Distorted weight perception correlates with disordered eating attitudes in Kuwaiti college women

Disordered Eating Attitudes and Their Association with Age, BMI, Stress, and Diet in College Students

OBJECTIVE

College students are at risk of disordered eating, particularly students with overweight/obesity and with higher stress, but little is known about how disordered eating may be related to diet. This study evaluated the associations between the Disordered Eating Attitudes Scale (DEAS) and age, BMI, stress, and diet.

METHODS

This is a secondary analysis of the baseline data in participants from the Snackability Trial. Participants completed a questionnaire on socio-demographics, DEAS, and snacking, self-reported their weight and height (to calculate BMI), and completed two 24 h non-consecutive dietary recalls (to calculate diet quality using HEI-2015 and snack quality score using an algorithm developed by our group). Associations between variables were assessed with Spearman correlations.

RESULTS

A total of 140 participants completed all assessments. The median age was 21.0 and the median BMI was 28.5 kg/m2 (43.7% had overweight and 41.5% had obesity). A total of 86.4% were females, 41.4% were white, 51.4% were low-income, and 30.7% were Hispanic/Latino. The total DEAS and the subscale 'Relationship with food' were positively correlated with stress and BMI (p < 0.05) but inversely correlated with HEI-2015 (p < 0.05). The subscales 'Restrictive and compensatory behaviors' and 'Concern about food and weight gain' were also positively correlated with stress (p < 0.001).

CONCLUSION

College students with higher disordered eating attitudes also had higher stress and BMI but poorer diet quality. Interventions may be needed for this group to manage stress and improve weight and diet quality, as well as promote awareness about disordered eating attitudes.

Body Composition, Energy Availability, Risk of Eating Disorder, and Sport Nutrition Knowledge in Young Athletes

Young athletes may be at risk for low energy availability (LEA) or dietary habits that are indicative of eating disorders. Thus, the purpose of the current study was to investigate the prevalence of LEA among high school athletes and examine those at risk for eating disorders. A secondary aim was to examine relationships between sport nutrition knowledge, body composition, and LEA.

METHODS

94 male (n = 42) and female (n = 52) mean ± SD age: 18.09 ± 2.44 y; height: 172.6 ± 9.8 cm; body mass: 68.7 ± 14.5 kg; BMI: 22.91 ± 3.3 kg·m^-2) athletes completed a body composition assessment and electronic versions of the abridged sports nutrition knowledge questionnaire (ASNK-Q), brief eating disorder in athletes questionnaire (BEDA-Q), and the low energy availability for females questionnaire (LEAF-Q; females only).

RESULTS

52.1% of female athletes were classified as being at risk for LEA. Moderate inverse relationships existed for computed LEAF-Q scores and BMI (r = -0.394; p < 0.01). A total of 42.9% of males (n = 18) and 68.6% of females (n = 35) were at risk for eating disorders, with females being at greater risk (p < 0.01). Body fat percentage was a predictor (β = -0.095; p = -0.01) for eating disorder risk status. For every 1 unit increase in body fat percentage, athletes were 0.909 (95% CI: 0.845-0.977) times less likely to be classified as at risk for an eating disorder. Male (46.5 ± 13.9) and female (46.9 ± 11.4) athletes scored poorly on the ASNK-Q, with no differences between sex (p = 0.895).

CONCLUSIONS

Female athletes were at a greater risk for eating disorders. No relationships existed between sport nutrition knowledge and %BF. Female athletes with a higher %BF had a lower risk for an eating disorder and risk for LEA.

Comparison of the burden of anorexia nervosa in the Middle East and North Africa region between 1990 and 2019

BACKGROUND

Anorexia nervosa (AN) is a complex and heritable psychiatric disorder, which imposes significant mortality and morbidity on sufferers globally. We aimed to report the prevalence, incidence and disability-adjusted life-years (DALYs) attributable to AN in the Middle East and North Africa (MENA) region by age, sex and socio-demographic index (SDI), between 1990 and 2019.

METHODS

The disease burden attributable to AN was obtained for the 21 countries located in the MENA region between 1990 and 2019 using publicly available data from the Global Burden of Disease (GBD) 2019 study. All estimates were provided as counts and age-standardized rates per 100,000 population, along with 95% uncertainty intervals (UIs).

RESULTS

In 2019, the estimated age-standardised point prevalence and incidence rate of AN (per 100,000) in MENA were 49.3 (95% UI: 34.6-70.4) and 16.0 (11.3-22.0), which were 11.4% (7.3-15.4) and 5.9% (2.6-9.1) higher than in 1990, respectively. Furthermore, the regional age-standardised DALY rate was 10.6 (6.3-17.0) per 100,000 in 2019, which was 11.8% (5.2-19.1) higher than in 1990. In 2019, Kuwait [17.3 (10.3-27.9)] and Afghanistan [6.3 (3.7-10.3)] had the highest and lowest age-standardised DALY rates, respectively. In addition, Iran showed the largest increases in the age-standardised point prevalence [30.0% (24.1-36.2)], incidence [24.6% (18.6-30.4)] and DALY [30.5% (22.6-38.9)] rates between 1990 and 2019. In 2019, the number of prevalent cases and prevalence estimates peaked in the 15-19 age group for males and the 20-24 age group for females, with females having a higher number of cases and prevalence in all age groups. In 2019, the age-standardised DALY rates in MENA were higher than the global rates among males aged 10-34 years, but were lower than the global estimates among females in almost all age groups. In addition, the burden of AN was positively associated with the level of socio-economic development during the measurement period.

CONCLUSIONS

The burden of AN in the MENA region increased between 1990 and 2019, which indicates that it is likely to become a more serious public health issue in the future. Up-to-date information about the epidemiological trends in the region would allow health policymakers to make informed and appropriate decisions to help address this issue. The findings of the present study showed that the point prevalence and incidence rate of anorexia nervosa have increased in the Middle East and North Africa region between 1990 and 2019. The highest burden in 2019 was found in Kuwait, while Afghanistan had the lowest attributable burden. In addition, between 1990 and 2019 Iran had the largest increase in the point prevalence of anorexia nervosa. Also in 2019, anorexia nervosa was more prevalent in females and peaked in the 15-19 age group for males and the 20-24 age group for females. Furthermore, as the level of socioeconomic development increased, so did the burden attributable to anorexia nervosa.

The prevalence and risk factors of screen-based disordered eating among university students: a global systematic review, meta-analysis, and meta-regression

PURPOSE

The purpose of this review was to estimate the prevalence of screen-based disordered eating (SBDE) and several potential risk factors in university undergraduate students around the world.

METHODS

An electronic search of nine data bases was conducted from the inception of the databases until 1st October 2021. Disordered eating was defined as the percentage of students scoring at or above established cut-offs on validated screening measures. Global data were also analyzed by country, research measure, and culture. Other confounders in this review were age, BMI, and sex.

RESULTS

Using random-effects meta-analysis, the mean estimate of the distribution of effects for the prevalence of SBDE among university students (K = 105, N = 145,629) was [95% CI] = 19.7% [17.9%; 21.6%], I2 = 98.2%, Cochran's Q p value = 0.001. Bayesian meta-analysis produced an estimate of 0.24, 95% credible intervals [0.20, 0.30], τ = 92%. Whether the country in which the students were studying was Western or non-Western did not moderate these effects, but as either the mean BMI of the sample or the percentage of the sample that was female increased, the prevalence of SBDE increased.

CONCLUSIONS

These findings support previous studies indicating that many undergraduate students are struggling with disordered eating or a diagnosable eating disorder, but are neither receiver effective prevention nor accessing accurate diagnosis and available treatment. It is particularly important to develop ever more valid ways of identifying students with high levels of disordered eating and offering them original or culturally appropriate and effective prevention or early treatment.

LEVEL OF EVIDENCE

I, systematic review and meta-analysis.

Orthorexia nervosa, mindful eating, and perfectionism: an exploratory investigation

PURPOSE

Research has drawn associations between Mindful Eating (ME) and perfectionism in the aetiology and treatment of eating disorders (ED), but understanding into the relationship between these factors and Orthorexia nervosa (ON) is limited. The purpose of this research is to explore the relationship between perfectionism, ME, and ON.

METHOD

Participants (n = 670) completed the Düsseldorf Orthorexia scale, the Mindful Eating Behavior scale, and the Big-Three Perfectionism scale Short-form, to reveal the relationship between ON, ME, and perfectionism. The relationship was assessed using correlational and regression analyses.

RESULTS

A positive association was observed between perfectionism and ON. Moreover, perfectionism demonstrated a significant negative correlation with three out of four ME facets, with "eating without distraction" displaying the highest correlation. The "eating with awareness" facet of ME demonstrated a significant relationship with ON, in a negative direction. An unexpected relationship was observed between the focused eating facet of ME and ON, with a positive association being found. A further regression analysis revealed both perfectionism and ME to predict orthorexic tendencies.

CONCLUSION

These findings identify a relationship between ON, ME, and perfectionism. It offers suggestion for the complexity of ME, and how it should be recognised by its different components, estimating a differential predictability and estimation of ON. Further research is required to clarify the direction of causality in the relationships observed, to inform the clinical diagnoses and intervention of ON.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

The Effect of Bigorexia Nervosa on Eating Attitudes and Physical Activity: A Study on University Students

PURPOSE

This study aims to examine the relationship between physical activity, eating attitude, and bigorexia nervosa among university students.

METHOD

A questionnaire form consisting of sociodemographic characteristics, eating habits, the Eating Attitude Scale (EAT-40), the International Physical Activity Questionnaire (IPAQ), and the Muscle Appearance Satisfaction Scale (MASS) was conducted on undergraduate students at Üsküdar University.

RESULTS

There were 1006 students who participated in this study with a mean age of 22.58 ± 2.87 years. The median "muscle appearance satisfaction" score of the obese students was statistically higher than the normal weight and underweight students. The median score for "Obesity Anxiety" was statistically higher in underweight students than in obese ones. A one-unit increase in IPAQ scores was related to an elevation of 24.9% in the MASS and a decrease of 17.9% in the EAT-40 scores, while a one-unit increase in MASS scores was related to a reduction of 12.5% in the EAT-40 scores.

CONCLUSION

Eating attitude is associated with bigorexia nervosa, and as MASS scores increase, EAT-40 scores decrease and as IPAQ scores increase, and EAT-40 scores decrease. In other words, as physical activity increases, muscle strength satisfaction elevates, and in parallel with this increase, a positive eating attitude improves.

Weight Perception Measured by Verbal Descriptions and Visual Descriptions: Which Measurement Correlates with Weight Loss Intentions among Female Nursing Students?

Background: Young females tend to overestimate their weight status, which might induce unhealthy weight loss intentions and behaviours. This study aimed to examine weight perception measured by visual and verbal descriptions and its correlation with weight loss intentions among female nursing students. Methods: A cross-sectional survey was conducted among 600 female nursing students from four medical colleges in Shanghai, China. The participants rated perceptions of their weight by selecting a silhouette from the female Photographic Figure Rating Scale (PFRS) and one of the following verbal descriptions: “very underweight”, “slightly underweight”, “normal”, “overweight” or “obese”. Weight loss intentions were measured using the question “How often do you want to lose weight?”. Body mass index (BMI) was calculated from self-reported height and weight. Data were analysed using univariate and ordinal logistic regression analyses. Results: The accuracy of weight perceptions measured by verbal descriptions and visual descriptions was 44.50% and 55%, respectively. In females with underweight BMI (n = 135), 88.15% and 49.63% accurately classified their weight using visual descriptions and verbal descriptions, respectively. These females were more likely to overestimate (53.83% vs. 14.50%) and less likely to underestimate (1.67% vs. 30.50%) their weight when using verbal descriptions than when using visual descriptions. For verbal descriptions, weight overestimation was associated with weight loss intentions (odds ratio, 1.80; 95% confidence interval, 1.25–2.60). However, for visual descriptions, the two variables were not associated. Conclusions: A mismatch occurred between weight perceptions measured by the two methods and BMI status among female nursing students. Compared with verbal descriptions, visual descriptions had higher weight perception accuracy. However, weight overestimation measured by verbal descriptions was more likely to be associated with stronger intentions to lose weight than that of visual descriptions. These findings suggest that methodological discrepancies should be taken into account when measuring weight perception in future studies.

Neuropeptide Y and Peptide YY in Association with Depressive Symptoms and Eating Behaviours in Adolescents across the Weight Spectrum: From Anorexia Nervosa to Obesity

Neuropeptide Y (NPY) and peptide YY (PYY) are involved in metabolic regulation. The purpose of the study was to assess the serum levels of NPY and PYY in adolescents with anorexia nervosa (AN) or obesity (OB), as well as in a healthy control group (CG). The effects of potential confounders on their concentrations were also analysed. Eighty-nine adolescents were included in this study (AN = 30, OB = 30, and CG = 29). Anthropometric measurements and psychometric assessment of depressive symptoms, eating behaviours, body attitudes, and fasting serum levels of NPY and PYY were analysed. The AN group presented severe depressive symptoms, while the OB group held different attitudes towards the body. The levels of NPY were lower in the AN and OB groups as compared with the CG. The PYY levels were higher in the OB group than in the AN group and the CG. The severity of eating disorder symptoms predicted fasting serum concentrations of NPY. Lower levels of NPY in AN, as well as in OB suggests the need to look for a common link in the mechanism of this effect. Higher level of PYY in OB may be important in explaining complex etiopathogenesis of the disease. The psychopathological symptoms may have an influence on the neurohormones regulating metabolism.

Eating Disorders and the Use of Cognitive Enhancers and Psychostimulants Among University Students: A Cross-Sectional Study

BACKGROUND

University students, who are at risk of eating disorders (ED), are more liable to use cognitive enhancers and psychostimulants to improve their cognitive functions and lose weight. ED in Palestinian male students is a neglected health issue. We aimed to investigate the prevalence and the association between ED and cognitive enhancers, and psychostimulants use among An-Najah National University students (ANNU).

METHODS

In a cross-sectional study conducted in 2020 at ANNU, 1047 students completed anonymous surveys for cognitive enhancers practice, the Eating Attitude Test-26 (EAT-26), Sick, Control, One, Fat and FOOD (SCOFF) screening tests.

RESULTS

The prevalence of ED among ANNU students was 21.2% based on EAT-26 (17.1% in males, 23.8% in females) and 31.5% based on SCOFF (24.0% in males, 36.3% in females). The binary logistic regression revealed that students at risk to have ED were water-pipe smokers (OR: 1.471, p-value 0.047), especially males, while students who were less likely to have ED were males (OR: 0.341, p-value<0.001), coffee users (OR: 0.581, p-value 0.014) and chocolate users (OR: 0.530, p-value 0.041) than nonusers. Moreover, the risk of ED increased with increasing body mass index (p-value<0.01). Clinical medical students showed the lowest prevalence (11.1%) compared to preclinical (22.5%), health sciences (23.7%), and non-medical students (20.9%) (p-value 0.059).

CONCLUSION

Our findings highlight water-pipe smoking as a significant health problem in males with ED, which may require unique treatment and prevention strategies. Moreover, coffee and chocolate consumption were associated with decreased risk of ED, only among males. The gender-gap in ED prevalence was very narrow compared to international results. These results prompt the need to focus on both genders in future studies instead of females. They also suggest the urgent need to address ED among Palestinian university students by educating students about mental health, identifying high-risk students, and offering easily accessible psychological help.

Internalization of the Thin-Ideal and Eating Pathology in Kuwaiti Adult Women

Rapid socioeconomic growth, Western acculturation, and thin-ideal internalization are theorized to be linked to dieting, weight concerns, and disordered eating in Arab countries. The purpose of this study was to examine eating pathology and the internalization of Western messages regarding the importance of thinness in a community sample of Kuwaiti women. Participants (N = 83) aged 18–35 years with BMIs between 17.58 and 24.88 (M = 21.30; SD = 1.83) completed measures of thin-ideal internalization and eating pathology. Results demonstrated that approximately 28% of the sample was at risk for eating pathology. Thin-ideal internalization was also found to significantly predict eating pathology. Study findings extend prior research on eating pathology in Arabic nations. This study is the first to examine the internalization of the thin-ideal in a community sample of Kuwait adult women and lends further support to the importance of continued research in this population.

The use of internet sources for nutritional information is linked to weight perception and disordered eating in young adolescents

The internet serves as an accessible and confidential resource for young adolescents seeking nutritional information. However, the quality of information retrieved online is mixed and could have serious implications for users. Young adolescents who perceive themselves as overweight may be disproportionately affected as they are at greater risk for disordered eating. The current study aimed to (1) assess whether the frequency of use of different internet sources to obtain nutritional information differs between healthy weight young adolescents and those with overweight/obesity based on both objective and perceived weight status and (2) evaluate the relationships between different internet sources utilized for nutritional information and disordered eating. Young adolescents (n = 167; 10-15 years) completed the Children's Eating Attitudes Test (ChEAT; total disordered eating), indicated their perceived weight status, and reported how often they obtained nutritional information from the following internet sources: professional websites, personal websites, social media, commercial weight loss websites, and forums. Objective height and weight measurements were obtained. Young adolescents that perceived themselves to be a little overweight or overweight reported greater use of personal websites (p = .012), commercial weight loss websites (p = .011), and social media (p = .019) for nutritional information than those that did not perceive themselves to be a little overweight or overweight. The frequency of use of internet sources for nutritional information did not differ based on objective weight status. Greater use of each of the internet sources for nutritional information was related to greater disordered eating (p's < 0.05). While longitudinal research is needed to further examine these relationships, healthcare providers and teachers should provide young adolescents with guidance for interpreting and using online nutritional information to encourage valid and reliable health recommendations.

The role of weight perceptions and their impact on health and well-being: A multiple mediation model

The present study analyses the role of weight distortion and weight self-criticism in explaining the relationship between actual weight and perceived health, well-being, body satisfaction and emotional eating. Eight hundred and six individuals were selected from a national study on nutrition. They were divided into two groups according to self-reported dieting. A questionnaire measuring the outcome variables was implemented. Weight distortion and self-criticism were calculated using actual, estimated and desired BMI. A multiple mediation model was estimated using structural equation modelling. A valid model was obtained in which weight self-criticism is a partial mediator of the relationship between weight and body satisfaction and a full mediator of the relationship between weight and emotional eating for the non-dieter group. For the dieter group, full mediation of weight self-criticism is observed in the relationships between weight and health, well-being and body satisfaction. For weight distortion, no mediation effect is found in either group. The results highlight the importance of weight perceptions in understanding the influence of body weight on several aspects of health and well-being. The type of weight perception is also relevant. A critical attitude towards weight is more determinant than the distortion in weight appraisal.

The impact of urbanization on risk for eating disorders

PURPOSE OF REVIEW

Urbanization has broadly been implicated in negatively impacting mental health, including risk for disordered eating and eating disorders. Understanding the specific mechanisms that contribute to risk for maladaptive eating behavior in the context of urbanization is essential to improving public health policy and guiding future clinical, research, and prevention efforts.

RECENT FINDINGS

This review of recent investigation related to the impact of urbanization on eating disease highlights specific risk factors for eating disorders, including acculturation to Western standards of beauty and food resources with associated body weight and body image concern.

SUMMARY

Recommendations for clinical and research endeavors include improved specificity in defining urbanization, as well as increased sensitivity within community-based assessment of cultural and demographic variables that may impact eating behavior and risk for eating disorders.

Trends in Fast-food Consumption among Kuwaiti Youth

BACKGROUND

We assessed fast-food consumption including frequency, type, and reasons among college students from the Kuwait University, and whether there were any key sex differences.

METHODS

A cross-sectional survey was conducted from January-March 2016 with 421 students (297 women, mean age = 20.99 ± 3.14 years). Students completed self-administered fast-food questionnaires and weight and height measurements were obtained.

RESULTS

Most (81.4%) consumed fast food more than twice per week and more men than women were overweight or obese (54.8% vs. 38.7%, respectively; P = 0.002); however, there were no differences in the fast-food frequency per body mass index or sex. Taste was the most reported motivator to consume fast food (46.7%) and women were significantly more likely to value taste as compared to men (49.8% vs. 38.9%, respectively; P = 0.005).

CONCLUSIONS

Fast food is a key part of college students' diet in Kuwait; therefore, students should be educated on the negative effects of frequent fast-food consumption. University health promotional activities should include nutrition education on healthier fast-food options and how to prepare easy-to-cook meals at home.

Disordered eating attitudes correlate with body dissatisfaction among Kuwaiti male college students

BACKGROUND

The prevalence of disordered eating attitudes and body dissatisfaction based on muscularity and body fat was investigated among male college students in Kuwait with a range of body mass index values including underweight, normal weight, overweight, and obese participants.

METHODS

Data were collected, using the Eating Attitudes Test (EAT-26) and the Bodybuilder Image Grid (BIG), from 400 male undergraduate students (84.8% Kuwaiti nationals) recruited from both public and private universities in Kuwait. An anonymous, self-administered questionnaire was used to determine the prevalence of symptomatology indicative of anorexia nervosa and bulimia nervosa and to examine the associations between body dissatisfaction and muscularity and body fat.

RESULTS

Most participants were dissatisfied with their current muscle mass and body fat (67.3 and 69%, respectively). Logistic regression analyses produced odds ratios (ORs) demonstrating that students dissatisfied with their muscularity and body fat and those who indicated a desire to decrease both muscularity and body fat had significantly higher odds of being at risk of disordered eating attitudes (OR = 2.241, 95% CI [1.17, 3.6], p = .032, and OR = 1.898, 95% CI [1.214, 2.967], p = .005, respectively). Obese participants also had higher odds of exhibiting disordered eating attitudes (OR = 2.06, 95% CI [1.17, 3.60], p = .011).

CONCLUSION

The high proportion of disordered eating attitudes among Kuwaiti college men was associated with high levels of body image dissatisfaction in relation to both body fat and muscularity. High levels of eating disorder symptoms were also linked to obesity.

Gender differences in weight status, dietary habits, and health attitudes among college students in Kuwait: A cross-sectional study

Background:

A better understanding of the factors involved in health and wellness among college students can aid in the design of interventions that can reduce the rate of weight gain during young adulthood.

Aim:

The aim of this study was to determine the gender differences in weight status, dietary habits, and health attitudes in a sample of college students at Kuwait University (KU).

Methods:

In this cross-sectional study, 615 students were recruited from KU between November 2013 and March 2014. Components of the study included a self-report questionnaire, assessment of body mass index, and calculation of Healthy Eating Score (HES) to assess eating habits and attitudes. Statistical analyses were performed to assess the gender differences among these domains.

Results:

The findings revealed that a greater proportion of men were overweight and obese compared to women (28.7% and 23.8% vs. 19.9% and 12.1%, respectively). Both genders show equally unhealthy dietary habits, marked by low mean HES scores. Gender-specific dietary patterns were noted, with more men reporting eating >6 oz (168 g) of animal protein per day as compared to women (48.4% vs. 28.9%, p < 0.001). A higher proportion of female students reported regular consumption of potato chips and fatty salty snacks (51.3% and 40.4%, respectively, p = 0.12) and that they ate sweets more than twice a day (52.5% and 39.9%, respectively, p = 0.041).

Conclusions:

Our findings highlight the need for evidence-based gender-specific strategies to reduce the number of overweight and obese college students and promote healthy dietary habits and eating attitudes among this population.

Distorted weight perception correlates with disordered eating attitudes in Kuwaiti college women

OBJECTIVE

We investigated the presence of disordered eating attitudes and weight perception among young women at body mass index (BMI) values that correspond to underweight, normal weight, overweight, and obese weight status.

METHOD

Data were collected from 1,147 female undergraduate students (89% Kuwaiti nationals) recruited from Kuwait University through employment of the eating attitude test (EAT-26) together with an anonymous, self-administered questionnaire to determine the prevalence of symptomatology indicative of anorexia nervosa and bulimia nervosa.

RESULTS

The mean EAT-26 scores differed significantly between the weight categories. More students with overweight and obesity scored above the established EAT-26 cut off value indicating at risk of disordered eating compared to students who were at a normal weight or underweight (52.1% vs. 38.8%, respectively, X² (1) =16.1, p < .001). Logistic regression analyses showed significantly higher odds ratios (ORs) for the groups with overweight and obesity for dieting and bulimic behaviors, while women at normal and underweight had higher ORs for restrictive oral control behaviors associated with anorexia nervosa. Distorted weight perception was found in all weight categories.

DISCUSSION

The high proportion of disordered eating attitudes among Kuwaiti college women could not be attributed to obesity alone as the type of disordered eating behavior varied more by weight perception than by weight status. The high levels of eating disorder related symptoms could be due to a combination of the social influences, diet, and lifestyle of college students. Such factors need to be considered by healthcare professionals as early as possible with more focused programs towards promotion of healthy weight for college students.