Presence and severity of anorexia and bulimia among male and female Omani and non-Omani adolescents

A feasibility randomized controlled trial of culturally adapted Getting Better Bite-by-Bite (Ca-GBBB) intervention for individuals with eating disorders in Pakistan

BACKGROUND

Eating disorders (EDs) are serious mental health conditions that affect a person physically and psychologically. In the past, EDs were only recognized as a cultural phenomenon/societal by-product of the West. However, research evidence marks its presence in non-western countries also, including South Asia. This study aims to evaluate the feasibility and acceptability of a manualized psychological intervention called Getting Better Bite by Bite (GBBB) in individuals who screened positive on measures of EDs in Pakistan.

METHODS

The proposed study is a feasibility randomized controlled trial (fRCT). The study will be conducted at five sites across Pakistan: Karachi, Hyderabad, Lahore, Rawalpindi, and Multan to recruit a total of 80 participants. Eligible participants will be randomized to either (1) the intervention group; in which they will receive one-to-one sessions of GBBB along with routine care or (2) the routine care group; in which they will only have access to the routine care. We have received ethics approval by the National Bioethics Committee. The study is registered at clinicaltrials.gov (NCT05724394). The study team has received permission from recruitment centers: hospitals (i.e. the psychiatry department of public and private hospitals based in these cities), fitness centers (i.e., gyms), educational institutes (i.e., colleges and universities), and community settings (i.e. community health clinics). Self-referrals from General Practitioners and community settings will be accepted. The intervention manual has been translated into Urdu and a multidisciplinary team including service users has culturally adapted the content of intervention for local context.

DISCUSSION

This study will provide evidence on feasibility and acceptability of a culturally adapted intervention for individuals who screen positive on measures of EDs. The findings of this study will inform a fully powered Randomized Controlled Trial of the proposed intervention.

TRIAL REGISTRATION

The study is registered on clinicaltrials.gov (NCT05724394). Protocol version (1.0. 1st June 2022).

Psychometric properties of an Arabic translation of the Nine Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) in a community sample of adults

BACKGROUND

No epidemiological data is yet available on Avoidant/Restrictive Food Intake Disorder (ARFID) in Arab countries, which may in part be due to the lack of measures available in Arabic language. This constitutes a major obstacle to further progress of our understanding of the nature, aetiology, course, treatment, and prevention of ARFID, especially as some evidence suggested that ARFID may vary across cultures and food environments. We aimed to contribute to the literature in the eating disorders field by examining the psychometric properties of an Arabic translation of the Nine Item ARFID Screen (NIAS).

METHOD

This was a cross-sectional, web-based study. A total of 515 Lebanese community adults (mean age of 27.55 ± 10.92 years, 69.9% females) participated. The forward-backward method was adopted to translate the NIAS from English to Arabic.

RESULTS

Confirmatory Factor Analyses provided evidence for the adequate fit indices for the three-factor model (i.e., Picky eating, Fear, and Appetite) and the 9-item version of the NIAS. An adequate reliability of the Arabic NIAS was achieved, with McDonald's ω ranging from .75 to .90 for the total score and all three subscores. Multi-group analyses demonstrated measurement invariance by sex (males vs. females) and weight groups (underweight/healthy weight [BMI ≤ 25] vs. overweight/obese [BMI > 25]) at the configural, metric, and scalar levels. Adequate patterns of correlations between the NIAS and measures of disordered eating symptoms, psychological distress and well-being were seen. In particular, fear was significantly associated with non-ARFID disordered eating symptoms. Appetite and Picky eating, but not Fear, were inversely correlated with well-being. All three NIAS subscores and the total score were positively correlated with psychological distress.

CONCLUSION

Findings provided evidence that the Arabic NIAS is a short, valid and reliable self-report measure to screen for ARFID symptoms. In light of these findings, we recommend its use for clinical and research purposes among Arabic-speaking adults.

Validity and Consistency of the Arabic Version of the Eating Disorder Examination Questionnaire (EDE-Q) among Saudi Adults

The prevalence of eating disorders (EDs) is growing, and early screening is important to prevent related health complications. The Eating Disorder Examination Questionnaire (EDE-Q) has been widely used as a diagnostic tool to identify cases of EDs; however, a validated Arabic version of the tool is needed to help in the screening process of EDs. The aim of this study was to validate the Arabic version of EDE-Q. A cross-sectional study included a sample of 549 adults, who were recruited mainly from the four major provinces in Saudi Arabia. A forward–backward translation method was conducted, and then the tool was validated using the confirmatory factor analysis (CFA). The dataset was split for further convergent analysis using exploratory factor analysis (EFA) and CFA. The results of CFA from the main dataset did not support the four-factor original EDE-Q. The results of EFA from the first data-split suggested a three-factor EDE-Q-14 Arabic version. This was supported by the results of CFA of the second data-split. A total of five items were allocated in each shape and weight concern, and restraint component, with correlations ranging from 0.969 and 0.462 and from 0.847 to 0.437, respectively. A total of four items were allocated in eating concern, with correlations ranging from 0.748 to 0.556. The internal consistency of the global and the three subscales were high, with Cronbach’s α ranging from 0.762 to 0.900. Findings of the current study suggest that the Arabic version of the EDE-Q-14 is a valid and reliable tool to screen for EDs among adults in Saudi Arabia.

Prevalence of body image dissatisfaction among youth in the United Arab Emirates: gender, age, and body mass index differences

The term body image dissatisfaction (BID) describes the negative perceptions that a person carries about his or her own body. This study aimed to determine the prevalence of BID among youth in the UAE and how it is affected by three variables: sex, age, and body mass index (BMI). Participants were 728 UAE federal university students who responded to the Body Shape Questionnaire. Results indicated that 36.7% of students are dissatisfied with their body image. Gender differences analysis showed a higher level of BID for men than with women. No significant differences were observed for BID among the four age groups. Significant differences were shown for BID among the four common BMI/weight categories (underweight, normal, overweight, obesity. On the light of the results, the study suggested offering awareness programs for youth about healthy practices in daily life and including health education in schools and colleges curriculum. The study discussed the findings in relation to the available literature in the area and suggested some directions and topics for future research.

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.

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.

Binge eating behavior in a sample of Lebanese Adolescents: Correlates and Binge Eating Scale validation

BACKGROUND

Binge eating disorder is a common eating disorder among the adolescent population. The available literature in the Middle East in general, and Lebanon specifically, is relatively scarce and/or outdated. The objectives of this study were to (1) validate the Binge Eating Scale (BES) for use in Lebanese adolescents, and (2) assess correlates of binge eating behavior among this population.

METHODS

A cross-sectional study conducted between May and June 2020, enrolling 555 adolescents between the ages of 15-18 years old from all Lebanese governorates. The Binge Eating Scale was used to screen for the presence/absence of binge eating.

RESULTS

A confirmatory factor analysis revealed that the one-factorial model fits the data best. The results of a linear regression, taking the binge eating score as the dependent variable, showed that higher body dissatisfaction, more alcohol use disorder, higher depression, vomiting to lose weight and starving to lose weight were significantly associated with more binge eating. Higher self-esteem was significantly associated with less binge eating.

CONCLUSION

The Arabic Version of the BES scale seems to be a reliable tool to be used in Lebanese adolescents for the assessment of binge eating. More body dissatisfaction, lower self-esteem, increased depressive symptoms were associated with more binge eating. We hope this tool will be a reliable one to be used in epidemiological studies and research about eating behaviors/disorders. The results showed that higher body dissatisfaction, higher depression, vomiting to lose weight and starving to lose weight were significantly associated with more binge eating. Our study also showed that the Binge Eating Scale is an adapted and validated tool to be used among Lebanese adolescents for the assessment of binge eating. We hope that the study results will help clinicians in the screening and management of Binge Eating behaviors among Lebanese adolescents.

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.

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.

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.

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.

Disordered eating attitudes in female students of An-Najah National University: a cross-sectional study

BACKGROUND

Eating disorders (ED) are serious psychiatric disorders characterized by unhealthy eating habits. There is a limited number of studies on eating disorders among female university students in Arab countries. Therefore, the objective of this study was to examine the prevalence of disordered eating attitudes (EA) among female students at An-Najah National University, Palestine.

METHODS

A survey study on 2001 female students at An-Najah National University was carried out. The Sick, Control, One Stone, Fat, Food (SCOFF) screening questionnaire and the Eating Attitudes Test (EAT-26) were used.

RESULTS

Of the 2001 participants, 28.6% scored ≥ 20 on the EAT-26 while 38.2% scored ≥ 2 on the SCOFF scale. A significant positive correlation was found between body mass index (BMI) and EAT-26 and SCOFF scores. There was a significant difference in EAT-26 (p < .01) and SCOFF scores (p = .037) between different academic specializations. Female students in non-scientific fields (arts and humanities) obtained higher scores than female students in scientific/medical fields. Age was significantly and negatively correlated with EAT-26 scores but not with SCOFF scores. Approximately 85% of students with scores in the "high risk" category of the EAT-26 scale endorsed the item "I am terrified about being overweight".

CONCLUSION

Awareness regarding appropriate nutrition in relation to body weight is needed among female university students. A general university elective course in this regard might be helpful.

Risk of eating disorders in a non-western setting: an exploratory study in Khartoum state, Sudan

PURPOSE

Recent research suggests an emergence of eating disorders [ED] in non-western settings for unknown reasons. This research investigates the presence of ED in Khartoum State [Sudan], and explores relevant factors amongst women at risk of ED and stakeholders involved with mental health care and policy-making.

METHODS

Women from four summer schools were approached and screened for risk of ED using a validated and adapted form of the Eating Attitudes Test-26. Focus groups were performed within the schools, selected participants at high risk were interviewed, and interviews with stakeholders were performed.

RESULTS

Around a third (32.6%) of participants scored as having high risk of ED. Interviews showed recurring themes determining eating attitudes including: intention, knowledge, environment and habit. Stakeholders' opinions depended on whether they work directly with those affected by ED or in policy-making. The former advocated increased attention on ED, the latter did not. Overall, services for ED were lacking.

CONCLUSIONS

A high presence of negative eating attitudes was found amongst screened participants with high risk of ED. Individual intention overrides all other determinants for abnormal eating. Moreover, evidence suggests that westernization may attribute to ED, supporting the view that ED are culturally bound. The differing stakeholders' views, together with other data found in this study, allow a number of recommendations for increasing awareness and identification of ED in Sudan.

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.

Prevalence of Eating Disorders Among Adolescents in the Northwest of Iran

Background:

Perceived sociocultural pressure to be thin has an important impact on disordered eating during early and middle adolescence, but less is known about late adolescence. Adolescents face special problems that are less common during childhood. Several studies indicate that the prevalence of eating disorders has been increased among adolescents.

Objectives:

The aim of the present study was to investigate the occurrence, prevalence and correlates of eating disorders (ED) among adolescents in two cities of Iran, Urmia and Tabriz.

Patients and Methods:

This was a cross-sectional survey in which 1990 adolescent boys and girls were selected through multistage random sampling. The study was based on self-report questionnaires including eating attitudes test (EAT-26) and DSM-IV criteria for the presence of eating disorders. To analyze the obtained data we calculated measures of central tendency and dispersion, linear and logistic regression and Fisher’s exact test.

Results:

According to diagnostic criteria of EAT-26, 492 students (24.2%) were at risk of ED and scored above the recommended cut-off point on EAT-26. Among 1990 students, a total of 51 cases (0.25%) of eating disorder (14 anorexia nervosa, 18 bulimia nervosa, and 19 eating disorder not otherwise specified) were diagnosed.

Conclusions:

The obtained prevalence of ED in our study was higher than previous studies in Iran. We found high numbers of boys with ED. Overweight adolescents were shown to be more susceptible to strict dieting than normal-weight adolescents. These results suggest that it is necessary to provide screening and treatment services for Iranian adolescents. Further research is needed to develop intervention programs to control eating disorders among Iranian adolescents.

Disclosure of Medical Errors in Oman: Public preferences and perceptions of current practice

OBJECTIVES

This study aimed to provide insight into the preferences for and perceptions of medical error disclosure (MED) by members of the public in Oman.

METHODS

Between January and June 2012, an online survey was used to collect responses from 205 members of the public across five governorates of Oman.

RESULTS

A disclosure gap was revealed between the respondents' preferences for MED and perceived current MED practices in Oman. This disclosure gap extended to both the type of error and the person most likely to disclose the error. Errors resulting in patient harm were found to have a strong influence on individuals' perceived quality of care. In addition, full disclosure was found to be highly valued by respondents and able to mitigate for a perceived lack of care in cases where medical errors led to damages.

CONCLUSION

The perceived disclosure gap between respondents' MED preferences and perceptions of current MED practices in Oman needs to be addressed in order to increase public confidence in the national health care system.

A study on knowledge, attitude, and practice towards premarital carrier screening among adults attending primary healthcare centers in a region in Oman

Background

Despite that hereditary diseases are widespread among the Arab population due to high rates of consanguineous marriages, research regarding community awareness towards premarital carrier screening in some countries such as Oman, is extremely scarce. This study aimed to investigate knowledge and attitude towards premarital carrier screening (PMCS) in Oman.

Methods

A cross-sectional study was conducted using a self-administered questionnaire which was distributed to 400 Omani adults aged 20–35 who attended primary healthcare institutions at the South Batinah Governorate in Oman.

Results

The majority of the participants (84.5%) believed that PMCS was necessary, and about half of them (49.5%) supported the view of making PMCS compulsory. On the contrary, approximately one third (30.5%) of the participants reported that they were not in favor of taking the blood screening test. Overall, unwillingness to perform pre-marital testing was associated with female gender, younger age, being single, less education, and increased income.

Conclusion

Despite the relatively high level of knowledge, about one third of the participants were still reluctant to carry out premarital testing. Such attitude calls for immediate need for community-based campaigns to encourage the public to do premarital testing.

Eating Behaviours and Body Weight Concerns among Adolescent Girls

This paper presents a global review of research done on adolescent eating behaviours and food choices and the probable factors underlying it. Worldwide adolescent girls tend to develop moderate to high level of disordered eating behaviour as a result of their excessive concern with body weight or obsession with thinness. The objective of the review is to understand the concerns over body weight and the current eating patterns of adolescent girls in the developed and developing countries.

Relationship between eating pathology, body dissatisfaction and depressive symptoms among male and female adolescents in the United Arab Emirates

Research in the field of eating disorders remains limited in the Arab world. The cross-sectional study addressed this gap by examining eating disturbances and related problem behaviors among 361 (284 females, 77 males) undergraduates in the United Arab Emirates (UAE). Standardized measures were used to assess the relationship between symptoms of eating pathology, body dissatisfaction and depression. Three quarters (73%) of the sample indicated body dissatisfaction (78% of females, 58% of males) and 20% scored above the clinical cutoff on the eating pathology scale (20% of females, 22% of males). Depressive symptomatology predicted significantly higher levels of eating pathology in both genders. The findings highlight that eating disturbances and body dissatisfaction are of concern among adolescents in the UAE. Local eating disorders prevention strategies should address the needs of both females and males and consider potential depressive co-morbidity.

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.

Classification of feeding and eating disorders: review of evidence and proposals for ICD-11

Current classification of eating disorders is failing to classify most clinical presentations; ignores continuities between child, adolescent and adult manifestations; and requires frequent changes of diagnosis to accommodate the natural course of these disorders. The classification is divorced from clinical practice, and investigators of clinical trials have felt compelled to introduce unsystematic modifications. Classification of feeding and eating disorders in ICD-11 requires substantial changes to remediate the shortcomings. We review evidence on the developmental and cross-cultural differences and continuities, course and distinctive features of feeding and eating disorders. We make the following recommendations: a) feeding and eating disorders should be merged into a single grouping with categories applicable across age groups; b) the category of anorexia nervosa should be broadened through dropping the requirement for amenorrhoea, extending the weight criterion to any significant underweight, and extending the cognitive criterion to include developmentally and culturally relevant presentations; c) a severity qualifier "with dangerously low body weight" should distinguish the severe cases of anorexia nervosa that carry the riskiest prognosis; d) bulimia nervosa should be extended to include subjective binge eating; e) binge eating disorder should be included as a specific category defined by subjective or objective binge eating in the absence of regular compensatory behaviour; f) combined eating disorder should classify subjects who sequentially or concurrently fulfil criteria for both anorexia and bulimia nervosa; g) avoidant/restrictive food intake disorder should classify restricted food intake in children or adults that is not accompanied by body weight and shape related psychopathology; h) a uniform minimum duration criterion of four weeks should apply.

Emerging Burden of Frail Young and Elderly Persons in Oman: For whom the bell tolls?

Recent improvements in health and an increased standard of living in Oman have led to a reduction in environment-related and infectious diseases. Now the country is experiencing an epidemiological transition characterised by a baby boom, youth bulge and increasing longevity. Common wisdom would therefore suggest that Omanis will suffer less ill health. However, a survey of literature suggests that chronic non-communicable diseases are unexpectedly becoming common. This is possibly fuelled by some socio-cultural patterns specific to Oman, as well as the shortcomings of the 'miracle' of health and rapid modernisation. Unfortunately, such new diseases do not spare younger people; a proportion of them will need the type of care usually reserved for the elderly. In addition, due to their pervasive and refractory nature, these chronic non-communicable diseases seem impervious to the prevailing 'cure-oriented' health care system. This situation therefore calls for a paradigm shift: a health care system that goes beyond a traditional cure-orientation to provide care services for the chronically sick of all ages.

Adolescent male with anorexia nervosa: a case report from Iraq

This is the first reported case of an adolescent male with anorexia nervosa in Iraq. This disorder is believed to be rare in males across cultures and uncommon for both genders in Arab countries. The patient met the DSM-IV diagnostic criteria for anorexia nervosa. He was hospitalized and received medical and psychiatric treatment at local facilities as discussed below and responded well to treatment.

Disordered Eating Attitudes and Their Correlates among Iranian High School Girls

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Eating attitudes and body image concerns among female university students in the United Arab Emirates

OBJECTIVES

A number of socio-cultural factors have been associated with the emergence of eating disorders in non-western nations. The United Arab Emirates (UAE) is characterized by many, if not all of these socio-cultural factors. To date, however there have been very few studies exploring the prevalence of eating disorders symptomatology within the UAE. The present study investigates the prevalence of disordered eating attitudes within Emirati-female university students. It also explores the relationship between these attitudes and body image concerns.

DESIGN

A correlational study design was used to explore the prevalence of abnormal eating attitudes and their relationship with body image concerns.

METHOD

228 female students attending Zayed University in the UAE completed the Eating Attitudes Test 26 item version (EAT-26), along with the Figure Rating Scale: a visual scale used to assess current body size/shape estimation, preference, and dissatisfaction.

RESULTS

Exactly 24% of the sample scored above the EAT-26 cut-off, indicative of disordered eating attitudes and possible eating disorder. Additionally 74.8% of the participants were dissatisfied with their current estimated body image, furthermore disordered eating attitudes were positively correlated with body image dissatisfaction, and negatively correlated with body image ideals.

CONCLUSIONS

The prevalence of disordered eating attitudes amongst the present UAE sample broadly mirrors those reported in nations where eating disorders have been widespread for decades. The widespread disordered eating attitudes in the present population may in part arise from body image dissatisfaction and ultra-thin body image ideals.

Clarifying criteria for cognitive signs and symptoms for eating disorders in DSM-V

OBJECTIVE

This article reviews literature relevant to challenges in clinical ascertainment of cognitively-based diagnostic criteria of anorexia nervosa (AN) and bulimia nervosa (BN) to examine whether revision might enhance their clinical utility.

METHOD

We performed a systematic literature search to identify publications relevant to clinical evaluation of cognitive symptoms of AN and BN.

RESULTS

The literature supports several reasons that individuals with an eating disorder may not endorse cognitive symptoms, despite their presence. These include limited insight, minimization, or denial, as well as intentional concealment related to perceived stigma, social desirability, or investment in maintaining behavioral symptoms. We also identified reasons that the word "refusal" in AN criterion A may render its application problematic.

DISCUSSION

We conclude that specific guidance for ascertainment of cognitive signs for AN and BN in the absence of patient disclosure or endorsement, longitudinal evaluation, and/or collateral data may improve clinical utility of these diagnostic criteria.

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.

Is there evidence that religion is a risk factor for eating disorders?

OBJECTIVE

Is there evidence that religion is a risk factor for eating disorders?

METHODS

A literature search was performed to examine whether there is an association between religion and eating disorders.

RESULTS

There were some cross-sectional studies, case studies, and anthropological commentaries reporting eating disorders in various cultures and religions. Religious affiliation was usually reported as an incidental finding but not analyzed. A number of prevalence studies were reported from Islamic communities. This raises the possibility that young Muslim women have a higher prevalence of elevated EAT scores compared to non-Islamic women.

CONCLUSION

This literature search raises the possibility that there is an association between Islamic affiliation and positive screening for eating disorder behaviors. This supports the hypothesis that the effect of culture on eating disorders may be religious as well as secular. Carefully designed studies of the prevalence of eating disorders in multicultural populations with multiple religious affiliations may help further clarify the relationship between religion and eating disorders.

Eating attitudes and body dissatisfaction in adolescents: Cross-cultural study

AIMS

Sociocultural factors are thought to be important in the pathogenesis of eating disorders. However, there have been few studies comparing eating behavior among various cultural populations. The aim of the present study is to compare attitudes towards bodyweight and shape, and desire for thinness in Japanese male and female subjects with those in people from other countries and of different ethnic origin.

METHODS

The subjects were 411 Japanese, 130 Indian, 135 Omani, 113 Euro-American and 196 Filipino adolescents. The Eating Attitude Test-26 and the Drive for Thinness subscale of the Eating Disorder Inventory-2 were used to assess eating attitudes and fat phobia.

RESULTS

Subjects from India, Oman and the Philippines demonstrated eating attitudes that were similar to or worse than subjects from Western countries and Japan, although their desire for thinness was not as strong. The relationship between body mass index and eating attitudes or fat phobia in Indian, Omani and Filipino subjects differed from that in subjects from Western countries and Japan. In addition, both males and females showed disturbed eating attitudes in the Indian, Omani, and Filipino subjects.

CONCLUSION

There are differences in eating attitudes and the drive for thinness among different cultural groups.

Tendency toward deliberate food restriction, fear of fatness and somatic attribution in cross-cultural samples

OBJECTIVE

To compare Omani and western teenagers attending schools in Muscat, Sultanate of Oman and Filipino teenagers residing in Manila, Philippines on indices of deliberate food restriction and dieting behavior.

METHODS

The sample consisted of 444 students who were assessed using the cross-culturally valid measure, Eating Attitude Test-26, a subscale of Eating Disorder Inventory to gauge the presence of the drive for thinness or 'fat phobia' and the Bradford Somatic Inventory to elicit the presence of somatization.

RESULT

Significant differences in attitudes to eating, body image and somatization between the western and non-western teenagers were found.

CONCLUSION

This paper suggests that trajectories of eating disorder, such as body image disturbances as expressed in fat phobia and somatization, tend to vary from culture to culture and underscore the view that some of the health related behavior among adolescents need to be examined within socio-cultural contexts.

The role of ethnicity and culture in body image and disordered eating among males

An increasing number of researchers have examined body image concerns, disordered eating, and other behaviors associated with increasing muscle size among men from different cultural groups. However, to date there has been no synthesis or evaluation of these studies. In this paper we specifically review studies which have included a comparison between males from different cultural groups with White males on body image concerns or other related behaviors. The groups include Blacks, Hispanic Americans, Asians, Native Americans, Pacific Islanders, and men from Middle Eastern countries. Overall, evidence suggests that males from a range of cultural groups engage in more extreme body change strategies and binge eating than Whites. On the other hand, there is no consistent pattern which summarizes the nature of body image concerns across the different cultures. Mediating and/or moderating variables are proposed to account for the inconsistent findings. These include body build, levels of acculturation, socio-economic status, media exposure, and internalization of the muscular and lean body ideal.

Disordered eating attitudes and symptomatology among adolescent girls in the United Arab Emirates

OBJECTIVE

To ascertain the prevalence and correlates of disordered eating attitudes and symptomatology in a school-based Arab population.

METHODS

A representative stratified random sample of 495 adolescent girls completed the Eating Attitudes Test (EAT-40) in the United Arab Emirates (UAE). A randomly selected subgroup from the those who scored above the recommended cut-off of 30 on the EAT-40 and an equal number of those who scored below 30 were interviewed in stage 2 by a psychiatrist, blind to the EAT scores, using the Schedule for Affective Disorders and Schizophrenia (KSADS) and DSM-IV criteria for the presence of eating disorders.

RESULTS

116 girls (23.4%) scored above the recommended cut-off on EAT. High EAT score was associated with age, BMI, internalization of thin ideal and drive for thinness, knowing someone on a weight loss strategy, having a family member with weight-related or mental health problem and watching western TV programs. Using clinical interview of 100 girls in stage 2, half of those who scored above the cut-off on EAT were found to have a propensity for anorexic behavior, while 2% met the criteria for the full clinical syndrome.

CONCLUSIONS

Thin body preoccupation as well as family and social factors are important in the development of abnormal eating attitudes among adolescents in this Arabian Gulf country.

Risky weight control among university students

OBJECTIVE

The objectives of the current study were to investigate risky weight control measures (vomiting or pills) among university students in Lebanon and to assess their relation to demographic, scholastic, and health risk behavioral characteristics.

METHOD

The study used a cross-sectional design. A proportionate random sample of 2,013 students was selected from public and private universities in Greater Beirut. Each participant completed a self-administered anonymous questionnaire.

RESULTS

Among participating students, 123 (6.1%) reported practicing risky weight control measures. Multivariate analysis indicated that younger females, cigarette smokers, engaged/married students, and those with a higher body mass index (BMI) were at increased odds of performing risky weight control measures.

CONCLUSION

Health awareness measures need to be proposed and, if possible, implemented to better define the motives and methods of weight reduction among Lebanese youth.

Bulimic Investigatory Test, Edinburgh (BITE). A validation study of the Italian version

OBJECTIVE

To explore the psychometric properties of the Italian version of the Bulimic Investigatory Test, Edinburgh (BITE).

SUBJECTS

A general population sample of 995 subjects (621 females), a clinical sample of 388 eating disordered females and a clinical sample of 710 patients with obesity (575 females).

RESULTS

Internal consistency was satisfactory. The factor analysis confirmed that the Symptom Scale is mono-factorial. Patients with bulimia nervosa (BN) purging showed the highest scores and those with anorexia nervosa (AN) restricting type the lowest. Obese patients showed higher BITE scores than controls in both sexes (P<0.01) and those with binge eating disorder (BED) showed higher scores than the rest of the sample (P<0.05). In patients with obesity with the threshold of 10 the Symptom Scale had a sensitivity for BED of 93% and a specificity of 55%; with the threshold of 20, sensitivity and specificity were, respectively, 44% and 92%. Normative values for BITE total and sub-scale scores in clinical and non-clinical samples are reported.

CONCLUSION

The Italian version of BITE is psychometrically sound and it can be a useful screening tool. Our data suggest that Symptom Scale, with a threshold of 20, has a good sensitivity for BN, although it does not effectively discriminate patients with BN from those affected by other eating disorders with binge-eating (BED, AN bingeing-purging type).