1
|
Ghazzawi HA, Nimer LS, Sweidan DH, Alhaj OA, Abulawi D, Amawi AT, Levine MP, Jahrami H. The global prevalence of screen-based disordered eating and associated risk factors among high school students: systematic review, meta-analysis, and meta-regression. J Eat Disord 2023; 11:128. [PMID: 37537604 PMCID: PMC10398929 DOI: 10.1186/s40337-023-00849-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/24/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE Estimate the prevalence, and associated risk factors, of high school students who are considered at risk for an eating disorder based on screening measures. METHODS An electronic search of nine databases was completed from their inception until 1st September 2022. A random-effects meta-analysis was conducted, and confounder (moderator) analyses and meta-regressions examined whether the overall prevalence estimate for of screen-based disordered eating (SBDE) was moderated by student age, BMI, or gender, as well as culture and type of SBDE assessment. RESULTS The mean estimate of the prevalence of SBDE among high school students (K = 42 (66 datapoints), N = 56282] in the sample of 25 countries was 13% ([95% CI] = 10.0-16.8%, I2 = 99.0%, Cochran's Q p = 0.001). This effect was not moderated by features of the samples such as gender, BMI, or age. Among cultures, non-Western countries had a higher prevalence of SBDE prevalence than Western countries, but the difference was not significant. There was considerable variability in the prevalence estimates as a function of the assessment measure, but no meaningful pattern emerged. CONCLUSION The estimated figure of 1 in 8 high school students with SBDE-unmoderated by gender and BMI-stands out as a problem in need of attention from public health officials, psychologists, psychiatrists, pediatricians, parents, and educators. There is a great need for innovative, integrated policy and program development all along the spectrum of health promotion and universal, selective, and indicated prevention. Further research is also needed to validate and refine this estimate by (a) conducting basic research on the accuracy of eating disorder screening measurements in samples ages 14 through 17; (b) examining representative samples in more countries in general and Latin American countries in particular; (c) clarifying the relationships between SBDE and age throughout the different phases of late childhood, adolescence, and emerging adulthood; and (d) investigating whether there are meaningful forms of disordered eating and whether these are associated with variables such as gender, ethnicity, and BMI.
Collapse
Affiliation(s)
- Hadeel A. Ghazzawi
- Department Nutrition and Food Technology, School of Agriculture, The University of Jordan, P.O. Box 11942, Amman, Jordan
| | - Lana S. Nimer
- Department Nutrition and Food Technology, School of Agriculture, The University of Jordan, P.O. Box 11942, Amman, Jordan
| | - Dima H. Sweidan
- Department of Nutrition, Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | - Omar A. Alhaj
- Department of Nutrition, Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | - Duha Abulawi
- Department Nutrition and Food Technology, School of Agriculture, The University of Jordan, P.O. Box 11942, Amman, Jordan
| | - Adam T. Amawi
- Department of Physical and Health Education, Faculty of Educational Sciences, Al-Ahliyya Amman University, As-Salt, 19328 Jordan
| | | | - Haitham Jahrami
- Goverment Hospitals, Manama, Bahrain
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| |
Collapse
|
2
|
Kenny B, Bowe SJ, Taylor CB, Moodie M, Brown V, Hoban E, Williams J. Longitudinal relationships between sub-clinical depression, sub-clinical eating disorders and health-related quality of life in early adolescence. Int J Eat Disord 2023; 56:1114-1124. [PMID: 36896467 PMCID: PMC10946984 DOI: 10.1002/eat.23928] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE A comprehensive understanding of the relationship between depressive symptoms and eating disorder (ED) symptoms requires consideration of additional variables that may influence this relationship. Health-related quality of life (HRQOL) has been associated with both depression and EDs; however, there is limited evidence to demonstrate how all three variables interact over time. This study sought to explore the bi-directional relationships between depressive symptoms, ED symptoms and HRQOL in a large community sample of young adolescents METHOD: Adolescents (N = 1393) aged between 11 and 14 years (M = 12.50, SD = 0.38) completed an online survey measuring depressive symptoms, ED symptoms and HRQOL. Two-level autoregressive cross-lagged models with three variables (i.e., depressive symptoms, HRQOL and ED) assessed across two time points (T1 and T2) were created to address the study aims. RESULTS HRQOL was found to predict depressive symptoms and depressive symptoms were found to predict ED symptoms. Components of HRQOL (i.e., social relationships and ability to cope) were found to share a differential relationship with depressive symptoms. Inability to cope predicted depressive symptoms and depressive symptoms predicted negative social relationships. EDs were found to predict reduced HRQOL and negative social relationships. DISCUSSION Findings suggest prevention and early intervention programs designed to address adolescent depression should focus on improving HRQOL. Future research should assess the relationship between HRQOL and individual ED symptoms (e.g., body-related ED symptoms, restrictive symptoms) as a means of exploring relationships that may have been masked by assessing ED symptoms using a total score. PUBLIC SIGNIFICANCE This study sought to explore how eating disorders, depressive symptoms, and health-related quality of life (HRQOL) relate over time in a sample of young adolescents. Findings indicate adolescents who self-reported lower levels of HRQOL, including a reduced ability to cope, are at risk of experiencing depressive symptoms. Adolescents should be provided with the tools to develop problem-focused coping strategies as a means of reducing depressive symptoms.
Collapse
Affiliation(s)
- Bridget Kenny
- School of Health and Social Development, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - Steven J. Bowe
- Biostatistics Unit, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - C. Barr Taylor
- School of Medicine, Department of Psychiatry and Behavioral SciencesStanford UniversityStanfordCaliforniaUSA
- Center for m2HealthPalo Alto UniversityPalo AltoCaliforniaUSA
| | - Marj Moodie
- Deakin Health Economics, School of Health and Social Development, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - Vicki Brown
- Deakin Health Economics, School of Health and Social Development, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - Elizabeth Hoban
- School of Health and Social Development, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - Joanne Williams
- School of Health and Social Development, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
- School of Health SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
| |
Collapse
|
3
|
Alhaj OA, Fekih-Romdhane F, Sweidan DH, Saif Z, Khudhair MF, Ghazzawi H, Nadar MS, Alhajeri SS, Levine MP, Jahrami H. The prevalence and risk factors of screen-based disordered eating among university students: a global systematic review, meta-analysis, and meta-regression. Eat Weight Disord 2022; 27:3215-3243. [PMID: 35925546 PMCID: PMC9362208 DOI: 10.1007/s40519-022-01452-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/12/2022] [Indexed: 01/05/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Omar A. Alhaj
- Department of Nutrition, Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | - Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- The Tunisian Center of Early Intervention Is Psychiatry, Department of Psychiatry “Ibn Omrane”, Razi Hospital, rue des orangers, Manouba, Tunisia
| | - Dima H. Sweidan
- Department of Nutrition, Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | | | - Mina F. Khudhair
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Hadeel Ghazzawi
- Nutrition and Food Science Department, Agriculture School, The University of Jordan, P.O.Box 11942, Amman, Jordan
| | - Mohammed Sh. Nadar
- Occasional Therapy Department, Faculty of Allied Health Sciences, Kuwait University, Kuwait City, Kuwait
| | | | - Michael P. Levine
- Emeritus Professor, Department of Psychology, Kenyon College, Gambier, OH 43022 USA
| | - Haitham Jahrami
- Ministry of Health, Manama, Bahrain
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| |
Collapse
|
4
|
Ghazzawi HA, Alhaj OA, Nemer LS, Amawi AT, Trabelsi K, Jahrami HA. The Prevalence of "at Risk" Eating Disorders among Athletes in Jordan. Sports (Basel) 2022; 10:182. [PMID: 36422951 PMCID: PMC9693192 DOI: 10.3390/sports10110182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 06/26/2024] Open
Abstract
Eating disorders (EDs) are addressed as one of the expanding mental health problems worldwide. While an ED is a clinical psychiatric diagnosis that can only be established after a psychiatric assessment, it is important to note that "at-risk" refers to people who will exhibit aberrant eating patterns but do not fully meet the requirements for an ED diagnosis. This study was designed to address the ED symptoms (i.e., "at-risk") in Jordanian athletes and their association with age, sex, body mass index (BMI), and type of sport. A convenient, cross-sectional study was conducted among 249 athlete participants by answering the Eating Attitude Test (EAT-26). The EAT-26 results indicated an ED prevalence of 34% among Jordanian athletes. Within "at-risk" ED athletes, sex, age, and BMI had no significant differences in the rates of EDs. Outdoor sports had the least effect on EDs, while the highest was amongst gymnastics. EDs prevalence is alarming among Jordanian athletes. Gymnastics is a risk factor for increasing EDs. Our results should be taken into consideration by physicians, mental health professionals, sports nutritionists, coaches, and sport medicine specialists. We recommend establishing strategies pertaining to mental health, especially EDs in sports centers, along with screening programs for those who demand additional assessment and supervision.
Collapse
Affiliation(s)
- Hadeel A. Ghazzawi
- Department Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman 11942, Jordan
| | - Omar A. Alhaj
- Department of Nutrition, Faculty of Pharmacy and Medical Sciences, University of Petra, Amman 1196, Jordan
| | - Lana S. Nemer
- Department Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman 11942, Jordan
| | - Adam T. Amawi
- Department of Physical and Health Education, Faculty of Educational Sciences, Al-Ahliyya Amman University, Al-Salt 19328, Jordan
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia
- Research Laboratory Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax 3000, Tunisia
| | - Haitham A. Jahrami
- Ministry of Health, Manama 410, Bahrain
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 323, Bahrain
| |
Collapse
|
5
|
Donti O, Donti A, Gaspari V, Pleksida P, Psychountaki M. Are they too perfect to eat healthy? Association between eating disorder symptoms and perfectionism in adolescent rhythmic gymnasts. Eat Behav 2021; 41:101514. [PMID: 33964708 DOI: 10.1016/j.eatbeh.2021.101514] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Eating disorders are associated with perfectionism in adults, but evidence is lacking in adolescent competitive athletes. This study examined eating disorder symptoms and perfectionism in a sample of 13-15 years old, adolescent rhythmic gymnasts. METHODS Eighty-nine female rhythmic gymnasts (41 international and 48 recreational level gymnasts), completed the Eating Attitudes Tests 26 (EAT-26), the Sport Perfectionism Questionnaire (SPQ), the Social Desirability Scale (SDS) and provided information on their training. RESULTS It was found that 41.46% of the international and 14.58% of the recreational level gymnasts scored ≥20 in EAT-26. International level gymnasts also scored higher than recreational in EAT-26 (p = 0.002), and its subscales Dieting (p = 0.012) and Oral Control (p ˂ 0.001) and in the Sport Perfectionism Questionnaire (p = 0.005) and the subscales Striving for Perfectionism (p ˂ 0.001) and Personal Standards (p ˂ 0.001). No differences were found between groups in the subscales Concerns over Mistakes (p = 0.429), and Negative Reactions to Imperfection (p = 0.096). Multiple regression analysis in international level gymnasts, showed that Negative Reactions to Imperfection, body mass index and training experience accounted for 33.2% of the variance in EAT-26 (adjusted R2 = 0.332, F = 6.786, p ˂ 0.001). A negative association was observed between training experience and eating disorder symptoms in international level athletes. No association was found between the subscales of perfectionism and EAT-26 in recreational gymnasts (p ˃ 0.316). CONCLUSIONS International level, adolescent rhythmic gymnasts show more eating pathology than recreational. Negative Reactions to Imperfection and BMI seem relevant for gymnasts' dieting behaviour while training experience may help adolescent athletes to cope with disturbed eating behaviours.
Collapse
Affiliation(s)
- Olyvia Donti
- School of Physical Education & Sport Science, National & Kapodistrian University of Athens, Greece.
| | - Anastasia Donti
- School of Physical Education & Sport Science, National & Kapodistrian University of Athens, Greece
| | - Vasiliki Gaspari
- School of Physical Education & Sport Science, National & Kapodistrian University of Athens, Greece
| | - Paraskevi Pleksida
- School of Physical Education & Sport Science, National & Kapodistrian University of Athens, Greece
| | - Maria Psychountaki
- School of Physical Education & Sport Science, National & Kapodistrian University of Athens, Greece
| |
Collapse
|