Disordered eating behaviors in university students in Hanoi, Vietnam

Introducing Diagnostic Classification Modeling as an Unsupervised Method for Screening Probable Eating Disorders

Screening for eating disorders (EDs) is an essential part of the prevention and intervention of EDs. Traditional screening methods mostly rely on predefined cutoff scores which have limitations of generalizability and may produce biased results when the cutoff scores are used in populations where the instruments or cutoff scores have not been validated. Compared to the traditional cutoff score approach, the diagnostic classification modeling (DCM) approach can provide psychometric and classification information simultaneously and has been used for diagnosing mental disorders. In the present study, we introduce DCM as an innovative and alternative approach to screening individuals at risk of EDs. To illustrate the practical utility of DCM, we provide two examples: one involving the application of DCM to examine probable ED status from the 12-item Short form of the Eating Disorder Examination-Questionnaire (EDE-QS) to screen probable thinness-oriented EDs and the Muscularity-Oriented Eating Test (MOET) to screen probable muscularity-oriented EDs.

The use and misuse of the SCOFF screening measure over two decades: a systematic literature review

PURPOSE

The SCOFF questionnaire was designed as a simple, memorable screening tool to raise suspicion that a person might have an eating disorder. It is over 20 years since the creation of the SCOFF, during which time it has been widely used. Considering this, we wish to review the use of the SCOFF in peer-reviewed scientific journals, and to assess whether it is being used appropriately in the manner in which it was originally devised and tested.

METHODS

The Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines were followed, and all search strategies and methods were determined before the onset of the study. PubMed and Wiley Online Library were searched using the terms SCOFF and eating. Two reviewers were involved in the reviewing process. Criteria for appropriate use of the SCOFF were formalised with the tool's original authors.

RESULTS

180 articles were included in the final review. 48 articles had used the SCOFF appropriately, 117 articles inappropriately and 15 articles had been mixed in the appropriateness of their use.

CONCLUSION

This systematic review highlights the inappropriate use of the SCOFF in diverse languages and settings. When used correctly the SCOFF has made a significant contribution to the understanding of eating disorders and its simplicity has been applauded and led to widespread use. However in over two-thirds of studies, the use of the SCOFF was inappropriate and the paper highlights how and in what way it was misused, Guidelines for the appropriate use of the SCOFF are stated. Future validation and avenues of research are suggested.

LEVEL OF EVIDENCE

Level I.

Eating Concerns Associated with Nutritional Information Obtained from Social Media among Saudi Young Females: A Cross-Sectional Study

Eating disorders have been highly prevalent in young females for decades for many reasons. Social media platforms have an enormous impact on users, especially young adults, who use them every day. In Saudi Arabia, social media is popular, with an estimated 72% of users being active in 2020. Therefore, the primary aim of this study was to assess the relationship between using social media to search for nutritional information and eating concerns. A nationwide study was conducted on 1092 young Saudi females aged 18-30 years from five administrative regions in the Kingdom of Saudi Arabia. Data were collected using an online validated questionnaire, and symptoms of eating concerns were assessed using two brief instruments: SCOFF [Sick, Control, One Stone, Fat, Food] and Eating disorders Screen for Primary care [ESP]. The prevalence of eating concerns was 49.6% among Saudi females. Moderate eating concerns were more prevalent in the central region 24.8%, whereas high eating concerns were more prevalent in the southern region 27.6%. Personal accounts of dietitian/nutritionists (OR = 1.170; 95% CI 1.071-1.277; p ≤ 0.001), interaction with offered experiments about new meals/restaurants, and diets on social media that were mostly promoted by celebrities/influencers (OR = 1.554; 95% CI 1.402-1.723; p ≤ 0.000) were the most prominent risk factors associated with being more likely to suffer from eating concerns. The present study recommends opening clinics specializing in nutrition on social media platforms that target young females to provide nutritional counselling and encourage a healthy lifestyle. In addition, it is important to plan awareness campaigns intended to educate young females on how to deal with messages that circulate on social media without any evidence regarding their truthfulness.

Risk factors for eating disorders among Chinese and international university students: a comparative cross-sectional study

OBJECTIVE

The aim of the study was to investigate the prevalence of eating disorders (EDs) and their association with socio-demographic and behavioural factors among university students.

METHODS

A cross-sectional study among university students (Chinese and international) in Nanjing, China. We collected the data from 877 students, of which 811 were eligible for this study. They submitted a self-administered questionnaire (Eating Disorder Examination Questionnaire 6 (EDE-Q6) related to socio-demographic, health variables and lifestyle factors. Data were assessed with the help of SPSS software.

RESULTS

A total of 401 Chinese and 410 international university students (49.44% vs. 50.55%) participated in this study. Binary logistic regression showed that young female adults of 18~25 years of age had more risk of developing eating disorders. Higher body mass index (BMI), such as overweight and obesity, were more influential risk factors (p < 0.001) for eating disorders. The significant risks (p < 0.001) EDs were found in students who were athletes, physically active, and involved in various extra-curricular activities. Alcohol and smoking were significant risk factors associated with eating disorders.

CONCLUSION

The results indicated higher risks of eating disorders followed by objective binge eating and compensatory behaviour. In this scenario, early assessment and treatment are necessary to reduce the burden of eating disorders and to promote good nutritional practices among university students.

The prevalence and risk factors of screen-based disordered eating among university students: a global systematic review, meta-analysis, and meta-regression

PURPOSE

The purpose of this review was to estimate the prevalence of screen-based disordered eating (SBDE) and several potential risk factors in university undergraduate students around the world.

METHODS

An electronic search of nine data bases was conducted from the inception of the databases until 1st October 2021. Disordered eating was defined as the percentage of students scoring at or above established cut-offs on validated screening measures. Global data were also analyzed by country, research measure, and culture. Other confounders in this review were age, BMI, and sex.

RESULTS

Using random-effects meta-analysis, the mean estimate of the distribution of effects for the prevalence of SBDE among university students (K = 105, N = 145,629) was [95% CI] = 19.7% [17.9%; 21.6%], I2 = 98.2%, Cochran's Q p value = 0.001. Bayesian meta-analysis produced an estimate of 0.24, 95% credible intervals [0.20, 0.30], τ = 92%. Whether the country in which the students were studying was Western or non-Western did not moderate these effects, but as either the mean BMI of the sample or the percentage of the sample that was female increased, the prevalence of SBDE increased.

CONCLUSIONS

These findings support previous studies indicating that many undergraduate students are struggling with disordered eating or a diagnosable eating disorder, but are neither receiver effective prevention nor accessing accurate diagnosis and available treatment. It is particularly important to develop ever more valid ways of identifying students with high levels of disordered eating and offering them original or culturally appropriate and effective prevention or early treatment.

LEVEL OF EVIDENCE

I, systematic review and meta-analysis.

Eating disorder risk identification through embedded electronic medical record prompting

Objective: To evaluate whether the use of electronic medical record (EMR) to prompt universal eating disorder screening with a short questionnaire improved risk detection in a college gynecology clinic. Design: Data obtained via a convenience sample of patients accessing a university health clinic. Clinicians were prompted with the SCOFF tool, a 5-item questionnaire for eating disorder risk with sensitivity of 87.5% and specificity of 95%. Participants: 111 Female-identified patients, ages 18-37. Methods: Clinicians assessed eating disorder symptoms via EMR prompting. Comparison of risk identification from the previous year, in which patients were not universally screened, was conducted via EMR review. Results: Findings showed improved risk identification compared with previous year's symptom-only identification (p = .0047). Conclusion: The SCOFF tool, combined with EMR prompting, can improve eating disorder risk detection.

Association between the recognition of muscle mass and exercise habits or eating behaviors in female college students

This study aimed to examine the association between muscle mass and perception of body shape, desired body shape, physical strength, exercise habits, and eating behaviors. Height, weight, and body composition in 270 female university students were measured. The questionnaire on body shape perception, desired body shape, dieting experience, current, and past exercise habits, exercise preference, and eating behaviors were administered. The analysis of covariance with body fat mass as the covariate found that the skeletal muscle index (SMI) was different among each group on each of body perception or desired body shape (all, p < 0.001). In the post hoc test on body shape perception, the SMI in "obese" was significantly more than that in "slim" (p < 0.001) and "normal" (p < 0.001). In the desired body shape, the SMI in "become thin" was more than that in "maintain as current shape" (p < 0.001). Further, a significant difference was found among the categories of diet experience, with body fat mass as the covariate. In the post hoc test, the SMI in "yes" was more than that in "no" (p < 0.001). These results indicate that not only body fat mass but skeletal muscle mass drives young females' desire for thinness even with exercise advantages.

Psychological Risk Factors for the Development of Restrictive and Bulimic Eating Behaviors: A Polish and Vietnamese Comparison

The aim of this paper is to identify psychological factors which are culture specific or common predictors for restrictive and bulimic behaviors towards eating for young women raised in different cultures. The study included 661 young women from Poland (n = 233) and Vietnam (n = 428). Subjects filled-in the Eating Disorders Inventory (EDI-3) and the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS), and body measurements were collected to calculate anthropometric indices. Women form Vietnam were less satisfied with their appearance than were their Polish peers, but Vietnamese showed a lower level of preoccupation with being overweight and fear of obesity. Intercultural differences indicate that Vietnamese women show greater intensities for psychological variables, connected with restrictive and bulimic eating behaviors, verified in the research model: low self-esteem, personal alienation, interpersonal insecurity, interpersonal alienation, emotional dysregulation, interoceptive deficits, perfectionism and asceticism, and anxiety.

Association between dental fear and eating disorders and Body Mass Index among Finnish university students: a national survey

Background

Little is known about the association between eating disorders (ED) and dental fear. This study investigated the association between dental fear and EDs through body mass index (BMI), and SCOFF (sick, control, one stone, fat, food) questionnaire among Finnish university students. We hypothesised that dental fear is associated with EDs and BMI.

Methods

We used the latest data from the Finnish University Student Health Survey 2016. This survey targeted undergraduate Finnish students (n = 10,000) of academic universities and universities of applied sciences. We enquired about e.g. age, gender, height, weight, educational sector and perceived mental well-being. We used the SCOFF questionnaire to assess those at risk for developing EDs. The question ‘Do you feel scared about dental care?’ enquired about dental fear. We used the chi-square test and gender-specific logistic regression to analyse the associations between dental fear, EDs and BMI controlling for age, educational sector and mental well-being.

Results

In total, 3110 students participated in the study. Overall 7.2% of the students reported high dental fear and 9.2% scored SCOFF positive; more women than men reported high dental fear (11.2% vs. 3.8%, p < 0.001) and scored positive on SCOFF (14.2% vs. 3.6%, p < 0.001). Gender modified the association between dental fear and EDs and BMI. Among females, when controlling for educational sector and BMI, those with positive SCOFF score were more likely to have high dental fear than those with negative SCOFF score (OR = 1.6; CI = 1.0–2.4). After adding perceived mental well-being to the gender-specific regression analyses, overweight and obese males, BMI ≥ 25 (OR = 2.4; CI 1.3–4.4) and females with poor to moderate mental well-being (OR = 2.1; CI 1.4–2.9) were more likely than their counterparts to have high dental fear.

Conclusions

Among the Finnish university students BMI in males and problems of mental well-being in females were positively associated with high dental fear. The results of this study support possible common vulnerability factors that dental fear and other psychological disorders may share.

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.

The Association Between Eating-Compensatory Behaviors and Affective Temperament in a Brazilian Population

Eating-compensatory behaviors are associated with biological and psychological complications, with high rates of morbidity and mortality. Different elements may contribute to the development of eating-compensatory behaviors, such as genetic, physiological, environmental, and temperamental factors. Therefore, the aim of this study was to examine the association between affective temperaments and eating-compensatory behaviors. A sample of 27,501 volunteers, between 18 and 55 years old, mean age 28.9 ± 8.7 years (69.6% women), were assessed by the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). The results showed that eating-compensatory behaviors were associated with distinctive affective temperaments. Cyclothymic types were more associated with eating-compensatory behaviors. The avoidant and irritable types presented lower percentages of eating-compensatory behaviors in women and men, respectively. In conclusion, this study highlighted that participants who adopted frequent eating-compensatory behaviors are more likely to have dysfunctional affective traits. Consequently, the affective temperaments should be considered as a strategy to build capacity for prevention, treatment, and care of eating-compensatory behaviors.

Risk of disordered eating attitudes and its relation to mental health among university students in ASEAN

PURPOSE

Since there is a lack of information on eating disorders attitudes in Association of Southeast Asian Nations (ASEAN), the aim of this study was to explore the prevalence of eating disorder attitude and its relation to mental distress among university student populations in Indonesia, Malaysia, Myanmar, Thailand and Vietnam.

METHODS

A cross-sectional questionnaire survey and anthropometric measurement were conducted with undergraduate university students that were randomly recruited. The Eating Attitudes Test (EAT-26) was utilized to determine the prevalence of disordered eating attitudes. The sample included 3148 university students, with a mean age of 20.5 years, SD = 1.6.

RESULTS

Using the EAT-26, 11.5% of the students across all countries were classified as being at risk for an eating disorder, ranging from below 10% in Indonesia, Thailand and Vietnam to 13.8% in Malaysia and 20.6% in Myanmar. In multivariable logistic regression analysis, sociodemographic factors (wealthier subjective economic status, and living in a lower middle income country), underweight and overweight body weight perception, psychological factors (depression symptoms and pathological internet use), and being obese were associated with eating disorder risk.

CONCLUSIONS

Relatively high rates of eating disorder risk were found. This result calls for increased awareness, understanding of eating disorders and related risk factors and interventions in university students in ASEAN.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional survey.

Wealth gradient-based divergence in the prevalence of underweight among women by marital status in Quoc Oai district, Vietnam

Background: The prevalence of underweight is high among women in Asian countries, despite nutritional changes in the region. Previous studies have demonstrated independent associations between female body weight, marital status and economic status. However, few studies have investigated possible interaction between marital and economic status in relation to Asian women’s body weight.

Objective: This study aimed to test associations between household wealth, marital status and underweight among women living in the Quoc Oai district of Vietnam and to identify wealth–marital status interaction in relation to body weight in these women.

Methods: Data from 1087 women aged 19–60 years were collected via a baseline community survey conducted in the Quoc Oai district of Hanoi, Vietnam, in 2016. Underweight was defined using an Asian-specific body mass index cut-off (<18.5 kg/m²). Marital status was dichotomized into ‘never married’ and ‘ever married.’ Economic status was measured using household wealth index quintiles. Multivariable logistic regressions tested association between wealth and underweight after adjusting for marital status and other confounders. An interaction term (wealth index*marital status) was fitted to determine whether the association between wealth and body weight is modified by marital status.

Results: Our results show that underweight was independently associated with a wealth status (odds ratio [OR]: 0.88, 95% confidence interval [CI]: 0.79–0.98, p = 0.026) and ever-married status (OR: 0.50, 95% CI: 0.34–0.75, p = 0.002). A significant interaction effect (OR: 0.67, 95% CI: 0.50–0.90, p = 0.010) indicated that wealthy married women were less likely to be underweight, whereas wealthy never-married women were more likely to be underweight.

Conclusions: Our results suggest that the interaction between wealth and marital status has divergent effects on underweight among Asian women. Interventions to reduce underweight among Asian women should simultaneously consider economic and marital status.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Association of weight control behaviors with body mass index and weight-based self-evaluation

Objective:

To determine the frequency of weight control behaviors (WCBs) and their correlation with body mass index (BMI) and weight-based self-evaluation.

Methods:

Data were collected by the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP) from 27,501 volunteers (30.4% men, mean age 28.9±8.7 years).

Results:

The most prevalent WCBs for men and women were exhaustive physical exercise and prolonged fasting, respectively. Frequent exhaustive physical exercise was the only behavior more often adopted by men. BMI was positively associated with WCBs, which were very frequent in obese subjects. About 15% of normal-weight women reported using diuretics and laxatives, and 12.2% reported vomiting as a WCB at least occasionally. Among subjects who regarded body weight highly in their self-evaluation, there was a strong positive association with all WCBs, at similar degrees, in both genders. Compared to those who never base their intrinsic personal value on body weight, those who frequently base intrinsic value on body weight were at 25-30 times higher risk of inducing vomiting.

Conclusion:

The prevalence of participants adopting WCBs was high, especially in women and obese subjects. Weight-based self-evaluation was more strongly associated with WCBs than BMI.

Updates in the epidemiology of eating disorders in Asia and the Pacific

PURPOSE OF REVIEW

This review summarizes and contextualizes the recent epidemiologic data on eating disorders in the Asia and Pacific regions.

RECENT FINDINGS

Gaps in epidemiologic data on eating disorders from the Asia and Pacific regions stem, in part, from omission of eating disorder-specific assessments in large nationally representative cohort studies of mental disorders. Available data - often from clinical and school-going cohorts - support that the prevalence of both eating disorders and associated attitudes and behaviors in many Asian and Pacific regions studied may be comparable to those reported in Europe and North America. Moreover, the prevalence of eating disorders in some regions of Asia may be increasing. Some of the national and subnational regions with the highest annual percent increases in disability-adjusted life years per 100 000 caused by eating disorders over the past two decades are located in Asia.

SUMMARY

Notwithstanding sparse epidemiologic data concerning eating disorders in Asia and the Pacific, available evidence supports comparable prevalence to other global regions and that associated health burdens in some regions of Asia may be rising. This further supports that eating disorders are trans-national in distribution and challenges the previous understanding that they were primarily culture-bound to the Global North.