Factors Associated with Binge Eating Behavior among Malaysian Adolescents

Perfectionistic Self-Presentation and Psychopathology: A Systematic Review and Meta-Analysis

Decades of research implicate perfectionism as a risk factor for psychopathology. Most research has focused on trait perfectionism (i.e., needing to be perfect), but there is a growing focus on perfectionistic self-presentation (PSP) (i.e., the need to seem perfect). The current article reports the results of a meta-analysis of previous research on the facets of PSP and psychopathology outcomes (either clinical diagnoses of psychiatric disorders or symptoms of these disorders). A systematic literature search retrieved 30 relevant studies (37 samples; N = 15,072), resulting in 192 individual effect-size indexes that were analysed with random-effect meta-analysis. Findings support the notion of PSP as a transdiagnostic factor by showing that PSP facets are associated with various forms of psychopathology, especially social anxiety, depression, vulnerable narcissism and-to lesser extent-grandiose narcissism and anorexia nervosa. The results indicated that there both commonalities across the three PSP and some unique findings highlighting the need to distinguish among appearing perfect, avoiding seeming imperfect and avoiding disclosures of imperfections. Additional analyses yielded little evidence in the results across studies including undergraduates, community samples and clinical samples. Our discussion includes a focus on factors and processes that contribute to the association between PSP and psychopathology.

Assessing the factor structure of the Eating Attitude Test-26 among undergraduate students in Malaysia

The objective of this study was to assess the factor structure of the 26-item Eating Attitude Test (EAT-26) through confirmatory factor analysis (CFA) among 1,084 undergraduate students in Malaysia. The initial findings indicated a lack of support for the proposed three-factor structure. Model modifications were made due to the inadequate initial fit. The fit of the model was significantly improved by excluding items with factor loadings below 0.40 and integrating residual covariances. In conclusion, it is necessary to make contextual modifications to the EAT-26 in order to effectively utilize it among Malaysian undergraduates. This highlights the significance of cultural adaptations in psychological instruments.

Family cohesion and intuitive eating in Chinese college students: A serial mediation model

Improving intuitive eating can effectively prevent emotional eating, restrained eating, and overeating, and help improve people's physical and mental health. Based on the acceptance model of intuitive eating, ecological systems theory, family stress model, and transactional model of stress and coping, the present study aimed to explore the relationship between family cohesion and intuitive eating and its underlying mechanisms through a cross-sectional study design. A random sample of 702 college students from 29 provinces in China, aged from 18 to 26 years (54.56% male, M age = 21.12 years), voluntarily participated in the survey. Demographic variables, family cohesion, intuitive eating, perceived stress, and coping style were measured. The results indicated that family cohesion was significantly positively correlated with intuitive eating and the direct effect between them was significant. Meanwhile, there was a significant indirect effect of family cohesion on intuitive eating through perceived stress and positive coping styles. Moreover, perceived stress and positive coping styles, rather than negative coping styles, acted as serial mediators in the association between family cohesion and intuitive eating. The findings shed light on the prevention and intervention for disordered eating and obesity and provided a new theoretical perspective for the mental health education of college students. In addition, implications and directions for future research were also 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.

Eating Disorders among Adolescent Female Students in Jeddah, Saudi Arabia

Background

Eating disorders (EDs) are characterised by an abnormal attitude towards food that causes someone to change their eating habits and behaviour. This study aimed to investigate the prevalence of EDs and their associated factors among female going-school adolescents in Jeddah, Saudi Arabia.

Methods

A cross-sectional study was conducted in five schools in Jeddah, Saudi Arabia, among a representative random sample of female adolescent students aged 13 years old-18 years old. A simple random sampling method was used to select the participants. An online self-administered questionnaire, the Arabic version of eating attitude test (EAT-26) and socio-cultural attitudes toward appearance questionnaire (SATAQ-4), was used.

Results

More than half (53.6%) of adolescent girls scored at or above the cut-off point of EAT-26. Around 45% of the participants had experienced family influence on their appearance and body shape, 36.7% had experienced peer influence on these factors, and 49.4% had experienced media influence. Family influence was significantly associated with EDs (P = 0.013).

Conclusion

The high prevalence of EDs among female going-school adolescents in Jeddah, Saudi Arabia, is of great concern. To mitigate this problem, effective programmes must be designed to change their dietary habits while considering the effects of family, peer and media influence, as well as focusing on the importance of eating breakfast and practising physical activity.

Beyond emotion: online takeaway food consumption is associated with emotional overeating among Chinese college students

BACKGROUND

Online takeaway food has become very popular in China. However, the potential effects of online takeaway food consumption on eating behaviours among individuals during the transition stage from adolescence to young adulthood have not yet been assessed.

OBJECTIVE

This study aimed to examine the effects of takeaway food consumption on emotional overeating behaviour among college students.

METHODS

Data were collected from 1450 college students from six universities in Anhui, China. The frequency of emotional overeating during the past 4 weeks was assessed by the emotional overeating questionnaire (EOQ). Data on the frequency of online takeaway food consumption and other potential risk factors at the individual, interpersonal, physical environment, and macro-system levels were assessed by questionnaire. Multilevel linear regression analyses were employed to explore the association between takeaway food consumption and emotional overeating behaviour.

RESULTS

Compared to those who consumed online takeaway food less than 1 day per week, participants who consumed this food 4-5 days per week and participants who consumed this food 6-7 days per week had significantly higher EOQ scores (β = 0.14, p < 0.05 and β = 0.67, p < 0.001, respectively). More frequent consumption was associated with higher EOQ scores (p for trend < 0.001).

CONCLUSION

A higher frequency of takeaway food consumption was associated with an elevated risk of emotional overeating among college students independent of personal emotional status and other potential confounders at the interpersonal, physical environmental and macro-system levels.

LEVEL OF EVIDENCE

Level V; cross-sectional descriptive study.

Influence of a Nutrigenetic Intervention on Self-Efficacy, Emotions, and Rewarding Behaviors in Unhealthy Eating among Mexicans: An Exploratory Pilot Study

The Genome-based Mexican (GENOMEX) diet is a strategy for preventing and managing obesity. Emotion and eating behavior in the context of a nutrigenetic intervention have not been thoroughly studied. We aimed to explore the influence of the GENOMEX diet on emotions, self-efficacy, and rewarding behaviors in unhealthy eating among subjects with risk factors for obesity-related chronic diseases. Twenty-eight subjects included in the six-month GENOMEX intervention answered questions regarding emotions that influence food consumption. Additionally, the Patient Health Questionnaire (PHQ-9) and the Reward-based eating drive scale (RED) were applied. In the study, minimal, mild, moderate, and severe depression were present in 46.4%, 39.3%, 10.7%, and 3.6%, respectively. RED did not change, but it correlated with a higher intake of fats (r² = 0.684, β = 2.066, p = 0.003). Mood influenced unhealthy eating in 71.7% of subjects, and 76.9% experienced binge episodes triggered by anxiety. Sugars were the most consumed foods during binge episodes (42.2%). Both low self-efficacy levels and binge episodes were associated with high consumption of unhealthy foods. After the intervention, 10.7% of subjects reported a high level of self-efficacy. In conclusion, a culturally acceptable and genetically compatible regional Mexican food diet reduced negative emotions and unhealthy eating while increasing self-efficacy.

Risk factors for binge eating severity among adolescent girls and boys. A structural equation modeling approach

OBJECTIVE

Parental bonding, low self-esteem, emotion dysregulation, and eating style are correlated with each other and are associated with binge eating among adolescents. However, no studies have yet examined all these variables simultaneously. In the current study, the independent and combined influences of such constructs on binge eating were tested with structural equation modeling.

METHOD

A sample of 973 students aged between 12 and 16 (M = 14.17, SD = 1.25) years was screened by means of self-report measures assessing parental bonding, self-esteem, emotion dysregulation, eating styles and binge eating severity.

RESULTS

Self-esteem (β = -0.205) and eating styles (emotional β = 0.313, external β = 0.133, and restrained β = 0.178) had a direct effect on binge eating severity. The model (χ²₍₂₂₎ = 57.679; RMSEA = 0.041; CFI = 0.987; TLI = 0.949; SRMR = 0.024) revealed that the paths from both maternal and paternal care and maternal overprotection to binge eating were mediated through low self-esteem, emotion dysregulation and each eating style, explaining 35% of the variance.

DISCUSSION

Findings provide support for a comprehensive theoretical-based model of risk factors for binge eating and suggest the possible mechanisms through which the quality of early parental relationships contribute to developing dysfunctional eating patterns. Treatment and prevention efforts should improve self-esteem and emphasize emotion regulation capabilities.

Binge eating among young adults: association with sociodemographic factors, nutritional intake, dietary n-6:n-3 ratio and impulsivity

Binge eating behaviour (BE) is the major symptom of binge eating disorder (BED). This study aimed to compare the nutritional intake in the presence or absence of BE, with a particular focus on dietary n-6:n-3 ratio, to assess the association between BE and impulsivity and the mediating effect of BMI on this association. A total of 450 university students (age 18-28 years) participated. The self-administered questionnaires were a semi-quantitative FFQ and the UPPS-P Impulsive Behavior Scale and the binge eating scale. The average BE score was 11·6 (se 7·388), and 20 % of the total participants scored above the cut-off of 17, thus presenting BE with 95 % CI of 16·3, 23·7 %. Our study revealed that greater BMI, higher total energy intake, greater negative urgency and positive urgency scores were significantly associated with BE. Participants with high value of dietary n-6:n-3 ratio were 1·335 more at risk to present a BE compared with those with a lower value of this ratio (P = 0·017). The relationship between BE score and UPPS domains score was not mediated by the BMI. This is the first study reporting a link between high dietary n-6:n-3 ratio and BE as well as the fact that BE was linked to both, negative and positive urgencies, and that the association between BE and impulsivity was not mediated by BMI. These findings can help to deal more efficiently with people suffering from BE, a symptom that can precede the development of BED.

Self-Esteem and Binge Eating among Adolescent Boys and Girls: The Role of Body Disinvestment

Although low self-esteem and body disinvestment have been recognized as potential risk factors for disordered eating, no studies have explored how these factors may work together to predict binge eating in adolescents. Therefore, we hypothesized a path model for girls and boys separately to investigate whether the body’s investment dimensions (feelings towards the body, physical touch, body care, body protection) mediate the relationship between self-esteem and binge eating, and age moderate such relationships. Participants were 1046 Italian students aged between 11 and 19 years (472 girls, M_age = 14.17; 574 boys, M_age = 14.60) screened through self-report measures. Both models showed an acceptable fit (males: χ²₍₂₂₎ = 30.441; RMSEA = 0.026; CFI = 0.99; TLI = 0.97; SRMR = 0.023; females: χ²₍₂₂₎ = 34.723; RMSEA = 0.35; CFI = 0.98; TLI = 0.95; SRMR = 0.029). Negative body feelings and reduced body protection fully mediated the relationship between self-esteem and binge eating, regardless of gender. Our findings highlight the importance of interventions promoting body emotional investment to reduce adolescents’ vulnerability to binge eating.

Depression and physical health as serial mediators between interpersonal problems and binge-eating behavior among hospital nurses in South Korea

This cross-sectional study examined the relationship between depression, physical health, interpersonal problems, and binge-eating behavior among South Korean nurses. Self-report questionnaires were answered by 187 nurses from five hospitals. Mediating roles of depression and physical health between interpersonal problems and binge-eating behavior were examined using mediation analyses with bootstrapping. Total and direct effects of interpersonal problems on binge-eating behavior were significant. Indirect effects of path through depression and physical health as mediators, and through single mediation of physical health were significant, while indirect effects through depression were not. Thus, physical health affects nurses' vulnerability to interpersonal problems and binge-eating behavior.

The role of the intestinal microbiota in eating disorders - bulimia nervosa and binge eating disorder

Bulimia nervosa (BN) and binge eating disorder (BED) are both eating disorders (EDs) characterised by episodes of overeating in which large amounts of food are consumed in short periods. The aetiology of BN and BED is not fully understood. Psychological and social factors influence the development of BN and BED, but biological factors such as neurohormones that regulate hunger and satiety, or neurotransmitters responsible for mood and anxiety play a significant role in sustaining symptoms. Increasing numbers of studies confirm the relationship between the composition of intestinal microbiota and the regulation of appetite, mood, and body mass. In this manuscript, we will describe the mechanisms by which intestinal dysbiosis can play an important role in the aetiology of binge eating episodes based on current understanding. Understanding the two-way relationship between BN and BED and alterations in the intestinal microbiota suggest the utility of new treatment methods of these disorders aimed at improving the composition of the intestinal microflora.

School-Based Intervention to Improve Healthy Eating Practices Among Malaysian Adolescents: A Feasibility Study Protocol

Introduction: School environments can influence students' dietary habits. Hence, implementing a healthy canteen intervention programme in schools is a recommended strategy to improve students' dietary intake. This study will evaluate the feasibility of providing healthier food and beverage options in selected secondary schools in Malaysia by working with canteen vendors. It also will assess the changes in food choices before and after the intervention.

Methods: A feasibility cluster randomised controlled study will be conducted in six secondary schools (intervention, n = 4; control, n = 2) comprising of rural and urban schools located in Selangor and Perak states in Malaysia. Four weeks of intervention will be conducted among Malaysian adolescents aged 15 years old. Two interventions are proposed that will focus on providing healthier food options in the canteen and convenience shops in the selected schools. Interventions 1 and 2 will entail training the canteen and school convenience shop operators. Intervention 2 will be applied to subsidise the cost of low energy-dense kuih (traditional cake), vegetables, and fruits. The control group will continue to sell the usual food. Trained dietitians will audit the canteen menu and food items sold by the school canteen and convenience shops in all schools. Anthropometric measurements, blood pressure and dietary assessment will be collected at baseline and at the end of 4-week intervention. Focus group discussions with students and in-depth interviews with headmasters, teachers, and school canteen operators will be conducted post-intervention to explore intervention acceptability. Under this Healthy School Canteen programme, school canteens will be prohibited from selling “red flag” foods. This refers to foods which are energy-dense and not nutritious, such as confectionery and deep-fried foods. They will also be prohibited from selling soft drinks, which are sugar-rich. Instead, the canteens will be encouraged to sell “green flag” food and drinks, such as fruits and vegetables.

Conclusion: It is anticipated that this feasibility study can provide a framework for the conception and implementation of nutritional interventions in a future definitive trial at the school canteens in Malaysia.

Effectiveness of a school-based intervention on knowledge, attitude and practice on healthy lifestyle and body composition in Malaysian adolescents

Background

The ‘Eat Right, Be Positive About Your Body and Live Actively’ (EPaL) intervention programme was developed to prevent overweight and disordered eating in Malaysian adolescents. This study aimed to evaluate the effectiveness of the EPaL programme on knowledge, attitudes and practices on healthy lifestyle and body composition (body mass index z-score [zBMI], waist circumference [WC] and body fat percentage [BF%]) among adolescents.

Methods

All measures were taken at three time points: before intervention (Pre), after intervention (Post I) and 3 months after intervention (Post II). The intervention group (IG) participated in the EPaL programme for 16 weeks, whereas the comparison group (CG) received no intervention. Seventy-six adolescents (IG: n = 34; CG: n = 42) aged 13–14 years were included in the final analysis. Repeated measures analysis of covariance (ANCOVA) was used to assess the impact of the EPaL intervention programme on the measures between groups (IG and CG) at Post I and Post II.

Results

The IG reported significantly higher knowledge scores at both Post I (adjusted mean difference = 3.34; 95% confidence interval [CI] = 0.99, 5.69; p = 0.006) and Post II (adjusted mean difference = 2.82; 95% CI = 0.86, 4.78; p = 0.005) compared with the CG. No significant differences between the IG and CG were found at either Post I or Post II in attitudes, practices, zBMI, WC and BF%. The proportion of participants who were overweight or obese was consistent from Pre to Post II in the IG (35.3%) and increased from 26.2% at Pre to 28.5% at Post II in the CG, but the difference was not statistically significant. The proportion of participants who had abdominal obesity in the IG decreased from 17.6% at Pre to 14.7% at Post II and increased from 16.7% at Pre to 21.4% at Post II in the CG, but the differences were not statistically significant.

Conclusion

Despite no significant reduction of body composition, this programme shows the positive effect on the adolescents’ knowledge regarding healthy lifestyle. This study contributes to the evidence on the effectiveness of school-based health interventions in Malaysian adolescents.

Trial registration

UMIN Clinical Trial Registration UMIN000024349. Registered 11 October 2016.

A prospective study on the link between weight-related self-stigma and binge eating: Role of food addiction and psychological distress

OBJECTIVES

This prospective study investigated the link between weight-related self-stigma and binge eating by (a) examining the temporal association between weight-related self-stigma and binge eating; (b) investigating the mediating role of food addiction in the association between weight-related self-stigma and binge eating; and (c) examining the mediating role of psychological distress in the association between weight-related self-stigma and binge eating.

METHOD

Participants comprised 1,497 adolescents (mean = 15.1 years; SD = 6.0). Body mass index and weight bias were assessed at baseline; psychological distress (i.e., depression, anxiety, and stress) assessed and food addiction at 3 months; and binge eating at 6 months. The mediation model was analyzed using Model 4 in the PROCESS macro for SPSS with 10,000 bootstrapping resamples.

RESULTS

There was no significant direct association between weight-related self-stigma and binge eating. However, food addiction and psychological distress significantly mediated the association between weight-related self-stigma and binge eating.

DISCUSSION

These findings highlight the indirect association between weight-related self-stigma and binge eating via food addiction and psychological distress. Consequently, intervention programs targeting food addiction and psychological distress among adolescents may have significant positive effects on outcomes for weight-related self-stigma and binge eating. The findings will be beneficial to researchers and healthcare professionals working with adolescents during this critical developmental period.

Comparison of Factors Associated with Disordered Eating between Male and Female Malaysian University Students

Disordered eating is prevalent among university students, especially females. Whilst literature suggests that factors associated with disordered eating may differ according to gender, such an association has not been studied in Malaysia. This cross-sectional study aims to compare factors associated with disordered eating between male and female university students. A total of 716 university students (male: 27.4%; female: 72.6%) were recruited in Kuala Lumpur and Selangor, Malaysia. All participants completed a set of self-administered questionnaires and their body weight and height were recorded. About one in five of the university students (20.3%) were found to have disordered eating. There were more female students (22.9%) disordered eating compared to males (13.3%, χ² = 8.16, p < 0.05). In male students (β = 0.228, p < 0.01), depressive symptoms were the only significant predictor for disordered eating. In females, the strongest predictor was depressive symptoms (β = 0.214, p < 0.001), followed by body size satisfaction (β = -0.145, p < 0.01) and body appreciation (β = -0.101, p < 0.05). These findings suggest that there are gender differences in the factors associated with disordered eating among Malaysian university students. Intervention programmes that address disordered eating should take into account these sex differences and its contributing factors.

Malaysian adolescents' perceptions of healthy eating: a qualitative study

OBJECTIVE

To explore the concepts of healthy eating and to identify the barriers and facilitating factors for dietary behaviour change in adolescents.

DESIGN

A qualitative study involving twelve focus groups.

SETTING

Two secondary schools in the district of Hulu Langat in Selangor, Malaysia.

PARTICIPANTS

Seventy-two adolescents aged 13-14 years.

RESULTS

Adolescents had some understanding regarding healthy eating and were able to relate healthy eating with the concepts of balance and moderation. The adolescents' perceptions of healthy and unhealthy eating were based on food types and characteristics, cooking methods and eating behaviours. Facilitators for healthy eating were parents' control on adolescents' food choices, feeling concern about own health and body, being influenced by other's health condition, and knowledge of healthy or unhealthy eating. On the other hand, barriers for healthy eating were the availability of food at home and school, taste and characteristics of foods, and lack of knowledge on healthy or unhealthy foods.

CONCLUSIONS

The findings contribute to a better understanding of the adolescents' concept of healthy eating, as well as the facilitators and barriers to practising healthy eating. Future interventions should include a method of promoting the immediate benefits of healthy eating, the way to cope with environmental barriers for healthy eating, and increasing the availability of healthy food choices at home and in the school environment. The health and nutrition education programmes should also focus on educating parents, as they can be role models for adolescents to practise more healthful behaviours.

A Randomised Experiment Evaluating the Mindful Raisin Practice as a Method of Reducing Chocolate Consumption During and After a Mindless Activity

The present study investigated the impact of the mindful raisin exercise on overeating during and after the experiment while controlling for wellbeing. One-hundred and twenty-eight participants were recruited and completed a questionnaire on wellbeing (i.e. depression, anxiety and stress) and state mindfulness. Participants were randomly allocated to either the mindful raisin exercise or a newspaper reading control condition. The State Mindfulness Scale was then completed again, and participants watched a neutral video while exposed to chocolate for 10 min. For those 10 min, results showed that the mindfulness condition translated into lower food consumption during the mindless activity when compared to the control condition. Post experiment, participants were asked to wait for 5 min, and any extra chocolate consumption during this time was recorded. Post-consumption was non-significantly different between the two groups, with those in the mindfulness condition consuming 1.3 g less than those in the control group. Controlling for wellbeing did not alter the impact of the mindfulness intervention on consumption. Implications for future work and practical applications for weight regulation are discussed.

Family mealtime negativity and adolescent binge-eating: A replication and extension study in a community sample

OBJECTIVE

To explore differences in family mealtime characteristics and family mealtime emotions among adolescents who report engaging in binge-eating in comparison to those who do not.

METHOD

Adolescents (N = 495) recruited from UK schools/colleges reported on their family mealtime frequency and atmosphere, family mealtime emotions, anxiety, depression and eating psychopathology.

RESULTS

No significant differences were found between adolescents who reported binge-eating (n = 32 boys; n = 82 girls) and those who did not (n = 196 boys; n = 185 girls) on family mealtime frequency or mealtime atmosphere scores. However, boys and girls who binge-eat reported significantly lower levels of positive family mealtime emotions and significantly higher levels of family mealtime anxiety and anger (girls only), compared with their peers who did not report binge-eating.

DISCUSSION

Adolescents who binge-eat experience significantly greater negative emotional responses to family mealtimes than their peers. Further research should explore why these experiences are more negative, including broader familial factors and interactions.