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

Systematic review of the epidemiology of eating disorders in the Arab world

PURPOSE OF REVIEW

The Arab world is dealing with modernization and sociocultural changes both associated with eating disorders. The present review provides an update of 'Eating disorders in the Arab world: a literature review', which was published in 2020.

RECENT FINDINGS

There are 22 recent epidemiological studies on eating disorders in five different countries in the Arab world. A large-scale national mental health survey reported a 12-month eating disorder prevalence of 3.2% and an eating disorder lifetime prevalence of 6.1%. Binge-eating disorder was the most common eating disorder (12-month prevalence = 2.1%, lifetime prevalence = 2.6%), 1.6% was at high risk for binge-eating disorder. Overall, between 23.8 and 34.8% was at high risk for any eating disorder. Body-shape dissatisfaction, a high BMI and separated/widowed/single marital status were associated with eating disorder pathology.

SUMMARY

Although there is still a lack of studies compared to the western world, the number of epidemiological studies on eating disorders in the Arab world is growing and there is an increase in studies using appropriate assessment-tools and norms. It is recommended to offer specialized treatment and to implement preventive programs.

Addressing nutritional issues and eating behaviours among university students: a narrative review

University life is a critical period for establishing healthy eating habits and attitudes. However, university students are at risk of developing poor eating habits due to various factors, including economic conditions, academic stress and lack of information about nutritional concepts. Poor diet quality leads to malnutrition or overnutrition, increasing the risk of preventable diseases. Food environments on university campuses also play a significant role in shaping the dietary habits of students, with the availability of and accessibility to healthy food options being important factors influencing food choices and overall diet quality. Disordered eating habits and body dissatisfaction are prevalent among university students and can lead to eating disorders. Income and living arrangements also influence dietary habits, with low household income and living alone being associated with unhealthy eating habits. This study is a narrative review that aimed to address nutritional issues and eating behaviours, specifically among university students. We investigated the eating behaviours of university students, including their dietary patterns, food choices and food environments. The objective of this review was to provide insights into the nutritional issues and eating behaviours of university students, with the aim of identifying target areas for intervention to improve the overall health and wellbeing among college students. University food environments need to be restructured to promote healthy eating, including the availability, accessibility, affordability and labelling of healthy foods, and policies to limit the availability of unhealthy foods and drinks on campus.

Psychometric properties of an Arabic translation of the body appreciation scale (BAS-2) and its short forms (BAS-2SF) in a community sample of Lebanese adults

OBJECTIVES

The present study sought to examine the factor structure, reliability, validity and gender invariance of the Arabic Body Appreciation Scale (BAS-2), and its two short forms (the 3-item and 2-item BAS-2SF) among community Lebanese Arabic-speaking adults.

METHODS

We carried-out an online cross-sectional survey. The 10-item BAS-2, the functionality appreciation scale and the Eating Attitudes Test-26 were completed by 826 Lebanese community adults (57.9% females, aged 25.42 ± 8.44 years).

RESULTS

The Arabic 10-item, 3-item and 2-item BAS-2 converged on a one-factor solution, and demonstrated high internal consistency (McDonald's ω value of .92, .88, and .86 respectively). All indices suggested that configural, metric, and scalar invariance was supported across gender. The 3-item and 2-item BAS-2SF were highly correlated with the original BAS-2 (r > 0.9). Higher 10-item, 3-item and 2-item BAS-2 scores correlated significantly and strongly with more positive eating attitudes and greater functionality appreciation, and higher 10-item BAS-2 scores correlated positively and weakly with BMI, supporting convergent validity.

CONCLUSION

The present work contributes to the literature by providing a psychometrically sound Arabic-translation of the BAS-2 and short-forms, benefitting both researchers and clinicians.

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

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

Body Composition, Energy Availability, Risk of Eating Disorder, and Sport Nutrition Knowledge in Young Athletes

Young athletes may be at risk for low energy availability (LEA) or dietary habits that are indicative of eating disorders. Thus, the purpose of the current study was to investigate the prevalence of LEA among high school athletes and examine those at risk for eating disorders. A secondary aim was to examine relationships between sport nutrition knowledge, body composition, and LEA.

METHODS

94 male (n = 42) and female (n = 52) mean ± SD age: 18.09 ± 2.44 y; height: 172.6 ± 9.8 cm; body mass: 68.7 ± 14.5 kg; BMI: 22.91 ± 3.3 kg·m^-2) athletes completed a body composition assessment and electronic versions of the abridged sports nutrition knowledge questionnaire (ASNK-Q), brief eating disorder in athletes questionnaire (BEDA-Q), and the low energy availability for females questionnaire (LEAF-Q; females only).

RESULTS

52.1% of female athletes were classified as being at risk for LEA. Moderate inverse relationships existed for computed LEAF-Q scores and BMI (r = -0.394; p < 0.01). A total of 42.9% of males (n = 18) and 68.6% of females (n = 35) were at risk for eating disorders, with females being at greater risk (p < 0.01). Body fat percentage was a predictor (β = -0.095; p = -0.01) for eating disorder risk status. For every 1 unit increase in body fat percentage, athletes were 0.909 (95% CI: 0.845-0.977) times less likely to be classified as at risk for an eating disorder. Male (46.5 ± 13.9) and female (46.9 ± 11.4) athletes scored poorly on the ASNK-Q, with no differences between sex (p = 0.895).

CONCLUSIONS

Female athletes were at a greater risk for eating disorders. No relationships existed between sport nutrition knowledge and %BF. Female athletes with a higher %BF had a lower risk for an eating disorder and risk for LEA.

"I was bullied for being fat in every situation, in every outfit, at every celebration": A qualitative exploratory study on experiences of weight-based oppression in Qatar

Introduction

Weight-based oppression (WBO) has been documented as a widespread phenomenon in Western countries and is associated with a range of psychological, physiological, and behavioral harms. Research on weight-based oppression is largely absent from the Arab region.

Methods

We conducted a qualitative exploratory study using semi-structured in-depth interviews to examine the internalized attitudes, values, and beliefs related to body weight, and experiences of external weight-based oppression of 29 staff, faculty, and students at Qatar University.

Results

Thematic analysis revealed six major themes on the characteristics of internalized WBO, and the nature, timing, source, extent, and impact of external WBO. WBO was regarded as so common in the Arab culture as to be normative, with damaging exposure to WBO beginning in early childhood.

Conclusion

WBO in the Arab region is an important and unrecognized public health issue. Programs to reduce WBO should be developed in all sectors.

Comparison of the burden of anorexia nervosa in the Middle East and North Africa region between 1990 and 2019

BACKGROUND

Anorexia nervosa (AN) is a complex and heritable psychiatric disorder, which imposes significant mortality and morbidity on sufferers globally. We aimed to report the prevalence, incidence and disability-adjusted life-years (DALYs) attributable to AN in the Middle East and North Africa (MENA) region by age, sex and socio-demographic index (SDI), between 1990 and 2019.

METHODS

The disease burden attributable to AN was obtained for the 21 countries located in the MENA region between 1990 and 2019 using publicly available data from the Global Burden of Disease (GBD) 2019 study. All estimates were provided as counts and age-standardized rates per 100,000 population, along with 95% uncertainty intervals (UIs).

RESULTS

In 2019, the estimated age-standardised point prevalence and incidence rate of AN (per 100,000) in MENA were 49.3 (95% UI: 34.6-70.4) and 16.0 (11.3-22.0), which were 11.4% (7.3-15.4) and 5.9% (2.6-9.1) higher than in 1990, respectively. Furthermore, the regional age-standardised DALY rate was 10.6 (6.3-17.0) per 100,000 in 2019, which was 11.8% (5.2-19.1) higher than in 1990. In 2019, Kuwait [17.3 (10.3-27.9)] and Afghanistan [6.3 (3.7-10.3)] had the highest and lowest age-standardised DALY rates, respectively. In addition, Iran showed the largest increases in the age-standardised point prevalence [30.0% (24.1-36.2)], incidence [24.6% (18.6-30.4)] and DALY [30.5% (22.6-38.9)] rates between 1990 and 2019. In 2019, the number of prevalent cases and prevalence estimates peaked in the 15-19 age group for males and the 20-24 age group for females, with females having a higher number of cases and prevalence in all age groups. In 2019, the age-standardised DALY rates in MENA were higher than the global rates among males aged 10-34 years, but were lower than the global estimates among females in almost all age groups. In addition, the burden of AN was positively associated with the level of socio-economic development during the measurement period.

CONCLUSIONS

The burden of AN in the MENA region increased between 1990 and 2019, which indicates that it is likely to become a more serious public health issue in the future. Up-to-date information about the epidemiological trends in the region would allow health policymakers to make informed and appropriate decisions to help address this issue. The findings of the present study showed that the point prevalence and incidence rate of anorexia nervosa have increased in the Middle East and North Africa region between 1990 and 2019. The highest burden in 2019 was found in Kuwait, while Afghanistan had the lowest attributable burden. In addition, between 1990 and 2019 Iran had the largest increase in the point prevalence of anorexia nervosa. Also in 2019, anorexia nervosa was more prevalent in females and peaked in the 15-19 age group for males and the 20-24 age group for females. Furthermore, as the level of socioeconomic development increased, so did the burden attributable to anorexia nervosa.

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.

Examination of the association of muscle dysmorphia (bigorexia) and social physique anxiety in the male bodybuilders

PURPOSE

This study aimed to examine the association between social physique anxiety and muscular dystrophy in bodybuilders.

DESIGN AND METHODS

This cross-sectional study included 384 male bodybuilders.

FINDINGS

5.7% of the participants reported muscular dystrophy. Younger age and use of protein powder were associated with higher scores on the muscle dysmorphic disorder Inventory. Higher muscular dystrophy was associated with higher social physique anxiety.

PRACTICE IMPLICATIONS

Young male bodybuilders using protein powder are at increased risk to suffer from social physique anxiety and muscular dystrophy.

Validation of a shortened version of the Eating Attitude Test (EAT-7) in the Arabic language

BACKGROUND

Eating disorders are quite common around the world, disabling, and potentially lethal; but they remain so far under-captured and subject to substantial delays in treatment. We propose through this study to develop and validate a shortened version of the Eating Attitude Test (EAT) in the Arabic language among non-clinical Arabic-speaking Lebanese participants from the general population.

METHODS

1175 participants enrolled in this cross-sectional study, based on an online survey. The Eating Attitude Test-26 items, Drunkorexia Motives and Behaviors Scales and Lebanese Anxiety Scale were used to answer our objectives.

RESULTS

Our results confirmed validity and reliability of the questionnaire. Exploratory Factor Analyses showed that all items converged over a one-factor solution, with an excellent Cronbach's alpha (> 0.9). Confirmatory Factor Analyses found that the 7-item-version yielded excellent model fit. The instrument also revealed strong evidence of divergent validity, being highly correlated with measures of anxiety and drunkorexia motives and behaviors.

DISCUSSION

Findings provided evidence supporting that the Arabic seven-item one-factor structure of the scale (EAT-7) is valid, reliable, and can be used in clinical practice, preventive interventions and future eating disorders research in Arab settings.

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

OBJECTIVES

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

METHOD

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

RESULTS

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

DISCUSSION

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

Factors associated with disordered feeding among high school students in Kerman City, Iran

BACKGROUND

Mental health problems and disordered eating, are more common in adolescents. This study investigated relationship between mental health and disordered eating in high school girls in southeast Iran.

METHODS

This cross-sectional descriptive correlational study accomplished in high school girls of Kerman at the southeast of Iran in 2019. Using three parts demographic, Standard General Health Questionnaire (GHQ-28) and Eating Attitudes questionnaire, (Eat-26) with three subscales: eating habits, desire to eat and oral control. We investigated high school girl's mental health and relationship with disordered eating with cluster sampling method (600 high school girl). Multivariate logistic regression was used to determine the association between significant variables and the risk of General Health (Yes/No) and Eating attitude (Yes/No). Spearman correlation test, Mann-Witheny U test and Kruskal-Wallis test were used, and Significant level was considered at P < 0.05.

RESULTS

A direct and significant relationship between mental health and disordered eating (r = 0/19, P < 0.001). In other words, the higher the mental health disorder score, the higher the disordered eating score, and the higher disordered eating score, the higher mental problems. There was a direct and significant relationship between mental health and all aspects of disordered eating including eating habits (r = 0/12, P < 0.05), desire to eat (r = 0/1, P < 0.05) and oral control (r = 0/14, P < 0.001).

CONCLUSIONS

It seems that the disordered eating and mental health have a determinant role in relationship with each other. Therefore, prevention and health promotion programs should be implemented to improve female adolescent mental health and reduce disordered eating.

The Effect of Bigorexia Nervosa on Eating Attitudes and Physical Activity: A Study on University Students

PURPOSE

This study aims to examine the relationship between physical activity, eating attitude, and bigorexia nervosa among university students.

METHOD

A questionnaire form consisting of sociodemographic characteristics, eating habits, the Eating Attitude Scale (EAT-40), the International Physical Activity Questionnaire (IPAQ), and the Muscle Appearance Satisfaction Scale (MASS) was conducted on undergraduate students at Üsküdar University.

RESULTS

There were 1006 students who participated in this study with a mean age of 22.58 ± 2.87 years. The median "muscle appearance satisfaction" score of the obese students was statistically higher than the normal weight and underweight students. The median score for "Obesity Anxiety" was statistically higher in underweight students than in obese ones. A one-unit increase in IPAQ scores was related to an elevation of 24.9% in the MASS and a decrease of 17.9% in the EAT-40 scores, while a one-unit increase in MASS scores was related to a reduction of 12.5% in the EAT-40 scores.

CONCLUSION

Eating attitude is associated with bigorexia nervosa, and as MASS scores increase, EAT-40 scores decrease and as IPAQ scores increase, and EAT-40 scores decrease. In other words, as physical activity increases, muscle strength satisfaction elevates, and in parallel with this increase, a positive eating attitude improves.

Lean Body Mass and Self-Perceived Body Image among Youth in the United Arab Emirates

BACKGROUND AND AIM

Lean body mass may be a promising tool to screen body image disorders. This study aim was to explore the relationships between fat free mass index (FFM-I) on self-perceived body image and shape among university students in the United Arab Emirates.

METHODS

Cross-sectional study, using questionnaires to evaluate demographics, body figure, shape and image dissatisfaction; in addition to anthropometrics like BMI and FFM-I. Accordingly, participants were categorized into adequate muscle mass (AMM) and low muscle mass (LMM) individuals.

RESULTS

A total of 402 participants (50.4% females) aged between 18 and 25 years, were recruited. Almost third (33.8%) of the participants were overweight/obese, 81% had AMM; 48.5% and 76.3% of them were concerned about their body shape and image, respectively; 55.2% desired to be thinner. Males (M) had significantly higher BMI and body fat compared to females (F). Subjects with LMM, irrespective of sex, were underweight (49% F; 40.7% M), desired to be heavier (44.9% F; 74.1% M) and they had a lower agreement in their perceived BMI versus actual (k=0.024; poor) compared with those with AMM (k=0.408; fair); and in general males had a better agreement between their perceived and actual BMI compared to females (0.432, moderate vs. 0.308, fair).

CONCLUSIONS

Our results conclude that female sex and LMM were associated with higher body image and shape dissatisfaction; thus, highlighting the importance of increasing awareness among youth to assess body composition and engage in muscle mass building activities as an effective step towards improving body image perception. (www.actabiomedica.it).

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

BACKGROUND:

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

MATERIALS AND METHODS:

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

RESULTS:

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

CONCLUSION:

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

Eating disorders in the Arab world: a literature review

BACKGROUND

The prevalence of eating disorders has been assumed to be low in the Arab world, due to the alleged absence of the thin ideal. However, the Arab world is undergoing rapid sociocultural changes, and there are reports of an increase of the desire to be thin. This literature review therefore provides point-prevalence of Arabs at high risk for eating disorders, and a comprehensive synthesis of correlates of eating disorder symptoms, eating disorder-related variables and of a high risk for eating disorders.

METHOD

Several electronic databases were searched for published, peer-reviewed studies between 1986 and 2019 involving several key terms. From 317 screened studies, 81, mainly cross-sectional, were included. Preferred Reporting Items for Systematic reviews and meta-analyses was used as guidance and the quality of studies were assessed using the Newcastle-Ottawa scale.

RESULTS

Estimates of individuals at high risk for eating disorders ranged from 2 to 54.8%. The eating disorder-related variables identified were desire to be thin, body dissatisfaction, disturbed-, and dieting- eating behavior. Identified correlates were increased affluence, media use, western influences, and obesity. An additional finding was that in some cases eating disorders were expressed somatically rather than psychiatrically.

DISCUSSION

In the Arab world, females were most at risk for eating disorders and eating disorder symptoms. Sociocultural changes gave rise to the thin ideal and the prevalence of obesity, increasing the risk for the development of eating disorder-related variables and eating disorders. The literature on eating disorders in the Arab world suffers from potential limitations due to the use of non-validated assessment tools. Further research is necessary, particularly on the development and validation of a culturally sensitive assessment tool. Improved knowledge is likely to increase the number of people seeking treatment and decrease the stigma of psychotherapy.