Eating disorders, body image and media exposure among adolescent girls in rural Burkina Faso

Body image dissatisfaction is associated with perceived body weight among secondary school adolescents in Harar Town, eastern Ethiopia

Purpose

Body image dissatisfaction has emerged as an important determinant of dietary and physical activity, which in turn determine adolescents' nutritional status. Hence, it is important to understand predictors of body image dissatisfaction. Therefore, this study aimed to assess body image dissatisfaction and its associated factors among secondary school adolescents in the study area.

Methods

Data collected for other purposes were used to assess body image dissatisfaction among adolescents in Harar town. Body image dissatisfaction was assessed using the Body Part Satisfaction Scale. Data processing and analysis were performed using STATA version 14, and binary logistic regression was used to identify factors associated with body image dissatisfaction. Factors associated with body image dissatisfaction were determined by estimating AOR along with 95% CI and the statistical significance was declared at a p-value less than or equal to 0.05.

Result

The prevalence of body image dissatisfaction was 22.06% [95% CI (19.63, 24.70)]. This study also revealed that males were more dissatisfied with their upper torso and face, and females were more dissatisfied with their middle torso, lower torso, height, and weight than males. In this study, body image dissatisfaction was associated with perception of being fat [AOR = 1.89, 95% CI (1.23, 2.91)], anxiety [AOR = 1.59, 95% CI (1.02, 2.48)], and cigarette smoking [AOR = 1.63, 95% CI (1.03, 2.58)].

Conclusion

Almost one in five secondary school adolescents in Harar had body image dissatisfaction, which was significantly associated with perceptions of being fat, anxiety, and smoking. In this study, a significant number of the adolescents experienced body image dissatisfaction. Hence, all concerned bodies have to take action to reduce the burden.

Relationship satisfaction and metabolic health parameters: a cross-sectional study in Burkinabe population of older adults

BACKGROUND

Over- and undernutrition coexist in many African countries and pose a threat to metabolic health. This study assessed the associations between relationship satisfaction and Body Mass Index (BMI), waist circumference (WC), and glycated hemoglobin (HbA1c), in a rural population of older adults in Burkina Faso. It also explored potential gender differences and the mediating role of depressive symptoms.

METHODS

Data from the "Centre de Recherche en Santé de Nouna (CRSN) Heidelberg Aging Study (CHAS)," a cross-sectional population-based study conducted in 2018 in Burkina Faso, were used in our study. Hierarchical linear regression models were applied for each of the three outcome variables. Among 2291 participants aged 40 years or older who provided data on relationship satisfaction, 2221, 2223, and 2145 participants had BMI, waist circumference (WC), and HbA1c values respectively.

RESULTS

Higher relationship satisfaction (CSI-4 score) was associated with increased BMI (β = 0.05, p = 0.031) and WC (β = 0.12, p = 0.039). However, the association of CSI-4 and BMI became non-significant after controlling for depressive symptoms (PHQ-9 score) and physical inactivity (BMI: β = 0.04, p = 0.073). Depressive symptoms fully mediated the relationship between relationship satisfaction and BMI (β = -0.07, p = 0.005). There was no significant association between relationship satisfaction and HbA1c. These results were consistent across genders and age groups.

CONCLUSION

Higher relationship satisfaction may lead to increased body weight among Burkinabe adults aged 40 years and older, and depressive symptoms may be a mediator in this association.

Translation and cross-cultural adaptation of EAT-26 questionnaire in Urdu

EAT-26 questionnaire is used globally to screen people for the risk of eating disorders. In addition to this, the EAT-26 is being used in its original English version in research and clinical settings due to unavailability of the Urdu version. Therefore, the aim of this study was to introduce the Urdu version of EAT-26 to clinicians and academicians in Pakistan, interested in the assessment of population at risk of eating disorders. After getting the formal permission for translation by Dr. D. M. Garner, WHO guidelines were followed for the translation and adaptation process. Two independent translators with psychological background worked under the supervision of a lead to produce the definitive version following six steps of translation and adaptation. Cognitive interviews and focused group discussions helped in the assessment process for the understanding level of translated Urdu version. The pre-final version showed comprehension and acceptability during initial pilot testing.•The final translated version of EAT-26 in Urdu will be available on Internet to use. It is expected that the use of EAT-26 will be widespread in Pakistan, aiming at the assessment of eating disorders.•The Urdu version of EAT-26 is finalized, and ready to use by researchers and clinicians in Pakistan.

Exploring risk factors of drive for muscularity and muscle dysmorphia in male adolescents from a resource-limited setting in Burkina Faso

In low-income countries, Muscle Dysmorphia (MD) has only been investigated in adult south African amateur-bodybuilders. To date, there is no epidemic study about MD or its cardinal symptom "drive for muscularity" (DFM) and its impact on young men's lives in African low-income settings. We analyzed a population-representative cross-sectional study of 838 adolescent males aged 12-20 in the rural northwestern Burkina Faso. Participants were assessed for MD with the research criteria of Pope and its cardinal symptom DFM based on the DFM scale (DMS). Since DFM has not been studied in a comparable sample so far, all possible influencing variables were examined exploratively in a linear regression model. Many respondents were underweight (41.5%) and few overweight (1.3%). No-one met standard clinical MD criteria. While 60.1% of 837 wished to be more muscular, only 8.7% of 824 desired a lower body-fat percentage. Regression analysis revealed that higher DMS scores were associated with greater internalization of the muscular body ideal, going to school, living in a rural area, older age, and a history of having faced sexual harassment or assault, but not with media exposure. Our results show that levels of DMS in Burkinabe adolescents were elevated. Risk factors for DFM in environmental circumstances where undernutrition and poverty are common are discussed.

Characteristics of Malaysian 16-year-old girls who reported regular binge eating episodes and the associated risk factors: a descriptive study

OBJECTIVES

Adolescents may suffer from binge eating (BE), that refers to consuming a large amount of food in a short period of time and accompanied by feelings of loss of control (LOC) over eating. This study compared the prevalence of BE between 16-year-old Malaysian girls from two types of public schools, Malay-English-medium and Chinese-Malay-English-medium schools. Additionally, this study identified associated risk factors of those who presented regular BE episodes, including LOC eating, anxiety, body mass index (BMI), body dissatisfaction (BD) and eating disorders (EDs) psychopathology.

METHODS

398 participants completed self-reports assessing BE symptoms, LOC eating, state anxiety, trait anxiety, EDs psychopathology, and BD. They also reported heights and weights. Descriptive statistics, t-tests, chi-square tests, and Z-test for independent proportions were conducted.

RESULTS

There was no significant difference in either the prevalence of BE or EDs psychopathology between participants from the two types of schools. 71 (17.8 %) participants reported moderate-to-severe symptoms of BE, and 46 (11.6 %) reported moderate-to-severe levels of LOC eating. Those who reported moderate-to-severe symptoms of BE reported significantly higher levels of LOC eating, BD, drive to be thinner, BMI, state anxiety, and EDs psychopathology, compared to those who reported none-to-minimal BE.

CONCLUSIONS

BE and LOC eating appeared to be relatively common among secondary school girls in Malaysia. The relatively high prevalence of BE amongst adolescents in our sample highlighted the importance of early identification of signs for BE as preventive measures from developing EDs psychopathology among children and adolescents. We propose that attitudes towards eating and body image-related concerns should be included in school screenings aimed at preventing psychological problems in minors.

Thyroid dysfunction in children and adolescents affected by undernourished and overnourished eating disorders

Eating disorders (ED) are one of the most prevalent chronic disorders in adolescents and young adults, with a significantly increasing prevalence in younger children, particularly in girls. Even if obesity in essence is not framed as an eating disorder and has always been considered a separate pathology, ED and obesity could be considered part of a continuum. It has become evident that one condition can lead to another, such as binge eating disorder (BED) and bulimia nervosa, and that they share the same repercussions in terms of psychosocial, metabolic, and nutritional health. This narrative review aims to investigate the hypothalamic-pituitary-thyroid axis in undernourished and overnourished patients with ED, including obesity, in order to highlight the relationship between weight control and thyroid function and its effects and to consider therapeutic and preventive strategies in children and adolescents. Literature data report that thyroid alterations occur in patients with ED, both underweight and overweight, and represent a continuum of changes depending on the severity and time course of the disease involving the endocrine system. Considering the relevant role thyroid hormones (TH) play not only in energy expenditure (EE) but also in metabolic control and cardiovascular risks related to dysmetabolism and mood regulation, continuous monitoring of thyroid homeostasis in patients with ED is mandatory to prevent severe complications and to start early treatment when necessary.

The need for epidemiological research on eating disorders in Africa and the Caribbean

The eating disorders field acknowledges the need to include diverse populations in research. Although global diversity has increased in epidemiologic research, there is still a significant lack of research in Africa and the Caribbean. The objectives of this article are to highlight knowledge gaps in these regions and make recommendations to improve future research. We searched the literature about the epidemiology of eating disorders in Africa and the Caribbean and provided a brief summary of research findings and measures used to identify cases. There is a large knowledge gap about the epidemiology of eating disorders across African and Caribbean nations. Knowledge about the cultural appropriateness of measurement instruments and screening tools is also lacking. Inadequate information about the epidemiology of eating disorders in Africa and the Caribbean inhibits the eating disorders research field from identifying who is affected. Further, measures and screening instruments with uncertain cultural validity inhibit the ability to understand case presentations and treatment targets. We recommend that the field advocate for the inclusion of eating disorders in larger population health research and that future research should evaluate the appropriateness of measurement instruments to capture eating disorder cases in African and Caribbean countries. PUBLIC SIGNIFICANCE: There is a lack of eating disorder research in African and Caribbean countries. The limited studies that do exist show evidence of eating disorders in African and Caribbean countries. Research is needed to develop culturally relevant measures for screening and case identification, and to calculate incidence and prevalence.

Body image as a global mental health concern

Body image concerns related to weight or other dimensions of appearance are now prevalent on a global scale. This paper reviews the theoretical frameworks that account for the global similarities and regional differences in rates and presentation of body image concerns, as well as reviewing the extant data. Given the harmful consequences of body image concerns in terms of mental and physical health, their global burden is high. Interventions to mitigate these concerns at the individual and systemic level are warranted.

Worldwide prevalence of DSM-5 eating disorders among young people

PURPOSE OF REVIEW

Eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, and other eating disorders) affect young people worldwide. This narrative review summarizes key studies conducted on the prevalence of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) eating disorders among young people in 2013-22.

RECENT FINDINGS

In Western settings, a substantial proportion of young people have reported an eating disorder. Overall, 5.5--17.9% of young women and 0.6-2.4% of young men have experienced a DSM-5 eating disorder by early adulthood. Lifetime DSM-5 anorexia nervosa was reported by 0.8-6.3% of women and 0.1-0.3% of men, bulimia nervosa by 0.8-2.6% of women and 0.1-0.2% of men, binge eating disorder by 0.6-6.1% of women and 0.3-0.7% of men, other specified feeding or eating disorders by 0.6-11.5% of women and 0.2-0.3% of men, and unspecified feeding or eating disorders 0.2-4.7% of women and 0-1.6% of men. Gender and sexual minorities were at particularly high risk. Emerging studies from Eastern Europe, Asia, and Latin America show similar high prevalences. During the COVID-19 pandemic, the incidence of eating disorders has still increased.

SUMMARY

Eating disorders are a global health concern among young people. Improved detection, management, and prevention methods are urgently needed.

An update on the epidemiology of eating disorders in Latin America: current findings and future challenges

PURPOSE OF REVIEW

We systematically reviewed the recent literature on the epidemiology of eating disorders in Latin America.

RECENT FINDINGS

Most screened articles only investigated risk for eating disorders or disordered eating behaviors. Four studies reported prevalence for eating disorders. One study reported age-standardized prevalence ranging from 0.04% [95% confidence interval, CI (0.03, 0.06)] to 0.09% [95% CI (0.07, 0.13)] for anorexia nervosa and from 0.13% [95% CI (0.08, 0.17)] to 0.27% [95% CI (0.18, 0.37)] for bulimia nervosa. Three additional studies conducted in Brazil identified a general eating disorder point-prevalence of 0.40% in children aged 6--14 years and a point-prevalence of 0.7 % [95% CI (0.34, 1.55)] for bulimia nervosa, 1.4% [95% CI (0.81, 2.43)] for binge-eating disorder and 6.2% [95% CI (3.10, 5.27)] for recurrent binge eating.

SUMMARY

Since 2020, only few studies were published on the epidemiology of full-threshold eating disorders in Latin America. Prevalence was in a comparable range to previous findings. No studies regarding new DSM-5 eating disorder diagnoses were identified, and studies investigating the impact of the COVID-19 pandemic on prevalence or incidence of eating disorders in these countries are needed.

Eating Disorders and Sexual Satisfaction: The Mediating Role of Body Image Self-consciousness during Physical Intimacy and Dissociation

Women with eating disorders experience difficulties related to sexual activity, yet little is known about the indirect association between eating disorders and sexual satisfaction. This study examined the indirect association between eating disorders and sexual satisfaction using body image self-consciousness during physical intimacy and dissociation as mediators. Online questionnaires were answered by 985 Israeli women. Of them, 98 were identified as likely to have eating disorders (study group). A matching control group (n = 98) was selected from the remaining respondents. Participants in the study group had significantly higher body image self-consciousness and dissociation than the matched controls, as well as significantly lower sexual satisfaction. The research model revealed that body image self-consciousness during physical intimacy mediates the link between eating disorders and sexual satisfaction, while dissociation does not. Women with eating disorders have higher levels of self-consciousness about their body during sexual activity, which may distract them from their own sexual needs and desires and those of their partners, and this, in turn, is associated with sexual dissatisfaction. Findings highlight the need for improved evidenced-based assessment and management of the sexual satisfaction of women with eating disorders.Abbreviations: ED: eating disorders; AN: anorexia nervosa; BN: bulimia nervosa; BED: binge eating disorder.

Parental practices, body dissatisfaction and weight control practices in female adolescents from public schools in southern Brazil

The objective was to verify the association between body dissatisfaction (BD) - constituted by the desire to lose weight - with family and personal aspects related to the shape of the body and weight control practices in female adolescents. A cross-sectional, observational epidemiological study with adolescents aged 12-19 years, enrolled in classes of the 8th and 9th years of public schools belonging to the urban area of the city of Caxias do Sul/Rio Grande do Sul, Brazil, was conducted. A self-applicable questionnaire was used. BD was assessed using a silhouette scale. Multivariate regression was performed using Poisson regression with robust variation, hierarchically using a pre-established conceptual model, using the prevalence ratio (PR) adjusted with 95 % CI as a measure of effect. A significance level of 5 % (P ≤ 0·05) was considered. Among the 685 female students, 77·2 % had BD. The father's incentive to diet sometimes (PR 1·19; 95 % CI 1·07, 1·32; P ≤ 0·001) and always (PR 1·15; 95 % CI 1·03, 1·28; P ≤ 0·001), trying to lose weight (PR 1·63; 95 % CI 1·33, 1·99; P ≤ 0·001), dieting five times or more (PR 1·22; 95 % CI 1·09, 1·36; P ≤ 0·001) and skipping meals less than once a week (PR 1·16; 95 % CI 1·04, 1·29; P = 0·026) increased the chances of having BD. In conclusion, among the investigated parents' behaviours, only the father's incentive to go on a diet was associated with BD. Adolescent weight control practices increased the chances of having BD. Thus, it facilitates the identification of this condition at an early stage, enabling adequate treatment and prevention of health complications.

Prevalence of binge-eating disorder among children and adolescents: a systematic review and meta-analysis

The objective is to estimate the prevalence of binge-eating disorder (BED) and subclinical BED in children and adolescents. Relevant articles were searched in the databases of PubMED and PsycINFO. Articles were included if they measured BED, subclinical BED, binge eating and/or loss of control (LOC) eating in samples of up to 20 years of age or with a mean age below 20 years. Subclinical BED covers participants with < 4 OBEs but ≥ 1 OBE pr. month and studies measuring subclinical DSM-IV/DSM-5 BED, but where all criteria were not met. All study types and measuring methods were accepted, but studies were excluded if they did not assess and exclude cases of recurrent compensatory behaviors. Meta-analyses were used to obtain an overall estimate of the prevalence of BED and subclinical BED, while stratified meta-analyses were used to assess sources of heterogeneity. 39 studies measuring BED, subclinical BED and/or a low frequency of binge eating were included. Two meta-analyses resulted in an overall estimated prevalence of 1.32% BED and 3.0% subclinical BED in children and adolescents. The results were influenced by high heterogeneity. Potential sources to heterogeneity in the BED result were weight of participants and sample types as well as level of risk of bias in the included studies. BED seems to be as frequent in children and adolescents as anorexia nervosa and bulimia nervosa. Hence, treatment of BED and BED symptoms in younger populations should be prioritized on the same terms as anorexia and bulimia nervosa.

Design and Field Methods of the ARISE Network COVID-19 Rapid Monitoring Survey

The coronavirus disease 2019 (COVID-19) pandemic has significant health and economic ramifications across sub-Saharan Africa (SSA). Data regarding its far-reaching impacts are severely lacking, thereby hindering the development of evidence-based strategies to mitigate its direct and indirect health consequences. To address this need, the Africa Research, Implementation Science, and Education (ARISE) Network established a mobile survey platform in SSA to generate longitudinal data regarding knowledge, attitudes, and practices (KAP) related to COVID-19 prevention and management and to evaluate the impact of COVID-19 on health and socioeconomic domains. We conducted a baseline survey of 900 healthcare workers, 1,795 adolescents 10 to 19 years of age, and 1,797 adults 20 years or older at six urban and rural sites in Burkina Faso, Ethiopia, and Nigeria. Households were selected using sampling frames of existing Health and Demographic Surveillance Systems or national surveys when possible. Healthcare providers in urban areas were sampled using lists from professional associations. Data were collected through computer-assisted telephone interviews from July to November 2020. Consenting participants responded to surveys assessing KAP and the impact of the pandemic on nutrition, food security, healthcare access and utilization, lifestyle, and mental health. We found that mobile telephone surveys can be a rapid and reliable strategy for data collection during emergencies, but challenges exist with response rates. Maintaining accurate databases of telephone numbers and conducting brief baseline in-person visits can improve response rates. The challenges and lessons learned from this effort can inform future survey efforts during COVID-19 and other emergencies, as well as remote data collection in SSA in general.

Urbanization and eating disorders: a scoping review of studies from 2019 to 2020

PURPOSE OF REVIEW

This review scoped recent (2019-2020) literature investigating the association between urbanization and eating disorders, and the putative role of urbanization as a direct or indirect risk factor.

RECENT FINDINGS

There are few epidemiological studies which investigated adequately direct or indirect association between urban domicile and eating disorders. Findings suggest that urbanization is a complex phenomenon and its effects on eating behaviour are indirect, for example, because of other important social and environmental features, such as the amount of 'green' space, 'Western' thin idealization, and poverty. The review also supports others indicating an increase of eating disorders in Africa and Asia. The majority of research includes only adolescent and young woman.

SUMMARY

It does not seem likely that metropolitan dwelling in itself is a major risk factor for developing an eating disorder. However, when accompanied by other sociodemographic effects, there may well be an increase in eating disorder risk. There are opportunities for planners to design cities to be supportive of peoples' eating and mental health in general. More research investigating moderating and mediating effects on the associations between urban dwelling and eating disorder is needed as well as studies of more sexually and age diverse populations.

Understanding the relationship between sexual harassment and eating disorder psychopathology: A systematic review and meta-analysis

OBJECTIVE

The experience of sexual harassment (SH) may exacerbate the drive toward an ideal and often unattainable physical appearance, creating the foundation of unhealthy eating, and greater shape and weight concerns. This systematic review aimed to synthesize evidence on the relationship between SH and eating disorder psychopathology, as well as mediating and moderating factors that contribute to this relationship.

METHOD

Six key databases were searched from inception to August 2020; including CINAHL, PsycInfo, PubMed, Medline, Scopus, and Web of Science.

RESULTS

Overall, 15 studies meeting inclusion criteria were found, with 14 reporting a statistically significant relationship between SH and eating disorder psychopathology. A meta-analysis with 12 cross-sectional studies confirmed a small but significant effect for this concurrent association. Moderators of this relationship included gender, posttraumatic stress, and anxiety. No studies in this review conducted true mediation.

DISCUSSION

Conclusions about causal and mediating relationship between SH and eating disorder psychopathology are constrained by the preponderance of cross-sectional design (14 of the 15 studies). Therefore, it is recommended that future studies focus on the use of longitudinal design, and also on adolescent populations, where first experiences of SH are usually reported, and which is also the peak age of onset for eating disorders.

Nonverbal Response Cards Reduce Socially Desirable Reporting of Violence Among Adolescents in Rural Burkina Faso: A Randomized Controlled Trial

PURPOSE

Accurate measures of violence are difficult to obtain from self-reported data because of stigmatization and social undesirability of the topic. Most methods that attempt to reduce such biases require literacy and either remove the benefits of interviewer guidance or do not give individual-level results. We tested a low-tech nonverbal response card that avoids revealing interviewees' responses to interviewers while retaining interviewer support among adolescents in communities with very low educational attainment.

METHODS

As part of a broader health questionnaire, we asked a sample of 1,644 adolescents, aged 12-20 years, in northwestern Burkina Faso about their experiences of physical and sexual violence. We randomized participants to either a conventional verbal response arm or a nonverbal response card arm where respondents' answers were unspoken and not displayed to interviewers. We first evaluated response validity and reliability in each arm, then compared prevalence rates across arms and evaluated whether any differences varied by respondent characteristics using regression models.

RESULTS

The level of internal reliability of responses among nonverbal respondents was similar to or greater than that of verbal respondents. Nonverbal respondents reported similar patterns of physical assault and sexual debut as verbal respondents but significantly higher levels of sexual assault and forced sex. These differences were broadly similar across sample subgroups defined by age, gender, proneness to social desirability, and mental health.

CONCLUSIONS

Nonverbal response cards offer a practical and beneficial method for reducing underreporting of stigmatized and traumatic experiences while maintaining data quality in low-literacy populations.

Problematic usage of the internet and eating disorder and related psychopathology: A multifaceted, systematic review and meta-analysis

Eating disorders are widespread illnesses with significant impact. There is growing concern about how those at risk of eating disorders overuse online resources to their detriment. We conducted a pre-registered systematic review and meta-analysis of studies examining Problematic Usage of the Internet (PUI) and eating disorder and related psychopathology. The meta-analysis comprised n = 32,295 participants, in which PUI was correlated with significant eating disorder general psychopathology Pearson r = 0.22 (s.e. = 0.04, p < 0.001), body dissatisfaction r = 0.16 (s.e. = 0.02, p < 0.001), drive-for-thinness r = 0.16 (s.e. = 0.04, p < 0.001) and dietary restraint r = 0.18 (s.e. = 0.03). Effects were not moderated by gender, PUI facet or study quality. Results are in support of PUI impacting on eating disorder symptoms; males may be equally vulnerable to these potential effects. Prospective and experimental studies in the field suggest that small but significant effects exist and may have accumulative influence over time and across all age groups. Those findings are important to expand our understanding of PUI as a multifaceted concept and its impact on multiple levels of ascertainment of eating disorder and related psychopathology.

From the jungle to urban centers: body image and self-esteem of women in three different cultures

The aim of this study is to compare body image, body perception, body satisfaction, body-related self-esteem and overall self-esteem of women from three different cultural backgrounds. The survey covers a sample of 187 women, including 133 Germans, 31 Q’eqchi’, and 23 Colombians. Two groups (in Germany and Colombia) live in urban centers, while one group (in Guatemala: Q’eqchi’) is a jungle-based ethnic group descended from the Maya where the body perception was largely unaffected by media. The instruments used in this study are the Figure Rating Scale, the Body-Esteem Scale and the Rosenberg Self-Esteem Scale. According to the study, German and Colombian women prefer a significantly slimmer body and perceive themselves more critically than Q’eqchi’. There are no significant differences in body perception between German and Colombian women. Q’eqchi’ women do not have significantly higher body satisfaction than German and Colombian women. Although German women have significantly higher body satisfaction than Colombian women, Q’eqchi’ women have the highest body-related self-esteem on average. Colombian women in turn have a higher body-related self-esteem than German women. There is a positive correlation between body satisfaction with both body-related self-esteem and overall self-esteem in all three groups. In conclusion, the German and Columbian women living in urban settings look much slimmer, prefer much slimmer bodies and have lower body-related self-esteem, compared to jungle-dwelling Q’eqchi’ women in Guatemala.