Comparative study of eating-related attitudes and psychological traits between Israeli-Arab and -Jewish schoolgirls

Eating disorders and related psychological features among Arabs and Jews in Israel: Does culture play a moderating role?

Eating disorders (EDs) have been documented in various cultural settings. A continuous increase in ED' rates among non-Western cultures (e.g., Arab cultures and East-Asian cultures) has been reported. We aimed to investigate the relations among culture, ED symptoms, and psychological features that are highly relevant in EDs through a cultural comparison of three groups. The groups included female university students in Israel with varying levels of exposure to Westernization: 118 Jewish students, 132 Arab students studying at a mixed university with a Jewish majority, and 111 Arab students studying at Sakhnin College, a college for Arab students only. The groups differed significantly on the Conservation Value dimension from the Short Portrait Values Questionnaire. Four psychological features were examined as predictors of ED symptoms: Interoceptive-deficits, Ineffectiveness, Asceticism, and Maturity-fear. The results revealed a comparable prevalence of self-reported ED symptoms among Arabs and Jews, with a small exception for bulimic symptoms, which were less prevalent among those in the Sakhnin group, who also scored lower on Ineffectiveness and higher on asceticism than the other groups. Testing the relations between the four psychological features and ED symptoms revealed that culture played a moderating role in predicting the strength of ineffectiveness and maturity-fear. Ineffectiveness was not a predictor among the Sakhnin group, whereas maturity-fear was not a predictor in the least conservative Jewish group. Asceticism and interoceptive-deficits predicted ED symptoms across all study groups. Our findings indicate that the problem of EDs may be similar among Arab and Jewish women in Israel. Moreover, despite some similarities in the relevance of some ED-related psychological features, other features are moderated by culture.

Disordered eating among Arab and Jewish youth in Israel: the role of eating dinner with the family

Background

Disordered eating (DE), defined as unhealthy eating attitudes and behaviors, is considered a major public health problem among adolescents. Nevertheless, rates of DE among Arab and Jewish adolescents in Israel are still unknown. Furthermore, while previous studies have highlighted the role of frequent family meals as a protective factor against DE, studies examining home family dinners relative to other common dinner options (e.g., eating at home alone, eating out of the home, not eating dinner at all) are largely unavailable. We sought to use representative data of middle and high-school children in Israel in order to identify rates of DE among Arabs and Jews, while examining the relations of home family dinners (vs. other dinner options) with DE.

Methods

A nationally representative school-based survey of 4926 middle and high-school children (11–19 years old) was conducted during 2015–2016. Participants indicated where and with whom they had eaten dinner the day before. The 5-item SCOFF questionnaire was used (> 2 affirmative items were considered a likely case of DE). Height and weight were measured by personnel.

Results

DE was more prevalent among girls (29.7%) relative to boys (12.2%), Arabs (25.1%) relative to Jews (19.5%), and older (25.3%) relative to younger (17.6%) adolescents. Arabs were more likely to eat dinner at home with parents/family (chi² = 10.75, p = .001), or not to eat dinner at all (chi² = 63.27, p < .001), while Jews were more likely to eat dinner alone (chi² = 5.37, p = .021) or to eat dinner out of the home (chi² = 67.65, p < .001). Logistic regressions (stratified by ethnicity and adjusted for gender, age, weight) revealed that family dinners acted as a protective factor against DE, relative to eating out of the home or relative to not eating dinner at all among both ethnic groups, and relative to eating dinner alone among Arabs.

Conclusion

There are differences between Arab and Jewish adolescents in terms of rates of yesterday’s family dinners and DE. Given that eating dinner with the family was linked with lower rates of DE, possible interventions to reduce DE may include educating parents of both Arab and Jewish adolescents regarding the importance of family meals.

Disordered eating behaviors in adolescents with celiac disease

PURPOSE

Celiac disease (CD) is a chronic immune-mediated systemic disease characterized by inflammation and villous atrophy of the small intestine. A strict, lifelong gluten-free diet (GFD) is the only treatment for CD. Disordered eating behaviors (DEBs) prevail in adolescence and young adulthood, and confer a risk of developing into full-blown eating disorders. The aims of the current study were to assess the incidence and risk factors for DEBs among individuals with CD, and to examine an association between adherence to GFD and DEBs.

METHODS

A cohort of 136 individuals with CD responded to a web-mediated survey that assessed DEBs and adherence to a GFD. The survey included demographic data (gender, age, weight, disease duration) and two self-rating questionnaires: the Eating Attitudes Test-26 and the gluten-free diet questionnaire.

RESULTS

DEBs were found in 19% of female and 7% of male responders. These individuals were characterized by being overweight (p = 0.02), of an older age (p = 0.04) and female sex (p = 0.06). Strict adherence to a GFD was reported by 32% of the responders and was not correlated with age, disease duration, age at diagnosis of CD and with being overweight.

CONCLUSIONS

Caregivers should be aware of the increased occurrence of DEBs in adolescents with CD, especially those who are overweight, older and of a female gender.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Disordered eating behaviors among Christian and Muslim adolescents in Ceuta, a multicultural town

Studies on disordered eating behaviors (DEB) in multicultural populations with multiple religious/cultural affiliations are needed in order to clarify the relationship between cultural background and DEB. Therefore, we compared the presence of DEB among Christian and Muslim adolescents who share their school environment, controlling for the effect of body mass index, demographic variables and lifestyle habits. A sample of 493 girls and boys (339 Christian, 138 Muslim) whose mean (±SD) age was 14.8 (±1.7) years completed self-reporting questionnaires and underwent measurements of anthropometric data. Religious/cultural affiliation was defined by self-identification. The dependent variable, DEB was assessed by means of the Eating Disorders Inventory (EDI-2). Muslim girls and boys score higher than Christians on EDI-2 total scores, especially on the perfectionism subscale. Bivariate and multivariate analyses were used to determine the characteristics associated with DEB, which were detected in 24% of participants (19% of Christians and in 35% of Muslims). Among girls, DEB were directly associated with overweight or obesity, the presence of frequent quarrels with parents, academic failure and spending more than 3 h a day watching screen images. Among boys, DEB were directly associated with overweight or obesity and Muslim background; and inversely associated with age and socioeconomic status.

Body image drawings dissociate ethnic differences and anorexia in adolescent girls

OBJECTIVES

To distinguish between ethnic differences among segregated schoolgirls and restrictive anorexia nervosa using a simple culture-fair test of body image (BI) figure drawings.

METHODS

Several responses to BI figure drawings by 178 adolescent schoolgirls from three ethnically distinct and segregated schools and communities in Israel, Jewish secular (JS), Jewish Haredi (H), and Christian Arab (C), and a group of 14 severely restricting anorexic girls (AN). BI evaluations were analyzed by MANCOVA, followed by paired or Student-t tests for comparisons between responses and groups respectively. Pearson r served for correlations and the Fisher Z for differences between slopes.

RESULTS

Despite the total ethnic segregation among the schoolgirls, there are commonalities; all prefer a thinner ideal BI, and are similarly dissatisfied with their BI. However, ethnic differences also emerge: C underestimate their BI and how others view them, and H true and Ideal BI evaluations correlate, unlike the other groups. Despite this variability, and in stark contrast, the anorexic girls show a gross misperception of their BI, even in comparison to girls equated for BMI.

DISCUSSION

The findings show that figure drawings evaluation of BI is a simple and robust instrument dissociating clinical and ethnic responses. Clinicians may consider body figure drawings as a simple, supportive, diagnostic for first-line recognition for risk of AN in adolescent girls.

Disordered eating & cultural diversity: a focus on Arab Muslim women in Israel

CONTEXT

A dearth of data concerning eating problems among adult women from minority population groups leaves substantial knowledge gaps and constrains evidence-based interventions.

OBJECTIVES

To examine prevalence and predictors of disordered eating behaviors (DEB) among Arab Muslim women in Israel, whose eating behaviors have not been previously examined and to compare with second generation Israeli-born Jews of European heritage.

DESIGN

Community-based study includes sub-samples of Arab Muslims and Israeli-born Jews. DEB is assessed with fourteen DSM-IV related symptoms. Hierarchical regressions examine influence of weight, self-criticism and psychological distress on DEB severity.

RESULTS

Relatively high prevalence rates emerge for Muslims (27%) and Jews (20%), a nonsignificant difference. In contrast, regressions reveal substantially different predictor patterns. For Arab Muslims, weight has the strongest association; for Jews, weight is not significant while self-criticism is the strongest predictor. Explained variance also differs considerably: 45% for Muslims and 28% for Jews.

CONCLUSIONS

Surprising similarities and distinct differences underscore complex patterns of eating disturbances across culturally diverse groups. Culturally sensitive interventions are warranted along with more illuminating explanatory paradigms than 'one size fits all.'

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.