|Year : 2020 | Volume
| Issue : 1 | Page : 53-56
A cross-sectional study on prevalence of eating disorder and body image disturbance among female undergraduate medical students
Siva Ilango Thangaraju, R Karpagalakshmi, S Arumuganathan, S Usaid, S Sumithra Devi, V Sethumadhavan
Department of Psychiatry, Karpaga Vinayaga Institute of Medical Sciences, Madhuranthagam, Tamil Nadu, India
|Date of Submission||01-Mar-2020|
|Date of Decision||02-May-2020|
|Date of Acceptance||31-May-2020|
|Date of Web Publication||7-Oct-2020|
Department of Psychiatry, Karpaga Vinayaga Institute of Medical Sciences, Madhuranthagam, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Eating disorders describe illnesses that are characterized by irregular eating habits and severe distress or concern about bodyweight or shape. Female college students have been reported to be more keen to have a thinner figure than their male counterparts in both Western and Asian settings. This study aims to find the prevalence of eating disorders and body shape concerns among female undergraduate medical students in South India. Materials and Methods: A cross-sectional study design was used to collect data from female undergraduate medical students of a private medical college in south India. Study instruments include a semi-structured pro forma, Eating Disorder Examination Questionnaire (EDE-Q 6.0), and Body Shape Questionnaire (BSQ 34). Descriptive analyses of sociodemographic variables and scores in the questionnaires were carried out. Results: One hundred and ninety-nine female students participated in the study were included for analysis. The mean age of the students was 20.4 years. Mean body mass index (BMI) score was found to be 23.78. On EDE-Q, 13.6% of students scored more than 5 suggesting presence of eating disorder. 61.9% had mild-to-moderate concerns on their body shape while 9% had severe concerns. BMI and body shape concerns positively correlated with subscales of eating disorder. Conclusion: This study showed significant presence of eating disorder symptoms and body image dissatisfaction among female college students. Addressing this subset of population with regards to these concerns may help prevent onset of mental health and behavioral problems in future.
Keywords: Body image disturbance, body mass index, eating disorder
|How to cite this article:|
Thangaraju SI, Karpagalakshmi R, Arumuganathan S, Usaid S, Devi S S, Sethumadhavan V. A cross-sectional study on prevalence of eating disorder and body image disturbance among female undergraduate medical students. J Mental Health Hum Behav 2020;25:53-6
|How to cite this URL:|
Thangaraju SI, Karpagalakshmi R, Arumuganathan S, Usaid S, Devi S S, Sethumadhavan V. A cross-sectional study on prevalence of eating disorder and body image disturbance among female undergraduate medical students. J Mental Health Hum Behav [serial online] 2020 [cited 2020 Nov 29];25:53-6. Available from: https://www.jmhhb.org/text.asp?2020/25/1/53/297410
| Introduction|| |
Eating disorders describe illnesses that are characterized by irregular eating habits and severe distress or concern about bodyweight or shape. It can develop during any stage in life but typically appear during the teen years or young adulthood. The most common forms include anorexia nervosa, bulimia nervosa, and binge eating disorder. Eating disorders have been associated with body image disturbances, disordered eating attitudes, and other psychiatric morbidities.,
Dissatisfaction with body shape has been found to be a predictor of depression in a prospective study.,,, Increased psychological problems and low self-esteem could be the possible connecting link between dissatisfaction with body image and abnormal eating behavior. Female college students have been reported to be more keen to have a thinner figure than their male counterparts, in both Western and Asian settings.,
There may be combination of biological, psychological, and environmental abnormalities contribute to the development of these illnesses. There is limited published literature on body shape and eating attitudes from nonwestern settings. In fact, it has been argued that eating disorders are culture-bound disorders specific to western societies., Consequently, these conditions remain understudied in most nonwestern settings. Literature from India on both anorexia nervosa and bulimia nervosa is restricted to case reports and very few original research articles. With increasing western influence in our society and students pursuing professional courses adopt these changes earlier, it becomes relevant to understand about the disorders that were once considered specific to western population. Of late, there has been greater emphasize on the body weight and shape among adolescents and young adults which is one of the major reasons behind rapidly growing fitness centers across the country. Hence, this study would help to understand the magnitude of the problem locally and address the concerns early to prevent onset of associated psychopathology.
The objective is to estimate the prevalence of eating disorder and body image disturbance among female under graduate medical students in South India.
| Materials and Methods|| |
The study participants were female undergraduate medical students undergoing medical education in a private college. It was a universal sampling and all the students were approached to be included in the study. The students who were willing to participate and gave consent were included. This study was approved by the institutional ethics committee.
The study participants were requested to be spontaneous and truthful with the choices they chose on the questionnaires. The participants were assured of confidentiality of the information provided and had the option of refusal to participate in the study.
The participant age, weight, height, and body mass index (BMI) were collected using semi-structured pro forma.
Eating disorder can be assessed using different measures such as Eating Attitude Test-26 (EAT-26), Eating Disorder Inventory (EDI-2and EDI-3), bulimia test-revised (BULIT-R), Questionnaire for Eating Disorder Diagnoses (QEDD), and Eating Disorder Examination Questionnaire (EDE-Q). The EDE-Q was based on the definitions of EDs from the DSM like the other measures but, was developed first into a structured interview format and then converted to a questionnaire making it more detailed and self-explanatory. The eating disorder examination questionnaire (EDE-Q 6.0) is a 28-item self-report version of the EDE interview (Fairburn et al., 2014) that assesses disordered-eating behaviors and attitudes focused on the past 28 days. It comprises four subscales, based on 22-item responses measured on 7 point Likert scale, assessing eating-disorder psychopathology (restraint, eating concern, shape concern, and weight concern) and six items measuring the occurrence and frequencies of key ED behaviors. Students scoring higher on the scale reflect more severe eating disorder symptoms. The current analysis only employed the EDE-Q global score where a cut off of more than 5 is considered to have eating disorder. Internal consistency for the EDE-Q was good (Cronbach's alpha = 0.84 for the Global scale).
The Body Shape Questionnaire (BSQ) is also a self-administered questionnaire. It has 34 items used to evaluate fear of putting on weight, feelings of low self-esteem because of one's appearance, the desire to lose weight, and body dissatisfaction. The scores are classified into four categories: not worried about body shape (<81), slightly worried (81–110), moderately worried (111–140), and extremely worried (>140). Internal consistency for the BSQ 34 was good (Cronbach's alpha = 0.95).
EDE-Q 6.0 and BSQ though used previously in similar population across world and in India, the measures were not validated in Indian context.
The collected data were analyzed using descriptive statistics including frequency, percentage, mean and standard deviation. Inferential statistics was analyzed using Independent t-test and Spearman's correlation.
| Results|| |
Two hundred and thirty-eight female medical students were available to be included in the study at the given point and all of them were approached. Two hundred and four students consented for the study and completed the questionnaires. The response rate was observed to be 84%. Five participants gave incomplete response on many variables and hence were excluded from the analysis. One hundred and ninety-nine students were included for analysis. The mean age of the students participated in the study was 20.40 years. Mean BMI of the sample 23.78.
Around half of all female students have abnormal weight pattern with 11.6% having BMI of more than 30 falling under obese category. About 14.1% of students are noticed to be underweight. Of the total sample, 27 (13.6%) scored more than 5 on EDE-Q suggesting probable presence of eating disorder among them. Eating disorder subscales showed higher mean values on shape and weight subscales compared to restraint and eating pattern subscales [Table 1].
|Table 1: Prevalence of eating disorder according to eating disorder examination questionnaire|
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One-third of the sample showed no concern on their body shape while half showed mild concerns. 9% of the female students had severe concerns on their body shape. The mean scores on the BSQ were found to be 95.40 [Table 2].
|Table 2: The prevalence of body image disturbance according to Body Shape Questionnaire (n=199)|
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Comparison of female students with and without eating disorder on age and scores on BSQ showed no significant difference [Table 3]. However, the eating disorder subscales including restraint, eating pattern, shape, and weight showed significant difference between the two groups.
|Table 3: Comparative analysis of subscales and body image of students with and without eating disorder|
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Variables such as age, BMI, and body shape concerns were positively correlated with eating disorder subscores indicating that higher the scores, more significant concerns on the subscales of eating disorders [Table 4].
|Table 4: Spearman correlation coefficient between age, body mass index, body shape concern, and eating disorders among female medical students|
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| Discussion|| |
The mean age of the female students participated in our study was 20.63 years. Nearly 27 (13.6%) of the students had obtained the score of more than 5 in the eating disorder questionnaire indicating the abnormal eating patterns among the female students. The results are consistent with many other studies done in India and Western countries. In the study done by Shashank et al., 29.3% of students had problem in eating attitudes and study by Ramaiah showed 16.9% had eating disorder symptoms. In a Mid-Atlantic coastal beach community study done in university nursing students showed a prevalence of 25%. The above studies used Eating Attitudes Test (EAT 26) and SCOFF questionnaire to screen the prevalence of eating disorder symptoms which may have contributed to higher prevalence. In a Turkish study with larger sample size (951 students) showed the prevalence of 2.2% of eating disorders with none of them were noted to have anorexia nervosa.
In our study, 9% of the students had severe concerns on their body shape while 61.9% had some concerns as evident from the BSQ. Although the students with severe concerns are less compared to other studies, students having some concerns in their body shape were high when compared with studies conducted by Goswami et al., (13.54%), Ramaiah (24%), and Rashmi et al. (19%). This may be explained by the recent changes in the expectations of the society itself where young women in particular, college students giving importance to physical appearance.
The prevalence of obesity in female students was found to be 11.6% in this study which is similar to the study findings of Chhabraand Chhabra (11.7%) in Delhi and Fernandez et al. (13.2%). The popularity of junk foods, abnormal food time patterns might be the reason for the students getting overweight. 14.1% of the female students were underweight which is less compared to students recruited in studies done by Shashank et al. and Rashmi et al., from North Karnataka.
We divided the sample into two groups of students with and without eating disorders to see if there are any differences in variables such as age, body shape concerns and subscales of eating disorders such as restraint, eating pattern, shape, and weight. The analysis did not show any significant difference on age and scores on BSQ but significant difference was noted in all the eating disorder subscales including the body shape. It could be that the BSQ with 34 items was more specific while the subscales of shape and weight on EDE-Q were more sensitive. We also think the students may have become more conscious when they were answering to the questions on body shape concerns separately using the BSQ but were less inhibited when they completed responses on body shape and weight on the subscales.
The result of this study on the prevalence of eating disorder adds further data to the existing literature and being locally relevant. Culture influence the presentation of eating disorders in India with relative lack of concern on body shape but with recent transition to western ideals, it is evident in this study that concur with only few studies, on the association between eating disorders and body shape concerns.
This study was done on female medical students and the results cannot be generalized to the general population as the professional students have different pressures affecting their eating pattern and the importance they give to body shape. The instruments used were not validated for use in local population. Although positive correlation was noted between some variables, inherent to study design causality could not be established. No attempt to establish diagnosis and associated psychopathology by clinical interview was carried out to corroborate the findings due to time constraints and as the study was designed to screen student population for eating disorders. However, the use of EDE-Q in our study to some extent would have reduced this limitation.
| Conclusion|| |
This study reports significant concerns of body shape and eating disorder among female medical undergraduate medical students. Body image dissatisfaction (body shape concerns) is also noted to be higher among students with high body mass index. These findings highlight the need for advocating healthy eating habits among female medical students. Validation of study instruments for use in Indian population to address the cultural sensitivity assumes prime importance and future studies need to be planned using a two-step approach of screening followed by diagnostic clinical interview. Further longitudinal studies at community level would not only give more accurate estimate on the prevalence but more understanding on the causative factors of eating disorders.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Steinhausen HC. The outcome of anorexia nervosa in the 20th
century. Am J Psychiatry 2002;159:1284-93.
Herpertz-Dahlmann B, Müller B, Herpertz S, Heussen N, Hebebrand J, Remschmidt H. Prospective 10-year follow-up in adolescent anorexia nervosa -” Course, outcome, psychiatric co-morbidity, and psychosocial adaptation. J Child Psychol Psychiatry 2001;42:603-12.
Eisenberg ME, Neumark-Sztainer D, Haines J, Wall M. Weight-teasing and emotional well-being in adolescents: Longitudinal findings from Project EAT. J Adolesc Health 2006;38:675-83.
Yamamoto C, Uemoto M, Shinfuku N, Maeda K. The usefulness of body image tests in the prevention of eating disorders. Kobe J Med Sci 2007;53:79-91.
Smith BL, Handley P, Eldredge DA. Sex differences in exercise motivation and body-image satisfaction among college students. Percept Mot Skills 1998;86:723-32.
Keel PK, Klump KL. Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology. Psychol Bull 2003;129:747-69.
Mendhekar DN, Arora K, Lohia D, Aggarwal A, Jiloha RC. Anorexia nervosa: An Indian perspective. Natl Med J India 2009;22:181-2.
Mendhekar DN, Mehta R, Srivastav PK. Bulimia nervosa. Indian J Pediatr 2004;71:861-2.
Stice E, Hayward C, Cameron RP, Killen JD, Taylor CB. Body-image and eating disturbances predict onset of depression among female adolescents: A longitudinal study. J Abnorm Psychol 2000;109:438-44.
Patton GC, Selzer R, Coffey C, Carlin JB, Wolfe R. Onset of adolescent eating disorders: Population based cohort study over 3 years. BMJ 1999;318:765-8.
Shroff H, Thompson JK. Body image and eating disturbance in India: Media and interpersonal influences. Int J Eat Disord 2004;35:198-203.
Yang SJ, Choi Y, Lee HY. Eating attitude, ego-identity, and self-esteem among the urban high school girls. J Korean Neuropsychiatry Assoc 2001;40:477-86.
Vaidyanathan S, Kuppili PP, Menon V. Eating disorders: An overview of Indian research. Indian J Psychol Med 2019;41:311-7.
] [Full text]
Pliatskidou S, Samakouri M, Kalamara E, Papageorgiou E, Koutrouvi K, Goulemtzakis C, et al
. Validity of the Greek eating disorder examination questionnaire 6.0 (EDE-Q-6.0) among Greek adolescents. Psychiatriki 2015;26:204-16.
Cooper PJ, Taylor MJ, Cooper Z, Fairburn CG. The development and validation of the Body Shape Questionnaire. Int J Eat Disord 1987;6:485-94.
Shashank KJ, Gowda P, ChethanTK. A crosssectional study to asses the eating disorder among female medical students in a rural medical college of Karnataka State. Ntl J Community Med 2016;7:524-7.
Ramaiah RR. Eating disorders among medical students of a rural teaching hospital: A cross-sectional study. Int J Community Med Public Health 2015;2:25-8.
Phillips L, Kemppainen JK, Mechling BM, MacKain S, Kim-Godwin Y, Leopard L. Eating disorders and spirituality in college students. J Psychosoc Nurs Ment Health Serv 2015;53:30-7.
Kugu N, Akyuz G, Dogan O, Ersan E, Izgic F. The prevalence of eating disorders among university students and the relationship with some individual characteristics. Aust N
Z J Psychiatry 2006;40:129-35.
Goswami S, Sachdeva S, Sachdeva R. Body image satisfaction among female college students. Ind Psychiatry J 2012;21:168-72.
] [Full text]
Rashmi BM, Patil SS, Angadi MM, Pattankar TP. A cross-sectional study of the pattern of body image perception among female students of BBM college in Vijayapur, North Karnataka. J Clin Diagn Res 2016;10:LC05-9.
Chhabra P, Chhabra SK. Distribution and determinants of body mass index of non-smoking adults in Delhi, India. J Health Popul Nutr 2007;25:294-301.
Fernandez K, Singru SA, Kshirsagar M, Pathan Y. Study regarding overweight/obesity among medical students of a teaching hospital in Pune, India. Med J DY Patil Univ 2014;7:279-83
Gupta N, Bhargava R, Chavan BS, Sharan P. Eating attitudes and body shape concerns among medical students in Chandigarh. Indian J Soc Psychiatry 2017;33:219-24. [Full text]
Balhara YP, Mathur S, Kataria DK. Body shape and eating attitudes among female nursing students in India. East Asian Arch Psychiatry 2012;22:70-4.
[Table 1], [Table 2], [Table 3], [Table 4]