Gender, school and academic year differences among Spanish university students at high-risk for developing an eating disorder: an epidemiologic study

Nutrient intake, alcohol consumption, emotional eating and anxiety in women nursing students

Objective

The aim of the study was to analyze dietary habits, alcohol habits, emotional eating and anxiety in a sample of Spanish nursing students. These students appear to be essential to the field of public health and to teaching their future patients about their own good practices.

Methods

A cross-sectional investigation was conducted. Participants completed the Emotional Eater Questionnaire, the Alcohol Use Disorder Identification Test (AUDIT) test to evaluate alcohol intake, the State-Trait anxiety Inventory (STAI) test to measure levels of anxiety as a state and anxiety as a trait, and self-reported sociodemographic data. Following classroom instruction, three-day food records were used to gauge food intake.

Results

The calorie intake for the macronutrients Ca, Mg, K, and Fe were below the Recommended Dietary Intakes (DRI) and imbalanced. The percentage E of proteins was 132.7 % more than recommended, while the percentage of carbohydrates is below the recommended level. Dietary energy consumption barely equaled 78 % of the total energy consumed by this sex and age group. With respect to emotional eating, nursing women students were low emotional eater (44 %) > emotional eater (30 %) > non-emotional eater (22.7 %). The students' emotional eating is substantially connected with fast food and sweets, or less healthy food intake behaviors. According to the Alcohol Use Disorder Identification Test (AUDIT), 82.7 % of female students used alcohol on a regular basis in a low-risk manner.

Conclusion

The findings demonstrated a link between anxiety and dietary fat intake. Trait anxiety was negatively connected with emotional eating (EE), whereas state anxiety was positively correlated with meat consumption. It is crucial to consider these findings when creating prevention/intervention plans and profiles of harmful eating behaviors.

Study the Effect of an Innovative Educational Program Promoting Healthy Food Habits on Eating Disorders, Mediterranean Diet Adherence and Body Composition in University Students

The university stage is a good time to promote healthy eating strategies. The sociological and cultural changes experienced by students lead them to skip meals, increase their intake of fast food and energy-dense foods, decreasing adherence to the Mediterranean diet (MD). Professionals related to food such as nutritionists and dietitians are also considered a population at risk of developing eating disorders due to the extensive knowledge they possess, which can be used for both good and bad practice. The objective was to analyze the impact of a 4-month educational program promoting the Mediterranean diet on risky eating behaviors, adherence to the Mediterranean diet, and body composition in nutrition and dietetics students, studying the differences according to the group investigated (control group and educated group). The context of the research was 196 students (49 males and 147 females) from two consecutive years. The control group did not receive any type of intervention, while with the control group (educated) an educational program was carried out. Results showed that women with greater control over energy intake, carbohydrates, and sugar had a lower percentage of fat mass, while in men, the relationship was established with weight. Regarding adherence to the Mediterranean diet, at post, it is adequate in both men (8.25 ± 2.87) and women (7.90 ± 2.89), with no significant differences between the intervention groups.

Actions Speak Louder Than Words: Health Behaviours and the Literacy of Future Healthcare Professionals

Our everyday behaviours in life can positively and negatively impact our health, thus cumulatively shaping our lifestyles as more or less healthy. These behaviours are often determined by our knowledge, literacy, motivations and socioeconomic backgrounds. The authors aimed to assess health behaviours and explore variables that may affect persons studying to become future healthcare professionals in Poland. This study was conducted with a group of 275 undergraduate students attending the Poznan University of Medical Sciences representing six different majors of study. We used self-reported, cross-sectional survey conducted through the use of a questionnaire that consisted of one standardised scale (Juczyński’s Health Behaviour Inventory) as well as a self-developed health literacy measure. The students showed average to high levels of health-promoting behaviours (mean HBI = 82.04 ± 11.26). Medium to strong associations were found between these behaviours and high scores on the health literacy scale (p = 0.001, r = 0.45 between total scores of the two scales). Dietetics students and female respondents scored significantly better on both scales, which suggests that their self-reported behaviours and health literacy were higher than those of other participants. Exhibiting health-protective behaviours and high health literacy is likely to result in the better individual health of our respondents, but, more importantly, will also influence their future professions. As members of the healthcare workforce they will be responsible for the health of the population and it is crucial for them not only to provide care, education, and guidance, but also to act as role-models for their patients and society.

Actions Speak Louder Than Words: Health Behaviours and the Literacy of Future Healthcare Professionals

Our everyday behaviours in life can positively and negatively impact our health, thus cumulatively shaping our lifestyles as more or less healthy. These behaviours are often determined by our knowledge, literacy, motivations and socioeconomic backgrounds. The authors aimed to assess health behaviours and explore variables that may affect persons studying to become future healthcare professionals in Poland. This study was conducted with a group of 275 undergraduate students attending the Poznan University of Medical Sciences representing six different majors of study. We used self-reported, cross-sectional survey conducted through the use of a questionnaire that consisted of one standardised scale (Juczyński’s Health Behaviour Inventory) as well as a self-developed health literacy measure. The students showed average to high levels of health-promoting behaviours (mean HBI = 82.04 ± 11.26). Medium to strong associations were found between these behaviours and high scores on the health literacy scale (p = 0.001, r = 0.45 between total scores of the two scales). Dietetics students and female respondents scored significantly better on both scales, which suggests that their self-reported behaviours and health literacy were higher than those of other participants. Exhibiting health-protective behaviours and high health literacy is likely to result in the better individual health of our respondents, but, more importantly, will also influence their future professions. As members of the healthcare workforce they will be responsible for the health of the population and it is crucial for them not only to provide care, education, and guidance, but also to act as role-models for their patients and society.

[Prevalence and factors associated with eating disorders in Peruvian Human Medicine students in the context of the COVID-19 pandemic: a multicentre study]

INTRODUCTION

Eating disorders (ED) are serious conditions that have diverse consequences, associated with high morbidity and mortality: Among the factors associated with their development are, being female, and stress, which increased during the pandemic, and was higher in medical students. Our objective was to identify the prevalence and factors associated with ED in medical students.

METHODS

Cross-sectional study, conducted with an online questionnaire, between January 1 and 31, 2021, in 22 universities, using the Eating Disorder Scale (EAT-26) and the Family Communication Scale (FCS). Generalized logistic regressions were used to identify the association between variables.

RESULTS

A total of 1224 participants were recruited, and the prevalence was 12.5%. Associated factors included a poor perception of health in 34.3%, having a family and/or social environment member with an eating disorder in 21.7%, and medium or low satisfaction with family communication in 57.3% and 34.9% respectively, in addition to the academic year, dieting, concern for body image and the perception of inadequate eating.

CONCLUSIONS

Our results show that, in the context of the COVID-19 pandemic, 1-2 out of 10 Human Medicine students had an ED. The associated factors that influenced development of the condition included a fair or poor perception of health, the academic year completed, and medium or low satisfaction with family communication.

Potential Triggers for Risking the Development of Eating Disorders in Non-Clinical Higher-Education Students in Emerging Adulthood

Nowadays, eating disorders (ED) among individuals during emerging adulthood have become a crucial challenge to public health, taking into account the fact that the global prevalence of the ED risk in student-aged populations already stands at 10.4% and has been sharply increasing during the COVID-19 pandemic. In all, from 50% to 80% of all the ED cases go undetected or are not correctly diagnosed; moreover, these individuals do not receive specialized treatment. Therefore, early diagnosis detected via screening questionnaires for ED is highly recommended. This study aimed to identify the triggers for ED risk development in emerging-adulthood individuals and to reveal the factors significant not only for ED prevention but also for assessing individuals with subthreshold symptoms. This cross-sectional study provides the results for the ED symptom screening in 1716 Lithuanian higher-education students aged 21.2 ± 3.9, during emerging adulthood. According to the results of this study, 19.2% of students were at risk for ED. Potential risk factors such as sex (odds ratio (OR): 3.1, 95% CI: 1.9–4.9), body weight (self-reported body mass index) (adjusted (A) OR: 1.4; 95% CI: 1.2–1.7) and comorbidities such as smoking (AOR: 2.1; 95% CI: 1.6–2.8), and perceived stress during the pandemic (AOR: 1.4; 95% CI: 1.1–1.8) are involved in anticipating the symptomatology of ED during emerging adulthood. Regular initial screenings with universally adopted questionnaires and further referral to a psychiatrist must be applied to promote both the diagnosis of early-onset symptomatology and the treatment of these ED in student-aged populations. Preventive programs for reducing the prevalence of overweight or obesity among students during emerging adulthood should focus on integration directions for the development of a positive body image.

Psychosocial profile related to disordered eating attitudes in Spanish adolescents

Different psychosocial variables are related to disordered eating attitudes in adolescents, especially in girls. But some studies show that the variables involved in eating disorders may be different in boys and girls. The aim of this study was to analyse the psychosocial profile related to disordered eating attitudes in adolescents of both sexes, separately. Method: a cross-sectional study was conducted in 1630 Spanish adolescents, 890 of whom were girls with an average age of 14 (SD = 1.34) selected from secondary schools in the province of Alicante through random sampling stratified by school year. Results: The cluster analysis showed two profiles in both sexes. One profile presents high disordered eating attitudes, where the highest scores were in body dissatisfaction, perfectionism, pressure to lose weight and social comparison, and the lowest scores were for self-esteem. This contrasts with the other profile that presents low disordered eating attitudes. The logistic regression model showed that girls were 3.8 times more likely to have disordered eating attitudes if they dieted, experienced body dissatisfaction and compared themselves socially with their peers. Disordered eating attitudes in boys was 3.3 times greater when they experienced body dissatisfaction and pressure to lose weight. Conclusion: These results showed that both sexes present similar profiles. Girls and boys present disordered eating attitudes when they have low self-esteem, body dissatisfaction, self-oriented and socially prescribed perfectionism, comparison with peers, pressure to lose weight, or are on a diet. In future studies, it will be necessary to develop further longitudinal studies which could help to shed light on the risks and protective factors of eating disorders.

Symptoms of disturbed eating behavior risk: Gender and study factors in a cross-sectional study of two Norwegian medical schools

BACKGROUND

Studies about medical student's stress associated with disturbed eating behavior are scarce.

OBJECTIVES

To study the explanatory role of curricular factors and distress in disturbed eating behavior among medical students and whether this varies according to gender, study stage, curriculum model, study stress and mental distress.

METHODS

The cross-sectional sample surveyed consisted of Norwegian medical students at two faculties with different curricular models (traditional and integrated). The total response rate was 64% (1044/1635). We tested differences in disturbed eating behavior symptoms (EDS) and their correlates using stepwise linear regression analysis.

RESULTS

In total, 18.3% were cases of disturbed eating behavior symptoms, including 23.5% of female and 5.6% of male participants. Disturbed eating behavior symptoms were independently associated with the medical school stress factors "medical school is cold and threatening" (β = 0.07, p = .041), "worries about work and competence" (β =0.15, p < .001) and "worries about finances and accommodation" (β = 0.07, p = .018), in addition to female gender (β = 0.30, p < .001), mental distress (β = 0.17, p < .001), and body mass index (β = 0.28, p < .001). The variables explained 28.9% of the variance in disturbed eating behavior symptoms, and medical school stress contributed 9%. "Worries about work and competence" was more important among the female students.

CONCLUSIONS

Nearly one in five female medical students in the current sample reported symptoms of disturbed eating behavior. The symptoms were associated with medical school stress factors, mental distress, and body mass index.

Prevalence and determinants of eating disorder risk among Bangladeshi public university students: A cross-sectional study

Eating disorders among university students have been increasing day by day in developing countries. However, there is a dearth of existing literature that assessed eating disorder risk among this population group in Bangladesh. Thus, this study aimed to assess the prevalence of eating disorder risk and its associated factors among university students. A cross-sectional study was conducted among 365 Bangladeshi public university students from October to December 2019. Data were collected by self-reported questionnaire on socio-demographic characteristics, risk of eating disorder, and nutritional status of study participants. The respondents' eating disorder risk and nutritional status were assessed using the validated eating attitudes test-26 (EAT-26) tool and anthropometric measurement, respectively. A cut-off score of ≥ 20 based on EAT-26 indicates the presence of an eating disorder risk. Finally, a binary logistic regression was employed to identify the determinants of an eating disorder. The prevalence of 'eating disorder risk' was 23.0% (95% confidence interval [CI]: 18.6 to 27.4). Being female (adjusted odds ratio [AOR] = 2.4, 95% CI: 1.4 to 4.2), aged between 17-21 years (AOR = 2.0, 95% CI: 1.2 to 3.6), overweight (AOR = 4.9; 95% CI: 1.6 to 14.9) and obese (AOR = 7.7, 95% CI: 1.9 to 31.4) showed a higher odds of having an eating disorder risk in the present study. The higher prevalence of eating disorders in the study indicates that psychological intervention and health awareness programs, particularly to younger age, female, and overweight and obese students at the university level, would effectively prevent the eating disorder risk.

Food addiction symptoms are related to neuroaffective responses to preferred binge food and erotic cues

It has been proposed that some individuals succumb to maladaptive eating behaviors because, like those with addiction, they attribute high incentive salience to food-associated cues. Here, we tested whether women that attribute high incentive salience to food-associated cues report high food addiction symptomatology. In 76 college women, we assessed self-reported food addiction symptoms using the Yale Food Addiction Scale and we recorded event-related potentials (ERPs, a direct measure of brain activity) to preferred food, erotic, unpleasant, and neutral images. We used the amplitude of the late positive potential (LPP, a component of the ERPs) as an index of the incentive salience attributed to the images. Using a multivariate classification algorithm (k-means cluster analysis), we identified two neuroaffective reactivity profiles that have been previously associated with individual differences in the tendency to attribute incentive salience to cues and with differences in vulnerability to addictive behaviors. Results showed that women with elevated LPP responses to preferred food cues relative to erotic images report higher food addiction symptoms than women with low LPP responses to preferred food cues relative to other motivationally relevant stimuli. These results support the hypothesis that individual differences in the tendency to attribute incentive salience to food cues play an important role in modulating food addiction symptomatology.

Psychological Burden During the COVID-19 Pandemic in Germany

After the first COVID-19 case was diagnosed in Germany, various measures limiting contact between people were introduced across the country. The implementation of these measures varied between jurisdictions and potentially had a negative impact on the psychological well-being of many people. However, the prevalence, severity, and type of symptoms of psychological burden has not been documented in detail. In the current study, we analysed various self-reported symptoms of psychological burden in a German sample. The dataset was collected between April 8th and June 1st, 2020, through an online survey measuring psychological burden using the ICD-10-symptom rating scale. More than 2,000 individuals responded to the survey, with a total of 1,459 complete datasets. Data was then sampled to compare (1) the new data to an existing demographically comparable reference dataset including a total of 2,512 participants who did not undergo any kind of contact restrictions or other pandemic measurements, and (2) psychological burden in two different German states. In line with recent observations from Germany, Italy, China, Austria and Turkey, we found a high prevalence of depressive symptoms in comparison to the reference sample. Furthermore, we found a high prevalence of eating disorder and compulsion symptoms. Especially younger adults and women reported a higher symptom severity compared to other groups during our measurement period. However, no difference between the two states in psychological burden was found.

A review of risk factors associated with insulin omission for weight loss in type 1 diabetes

Research suggests that as many as 60% of people with type 1 diabetes (T1D) admit to misusing insulin. Insulin omission (IO) for the purpose of weight loss, often referred to as diabulimia, is a behaviour becoming increasingly recognised, not least since prolonged engagement can lead to serious vascular complications and mortality. Several risk factors appear to be relevant to the development of IO, most notably gender, anxiety and depression and increased weight concerns and body dissatisfaction. Evidence suggests that women, especially young girls, are more likely to omit insulin as a method of weight loss compared to men. Mental health conditions such as anxiety and depression are increasingly prevalent in people with T1D compared to their peers, and appear to contribute to the risk of IO. Increased weight concerns and body dissatisfaction are further prominent risk factors, especially given increases in weight which often occur following diagnosis and the monitoring of weight by diabetes teams. This review presents evidence examining these risk factors which increase the likelihood of a person with T1D engaging in IO and highlights the complications associated with prolongment of the behaviour. Further research looking at the comorbidities of these risk factors, alongside other factors, would provide greater insight into understanding IO in people with T1D.

Psychometric characteristics of the Three-Factor Eating Questionnaire-18 and eating behavior in undergraduate students

PURPOSE

To assess the psychometric characteristics of the Three-Factor Eating Questionnaire-18 (TFEQ-18) and to estimate the prevalence of cognitive restraint (CRes), uncontrolled eating (UE), and emotional eating (EE) among Brazilian undergraduate students.

METHODS

A total of 775 students completed TFEQ-18 (62.1% females; total mean age = 20.9 years [SD = 2.8]; females mean age: 20.8 years [SD = 2.8]; males mean age: 21.2 years [SD = 2.7]). Total sample was randomly separated in test/validation samples. An assessment of psychometric characteristics was conducted to each subsample with confirmatory factor analysis considering the indices: chi-square per degree of freedom ratio (χ²/df), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and Root Mean Square Error of Approximation (RMSEA). The mean score of each TFEQ-18 factor was estimated. The prevalence of CRes, UE, and EE was calculated with 95% confidence intervals (95%CI) and compared by sex and weight status.

RESULTS

The psychometric characteristics of the TFEQ-18 were adequate in both samples (test/validation: χ²/df = 3.58/2.86; CFI = 0.938/0.958; TLI = 0.928/0.951; RMSEA = 0.081/0.069). The prevalence of students with moderate to exacerbated scores of CRes, UE, and EE was 34.4% (95%CI  31.1-37.7%), 35.6% (95%CI 32.2-39.0%), and 43.1% (95%CI 39.6-46.6%), respectively. There were no statistically significant differences in prevalence according to sex or weight status.

CONCLUSIONS

The TFEQ-18 presented adequate psychometric characteristics and indicated a high prevalence of CRes, UE, and EE among the students. This research emphasizes the importance of investigating aspects of eating behavior to best direct clinical and educational strategies for reducing the risk of adopting unhealthy eating behaviors among undergraduate students.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Eating Behavior of Brazilian College Students: Influences of Lifestyle, Negative Affectivity, and Personal Characteristics

In this study we proposed to estimate the impact of lifestyle, negative affectivity, and college students' personal characteristics on eating behavior. We aimed to verify that negative affectivity moderates the relationship between lifestyle and eating behavior. We assessed eating behaviors of cognitive restraint (CR), uncontrolled eating (UE), and emotional eating (EE)) with the Three-Factor Eating Questionnaire-18. We assessed lifestyle with the Individual Lifestyle Profile, and we assessed negative affectivity with the Depression, Anxiety and Stress Scale-21. We constructed and tested (at p < .05) a hypothetical causal structural model that considered global (second-order) and specific (first-order) lifestyle components, negative affectivity and sample characteristics for each eating behavior dimension. Participants were 1,109 college students (M age = 20.9, SD = 2.7 years; 65.7% females). We found significant impacts of lifestyle second-order components on negative affectivity (β = -0.57-0.19; p < 0.001-0.01) in all models. Physical and psychological lifestyle components impacted directly only on CR (β=-0.32-0.81; p < 0.001). Negative affectivity impacted UE and EE (β = 0.23-0.30; p < 0.001). For global models, we found no mediation pathways between lifestyle and CR or UE. For specific models, negative affectivity was a mediator between stress management and UE (β=-0.07; p < 0.001). Negative affectivity also mediated the relationship between thoughts of dropping an undergraduate course and UE and EE (β = 0.06-0.08; p < 0.001). Participant sex and weight impacted all eating behavior dimensions (β = 0.08-0.34; p < 0.001-0.01). Age was significant for UE and EE (β=-0,14- -0.09; p < 0.001-0.01). Economic stratum influenced only CR (β = 0.08; p = 0.01). In sum, participants' lifestyle, negative emotions and personal characteristics were all relevant for eating behavior assessment.

Occurrence, sociodemographic, and clinical correlates of eating disorders among a sample of secondary school students in Egypt

Background

Eating disorders are common in adolescents. Data on occurrence rates, sociodemographic correlates, and risk factors in Egyptian population are needed along with better screening tools to inform future research and service development. We aimed to estimate the occurrence of eating disorders in a representative sample of Egyptian adolescent students and to examine the sociodemographic and clinical risk factors associated with eating disorders. So, a multistage random selection of 407 adolescent students from public and private secondary schools in Eastern Tanta, Egypt, was carried out. All participants were subjected to screening using the Eating Attitude Test (EAT) and the eating disorders section of the clinician version of the Structured Clinical Interview for DSM-IV axis-I disorders

Results

Occurrence estimates of anorexia nervosa and bulimia nervosa were 6.1% and 3.2%, respectively. Being female, overweight (BMI = 25–29.9 kg/m2), low self-esteem, and high body shape preoccupation were significantly associated with eating disorders risk among adolescents.

Conclusions

Eating disorders are prevalent in the general adolescent population. The unmet treatment needs in the adolescent population place these disorders as important public health concerns.

Lifestyle choices of Brazilian college students

Background

Lifestyle choices reflect the beliefs that individuals attribute to aspects of life. This construct can be assessed with the Individual Lifestyle Profile (PEVI) questionnaire, which measures elements of Nutrition, Physical Activity, Preventive Behaviors, Social Relationships and Stress Management.

Objective

The objective of this study was to estimate the psychometric properties of the PEVI applied to a sample of Brazilian university students, identifying the prevalence of each lifestyle component according to participants’ age, sex, weight status, course area/field and economic stratum and to estimate the contribution of these characteristics on physical and psychological lifestyle.

Methods

The PEVI data was analyzed by confirmatory factor analysis, using the indexes chi-square per degrees of freedom ratio (χ²/df), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI) and Root Mean Square Error of Approximation (RMSEA). First-order and second-order models (physical and psychological lifestyle) were tested. Prevalences of lifestyle components were calculated and compared by participants’ age, sex, weight status, course area/field and economic stratum. A hypothetical causal structural model was elaborated to investigate the impact of sample characteristics on physical and psychological lifestyles. This model was evaluated considering the global fit to the data (χ²/df, CFI, TLI and RMSEA) and the hypothetical causal trajectories (β) (α = 5%).

Results

A sample of 1,303 students was used. The mean age was 20.9 (standard deviation = 2.8) years, 66.8% of participants were females, 63.4% had weights in the normal range and 73.7% were students of the social and exact sciences. The PEVI data showed an adequate fit for both the first- (χ²/df = 2.03, CFI = 0.98; TLI = 0.97; RMSEA = 0.04) and second-order (χ²/df = 2.25; CFI = 0.97; TLI = 0.97; RMSEA = 0.04) models. There was a higher prevalence of unfavorable physical and psychological lifestyle choices among females, among underweight and obese individuals, in older students and in those with lower economic strata. Moreover, negative behaviors in physical lifestyle were more prevalent in students from human/social/exact sciences and worse psychological lifestyle was observed among health sciences students. These results were confirmed by a structural model.

Conclusion

The PEVI data presented validity and reliability. Negative lifestyle choices had high prevalence among students. Moreover, individual characteristics had different impact on physical and psychological lifestyle choices.

Prevalence and Risk Factors of Disordered Eating Attitudes and Behaviors Among High-school Girls in Al-Madinah City, Saudi Arabia

Objectives::

To determine the prevalence of disordered eating attitudes and behaviors among high-school girls in Al-Madinah City, Saudi Arabia.

Methods::

A cross-sectional descriptive study was conducted in Al-Madinah city in 2014-15. A multi- stage random sampling technique was adopted to include female students of government secondary schools. The Eating Attitudes Test (EAT-26) and socio-economical questionnaires were used in the study for assessing the prevalence of disordered eating. All data were entered and analyzed using SPSS version 20.

Results::

Overweight and obesity were reported among 11.2% and 5.6% of them, respectively, whereas 31.3% of the participants were underweight. The overall prevalence of disordered eating attitudes among female students was 42.5%. This rate was significantly higher among younger (≤16 years old) and those of the first scholastic level than others. The rate of disordered eating attitude was reported at a higher rate among obese students (59.1%) than underweight (41.5%) and normal students (42.4%). The commonest reported disordered eating behavior was self-reported binge eating behaviour (25.2%), followed by self-induced vomiting (8.7%) and the use of laxatives/ diuretics to control weight (6.1%).

Conclusion::

The findings show a high prevalence of disordered eating attitude among high school female students in Al-Madinah city. Younger girls and those of the first scholastic level showed higher disordered eating attitude.

Drive for muscularity and disordered eating behaviors and its relationship with anthropometric indicators and physical activity in Mexican adolescent men

PURPOSE

Adolescent men have been identified as a risk population to develop eating disorders and other psychopathologies as drive for muscularity (DM) recently considered as muscularity-oriented disordered eating. It is important to identify risk factors as precursors of these pathologies. The aim of this study was to determine the risk of developing disordered eating behaviors (DEB) and DM and its relationship with anthropometric indicators and physical activity (PA) in adolescent men (high-school students, age 15-19) from Hidalgo, Mexico.

METHODS

A cross sectional, descriptive, and correlational field study was carried out in a non-probabilistic sample of 267 Mexican adolescents aged 15-19 years. Participants completed measures of DM, DEB, and PA. Each subject was weighted and heighted to calculate body mass index (BMI), body fat percentage, and fat-free mass index (FFMI).

RESULTS

Adolescents in the DM risk category (OR 8.28, CI 2.71-25.22) had significantly greater odds of developing DEB, while adolescents with higher BMI scores (OR 1.28, CI 1.14-1.45) tended to be more likely of developing DEB. The results showed that DEB and moderate PA were associated with DM; adolescents who engaged in DEB had an 8.64 times (CI 3.05-24.52) higher risk of developing DM. Participants classified in the category of highest moderate PA (OR 2.66, CI 1.26-5.59) had significantly greater odds of developing DM.

CONCLUSION

Important percentages of the risk of developing DEB and DM were determined in Mexican adolescent men. In agreement with other findings, there were no associations between anthropometric indicators and DM.

LEVEL OF EVIDENCE

V, descriptive cross-sectional study.

Disordered Eating Behaviors and Sexual Harassment in Italian Male and Female University Students

The aim of this study is to describe sexual harassment among Italian university students and analyze the relationship between harassment and disordered eating behaviors. An observational survey was conducted among university students at Trieste University (Italy) in spring 2014. Students answered an anonymous self-administered questionnaire about sexual harassment, including three domains-sexual harassment, unwanted comments on physical appearance, cyber-harassment-and disordered eating behaviors. The global sexual harassment index was computed with three levels: Level 0, no harassment; Level 1, harassment in at least one of the three domains; and Level 2, harassment in two or three domains. Disordered eating behaviors were classified by at least one of the following: (a) eating without being able to stop or vomiting at least once or twice a month, (b) using laxatives or diuretics at least once or twice a week, (c) monitoring weight every day, and (d) dieting at least very often. The sample included 759 students (347 men and 412 women; 18-29 years old). Experiencing sexual harassment was related to eating disorder symptoms for both genders with a regular gradient: the higher the harassment score, the more frequent the disordered eating behavior symptoms, even after adjusting for age and previous sexual violence. The association was stronger for males than females. Sexual harassment and disordered eating behaviors have long been considered mainly a female problem. Men are not exempt from these problems and in some cases may be more affected than women. The topics should be assessed in men and women.

A controlled study of an integrated prevention program for improving disordered eating and body image among Mexican university students: A 3-month follow-up

Obesity and eating disorders are currently two significant health problems in Mexico. The aim of this study was to examine the effects of an integrated prevention program on university students through an exploratory controlled study that targeted specific predisposing factors of disordered eating and obesity related to healthy eating, physical activity, body image satisfaction and perceived pressure to be thin. A total of 388 university students participated (264 females and 124 males) and were assigned either to an intervention condition or one of the two control conditions (study skills vs. nonintervention); each comprised of a total of eight workshops lasting 90 min. The program did not have any effect on the male students. In contrast, there was an interaction effect for time and group in thin-ideal internalization (η²  = 0.04) and in disordered eating attitudes/behaviours (η²  = 0.03); both showed improvements over time only among the female sample. Though, the effect size was insignificant, which means that the effectiveness of this integrated prevention program was limited. Integrated prevention approaches to eating and weight-related problems are still nascent in Mexico, and further research in this field is warranted so as to fine tune future prevention programs.

Disordered eating attitudes correlate with body dissatisfaction among Kuwaiti male college students

BACKGROUND

The prevalence of disordered eating attitudes and body dissatisfaction based on muscularity and body fat was investigated among male college students in Kuwait with a range of body mass index values including underweight, normal weight, overweight, and obese participants.

METHODS

Data were collected, using the Eating Attitudes Test (EAT-26) and the Bodybuilder Image Grid (BIG), from 400 male undergraduate students (84.8% Kuwaiti nationals) recruited from both public and private universities in Kuwait. An anonymous, self-administered questionnaire was used to determine the prevalence of symptomatology indicative of anorexia nervosa and bulimia nervosa and to examine the associations between body dissatisfaction and muscularity and body fat.

RESULTS

Most participants were dissatisfied with their current muscle mass and body fat (67.3 and 69%, respectively). Logistic regression analyses produced odds ratios (ORs) demonstrating that students dissatisfied with their muscularity and body fat and those who indicated a desire to decrease both muscularity and body fat had significantly higher odds of being at risk of disordered eating attitudes (OR = 2.241, 95% CI [1.17, 3.6], p = .032, and OR = 1.898, 95% CI [1.214, 2.967], p = .005, respectively). Obese participants also had higher odds of exhibiting disordered eating attitudes (OR = 2.06, 95% CI [1.17, 3.60], p = .011).

CONCLUSION

The high proportion of disordered eating attitudes among Kuwaiti college men was associated with high levels of body image dissatisfaction in relation to both body fat and muscularity. High levels of eating disorder symptoms were also linked to obesity.

Eating disorder symptoms in Brazilian university students: a systematic review and meta-analysis

Objective:

To synthesize the risk of eating disorder (ED) symptoms in Brazilian university students through a systematic review and meta-analysis. Secondary goals were to analyze whether any specific majors were related to higher ED risk and whether any regions of Brazil had higher proportions of college students at risk of ED.

Methods:

The procedures followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, and a search was conducted in three electronic databases (MEDLINE, LILACS, and SciELO).

Results:

Thirty-three studies were included in the analysis, of which 14 were included in the meta-analysis. All included studies used self-report questionnaires, the most frequent of which was the Eating Attitudes Test (EAT-26). None of the studies used a structured interview to diagnose ED. A meta-analysis of studies with a cutoff ≥ 20 for the EAT-26 (n=5) found 14.9% (95%CI 12.8-17.2%) positive screenings, while those with a cutoff of t ≥ 21 (n=9) found 13.3% (95%CI 11.3-15.6%) positive screenings. There was a significantly higher proportion of positive screenings among nutrition majors than all other majors combined (26.5 and 20.5%, respectively).

Conclusion:

Nutrition students seem to be at higher risk of ED. Further research should investigate whether positive screenings translate to actual ED diagnoses.

Family profiles in eating disorders: family functioning and psychopathology

Research has studied family functioning in families of patients suffering from eating disorders (EDs), particularly investigating the associations between mothers’ and daughters’ psychopathological symptoms, but limited studies have examined whether there are specific maladaptive psychological profiles characterizing the family as a whole when it includes adolescents with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Through the collaboration of a network of public and private consultants, we recruited n=181 adolescents diagnosed for EDs (n=61 with AN, n=60 with BN, and n=60 with BEDs) and their parents. Mothers, fathers, and youths were assessed through a self-report measure evaluating family functioning, and adolescents completed a self-report questionnaire assessing psycho-pathological symptoms. Results showed specific family functioning and psychopathological profiles based on adolescents’ diagnosis. Regression analyses also showed that family functioning characterized by rigidity predicted higher psychopathological symptoms. Our study underlines the importance of involving all members of the family in assessment and intervention programs when adolescent offspring suffer from EDs.

Male body dissatisfaction scale (MBDS): proposal for a reduced model

AIMS

To evaluate the psychometric properties of the male body dissatisfaction scale (MBDS) in Brazilian and Portuguese university students; to present a reduced model of the scale; to compare two methods of computing global scores for participants' body dissatisfaction; and to estimate the prevalence of participants' body dissatisfaction.

METHODS

A total of 932 male students participated in this study. A confirmatory factor analysis (CFA) was used to assess the scale's psychometric properties. Multi-group analysis was used to test transnational invariance and invariance in independent samples. The body dissatisfaction score was calculated using two methods (mean and matrix of weights in the CFA), which were compared. Finally, individuals were classified according to level of body dissatisfaction, using the best method.

RESULTS

The MBDS model did not show adequate fit for the sample and was, therefore, refined. Thirteen items were excluded and two factors were combined. A reduced model of 12 items and 2 factors was proposed and shown to have adequate psychometric properties. There was a significant difference (p < 0.001) between the methods for calculating the score for body dissatisfaction, since the mean overestimated the scores. Among student participants, the prevalence of body dissatisfaction with musculature and general appearance was 11.2 and 5.3%, respectively.

CONCLUSIONS

The reduced bi-factorial model of the MBDS showed adequate validity, reliability, and transnational invariance and invariance in independent samples for Brazilian and Portuguese students. The new proposal for calculating the global score was able to more accurately show their body dissatisfaction. No level of evidence Basic Science.

'I can't accept that feeling': Relationships between interoceptive awareness, mindfulness and eating disorder symptoms in females with, and at-risk of an eating disorder

Mindfulness based therapies (MBTs) for eating disorders show potential benefit for outcomes yet evidence is scarce regarding the mechanisms by which they influence remission from symptoms. One way that mindfulness approaches create positive outcomes is through enhancement of emotion regulation skills. Maladaptive emotion regulation is a key psychological feature of all eating disorders. The aim of the current study was to identify facets of emotion regulation involved in the relationship between mindfulness and maladaptive eating behaviours. In three cross-sectional studies, clinical (n=39) and non-clinical (n=137 and 119) female participants completed: 1) the Eating Disorder Inventory (EDI) eating specific scales (drive-for-thinness and bulimia) and the EDI psychological symptom scales (emotion dysregulation and interoceptive deficits); and 2) mindfulness, impulsivity, and emotion regulation questionnaires. In all samples mindfulness was significantly and inversely associated with EDI eating and psychological symptom scales, and impulsivity. In non-clinical samples interoceptive deficits mediated the relationship between mindfulness and EDI eating specific scales. Non-acceptance of emotional experience, a facet of interoceptive awareness, mediated the relationship between mindfulness and eating specific EDI scores. Further investigations could verify relationships identified so that mindfulness based approaches can be optimised to enhance emotion regulation skills in sufferers, and those at-risk, of eating disorders.

An attentional bias for thin bodies and its relation to body dissatisfaction

Research suggests that humans have an attentional bias for the rapid detection of emotionally valenced stimuli, and that such a bias might be shaped by clinical psychological states. The current research extends this work to examine the relation between body dissatisfaction and an attentional bias for thin/idealized body shapes. Across two experiments, undergraduates completed a gender-consistent body dissatisfaction measure, and a dot-probe paradigm to measure attentional biases for thin versus heavy bodies. Results indicated that men (n=21) and women (n=18) show an attentional bias for bodies that correspond to their own gender (Experiment 1), and that high body dissatisfaction among men (n=69) and women (n=89) predicts an attentional bias for thin same-gender bodies after controlling for body mass index (BMI) (Experiment 2). This research provides a new direction for studying the attentional and cognitive underpinnings of the relation between body dissatisfaction and eating disorders.

Disordered Eating Behaviors and Food Addiction among Nutrition Major College Students

Evidence of whether nutrition students are free from food-related issues or at higher risk for eating disorders is inconsistent. This study aimed to assess disordered eating behaviors and food addiction among nutrition and non-nutrition major college students. Students (n = 967, ages 18–25, female 72.7%, white 74.8%) enrolled at a public university completed online demographic characteristics surveys and validated questionnaires measuring specific disordered eating behaviors. Academic major category differences were compared. Additionally, high risk participants were assessed by weight status and academic year. Overall, 10% of respondents were a high level of concern for developing eating disorders. About 10.3% of respondents met criteria for food addiction. In addition, 4.5% of respondents had co-occurrence of eating disorder risk and food addiction risk out of total respondents. There were no significant differences in level of concern for developing an eating disorder, eating subscales, or food addiction among academic majors. The percentage of high risk participants was lower in the underweight/normal weight group than in the overweight/obese group in health-related non-nutrition major students but not in nutrition students. Early screening, increasing awareness, and promoting healthy eating habits could be potential strategies to help treat and prevent the development of disorders or associated health conditions in nutrition as well as non-nutrition students.

Factors that contribute to the body image concern of female college students

OBJECTIVE

To estimate the contribution of sociodemographic and labor variables and body mass index to body image concern.

METHODS

In order to estimate body image concern, the Body Shape Questionnaire (BSQ) and the Weight Concerns Scale (WCS) were applied. A confirmatory factor analysis of scales was carried out. The reason χ2 by degree of freedom ratio (χ2/df ), Comparative Fit Index (CFI), Normed Fit Index (NFI), and root mean square error of approximation (RMSEA) were used. Convergent validity was assessed through the average variance extracted and composed reliability and the internal consistency through standardized Cronbach's alpha coefficient (α). A structural model was developed, and the body image concern was the second-order main construct. The model appropriation was evaluated based on the goodness-of-fit indices. The z test was used to estimate the significance of trajectories (β) using a 5% significance level.

RESULTS

Totally, 595 female college students participated in the study, with a mean age of 20.42 ± 2.44 years. The entire model, with the inclusion of all independent variables, showed unsatisfactory adjustment and was refined. The final model presented a satisfactory adjustment (χ2/df = 5.75; CFI = 0.87; NFI = 0.85; RMSEA = 0.09) with inclusion of medication use because of studies (β = 0.08; p = 0.04), academic performance (β = 0.09; p = 0.02), economic class (β = 0.08; p = 0.03), and body mass index (β = 0.44; p < 0.001). This model explained 22% of body image concern.

CONCLUSION

Medication use due to studies, academic performance, economic class and body mass index significantly contribute to body image concern.

The Relationship of Disordered Eating Attitudes With Body Composition and Anthropometric Indices in Physical Education Students

Background:

Abnormal eating behavior, unhealthy weight control methods, and eating disordered symptoms have risen among college students.

Objectives:

The aim of this study was to examine disordered eating attitudes and their relationship with anthropometric and body composition indices in physical education students in Tabriz, the capital of East Azerbaijan province, Iran.

Patients and Methods:

This cross-sectional study was conducted on 210 physical education students, 105 males and 105 females aged 18 to 25, who were selected by systematic random sampling from physical education faculty of Tabriz University in Tabriz, Iran, in 2013. Eating attitude test (EAT-26) was used for the assessment of disordered eating attitudes. In addition, anthropometric and body composition indices were assessed.

Results:

About 10% of the studied subject had disturbed eating attitudes; significantly more males (15.4%) reported an EAT-26 ≥ 20 (disordered eating attitudes) than females (4.8%) (P < 0.05). In males, the EAT-26 score was positively correlated with weist perimeter (WP) (r = 0.21, P < 0.05) and the waist-to-hip ratio (r = 0.26, P < 0.01). In females, the EAT-26 score was positively correlated with weight (r = 0.19, P < 0.05) and the WP (r = 0.28, P < 0.01). In females, weight (P < 0.05), body mass index (BMI) (P < 0.05), WP (P < 0.01), and waist-to-hip ratio (P < 0.05) were significantly different between disordered eating attitude and healthy subjects, while in males there was no significant difference between the two groups regarding the anthropometric and body composition indices.

Conclusions:

Abnormal eating attitude was notable among physical education students in Tabriz, Iran. It seems that some anthropometric indices such as BMI and central obesity indices were related to the increase of disordered eating attitude.

Preocupação com a forma do corpo de graduandos de Farmácia-Bioquímica

Objetivo Identificar a preocupação com a forma do corpo de estudantes de Farmácia-Bioquímica e sua relação com variáveis sociais e laborais e com o estado nutricional. Métodos Participaram 346 discentes com média de idade de 20,2 (DP = 2,4) anos, sendo 278 (80,3%) do sexo feminino. Utilizou-se o Body Shape Questionnaire (BSQ). As validades fatorial e convergente e a consistência interna (α) do BSQ foram estimadas. Utilizaram-se como índices de ajustamento o qui-quadrado pelos graus de liberdade (χ2/gl), o Comparative Fit Index (CFI), o Normed Fit Index (NFI) e o Root Mean Square Error of Approximation (RMSEA). O escore médio de preocupação com a forma do corpo foi obtido por meio de algoritmo gerado na análise fatorial confirmatória. Para comparar os escores médios segundo as variáveis de interesse, utilizou-se Análise de Variância (ANOVA). Resultados O BSQ apresentou, para a amostra de estudo, adequada validade (χ2/gl = 3,29; CFI = 0,87, NFI = 0,82, RMSEA = 0,08) e confiabilidade (α = 0,97) após ajustamento. Verificou-se que as mulheres (p < 0,001) apresentaram maior preocupação com a forma do corpo que os homens. Além disso, os estudantes que avaliaram o curso como pior que as expectativas iniciais (p = 0,048), que consomem medicamentos por causa dos estudos (p < 0,001), que já pensaram em desistir do curso (p = 0,002) e foram classificados com sobrepeso/obesidade (p < 0,001) também apresentaram alta preocupação com a forma do corpo. Conclusão As varáveis sexo, avaliação em relação ao curso, ingestão de medicamentos por causa dos estudos, pensamento em desistir do curso e o estado nutricional apresentaram relação significativa com a preocupação com a forma do corpo entre os estudantes.

Late onset eating disorders in Spain: clinical characteristics and therapeutic implications

OBJECTIVE

The literature on later age of onset (LAO) in women with eating disorders is scarce. We compared the severity of eating disorders, eating disorder subtype, and personality profiles in a clinical sample of consecutively assessed women with eating disorders with later age of onset (LAO, > = 25 years) to women with typical age of onset (TAO, <25 years).

METHOD

All eating disorder patients met the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) criteria and were admitted to the Eating Disorder Unit of the University Hospital of Bellvitge in Barcelona, Spain. Ninety-six patients were classified as LAO and 759 as TAO.

ASSESSMENT

Measures included the Eating Attitude Test-40 (EAT-40), Eating Disorders Inventory-2 (EDI-2), Bulimic Investigatory Test Edinburgh (BITE), Symptom Checklist Revised (SCL-90-R), and the Temperament and Character Inventory-Revised (TCI-R), as well as other clinical and psychopathological indices.

RESULTS

LAO individuals reported significantly fewer weekly vomiting episodes, fewer self-harming behaviours, less drug abuse, and lower scores on the BITE symptoms, the EDI-2 drive for thinness, and the TCI-R harm avoidance scales than TAO individuals. Conversely, the LAO group reported more current and premorbid obesity than the TAO group.

CONCLUSION

LAO eating disorder patients in this sample presented with milder symptomatology and less extreme personality traits. Premorbid obesity may be more relevant to LAO than TAO eating disorders and should be routinely assessed and considered when planning treatment.

A randomized control trial: training program of university students as health promoters

BACKGROUND

Several studies have reported the following as determining factors for the adoption of healthy lifestyles among undergraduate students: gender, socioeconomic level, prior lifestyles, environment, parental lifestyles and health status, career choice, and healthy support networks. However, these factors are influenced by students' knowledge about healthy lifestyles.

METHODS/DESIGN

We will carry out a randomized trial in a sample of 280 new undergraduate students at the National Autonomous University of Mexico's Faculty of Higher Studies-Zaragoza (FES-Zaragoza, UNAM). There will be an experimental group (n = 140), comprising 20 students from each of the seven university departments (careers); these students will receive training as university student health promoters through an e-learning course. This course will allow the topics necessary for such promoters to be reviewed. There will be a control group (n = 140), comprising 20 students from each of the seven departments (careers); these students will not undergo the training. Later, the students who comply satisfactorily with the e-learning course will replicate the course to 10 of their classmates. A healthy-lifestyle questionnaire will be given to all the participants, and the parameters established in the self-care card will be recorded before and after the training. The study variables are as follows: (i) independent variable-compliance with the e-learning course; (ii) dependent variables-lifestyles changes prior to the educative intervention (including healthy eating, physical activity, and addiction prevention) and parameters related to health status established in self-care (including weight, body mass index, waist circumference, and hip circumference). Data will be analyzed using Student's t test and logistic regression analysis odds ratios with 95% confidence intervals. The analysis of the open answers will be carried out with ATLAS. ti 5.5 software.

DISCUSSION

Health promotion among university students should incorporate options that are feasible for and attractive to students. Thus, as proposed in the present protocol, e-learning courses offer excellent possibilities because they allow students to program their learning in their available time without affecting their academic studies.

TRIAL REGISTRATION

http://ISRCTN77787889.

A cross-sectional study of body shape and eating attitude among Indian female healthcare students

OBJECTIVE

The current study aimed at assessing eating attitude and body shape concerns among Indian female healthcare students who had received some teaching/training in Psychiatry.

METHOD

The study was conducted at government medical and nursing college. All the undergraduate healthcare students enrolled with institute at the time of study constituted the sampling frame for the study. Survey-based methodology was used for data collection. Study scales included semi-structured proforma, Eating Attitudes Test-26 (EAT-26) (including the three sub-scales), and Body Shape Questionnaire (BSQ). Data were analyzed using Pearson's and Spearman's correlation statistics and ANOVA with post hoc analysis.

RESULTS

A total of 498 students returned the completed study questionnaire. There was significant correlation between Body Mass Index (BMI) and EAT-26 scores) including the sub-scales score of EAT-26). Similarly, BMI and BSQ scores were also significantly correlated.

DISCUSSION

The findings from current study help understand the body shape and eating attitudes of Indian female healthcare students who had received some teaching/training in Psychiatry.

Eating Disorder Examination Questionnaire (EDE-Q)

Background: Most studies on the Eating Disorder Examination Questionnaire (EDE-Q) focus exclusively on women. Aims: To examine the internal consistency and convergent validity of the EDE-Q in Spanish undergraduate men and to compare the results with those obtained previously in college samples of Spanish women and American men. Methods: 269 college men, aged 18–30 years, answered the EDE-Q, Eating Disorder Inventory (EDI-2), and Body Shape Questionnaire (BSQ). Results: The four subscale scores and the global score of the EDE-Q achieved acceptable internal consistency (α ≥ .65), and evidence on convergent validity with EDI-2 and BSQ was obtained (r ≥ .41). Average scores, standard deviations, and percentile ranks for the raw EDE-Q subscales and data on the occurrence of binge eating and compensatory behaviors are presented. Most values were lower than those found in previous studies with Spanish undergraduate women and American undergraduate men. Discussion: Lower scores in EDE-Q subscales provide country differences between Spain and United States and support the existence of gender differences in eating disorders attitudes. These data should help clinicians and researchers to interpret the EDE-Q scores of college men in Spain.

Lifestyle and health among Spanish university students: differences by gender and academic discipline

Today the need to analyze health behaviour from a gender perspective is as imminent as ever, particularly at university, where the number of women who register is on the rise and has exceeded the number of male students worldwide. We carried out a prevalence study aimed at analyzing Spanish university students’ lifestyles and identify differences according to gender and academic discipline. Of 3,646 eligible subjects doing university courses related to health (Group A), education (Group B) and other professions (Group C), 985 (27.0%) participated in the study. Information was elicited about their physical activity level, disturbed eating attitudes, consumption of alcohol, tobacco and illegal substances. Prevalence and Odds Ratios (OR) were calculated according to sex and kind of academic discipline. The obtained data confirmed that only 27.4% of the students were considered as sufficiently active, while 14.9% of them suffered from disturbed eating attitudes (DEA). Women were particularly less active (OR 0.46 (0.32–0.66); p < 0.0001), and more sedentary than men (OR 1.40 (1.00–1.97); p = 0.03). Binge drinking was more frequent in female than in male students (OR 1.79 (1.29–2.47); p = 0.0004). A third of the analyzed sample admitted that they had used illegal substances, while a lower consumption prevalence was found in women (OR 0.53 (0.40–0.71); p < 0.0001). The studied population was not very active (27.4%), especially women (OR = 0.45). Therefore, it seems that Spanish university students lead an unhealthy lifestyle, a situation which seems more conspicuous amongst females.

A synopsis of recent influential papers published in psychiatric journals (2010-2011) from the Arab world

Six recent and influential papers that have appeared in the three leading psychiatry journals from the Arab region are summarized in this review. The first paper examined the prevalence of eating disorders (EDs) in rural and urban secondary school girls in Sharkia; more EDs were found among urban than rural population. The second study reported the high prevalence of Post Traumatic Stress Disorder (PTSD) in primary school children in Iraq in context of the present situation in Iraq dominated by violence creating a traumatizing atmosphere for the population, especially children. The third paper reported that substance dependent patients manifest elevated traits of impulsivity; emotionally driven impulsivity in particular predicted substance related problems. The fourth study reported significant cognitive impairments at illness onset in a large sample of patients with a first psychotic episode. The fifth paper, investigated the cultural imprint on symptom profile of mood disorders. Culture effect on mood disorder was more prominent in depression than in mania. The last article examined the relations between social circumstances, medical morbidity, locus of control and depression in elderly patients suffering from medical conditions. Overall, the papers describe a wide spectrum of research initiatives in the Arab World that are likely to have implications for global mental health.

Severe anorexia nervosa in men: comparison with severe AN in women and analysis of mortality

OBJECTIVE

To compare clinical characteristics of men and women with severe AN and to analyze mortality in men.

METHOD

One thousand and nine patients including 23 anorectic males were hospitalized in St. Anne Hospital in Paris between 1988 and 2004. Data were collected during hospitalization. Fatal outcome was assessed in 2008.

RESULTS

Men presented significantly later age of onset, were more likely to have a history of premorbid overweight than women and less likely to have attempted suicide. Mortality in men was high (standardized mortality ratio: 8.08; 95% CI: 1.62-23.62). Several predictive factors for mortality in men were identified: lower admission body mass index (BMI), later age at admission, and AN-R subtype. All the three deceased patients had dropped out from the inpatient unit. The 10-year survival did not differ between men and women, but men died sooner after hospitalization.

DISCUSSION

Male inpatients should receive close follow-up after their discharge, especially if they have a restrictive form of AN, present low BMI, or are older at admission.

Disordered eating attitudes in Egyptian antipsychotic naive patients with schizophrenia

OBJECTIVES

The study aimed to test in a sample of Egyptian antipsychotic naive patients the hypotheses that the disordered eating attitudes co-occur with schizophrenia in a higher frequency than would be expected by chance in the general population and that the disordered eating comorbidity would be associated with more severe schizophrenia psychopathology. Previous studies have been mostly concerned with the impact of the antipsychotics. Studies relating abnormal eating behavior to the schizophrenia psychopathology rather than to its treatment are lacking.

METHOD

In this case-control cross-sectional study, 50 consecutive antipsychotic naive patients, newly attending the psychiatric outpatient clinic, University Hospital, Zagazig, Egypt, with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of schizophrenia, were assessed by the Positive and Negative Syndrome Scale and compared with 50 nonpsychiatric controls using the Eating Attitudes Test (EAT40).

RESULTS

Patients with schizophrenia had an EAT40 mean score (23.4 ± 7.8) higher than that of controls (19.7 ± 7.2) (P = .015). Prevalence of disordered eating (defined by a score of ≥ 30 on the EAT40) in these patients was higher than in the control group (30% vs 12%, P = .027). Comparison between schizophrenia patients with and without disordered eating showed no significant differences in demographic and a number of clinical variables, but they differed in their scores on lifestyle characteristics and anthropometric measures. The group of patients with disordered eating had also higher scores on total and all scale factors but not on the negative symptom scale.

CONCLUSIONS

Data of this study show, perhaps for the first time, that "disordered" eating attitudes, as measured by the EAT40, are higher in a group of Egyptian patients with schizophrenia than in controls. However, the lack of difference between patients with and without disordered eating in terms of demographic and a number of clinical characteristics fail to explain the hypothesis that schizophrenia with disordered eating is a distinct subtype of schizophrenia. Data indicate, on the other hand, that the presence of disordered eating behavior in patients with schizophrenia is associated with the expression of more active psychotic symptoms.

How frequent are eating disturbances in the population? Norms of the eating disorder examination-questionnaire

OBJECTIVE

The Eating Disorder Examination-Questionnaire (EDE-Q) is a self-report instrument assessing the specific psychopathology and key behaviors of eating disorders. This study sought to determine the prevalence of eating disturbances, and to provide psychometric properties and norms of the EDE-Q, in a representative German population sample.

METHODS

A total of 2520 individuals (1166 men, 1354 women) were assessed with the EDE-Q.

RESULTS

Eating disorder psychopathology was higher and most key behaviors were more prevalent in women than in men. Psychopathology declined with age ≥65 in both sexes, and showed a peak at age 55-64 in men. Overall, 5.9% of the women and 1.5% of the men revealed eating disturbances. The prevalence of eating disturbances decreased with age in women and was significantly higher in obese than in normal-weight individuals. Psychometric analyses showed favorable item characteristics. Internal consistencies of EDE-Q composite scores were ≥.80 for women and ≥.70 for men. The factor structure of the EDE-Q was partially reproduced. Sex- and age-specific population norms are reported.

DISCUSSION

This study provides population norms of the EDE-Q for both sexes and across the age range, demonstrates demographic variations in symptomatology, and reveals satisfactory psychometric properties. Further research is warranted on eating disturbances in older adults.

Mental health and behaviour of students of public health and their correlation with social support: a cross-sectional study

Background

Future public health professionals are especially important among students partly because their credibility in light of their professional messages and activities will be tested daily by their clients; and partly because health professionals' own lifestyle habits influence their attitudes and professional activities. A better understanding of public health students' health and its determinants is necessary for improving counselling services and tailoring them to demand. Our aim was to survey public health students' health status and behaviour with a focus on mental health.

Methods

A cross-sectional study was carried out among public health students at 1-5-years (N = 194) with a self-administered questionnaire that included standardized items on demographic data, mental wellbeing characterized by sense of coherence (SoC) and psychological morbidity, as well as health behaviour and social support. Correlations between social support and the variables for mental health, health status and health behaviour were characterized by pairwise correlation.

Results

The response rate was 75% and represented students by study year, sex and age in the Faculty. Nearly half of the students were non-smokers, more than one quarter smoked daily. Almost one-fifth of the students suffered from notable psychological distress. The proportion of these students decreased from year 1 to 5. The mean score for SoC was 60.1 and showed an increasing trend during the academic years. 29% of the students lacked social support from their student peers. Significant positive correlation was revealed between social support and variables for mental health. Psychological distress was greater among female public health students than in the same age female group of the general population; whereas the lack of social support was a more prevalent problem among male students.

Conclusions

Health status and behaviour of public health students is similar to their non-students peers except for their worse mental health. Future public health professionals should be better prepared for coping with the challenges they face during their studies. Universities must facilitate this process by providing helping services targeted at those with highest risk, and developing training to improve coping skills. Social support is also a potentially amenable determinant of mental health during higher education.

Do men with eating disorders differ from women in clinics, psychopathology and personality?

OBJECTIVE

To determine if male and female eating disorders differ in clinics, psychopathology and personality traits when compared with a healthy group.

METHODS

Sixty male and 60 female eating disorder individuals (16% anorexia nervosa, 42% bulimia nervosa and 42% eating disorder not otherwise specified), matched for age and diagnostic, were compared with 120 healthy-eating participants (60 male and 60 female participants). All were diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Assessment measures included Eating Disorder Inventory--2, Symptom Checklist--Revised and Temperament and Character Inventory--Revised, as well as other clinical and psychopathological indices.

RESULTS

Male eating disorder participants reported significant lower laxative abuse (p = 0.020) and significant higher vomiting episodes (p = 0.019) than female eating disorder participants. Differences on drive for thinness, body dissatisfaction and some Symptom Checklist--Revised scales were found across genders in eating disorder participants. Male eating disorder participants scored significantly lower than female participants with eating disorders on harm avoidance, reward dependence and cooperativeness.

CONCLUSIONS

Although eating disorder clinical features were similar across genders, male eating disorder participants had less body image concern and general psychopathology than female eating disorder participants.

The effect of attachment insecurity in the development of eating disturbances across gender: the role of body dissatisfaction

The present study examined the effects of insecure attachment on the development of negative body image as a contributing factor to the development of disturbed eating patterns in male and female university students. Participants were nonclinical male (n = 100) and female (n = 381) university students. Administering self-report questionnaires, the authors assessed demographic information (gender, age), anthropometric data (Body Mass Index [BMI], age), romantic attachment (ECRS-R; R. C. Fraley, N. G. Waller, & K. A. Brennan, 2000), body dissatisfaction (BSQ), and disturbed eating (EAT-26). The authors found body dissatisfaction to fully mediate the relationship between attachment anxiety and disordered eating in women. Body dissatisfaction mediated anxious attachment and dieting in men. In addition, attachment avoidance had a direct impact on eating behaviors for both genders, without the mediation of any variables measured in this study. The findings of the present study suggest that the anxiety and avoidance dimensions of attachment insecurity affect eating behaviors differently, and the effects are different across genders. The authors discuss results in the context of therapeutic interventions design.

Symptoms of disordered eating, body shape, and mood concerns in male and female Chinese medical students

OBJECTIVE

This cross-sectional study explored the prevalence of disordered eating attitudes, body shape concerns, and social anxiety and depressive symptoms in male and female medical students in China.

METHOD

Four hundred eighty-seven students from Central South University (Hunan Province, Changsha City, China) completed the following self-report measures: Eating Attitudes Test-26, Eating Disorders Assessment Questionnaire, Body Shape Questionnaire, Swansea Muscularity Attitudes Questionnaire, Social Interaction Anxiety Scale, and the Self-Rating Depression Scale.

RESULTS

A comparatively lower rate of at-risk eating attitudes (2.5%) and eating disorders (0.90%) were found compared to those reported in other studies. Significantly more female (3.2%) than male (1.2%) students had abnormal eating attitudes with 4 female students meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for bulimia nervosa. Significant relationships were observed between eating attitudes, body shape concern, social anxiety, depression, and body mass index. For females, the most significant correlate of distorted eating attitudes was body shape concern, whereas for male students, social anxiety and concern with muscle size and shape were most strongly correlated with distorted eating attitudes.