Cultural trends and eating disorders

Sex-Specific Sarcopenia Prevalence and Risk Factors in the Korean Population: A Cross-Sectional Epidemiological Study

Background and Objective: This study aimed to identify the incidence of sarcopenia and disease risk factors in Korean adults and to provide data for sarcopenia prevention. Materials and Methods: Based on the Korea National Health and Nutrition Survey, 2008-2011, we selected 14,185 adults over the age of 20 who participated in sarcopenia diagnostic tests and health surveys. We analyzed sarcopenia risk factors using complex sample multi-logistic regression analysis. Results: The prevalence of sarcopenia in Korea was 31.3%, with 20.2% in men and 40.4% in women. In men, there was a higher risk of sarcopenia in those of older age, without a spouse, with a low body mass index (BMI), who never engage in resistance exercise, or who do mid-level intensity resistance exercises. In women, sarcopenia risk was higher in those in their 20s compared to those in their 60s, and risk factors included a low BMI, high-density lipoprotein cholesterol and waist circumference measurements, alcohol consumption, aerobic exercise, and resistance exercise. Conclusions: Interventions and lifestyle improvements will help prevent the onset of sarcopenia in elderly men and young women with risk factors such as a low BMI.

Validation and Psychometric Properties of the Chinese Version of the Binge Eating Scale in Young Adults

Background

Although structured clinical interviews are considered the gold standard for assessing binge eating disorder (BED), the self-administered Binge Eating Scale (BES) has been widely used as a screening tool for BED in clinical research. However, the psychometric properties of the BES among Chinese young adults remain unclear. This study aimed to examine the validity of a Chinese version of the BES with a large sample.

Methods

A total of 2182 young adult college students were tested using the Simplified Chinese version of BES (SCBES), the 7-Item Binge-Eating Disorder Screener (BEDS-7), the Zung Self-Rating Depression Scale (SDS), the Generalized Anxiety Disorder Scale (GAD-7), and the Dual-Modes of Self-Control Scale (DMSC). The frequency of objective binge-eating episodes was used as a measure of severity. Validity and reliability of the SCBES were assessed through multiple analyses, along with the item analysis.

Results

The data revealed that the SCBES demonstrated reasonable reliability and validity. The Cronbach's α value was 0.813, with a one-month test-retest reliability of 0.835. The exploratory factor analysis (EFA) extracted three first-order factors, which explained a total of 53.82% of the variance. The confirmatory factor analysis (CFA) confirmed the three-factor model (ie, Binge-eating behaviors, Lack of control, Negative affects related to overeating), with a good model fit. The SCBES also demonstrated excellent concurrent and criterion validity, significantly correlating with the BEDS-7 and frequency of objective binge-eating episodes (r=0.760-0.782, p<0.001). Gender, body mass index, depression, anxiety, impulsivity, and self-control were significantly associated with the total score of SCBES.

Conclusion

The SCBES demonstrated sound psychometric properties and exhibited good cross-cultural adaptability in Chinese young adults, with a novel three-factor model fitting the data best. This scale could serve as a useful screening tool for identifying the severity of binge eating behaviors among Chinese youths.

Prevalence of Eating Disorders and Comorbidity With Depression Among Adolescents in Saudi Arabia: A Cross-Sectional Study

Background Patients diagnosed with eating disorders (EDs) have demonstrated elevated levels of eating psychopathology, including distorted body image, and general psychopathology, encompassing depression, anxiety, impulsivity, and low self-esteem, surpassing anticipated levels. However, the measurement of EDs' prevalence related to depression and mental disorders in Saudi society remains insufficient. There is a clear need for additional studies to establish and substantiate the relationship between these issues and their frequency. In response to this gap, the current study delves into the psychosocial implications of disordered eating in Saudi Arabian adolescents and adults. The primary objective of this study is to contribute to an expanded understanding of the psychosocial effects associated with EDs, shedding light on their prevalence and interconnectedness with mental health concerns among adolescents in Saudi Arabia. Methodology A cross-sectional study was conducted in Saudi Arabia among adolescents based on self-report questionnaires, including the Patient Health Questionnaires for Eating Disorders and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for the presence of EDs. To analyze the obtained data, we calculated the responses from participants who met the following criteria: adolescents (ages 10 to 18 years) from all regions in Saudi Arabia who were ethnically Saudi and included both male and female individuals. Those older than 18 years were excluded from the study. Results We collected data from 422 participants; however, 43 responses were excluded because the respondent was under 10 years or over 18 years old. According to the Patient Health Questionnaire 9 (PHQ-9), the prevalence of depression was 83.9%; 36.7% of the participants had severe depression, 23.2% had moderate depression, and 24% had mild depression. According to the Patient Health Questionnaire Eating Disorders Scale, the prevalence of EDs was 23.5%, with the prevalence of binge eating disorder and bulimia nervosa being 14.8% and 8.7%, respectively. We found a significant correlation between EDs and depression, and the severity of depression (P=0.005). The prevalence of depression among patients with EDs was 93.3%: 17.9% of patients with EDs had mild depression, 21.3% had moderate depression, and 54.1% had severe depression. Conclusion There is an alarming finding of the high prevalence of both EDs and depression among young adolescents in elementary school, which requires urgent intervention. The study found a significant relationship between EDs and depression: the more severe the depressive symptoms, the higher the prevalence of EDs.

A network analysis of disordered eating symptoms, big-five personality traits, and psychological distress in Chinese adults

OBJECTIVE

Previous studies have revealed associations between disordered eating symptoms, big-five personality traits, and psychological distress. However, limited research has explored these relationships as a network, including their interconnections, and even less has done so in non-Western populations. We employed network analysis to investigate the co-occurrence of disordered eating symptoms, big-five personality traits, and psychological distress in Chinese adults.

METHOD

A sample of 500 Chinese adults (256 men) completed measures assessing big-five personality traits, psychological distress, and disordered eating symptoms. The network of personality traits, psychological distress, and disordered eating symptoms was estimated, including its central and bridge nodes.

RESULTS

The central nodes in the network were the facets of openness (like adventure), extraversion (like going to social and recreational parties), and disordered eating symptoms (dissatisfaction with body weight or shape). Moreover, certain facets of neuroticism (always worrying something bad will happen), psychological distress (feeling worthless), and an inverse facet of extraversion (bored by parties with lots of people) were identified as essential bridge nodes in maintaining the structure of the network.

CONCLUSION

Our findings suggest that personality traits (e.g., openness and extraversion) and body dissatisfaction are important in maintaining the network in a community sample of Chinese adults. While future replication is needed, findings from this study suggest that individuals with negative self-thinking, predisposed neuroticism, and extraversion may be at risk of developing disordered eating symptoms.

PUBLIC SIGNIFICANCE

The present study contributes to existing knowledge by employing a network perspective to examine the associations between disordered eating symptoms, big-five personality traits, and psychological distress in a Chinese adult community sample. The identified facets of neuroticism and extraversion and symptoms of psychological distress may be worthy of targeting in the prevention and treatment of disordered eating in the Chinese context.

Examining an integrated sociocultural and objectification model of thinness- and muscularity-oriented disordered eating in Chinese older men and women

OBJECTIVE

We tested an integrated model of three prominent theories of disordered eating (tripartite influence theory, objectification theory, and social comparison theory) in a sample of older Chinese men and women.

METHOD

Chinese older men (n = 270) and women (n = 160) completed questionnaires assessing the tripartite influence, objectification, and social comparison theories and thinness- and muscularity-oriented disordered eating. Two structural equation models were tested in Chinese older men and women.

RESULTS

The integrated model showed good model fit and described meaningful variance in thinness- and muscularity-oriented disordered eating in Chinese older men and women. Higher appearance pressures were uniquely related to higher muscularity-oriented disordered eating in men. Across both gender groups, higher thinness internalization was uniquely related to higher thinness- and muscularity-oriented disordered eating, and in women only, higher muscularity internalization was uniquely related to lower thinness-oriented disordered eating. In men, higher upward and downward body image comparisons were uniquely related to higher and lower, respectively, muscularity-oriented disordered eating. In women, higher upward body image comparisons were only uniquely related to higher muscularity-oriented disordered eating while higher downward body image comparisons were uniquely related to both outcomes. Higher body shame was uniquely related to higher thinness-oriented disordered eating across both groups and in men alone, higher body shame was also uniquely related to higher muscularity-oriented disordered eating.

DISCUSSION

Findings, which tested the integration of tripartite influence, objectification, and social comparison theories, inform the prevention and treatment of disordered eating in Chinese older populations.

PUBLIC SIGNIFICANCE

The present study is the first to describe theories of disordered eating (tripartite influence, objectification, and social comparison) in Chinese older adults. Findings suggested good model fit and the integrated models described meaningful variance in thinness- and muscularity-oriented disordered eating in Chinese older women and men. Findings extend existing theories of disordered eating and, pending further study, may inform theory-driven prevention and treatment approaches in Chinese older adults.

Bullying as a Risk Factor for Eating Disorder Behaviors Among Students: Secondary Analysis for a Cluster Randomized Controlled Trial

This study aimed to examine whether being a victim of bullying predicted body dissatisfaction and eating disorder behavior (EDB). In this study, we performed secondary analysis from a cluster randomized controlled trial among 5208 eight grade students from 73 public schools in three Brazilian cities. Data were collected in 2019 through an anonymous self-report questionnaire on bullying, body dissatisfaction, and EDB. We used factor analysis, multivariate linear regression, and multinomial logistic regression to verify whether being a victim of bullying during the baseline results in body dissatisfaction and EDB at the nine months follow-up for the control and intervention groups. Our results showed that being female (OR 1.41, 95% CI 1.22-1.63) is a risk factor for dissatisfaction by overweight. Bullying was not a predictor of body dissatisfaction; however, being a victim of bullying (β 0.40, 95% CI 0.35-0.46) is a predictor of having more EDB, independent of the exposure to the program. Therefore, bullying deserves attention in the school environment.

Bariatric Surgery Reduces Weight Loss, Comorbidities Prevalence, and Improves Quality of Life in the Southern Region of Saudi Arabia

Background and Objectives: Bariatric surgery has been proposed as a treatment option for type 2 diabetes, but there is limited research on its efficacy and the use of standardized outcome measures. Therefore, this study aimed to evaluate the efficacy of bariatric surgery in managing type 2 diabetes and to assess the BAROS protocol postoperatively. Material and Methods: This cross-sectional study was conducted in southern Saudi Arabia, involving 346 bariatric surgery patients aged 18-60. This study collected data through an electronic questionnaire distributed via a Telegram group and Twitter hashtag. Anthropometric data, postoperative complications, and the evolution of obesity-related comorbidities were collected. The quality of life was evaluated using the Moorehead-Ardelt questionnaire of the BAROS protocol. The total BAROS score was classified as "Insufficient", "Moderate", "Good", "Very good", or "Excellent", considering the presence of comorbidities. The data were analyzed using SPSS software ver.23. Results: The mean age of the participants was 30.97 ± 8.49 years, and 70.81% were female. Sleeve Vertical Gastrectomy was the most common surgical technique used (n = 336). The excess weight loss percentage (EWL%) was 70.55 ± 22.57%, and 27.75% of participants achieved complete remission of type 2 diabetes. The total BAROS score was "Excellent" for 40.17% of participants and "Moderate" for 27.16%. The presence of comorbidities was negatively correlated with the BAROS score (r = -0.651, p < 0.001). Conclusions: Bariatric surgery effectively manages type 2 diabetes with a high rate of EWL% and complete remission. The BAROS protocol is a valuable tool for assessing the quality of life postoperatively, with most participants achieving a "Moderate" to "Excellent" score. Comorbidities negatively impact the BAROS score, highlighting the importance of managing these conditions postoperatively.

Psychometric properties of an Arabic translation of the short 9-item drive for muscularity scale (DMS-9)

BACKGROUND

After the original 15-item Drive for Muscularity Scale developed by McCreary et al. in 2004, a more theoretically based scale that replicates the original DMS subscales with a better conceptual clarity and a shorter number of items, i.e., the DMS-9, has recently been developed by Chaba et al. in 2018. We sought to contribute to the literature especially under the Arab context, by investigating the psychometric properties of an Arabic translation of the DMS-9 in a sample of Arabic-speaking Lebanese university students of both genders.

METHODS

University students (N = 402; 55.2% females) from multiple universities in Lebanon were invited to fill the survey in this cross-sectional designed study (December 2022 and January 2023). Our sample was chosen using the snowball technique; a soft copy of the questionnaire was created using google forms software, and an online approach was conceived to proceed with the data collection.

RESULTS

Using an Exploratory Factor Analysis-to- Confirmatory Factor Analysis strategy, we found that the original two-factor model of the DMS proposed in the parent study was adequately replicated in our sample. The two DMS-9 factor scores showed very good McDonald's omega values (ω > 0.8). Findings also showed that gender invariance was achieved at the configural, metric, and scalar levels. Additionally, drive for muscularity scores correlated in the expected way with other study variables, providing support for the convergent and divergent validity of the Arabic DMS-9. Specifically, we found that greater drive for muscularity attitudes and behaviors significantly correlated with more severe muscle dysmorphic symptoms, inappropriate eating attitudes, muscle bias internalization, and lower body appreciation.

CONCLUSION

Findings preliminarily suggest that the Arabic DMS-9 is psychometrically sound and suitable tool to assess the drive for muscularity construct among Arabic-speaking community adults. Making the Arabic DMS-9 available will hopefully benefit the scientific community working in Arab settings, promote local and international research in this area, and offer descriptive data on how drive for muscularity may interfere with health indicators in the general Arab population.

Muscularity teasing and its relations with muscularity bias internalization, muscularity-oriented body dissatisfaction, and muscularity-oriented disordered eating in Chinese adult men

Despite increasing research on weight teasing and other forms of appearance teasing, muscularity teasing, which occurs when an individual is victimized due to low muscularity, has not yet received research attention. Given the solid evidence of positive relations between weight teasing and thinness-oriented body dissatisfaction and disordered eating, we aimed to tap into muscularity teasing and examine its relations with muscularity-oriented body dissatisfaction and muscularity-oriented disordered eating (e.g., rigid dietary rules for enhancing muscularity). A sample of 500 Chinese men, aged 18 - 62 years, were recruited online, and they competed questionnaires assessing muscularity teasing, muscularity bias internalization, muscularity-oriented body dissatisfaction, and muscularity-oriented disordered eating. Correlation analyses showed that muscularity teasing was significantly related to muscularity bias internalization (r = 0.55, p < .001), muscularity-oriented body dissatisfaction (r = 0.50, p < .001), and muscularity-oriented disordered eating (r = 0.38, p < .001). Structural equation modelling indicated that muscularity bias internalization and muscularity-oriented body dissatisfaction, as concurrent mediators, fully mediated the relationships between muscularity teasing and muscularity-oriented disordered eating. Findings extend existing knowledge in appearance teasing research to encompass muscularity teasing in order to better understand the etiology of muscularity-oriented body dissatisfaction and muscularity-oriented disordered eating.

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.

The social media diet: A scoping review to investigate the association between social media, body image and eating disorders amongst young people

Background

Eating disorders are a group of heterogenous, disabling and deadly psychiatric illnesses with a plethora of associated health consequences. Exploratory research suggests that social media usage may be triggering body image concerns and heightening eating disorder pathology amongst young people, but the topic is under-researched as a global public health issue.

Aim

To systematically map out and critically review the existing global literature on the relationship between social media usage, body image and eating disorders in young people aged 10–24 years.

Methods

A systematic search of MEDLINE, PyscINFO and Web of Science for research on social media use and body image concerns / disordered eating outcomes published between January 2016 and July 2021. Results on exposures (social media usage), outcomes (body image, eating disorders, disordered eating), mediators and moderators were synthesised using an integrated theoretical framework of the influence of internet use on body image concerns and eating pathology.

Results

Evidence from 50 studies in 17 countries indicates that social media usage leads to body image concerns, eating disorders/disordered eating and poor mental health via the mediating pathways of social comparison, thin / fit ideal internalisation, and self-objectification. Specific exposures (social media trends, pro-eating disorder content, appearance focused platforms and investment in photos) and moderators (high BMI, female gender, and pre-existing body image concerns) strengthen the relationship, while other moderators (high social media literacy and body appreciation) are protective, hinting at a ‘self-perpetuating cycle of risk’.

Conclusion

Social media usage is a plausible risk factor for the development of eating disorders. Research from Asia suggests that the association is not unique to traditionally western cultures. Based on scale of social media usage amongst young people, this issue is worthy of attention as an emerging global public health issue.

Depression in Chinese Patients with Cleft Lip and/or Palate: A Preliminary Study

(1) Objectives: To investigate the difference in prevalence of depression between patients with CL/P (cleft lip and/or palate) and analyze the possible demographic factors that affect the prevalence of depression in Chinese patients with CL/P. (2) Methods: Patients with CL (cleft lip only), CP (cleft palate), and CLP (cleft lip and palate) were included in the study group. Non-CL/P individuals were included in the control group. The Patient Health Questionnaire (PHQ-9) was used to screen the depression of Chinese patients with CL/P. The different proportions of different depression groups between the CL/P group and the control groups were tested by the Fisher-Freeman-Halton test and Bonferroni correction. The scores between the study groups and the control group were analyzed by one-way ANOVA. In the study groups, demographic and clinical data of the patients, including diagnosis (CL, CP, CLP), gender, age, the only child or not, and region were collected to analyze whether they were the possible factors affecting depression through one-way independent-samples t-test. Pearson correlation analysis was used to analyze the correlation between monthly family income and depression. (3) Results: 111 and 80 valid questionnaires were collected from the study and control groups, respectively. The mean PHQ-9 score of the study group (5.459 ± 6.082) was relatively higher than the control group (4.362 ± 3.384), and the difference in proportions of depression groups was statistically significant between the CL/P group and the control group (p = 0.01), especially in the mild depression (p < 0.05) and moderately severe depression groups (p < 0.05). Statistically significant differences in PHQ-9 scores were observed between the individuals of different genders (p = 0.036) and ages (p = 0.007) in patients with CL/P, the individuals who were the only child or not in patients with CL (p = 0.007), and the individuals of different ages in patients with CP (p = 0.016). (4) Conclusions: The prevalence of depression in Chinese patients with CL/P was different compared with those without CL/P, while gender, age, the only child or not, and region played significant roles in affecting depression psychology.

Prevalence of food addiction determined by the Yale Food Addiction Scale in Latin America: A systematic review with meta-analysis

OBJECTIVE

Food addiction (FA) has been extensively investigated worldwide; however, the prevalence of FA in the Latin American population has yet to be established and past work has largely neglected the specificities of this region, that includes the most significant economic disparities in the world. Thus, the objective of this study was to assess the prevalence of FA measured by the Yale Food Addiction Scale in Latin America.

METHOD

The search was performed on MEDLINE, ScienceDirect, LILACS, IBECS, SciELO, PsycArticles, CENTRAL, and the gray literature. FA prevalence data were collected, and random effects meta-analyses were performed to calculate the overall weighted prevalence, the prevalence by country, and by clinical and non-clinical samples.

RESULTS

A total of 10,082 occurrences were identified through database searches, and 23 studies were included (Mexico = 9; Brazil = 7; Chile = 4; Argentina = 1; Peru = 1; Uruguay = 1). The prevalence of FA found in clinical samples was 38% (95% CI: 16%-63%; I²  = 98.67%; 8 studies), while in non-clinical samples, it was 15% (95% CI: 10%-21%; I²  = 98.51%; 15 studies).

DISCUSSION

The average prevalence of FA in the Latin American countries included here was in accordance with that reported in other regions worldwide. It is noteworthy that the studies were conducted only in six countries, which are among those with the highest income in the region and do not represent the situation in native populations or those with lower purchasing power. This gap in the data also reflects the effects of economic disparities on the availability of empirical data in the region.

PUBLIC SIGNIFICANCE

The prevalence of food addiction in Latin America was similar to that reported in other regions. It was higher among individuals with overweight, whether or not undergoing bariatric surgery, than in non-clinical samples. These findings contribute to aggregate information about this condition that has drawn the attention of clinicians and researchers.

Validation of the Arabic version of the Muscle Dysmorphic Disorder Inventory (Ar-MDDI) among Lebanese male university students

BACKGROUND

To date, the vast majority of research on disordered eating symptomatology and body image disturbances from the Arab world have been performed exclusively among women; and mainly used thinness-oriented measures that are not sensitive to detect muscularity-oriented symptoms, which are more evident in males. Therefore, the objective of our study was to validate the Arabic version of the Muscle Dysmorphic Disorder Inventory (Ar-MDDI), in order to make it accessible for Arabic-speaking populations.

METHODS

Using a snowball sampling technique, men university students (n = 396) from multiple universities in Lebanon filled the survey in this cross-sectional designed study (January-May 2022). A soft copy of the questionnaire was created using google forms software, and sent to participants through the different social media platforms such as Facebook, Instagram, and WhatsApp. We used the Muscle Dysmorphic Disorder Inventory to assess Muscle Dysmorphia, along with the Big Three Perfectionism Scale to assess perfectionism and Eating Attitude Test (EAT) to evaluate the inappropriate eating attitudes. To explore the factor structure of Ar-MDDI, we computed a principal-axis Exploratory Factor Analysis (EFA) with the first split-half subsample using the FACTOR software. We used data from the second split-half to conduct a Confirmatory Factor Analysis (CFA) using the SPSS AMOS v.29 software. Pearson correlation test was used to test the convergent and divergent validity of the Ar-MDDI scale with the other scores included in the study.

RESULTS

The results of the EFA revealed three factors, which explained 57.68% of the common variance: Factor 1 = Appearance intolerance, Factor 2 = Drive for size, and Factor 3 = Functional impairment. The CFA fit indices of the three-factor model of the Ar-MDDI scale showed good results. Moreover, 254 (64.1%) of the participants had inappropriate eating attitudes (EAT scores ≥ 20). Indices suggested that configural, metric, and scalar invariance was supported according to eating attitudes. No significant difference between participants with appropriate versus inappropriate eating attitudes in terms of functional impairment, drive for size and appearance intolerance. Perfectionism scores correlated positively with the Ar-MDDI, which suggests divergent validity.

CONCLUSION

Our findings revealed that the validation of the Arabic scale yielded excellent properties, preliminarily supporting its use for the assessment of muscle dysmorphia among Arabic-speaking university men. This would hopefully allow for its timely detection and management in Arab clinical settings and encourage cross-cultural research on this topic.

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.

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).

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.

Assessing eating disorder symptoms in low and middle-income countries: a systematic review of psychometric studies of commonly used instruments

BACKGROUND

Various well-validated interview and self-report instruments are available to assess eating disorder symptomatology. However, most psychometric studies have been conducted in high-income countries. The aim of the present study was to systematically review the available psychometric studies conducted in low- and middle-income countries on well-known measures for assessing eating disorder symptoms.

METHODS

Psychometric studies with the following instruments were included: the Eating Disorder Examination (EDE), the Eating Disorder Examination Questionnaire (EDE-Q), the Eating Disorder Inventory (EDI), the Eating Attitudes Test (EAT), and the Children's Eating Attitudes Test (ChEAT). Searches were conducted on August 30, 2021, in the following databases: MEDLINE, EMBASE, LILACS, Web of Science, PsycINFO, and CABI. The methodological quality of the studies was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The studies were considered to have conducted the minimum psychometric evaluation if they assessed at least the three types of validity (content, criteria, and construct) or diagnostic performance. The psychometric properties were also evaluated considering the cut-off points described in the literature for each of the analysis methods used to evaluate validity and reliability and two reviewers independently selected the studies and evaluated the quality criteria.

RESULTS

A total of 28 studies were included. The studies were conducted in 13 countries (10 middle income and 3 low income). The instruments that were most used in the studies were the EAT and EDE-Q. According to the overall COSMIN assessment, in most (57%) of the studies the psychometric properties assessed were not described. Forty-three percent of the studies conducted the minimum psychometric evaluation. However, according to the described cut-off points, the results for the psychometric properties assessed showed, in general, acceptable validity and reliability.

CONCLUSION

The results of this review suggest a lack of studies with the recommended psychometric properties in low- and middle-income countries on these commonly used instruments. With the steady increase in the prevalence of eating disorders globally, psychometric investigations of instruments for measuring eating disorder symptoms in these countries should be encouraged to promote their early detection and treatment.

Media pressure and the process of Westernization in the context of body self-assessment among young heterosexual and gay Polish men

Mass media and social networks portray a unified image of the perfect male body. The intensity and universality of this influence is an important element of the process of Westernization, especially in traditional cultures such as that of Poland. The main aim of the present study was to investigate the differences between Polish gay and heterosexual men in terms of the role played by self-esteem and the level of internalization of sociocultural standards of body appearance as predictors of the development of their body images. The research study was conducted by reference to 19- to 29-year-old Polish heterosexual (n = 287) and gay (n = 97) men. The variables were measured using Polish versions of the Sociocultural Attitudes towards Appearance Scale-3, the Self-Esteem Scale, and the Multidimensional Body–Self Relations Questionnaire. Statistical analyses identified several variables as the main predictors of body image in both heterosexual and gay young men: self-esteem, information-seeking, perceived pressure and the internalization of sociocultural standards regarding an athletic body image drawn from mass media. The only significant difference between the two groups was the fact that self-esteem, perceived pressure and the internalization of sociocultural standards from mass media did not play a predictive role with respect to Appearance Orientation among the group of gay men.

Body image and disordered eating behaviors in Hispanic/Latino Youth: Findings from the Hispanic Community Health Study/Study of Latino Youth

BACKGROUND

Prevalence of certain disordered eating behaviors is higher among Hispanic youth compared to non-Hispanics. Understanding the role of body image and social attitudes towards weight in disordered eating may inform treatment in Hispanic youth.

METHODS

We analyzed data from the Hispanic Community Health Study/Study of Latino Youth (SOL Youth). Our sample included 1,463 children aged 8-16 years from four sites (Bronx, Chicago, Miami, San Diego) assessed in 2011-2014. Body image discrepancy score was calculated as the difference between perceived ideal body image and actual body image using two numbered visual graphs: adolescent (n = 728) or child (n = 735), each with slightly different scales. Questionnaires measured influences from social attitudes toward weight and disordered eating behaviors. Three disordered eating behaviors (dieting, overeating, and compensatory behaviors) were analyzed as the dependent variable. Logistic regression models adjusted for age, sex, acculturative stress, and field center to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI).

RESULTS

Mean body image discrepancy score was -0.79 for adolescents (SE = 0.08) and -0.50 for children (SE = 0.05), with a negative score signifying a perceived actual body image larger than their ideal. Body image discrepancy was strongly associated with dieting (dieting ≥5 times/year aOR = 0.64, 95% CI 0.53, 0.77) and compensatory behaviors (aOR = 0.65, 95% CI 0.50, 0.85) among adolescents, and was strongly associated with overeating among children (aOR = 0.74, 95% CI 0.61, 0.91). Significant associations were not observed with social attitudes towards weight.

CONCLUSIONS

Associations observed with body image discrepancy and disordered eating behaviors can inform interventions in Hispanic/Latino youth, which should consider acculturative stress.

Potential eating disorder exhibited with daytime functional vulnerabilities associated with sleep problems in Japanese adolescents: A cross-sectional study

OBJECTIVES

Eating disorders (ED) are serious psychiatric disorders that affect individuals, especially adolescents. It has been suggested that nonclinical ED-like characteristics are related to sleep problems. We conducted a survey of Japanese adolescents to investigate this claim.

METHOD

In this cross-sectional study, 398 adolescents aged 12-18 years responded to a self-administered questionnaire survey. We used the Eating Attitudes Test-26 (EAT-26) and the Athens Insomnia Scale (AIS) to measure potential ED and sleep problems, respectively.

RESULTS

Adolescents with potential ED had significantly higher daytime functional vulnerability potentially associated with sleep problems than those without ED. In particular, problems with a sense of well-being and physical and mental functioning during the day were significant. In contrast, no significant associations were found between potential ED and sleep initiation, awakenings during the night, early morning awakening, total sleep duration, or overall quality of sleep. Finally, nocturnal and daytime sleep scores were significantly associated with dieting, bulimia, and oral control EAT-26 subscores.

DISCUSSION

Participants with possible ED experienced problems related to well-being and mental and physical functioning, which are indicators of daytime functional vulnerability potentially associated with sleep problems. Further, adolescents with more severe ED characteristics are more likely to have a higher degree of daytime psychological vulnerability potentially attributable to sleep problems. The study suggested that professionals treating adolescent mental health issues need an approach that comprehensively integrates both sleep problems and potential ED.

The validation of a Farsi version of the Clinical Impairment Assessment (F-CIA) among Iranian adolescent boys and girls

PURPOSE

Although some studies have been conducted to examine general psychosocial impairment in Iran, there is no research to date on clinical impairment secondary to disordered eating in Iranian adolescents. The purpose of this study was to evaluate the Farsi version of the Clinical Impairment Assessment (F-CIA) among Iranian adolescents.

METHODS

A total of 1112 adolescents (age_{M [SD]} = 15.55 [1.59], body mass index [zBMI] _{M [SD]} = - 0.00 [1.0]; 54.6% girls) were recruited from four cities (Tehran [Capital], Tabriz [North-Western], Kurdistan [West], and Rasht [North]) in Iran. After translation and back-translation procedures, the F-CIA, Eating Disorder Examination Questionnaire (EDE-Q), and Beck Depression Inventory-Second Edition (BDI-II) were administered to adolescents. We used confirmatory factor analysis (CFA), measurement invariance, independent samples t tests, Pearson correlation, chi-square tests, and internal consistency to test validity and reliability.

RESULTS

CFA indicated that F-CIA demonstrated good fit to the data and supported a three-factor model. The scale was invariant across gender and zBMI. The F-CIA had good internal consistency (αs = 0.76-0.93) and positive associations (rs = 0.13-0.62; p < 0.001) with zBMI, disordered eating symptoms, and binge/purge symptoms. We found no gender differences across mean scores on the F-CIA, but adolescents with higher zBMI reported higher scores on the F-CIA relative to those with lower zBMIs. Finally, adolescents scoring above CIA cutoffs reported higher zBMI, disordered eating outcomes, and depression.

CONCLUSION

Findings suggested that the F-CIA is a reliable and valid measure of clinical eating disorder-related impairment in Iranian adolescents.

LEVEL OF EVIDENCE

III; Evidence obtained from well-designed observational study, including case-control design for relevant aspects of the study.

Risk of eating disorders in a representative sample of Italian adolescents: prevalence and association with self-reported interpersonal factors

PURPOSE

Adolescence represents a critical period for the onset of eating disorders (EDs). The present study aimed to provide the prevalence of individuals at risk for EDs psychopathology in a representative population of adolescents aged 14-19 and to characterize this population regarding interpersonal and psychological factors.

METHODS

The percentage of participants at risk for EDs in a representative high school population was assessed through the SCOFF screening questionnaire (cut-off score: 3) in the total sample (N: 6551) and in gender-based subgroups for different body mass index (BMI) categories. Odds ratios for being at risk of ED (SCOFF ≥ 3) were esteemed in a multivariable analysis including self-reported parental education, quality of family and peer relationships, bullying victimization, age at first sexual intercourse, and psychological distress.

RESULTS

A SCOFF score ≥ 3 was found in 31.0% of participants (boys: 19.4%; girls: 44.6%), with a greater prevalence among higher BMI categories. Bad family relationships, being bullied, having the first sexual intercourse before the age of 14, and experiencing high distress were associated with this risk condition. Among girls, bad peer relationships were associated with a low-risk SCOFF score.

CONCLUSION

A remarkable percentage of adolescents reported significant body image or eating concerns. Screening programs are deeply needed, and particular attention should be devoted to interpersonal factors, such as the quality of family relationships and interactions with peers, which represent potential indicators of this vulnerability.

LEVEL OF EVIDENCE

Level V - Cross-sectional study.

Using machine learning to explore core risk factors associated with the risk of eating disorders among non-clinical young women in China: A decision-tree classification analysis

BACKGROUND

Many previous studies have investigated the risk factors associated with eating disorders (EDs) from the perspective of emotion regulation (ER). However, limited research has investigated interactions between co-existing risk factors for EDs, especially in China where research in EDs is underrepresented.

METHODS

This study examined core risk factors related to maladaptive eating behaviors and ER, and how their interactions affect the detection of EDs. Using machine learning, a decision tree model was constructed on a data set of 830 non-clinical Chinese young women with an average age of 18.91 years (SD = 0.95). The total data set was split into training and testing data sets with a ratio of 70 to 30%.

RESULTS

Body image inflexibility was identified as the major classifier for women at high risk of EDs. Furthermore, interactions between body image inflexibility, psychological distress, and body dissatisfaction were important in detecting women at high risk of EDs. Overall, the model classifying women at high-risk for EDs had a sensitivity of 0.88 and a specificity of 0.85 when applied to the testing data set.

CONCLUSIONS

Body image inflexibility, psychological distress, and body dissatisfaction were identified as the major classifiers for young women in China at high risk of EDs. Researchers and practitioners may consider these findings in the screening, prevention, and treatment of EDs among young women in China.

Eating disorder examination questionnaire (EDE-Q): validity and norms for Saudi nationals

PURPOSE

The aim of this study was to develop an Arabic version of the EDE-Q and to assess its psychometric properties and utility as a screener in the Saudi population. An additional aim was to establish EDE-Q norms for Saudis.

METHOD

EDE-Q data were collected in a convenience sample of the Saudi community (N = 2690), of which a subset was also subjected to the EDE interview (N = 98). Various models for the factor structure were evaluated on their fit by CFA. With ROC analysis, the AUC was calculated to test how well the EDE-Q discriminated between Saudis at high and low risk for eating disorders.

RESULTS

The original four factor model of the EDE-Q was not supported. Best fit was found for a three factor model, including the weight/shape concern scale, dietary restraint scale and eating concern scale. The ROC analysis showed that the EDE-Q could accurately discriminate between individuals at high and low risk for an eating disorder according to the EDE interview. Optimal cut off of 2.93 on the global score yielded a sensitivity of 82% and specificity of 80%. EDE-Q scores were fairly associated with BMI.

DISCUSSION

Psychometric characteristics of the Saudi version of the EDE-Q were satisfactory and results support the discriminant and convergent validity. Severity level of eating disorder pathology can be determined by the EDE-Q global score. Global scores were high compared to what is found in Western community samples, leading to high prevalence estimates for Saudis at high risk for eating disorders.

LEVEL OF EVIDENCE

Not applicable, empirical psychometric study.

Characterizing eating disorder psychopathology and body image related constructs in treatment-seeking Black individuals with binge-eating spectrum disorders

PURPOSE

Black individuals are at risk for developing eating disorders (EDs), while also facing an increased mental health burden as a marginalized group. However, few studies have examined whether treatment-seeking Black individuals with EDs present with different symptom profiles than White individuals. This study sought to characterize baseline ED symptomatology in Black participants with bulimia nervosa spectrum or binge eating disorder spectrum pathology compared to White participants in a treatment-seeking sample.

METHODS

The sample consisted of 33 Black participants and 126 White participants who participated in a clinical trial at a mid-Atlantic University from 2015 to 2020. Data was analyzed using chi-square and independent samples t-tests.

RESULTS

Black participants were much less likely to engage in self-induced vomiting, despite being just as likely to meet criteria for a bulimia nervosa spectrum diagnosis and having similar rates of binge-eating and distress towards body image concerns. Black participants were more likely to experience obesity but maintained similar levels of body image concerns as White participants.

CONCLUSION

Given the evidence that Black participants often are under-diagnosed, particularly with bulimia nervosa spectrum disorders, these results could suggest that weight biases and/or expectations that patients with bulimia nervosa spectrum disorders will primarily present with self-induced vomiting could be contributing to these diagnostic errors.

LEVEL OF EVIDENCE

Level I, randomized controlled trials.

The landscape of eating disorders research: A 40-year bibliometric analysis

OBJECTIVE

Employing bibliometric methods, the present study aimed to map out the general landscape of existing research on eating disorders (EDs) over the past decades.

METHOD

Using the Web of Science database, we retrieved 41,917 research articles related to EDs published from 1981 to 2020. After removing those without an abstract, a total of 37,446 articles were retained. The study outlined the distribution of scholarship by time, languages, regions, and countries, and identified major research lines by applying latent topic modelling.

RESULTS

Results revealed a general increasing trend in the number of publications on EDs research, and researchers from Western countries dominated the production of related scholarship. The distribution of published scholarship varied significantly by languages, regions, and countries. Seven main research topics emerged from past research (i.e., animal studies of food intake, risk factors and at-risk groups for eating disorders, body image in eating disorders, studies of cognition and brain in eating disorders, symptomatology and comorbidity of eating disorders, body weight and nutrition status in eating disorders, and treatment of eating disorders), with different topics showing unique research trends across the years.

CONCLUSIONS

This bibliometric analysis presents the most complete up-to-date overview on published research on EDs. While there is an increasing trend for EDs research, the available research evidence is generally from Western countries; thus, it is suggested that cooperation on EDs research should be strengthened between Western countries and other countries in the future.

Restrained eating in Lebanese adolescents: scale validation and correlates

BACKGROUND

Restrained eating disorder is prevalent worldwide across both ethnic and different cultural groups, and most importantly within the adolescent population. Additionally, comorbidities of restrained eating present a large burden on both physical and mental health of individuals. Moreover, literature is relatively scarce in Arab countries regarding eating disorders, let alone restrained eating, and among adolescent populations; hence, the aim of this study was to (1) validate the Dutch Restrained Eating Scale in a sample of Lebanese adolescents and (2) assess factors correlated with restrained eating (RE), while taking body dissatisfaction as a moderator between body mass index (BMI) and RE.

METHODS

This cross-sectional study, conducted between May and June 2020 during the lockdown period imposed by the Lebanese government, included 614 adolescents aged between 15 and 18 years from all Lebanese governorates (mean age of 16.66 ± 1.01 years). The scales used were: Dutch Restrained Eating Scale, body dissatisfaction subscale of the Eating Disorder Inventory-Second version, Rosenberg Self-Esteem Scale, Beirut Distress Scale (for psychological distress), Hamilton Anxiety Rating Scale and Patient Health Questionnaire (for depression).

RESULTS

The factor analysis yielded a one-factor solution with Eigen values > 1 (variance explained = 59.65 %; α_Cronbach = 0.924). Female gender (B = 0.19), higher BMI (B = 0.49), higher physical activity index (B = 0.17), following a diet to lose weight (B = 0.26), starving oneself to lose weight (B = 0.13), more body dissatisfaction (B = 1.09), and higher stress (B = 0.18) were significantly associated with more RE, whereas taking medications to lose weight (B=-0.10) was significantly associated with less RE. The interaction body mass index (BMI) by body dissatisfaction was significantly associated with RE; in the group with low BMI, higher body dissatisfaction was significantly associated with more RE.

CONCLUSIONS

Our study showed that the Dutch Restrained Eating scale is an adapted and validated tool to be used among Lebanese adolescents and revealed factors associated with restrained eating in this population. Since restrained eating has been associated with many clinically-diagnosed eating disorders, the results of this study might serve as a first step towards the development of prevention strategies targeted towards promoting a healthy lifestyle in Lebanese adolescents.

Prevalence and associated factors of eating disorders in patrons of sport centers in Saudi Arabia

BACKGROUND:

In recent times, mental health problems have been on the increase worldwide. Among these are eating disorders. The current study aim was to assess the prevalence of the symptoms of eating disorders in patrons of sport centers in the Eastern Province of Saudi Arabia, and its association with patrons' sociodemographic, and exercise characteristics, as well as social media use.

MATERIALS AND METHODS:

This cross-sectional study was conducted among 560 sport center clients. The Eating Attitude Test (EAT-26), as well as questions on sociodemographic, exercise, and the use of the social media was collected through self-administered questionnaires. Descriptive statistics, Chi-squared test, and Fischer's exact tests were performed.

RESULTS:

The prevalence of the symptoms of eating disorders was found to be 36.6% according to the results of the EAT-26. There were no significant differences in the rates of eating disorders between genders. Frequencies of eating disorder symptoms increased with an increase in the body mass index of the participants. In addition, more than half of the participants who were pressured by social media to be slim and perceived that social media influencers motivated them to go to the gym had eating disorders' symptoms.

CONCLUSION:

The prevalence of eating disorders symptoms was high among the sport center patrons examined. The findings from this study might help family physicians, mental health professionals, and sport medicine specialists wishing to understand this issue in Arab populations. Developing strategies regarding mental health in sport center patrons are suggested. In addition, a screening program is recommended for this population to identify those who need further evaluation and management.

[Female patients with eating disorders and their parents experience in China: A qualitative study]

INTRODUCTION

Recent tendencies show a stabilization in Western countries of the incidence of anorexia nervosa but an increase in Asian countries where it used to be lower. The emergence of these diseases in non-Western countries suggests a culture change syndrome on an individual or societal scale. The great number of changes having occurred in China in the past decades would favor the occurrence of eating disorders. A variability of symptoms of eating disorders can be observed depending on the cultural background which also influences the treatment. There are few studies that exist within an Asian context, and they mostly focus on the care.

OBJECTIVES

In this study, we intend to explore the experience of Chinese female patients hospitalized for an eating disorder and the experience of their parents: their relationship with the symptoms, with their health and their understanding of the disease, in order to identify the impact of the Chinese cultural context upon the disorder.

METHOD

It is an observational, phenomenological and qualitative study. A purposive sampling was formed from a clinical population group of young teenagers and women, coming from various areas of China and hospitalized in the specialized Psychosomatic Department of Shanghai Mental Health Center, in August and December 2017. The degree of urbanization, the regions and ages categories were wide-ranging, allowing us to maximize the richness of the data assessing the disease and care representations. Two semi-structured interviews were realized with the participants, then with one or both parents. The interviews were realized with an evaluative interview guide by the same researcher together with a Chinese psychology student in order to clarify the translation and the interpretation of the cultural elements expressed by the participants. The analysis was based on the Interpretative Phenomenological Analysis. Two researchers read the interview transcripts several times, identified themes then connections between the themes to build a set of meta-themes depicting the narratives. Every meta-theme was linked with its corresponding themes which necessitated during the analysis constant back and forth between the analytical data and the source material.

RESULTS

Thirteen female patients and 11 parents took part in the study. The patients were between 12 and 31 years of age. They showed a wide range of eating disorders: restrictive anorexia, anorexia nervosa, or bulimia nervosa. Their Body Mass Index at the time of the interview ranged from 11 to 22. Three meta-themes emerged from the analysis: concerns about thinness and health are real catalysts for seeking care, the opposition between parental beliefs about factors of good health and eating symptoms in young girls, and changes in parenting and traditional educational methods induced by eating symptoms. These different themes highlight the fear of thinness and good health being powerful therapeutic levers in China, the intergenerational agreements and disagreements on the factors of good health with the parental experience of consideration around the eating disorder of their daughter, and an impact of traditional educational modalities on the family relational aspects that change with the disorder.

DISCUSSION

Exploring the experience of young Chinese girls or women suffering from eating disorders highlights the complex interactions between the cultural and clinical context of eating disorders. Weight loss is experienced with great difficulty by the young women of our study, who report somatic symptoms and worry about their thinness. Our results show the central position occupied by maintaining oneself in good health in China, for parents and teenagers alike. This allows a quick reliance on healthcare. The intergenerational differences in China are increased by the rapid changes occurring within Chinese society which can cause conflicts and particularly violent struggles. Its younger generations are becoming more and more globalized. These results provide further evidence that eating disorders are culture change syndromes. The therapeutic impact of our results is twofold. On the individual level, there are therapeutic cultural levers linked with Chinese culture, and they have to be sought in all cultures. The therapeutic education of Chinese patients must be centered on the somatic consequences of the disease in order to increase the adherence to the care. On the familial level, the therapeutic approaches centered on intergenerational conflicts must be developed.

CONCLUSION

The rapid sociocultural changes in China are causing important intergenerational differences, notably between traditional educational modalities and the need for independence of young people who require specific familial therapy. The cultural elements must be taken into account in order to understand eating disorders and to develop relevant therapeutic approaches.

The moderating effects of self and other mentalizing on the relationship between distress and disordered eating: A cross-cultural examination

OBJECTIVE

Cross-cultural comparisons that focus on underlying psychological mechanisms in disordered eating (DE) are lacking. With the aim of addressing this gap, we investigated the interplay between mentalizing, distress, and DE in two cultural groups: the ultra-Orthodox and secular Jewish societies in Israel.

METHOD

A combination of performance-based and self-report measures of two mentalizing-related constructs (emotional awareness and alexithymia), along with self-report measures of distress, DE, and values preferences, were employed in a community sample (N = 300) of ultra-Orthodox and secular Jewish women.

RESULTS

Distress predicted DE in both cultural groups, yet there were cultural differences in the moderating role of mentalizing. Both mentalizing measures moderated the distress-DE link in the secular group, but not in the ultra-Orthodox group. Furthermore, there were cultural differences in the moderating effects of self versus other mentalizing.

CONCLUSIONS

The results suggest cultural differences in the underlying psychological mechanism of DE.

Binge eating, orthorexia nervosa, restrained eating, and quality of life: a population study in Lebanon

OBJECTIVES

To assess the implication of disordered eating behaviors (DEBs) on the quality of life (QOL) of a sample of the Lebanese population, after adjustment over sociodemographic characteristics of those participants. Secondary objective aimed to assess the role of body dissatisfaction (BD) in the association of DEBs and QOL.

METHODS

This cross-sectional study was done between January and May 2018 and enrolled 811 participants from the community. A proportionate random sample technique was used to select the sample from all Lebanese Mohafazat. The World Health Organization Quality-of-life (WHOQOL)-BREF was used to assess the QOL and it includes four domains: physical health, psychological health, social relations, and environment.

RESULTS

Body dissatisfaction was found to be a major confounding factor contributing to psychological and environmental HQOL impairments in patient with restrained eating. Nevertheless, orthorexia nervosa was associated with QOL impairments in its physical and environmental domains, regardless of body dissatisfaction that was shown to be a major contributor for QOL impairments. Similarly, ON was directly correlated with QOL of life impairment in its physical and environmental domains, independently of all other risk factors.

CONCLUSION

When adding body dissatisfaction as a confounding variable, restrained eating and orthorexia nervosa remained significantly associated with quality-of-life impairments.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Risk factors for anorexia nervosa and bulimia nervosa in Japan and compared to a U.S. sample

OBJECTIVE

This study provides the first systematic investigation of environmental exposure to putative psychosocial risk factors for eating disorders in individuals with AN and BN in Japan. It also provides a comparison of risk factors for the development of AN and BN in Japan versus the United States.

METHOD

Participants in Japan were 96 women with a current DSM-IV AN or BN primary diagnosis (AN, n = 60; BN, n = 36) and 57 women with no current psychiatric diagnosis (NC group). Participants in the United States were 137 women with a current DSM-IV AN or BN primary diagnosis (AN-U.S., n = 71; BN-U.S., n = 66). A standardized semi-structured interview retrospectively assessed exposure to risk factors prior to first symptom onset, which were analyzed using General Linear Model analyses.

RESULTS

Perfectionism and negative affectivity, family relationship issues, and, to a lesser degree, parental psychopathology predicted the emergence of AN and BN in Japan. Physical and sexual abuse and family eating and weight concerns were not significant risk factors in Japan. Compared to their respective diagnostic U.S. groups, the Japanese AN group reported higher levels of individual mental health factors and lower levels of family dieting and family overweight, and the Japanese BN group reported higher levels on individual mental health factors, lower exposure to problems with their parents, and lower exposure to family weight and eating concerns.

DISCUSSION

These country-specific data from Japan contribute to an increasingly nuanced and global understanding of risk factors for eating disorders.

Eating disorder symptoms among adolescent boys and girls in Iran

OBJECTIVE

Few studies of eating disorder (ED) symptoms among young people in Iran have been conducted. This cross-sectional study examined ED symptoms, assessed by the Eating Disorder Examination Questionnaire (EDE-Q).

METHOD

Adolescent boys (n = 498) and girls (n = 607) aged 12-19 years, recruited from schools in four different regions of Iran, completed a survey that included the EDE-Q. ED symptoms, namely, EDE-Q global scores and the occurrence of specific ED behaviors, were compared between boys and girls.

RESULTS

Girls had higher global scores and were more likely to report regular extreme dietary restriction than boys (16.6 vs. 12.0%). The effect sizes for these differences were small. The regular occurrence of other behaviors (girls vs. boys-binge eating: 21.1 vs. 18.8%; self-induced vomiting: 3.3 vs. 5.4%; laxative misuse: 6.1 vs. 7.6%; excessive exercise: 5.3 vs. 4.4%) did not significantly differ by gender. Twelve percent of boys and 12.9% of girls met criteria for an operational definition of "probable ED case."

CONCLUSION

ED symptoms appear to be relatively common among Iranian adolescent boys and girls. Programs designed to reduce the occurrence and adverse impact of these symptoms may therefore be increasingly important.

Virtual Online Home-Based Treatment During the COVID-19 Pandemic for Ultra-Orthodox Young Women With Eating Disorders

Background: With the outbreak of the COVID-19 pandemic, the need arose to maintain treatment continuity for religious Jewish Ultra-Orthodox young women with eating disorders (EDs) previously hospitalized in the ED department at the Ultra-Orthodox "Mayanei Hayeshua" medical center in Israel. This need led to the development of home-based online treatment channels, previously unfamiliar, and unaccepted in this population. The implementation of this model had to take into consideration many of the difficulties inherent in the use of online treatment in Jewish Ultra-Orthodox mental health patients. Aims: We sought to investigate our online home-based treatment model implemented during the COVID-19 pandemic in previously hospitalized young Ultra-Orthodox women with EDs. Method: We briefly review the literature on: (1) The Jewish Israeli Ultra-Orthodox culture; (2) Young women in Ultra-Orthodox society; and (3) EDs in Jewish Israeli Ultra-Orthodox women. We then present the inpatient ED department for Ultra-Orthodox young women and describe the online treatment model adapted to this population during the COVID-19 pandemic. We highlight the difficulties, dilemmas, and advantages of our online model with the description of three patients. Findings: Online therapy can serve as a barrier to treatment in some cases, due to physical (lack of suitable online devices except phones), familial (over-crowded families), and religious circumstances, as well as because of the patients' reluctance to take part in this treatment. In other cases, virtual home-based treatment can lead to a positive change. This may be the case in patients who find the distancing online model suitable for them, and in parents who are committed to treatment, using their greater physical and emotional presence at home during the COVID-19 pandemic for the good if their ill-daughters. Discussion: This paper highlights the difficulties and possibilities inherent in a virtual home-based treatment during the COVID-19 pandemic for Ultra-Orthodox young women previously hospitalized because of an ED. This model can be effective for some patients and families if undertaken by a multidisciplinary team that is not only knowledgeable about the treatment of EDs and the use of online strategies but also knowledgeable and culturally sensitive to the specific needs and codes of Ultra-Orthodox populations.

Trends in the prevalence and disability-adjusted life years of eating disorders from 1990 to 2017: results from the Global Burden of Disease Study 2017

AIM

Eating disorders have increasingly become a public health concern globally. This study aimed to reveal the burden of eating disorders at the global, regional and national levels using the Global Burden of Disease (GBD) Study 2017 data.

METHODS

We extracted the age-standardised rates (ASRs) of prevalence and disability-adjusted life years (DALYs) and their 95% uncertainty intervals (UIs) of eating disorders, including anorexia nervosa and bulimia nervosa, between 1990 and 2017 from the GBD 2017 data. The estimated annual percentage changes (EAPCs) were calculated to quantify the secular trends of the burden of eating disorders.

RESULTS

The ASRs of prevalence and the DALYs of eating disorders continuously increased worldwide from 1990 to 2017 by an average of 0.65 (95% UI: 0.59-0.71) and 0.66 (95% UI: 0.60-0.72), respectively. The burden of eating disorders was higher in females than in males, but the increment in ASRs was greater in males than in females over time. In 2017, the highest burden of eating disorders was observed in the high sociodemographic index (SDI) regions, especially Australasia (ASR of prevalence = 807.13, 95% UI: 664.20-982.30; ASR of DALYs = 170.74, 95% UI: 113.43-244.14, per 100 000 population), Western Europe and high-income North America. However, the most significant increment of the burden of eating disorders was observed in East Asia (EAPC for prevalence = 2.23, 95% UI: 2.14-2.32; EAPC for DALYs = 2.22, 95% UI: 2.13-2.31), followed by South Asia. An increasing trend in the burden of eating disorders at the national level was observed among most countries or territories. The countries with the top three highest increasing trends were Equatorial Guinea, Bosnia and Herzegovina and China. Positive associations were found between the burden estimates and the SDI levels in almost all geographic regions during the observed 28-year period. We also found that the human development indexes in 2017 were positively correlated with the EAPCs of the ASRs of prevalence (ρ = 0.222, P = 0.002) and DALYs (ρ = 0.208, P = 0.003).

CONCLUSION

The highest burden of eating disorders remains in the high-income western countries, but an increasing trend was observed globally and in all SDI-quintiles, especially in Asian regions that were highly populous. These results could help governments worldwide formulate suitable medical and health policies for the prevention and early intervention of eating disorders.

Eating disorders in New Zealand: Implications for Māori and health service delivery

OBJECTIVE

Lifetime prevalence rates in Te Rau Hinengaro (The New Zealand Mental Health Survey) suggest eating disorders are at least as common in the Māori population as the non-Māori population, yet little is known at a population level about those accessing specialist mental health treatment for eating disorders in New Zealand. The aim of this study was to describe the population undergoing specialist mental health treatment for eating disorders and compare Māori and non-Māori clinical characteristics and service use.

METHOD

This study uses the Programme for the Integration of Mental Health Data data set, managed by the New Zealand Ministry of Health to describe the characteristics of people with eating disorders and their use of specialist mental health services from 2009 to 2016.

RESULTS

There were 3,835 individuals with a diagnosed eating disorder who had contact with specialist mental health services in this time period, 7% of whom were Māori. Within the cohort, Māori had a higher prevalence for a bulimia nervosa diagnosis, fewer diagnosed with anorexia nervosa, and a higher prevalence of other psychiatric comorbidity than non-Māori.

DISCUSSION

There is discrepancy between the proportion of service users accessing specialist mental health services who are Māori and the assessed crude prevalence of eating disorders for Māori in national estimates. Once Māori are in specialist services; however, their use of services is comparable to non-Māori. Further research is needed to highlight the experiences of those Māori with eating disorders and address barriers to accessing services for Māori with eating disorders.

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.

Considering Food Addiction through a Cultural Lens

Purpose of Review

Research suggests that cultural factors influence eating behaviors, however little is known about the relationship between food addiction and culture. This narrative review aimed to i) review theoretically related work on the relationship between sociocultural demographic variables, food cravings, and eating disorders; ii) review the available literature assessing cultural aspects of food addiction, specifically the rates of food addiction across the globe and notable differences in relevant sociodemographic variables: race, ethnicity, gender and acculturation level; iii) discuss the potential impact of culture on our current understanding of food addiction and future research directions emphasizing the inclusion of sociocultural variables.

Recent Findings

Preliminary data suggest that food addiction symptoms occur cross-culturally, and that there may be significant differences between sociodemographic groups. Issues related to adequate lexicalization of concepts central to food addiction (e.g., craving, addiction) and global variations in eating culture and presentation of similar constructs (e.g. binge-eating) contribute to questions raised and identify avenues for further research.

Summary

Multidimensional cultural assessment is called for to characterize food addiction among diverse groups and improve our understanding of the etiology, maintenance, and sequelae of food addiction cross-culturally.

The Western diet: a blind spot of eating disorder research?-a narrative review and recommendations for treatment and research

Over the last 50 years, in parallel with the obesity epidemic, the prevalence of eating disorders has increased and presentations have changed. In this narrative review, we consider recent research exploring the implications of changing patterns of food consumption on metabolic and neurobiological pathways, a hitherto neglected area in eating disorder research. One of the major changes over this time has been the introduction of ultra-processed (NOVA-4) foods, which are gradually replacing unprocessed and minimally processed foods. This has resulted in the increased intake of various sugars and food additives worldwide, which has important metabolic consequences: triggering insulin and glucose response, stimulating appetite, and affecting multiple endocrine and neurobiological pathways, as well as the microbiome. A paradigm shift is needed in the conceptual framework by which the vulnerability to, and maintenance of, different eating disorders may be understood, by integrating recent knowledge of the individual metabolic responses to modern highly processed foods into existing psychological models. This could stimulate research and improve treatment outcomes.

Female and male body image ideals among Arab immigrants and Germans in Germany

The current study explores cross-cultural differences of male and female body image ideals within a rapidly developing intercultural, immigration context that has garnered a considerable degree of popular and scholarly interest; recent Arab immigration to Germany. One hundred eighty participants (Arab immigrants or ethnic Germans) completed self-report online questionnaires (in either Arabic or German) regarding male and female body image ideals, as well as an assessment of their own body image perception. The data suggest cross-cultural differences in the body image ideals of, and held by, men and women of both groups. Slimmer ideals were held by Germans, especially German women, something that has repercussions for self-perceptions of being over- or under-weight by both Arabs and Germans. Culturally-bound body image ideals are important for the study of demographic changes in such socio-biological patterns as weight, weight-related health issues, and intergroup attraction and reproduction. The current study highlights the importance of psychological research on body image ideals for better understanding trends observed in "objective" measures of physiology (e.g., weight, weight-related health conditions) or relationship patterns (e.g., marriages, reproduction).

Incidence of Anorexia Nervosa in Women: A Systematic Review and Meta-Analysis

Background: Anorexia nervosa (AN) among the general population is a rare but often fatal illness. Objective: To summarize the incidence of AN using a systematic review and meta-analysis. Methods: Four online databases (PubMed, Scopus, WoS and Embase) were consulted. The review was conducted according to with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was limited to women. The methodological quality of the studies was assessed by the Newcastle–Ottawa Scale (NOS). Results: A total of 31 articles were included in the study. The incidence rate of AN ranged from 0.5 to 318.0 cases per 100,000 women–years. The incidence in studies based on outpatient healthcare services (OHS) was higher than those based on hospital admissions (HA) (8.8 95% CI: 7.83–9.80 vs. 5.0 95% CI: 4.87–5.05). In young women, the incidence in OHS was higher than HA (63.7, 95% CI 61.21–66.12 vs. 8.1 95% CI 7.60–8.53). The linear trend in the incidence of AN was increasing in all ages of women and young women, both in studies with hospital admission records, and in those based on outpatient healthcare services. Conclusion: The incidence of AN depends on the methodology, the type of population and the diagnostic criteria used.

Eating-disordered behavior among male and female college students in Iran

OBJECTIVE

Few studies of eating-disorder behaviors (EDBs) in Iran have been conducted and no study has examined the occurrence of these behaviors (EDBs) among young Iranian men. This cross-sectional study examined the occurrence of EDBs, as assessed by the Eating Disorder Examination Questionnaire (EDE-Q), among young men and women in Iran.

METHOD

Male (n = 253) and female (n = 384) college students completed the EDE-Q. Mean scores on the EDE-Q subscales and the occurrence and regular occurrence of EDBs, namely, binge eating, self-induced vomiting, laxative misuse, extreme dietary restriction and excessive exercise, were compared between male and female participants.

RESULTS

Female students had higher scores on the EDE-Q Shape Concern subscale than males, whereas scores on the other subscales did not differ by gender. Male students were more likely to report self-induced vomiting (any occurrence: 10.4% vs. 3.2%) and excessive exercise (28.0% vs. 20.0%) than female students. The occurrence of other EDBs did not differ by gender and binge eating was the most common EDB in both men (regular occurrence = 24.7%) and women (27.5%).

CONCLUSION

The findings suggest that EDBs are relatively common among college students in Iran and that most EDBs are equally common among male and female students. Prevention and health promotion programs designed to reduce the occurrence and adverse impact of EDBs may be increasingly important in Iran.

Prevalence of eating disorder is lower in migrants than in the Australian-born population

OBJECTIVES

There are limited data on the epidemiology of eating disorders (ED) in migrants. Recent Scandinavian research suggests that migrants are at lower risk of eating disorders, however, to our knowledge there have not been comparable studies exploring eating disorders in Australian adult populations. We sought to explore the prevalence of EDs in first-generation migrants to Australia in comparison with the Australian-born population. A secondary aim was to explore ED prevalence across first-generation migrants from different regions of birth (Europe, Asia, Africa, and Other).

METHODS

We conducted sequential cross-sectional population surveys in South Australian individuals aged over 15 years in 2015 and 2016 (n = 6052). Demographic data were collected and migration status was inferred based on a country of birth outside Australia. Questions asked regarding disordered eating were based on the Eating Disorders Examination.

FINDINGS

The 3-month prevalence of any ED was found to be significantly lower in first-generation migrants born outside Australia (4.5%, 95% CI 3.6-5.6) in comparison to the Australian-born population (6.4%, 95% CI 5.7-7.2). People born in countries in Africa (11.0% 95% CI 6.1-19.1) had a significantly higher prevalence of EDs than those born in Asia (4.0% 95% CI 2.7-5.8).

CONCLUSIONS

First-generation migrants to Australia may be at lower risk of eating disorders compared to their Australia-born peers, suggesting support for a 'healthy immigrant effect'.

Treating Individuals With Eating Disorders: Part 1

According to the American Psychiatric Association, eating disorders (EDs) are characterized by a persistent disturbance of eating or eating-related behaviors that result in altered consumption or absorption of food and that significantly impair physical health and/or psychosocial functioning. EDs are chronic psychiatric illnesses and are notoriously difficult to treat. The etiology of eating disorders is unknown and thought to be a complex interplay among biological predisposition, environmental and sociocultural factors, neurobiological influences, and psychological factors. Moreover, prevalence of eating disorders is increasing despite variation in prevalence estimates across studies. Nurses are well-positioned to implement appropriate screening for and comprehensive assessment of EDs as well as offer patient-centered treatment options including referrals when indicated. As the first in a two-part series, this article provides an overview of the clinical characteristics of EDs and key areas for assessment and diagnostic considerations. The follow-up article in this series will focus on pharmacological treatment strategies. [Journal of Psychosocial Nursing and Mental Health Services, 58(3), 7-13.].

Body Dissatisfaction, Restrictive, and Bulimic Behaviours Among Young Women: A Polish-Japanese Comparison

The growing number of women, who are characterized by restrictive and bulimic behaviours towards their own body is observed especially in countries influenced by Westernalization. However, there is a lack of cross-cultural studies in this area. The main aim of the present study was to examine the psychological and socio-cultural risk factors for eating disorders in Polish and Japanese women. A cross-sectional research study was conducted among 18- to 29-year old Polish (n = 89) and Japanese (n = 97) women. The variables were measured using the Sociocultural Attitudes Towards Appearance Scale SATAQ-3, and the Eating Disorders Inventory EDI-3. The descriptive and comparative statistics, Spearman's rho, and the stepwise regression analysis were used. The global internalization of socio-cultural standards of body image proved to be a significant predictor of Body Dissatisfaction among Polish and Japanese women. The main analysis showed a significant relation between the Drive for Thinness and Interoceptive Deficits in the group of Japanese women, as well as a correlation between Drive for Thinness and Asceticism in the group of Polish women. The obtained results could improve the prevention aimed the dysfunctional eating behaviours. However, the cultural nuances need to be considered in understanding the risk factors for eating disorders.

Are bulimia nervosa and binge eating disorder increasing? Results of a population-based study of lifetime prevalence and lifetime prevalence by age in South Australia

OBJECTIVE

This study aimed to provide updated lifetime prevalence estimates of eating disorders, specifically bulimia nervosa (BN) and binge eating disorder (BED) and investigate changes over time in lifetime prevalence by age.

METHOD

Two thousand nine hundred seventy-seven participants from South Australia were interviewed in the Health Omnibus Survey. DSM-5 criteria were used for current and broad (in accord with the International Statistical Classification of Diseases and Related Health Problems-11 [ICD-11]) criteria for lifetime prevalence of BED.

RESULTS

This study found that the lifetime prevalence of BN was 1.21% (95% CI [0.87, 1.67]) and 2.59% (95% CI [2.07, 3.22]) for males and females, respectively, and that lifetime prevalence for BED-broad was 0.74% (95% CI [0.49, 1.11]) and 1.85% (95% CI [1.42, 2.40]) for males and females, respectively, which is higher than reported in previous research. Current prevalence (past 3 months) of BN was 0.40% (95% CI [0.23, 0.70]) and 0.81% (95% CI [0.54, 1.20]) for males and females, respectively, and current prevalence for BED was found to be 0.03 (95% CI [0.01, 0.04]) and 0.20% (95% CI [0.09, 0.44]) for males and females, respectively.

CONCLUSIONS

The current study confirmed the moderate community prevalence of BN and BED. BED was found to be less prevalent than BN in the present study, and a significant lifetime prevalence by age effect was found for both. Lifetime prevalence by age indicated that past increases in prevalence may be waning in this century and that overall BN and BED are not increasing in Australia.

Eating disorders, body image and media exposure among adolescent girls in rural Burkina Faso

Objective

Body dissatisfaction and eating disorders (ED) among young females may increase in limited‐resource settings as exposure to media and higher‐resource cultures increases. We examined ED prevalence and its predictors among adolescent girls in rural north‐western Burkina Faso.

Methods

Fieldworkers interviewed 696 female adolescents aged 12‐20 years in the Nouna Health and Demographic Surveillance System (HDSS). ED were evaluated using the Structured Clinical Interview for DSM‐5 (SCID‐5), self‐perceived appearance and body ideal were measured using Thompson and Gray’s Contour Drawing Rating Scale (CDRS) and eating disorder predictors by the Eating Disorder Examination Questionnaire (EDE‐Q). We assessed media exposure to magazines, radio, television, and the internet.

Results

16% of respondents had a BMI below WHO age‐standardised 5th percentile, while 4% were above the 85th percentile; most respondents wanted to be larger. DSM‐5 criteria for anorexia nervosa (AN) were fulfilled by four of 696 respondents (0.6%), those for bulimia nervosa by none, and those for binge eating disorder by two (0.3%). In multivariable regression, more AN symptoms were associated with greater EDE‐Q body dissatisfaction, desiring a thinner body and a history of sexual harassment or assault, but not with media exposure. A thinner desired body was associated with greater media exposure, higher BMI z‐score and greater EDE‐Q disordered eating.

Conclusion

ED were very rare in rural Burkinabé female adolescents, but factors predictive of ED in higher‐resource settings were also predictive of ED precursor symptoms here. Our findings suggest that increasing media exposure in resource‐limited settings may lead to increased body dissatisfaction, and potentially to increased future ED prevalence.