Prevalence of disordered eating behaviors and associated factors in Brazilian university students

Eating Disorders and Disordered Eating Behaviors Among Undergraduate Students in Pakistan as Measured by Eating Disorder Examination Questionnaire (EDE-Q)

Objectives Eating disorders (ED) are an emerging public health issue globally, especially in young adults studying at the undergraduate level. This study aims to assess the frequency of eating disorders, their types, and disordered eating behaviors among such students. Moreover, it aims to identify factors like weight concern, shape concern, eating concern, and restraint, along with assessing the shifting trend of BMI impact on eating disorders using a standardized Eating Disorder Examination Questionnaire (EDE-Q). Methods In this cross-sectional study, 400 undergraduate students (aged 18-25) from four public universities participated from July 2022 to November 2023. Data was collected using the Eating Disorder Examination Questionnaire (EDE-Q). The frequency of eating disorders was computed using SPSS version 27. Results Among the participants, 21.75% (n=84) were identified as having a score surpassing the clinical cut-off. This group comprised 5.5% males (n=22) and 16% females (n=64). The highest prevalence among the four subscales was observed in the Shape Concern subscale (10.5%). Objective binge episodes (19.3%) emerged as the most notable disordered eating attitude. Atypical anorexia nervosa accounted for 13.8% of different eating disorders, while disordered eating was noted in 19.5% (n=78) of individuals. Discussion This study offers critical insights into eating disorders among Pakistan undergraduate students, utilizing the EDE-Q 6.0. Disordered eating behaviors, particularly shape concern and objective binge eating, exhibit significant correlations with these disorders. Weight dissatisfaction emerges as a prominent predictor, suggesting societal influence. The study also reveals a moderate correlation between BMI and eating disorders, challenging conventional assumptions. Furthermore, a changing trend in the prevalence of eating disorders is observed among the male population.

Weight stigma and disordered eating behaviors during the COVID-19 pandemic: the mediating role of weight gain concern and psychological distress

OBJECTIVES

The purpose of this study is to investigate whether the relationship between weight stigma experiences and disordered eating behaviors during the COVID-19 pandemic is mediated by weight gain concern and psychological distress among university students with and without overweight.

METHODS

A cross-sectional study was conducted with university students from five regions of Brazil who participated in the baseline assessment of the Online Cohort on Eating Behavior and Health (July/August 2020). Information on the frequency of binge eating episodes, food restriction, and purging, as well as experienced weight stigma, weight gain concern, and psychological distress, were recorded in an online questionnaire. Stratified structural equation modeling (SEM) analyses were performed to address the research questions of interest.

RESULTS

Out of the total sample (n = 2511), 33.5% of participants reported experiencing weight stigma. The prevalence of binge eating episodes, food restriction, and purging was 43.7%, 24.1%, and 5.4%, respectively. These behaviors were more prevalent in individuals with overweight than in those without this condition. Furthermore, it was observed that weight gain concern and psychological distress mediated the relationship between weight stigma and disordered eating behaviors regardless of body weight status.

CONCLUSIONS

Experiences of weight stigma and disordered eating behaviors were prevalent among Brazilian university students, especially among those with overweight. Weight gain concern and psychological distress appear to be important factors underlying the relationship between these constructs during the pandemic, and they can contribute to the development of targeted strategies for the prevention and management of disordered eating.

LEVEL OF EVIDENCE

Level V, cross-sectional study.

Delayed Mid-Sleep Time Associated With Weight Gain While Controlling for Eating Behaviors and Attention Deficit Hyperactivity Disorder Symptoms During the COVID-19 Pandemic

OBJECTIVE

Society's sleep-wake cycle and eating behaviors have altered and are considered the psychological outcomes of the coronavirus disease-2019 (COVID-19) pandemic. Our aim was to examine the relationship between sleep-wake rhythms, eating behaviors (dieting, oral control, and bulimic behaviors), and attention deficit hyperactivity disorder (ADHD) symptoms with weight gain during the COVID-19 pandemic.

METHODS

The participants were 578 female university students divided into three groups based on weight change during COVID-19 who lost weight, whose weight did not change (nWC), and who gained weight (WG). The participants' information about weight change in the last year and responses to the Pittsburg Sleep Quality Index, Eating Attitudes Test, Adult ADHD Severity Rating Scale, and Wender Utah Rating Scale were collected via an online survey from January 8, 2021 to January 11, 2021.

RESULTS

The sleep-wake phase was more delayed in WGs than in the other two groups. The bulimic behavior score was higher and the oral control behavior score was lower in the WG group than in the nWC group. A hierarchical regression analysis model, in which weight change scores were dependent variables, showed that mid-sleep time in second step (β=4.71, t=2.18, p=0.03), and oral control (β=-0.11, t=-3.24, p=0.001)/bulimic behaviors (β=0.20, t=3.20, p=0.001) in third step were associated with weight change after controlling for both current and childhood ADHD symptoms.

CONCLUSION

Chronotherapeutic approaches that regulate sleep-wake rhythm may facilitate weight control of individuals during stressful periods, such as the COVID-19 outbreak.

The relationship between food and cooking skills, and eating behaviors in people with overweight or obesity

BACKGROUND

In the present study, the authors aimed to determine food skills and cooking skills, and eating behaviors, and to evaluate the relationship between food skills and cooking skills, and eating behaviors in people with overweight or obesity.

METHODS

This cross-sectional study was conducted with 185 people with overweight or obesity. The researchers collected the study data using the face-to-face interview method through a questionnaire including the Descriptive Information Form, Cooking Skills and Food Skills Scale, and Three-Factor Eating Questionnaire-R21. Numbers, percentages, arithmetic mean, standard deviation, Student's t-test, Pearson Chi-Square test, and multiple linear regression analysis were used in the analysis of the data.

RESULTS

The mean scores of the individuals obtained from the overall Cooking Skills and Food Skills Scale, and cooking skills, food skills, uncontrolled eating, cognitive restraint, and emotional eating sub-dimensions were 148.17 ± 52.20, 70.45 ± 27.48, 77.84 ± 28.90, 43.90 ± 22.74, 36.95 ± 23.93, and 38.94 ± 29.17 respectively. Multiple linear regression was fitted to determine the association between food skills and cooking skills and eating behaviors while adjusting for sociodemographic and health-related characteristics. Food skills and cooking skills were positively associated with uncontrolled eating (β = 0.213, p = 0.030), cognitive restraint (β = 0.245, p = 0.009), and emotional eating behaviors (β = 0.338, p = 0.001).

CONCLUSION

In people with overweight or obesity, cognitive restraint and emotional eating behaviors improve as their food preparation and cooking skills improve. Therefore, education and public health practices on eating awareness, food skills, and cooking skills can play an important role in bringing healthy behavior change into practice in society.

Validation and measurement invariance of the muscularity-oriented eating test among Brazilian men and women

OBJECTIVE

The Muscularity-Oriented Eating Test (MOET) is a 15-item unidimensional scale, designed to assess eating practices that occur in the pursuit of a muscular body. The aim of the present study was to describe the translation and cultural adaptation of the MOET to Brazilian Portuguese, to explore its factor structure and measurement invariance, and to evaluate its internal consistency, three-week test-retest reliability, and convergent validity in a community sample of Brazilian men and women.

METHOD

After the back-translation procedure, the Brazilian MOET was administered online to a sample of 1246 adults (634 men and 612 women), along with measures of drive for muscularity, muscle dysmorphia symptoms, muscular/athletic-ideal internalization, disordered eating behaviors, and exercise dependence.

RESULTS

Findings from an exploratory factor analysis and a confirmatory factor analysis revealed a one-factor structure and adequate internal consistency for men (ω = 0.86; α = 0.86) and women (ω = .84; α = .83). Measurement invariance across gender was supported. In addition, the scale demonstrated good three week test-retest reliability for both men (ICC = .96; p < .001) and women (ICC = .92; p < .001), and the subscales revealed moderate to large associations with drive for muscularity, muscle dysmorphia symptoms, muscular/athletic-ideal internalization, disordered eating, and exercise dependence.

CONCLUSION

This study supports the validity and reliability of the MOET in a community sample of Brazilian men and women and represents an advance in measures of muscularity-oriented disordered eating in Brazilian adults, allowing for future cross-cultural studies in this field.

PUBLIC SIGNIFICANCE

The Muscularity-Oriented Eating Test (MOET) is a measure of muscularity-oriented disordered eating, which assess strict adherence to diet rules, including the food's macronutrient content, regulation of protein intake, and eating less or more to influence muscle gain. This study evaluated the validity and reliability of the MOET in a community sample of Brazilian men and women. Our findings represent an advance in measures of muscularity-oriented disordered eating in Brazilian adults.

Association between body weight misperception and dietary patterns in Brazilian adolescents: Cross-sectional study using ERICA data

The association between body image and eating behaviors or weight control strategies has been demonstrated in the scientific literature, but there is a lack of evidence on the association between weight misperception and food consumption indicators in adolescents. This study aimed to evaluate the association between weight misperception and dietary patterns (DPs) in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA). It was a national school-based cross-sectional study conducted among students aged 12–17 years. Data were collected in the form of anthropometric measurements, responses in self-answered questionnaires, and 24-h dietary recall. The following variables were assessed: weight underestimation and overestimation (independent variables), which were defined as the presence of a disagreement between nutritional status and self-perceived weight; dietary patterns (dependent variables), defined by a posteriori method using principal component factor analysis; and individual and demographic variables (covariates). Data analysis was performed using the Poisson regression models method, stratified by sex. A total of 52,038 adolescents with normal weights were evaluated. The weight misperception prevalence was 34.0% (95% confidence interval [CI]: 33.0, 35.0). Three DPs were identified: “Traditional Brazilian,” “Processed meat sandwiches and coffee,” and “Ultra-processed and sweet foods.” In girls, weight underestimation was directly associated with the “Traditional Brazilian” (1.24; 95% CI: 1.08, 1.43) and “Ultra-processed and sweet foods” DPs (1.29; 95% CI: 1.09, 1.54), and overestimation was inversely associated with all the DPs. In boys, a direct association between underestimation and the “Ultra-processed and sweet foods” DP (1.29; 95% CI: 1.10, 1.51) was found. Overestimation was inversely associated with the “Traditional Brazilian” DP (0.79; 95% CI: 0.63, 0.99). The inverse association between overestimation and the “Traditional Brazilian” DP, and the direct association between underestimation and the “Ultra-processed and sweet foods” DP indicated that weight misperception was related to unhealthy eating habits in Brazilian adolescents.