Prevalence of Eating Disorders Among Adolescents in the Northwest of Iran

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

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

The mediating effect of sense of coherence in the relationship between eating attitudes and self-esteem in adolescents

PURPOSE

This study aimed to examine the mediating effect of a sense of coherence (SOC) in the relationship between eating attitudes and self-esteem in adolescents.

METHODS

The study was conducted in a descriptive-correlational exploratory design. The sample of the study consisted of 1175 adolescents who met the inclusion criteria. Data were obtained by the researchers using personal information form, the Sense of Coherence Scale (SOC-13), the Eatıng Attitude Test (EAT-26), and the Rosenberg Self-Esteem Scale (RSES).

RESULTS

SOC-13 mean score was 50.21 ± 11.06, EAT-26 mean score was 14.53 ± 10.17, and RSES mean score was 4.17 ± 1.66. It was found that there was a statistically significant negative relationship between the mean scores of RSES and the EAT, a positive relationship between the mean scores of the RSES and SOC, and a negative relationship between the mean scores of EAT and SOC. Moreover, the mediating role of SOC was found to be moderate. Furthermore, 4.5% of adolescents' SOC scores are explained by eating attitude. On the other hand, 16.4% of self-esteem scores are explained by eating attitude and SOC.

CONCLUSION

As a result of this study, it was determined that students' SOC moderately mediated the relationship between eating attitude and self-esteem. At the same time, eating attitude had a direct predictive effect on self-esteem.

Prevalence of Eating Disorders and Disordered Eating Behaviours amongst Adolescents and Young Adults in Saudi Arabia: A Systematic Review

Eating disorders (EDs) and disordered eating behaviours (DEBs) are significant health problems related to body image and weight dissatisfaction among adolescents and young adults worldwide. During this stage of sensitive development, these behaviours may hinder the optimal growth process and can consequently lead to wasting, stunting, and micronutrient deficiencies. However, there is a limited amount of literature on DEB among Arab populations, particularly in Saudi Arabia. This review aims to assess the prevalence of EDs/DEB and to develop a clear understanding of the epidemiology of such conditions among adolescents and youth in Saudi Arabia. Five databases were systematically searched and 14 papers met the inclusion criteria. The Eating Attitudes Test (EAT-26) was the predominant tool used for evaluating aberrant eating behaviours, indicating a high prevalence of EDs/DEB ranging from 10.2% to 48.1%. The highest prevalence of EDs/DEB was reported in the eastern region ranging from 29.4% to 65.5%. In terms of age and sex, the prevalence was higher among older students compared to younger school students and males reported more Eds/DEB compared to female students. These disorders are found to be prevalent in Saudi Arabia, and the risk of developing such conditions is high across the whole age range.

The role of mothers' involvement in their daughters' self-esteem and dieting behaviors

This study presents an initial effort to develop disordered eating pathology (DEP) prevention program with an emphasis on maternal involvement. Disordered eating pathology representing a range of behaviors and attitudes, from negative body image to full-blown eating disorder. It appears mainly in adolescent females and related to psychological and familial factors, including maternal modeling of thinness. A sample of 118 Israeli girls (11-12) was divided into three groups: participants in the program in parallel with their mothers, participants without their mothers, and control. Participants completed self-report questionnaires. Groups were tested three times: pre-intervention, post-intervention, and follow-up. For those girls who participated in parallel with their mothers, higher self-esteem was associated with fewer pathological diet behaviors. Findings deepen understanding of the risk factors involved in the development of DEP. The main study contribution is the important role mothers play in preventing DEP among their daughters.

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.

Correlates of eating disorder pathology in Saudi Arabia: BMI and body dissatisfaction

BACKGROUND

Saudi Arabia is undergoing rapid sociocultural changes, which may have led to an increase of body mass index and eating disorder pathology. The aim of this study is to investigate whether body dissatisfaction, self-esteem, having lived abroad, cultural orientation, perceived stress, media use, and socioeconomic status are correlates of eating disorder pathology with body mass index as a covariate. Additional aims are to investigate if cultural orientation is associated with symptomatology and if stress is a covariate in the association between eating disorder pathology and Western orientation.

METHOD

Self-report measures were administered in a convenience Saudi community sample (N = 1225) between April 2017 and May 2018. Hierarchical multiple linear regression analyses with eating disorder pathology as dependent variable were performed to establish the associations among the variables.

RESULTS

After adjusting for the effect of BMI, only body dissatisfaction and eating disorder pathology were moderately associated. Eating disorder pathology and body dissatisfaction were more severe among Saudi citizens with a higher BMI.

DISCUSSION

Several explanations for the lack of associations of westernization, self-esteem, and stress with eating disorder pathology are reviewed and discussed. The majority of this convenience sample existed of young unmarried Saudi females of high socioeconomic status. Of the total sample, 35% displayed eating disorder pathology which may be a reflection of the high rates of excess weight.

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.

The translation and psychometric assessment of the SCOFF eating disorder screening questionnaire: the Persian version

BACKGROUND

Eating Disorders (EDs) are defined by abnormal eating habits. The SCOFF (Sick-Control-One stone-Fat-Food) is a simple screening questionnaire for EDs. This study was conducted to translate and evaluate the psychometric properties of the SCOFF questionnaire in Iranian university students.

METHODS

A total of 310 Iranian students of the Shahid Beheshti University of Medical Sciences completed a test battery of questionnaires including the well-known screener of eating disorder symptoms, the SCOFF. All measures were presented to the participants in Persian. The 5-item SCOFF questionnaire was translated to Persian using the forward-backward method. The face, content, criterion, and construct validity of the Persian version of the SCOFF were assessed. The validity and reliability of the Persian version of the SCOFF was assessed and factor analysis was conducted.

RESULTS

All five items of the translated questionnaire were approved after face validity. Content validity ratio was 0.73 (range 0.66-0.83) and content validity index was 0.96 (range 0.91-1), so all items were approved. Exploratory factor analysis revealed a 2-factor structure, which explained 52.47% of the variance. Confirmatory factor analysis showed a very good goodness-of-fit for the 2-factor model. 2-factor and 1-factor models indicate a very good goodness-of-fit in females and adequate goodness-of-fit in males. Criterion validity showed an acceptable correlation between the SCOFF and the EDE-Q. Reliability was acceptable based on the stability [ICC = 0.905(95% CI .760-.962 p < 0.001)] and the internal consistency (KR20 = 0.4).

CONCLUSION

Appropriate psychometric properties of the 5-item Persian version of the SCOFF (both models) were confirmed, suggesting its use as a valid questionnaire in EDs screening.

The prevalence and nutritional status of adolescent Saudi girls with disordered eating

This study on adolescents was intended to assess the prevalence of disordered eating attitudes and the nutritional status of adolescent girls in Saudi Arabia. Disordered eating attitudes and behaviour were assessed using the EAT-26. The type of eating disorder (ED) was determined using Diagnostic statistical manual of mental disorders, fifth edition. The nutritional status of the adolescent girls was determined by measuring their weight and height twice using standard protocols. The BMI-for-age and height-for-age were defined using WHO growth charts. Comparisons between adolescent girls with and without EDs were conducted using SPSS version 26. Eating disorders (EDs) were prevalent among 10⋅2 % of these girls. Other specified feeding or EDs were the most prevalent ED (7⋅6 %), followed by unspecified feeding or eating disorder (2⋅4 %). Anorexia nervosa was common among 0⋅3 % of the girls. The eating disordered adolescents were either overweight (7⋅7 %), obese (10⋅3 %), stunted (7⋅7 %) or severely stunted (2⋅6 %). ANOVA revealed that the BMI-for-age was influenced by age (P = 0⋅028), the type of ED (P = 0⋅019) and the EAT-26 (P < 0⋅0001). Pearson's correlation showed that the EAT-26 score increased significantly with the BMI (r 0⋅22, P = 0⋅0001), height (r 0⋅12, P = 0⋅019) and weight (r 0⋅22, P = 0⋅0001). The early detection of EDs among adolescents is highly recommended to reduce the risk associated with future impaired health status. Nutrition professionals must target adolescents, teachers and parents and provide nutritional education about the early signs and symptoms of ED and the benefits of following a healthy dietary pattern.

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.

Disordered eating, self-esteem, and depression symptoms in Iranian adolescents and young adults: A network analysis

OBJECTIVE

The network theory of psychopathology examines networks of interconnections across symptoms. Several network studies of disordered eating have identified central and bridge symptoms in Western samples, yet network models of disordered eating have not been tested in non-Western samples. The current study tested a network model of disordered eating in Iranian adolescents and college students, as well as models of co-occurring depression and self-esteem.

METHOD

Participants were Iranian college students (n= 637) and adolescents (n = 1,111) who completed the Eating Disorder Examination-Questionnaire (EDE-Q), Rosenberg Self-Esteem Scale (RSES) and Beck Depression Inventory, Second Edition (BDI-II). We computed six Glasso networks and identified central and bridge symptoms.

RESULTS

Central disordered eating nodes in most models were a desire to lose weight and discomfort when seeing one's own body. Central self-esteem and depression nodes were feeling useless and self-dislike, respectively. Feeling like a failure was the most common bridge symptom between disordered eating and depression symptoms. With exception of a few differences in some edges, networks did not significantly differ in structure.

DISCUSSION

Desire to lose weight was the most central node in the networks, which is consistent with sociocultural theories of disordered eating development, as well as prior network models from Western-culture samples. Feeling like a failure was the most central bridge symptom between depression and disordered eating, suggesting that very low self-esteem may be a shared correlate or risk factor for disordered eating and depression in Iranian adolescents and young adults.

Body-, eating-, and exercise-related social comparison behavior and disordered eating in college women in the U.S. and Iran: A cross-cultural comparison

Wearing of the hijab is associated with lower eating disorder (ED) attitudes and behaviors in women. However, this potential buffering role of the hijab has been questioned in countries, such as Iran, where its wearing is compulsory. Further, cross-cultural comparisons between disordered eating behaviors and correlates in Iranian and U.S. women are lacking. This study examines social-cognitive correlates of disordered eating in U.S. and Iranian women, comparing rates of ED- related social comparison and eating pathology. College women in the U.S. (n = 180) and Iran (n = 384) completed the Body, Eating, and Exercise Comparison Orientation Measure (BEECOM) and the Eating Disorder Examination-Questionnaire (EDE-Q) in one session. One-way analyses of covariance and partial correlations were used to test the mean differences and inter-correlations between the variables among U.S. and Iranian women. U.S. women endorsed higher BEECOM scores and higher levels of overvaluation of weight and shape and dietary restraint compared to Iranians. Most BEECOM subscales and disordered eating symptoms were inter-correlated in each culture. The tendency to engage in exercise comparison was not significantly correlated with excessive exercise for U.S. women. Correlations between variables were stronger for U.S. women compared to Iranian women. While the ED-related social comparison levels were higher for U.S. women, the typical Western patterns of social comparison and disordered eating extend to Iranian women. Eating disorder-related social comparison is a recommended clinical target in both Eastern and Western cultures.

Eating disorder symptoms among adolescent boys and girls in Iran

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Disordered eating behaviours and attitudes among adolescents in a middle-income country

PURPOSE

Adolescent-disordered eating behaviours and attitudes (DEBA) are noted to be increasing in prevalence internationally. The aim of this study was to explore the DEBAs among Jamaican adolescents and identify those adolescents most at risk.

METHODS

521 high school participants (females, n = 292), ages 11-19 years, completed measures assessing socio-demographic factors, self-esteem, symptoms of anxiety and depression, behavioural factors, and anthropometry. Weight-related behaviours and attitudes were explored using the Eating Attitudes Test (EAT-26).

RESULTS

Thirty-one percent of participants reported engaging in at least one disordered eating behaviour, with bingeing as the most common. Female participants had significantly higher mean body mass index (p < 0.01) and mean EAT-26 score (p < 0.05) compared to males. Adolescents with EAT-26 score ≥ 20 were more desirous of being thinner (p < 0.01) and having a lighter skin complexion (p < 0.05). A greater proportion of adolescents with an EAT-26 score ≥ 20 had engaged in self-harm (p < 0.05), had smoked cigarettes (p < 0.05), had been sexually active (p < 0.01), and gave a history of sexual abuse (p < 0.01). Adolescents with overweight/obesity reported higher use of chemical weight manipulation (laxatives, diuretics, and diet pills) (p = 0.01).

CONCLUSIONS

Our data are consistent with the global figures showing both male and female adolescents endorsing disordered eating behaviours and attitudes (DEBAs). While this study highlights weight and shape dissatisfaction and associated DEBAs, it also raises the concern of an association with skin bleaching and elevated EAT-26 scores among Jamaican adolescents.

LEVEL OF EVIDENCE

Level V: cross-sectional descriptive study.

Bulimia symptoms in Czech youth: prevalence and association with internalizing problems

OBJECTIVE

Although clinical studies suggest that bulimia symptoms are common in youth, research on the prevalence of such symptoms and of their association with comorbid internalizing problems in the general population has been limited. This study aimed to evaluate the gender-specific prevalence of bulimia symptoms in Czech youth and explored the association between a clinical level of self-reported bulimia symptoms (CLBS) and internalizing problems by gender, controlling for age, socio-economic status and puberty status.

METHOD

The study was conducted on a representative national sample of Czech youth (N = 4430, 57.0% female) using self-report scales. Multivariate analysis of covariance (MANCOVA) was used to examine the associations.

RESULTS

The 3-month CLBS prevalence was higher in girls (11.4%) than in boys (3.8%) and in both genders a CLBS was associated with higher levels of comorbid internalizing problems.

DISCUSSION

Timely recognition of bulimia symptoms and associated risk factors is important for early prevention and intervention strategies.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study (according to Oxford (UK) CEBM Levels of Evidence, 2011).

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.

Validation of the Arabic version of the Eating Attitude Test in Lebanon: a population study

OBJECTIVES

To validate an Arabic version of the Eating Attitude Test (EAT-26) and identify factors (such as depression, stress, anxiety and body dissatisfaction) that might be associated with disordered eating among a sample of the Lebanese population.

DESIGN

Cross-sectional study.

SETTING

All Lebanese governorates.

PARTICIPANTS

A total of 811 participants randomly selected participated in this 5-month study (January-May 2018).

RESULTS

The EAT-26 scale items converged over a solution of six factors that had an eigenvalue over 1, explaining a total of 60·07 % of the variance (Cronbach's α = 0·895). The prevalence of disordered eating attitudes was 23·8 %. Higher EAT-26 scores (disordered eating attitudes) were significantly associated with higher depression (β = 0·325), higher emotional eating (β = 0·083), daily weighing (β = 3·430), higher physical activity (β = 0·05), starving to reduce weight (β = 4·94) and feeling pressure from TV/magazine to lose weight (β = 3·95).

CONCLUSIONS

The Arabic version of EAT-26 can be a useful instrument for screening and assessing disordered eating attitudes in clinical practice and research. Some factors seem to be associated with more disordered eating attitudes among participants for whom psychological counseling may be needed. Yet, our findings are considered preliminary, and further studies are warranted to confirm them.

The validity and reliability of the Farsi version of the Body, Eating, and Exercise Comparison Orientation Measure (F-BEECOM) among Iranian male and female students

Body-, eating-, and exercise-related social comparison tendencies are implicated in body dissatisfaction and disordered eating among Western women. To date, no published study examines eating- and exercise-related comparisons in a male or non-Western sample. The current series of studies fills these gaps in the literature by translating and validating the existing measure of these comparisons (the 18-item Body, Eating, and Exercise Comparison Orientation Measure [BEECOM]) in samples of Iranian men and women. In Studies 1 and 2, female (n = 284) and male (n = 302) participants completed the translated Farsi BEECOM. Scores were analyzed by exploratory factor analyses (EFA) revealing two different three factor, 15-item scale structures for men and women. In Studies 3 and 4, participants (female n = 384; male n = 253) completed measures of social comparison and psychological functioning in one session. These data were analyzed using confirmatory factor analyses (CFA) and Pearson correlations. Each CFA yielded adequately fitting models. Results support the use of two different 15-item Farsi BEECOM measures with women and men and highlight unique gender differences in social comparison tendencies. The resulting F-BEECOM demonstrates strong psychometric properties and will be a useful research tool in Iranian women and men.

Disordered eating attitudes among Iranian university students of medical sciences: The role of body image perception

BACKGROUND

Disordered eating attitudes and behaviors have become an issue of worldwide concern.

AIM

This research was designed to investigate the role of body image satisfaction in the relationship with eating attitudes among students of Qazvin University of Medical Sciences in Iran.

METHODS

In this cross-sectional study, 385 Qazvin university students of medical sciences were recruited by randomized stratified sampling in 2014. The students completed a three-part questionnaire (socio-demographic, Eating Attitudes Test and Body Shape Questionnaire) in their classrooms. We used hierarchical generalized linear models to identify variables significantly associated with Eating Attitudes Test scores.

RESULTS

The mean age of the students was 21.80 ± 2.98 years. Mean scores for the Eating Attitudes Test and Body Shape Questionnaire were 66.75 ± 29.8 and 11.86 ± 10.97 respectively; 18.5% of students had a score of 20 and above (≥ 20) that indicated disordered eating attitudes or as being at risk of eating disorders. In the multiple regression model, the Eating Attitudes Test was related to screening body image dissatisfaction (β = 0.122, P < 0.001). Body mass index was negatively related to the Eating Attitudes Test score (β= -0.488, P < 0.016), and diet was significantly correlated with an increased Eating Attitudes Test score (β = 5.803, P < 0.001).

CONCLUSIONS

The risk of eating disorders is relatively high among Iranian university students. It can be a warning to health policy makers and should be the focus of special attention. In the present study, the most important factor related to abnormal eating attitudes was body image dissatisfaction. Regarding the complexity of the causes of eating disorders, various preventive and therapeutic interventions are necessary to avoid the dissemination in society of an idealized view of excessive thinness and further unfavorable outcomes in college students.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Prevalence, correlates and comorbidities of feeding and eating disorders in a nationally representative sample of Iranian children and adolescents

OBJECTIVE

This study investigated the prevalence of feeding and eating disorders, and identified their correlates and comorbidities among children and adolescents.

METHOD

We used the nationally representative sample of the Iranian Children and Adolescents' Psychiatric disorders (IRCAP) survey, with 30,532 participants randomly selected by a multistage cluster sampling method. We employed the kiddie schedule for affective disorders and schizophrenia-present and lifetime version (K-SADS-PL) semi-structured face-to-face interview to screen for any psychiatric disorders, including feeding and eating disorders, and associated factors. We used multivariate binary logistic regression to analyze the data.

RESULTS

Valid data from 27,111 participants were analyzed. The total prevalence of feeding and eating disorders among children and adolescents was 0.89 (0.81-1.10). In all types of feeding and eating disorders, the adjusted odds ratio was higher among girls (except binge-eating disorder) and older adolescents but was lower among rural residents. The most common psychiatric comorbidities observed in children and adolescents with feeding and eating disorders were obsessive-compulsive disorder (20.2%), agoraphobia (20.2%), depressive disorder (16.4%), social phobia (10.1%), oppositional defiant disorder (10.1%), generalized anxiety disorder (9.4%), attention deficit hyperactivity disorder (7.5%), and conduct disorder (5.7%), which were significantly more common compared to their peers without feeding and eating disorders.

DISCUSSION

Older age, female gender and living in an urban area are predisposing factors in feeding and eating disorders (in binge-eating disorder, the male gender is a positive correlate). We suggest that future works pay attention to the role of gender, comorbidities and predisposing factors.

A battery of self-screening instruments and self-reported body frame could not detect eating disorders among college students

Objective

Although studies have shown inconsistent results in terms of prevalence of eating disorders, the Eating Attitudes Test (EAT-26) was used to screen students for abnormal eating behaviors. The results of the self-reported EAT-26 and body frame, as well as the efficacy of using self-administered questionnaires (SAQs) were examined to detect eating disorders in new college students.

Results

An anonymous questionnaire (EAT-26) was provided to 7738 new students; 4552 (58.8%) responders were included in the final analysis. Semi-structured interviews were conducted for 131 (1.7%) students. Among them, 6 students showed a high EAT-26 score, but were not diagnosed with an eating disorder based on the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Three students were diagnosed with an eating disorder using SCID-I, but their EAT-26 scores were below the threshold. From these results, in a non-clinical population, findings on EAT-26 do not agree with those on SCID-I in terms of the diagnosis of eating disorders, and this battery is not appropriate for detecting eating disorders.

An Intergenerational Approach to Break the Cycle of Malnutrition

PURPOSE OF REVIEW

This article examines how nutritional status is treated throughout the lifecycle. In doing so, the review identifies promising life stages during which intervention may improve nutritional status of future generations.

RECENT FINDINGS

A life course perspective suggests that nutritional changes are most likely to be sustained when they occur during times of developmental transition, such as pregnancy or adolescence. Adolescence is a unique period in which malnutrition in future generations may be addressed because it is the first life stage at which pregnancy becomes feasible and individuals seek independence from parents. A need exists to begin investigating not just how nutrition changes are sustained throughout the lifespan, but how nutritional intervention in one generation impacts the next. This intergenerational approach should be undertaken with cross-discipline collaboration to have the best chance at impacting underlying determinants of malnutrition like poverty and women's education.

Prevalence of disordered eating attitudes among adolescent girls in Arar City, Kingdom of Saudi Arabia

Eating disorders (ED) are one of the most common psychiatric problems faced by todays adolescent girls where the attitude towards weight and shape as well as their perception of body shape are disturbed. The aim of the paper is to assess the prevalence and associated factors of disordered eating attitudes among adolescent girls of Arar city, Kingdom of Saudi Arabia. This is a cross-sectional survey design in which 314 adolescents females (age: 15-19 years) were selected from four schools of Arar city, KSA. Subjects were asked to fill pre-tested questionnaire about socioeconomic status, eating habits and Eating attitude test 26 (EAT 26), there height and weight were measured and BMI was calculated. Disturbed eating behaviors (EAT-26>20) was found in 25.47% participants. The prevalence of disordered eating was more in overweight and obese than normal weight. Vegetarian girls had higher EAT 26 score than non - vegetarian and significant difference was found in total EAT 26 score and subgroup namely oral control and dieting score (P<0.01) but non-significant difference was found between Saudi and non-Saudi adolescent girls in different BMI ranges. Eating disorders prevalent in adolescent girls and were strongly associated with weight status and eating habits. Future prospective and experimental studies are warranted to advance our understanding of the risk factors to enable better preventive program planning.

Disordered eating attitudes: demographic and clinico-anthropometric correlates among a sample of Nigerian students

OBJECTIVES

We set out in this study to determine the demographic and clinico-anthropometric correlates of disordered eating attitudes among undergraduate students of two higher institutions in Lagos, Nigeria.

METHODS

This cross-sectional descriptive study was conducted among 1,054 participants after written informed consent. A socio-demographic questionnaire, the Eating Attitude Test (EAT-26) and 12-item General Health Questionnaire (GHQ-12) were administered to the participants. In addition, their blood pressure, height and weight were measured, and body mass index (BMI) was calculated.

RESULTS

The study participants comprised of 561(55.6%) males with median age of 21.4 years. The mean (±SD) score on EAT-26 was 11.52(±8.54), and 16% of all the respondents were categorized as having disordered eating attitude. A significant relationship was found between disordered eating attitude and age (p= 0.027), gender (p= <0.001), institution of study (p= 0.005), systolic blood pressure (p=0.019), BMI (p= 0.027) and psychological distress (p=0.005).

CONCLUSION

Our study observed disordered eating attitude to be prevalent among young adults, and demographic along with clinico-anthropometric factors constituted associated factors. Our findings strengthen the basis to incorporate health awareness programs aimed at improving nutrition and eating behavior among the young adult population. Future research is needed.

Disordered eating attitude and associated factors among high school adolescents aged 12-19 years in Addis Ababa, Ethiopia: a cross-sectional study

BACKGROUND

Eating disorders are very complex, frequently developed and have a public health impact on adolescents. Different studies revealed that eating disorders is a pressing public health problem among adolescents. Eating disorders may also lead to mortality due to their physiological sequelae. There is no previous study regarding disordered of eating attitude in Ethiopian adolescents. Therefore, this study aimed to assess prevalence of disordered eating attitude and its associated factors among adolescents in Addis Ababa high schools.

METHODS

A school-based cross sectional study was conducted. Data were collected among 836 high school adolescents aged 12-19 years from May to June, 2015 in Addis Ababa city. The data were collected by self-administered questionnaire containing eating attitudes test-26 items (EAT-26) and socio-demographic factors. Binary logistic regression analysis was carried out to identify factors associated with disordered eating attitude. Both crude odds ratio and adjusted odds ratio were calculated to show the strength of association. In multivariable analysis, variables with a P value of <0.05 were considered statistically significant.

RESULTS

The prevalence of disordered eating attitude among adolescents was 8.6% [95% CI 4.9, 12.3]. Being female [AOR = 1.75, 95% CI 1.03, 3.00], Mother's educational status (Primary [AOR = 0.28, 95% CI 0.11, 0.78], Certificate/diploma [AOR = 0.22, 95% CI 0.07, 0.58] and first degree and above [AOR = 0.16, 95% CI 0.07, 0.40]) were found to be significantly associated with disordered eating attitude.

CONCLUSION

The finding of this study revealed that a significant number of adolescents were susceptible to developing disordered eating attitude. Being female and Mothers' education status were significantly associated with disordered eating attitude among adolescents. Provision of screening test for eating disorders focusing on female adolescents is highly recommended.