Eating disorders are often thought to be a Twentieth Century Western phenomenon.
This is not so: patients with these features have been described for over thousand
years. Eating disorders, in fact, can be separated into at least three different
types: anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified.
Early descriptions are found in religious literature and case examples of anorexia
nervosa were described but not named by physicians in the seventeenth century.
Eating disorders are most common among females in late adolescence and early adulthood.
The female to male ratio is approximately 10:1 (Blashki et
al., 2007). Notably there is appears to be an increase in the prevalence
of eating disorders in the last 50-60 years. Anorexia nervosa occurs predominantly
in females and usually presents in late adolescence. The median age of onset is
17, with new cases rarely occurring after age 40. The deported prevalence of anorexia
nervosa in the United States ranges from 1 in 100 to 1 in 800 for females between
the ages of 12 and 18 years. The diagnosis of anorexia nervosa may be missed more
often in males, where there is no obvious maker such as cessation of menstruation
(Blashki et al., 2007).
Bulimia nervosa also occurs predominantly in females (90%) and usually
presents in adolescence or early adult life. Bulimia nervosa has been
studied primarily in college students and therefore, knowledge of its
prevalence may be limited by the lack of data from other populations.
Between 1 and 3% of adolescent and young adult females meet diagnostic
criteria for bulimia nervosa, with the prevalence being about one-tenth
that in males.
Cattarin et al. (2000) argued that media-presented
images of women have the ability to affect (either positively or negatively)
both mood and satisfaction with appearance within a normative female sample.
A moderating factor to this finding was the tendency of the participant to internalize
sociocultural norms for attractiveness. Thus, if females are especially susceptible
to the sociocultural norm of attractiveness being associated with thinness and
are bombarded with images of such, they tend to be more at risk to have a higher
level of body dissatisfaction and thus an eating disorder.
In another study, Groesz et al. (2002) explained
that females participants were significantly more dissatisfied with their
bodies after viewing thin media images than after viewing of average sized models,
plus sized models.
Body dissatisfaction and body distortion are both strongly predict mild and
severe eating disorders (Cattarin and Thoson, 1994;
Stice, 2002). Stice (2002) in
a meta-analytic review showed that body dissatisfaction predicted increase in
negative effect (r = 0.14), bulimic pathology and eating pathology (r = 0.13)
and dieting (r = 0.26). In addition, body dissatisfaction predicted maintenance
of bulimic symptoms (r = 0.30). Statistics supported Stices result that
the body dissatisfaction variable emerged as one of the most consistent and
robust risk and maintenance factors for eating pathology.
In European and African American women, there was association between
greater awareness and acceptance of the thin beauty ideal and greater
disordered eating characteristics.
Social comparison theory says that women usually compare themselves to thin
models in the media. Bissell and Zhou (2004) argued
that high exposure to entertainment television that had thin ideal characters
predicted decreased satisfaction with the body and more negative attitudes regarding
the ideal body shape as well as higher scores on disordered-eating scales.
Faer et al. (2006) studied the relationship
between female intrasexual competition and the pursuit of thinness. They found
that females compete among themselves for mates and status.
Weichmann (2007) in the longitudinal course of body dissatisfaction
on a college sample of undergraduate females showed that new students had highest
levels of dissatisfaction. This dissatisfaction decreased throughout their college
With so many studies looking at the correlation between body shape perception
and eating disorders, a natural inquiry would be to see how measures for
each variable correlate. Though some studies have looked at this correlation,
very little research on the subject has been done in Iran. The present
study attempts to examine correlations between eating attitudes and the
body Shape in college students.
The main research question is whether there is relationship between body
shape and the risk of eating disorders. To answer this question, the following
hypotheses (primary and secondary) are proposed:
Hypotheses 1: There is correlation between eating disorders and
Hypotheses 2: The weight has influential impact on eating disorder
In the present study, the term eating disorders defined as a general category
of eating disturbance. Eating disorders, in fact, can be separated into at least
three different types: anorexia nervosa, bulimia nervosa and eating disorder
not otherwise specified. The core features of anorexia nervosa include refusal
to maintain a minimal normal body weight (e.g., > 85% normal body weight
or body mass index > 17.5 kg m-2), intense fear and obsession
about weight gain or being fat, a distorted body image and amenorrhea (clinical).
The core features of bulimia nervosa is binge eating-an excessive intake of
calorie-laden food over a short period of time (clinical). Some inappropriate
methods of compensating for a binge is vomiting, misusing laxatives, diuretics
and enemas and excessive fasting or exercise. Of all these methods, 80-90% of
individuals with bulimia engage in vomiting (APA, 2000).
Eating disorder not otherwise specified, describes disorder of eating that fail
to meet the criteria for either anorexia or bulimia.
Admittedly, observations of or responses to appearance are highly subjective.
Indeed, what is beautiful to one person might be distasteful to another.
Even so, a persons perception of or attitude toward his or her body
is most likely only a portion of what he or she uses to evaluate the self,
but these perceptions and attitudes often constitute an important part
of this self evaluation. The body shape is the only portion of the self
that is immediately observable to others. The physical body is unique
among other characteristics of the self in that it is readily comparable
to other bodies, is easily objectified, requires nothing more than observation
in order to be judged and yet can be responsible for affecting most-if
not all-of the aforementioned internal features of the self.
MATERIALS AND METHODS
Eating disorders often remain unreported, which may put the lives of
individuals suffering from them at risk. To decrease this risk, researchers
have developed various methods of assessing individuals for an eating
disturbance. Since, negative body shape and image have been found to be
a risk factor for eating disorders, researchers have developed various
measurements and questionnaires that measure an individuals body
Due to time limitation it was not virtually possible to cover all the
female students in universities of Iran. Therefore, the research population
is reduced to the female students in Department of Psychology in Shahid
Chamran University of Ahvaz. Considering the size of population and necessity
of representativeness of the sample, the initial size of the sample, using
Morgans formula was 100. The studied sample size which was obtained
through random selection increased to 140. The majority of participants
were within the age range of 18-24 in 2008. In order to collect the data,
each student was given the Eating Attitudes Test (EAT-40), the Body Shape
Questionnaire (BSQ) and a demographics questionnaire to fill out. Each
subject was assigned an identification number so as to keep track of each
The Eating Attitudes Test (EAT) was developed in 1979 to be used as a screening
tool for anorexia nervosa. It is an objective, self-report questionnaire that
consists of 40 questions that are answered using a 6-point Likert scale ranging
from never to always. Only the three most extreme scores are assigned a point
value from 1 to 3, resulting in total scores that can range from 0 to 120. Any
subject who has a total score of 30 or above on the EAT is considered to be
at risk for eating disorder behavior and symptomatology. The EAT has a validity
coefficient of .87 and an internal consistency coefficient of .79 for anorexic
patients and .94 for control subjects (Garner and Garfinkel,
The Body Shape Questionnaire (BSQ) was developed in 1987 to measure an individuals
concerns about body shape, especially their concerns of feeling fat. It is a
self-report questionnaire that consists of 34 questions that refer to the subjects
feelings about their appearance for the earlier four weeks. Questions are answered
using a 6-point Likert scale ranging from never to always. Each scaled answer
is assigned a point value from 1 to 6 resulting in total scores that can range
from 34 to 204. Those who are considered probable cases or definite cases of
bulimia score about 130 or above on the BSQ (Cooper et
al., 1987). The BSQ takes approximately 10 min to complete. This questionnaire
provides a measure of the extent of psychopathology rather than a means of case
detection (Cooper et al., 1987).
Rosen et al. (1996) reported a test-retest reliability of 0.88 and
a concurrent validity of 0.77 with the Body Dysmorphic Disorder Examination
among university undergraduates.
The collected data was imported in to SPSS software. The data were analyzed
using correlational statistics.
RESULTS AND DISCUSSION
Data analysis yielded information included in Table 1 and
for the purposes of this analysis and according to the questionnaire creators,
any subject who has a total score of 30 or above on the Eating Attitudes Test
(EAT) is consider to be at risk for eating disorder and 130 or above on the
Body Shape Questionnaire (BSQ) probable cases or definite cases of bulimia (Cooper
et al., 1987). As shown in Table 1, median and
mean for EAT and BSQ indicate that large number of sample are not at risk for
eating disorder or bulimia. The results showed that the correlations on the
EAT and BSQ is r = 0.689. In EAT 94.3 and in BSQ 92.9 of the total sample scored
within non clinically significant rang. The majors with percentages of participants
who scored within the non clinically ranges that are lower than that reported
for life total sample were designated as majors of non clinically significant
rang. Consider to that only 7.1% of students are probable cases for bulimia
and 5.7 of them are at risk for eating disorder. This risk of eating disorder
is decreased according to high level of body satisfaction. After descriptive
evidence, we turn the arguments toward the main research question that whether
there is a statically significant relationship between the eating disorders
and body shape. To this end, pearson correlation was used to test the research
hypotheses which were presented in the first section to answer the research
question. Results of correlation indicate that there is a significant positive
correlation (r = 0.689) between EAT and BSQ.
|| Descriptive indexes for EAT and BSQ
The correlations between Thus, it can be said with more confidence that if
subjects scored low on the EAT, they were more likely to score low on the BSQ.
This result is slightly higher as that of Cooper et al. (1987) (r = 0.61)
and Mumford and Choudry (2000) (r = 0.57).
Since, in this study the high correlation has been found between EAT and BSQ,
thus Hypothesis 1 holding that there is correlation between eating disorders
and body shape is accepted. The results also show that the weight had the most
influential impact on eating disorder symptomatology and body dissatisfaction,
which is supported by Freedman et al. (2004).
That of Freedman, et al many people consider weight as the determining factor
of outward appearance, regardless of body shape. The mean weight of the present
sample was 54.86 and the mean high was 161.33. Regarding to that the body mass
index is 21.078 kg m-2, which shows normal body weight (body mass
index > 17.5 kg m-2). Hence, according to the findings, Hypothesis
2 holding that the weight have influential impact on eating disorder symptomatology
The total frequency of the studied bedridden eating Attitudes, in females
according to their weight, high, age and body mass index suggests that
the eating disorder follows by body dissatisfaction.
This finding is precisely in line with previous related studies, mainly
after 1980s, which have been reviewed in the study.
The results suggest that there is a positive correlation between the
likelihood of eating disorder and body dissatisfaction.
In this study, the students are often satisfied with their body shapes.
So, their eating attitudes are often positive and there isnt a significant
Two factors which cause these results include: Linear growth of a person
continues to about 25 years, then he/she starts to become obese.
Mean age of our sample is 21.4. The sample hasnt entered to this
critical stage. In this stage, a person is high risk for getting obesity.
So, they are afraid of gaining weight which leads to eating disorder.
Also, it is possible that they exercise. These factors lead them to close
to thin ideal. Mean body mass index is 210.78 that is more than estimated
range (BMI < 17) which causes eating disorder. According to this study,
we havent any eating disorder. This conclusion accepts the results
from BMI. However, the people who are high risk for eating disorder should
be treated. Because we always bombard through movies, television, our
culture and magazines, they affect our body images and our attitude toward
eating. The message is only women who are thin are attractive. It is true
that their physical changes affect their eating attitudes. However, cultural
and social pressures have powerful influences over the way human feel,
think, image and act.
Multidisciplinary treatment is necessary to ensure a positive outcome,
because the cause of eating disorder is complex.
The cornerstone of treatment is non pharmacologic measures such as nutritional
counseling, educational therapy, multimodal behavioral therapy. These
kinds of psychotherapies can help to change the way person thinks and
behaves not just about food but about herself and her world. These therapies
identify and challenge the characteristic images and thoughts that reinforce
eating attitudes. Pharmacotherapy (Antidepressants such as Selective Serotonin
Reuptake Inhibitors (SSRIs) remains adjunctive to nondrug treatments.