The impact of ongoing westernization on eating disorders and body image dissatisfaction in a sample of undergraduate Saudi women

Addressing nutritional issues and eating behaviours among university students: a narrative review

University life is a critical period for establishing healthy eating habits and attitudes. However, university students are at risk of developing poor eating habits due to various factors, including economic conditions, academic stress and lack of information about nutritional concepts. Poor diet quality leads to malnutrition or overnutrition, increasing the risk of preventable diseases. Food environments on university campuses also play a significant role in shaping the dietary habits of students, with the availability of and accessibility to healthy food options being important factors influencing food choices and overall diet quality. Disordered eating habits and body dissatisfaction are prevalent among university students and can lead to eating disorders. Income and living arrangements also influence dietary habits, with low household income and living alone being associated with unhealthy eating habits. This study is a narrative review that aimed to address nutritional issues and eating behaviours, specifically among university students. We investigated the eating behaviours of university students, including their dietary patterns, food choices and food environments. The objective of this review was to provide insights into the nutritional issues and eating behaviours of university students, with the aim of identifying target areas for intervention to improve the overall health and wellbeing among college students. University food environments need to be restructured to promote healthy eating, including the availability, accessibility, affordability and labelling of healthy foods, and policies to limit the availability of unhealthy foods and drinks on campus.

New understandings meet old treatments: putting a contemporary face on established protocols

In the twenty years since the publication of the most widely used treatment manuals describing evidence-based therapies for eating disorders, there have been some substantial advances in the field. New methods of delivering treatments have been trialled and our perception of mental health has advanced; significant cultural changes have led to shifts in our societal landscape; and new technologies have allowed for more in-depth research to be conducted. As a result, our understanding of eating disorders and their treatment has broadened considerably. However, these new insights have not necessarily been translated into improved clinical practice. This paper highlights the changes we consider to have had the greatest impact on our work as experienced clinical psychologists in the field and suggests a list of new learnings that might be incorporated into clinical practice and research design.

Stigmatisation of Obesity and its Relation to the Perception of Controllability in Riyadh, Saudi Arabia: A cross-sectional study

Objectives

This study assessed the stigmatisation of obesity among a sample of the general population in Riyadh and its association with the perception of controllability.

Methods

A cross-sectional analytical study was conducted in Riyadh, Saudi Arabia, during January-February 2021. The data were collected through a self-administrated online questionnaire. Statistical analysis was performed using John's Macintosh Project, Version 16.0.0.

Results

A total of 525 participants were recruited via convenience sampling. The majority of the participants exhibited a low level of stigma towards obesity (72.8%), and gender and BMI were significantly associated with the level of stigma (P = 0.0023 and 0.0360, respectively). The association between the perception of controllable factors and the level of stigma was also significant (P = 0.0001).

Conclusion

A significant association was found between the stigmatisation of obesity and the perception of controllability among the general population in Riyadh. Recommendations should be based on joint international consensus statements for ending obesity stigmatisation in different settings and categories; healthcare service providers and obese patients should be educated on the relationships demonstrated in these findings.

The impact of climate change on eating disorders: An urgent call for research

Climate change affects many of the documented risk factors for eating disorders (EDs) through direct and indirect pathways, yet to date the research in this area is nonexistent. Our aim is to identify the specific mechanisms through which climate change might be associated with increased risk for EDs, an exacerbation in symptoms, or poor clinical outcomes; highlight limited empirical data addressing these issues; and propose directions for a research program in this important area. Pathways for the impact of climate change on eating disorders and related data were reviewed. Four main pathways for the effects of climate change on EDs were identified including (1) decreased food access and security; (2) changes in mean temperature; (3) concerns related to food safety and eco-anxiety; and (4) indirect pathways through trauma, adversity, and increased mental health concerns. Except for the relationship between increased food insecurity and EDs, these pathways remain largely uninvestigated. Numerous factors may be implicated in the relationship between climate change and EDs. Future work in this area is imperative and should be conducted through a social justice lens with particular attention paid to the global areas most impacted by climate change and related vulnerabilities. Climate change will likely have adverse impacts on individuals with eating disorders and increase the risk for eating disorders. This paper reviews the different ways in which climate change may have these effects and calls for researchers to pay attention to this important area.

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.

The prevalence and correlates of bulimia nervosa, binge-eating disorder, and anorexia nervosa: The Saudi National Mental Health Survey

OBJECTIVE

Limited studies have been conducted in the Kingdom of Saudi Arabia on eating disorders (EDs). This study presents national epidemiological survey data on the prevalence and correlates of anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) and their association with other mental health disorders, impairment in role functioning, and individual help-seeking behaviors in the Saudi National Mental Health Survey (SNMHS).

METHOD

A face-to-face survey was conducted in a nationally representative household sample of Saudi citizens aged 15-65 (n = 4004). The Composite International Diagnostic Interview (CIDI 3.0) was used to produce estimates of lifetime and 12-month prevalence and treatment of common DSM-IV mental disorders.

RESULTS

Twelve-month prevalence of any of the three EDs was 3.2%; the overall lifetime prevalence was 6.1%. Education and marital status were significantly associated with both 12-month and lifetime EDs prevalence. Significant mental health comorbidities associated with 12-month EDs were anxiety, mood, and impulse-control disorders, while lifetime EDs were significantly related to all disorders. A similar percentage of respondents that reported having ED-related treatment at some point in their lifetime utilized healthcare and nonhealthcare sector. There was a significant relationship between body mass index category, and lifetime BED and BN.

DISCUSSION

The 12-month prevalence of EDs in the Saudi population was higher than the EDs rates reported worldwide. These findings can help healthcare experts, and policymakers in the implementation of initiatives for raising awareness of EDs among the Saudi population, and the development of a country-wide plan for the prevention of EDs.

PUBLIC SIGNIFICANCE STATEMENT

The study presents data on the prevalence, correlates, and help-seeking behaviors of AN, BN, and BED, in the Saudi National Mental Health Survey (SNMHS). Obtaining information on this underrepresented region is essential due to the large differences in cross-national data in addition to cultural beliefs about mental illness and treatment seeking to exert an important influence on eating disorders. Such knowledge could provide a better understand of mechanisms underlying the development of eating disorders and thereby improve prediction, prevention, and treatment.

The relationship between the high-risk disordered eating and social network navigation among Saudi college females during the COVID pandemic

Background

Disordered eating behaviors (DEBs) are complex health issues that may lead to negative physical and mental health outcomes among college students. More studies should be directed toward the screening of DEBs. This study aimed to determine the prevalence of DEBs among Saudi female university students and their association with social networking site (SNSs) usage and composite lifestyle behaviors during the unprecedented period of COVID-19.

Methods

This cross-sectional study included 445 females recruited using stratified random sampling. The participants self-reported demographic, social, medical, and lifestyle data and completed the validated Arabic version of the Eating Attitudes Test-26, Social Networking Sites (SNSs) Usage Questionnaire, Bergen Social Media Addiction Scale, and Body Shape Questionnaire.

Results

The prevalence of DEBs was 27.2% among the female students at Taif University. From the pre-pandemic period until the current time, the DEBs-risk group had a significantly higher SNS navigation rate (36.4%) than the normal group (20.4%) (X ² = 30.015, p = 0.001). The regression analysis revealed that females with a significant body image concern, higher number of SNSs friends, and frequent visits to SNSs, and those seeking social-dependent information in relation to weight loss/dieting were more likely to develop DEBs (Overall Model: Chi-Square X ² = 158.071, p < 0.000^**).

Conclusions

SNSs usage and DEBs were associated during the COVID-pandemic. However, the composite lifestyle score did not demonstrate a significant association with DEBs among the female students at Taif University. Investigating the magnitude of DEBs and understanding the role of SNS are essential for preventing disordered eating among young females.

Correlates of eating disorder pathology in Saudi Arabia: BMI and body dissatisfaction

BACKGROUND

Saudi Arabia is undergoing rapid sociocultural changes, which may have led to an increase of body mass index and eating disorder pathology. The aim of this study is to investigate whether body dissatisfaction, self-esteem, having lived abroad, cultural orientation, perceived stress, media use, and socioeconomic status are correlates of eating disorder pathology with body mass index as a covariate. Additional aims are to investigate if cultural orientation is associated with symptomatology and if stress is a covariate in the association between eating disorder pathology and Western orientation.

METHOD

Self-report measures were administered in a convenience Saudi community sample (N = 1225) between April 2017 and May 2018. Hierarchical multiple linear regression analyses with eating disorder pathology as dependent variable were performed to establish the associations among the variables.

RESULTS

After adjusting for the effect of BMI, only body dissatisfaction and eating disorder pathology were moderately associated. Eating disorder pathology and body dissatisfaction were more severe among Saudi citizens with a higher BMI.

DISCUSSION

Several explanations for the lack of associations of westernization, self-esteem, and stress with eating disorder pathology are reviewed and discussed. The majority of this convenience sample existed of young unmarried Saudi females of high socioeconomic status. Of the total sample, 35% displayed eating disorder pathology which may be a reflection of the high rates of excess weight.

Adapting the body project to a non-western culture: a dissonance-based eating disorders prevention program for Saudi women

PURPOSE

The main aim of this study was to test the feasibility of an adapted version of the Body Project for young Saudi women as their eating and body issues are comparable to western culture and linked to internalization of westernization. The study also aims to assess predictors of attrition and preliminary effectiveness.

METHOD

The intervention was adapted to local culture in collaboration with a co-director of the Body Project Collaborative. 48 Saudi undergraduate females were recruited, mean age was 19.16 years (SD = 1.23), baseline BMI was (M = 24.42, SD = 5.46). Eating pathology, body image, and comorbidities were assessed pre and post the intervention with adapted self-report measures.

RESULTS

The Body Project is feasible for young Saudi women. Participants were willing to enrol, they found the intervention useful, understandable, and enjoyable. There was no difference between completers and non-completers. The preliminary effect sizes are similar or higher than other effectiveness trials in other cultures.

CONCLUSION

A cognitive dissonance-based eating disorders prevention can be applicable across cultures where westernization is an influence. The effectiveness is yet to be affirmed. Future research is needed to investigate effectiveness in further robust studies and a bigger sample.

EVIDENCE-BASED MEDICINE

Level IV (evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence).