18 years, and the response rate was 97%.

MAIN OUTCOME MEASURE

The dependent variable was scores on the Eating Attitudes Test-26, with scores > or = 20 indicating abnormal eating attitudes.

ANALYSIS

Bivariate analysis included independent Student t test, chi-square test, and Fisher's exact test. Multivariate logistic regression analysis was applied for the identification of the predictive factors, which were associated independently with abnormal eating attitudes. A 2-sided P value of less than .05 was considered statistically significant.

RESULTS

The prevalence of abnormal eating attitudes was 16.7%. Multivariate logistic regression analysis demonstrated that females, urban residents, and those with a body mass index outside normal range, a perception of being overweight, body dissatisfaction, and a family member on a diet were independently related to abnormal eating attitudes.

CONCLUSIONS AND IMPLICATIONS

The results indicate that a proportion of Greek adolescents report abnormal eating attitudes and suggest that multiple factors contribute to the development of these attitudes. These findings are useful for further research into this topic and would be valuable in designing preventive interventions.

Dieting tendency and eating behavior problems in eating disorder correlate with right frontotemporal and left orbitofrontal cortex: a near-infrared spectroscopy study

Frontal lobe dysfunctions have been implicated as one of the pathophysiological bases in eating disorder (ED). Neural substrates of ED have been examined in neuroimaging studies employing symptom-related stimuli, such as food and body-image distortion, but with inconsistent results because of differences in study design, task, and stimulus used. In order to elucidate frontal lobe dysfunction correlates of clinical symptoms in ED, we examined the frontal lobe function during a cognitive task, not a symptom-related task, using near-infrared spectroscopy (NIRS), which is suitable for the functional neuroimaging study of ED because of its complete noninvasiveness and natural measurement setting. Regional hemodynamic changes were monitored during a verbal fluency task (letter version) using a 52-channel NIRS apparatus in 27 female ED patients and 27 matched healthy controls, and their correlations with clinical symptoms assessed using the Eating Attitude Scale (EAT-26) were examined. Regional hemodynamic changes were significantly smaller in the ED group than in the control group in the bilateral orbitofrontal and right frontotemporal regions, and negatively correlated with dieting tendency scores in EAT-26 in the right frontotemporal regions and with the eating restriction and binge eating scores in the left orbitofrontal regions. The clinical symptoms of ED are considered to consist of two components: dieting tendency that correlates with the right frontotemporal cortex and eating behavior problems that correlate with left the orbitofrontal cortex.

Eating disorders in adolescents and their repercussions in oral health

OBJECTIVE

To examine the prevalence of oral alterations related to eating disorders and associated factors.

METHOD

A cross-sectional study including 650 adolescents aged from 12 to 16 was carried out through self-report questionnaires (EAT-26; BITE and self-rating hamilton depression questionnaire, SRHDQ) and dental examination.

RESULTS

Significant associations were observed in mucositis, cheilitis, hypertrophy of salivary glands, and dental erosions. The prevalence of adolescents at risk for eating disorders was of 33.1%, according to EAT-26 and 1.7% (high scores) and 36.5% (medium scores), in BITE, higher among 13-year-old females, with brothers, parents or responsible person who are illiterate, being the youngest child, living in a residence of at most two rooms and who showed depressive symptoms. All these factors showed significant relation to eating disorders.

DISCUSSION

Presence of oral alterations is associated to symptoms of eating disorders, helping precocious detection of sub clinical cases.

Body image and eating disorders amongst Japanese adolescents. A review of the literature

This review describes the prevalence of eating disorders and disordered eating behaviors as well as factors influencing body image disturbance amongst Japanese adolescents and compares the prevalence and trends with those of Westernized countries. Although eating disorders have been previously regarded as peculiar to Western society, they are now a more global issue with reports of non-Western countries including Japan having increasing rates of eating disorders. As the aetiology of eating disorders is related to societal norms, culture and ethnicity, their study requires an understanding of body image disturbance within different cultural contexts. Although considered less prevalent than in the West, Japan has an early history of eating disorder research and trends outlined in this review suggest that, as in Western countries the interest in, and study of eating disorders in Japan has increased during the 1980s. The prevalence of eating disorders in Japan based on available reviews, epidemiological studies and clinical reports ranges from 0.025% to 0.2% for AN and from 1.9% to 2.9% for BN. Studies suggest that the prevalence of eating disorders has increased significantly during the past two decades but the prevalence is still quite low compared to those in Western countries. Strategies for culturally appropriate prevention are discussed.

Eating attitudes and dieting behavior among religious subgroups of Israeli-Arab adolescent females

OBJECTIVES

The aim of the study was to compare the eating attitudes and behaviors, including weight concerns and dieting behavior, among three religious subgroups (Moslems, Druze, and Christians) and three age subgroups (12-13, 14-15, and 16-18 years old) of Israeli-Arab adolescent females.

METHODS

The sample consisted of 1141 Israeli-Arab adolescent females, including 926 (81.2%) Moslem, 128 (11.2%) Christian, and 87 (7.6%) Druze schoolgirls in the seventh to twelfth grades. Participants were assessed using the EAT-26 questionnaire.

RESULTS

The results showed that 75% of the students had a negative EAT-26 score (>20) and that 25% of the students had a positive EAT-26 score (<20). No significant differences were found in total scores, subscale scores, or scores above 20 between the age subgroups or the religious subgroups. The results demonstrated a high prevalence of disturbed eating attitudes and behaviors among Israeli-Arab adolescent schoolgirls.

DISCUSSION

Higher prevalence of disturbed eating attitudes found among Israeli-Arab schoolgirls as compared to their Jewish counterparts. Although our sample is a communal based, there still remains an open question as to why the desired "slenderness culture" evident in the results is not reflected in the number of ED clinic referrals, among clinical population. These discrepancies were discussed in light of ethnicity-specific factors that may influence the perceived severity of eating disorders and the receptiveness of primary practitioners to address them.

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.

Disordered eating attitudes and behaviours among adolescents in Hong Kong: prevalence and correlates

AIMS

To study the prevalence of disordered eating attitudes and behaviours among adolescents in Hong Kong and to examine the socio-demographic and behavioural correlates.

METHODS

Three secondary schools with different academic performance were selected from the Eastern District of Hong Kong. A total of 2382 students enrolled in Forms 1-7 at the three schools completed a specially designed questionnaire. The questionnaire contained questions on socio-demographic information, body weight satisfaction, exposure to mass media, health behaviours as well as the Eating Attitudes Test - 26 (EAT-26). Data were analysed using Student's t-test, chi2 analysis and multivariate logistic regression models.

RESULTS

Disordered eating (EAT score > or =20) was present in 52 (3.9%) adolescent boys and 68 (6.5%) adolescent girls. The youngest case was only 11 years old. A high degree of body weight dissatisfaction was shared by our adolescents. Teenage girls, overweight youths and those with poor academic performance were at increased risk of having disordered eating. Strong associations were found between disordered eating and other health-compromising behaviours including smoking, alcohol and soft drug use, delinquent behaviours, suicidal ideation and self-harm behaviours. Exposure to entertainment, beauty and youth magazines was positively related to disordered eating.

CONCLUSIONS

Disordered eating is prevalent among adolescents in Hong Kong. It remains a significant public health challenge to our community. Prevention programmes targeting youths at the greatest risk should be considered.

Eating problems and personality traits. An Italian pilot study among 992 high school students

OBJECTIVE

To evaluate the prevalence of eating problems and to investigate personality traits associated with disturbed eating behaviours among Italian high school students.

METHOD

Cross-sectional study involving 992 students from six high schools in Turin, Italy. Students completed the Eating Attitudes Test-40 (EAT-40), the Temperament and Character Inventory (TCI) and a Food Frequency Questionnaire (FFQ); their weight and height were measured.

RESULTS

5.5% of the whole sample and 7.4% of girls scored above the EAT-40 cutoff value. A higher Body Mass Index (BMI) correlates with higher EAT scores. Low scores on Self-Directedness and Reward Dependence together with high Persistence emerged in subjects with eating problems.

DISCUSSION

Dieting and higher BMI are confirmed as correlates of eating problems. Personality traits measured with the TCI emerge for the first time as correlates of eating problems. Longitudinal studies should clear whether these are risk factors or not.

A comparison of disordered eating attitudes and behaviors among Filipino and American college students

OBJECTIVE

The purpose of this study was to compare the levels of eating disordered attitudes and behaviors among college students in the United States and the Philippines.

DESIGN

A convenience-based cross-sectional survey.

SETTING

General education classes in one college in Manila and another in the Western US.

PARTICIPANTS

340 college students.

INTERVENTIONS

A paper-pencil survey was given to the students in the classroom consisting of Eating Attitudes Test (EAT-26) and demographic variables.

MAIN OUTCOME MEASURES

Eating disordered attitudes and behaviors (scoring 20 or more on EAT-26) was the dependent variable, while gender and country of residence were the two main independent variables.

ANALYSIS

Frequency distributions, chi-squares, and logistic regression analysis were employed to summarize and analyze the data.

RESULTS

Filipino students were 10.9 times (p-value <0.0001) more likely to have eating disordered attitudes and behaviors than their American counterparts controlling for the demographics collected. This relationship remained significant when regression models were done for each gender separately. In addition, married students and more specifically married female students were more likely to have eating disordered attitudes and behaviors than single students or single females.

CONCLUSIONS AND IMPLICATIONS

Arguments are made as to why higher levels of eating disordered attitudes and behaviors are observed among Filipino college students. These results provide important information about the levels of eating disordered attitudes and behaviors in the Philippines and may be useful for developing future education programs.

Comparative study of attitudes to eating between male and female students in the People's Republic of China

OBJECTIVE

This study was conducted to compare eating attitudes and lifestyles of male and female college students in China (Beijing).

SUBJECTS AND METHODS

The subjects of this study consisted of 217 male and 177 female college students. They were asked to fill out the Eating Attitudes Test-26 (EAT-26) and a lifestyle questionnaire.

RESULTS

The percentages of those above the cutoff point on the EAT-26 for abnormal eating attitudes were 4.7% of male and 6.2% of female students. Body perception of being fat (distorted body image) was the factor most associated with abnormal eating attitudes.

DISCUSSION

Weight related concern was prevalent amongst the Chinese students. This suggests that the culture of the beauty of thinness is common among young students in Beijing, particularly female students.

Factors associated with abnormal eating attitudes among female college students in Japan

OBJECTIVES

To determine the prevalence rates of abnormal eating attitudes and associated risk factors among female Japanese college students.

SUBJECTS AND METHODS

The study population was 7812 female college students in Tokyo. They were asked to fill out the Japanese version of EAT-26 and lifestyle questionnaires.

RESULTS

5.1% of the subjects had a total EAT-26 score above the cutoff point (>20). Multiple regression analysis found the most important factors associated with abnormal eating attitudes were distorted body image, fewer sleeping hours, irregular meal habits, cigarette smoking and more exercise.

DISCUSSION

The prevalence of abnormal eating attitudes among female college students in this study was lower than that of Japanese female high school students and lower than that reported for college students of both western and non-western countries. Our results suggest that body image dissatisfaction may be the most important factor associated with abnormal eating behavior.

When ideals are too "far off': physical self-ideal discrepancy and body dissatisfaction in Japan

There is much evidence that young Japanese adults manifest relatively low body esteem-a phenomenon often explained as an outcome of modesty or limited need for self-enhancement. The author sought to identify additional determinants of this phenomenon and to explain its sources by examining the relationship between several presumed factors and level of body satisfaction rated by 263 Japanese students. The findings confirm earlier evidence of low body satisfaction among young Japanese adults and indicate that it is predicted mainly by a discrepancy between perceptions of the actual body and the ideal, self-esteem, and a predisposition to interpersonal phobia. Although some of the factors revealed are relevant to other cultures as well, the relatively wide discrepancy between self and ideal body and predisposition to interpersonal phobia may characterize young Japanese adults in particular and stem from a specific historical background. Overall, the results suggest that culture has a significant role in shaping collective body images in Japan and that a broader conceptualization of physical self-ideal discrepancy may better explain divergent levels of body satisfaction across cultures.

Eating attitudes in a diverse sample of Israeli adolescent females: a comparison study

OBJECTIVES

To estimate the eating attitudes in Israeli Jewish female adolescents.

METHODS

A representative sample of 1270 females in grades 7-12 from five different Israeli schools from five different residential areas were assessed by EAT-26.

RESULTS

Of the total sample, 19.5% were identified as having abnormal eating attitudes. In terms of age, the 16 year olds were found to have the significantly highest rate of total and positive EAT-26 scores. As for school subgroups, the secular boarding schools had the significantly highest rate and the kibbutz had the lowest rate of positive EAT-26 scores for the total and for all subscales.

DISCUSSION

EAT-26 was found to be a useful tool for screening and identifying at-risk groups in a large adolescent Israeli population.

Disordered eating attitudes and behaviours in the high-school students of a rural Canadian community

BACKGROUND

Most surveys of disordered eating attitudes in teenagers target females in urban areas. To help plan the distribution of treatment resources for eating disorders in British Columbia we studied male and female students in all of the high schools of a rural community.

METHODS

Three hundred and ninety-six of the 2,589 students attending the four high schools within the rural community completed the EAT-26 and a demographic questionnaire.

RESULTS

Three hundred and eighty-one of the 396 students (96%) satisfactorily completed and returned the survey. Their ages ranged from 12 to 19 years with a mean of 15.2 years (SD=1.5 years). Fifty-nine percent of participants were female. On average, males wanted to be 6.2 kg (SD=1.2 kg) heavier and females wanted to be 2.8 kg (SD=6.5 kg) lighter and 8.3 percent of males and 17.3 percent of females scored twenty or above on the EAT-26.

INTERPRETATION

The prevalence of disordered eating attitudes and behaviours in this rural setting was similar to that reported in urban communities in Canada. Disordered eating attitudes and behaviours were common in males. We conclude that there is need for treatment resources for males and that the need for treatment is as great in rural as urban communities.

Disordered eating attitudes: an emerging health problem among Mediterranean adolescents

Aim of the present study was to investigate eating attitudes in a group of Mediterranean high school students. One hundred and twenty high school students participated in this survey. The Eating Attitudes Test (EAT-26) was used for evaluating symptoms and attitudes associated with disordered eating. Body composition and dietary intake were also assessed. Using the cut-off point of 20 in the total EAT, 13 females (20.3%) and 4 males (7.3%) exhibited disordered eating behavior. Overweight students had significantly higher scores in the dieting scale than those in the normal BMI range. Percent fat mass was positively related to the total EAT (r=0.326, p<0.001) and the dieting scale (r=0.489, p<0.001). Waist/hip ratio was negatively related to total EAT and its scales. In conclusion, a significant percentage of students in this urban Mediterranean adolescent population found to have abnormal eating attitudes. This finding may be partly explained by the effect of cultural transition.

A cross-cultural analysis of 'motivation for eating' as a potential factor in the emergence of global obesity: Japan and the United States

This exploratory study compared motivation for eating between individuals from two different cultures that have moved through the nutrition transition at different rates and to different degrees. The analysis was based on a convenience sample of 1218 participants aged >or=18 years attending colleges in the US and Japan. The Motivation for Eating Scale (MFES) was used to evaluate different motivations for eating by nation and gender. The MFES consists of 12 items classified into three subscales: emotional, physical and environmental eating. The questionnaire used in the study also included responses about participants' motivation to lose weight, frequency of dieting, presence of previous or existing eating disorders, and frequency of exercise. Results showed no significant differences in the three MFES subscales for men in the US and Japan. For women, however, significant differences were seen for all three subscales. Women in the US were more likely to initiate eating for emotional reasons, while women in Japan were more likely to eat for physical or environmental reasons. Women and men in the US were more likely than the Japanese respondents to eat in response to watching TV or movies. These results suggest that there are national differences in the cultural environment that may impact individual motivations for eating. As such, various cultural perceptions of food should be considered in attempts to understand more fully the mechanics of the nutrition transition as it operates within a given country. By extension, public health policies and health promotion initiatives that are designed to limit the negative impacts of the nutrition transition may benefit from a greater understanding of the larger role that cultural perceptions of food may play in influencing individual motivations for eating.

Perception of self-physique and eating behavior of high school students in Japan

The authors investigated the condition of self-physique perception and eating behavior, and the relationship between self-physique perception and eating behavior of high school students in Japan. Regarding self-physique perception, subjects were shown six pictures of physiques and asked to choose one physique each for their actual physique and their ideal physique. With respect to eating behavior, the Japanese version of the Eating Attitudes Test (EAT)-26 was used. Groups of underweight girls, normal girls, and normal boys tended to regard their actual physiques as rather broad, demonstrating that many girls are excessively preoccupied with thinness. The rate of eating problems was 11.2% for the girls and 2.4% for the boys. For both boys and girls, those who idealized the thinner physique scored higher in terms of the EAT score and factor I score. Education regarding body perception and diet must be undertaken as soon as possible in Japan.

Screening for symptoms of eating disorders: reliability of the SCOFF screening tool with written compared to oral delivery

OBJECTIVE

The validity of the SCOFF delivered orally as a screening tool for eating disorders has previously been established, but clinical screening for eating disorders also occurs via written format, for example, in occupational health settings. The objective was to compare responses to the SCOFF between verbal and written administration.

METHOD

In a volunteer group of nursing and midwifery students at a South London University SCOFF was delivered orally at interview and via written questionnaire. Order was allocated randomly with repeat administration interrupted by distraction questions.

RESULTS

There were 185 students who participated, providing 178 fully completed responses. Twenty subjects were male. There was overall agreement in the scores of 157 subjects (88.2%), providing a kappa coefficient of 0.811, with agreement in prediction of eating disorder for 167 (93.8%) and a kappa value of 0.824 (both p < 0.001). For 82 subjects administered the SCOFF verbally first followed by the written version, the kappa statistic was 0.752 (p < 0.001). For 96 subjects with SCOFF administered in reverse order (written form first), kappa was 0.862 (p < 0.001).

DISCUSSION

Results demonstrated overall good replicability of the SCOFF administered as a written questionnaire compared to oral interview. Two trends were noted. The first was towards higher scores with written versus oral delivery irrespective of order, possibly indicating enhanced disclosure via written format. The second was of less consistency where verbal preceded written responses. Altogether findings support use of the SCOFF where a concise, valid and reliable screening for eating disorders is required in written form.

Eating attitudes in high school students in the Philippines: a preliminary study

PURPOSE

The purpose of this study was to examine the prevalence of abnormal eating attitudes among high school students from Pasig Catholic College in the Philippines.

METHODS

Two survey questionnaires, the Eating Attitudes Test (EAT) and Beck's Depression Inventory (BDI), were administered to 932 high school students. The height and weight of the subjects were measured, and their body mass indices (BMI) calculated.

RESULTS

The prevalence of abnormal eating attitudes according to the EAT scores was 14.5 +/- 3.2% among males and 15.0 +/- 3.5% among females, comparable to the 7-22% found in Western countries. There was a weak correlation between the EAT scores and BMI (r=0.180, p=0.01), and between the EAT scores and Beck's Depression Inventory (r=0.187, p=0.01).

CONCLUSIONS

The results indicate the presence of abnormal eating attitudes among Filipino high school students from Pasig Catholic College, which suggests that further study of eating disorders and their associated risks is warranted.

The eating attitudes test: twenty-five years later

This manuscript reviews the literature involved with the Eating Attitudes Test (EAT), first developed in the late 1970s as a self-report, indicative of the symptoms of eating disorders. The EAT has good psychometric properties of reliability and validity, and reasonable sensitivity and specificity for the eating disorders, but very low positive predictive value because eating disorders are relatively uncommon. In addition they exist on a continuum, because of denial and social desirability, the results of a self-report instrument may be affected. A very large literature has documented the use of the EAT in a variety of cultures. It is used to screen eating disturbances in general as the first part of a two-part diagnostic screen, as an ability to compare across groups and to measure change between groups and over time.

Eating disorders in the Far East

OBJECTIVE

To investigate eating disorders (EDs) prevalence rates among Asian populations and identify characteristics that distinguish them from their Western counterparts.

METHOD

Potential references were identified through an English-language literature search using Medline, Psychinfo, Dissertation Abstracts (1966 to 1999) and through extensive manual searching of textbooks, reviews and reference lists.

RESULTS

The majority of studies related to EDs were conducted in Japan and China and a few were conducted in Singapore, Malaysia, Taiwan, and Korea whereas there was none in the Philippines, Laos, Vietnam, Cambodia, Myanmar, Indonesia and Thailand. Prevalence rates in Japan range from 0.025 to 0.030% for anorexia nervosa (AN) and from 1.9 to 2.9% for bulimia nervosa (BN). Community studies in China have found the AN prevalence to be 0.01% and BN rates ranging from 0.5% to 1.3%. These rates are lower than ED rates in the West (particularly the U.S. and Britain). Body dissatisfaction (BD) and dieting rates, however, were similar to those in the West. BD rates ranged from 68% (Taiwan) to 81% (Korea) and dieting rates ranged from 34% (Taiwan) to 68% (Japan). Sociocultural and developmental risk factors were relevant to this population.

CONCLUSIONS

EDs in Asian populations have received little attention because they have been predominantly viewed as associated with Western culture. Classified by many as a "culture-bound syndrome" of the West, they may really be a culture-change syndrome.