Comparative study of the prevalence of abnormal eating attitudes among Arab female students of both London and Cairo universities

Eating disorders in minority ethnic populations in Australia, Canada, Aotearoa New Zealand and the UK: a scoping review

BACKGROUND

Historically, eating disorder (ED) research has largely focused on White girls and women, with minority ethnic populations underrepresented. Most research exploring EDs in minority ethnic populations has been conducted in the United States (US). The aim of this scoping review, the first of its kind, was to systematically examine research on disordered eating and EDs among minority ethnic populations in Australia, Canada, Aotearoa New Zealand and the United Kingdom (UK), four countries with shared sociocultural and healthcare characteristics. An inequity lens was applied to highlight gaps in research, access, and treatment experiences.

METHOD

Five databases (Medline, Embase, PsycINFO, CINHAL and Web of Science) were searched up to March 7, 2024. Two independent reviewers screened titles and abstracts and full texts against eligibility criteria resulting in the inclusion of 87 records (76 peer-reviewed articles and 11 theses). Included studies were charted according to their focus, study design, sample characteristics and findings, with a particular focus placed on prevalence, access to treatment and treatment experience.

RESULTS

The majority of identified studies were conducted in the UK (61%, 53 studies). There was a notable lack of studies investigating assessment, diagnosis and intervention. Methodologies varied, though most studies utilised cross-sectional survey designs. Most samples were non-clinical, exclusively or predominantly girls and women, and focused on adolescents and young adults. Asian populations were the most frequently studied minority ethnic group. Understanding of prevalence and treatment experience amongst minority ethnic groups was limited.

CONCLUSION

There is a need for further research addressing inequities in ED prevalence, service access, and treatment experiences among minority ethnic and Indigenous groups, especially in Australia, Canada and Aotearoa New Zealand. Improved ethnicity data collection and culturally sensitive approaches to assessment, diagnosis and treatment are essential. Recommendations for future research and clinical practice are provided.

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.

Depressive symptoms among a sample of Lebanese adolescents: Scale validation and correlates with disordered eating

BACKGROUND

Adolescence is a transitional phase that brings many psychological and physiological challenges that increase emotional vulnerability and threaten the adolescent's mental well-being. Indeed, mental illnesses, such as depression and eating disorders, show an alarming increase in prevalence after puberty. Adolescent depression is particularly concerning owing to the fact that it is a principal cause of disability among adolescents, an important risk factor for suicidality, and is associated with higher risks of present and subsequent morbidity. Our study aimed at (1) examining the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) and (2) evaluating the correlation between depression, eating disorders, stress, and other variables in a sample of Lebanese adolescents.

METHODS

This cross-sectional research enlisted 555 Lebanese teenagers (15-18 years) from all Lebanese governorates (May-June 2020). The confirmatory factor analysis of the PHQ-9 scale items was carried out using the SPSS AMOS program v.24. The relative chi-square, the root mean square error of approximation (RMSEA), Tucker Lewis Index (TLI) and the comparative fit index (CFI) were all utilized as goodness-of-fit indexes.

RESULTS

The median age of the participants was 16.66 ± 1.00 years, with 75.7% females. Among these 555 adolescents, 62.9% had mild-to-moderate depression and 14% reported moderately severe-to-severe depression, while only 23.1% were classified as not suffering from depression. Confirmatory factor analysis of the PHQ-9 scale was conducted using the one-factor structure that is described in the literature; the fit indices obtained were acceptable as follows: χ²/df= 136.26/27 =5.05, CFI=0.92, TLI=0.90 and RMSEA=0.085 [0.072-0.100]. However, the modification indices between items 6 and 9 were high; after correlating these two items, the fit indices improved more as follows: χ²/df= 105.59/26=4.06, CFI=0.94, TLI=0.92 and RMSEA=0.074 [0.060-0.089]. The multivariable analysis results showed that more stress (β=0.59), female sex (β=1.54), and more binge eating (β=0.16) were significantly associated with more depression.

CONCLUSION

This study supports the validity of the PHQ-9, which presents as a reliable tool for the evaluation of depression in future epidemiological studies of Lebanese adolescents. It also elucidates the high level of depression among this age group and its correlation with modifiable and unmodifiable factors.

Prevalence of eating disorders and disordered eating in Western Asia: a systematic review and meta-Analysis

This study aimed to systematically synthesize and appraise existing literature on the prevalence of eating disorders and disordered eating in Western Asia. A systematic literature search of major English and Arabic databases, i.e., PubMed/Medline, EMBASE, PsychInfo, Web of Science and Scopus (English), Al-Manhal (Arabic) and grey literature was done to obtain the prevalence of disordered eating and eating disorders in Western Asia. The literature search was conducted on June 12^th, 2020, and included papers from 1990-2020. Out of the 249 unduplicated original studies reviewed, 27 were included in the final meta-analysis. Data were then categorized according to the tools used to identify the presence of disordered eating or eating disorders. The pooled prevalence of disordered eating as solicited by both the Eating Attitudes Scale 26 and the Eating Attitudes Scale 40 (N = 11841) was 22.07%, the Sick, Control, One stone, Fat, Food Questionnaire (n = 3160) was 22.28% and the Eating Disorder Examination-Questionnaire (n = 425) was 7.95%. The pooled prevalence obtained from those studies using semi-structured interviews for anorexia nervosa (n = 118190) was 1.59%, bulimia nervosa (n = 118513) was 2.41% and the estimated prevalence of Eating Disorder Not Otherwise Specified (EDNOS) (n = 118087) was 3.51%. Although the prevalence rate of eating disorders solicited using semi-structured interviews appeared to parallel the international range, the overall prevalence rate of disordered eating appeared to be slightly higher than the global rates of prevalence. A significant number of the suspected/detected cases of disordered eating appear to fulfill the criteria for EDNOS. This study is classified as evidence obtained from systematic reviews and meta-analyses (i.e. Level 1).

Differences in the Factor Structure of the Eating Attitude Test-26 (EAT-26) in Different Cultures in Israel: Jews, Muslims, and Christians

BACKGROUND

In recent years, there has been a shift in the clinical presentation and, hence, diagnostic definitions of eating disorders (EDs), reflected in a dramatic change in the diagnostic criteria of EDs in the DSM-5. The Eating Attitudes Test-26 (EAT-26) is currently considered an accepted instrument for community studies of EDs, although it features an inconsistent factorial structure in different cultures. Therefore, it is essential to investigate whether the EAT-26 can still be considered an adequate instrument for identifying the risk of developing EDs in different cultures. The aim of the present study was to examine the construct validity and internal consistency of the EAT-26.

METHOD

The study used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) among different cultural populations in Israel.

RESULTS

Findings indicated different factors in different ethnic groups, most of which do not correspond with the original EAT-26 three-factor structure.

RESULTS

The analysis yielded two main factors among Israeli Jews, four main factors among Israeli Muslim Arabs, and three main factors among Israeli Christian Arabs.

CONCLUSION

These findings shed light on cultural factors affecting perceptions of the EAT-26 items. This calls for a reconsideration of the generalization of the original three-factor structure of the questionnaire in different cultures.

Eating disorders in the Arab world: a literature review

BACKGROUND

The prevalence of eating disorders has been assumed to be low in the Arab world, due to the alleged absence of the thin ideal. However, the Arab world is undergoing rapid sociocultural changes, and there are reports of an increase of the desire to be thin. This literature review therefore provides point-prevalence of Arabs at high risk for eating disorders, and a comprehensive synthesis of correlates of eating disorder symptoms, eating disorder-related variables and of a high risk for eating disorders.

METHOD

Several electronic databases were searched for published, peer-reviewed studies between 1986 and 2019 involving several key terms. From 317 screened studies, 81, mainly cross-sectional, were included. Preferred Reporting Items for Systematic reviews and meta-analyses was used as guidance and the quality of studies were assessed using the Newcastle-Ottawa scale.

RESULTS

Estimates of individuals at high risk for eating disorders ranged from 2 to 54.8%. The eating disorder-related variables identified were desire to be thin, body dissatisfaction, disturbed-, and dieting- eating behavior. Identified correlates were increased affluence, media use, western influences, and obesity. An additional finding was that in some cases eating disorders were expressed somatically rather than psychiatrically.

DISCUSSION

In the Arab world, females were most at risk for eating disorders and eating disorder symptoms. Sociocultural changes gave rise to the thin ideal and the prevalence of obesity, increasing the risk for the development of eating disorder-related variables and eating disorders. The literature on eating disorders in the Arab world suffers from potential limitations due to the use of non-validated assessment tools. Further research is necessary, particularly on the development and validation of a culturally sensitive assessment tool. Improved knowledge is likely to increase the number of people seeking treatment and decrease the stigma of psychotherapy.

Validation of the Arabic version of the binge eating scale and correlates of binge eating disorder among a sample of the Lebanese population

OBJECTIVES

To test the psychometric properties of the Arabic version of the Binge Eating Scale (BES), a self-questionnaire assessing binge eating, in a sample of the Lebanese population. The secondary objective was to evaluate factors associated with binge eating.

METHODS

This cross-sectional study, conducted between January and May 2018, enrolled 811 adult participants from all districts of Lebanon. The BES was administered to study its psychometric properties. The sample was divided into two separate samples (405 for sample 1 and 406 for sample 2). An exploratory factor analysis was executed on Sample 1, followed by a confirmatory factor analysis on Sample 2 using the structure obtained in Sample 1. Three hierarchical stepwise linear regressions were conducted to assess factors associated with binge eating.

RESULTS

The factor analysis suggested a two-factor structure for the BES explaining a total of 41.4% of the variance. All items could be extracted from the list. The internal consistency of the measurement was adequate (Cronbach's alpha = 0.86). The confirmatory factor analysis revealed an adequate fit to the model with satisfactory Maximum Likelihood Chi-Square/Degrees of Freedom (χ²/df), Steiger-Lind RMSEA, Joreskog GFI, and AGFI. Higher BMI, depression, anxiety, emotional eating, greater body dissatisfaction, and more pressure from media to lose weight were associated with higher binge eating. Higher expressive suppression facet score was associated with lower binge eating.

CONCLUSION

The Arabic version of BES could be a useful tool for screening and assessing the binge eating behaviors in clinical practice and research. Also, being dissatisfied with one's body size, having a history of sexual abuse, family history of binge eating, increased depressive/anxiety symptoms, and lower self-esteem seem to be associated with higher BES scores.

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.

Testing Western Media Icons Influence on Arab Women’s Body Size and Shape Ideals: An Experimental Approach

Western media globalization is implicated in the spread of the thin body ideal to traditional societies. Qatar—a small conservative Middle-Eastern country—has recently witnessed rapid Westernization, but the influence of Western media icons on women’s body image dissatisfaction has rarely been studied here. A 2 (celebrity or model) × 3 (thin, average, or heavy) plus a control condition between-subject experiment tested the primary hypothesis that exposure to images of thin Western models or celebrities promotes a thinner body ideal compared to neutral images. A sample of young women (n = 1145) was randomly assigned to experimental images as part of an online survey. After exposure to images, participants rated their current and desired body size and shape, reported celebrity liking, and evaluated their favorite celebrity’s body. We found little support for the desire of thinness. Viewing thin- and average-sized celebrities was significantly associated with desiring a heavier and a thinner look (respectively) among those favoring thin celebrities. Images of thin models induced the desire for a curvaceous body figure with hips especially among those favoring celebrities with hips. The findings highlight important nuances in the influence of Western media icons on body image among women in a non-Western culture.

Prevalence of disordered eating attitudes among adolescent girls in Arar City, Kingdom of Saudi Arabia

Eating disorders (ED) are one of the most common psychiatric problems faced by todays adolescent girls where the attitude towards weight and shape as well as their perception of body shape are disturbed. The aim of the paper is to assess the prevalence and associated factors of disordered eating attitudes among adolescent girls of Arar city, Kingdom of Saudi Arabia. This is a cross-sectional survey design in which 314 adolescents females (age: 15-19 years) were selected from four schools of Arar city, KSA. Subjects were asked to fill pre-tested questionnaire about socioeconomic status, eating habits and Eating attitude test 26 (EAT 26), there height and weight were measured and BMI was calculated. Disturbed eating behaviors (EAT-26>20) was found in 25.47% participants. The prevalence of disordered eating was more in overweight and obese than normal weight. Vegetarian girls had higher EAT 26 score than non - vegetarian and significant difference was found in total EAT 26 score and subgroup namely oral control and dieting score (P<0.01) but non-significant difference was found between Saudi and non-Saudi adolescent girls in different BMI ranges. Eating disorders prevalent in adolescent girls and were strongly associated with weight status and eating habits. Future prospective and experimental studies are warranted to advance our understanding of the risk factors to enable better preventive program planning.

Acculturation, out-group positivity and eating disorders symptoms among Emirati women

Western acculturation has been implicated in the development of eating disorders among populations living outside Europe and North America. This study explored the relationship between Western acculturation, in-group/out-group evaluations and eating disorders symptoms among female citizens of the United Arab Emirates (UAE). Emirati college women (N = 209) completed an affective priming task, designed to implicitly assess in-group (Emirati) and out-group (American) evaluations. Participants also completed the Westernization Survey, a widely used self-report measure of acculturation, and the Eating Attitudes Test (EAT-26). Across the whole sample, out-group positivity was correlated with higher levels of eating disorder symptoms. Participants classified as at risk for eating disorders showed a clear out-group preference (out-group positivity greater than in-group positivity). Western acculturation was also positively correlated with eating disorder symptoms. Overall, these findings lend further support to the acculturation hypothesis of eating disorders in the context of Emirati college women.

Migration and mental illness

Human beings have moved from place to place since time immemorial. The reasons for and the duration of these migrations put extraordinary stress on individuals and their families. Such stress may not be related to an increase in mental illness for all conditions or to the same extent across all migrant groups. In this paper, we provide an overview of some observations in the field of migration and mental health, hypothesise why some individuals and groups are more vulnerable to psychiatric conditions, and consider the impact of migration experiences on provision of services and care.

"Holy anorexia"-relevant or relic? Religiosity and anorexia nervosa among Finnish women

Since medieval times, an association between religiosity and anorexia nervosa has been suggested, but few systematic studies exist. This study examines in a nationwide setting whether personal or family religiosity is associated with lifetime anorexia nervosa among women in adolescence and early adulthood. Women (N = 2,825) from the 1975 to 1979 birth cohorts of Finnish twins were screened for lifetime DSM-5 anorexia nervosa (N = 92). Parental religiosity was assessed by self-report when the women were aged 16 years. The women self-reported their religiosity at ages 16 and 22 to 27 years. Parental religiosity did not increase the risk of lifetime anorexia nervosa, and neither did religiosity of the women themselves in adolescence. In early adulthood, a J-shaped curve was compatible with the data, indicating increased risk both at low and high levels of religiosity, but this result was statistically non-significant. Religiosity was weakly negatively correlated with body dissatisfaction. There was some suggestive evidence for socioregional variation in the association of religiosity with lifetime anorexia nervosa. In this first population study to directly address religiosity and anorexia nervosa, no evidence was found for a significant association of religiosity with anorexia nervosa either at the personal or family level. Some regional differences are possible. A modest protective association of religiosity with body dissatisfaction is also possible. Despite compelling case descriptions of "holy anorexia," religiosity does not appear to be a central factor in the development of anorexia nervosa in Finland, a highly secularized Christian country.

Investigating Vulnerability for Developing Eating Disorders in a Multi-confessional Population

The present study aimed to examine the vulnerability to eating disorders (ED) among 949 Lebanese female young adults as well as its association with stress, anxiety, depression, body image dissatisfaction (BID), dysfunctional eating, body mass index, religious affiliation (Christian, Muslim, Druze or Other), religiosity and activity level. Results showed that anxiety had the greatest effect on increasing the predisposition to ED, followed by stress level, BID, depression and restrained eating. Affiliating as Christian was found to significantly decrease the vulnerability to developing an ED. Furthermore, the interaction of anxiety with intrinsic religiosity was found to have a protective role on reducing ED. The current study emphasized a buffering role of intrinsic religiosity against anxiety and ED vulnerability.

Eating Disorders in Lebanon: Directions for Public Health Action

Research in the field of eating disorders (ED) is limited in the Middle East. The aim of the present study was to profile Lebanese ED outpatients. A mixed-method design was used. Clinicians across Lebanon filled individual questionnaires about their 2013 ED outpatients (n = 104) and participated in focus groups. Results showed that bulimia nervosa was the most prevalent ED (46.1 %) followed by anorexia nervosa (39.4 %) and binge eating (14.4 %). The emerging socio-demographic profile of the Lebanese ED patient was that of a single female young adult of middle to high socio-economic status with severe ED symptoms (amenorrhea, multiple purging behaviors) and depression. Also, there was a general delay in seeking help which made patient recovery more difficult. The present study emphasizes the critical need for a public health approach to ED awareness and could help in developing preventive and remedial educational programs targeting youth in Lebanon and the Middle East.

Adolescent Health-Related Behaviors in Postwar Lebanon: Findings among Students at the American University of Beirut

This study presents the findings of a survey of health risk behaviors of entering students at the American University of Beirut as a first attempt to examine adolescent health behaviors in postwar Lebanon. The final sample used for analysis included 954 students. The most frequently occurring risk behaviors were unhealthy dietary patterns, lack of seat belt use, lack of exercise, and poor oral hygiene. Also common were physical fighting, smoking, and alcohol use. Sexual activity, drug and sedative use, and suicide ideation were least common. Gender was a main influencing factor. Eighty-nine percent of students reported two or more risk behaviors. Interpretation of our data in comparison with studies from the United States and other Middle Eastern countries showed both areas of similarities and areas of differences. Results point to the need for health promoting interventions, particularly in the policy area.

A Comparison Study of United States and African Students on Perceptions of Obesity and Thinness

There is a negative correlation between body weight and income in the United States, and epidemic numbers of people diet to become thin. In developing nations, on the other hand, there is a positive correlation between weight and income, and fatness is associated with wealth and abundance. Although these differing cross-cultural trends have been documented by anthropologists, there has been minimal cross-cultural research on attitudes toward obesity and thinness and corresponding dieting behaviors in the psychological literature. A sample of 349 students at a university in Ghana and 219 students at a U.S. university completed questionnaires about their weight, frequency of dieting and restrained eating, the degree to which their weight has interfered with social activities, their perceptions of ideal bodies, disordered eating, and stereotypes of thin and heavy people. Students in Ghana more often rated larger body sizes as ideal for both males and females and also assumed that these larger sizes were held as ideals in society, than did U.S. students. U.S. students (regardless of weight) were more likely to have dieted than were Ghanaian students, with U.S. females being most likely to diet. Additionally, U.S. females scored significantly higher on restraint, eating-disordered behavior, and experiencing weight as social interference. Findings illustrate that perceptions of ideal body size and corresponding behaviors are influenced by culture and gender.

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.

A Cultural Analysis of Adolescent Psychopathology

Behavior problems of adolescents have increasingly come to be examined as psychopathology. A medical/psychological view conflicts with a cultural interpretive approach. Material in the literature that bears on this topic is reviewed and analyzed critically. The goal is to illustrate how the concept of culture has been used to enhance understanding of adolescent psychopathology. Pertinent studies rely on differing methods, procedures, and conceptualizations of culture and psychopathology itself Epidemiologists handle culture abstractly and in a static way as a type of independent variable, and psychopathology is operationalized in terms of discreet disorders. Other researchers handle culture more broadly as systems of meaning and tend to examine descriptive aspects of behavior that reflect problems of adjustment. Advantages and disadvantages of the differing approaches are discussed. The needforstudies that balance methodologic rigor with interpretive sensitivity is emphasized. Suggestionsfor enhancing cultural sensitivity are presented.

Acculturation, Internalization of Western Appearance Norms, and Eating Pathology Among Japanese and Chinese International Student Women

In the context of the sociocultural model of eating disorders, this study investigated the hypothesis that Westernization would be positively associated with eating pathology among non-Western women. International participants from Japan ( n = 26), Peoples Republic of China ( n = 25), Taiwan ( n = 30), and Hong Kong ( n = 25) who were studying in the United States completed the Eating Attitudes Test, Symptoms Checklist, Sociocultural Attitudes Toward Appearance Questionnaire, the American–International Relations Survey, and a demographic questionnaire. Awareness and internalization of Western appearance norms were positively associated with eating disordered symptoms, but acculturation was not. Results lend further support for the sociocultural model. It is suggested that measures of eating pathology and acculturation be closely examined with respect to their cross-cultural relevance, particularly when conducting research involving international populations.

Implicit out-group preference is associated with eating disorders symptoms amongst Emirati females

Studies exploring the relationship between acculturation and eating disorders symptoms have proven equivocal. Socially desirable responding associated with the use of explicit measures may account for these mixed findings. This study explores the relationship between in-group identity, acculturation and eating disorders symptoms using both implicit and explicit assessments. Emirati female college students (N=94) completed an affective priming task (APT) designed to implicitly assess Emirati in-group evaluations. Participants also completed explicit measures, including the Westernization Survey and the Multicomponent In-group Identification Scale. Eating disorders symptoms were assessed using the Eating Attitudes Test. Only implicit in-group evaluations were correlated with eating disorders symptoms. Specifically, increases in in-group preference were associated with lower levels of eating disorders symptomatology. Furthermore, participants with an actual out-group preference had significantly higher levels of eating disorders symptomatology compared with those demonstrating an in-group preference. These findings support the acculturative stress hypothesis, and suggest that the relationship between eating disorders and acculturation may be better understood with reference to implicit rather than explicit in-group evaluations.

Eating disorders in women

Eating disorders, especially anorexia nervosa and bulimia nervosa have been classically described in young females in Western population. Recent research shows that they are also seen in developing countries including India. The classification of eating disorders has been expanded to include recently described conditions like binge eating disorder. Eating disorders have a multifactorial etiology. Genetic factor appear to play a major role. Recent advances in neurobiology have improved our understanding of these conditions and may possibly help us develop more effective treatments in future. Premorbid personality appears to play an important role, with differential predisposition for individual disorders. The role of cultural factors in the etiology of these conditions is debated. Culture may have a pathoplastic effect leading to non-conforming presentations like the non fat-phobic form of anorexia nervosa, which are commonly reported in developing countries. With rapid cultural transformation, the classical forms of these conditions are being described throughout the world. Diagnostic criteria have been modified to accommodate for these myriad presentations. Treatment of eating disorders can be quite challenging, given the dearth of established treatments and poor motivation/insight in these conditions. Nutritional rehabilitation and psychotherapy remains the mainstay of treatment, while pharmacotherapy may be helpful in specific situations.

Cultural Influences on Body Size Ideals

Given that an important component of perceptual body dissatisfaction is the discrepancy between ideal and current body sizes, understanding how body size ideals are shaped and transmitted remains an important task for scholars. This review begins by examining cross-cultural patterns of body size ideals. Evidence is presented to indicate that the largest differences in body size ideals are no longer found between Western and non-Western cultures, but between sites differing in socioeconomic status. It is further argued that a thin ideal is now prevalent in most socioeconomically developed, urban sites. In explanation, it has been suggested that both Westernization and modernization bring cultural changes that promote a thin ideal. The present article reviews evidence in favor of both factors and concludes by looking at clinical implications for understanding corporeal experiences in a globalized world.

Cultural trends and eating disorders

PURPOSE OF REVIEW

Culture has long been recognized as significant to the cause and expression of eating disorders. We reviewed the recent literature about recent trends in the occurrence of eating disorders in different cultures.

RECENT FINDINGS

While historically, eating disorders were conceptualized as primarily afflicting Caucasian adolescent or young adult women within high-income, industrialized Western Europe and North America, eating disorders are increasingly documented in diverse countries and cultures worldwide. This study highlights recent trends that reflect the changing landscape of culture and eating disorders: stabilization of the incidence of anorexia nervosa and possibly lower incidence rates of bulimia nervosa in Caucasian North American and Northern European groups; increasing rates of eating disorders in Asia; increasing rates of eating disorders in the Arab region; and increasing rates of binge eating and bulimia nervosa in Hispanic and Black American minority groups in North America.

SUMMARY

The changing face of eating disorders calls for a new conceptualization of culture in both the emergence and spread of eating disorders across the globe.

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.'

War stress may be another risk factor for eating disorders in civilians: a study in Lebanese university students

OBJECTIVE

Traumatic life events are important risk factors for eating disorders (ED). War has been associated, in military populations, with an increased post-service incidence of ED and an increased mean body mass index. We hypothesize that a modification of eating behavior (EB) related to stress during wartime may increase the risk of developing an ED later on among civilians exposed to war stress during adulthood.

METHODS

This descriptive cross-sectional study was performed in a group of 303 undergraduate young adult students of both sexes from Lebanon, 6 months after the July 2006 war. Modification of EB during wartime, sociodemographic and other potential risk factors were assessed retrospectively. Students were then screened for ED using the SCOFF questionnaire.

RESULTS

SCOFF was positive in 31.4% of the students, with a mean value 41.6% higher among subjects who reported an altered EB during the war. Among subjects with a positive SCOFF screening, 71% had experienced a change of EB during wartime. Alteration of EB during war was related to an odds ratio for a positive SCOFF screening of 2.6 (95% CI 1.54-4.34) and 1.8 (95% CI 1.01-3.21) for non-adjusted and adjusted analysis, respectively.

CONCLUSIONS

Modification of EB related to stress during wartime is associated with an increased risk of eating disorders. Early detection and treatment of eating disorders may be improved by routinely evaluation of EB modification in patients with a past history of war exposure.

Role of obesity and media in body weight concern among female university students in Kuwait

The aim of this study was to find out the association of media and obesity status with body weight concern among female university students in Kuwait. 228 female students, aged 19-25 years, were selected at convenience from the Women's College in Kuwait. A previously validated questionnaire was used to collect information on the role of media in body concern and how parents, peers and the girls themselves perceived girls' body shapes. Weight and height were gathered by self-reporting. Use of internet and reading women's magazines had a significant impact on dieting by the girls to lose weight (P<0.0007 and P<0.0114, respectively). The mass media had two to three times more influence on obese girls than non-obese girls. Only watching television had a significant impact on girls' body shape concern (P<0.053). About 30% of non-obese and 81% of obese girls were dissatisfied with their current weight. There were significant differences between obese and non-obese girls regarding the girls' views and the views of their peers and parents about the body weight of the girls (P<0.000 for all). The pressure from peers and parents, in addition to the mass media, may lead to disturbed attitudes towards eating among Kuwaiti girls.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Risk of disordered eating attitudes among adolescents in seven Arab countries by gender and obesity: a cross-cultural study

The objectives were to discover the prevalence of disordered eating attitudes (EAs) among adolescent males and females, and the association of obesity with EA in seven Arab countries. A multistage stratified sampling technique was used to select secondary students aged 15-18 years from cities in Algeria, Jordan, Kuwait, Libya, Palestine, Syria and Sharijah Emirate (United Arab Emirates). The total sample was 4698 (2240 males and 2458 females). The Eating Attitudes Test (EAT-26) was used to measure those at risk of disordered EA. Obesity was calculated according to the International Obesity Taskforce criteria. Participants were grouped into two categories, non-obese and obese (overweight and obese). The risk of disordered EA was twice as high among females as in males in Jordan, Libya, Palestine and Syria. Kuwaiti adolescents (males and females) showed higher prevalence of disordered EA than their counterparts in other countries. The risk of disordered EA among obese adolescents was two to three times higher than that of non-obese adolescents, in both genders. Excepting Kuwaiti females and Palestinian males. The association of obesity with disordered EA was statistically significant. This study highlighted the magnitude of the risk of disordered eating attitudes among both male and female adolescents in Arab countries and identified the need for programmes to prevent and control these disorders in the Arab region.

Change in binge eating and binge eating disorder associated with migration from Mexico to the U.S

Exposure to Western popular culture is hypothesized to increase risk for eating disorders. This study tests this hypothesis with respect to the proposed diagnosis of binge eating disorder (BED) in an epidemiological sample of people of Mexican origin in Mexico and the U.S. Data come from the Mexico National Comorbidity Survey, National Comorbidity Survey Replication, and National Latino and Asian American Survey (N = 2268). Diagnoses were assessed with the WMH-CIDI. Six groups were compared: Mexicans with no migrant family members, Mexicans with at least one migrant family member, Mexican return-migrants, Mexican-born migrants in the U.S., and two successive generations of Mexican-Americans in the U.S. The lifetime prevalence of BED was 1.6% in Mexico and 2.2% among Mexican-Americans. Compared with Mexicans in families with migrants, risk for BED was higher in US-born Mexican-Americans with two U.S.-born parents (aHR = 2.58, 95% CI 1.12-5.93). This effect was attenuated by 24% (aHR = 1.97, 95% CI 0.84-4.62) with adjustment for prior-onset depressive or anxiety disorder. Adjustment for prior-onset conduct disorder increased the magnitude of association (aHR = 2.75, 95% CI 1.22-6.20). A similar pattern was observed for binge eating. Among respondents reporting binge eating, onset in the U.S. (vs. Mexico) was not associated with prevalence of further eating disorder symptoms. Migration from Mexico to the U.S. is associated with an increased risk for BED that may be partially attributable to non-specific influences on internalizing disorders. Among respondents reporting binge eating in either country, similar levels of further symptoms were endorsed, suggesting some cross-cultural generalizability of criteria.

Overweight and obesity in eastern mediterranean region: prevalence and possible causes

The objective of this paper was to explore the prevalence of overweight and obesity among various age groups as well as discuss the possible factors that associated with obesity in the Eastern Mediterranean Region (EMR). A systematic review of published papers between 1990 and 2011 was carried out. Obesity reached an alarming level in all age groups of the EMR countries. The prevalence of overweight among preschool children(<5 years) ranged from 1.9% to 21.9%, while the prevalence of overweight and obesity among school children ranged from 7% to 45%. Among adults the prevalence of overweight and obesity ranged from 25% to 81.9%. Possible factors determining obesity in this region include: nutrition transition, inactivity, urbanization, marital status, a shorter duration of breastfeeding, frequent snacking, skipping breakfast, a high intake of sugary beverages, an increase in the incidence of eating outside the home, long periods of time spent viewing television, massive marketing promotion of high fat foods, stunting, perceived body image, cultural elements and food subsidize policy. A national plan of action to overcome obesity is urgently needed to reduce the economic and health burden of obesity in this region.

Adolescent obesity in Syria: prevalence and associated factors

Abstract Background Data on the prevalence of overweight and obesity in Eastern Mediterranean countries remain scarce, particularly for children and adolescents. The objective of this study is to estimate the prevalence of obesity and examine associated factors and covariates amongst school adolescents in Syria. Methods A cross-sectional survey of a representative sample of 776 adolescents (386 males and 390 females), aged 15-18 years, was conducted in six randomly chosen secondary schools in Damascus, the capital city of Syria. Anthropometric measurements and dietary assessment data were collected using standard methods and techniques. Overweight and obesity were defined according to World Health Organization 2007 child growth standards. Results The prevalence rates of overweight and obesity were estimated at 18.9 and 8.6%, respectively. Carbohydrate and saturated fatty acid intakes were significantly higher amongst overweight and obese (250.66 and 32.82 g/day, respectively) as compared with normal weight adolescents (218.12 and 26.10 g/day, respectively). Regression analysis showed that the likelihood of obesity was significantly greater amongst adolescent boys than girls (OR = 2.30, P < 0.05) and amongst subjects reporting family history of obesity (OR = 2.98, P < 0.05). The odds of obesity increased consistently with increasing educational attainment of both parents and was higher (OR = 1.63) amongst adolescents reporting lower crowding index than their counterparts. Conclusion Our findings of a positive association between obesity and socio-economic status measured by parental education and crowding index call for intervention strategies for the promotion of healthy dietary practices not only amongst school adolescents but also parents, targeting families as the unit of intervention. Further studies are needed to examine nutritional habits and food choices amongst families of different socio-economic strata.

Mental health needs of Arab women

Researchers indicate that the prevalence of psychiatric morbidity in the Arab region is similar to that found in other parts of the world. Women, in particular, are more likely to suffer various disorders including depression, anxiety disorders, somatization, and eating disorders. In this article, the author highlights some of the research on the mental health needs of Arab women. Consideration is given to important cultural and contextual factors related to mental illness as well as potential risk factors. Finally, suggestions for future directions are provided in order to attempt to close the gap between the needs and the services available.

Anorexia nervosa: beyond boundaries

OBJECTIVE

To describe Anorexia Nervosa in a patient from the Middle-East where this condition is believed to be rare.

METHOD

The diagnosis of Anorexia Nervosa was based on detailed history and physical examination, and was in accordance with DSM-IV diagnostic criteria.

DISCUSSION

Anorexia Nervosa should not be overlooked in Middle-Eastern cultures. Local values may play an important role in the management of the disease.

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.