Comparative study of the prevalence of abnormal eating attitudes among Arab female students of both London and Cairo universities

Is there evidence that religion is a risk factor for eating disorders?

OBJECTIVE

Is there evidence that religion is a risk factor for eating disorders?

METHODS

A literature search was performed to examine whether there is an association between religion and eating disorders.

RESULTS

There were some cross-sectional studies, case studies, and anthropological commentaries reporting eating disorders in various cultures and religions. Religious affiliation was usually reported as an incidental finding but not analyzed. A number of prevalence studies were reported from Islamic communities. This raises the possibility that young Muslim women have a higher prevalence of elevated EAT scores compared to non-Islamic women.

CONCLUSION

This literature search raises the possibility that there is an association between Islamic affiliation and positive screening for eating disorder behaviors. This supports the hypothesis that the effect of culture on eating disorders may be religious as well as secular. Carefully designed studies of the prevalence of eating disorders in multicultural populations with multiple religious affiliations may help further clarify the relationship between religion and eating disorders.

Acculturation, body image, and eating behaviours in Muslim-Australian women

The relationship between western acculturation, body dissatisfaction, and eating behaviours was examined in a sample of 101 Muslim-Australian women between 18 and 44 years of age (M=27.3, SD=7.5). A questionnaire was completed containing measures of cultural identification (heritage and mainstream), body dissatisfaction and disordered eating (dietary control, bingeing and purging), internalization of the thin ideal, and self-esteem. A series of path analyses identified significant positive relationships between mainstream identification and the measures of body dissatisfaction and disordered eating that were mediated by thin-ideal internalization. Path analyses also identified significant negative relationships between heritage identification and the measures of body dissatisfaction and disordered eating that were mediated by self-esteem. These results are indicative of the potential risks to body image incurred by women who adopt Western values, and of the benefits in retaining heritage cultural values that promote a positive self image.

Comparative study of eating-related attitudes and psychological traits between Israeli-Arab and -Jewish schoolgirls

OBJECTIVE

The aims of the study were to examine weight concerns, dieting and eating behaviours in a group of Israeli-Arab schoolgirls as compared with Israeli-Jewish schoolgirls, as well as to investigate the reliability of the Arabic (Palestinian) version of the eating disorder inventory-2 (EDI-2).

METHOD

The sample consisted of 2548 Israeli schoolgirls, including 1885 Jewish and 663 Arab adolescents ranging in age from 12 to 18. The study was conducted in 1998-2003 from urban and rural residential settings in the northern part of Israel. The (EDI-2) was the assessment tool used, yielding scores on 11 sub-scales.

RESULTS

The Israeli-Arab schoolgirls scored significantly higher than the Israeli-Jewish schoolgirls in most EDI-2 sub-scales. In addition, the sub-scale inter-item consistency of the translated Arabic (Palestinian version) of the EDI-2 was found to be reliable.

DISCUSSION

The drive to be thin found among Israeli Arab schoolgirls is not reflected in their small number of ED clinic referrals. These discrepancies are discussed in light of the socio-cultural changes currently taking place in the Israeli Arab population due to the influence of Western-oriented life in Israel.

Disordered eating related behaviors among Arab schoolgirls in Israel: an epidemiological study

OBJECTIVE

To examine the prevalence of disordered eating attitudes and behaviors among three religious subgroups of Arab schoolgirls in Israel (Moslems, Druze, and Christians).

METHOD

The sample consisted of 1,131 Arab schoolgirls in Israel, including 922 (81.5%) Moslem, 125 (11.1%) Christian, and 84 (7.4%) Druze adolescents, in the 7-12th grades. The sample was drawn from urban and rural residential settings from all parts of Israel using a clusters sampling method.

RESULTS

The Christian subgroup had a significantly lower total eating disorder inventory-2 (EDI-2) score than the Druze and Moslem subgroups, which had similar total EDI-2 scores. Significant differences were found between the three religious subgroups in all subscales, except in drive for thinness (DT), bulimia, body dissatisfaction, and asceticism. A total of 154 (13%) Arab schoolgirls scored higher than the cut-off point of >>14 on the EDI-DT subscale.

CONCLUSION

The results are discussed in light of the differences between the Christian, Druze, and Moslem subgroups and in terms of various aspects of Arab culture in Israel.

Cultural correlates of eating attitudes: a comparison between native-born and immigrant university students in Israel

OBJECTIVE

This study explores the association between gender and exposure to Western culture and attitudes toward eating.

METHOD

Four hundred and ninety-nine university students participated in the study: 216 Israeli natives, 153 new immigrants (3 years or less since immigration) from the Former Soviet Union (FSU), and 130 veteran immigrants from FSU (4-15 years since immigration). Attitudes toward eating were measured using the Eating Attitude Test - EAT-26.

RESULTS

Israeli born women had higher weight and body mass index (BMI) than did new immigrant women. Higher scores on the EAT-26 were found among women than among men. Among women only, native-born Israelis and veteran immigrants were more likely to have positive EAT-26 scores (19.6%, 18.8%) than were new immigrant women (7.9%), indicating disordered eating attitudes. Part of the differences in EAT-26 scores was explained by differences between the groups on age and BMI; however, even after adjustment the differences remained significant on the bulimia subscale.

CONCLUSION

The results suggest a rapid cultural effect in attitudes toward eating that may reflect a tendency toward eating disorders as well as a difference in the proportion of obesity. It seems that the veteran immigrants have adopted Western cultural norms and eating patterns in a way that has erased the differences in tendency toward eating disorders between them and the Israeli born women.

Facets of acculturation and their diverse relations to body shape concern in Fiji

OBJECTIVE

The present study examines the relation between acculturation and body shape concern in Fiji--a society undergoing rapid social change.

METHOD

Data were from two cohorts of ethnic Fijian girls and women collected in 1998 (n = 115). A factor analysis was performed to identify dimensions of acculturation. The association of these with body shape concern was examined with linear regression.

RESULTS

Three dimensions of acculturation were identified. Multiple linear regression models demonstrated that each of these dimensions of acculturation had a unique relation to body shape concern. The adjusted R(2) for the fully adjusted model relating acculturation to body concern was 0.63, indicating a substantial degree of shared variation between measures of body shape concern and measures of acculturation.

CONCLUSION

Acculturation may have a strong impact on body shape concern in Fiji. However, acculturation is a multidimensional construct and does not likely have a monolithic relation to body shape concern.

Prevalence of overweight, obesity, and associated psychological problems in Qatari's female population

Dissatisfaction with body weight and the use of unhealthy weight reduction practices have been reported among adolescents. It is important to conduct rigorous studies using large representative samples of female adolescents to assess accurately the frequency of dieting, overweight and eating disorders and accompanying attitudes. The aim of the present study was to examine the severity of dieting and its association with obesity, body satisfaction and psychological problems in female adolescents. A representative sample of 800 girls aged 14-19 years were approached during the period of October to December 2004, and 566 girls gave consent and participated in the study, thus giving a response rate of 70.8%. Self-reports were obtained from 566 teenage girls using the Adolescent Dieting Scale and the Self-Reporting Questionnaire (SRQ-20) for psychopathology. Subjects were classified into three categories: acceptable weight (BMI < 25 kg m(-2)); overweight (BMI 25-29.9 kg m(-2)); and obese (BMI > 30 kg m(-2)). The prevalence of overweight and obesity for female adolescents were 13.4% vs. 1.8%; 39.9% were intermediate dieters, and 8.3% were extreme dieters. Dieting was not associated with age but was significantly associated with body mass index (BMI) (P = 0.045). Extreme dieting was strongly associated with peer perception of respondent's figure (P < 0.001) and self-perception of figure (P = 0.016). Additionally, in adult Qatari population overweight and obesity for males were (34.4% vs. 34.6%) and for females were (33.0% vs. 45.3%). This is significantly higher than adolescent girls. (P < 0.01). The SRQ score was significantly highest in the extreme dieters group (P = 0.005). The extreme dieters get most of their education about dieting from school (14.0%) and TV (43.6%). The present study revealed strong evidence for the association between frequent dieting and overweight, body image dissatisfaction and psychological problems among adolescent females.

Disordered eating attitudes and symptomatology among adolescent girls in the United Arab Emirates

OBJECTIVE

To ascertain the prevalence and correlates of disordered eating attitudes and symptomatology in a school-based Arab population.

METHODS

A representative stratified random sample of 495 adolescent girls completed the Eating Attitudes Test (EAT-40) in the United Arab Emirates (UAE). A randomly selected subgroup from the those who scored above the recommended cut-off of 30 on the EAT-40 and an equal number of those who scored below 30 were interviewed in stage 2 by a psychiatrist, blind to the EAT scores, using the Schedule for Affective Disorders and Schizophrenia (KSADS) and DSM-IV criteria for the presence of eating disorders.

RESULTS

116 girls (23.4%) scored above the recommended cut-off on EAT. High EAT score was associated with age, BMI, internalization of thin ideal and drive for thinness, knowing someone on a weight loss strategy, having a family member with weight-related or mental health problem and watching western TV programs. Using clinical interview of 100 girls in stage 2, half of those who scored above the cut-off on EAT were found to have a propensity for anorexic behavior, while 2% met the criteria for the full clinical syndrome.

CONCLUSIONS

Thin body preoccupation as well as family and social factors are important in the development of abnormal eating attitudes among adolescents in this Arabian Gulf country.

Eating attitudes in a group of 11-year-old urban South African girls

OBJECTIVES: To explore and describe eating attitudes in early pubertal 11-year-old black and white South African girls in an urban environment undergoing transition. DESIGN: The study was designed as a cross-sectional baseline initiative within a longitudinal study. SUBJECTS: Two hundred and two subjects were randomly selected; 54 were white and 148 black. METHODS: Subjects completed questionnaires, and anthropometric measurements were taken. OUTCOME MEASURES: Variables included body mass index (BMI), eating attitudes (EAT score), dietary intake, socio-economic status, pubertal status and level of physical activity. RESULTS: As expected, the prevalence rate of abnormal eating attitudes in this group of girls was low (1%). No significant ethnic differences were found in the total EAT scores. White participants displayed greater oral control, while their black peers displayed greater tendencies toward dieting (p = 0.05). Girls who scored higher on the dieting subscale had a larger body size and were more inactive than low dieting scorers (p = 0.05). A relationship between body size measurements and dietary intake was found only in black girls. Traditionally a larger figure is accepted in black culture. However our data suggest a move away from this, indicating acculturation, as awareness of increased body size significantly influenced dieting attitudes. However, scores were within the normal range. CONCLUSIONS: There is early evidence suggesting the impact of societal transition on young black girls with regard to eating attitudes. Black girls in this age group are adopting Western ideals of beauty and thinness.

Time trends in eating disturbances in young Greek migrants

OBJECTIVE

The study intends to measure time trends in eating disorder psychopathology in Greek adolescents in Veria (Greece) and migrant Greek adolescents in Munich (Germany). For this purpose, large samples of students were assessed at both locations in the 1980s and about two decades later. Our research question was whether the frequency of eating disorder-related psychopathology had changed over time and that there were differences between migrants and nonmigrants. The present-day prevalence of eating disorders in the Greek population was established.

METHOD

Greek adolescents were assessed in Munich and Veria in the 1980s (N = 2,631) and almost two decades later (N = 2,920). At both times, the Anorexia Nervosa Inventory for Self-Rating (ANIS) was used to assess eating disorder pathology and the General Health Questionnaire (GHQ-28) was used to assess mental health status. In the second wave, persons at risk for an eating disorder were interviewed using the Structured Interview for Anorexic and Bulimic Syndromes (SIAB-EX).

RESULTS

At both times and both locations, adolescent girls in comparison to boys had higher, more pathologic scores on the GHQ-28 and on all ANIS self-rating subscales. Females in Munich reported an increase over time in figure consciousness and their fear of negative effects of meals. In the 1980s, significantly higher scores of bulimic behavior were found in Veria as compared with Munich. In the second wave, bulimic behavior was considerably decreased in Veria for both girls and boys, and for bulimic behavior no significant differences were found between locations. The percentage of girls with a low body weight (<5th percentile) increased significantly over time in Veria and Munich. In the second wave, the current prevalence for girls with anorexia nervosa was 0.00% in Munich and 0.59% in Veria (lifetime 1.26% and 1.18%, respectively). For bulimia nervosa, current prevalence was 1.89% in Munich and 1.18% in Veria.

CONCLUSION

Differences between locations diminished over time. Bulimic syndromes are prevalent in both locations.

Eating attitudes in a diverse sample of Israeli adolescent females: a comparison study

OBJECTIVES

To estimate the eating attitudes in Israeli Jewish female adolescents.

METHODS

A representative sample of 1270 females in grades 7-12 from five different Israeli schools from five different residential areas were assessed by EAT-26.

RESULTS

Of the total sample, 19.5% were identified as having abnormal eating attitudes. In terms of age, the 16 year olds were found to have the significantly highest rate of total and positive EAT-26 scores. As for school subgroups, the secular boarding schools had the significantly highest rate and the kibbutz had the lowest rate of positive EAT-26 scores for the total and for all subscales.

DISCUSSION

EAT-26 was found to be a useful tool for screening and identifying at-risk groups in a large adolescent Israeli population.

A preliminary study of EAT and BITE scores for one school year in Bermuda: increased early anorexic measures related to socio-economic factors

BACKGROUND

Bermuda is a unique heterogeneous ethnic population in which it is possible to study the interaction of ethnicity, culture, gender and economic factors that influence abnormal eating attitudes.

METHOD

A cross-sectional survey of 836 adolescents, one total school year in Bermuda. The BITE and EAT self-report questionnaires were administered in a classroom setting. The analysis was for caseness and for total scores. Caseness represents possible developing anorexic or bulimic eating disorder pathology for this non-adult population.

RESULTS

7.3% fulfilled EAT caseness, 0.24% fulfilled BITE caseness. There was no gender or ethnic difference for caseness. Multivariate analysis for EAT caseness found Odds Ratios of 2.89 (95% CI 1.37, 6.11) for Manual maternal job status.

CONCLUSION

Despite the limitation of a questionnaire analysis, lower socioeconomic status increases the risk of possible eating disorder pathology in this adolescent population. Developing anorexic eating attitudes were more prevalent compared to bulimic attitudes for schoolchildren in this unique cultural setting.

A "coca-cola" shape: cultural change, body image, and eating disorders in San Andrés, Belize

Eating disorders have been associated with developing nations undergoing rapid social transition, including participation in a global market economy and heavy media exposure. San Andrés, Belize, a community with many risk factors associated with the cross-cultural development of eating disorders, has shown remarkable resistance to previously documented patterns, despite a local focus on female beauty. Drawing on longitudinal person-centered ethnography with adolescent girls, this article examines why this community appears exceptional in light of the literature. First, community beauty and body image ideals and practices are explicated. Then, a protective ethnopsychology is proposed as a key mediating factor of the rapid socio-cultural change among young women. Finally, possible nascent cases of eating disordered behavior are discussed in light of their unique phenomenology: that is, having to do more with economic opportunity in the tourism industry and less with personal distress or desire for thinness. Close, meaning-centered examination of eating and body image practices may aid understanding and prevention of eating disorders among adolescents undergoing rapid social change in situations of globalization and immigration.

Bulimia symptoms and risk factors in university students

We proposed a model for bulimic symptoms in a sample of 153 female university students attending the Faculty of Psychology, and determined the extent to which such symptoms could be explained by these variables. The following variables were measured during class time: the effects of aesthetic body modelling, the impact of teasing about weight and other aspects of physical appearance, body dissatisfaction, dieting severity, bulimic symptomatology, depression and self-esteem. The data underwent Lisrel analysis. The final model was similar to that initially proposed. The most important variables in emergent bulimic symptoms were the perceived pressure of aesthetic body modelling, teasing about weight, body dissatisfaction, self-esteem, depression and dieting. All of these play a role in eating disorder symptomatology through various pathways.

Genes and/or Jeans?

Eating disorders are prevalent among young adult females and pose serious psychological and medical risks. Notwithstanding important advances, efforts to develop effective means of preventing and treating eating disorders have been limited by an incomplete understanding of their multifactorial etiology. Whereas epidemiologic data strongly suggest the influence of socio-cultural context in moderating risk, many hypotheses about how these effects are exerted have remained empirically unevaluated. Specifically, experimental and observational data suggest that social transition (e.g., transnational migration, urbanization, modernization), Western media exposure, and certain peer environments (involving social comparison and teasing) may all contribute to risk. With respect to genetic influences on etiology, family and twin studies have supported a genetic diathesis to eating disorders. Whereas, molecular genetic studies have generated interesting leads- with the most promising findings emerging for genes related to the function of serotonin-they have yet to identify well-replicated susceptibility loci. This paper reviews the data supporting both socio-cultural and genetic contributions for eating disorders and suggests productive future strategies for continuing to unravel their likely multiple and complex interactions.

Bulimic Pathology in Black Students in South Africa: Some Unexpected Findings

A high frequency of behaviours and attitudes associated with bulimia nervosa among black respondents, including males, has recently been reported in South Africa. The aims of the present study were to replicate these findings using a sampling procedure which would yield few refusals or dropouts, and to interview black males with bulimic symptoms to gain an understanding of their behaviour and motivation. In total, 40 black females, 39 black males, 40 white females and 42 white males who were students in residence at Rhodes University completed the Bulimia Test (BULIT). The criterion for marked bulimic pathology was exceeded by 25% of white females, 10% of black females and 5% of black males. The mean BULIT score for white females was significantly greater than that of the other groups and the other three groups did not differ significantly among themselves. Interviews revealed marked variability in understanding technical terms related to eating disordered behaviour, particularly among black males. When respondents who answered inconsistently were identified and removed from the analysis, the main conclusions from the analysis of variance were unaltered although the mean BULIT for black males was reduced by 3.7 and only one (2.5%) black male remained above the cut-off. It is concluded that subgroups of educated blacks may show relatively little bulimic pathology, and that the previous finding of significant bulimic pathology among black males might be artifactual and needs to be replicated under carefully controlled conditions.

Disordered eating attitudes: an emerging health problem among Mediterranean adolescents

Aim of the present study was to investigate eating attitudes in a group of Mediterranean high school students. One hundred and twenty high school students participated in this survey. The Eating Attitudes Test (EAT-26) was used for evaluating symptoms and attitudes associated with disordered eating. Body composition and dietary intake were also assessed. Using the cut-off point of 20 in the total EAT, 13 females (20.3%) and 4 males (7.3%) exhibited disordered eating behavior. Overweight students had significantly higher scores in the dieting scale than those in the normal BMI range. Percent fat mass was positively related to the total EAT (r=0.326, p<0.001) and the dieting scale (r=0.489, p<0.001). Waist/hip ratio was negatively related to total EAT and its scales. In conclusion, a significant percentage of students in this urban Mediterranean adolescent population found to have abnormal eating attitudes. This finding may be partly explained by the effect of cultural transition.

Prevalence and covariates of obesity in Lebanon: findings from the first epidemiological study

OBJECTIVE

To estimate the prevalence of overweight and obesity and examine associated covariates in the Lebanese population.

RESEARCH METHODS AND PROCEDURES

A cross-sectional survey of a representative sample of 2104 individuals, 3 years of age and older. Anthropometric measurements and dietary assessments were conducted following standard methods and techniques. Overweight and obesity (classes I to III) were defined according to internationally standardized criteria for classification of BMI.

RESULTS

For children 3 to 19 years of age, prevalence rates of overweight and obesity were higher overall for boys than girls (22.5% vs. 16.1% and 7.5% vs. 3.2%, respectively). For adult men and women (age > or = 20 years), the prevalence of overweight was 57.7% and 49.4%, respectively. In contrast, obesity (BMI > or = 30 kg/m(2)) was higher overall among women (18.8%) than men (14.3%), a trend that became more evident with increasing obesity class. BMI, percentage of body fat, and waist circumference increased to middle age and declined thereafter. Whereas lack of exercise associated significantly with obesity among children, obesity in older adults was more prevalent among the least educated, nonsmokers, and those reporting a family history of obesity.

DISCUSSION

The results from this national population-based study in Lebanon show high prevalence rates of overweight and obesity comparable with those observed in developed countries such as the United States. While further studies are needed to examine the underlying social and cultural factors associated with lifestyle and nutritional habits, now is the time to institute multicomponent interventions promoting physical activity and weight control nationwide.

Risk factors for anorexia nervosa: a national cohort study

OBJECTIVE

To identify possible risk factors for anorexia nervosa through national registers.

METHOD

The study includes the entire Swedish population of 989,871 individuals born between 1973 and 1982. Patients with anorexia nervosa were identified through the Swedish Hospital Discharge Register from November 1990 to December 1999. Information about sociodemographic, perinatal, and psychosocial variables was obtained from different national registers. Attributable risk (AR) was calculated for potential risk factors.

RESULTS

Females had the highest AR for hospital admission because of anorexia nervosa (89.2%). Another important risk factor was having parents born in northern, central, or eastern Europe (AR: 49.3%). Psychosocial risk factors also were associated with an increased risk for anorexia nervosa (AR: 7.6%), whereas perinatal complications had an AR of only 3.6%.

DISCUSSION

The most important risk factors were related to the sociocultural context of the individual, thus supporting hypotheses of a sociocultural etiology of anorexia nervosa.

Prevalence of bulimic behaviours and eating attitudes in schoolgirls from Trinidad and Barbados

We investigated eating attitudes and the prevalence of bulimic disorders in a group of 362 schoolgirls from the islands of Trinidad and Barbados using key questions from the Bulimia Investigatory Test, Edinburgh (BITE) and additional questions for the exploration of eating attitudes and dieting practices. A random sample of 92 girls were interviewed using the DSM-III-R Bulimia Diagnostic Interview. Only three subjects (0.8%) scored over the cut-off point on the BITE. None of the interviewees was diagnosed as having bulimia nervosa. Two hundred and forty-five girls (67.7%) reported being terrified of becoming fat and fat-fear was associated with higher Body Mass Index, dieting and exercising for losing weight. Girls of African origin were found to have a more unusual eating pattern and more concerns about their eating habits. The prevalence of bulimic disorders in Caribbean schoolgirls is still very low, but they are a population at increasing risk since they share the western ideals of slimness and engage in dieting behaviours.

A survey of anorexia nervosa using the Arabic version of the EAT-26 and "gold standard" interviews among Omani adolescents

OBJECTIVE

The purpose of this study was to assess the validity of the Eating Attitude Test (EAT) in identifying the presence and severity of eating pathology in male and female Omani urban adolescents and to establish cut-off scores that matched those of anorexia identified by gold standard interviews without fear of fatness criteria.

METHODS

Both females (n=126) and males (n=136) were screened using the Arabic version of the EAT-26 and interviewed using a semi-structured, Composite International Diagnostic Interview (CIDI) in order to investigate the relationship between false positives and false negatives at various EAT-26 cut-off points. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the EAT-26 for every possible threshold score.

RESULTS

The EAT-26 identified 29% of the subjects as probable anorexic cases as against 9.5% identified during the structured interview based on the anorexia gold standard (32% males and 68% females). The sensitivity and specificity of the EAT-26 were respectively 24% and 69.6%. When using the ROC curve, a cut-off score of 10 gave the best compromise between sensitivity (64%) and specificity (38%).

DISCUSSION

Although the EAT-26 is the most widely used screening instrument in cross-cultural studies, it does not appear to be reliable in identifying probable cases of anorexia among Omani adolescents. The use of a gold standard interview without fat phobia criteria indicated that the rate of anorexia nervosa may be more prevalent among males than previously estimated. This intriguingly high preponderance of males is discussed in terms of prevailing demographic trends in Oman.

An exploration of eating disorders in a Georgian sample

BACKGROUND

There is debate as to whether eating disorders may be culture-bound. However, accumulating evidence suggests that eating disorders may be found outside of the West, although the precise form of the eating disorder may differ.

AIMS

There were two aims of this study: (1) to translate and establish the psychometric properties of standard questionnaires to measure eating pathology in a Georgian sample; (2) to use these measures to determine whether cases of eating disorders exist in Georgia.

METHODS

We held focus groups of various health professionals to establish how eating disorders present in Georgia and to identify groups perceived to be at high risk of having an eating disorder. We obtained translated versions of a number of standardized questionnaires (measuring eating and general psychopathology) from 245 women from these identified high risk groups and a subsample were given a structured clinical interview.

RESULTS

We estimated from the responses to the questionnaires, that as many as 5% may have clinically significant bulimia nervosa, 7% fell in the weight range for anorexia nervosa with a further 7% in the weight range for obesity. We interviewed a sample of the high scoring group which confirmed the presence of clinically significant eating pathology in the majority of those identified as possible cases.

CONCLUSIONS

The results of this study suggest there may be women in Georgia with significant eating problems.

Presence and severity of anorexia and bulimia among male and female Omani and non-Omani adolescents

OBJECTIVE

The population of Oman is a heterogeneous mix of nationalities providing a natural setting for studying the cross-cultural differences in the presence and severity of eating disorders as well as an opportunity for evaluating the performance of measurement instruments for these disorders.

METHOD

Disordered eating screening instruments (the Eating Attitude Test and the Bulimic Investigatory Test) were administered to Omani teenagers, non-Omani teenagers, and Omani adults.

RESULTS

On the Eating Attitude Test, 33% of Omani teenagers (29.4% females and 36.4% males) and 9% of non-Omani teenagers (7.5% of males and 10.6% females) showed a propensity for anorexic-like behavior. On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). Among the non-Omani teenagers, 18.4% showed a tendency toward bulimia, with females showing a slightly greater tendency than males. In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food.

CONCLUSION

Omani teenagers scored significantly higher than other ethnic groups and Omani adults. This finding is discussed in the light of emerging evidence from many parts of the world suggesting that cultural transition, compounded by demographic constraints, plays a significant role in abnormal eating attitudes.

Preoccupation with weight and disordered eating behaviors of entering students at a university in Lebanon

OBJECTIVES

This research explores the prevalence of preoccupation with weight indicators and disordered eating behaviors among entering university students, and identifies factors associated with these indicators and behaviors.

METHOD

Data was collected by means of a self-administered questionnaire. Comparisons were made by gender, mother's education, and body mass index (BMI).

RESULTS

The final sample included 954 students. The indicators held most "often" included a desire to be thinner, and an awareness of caloric content. The behaviors engaged in "most" often included strenuous exercising, and avoiding particular foods. Both indicators and behaviors varied by gender and body mass index.

DISCUSSION

The prevalence of indicators and behaviors is high. Body mass index is a critical variable to consider in the development of interventions. Further research should explore the context surrounding these indicators and behaviors.

Eating disorder symptoms and body image concerns in Iran: comparisons between Iranian women in Iran and in America

OBJECTIVE

Rates of eating disorder symptoms were compared between Iranian women living in Iran and Iranian women living in America, in order to assess the impact of Western culture on eating disorders. Women in Iran are mandated by law to cover their bodies with a long veil or overcoat and they have little legal exposure to Western culture and media.

METHOD

Fifty-nine female Iranian students living in Tehran and 45 female students of Iranian descent living in Los Angeles were surveyed with the Eating Disorder Examination-Questionnaire and the Figure Rating Scale.

RESULTS

Few differences were found between participants in the two samples, despite ample power to detect them. Participants in Iran reported as much disordered eating as participants who had immigrated to America.

DISCUSSION

Neither exposure to Western media nor acculturation to Western norms appeared to be related to symptoms of disordered eating and body image concerns in this sample.

The roles of ethnicity and culture in the development of eating disturbance and body dissatisfaction: a meta-analytic review

This meta-analysis involved 35 studies examining eating disturbance and body dissatisfaction in white and non-white populations and the role of acculturation in the development of eating-related psychopathology. While the role of acculturation in predisposing non-whites to eating disorders remains to be determined, mean effect sizes indicate that whites report more eating disturbance than non-whites. Differences are greatest when studies compare black and white college samples on measures of subclinical eating pathology, like dietary restraint, ideal body shape, and body dissatisfaction. They are weakest when non-clinic populations and clinical forms of eating disturbance, like bulimia nervosa, are examined. These findings suggest that the current literature may be incorrect in its view that subclinical and clinical forms of eating disturbance represent the poles of a single continuum. In addition, they call into question the belief that SES influences the development of eating pathology.

An integration of feminist and self-psychological approaches to bulimia nervosa

Theoretical frameworks have guided approaches to treatment for the eating disorders. While unitary models were characteristic of earlier eras, more recent formulations have attempted to improve understanding by integrating various schools of thought (1). Several of these have placed cultural factors in the context of individual and familial predispositions. A weakness of these models has been the relative lack of understanding of the means by which these cultural values create mechanisms for expression of these disorders in specific women. In this manuscript I will explore the theoretical framework which places eating disorders in the context of socialization and culture, and integrate this with our current understanding of the individual psychopathological factors that enhance a woman's susceptibility to eating disorders. This exploration of specific mechanisms has implications for the development of efficacious models of treatment.

Cross-Cultural Research on Anorexia Nervosa: Assumptions Regarding the Role of Body Weight

OBJECTIVE

To critically examine two assumptions guiding cross-cultural research on the weight concerns of anorexia nervosa: (1) that weight concerns are specific to contemporary, Western manifestations of the disorder and (2) that the dissemination of Western values regarding thinness is primarily responsible for the development of anorexia nervosa in non-Western contexts.

METHOD

A review of theoretical and empirical literature on cross-cultural aspects of anorexia nervosa and the medical records of 14 Asian patients treated for eating disorders in Sydney, Australia.

RESULTS AND DISCUSSION

Regarding the first assumption: It is argued that weight concerns when defined as weight loss that is positively valued (rather than a fat phobia) is a defining characteristic of anorexia nervosa and is not limited to contemporary, Western cases of the disorder. Regarding the second assumption: It is argued that the occurrence of anorexia nervosa in non-Western contexts cannot be solely attributed to the acceptance of Western thinness ideals because values and practices intrinsic to non-Western cultures are also likely to be etiologically relevant.

The eating attitudes test: twenty-five years later

This manuscript reviews the literature involved with the Eating Attitudes Test (EAT), first developed in the late 1970s as a self-report, indicative of the symptoms of eating disorders. The EAT has good psychometric properties of reliability and validity, and reasonable sensitivity and specificity for the eating disorders, but very low positive predictive value because eating disorders are relatively uncommon. In addition they exist on a continuum, because of denial and social desirability, the results of a self-report instrument may be affected. A very large literature has documented the use of the EAT in a variety of cultures. It is used to screen eating disturbances in general as the first part of a two-part diagnostic screen, as an ability to compare across groups and to measure change between groups and over time.

Culture and eating disorders: a historical and cross-cultural review

Cultural beliefs and attitudes have been identified as significant contributing factors in the development of eating disorders. Rates of these disorders appear to vary among different racial/ethnic and national groups, and they also change across time as cultures evolve. Eating disorders are, in fact, more prevalent within various cultural groups than previously recognized, both within American ethnic minorities and those in other countries. This review examines evidence for the role of culture as an etiological factor for the development of eating disorders. Historical and cross-cultural experiences suggest that cultural change itself may be associated with increased vulnerability to eating disorders, especially when values about physical aesthetics are involved. Such change may occur across time within a given society, or on an individual level, as when an immigrant moves into a new culture. Further research into the cultural factors that promote the development of eating disorders is much needed. Understanding how cultural forces contribute to the development of disorders is needed so that preventive interventions can be created.

An epidemiological study of eating disorders in Iran

OBJECTIVE

The purpose of this study was to assess the prevalence of anorexia nervosa (AN) and bulimia nervosa (BN) as well as the prevalence of weight concerns and weight loss behaviors among schoolgirls in Tehran, Iran.

METHOD

A two-stage approach was used. We screened a large sample of adolescent girls aged 15-18 (n = 3, 100) with a Persian translation of the Eating Attitudes Test (EAT-26). Girls who screened positively were further evaluated with the Eating Disorder Diagnostic Inventory and a supplementary clinical interview.

RESULTS

Results showed a lifetime prevalence of 0.9% for AN, 3.2% for BN, and 6.6% for the partial syndrome. Body dissatisfaction and a desire to be thin were common in this population.

DISCUSSION

This study suggests that the prevalence of eating disorders among female adolescents in Teheran is comparable to prevalence rates reported by studies in Western societies, and somewhat higher than what has been reported in other non-Western societies.

Some correlates of dieting behavior in Saudi schoolgirls

OBJECTIVES

The study examines the correlates of dieting behavior among Saudi schoolgirls.

METHODS

Stratified cluster sampling was used to select female students from Grades 7 to 11 in Riyadh, Saudi Arabia. Subjects completed a sociodemographic data sheet and the Eating Disorders Inventory (EDI); their heights and weights were measured by a trained nurse. The total sample size was 1,271 students with a response rate of 92.76%.

RESULTS

15.9% scored positively on the EDI-Drive for Thinness subscale. Body mass index, speaking a Western language, and having lived in a Western country were the most significant personal factors associated with dieting behavior. Small family size and higher parental education and better occupation were significant family factors associated with dieting.

DISCUSSION

Results reflect some culture-specific findings that are explained in cultural terms.

Eating problems in female Japanese high school students: a prevalence study

OBJECTIVES

This study was conducted to estimate the prevalence of eating problems and to identify factors associated with the eating problems among Japanese high school girls.

METHODS

This study used a cross-sectional design. The study population was 3,032 female students attending three high schools in Fukushima, Japan. The 26-item version of the Eating Attitudes Test (EAT-26) was administered to assess eating problems. Inquiries were also made regarding possible risk factors for the eating problems.

RESULTS

Of the 2,685 subjects, 5.4% had a total EAT-26 score above the cutoff point (20 < or =). Logistic regression analysis demonstrated that older age, higher body mass index, a distorted body image, obsessive-compulsive tendency, and some familial issues were independently related to the eating problems.

DISCUSSION

The prevalence of eating problems in the Japanese female population was low compared with reports from Western countries. In addition, distorted body image was suggested to have the greatest influence on eating problems.

Eating disorders and dieting behavior among Australian and Swazi university students

The eating behaviors of 192 Australian and 129 Swaziland university students were examined by using the Eating Attitudes Test (EAT-26; D. M. Garner, M. P. Olmsted, Y. Bohr, & P. E. Garfinkel, 1982). The results did not support the hypothesis that more Australian students than Swazi students would display eating disorder symptoms. Australian women scored significantly higher than Australian men. Surprisingly, scores on the EAT-26 for men and women from Swaziland did not differ significantly. Furthermore, there was little difference between the scores of Swazi men and either Australian women or Swazi women. Results are discussed in relation to various cultural factors and assessment issues.

Epidemiology of eating disordered symptoms in the Korean general population using a Korean version of the Eating Attitudes Test

OBJECTIVE

The purposes of the present study were to estimate the proportion of subjects with a high score on the Korean version of Eating Attitudes Test--26 (KEAT-26), which may provide preliminary data regarding the prevalence rate of eating disorders in the Korean general population, and to further examine the sociocultural hypothesis of eating disorders.

METHOD

Using a multi-stage questionnaire sampling method, we surveyed 3062 subjects (1249 males, 1813 females) from 3896 Korean adults in a nationwide area.

RESULTS

8.5% (260/3062) of subjects scored above the cut-off on the KEAT-26. Their demographic correlates, eating traits, and other characteristics relating to general psychopathology were similar to those of patients with eating disorders and female Caucasian controls in Western countries.

DISCUSSION

These results suggest that changes in various sociocultural aspects have increased the risk of developing eating disorders in Korea, and support the sociocultural hypothesis of eating disorders.

Eating disorders among Indian and Australian university students

In a study of eating disorders, 297 Australian and 249 Indian university students completed the Eating Attitudes Test (EAT-26; Garner, Olmsted, Bohr, & Garfinkel, 1982) and the Goldfarb Fear of Fat Scale (GFFS; Goldfarb, Dykens, & Gerrard, 1985). Contrary to predictions, the Indian participants scored significantly higher than the Australian participants on both measures. The Indian women scored significantly higher than the Australian women on the EAT-26 but not on the GFFS. The Australian men showed significantly fewer symptoms than all other groups. The Indian men did not differ from the Australian or Indian women on either the EAT-26 or GFFS. The urban Indians did not differ from their rural counterparts on the GFFS, but the rural Indians had significantly higher EAT-26 scores than the urban Indians.

Eating attitudes and behaviors in 1,435 South African Caucasian and non-Caucasian college students

OBJECTIVE

The purpose of this study was to examine the presence and severity of eating disorder pathology in students representing South Africa's ethnically and culturally diverse population.

METHOD

A questionnaire survey, which involved the Eating Attitude Test and the Bulimic Investigatory Test, was administered to 1,435 South African college students (739 Caucasian and 696 non-Caucasian) from six universities in two urban centers.

RESULTS

Black students scored significantly higher than the other ethnic groups on these measures. In addition, a comparable percentage of black and Caucasian female students had scores within the clinical range on these scales. Male students scored consistently lower than female students.

CONCLUSIONS

This study's findings challenge the notion that eating disorders are primarily a Western, Caucasian phenomenon and raise the possibility that the risk of eating disorders may increase in developing societies.

Cultural and historical aspects of eating disorders

A review of cultural and historical accounts of anorexia nervosa indicates that this disorder is found primarily in Westernized societies during periods of relative affluence and greater social opportunities for women. Some hypotheses regarding the vulnerability to eating disorders are proposed to the basis of these data.

The EAT speaks many languages: review of the use of the EAT in eating disorders research

The Eating Attitudes Test questionnaire (EAT) has been a major instrument for detecting eating morbidity in a great number of studies across the world. The instrument was devised by two Canadian research workers and was initially validated on a Canadian population. Since then it has been used with reasonable success in eating disorders research emanating from English speaking countries, particularly the UK. This paper attempts to focus on the application of the EAT in non-English speaking countries where it was essential to translate it into the language of these countries. Comparative analysis of the results is assessed and the degree of success of the instrument in these studies is evaluated. The outcome of this review could have significant implications for the future use of the EAT in eating disorders research.

Comparison of attitudes and behaviors related to nutrition, body size, dieting, and hunger in Russian, black-American, and white-American adolescents

Attitudes and behaviors related to nutrition are known to differ between white-American and black-American adolescents, however, little is known about teenagers from Russia. We hypothesized that, compared with white-American or black-American teenagers, Russian teenagers would prefer a larger body size, be less likely to diet, and be less concerned about being overweight. Self-administered questionnaires were completed by 196 students in Moscow, 326 white-American, and 239 black-American adolescents who attended school in North Carolina (mean age = 16). Ideal body mass index (BMI) was calculated from measured height and the response to the question, "What do you consider to be your ideal weight?" Mean ideal BMI was higher in black-American boys (25.1) and girls (21.4) than in white-American boys (22.1) and girls (19.2), and Russian boys (21.8) and girls (19.1). After controlling for BMI, black-American girls were less than half as likely to report dieting compared with white-American girls. There were no significant differences among white-American girls and Russian girls, and there were no ethnic differences between boys in the prevalence of dieting. White-American girls and black-American girls were much more likely to identify being overweight as an important nutritional concern than were Russian girls (odds ratios > 10), and there were no ethnic differences among boys. We conclude that preferences for body size, the prevalence of dieting, and concerns about being overweight were similar in Russian and white-American teens, with the exception of Russian teenaged girls who were less likely than American girls to identify being overweight as an important concern. Overall, weight-related attitudes and behaviors in Russian teenagers were more similar to those of white-American teenagers than those of black-American teenagers.