Table 4 Summary of studies reporting correlates of eating disorders and eating disorder-related variables in the Arab world

Algeria, Jordan, Kuwait, Libya, Palestinians residing in al-Khalil, Syria, UAE

Musaiger et al., (2013) [26]

N = 4698, 2240 male, 2458 female, age 15–18

Cross sectional

EAT 26

Obesity: disturbed eating behavior 2–3 times as high in obese than in non-obese males and females

p < 0.000

Bahrain, Egypt, Jordan, Oman, Syria

Musaiger (2014) [27]

N = 1134, female, university students, age 17–32

Cross sectional

Interview (self- developed)

Media use: exposure to magazines associated with dieting to lose weight in Bahrain, exposure to TV associated with desire to be thin in Egypt, Oman and Jordan, exposure to TV associated with dieting to lose weight in Egypt and Bahrain

Associations: magazines and dieting: Bahrain: OR = 2.29 [0.95–5.68], p < 0.044,

Egypt OR = 6.29 [2.21–17.39], p < 0.001, Jordan OR = 5.29 [1.78–16.83], p < 0.001.

TV and desire to be thin: Egypt OR = 2.05 [1.07–3.94], p < 0.019, Oman p < 0.019, OR = 2.41[1.09–5.48].

TV and dieting: Bahrain OR = 1.98 [1.00–3.94], p < 0.035, Egypt OR = 2.21 [1.01–4.92], p < 0.032

Egypt

Eladawi et al., (2018) [28]

N = 400, 112 male, 288 female, weight control center visitors

Case control

EAT 40

Increased affluence, female, rural residents, overweight, obesity associated with elevated EAT scores

Rural residents: OR = 1.75 [0.95–3.22], p = 0.044, affluence: OR = 3.17 [0.74–13.63], p = 0.023, weight: p = 0.006; overweight OR = 2.75 [1.42–5.33], obesity OR = 1.46 [0.82–2.59]

Iran

Abdollahi & Mann (2001) [64]

N = 114, female, university students, Iranian nationals, 45 resided in LA, 59 resided in Teheran

Cross sectional

EDE-Q

Western influences: difference between actual and desired BMI larger in LA sample than in Irani sample

p < 0.05

Iran

Raouf et al., (2015) [76]

N = 1990, 951 male, 1039 female, age 13–18, mean age = 15.8

Cross sectional

EAT 26

SCID

BMI, age, increased affluence, female gender associated with elevated scores

Female: EAT OR = 2.52 [0.42–0.65], p < 0.001, AN p < 0.001, BN p < 0.05, OSFED p < 0.001, age: OR = 1.09 [0.99–1.17], p = 0.036, BMI: OR = 0.93 [0.90–0.96], p < 0.001, increased affluence: OR = 1.17 [1.01–1.35], p = 0.029

Jordan

Madanat et al., (2007) [80]

N = 800, female, mean age = 33.5

Cross sectional

EAT 26

Motivation for eating scale

Restraint scale

Sociocultural attitudes towards appearance scale

Body esteem scale

9- figure silhouettes

Weight status: 53.8% overweight/ obese. Obesity associated with desire to lose weight, restrained eating, emotional eating, elevated EAT scores. Western advertising and media use associated with desire to lose weight, restrained eating, emotional eating, disturbed eating behavior. Increased affluence associated with elevated EAT scores

Obesity: p < 0.01 Increased affluence: p < 0.01. Associations Western advertising and media not reported.

Jordan

Madanat, Hawks, & Angeles (2011) [83]

N = 800, female

Cross sectional

9- figure silhouettes

BMI: 53.8% overweight/ obese, 66% body dissatisfaction, association between BMI and desire to lose weight

r = 0.858, p < 0.0001

Jordan

Mousa, Mashal, Al-Domi, & Jibril (2010) [84]

N = 326, female, age: 10–16

Cross sectional

EAT 26

BSQ

Media use associated with body dissatisfaction. BMI associated with body dissatisfaction. Residing in a Western country is protective factor for body dissatisfaction.

Obesity: OR = 2.8 [2.1–3.8], p < 0.01

Media: OR = 1.2 [1.1–1.4], p < 0.01, reside in Western country: [RR: 0.34 (0.12–1.1), p = 0.046].

Jordan

Zawawi (2014) [85]

N = 170, female, age: 20–55, fitness center users

Cross sectional

BSQ

BMI: positive association between BMI and body dissatisfaction

r = 0.729, r² = 0.53, F(1, 175) = 198.6, p < 0.01

Country

Authors (year)

Participants

Study design

Measures

Risk factors

M (SD)/ OR [95% CI]/ r

Kuwait

Ebrahim, Alkazemi, Zafar, & Kubow (2019) [86]

N = 400, Male, university students

Cross sectional

EAT 26

Obesity associated with disordered eating and dieting.

Disordered eating: OR = 2.06 [1.17, 3.60], p = 0.011, Dieting: OR = 2.063[1.01, 4.21], p = 0.043)

Kuwait

Musaiger & Al- Mannai (2013) [75]

N = 228, female, university students, age 19–25

Cross sectional

Questions validated by Field et al., 2005, translated into Arabic

Use of internet and reading magazines associated with dieting to lose weight, media influence 2–3 times higher in obese than in non-obese females, watching TV not associated with body shape concern.

Dieting: OR = 3.11 [1.5–6.47], Media influence: OR = 2.14 [0.93–5.09], internet: p = 0.000, magazines: p = 0.011, media influence in obese: p = 0.000

Lebanon and Cyprus

Zeeni, Gharibeh, & Katsounari (2013) [23]

N = 400, female, university students in Cyprus (n = 200) and Lebanon (n = 200)

Cross sectional

Dutch eating behavior questionnaire

Perceived sociocultural influences on body image and body change questionnaire

Lebanese students greater association between body image dissatisfaction and media use. Greater emotional eating and sociocultural influences in eating behavior, greater influence of media to become slimmer, eat less and exercise to lose weight (p < 0.05). Association between BMI and restraint and emotional eating in Lebanon and in Cyprus. No differences in restraint eating

Associations Lebanon: BMI and restrained r = 0.3, p < 0.001, BMI and emotional eating r = 0.2, p = 0.01, media to become slimmer t(371.66) = 5.02, p < 0.001, r = 0.25), eat less to lose weight t(383.31) = 3.02, p < 0.001, r = 0.15, exercise more to lose weight t(380.90) = 3.53, p < 0.001, r = 0.18

Oman

Al Adawi et al., (2002) [29]

N = 293, 106 teenagers, mean age = 15.12, 100 adults, mean age = 38.71; 87 Western teenagers resided in Oman, mean age = 15.10

Cross sectional

EAT

Bulimic Investigatory Test

Westernization: significant difference in BMI between Omani and Western teenagers, Omani teenagers significantly more susceptible for AN and BN than Western teenagers

BMI: p = 0.000

Oman

Kayano et al., (2008) [58]

N = 248, 135 Omani, 113 Westerners resided in Oman, age 13–18

Cross sectional

EAT 26

EDI 2 DT

Weight status: 13% obese, 27% underweight. BMI associated with desire to be thin, negative association between EDI and EAT 26 scores. Average score on EAT 26 higher in the Omani (9.2) than in the Western (5.59) group. EDI score 3 times higher in Western than in Omani group.

BMI: r = 0.03, p < 0.05, Omani higher EAT scores: F(2,240) = 10.95, p < 0.001. Europeans higher EDI 2 DT scores: F(2,240) = 71.72, p < 0.001

Oman

Viernes et al., (2007) [52]

N = 248, 135 Omani, 113 Westerners resided in Oman, age 13–18

Cross sectional

EAT 26

EDI 2 DT

BMI associated with desire to be thin and guilt after eating sweets. Terrified to become fat: European expats: 81%, Omani’s: 66%. higher fear of fatness. Somatic symptom presentation among Omani’s.

Desire to be thin: Omani OR = 1.60 [0.92 2.79], p = 0.09, European expats: OR = 8.17 [4.63 14.41], p = 0.00, guilt after eating sweets: Omani OR = 0.05 [0.01 0.36], p = 0.00. Terrified to become fat: F = 235.9, p < 0.001. Somatic symptom presentation: Kendall’s tau = 0.352, p < 0.001

Palestinians residing in the Northern and Haifa district

Latzer et al., (2009) [70]

N = 1141, female, age: 12–18, 81.2% Islamic, 11.2% Christian, 7.6% Druze

Cross sectional

EAT 26

Westernization: Druze subgroup higher scores on EAT

F [2] = 2.9, p < 0.05

Palestinians residing in Nablus

Saleh et al., (2018) [36]

N = 2001, female university students

Cross sectional

EAT 26

SCOFF

BMI: association between BMI and EAT score. Age: negative association between age and EAT score

BMI: r = 0.173, p < 0.011

age: r = −  0.058, p = .008

Qatar

Bener & Kamal (2006) [35]

N = 566, female, age 14–19

Cross sectional

Adolescent dieting scale

BMI associated with dieting

p = 0.045

Qatar

Bener, Kamal, Tewfik, & Sabuncuoglu (2006) [35]

N = 800, male, age 14–19

Case control (dieting)

Adolescent dieting scale

Self- reporting questionnaire

Obesity: 34% of dieters was overweight, TV was diet source (61.7%)

p = 0.014

Country

Authors (year)

Participants

Study design

Measures

Risk factors

M (SD)/ OR [95% CI]/ r

Qatar

Musaiger, Shahbeek, & Al-Mannai (2004) [15]

N = 535, male, age 20–67, primary health care center visitors

Cross sectional

9- figure silhouettes

Age and education associated with desire to be thin

Association with desire to be thin: education: p = 0.0001, age > 40 years p = 0.0001

Qatar and Lebanon

Kronfol et al., (2018) [55]

N = 1841, 167 Lebanon, 785 Qatar, 889 USA university students

Cross sectional

SCOFF

Risk factors: female gender, financial difficulties

p < 0.001

Saudi Arabia

Al- Subaie (2000) [87]

N = 1179, female, mean age = 16.1

Cross sectional

EDI 2 DT

BMI, speaking a Western language and lived in a Western country and SES associated with dieting behavior and drive for thinness

BMI: χ2(3) = 97.59, p = 0.0001, western language χ2(1) = 8.9, p = 0.002, lived in western country χ2(1) = 10.3, p = 0.001, SES χ2(4) = 12.32, p = 0.015

Saudi Arabia

Fallatah et al., (2015) [66]

N = 425, female, age 15–18

Cross sectional

EAT 26

Association between BMI and disturbed eating behavior

t = 3.095, p < 0.0001, df not reported

Saudi Arabia

Khalaf, Westergren, Berggren, Ekblom, & Al-Hazzaa (2015) [95]

N = 663, female, mean age = 20.4, university students

Cross sectional

Self-developed questionnaire

Weight status: 19.2% underweight, 56.9% normal weight, 23.8% overweight/ obesity, BMI was associated with increased affluence

p = 0.032

Saudi Arabia

Rasheed (1998) [68]

N = 144, female, 74 Obese, 70 non- obese, age 15–55

Case control study (obesity)

Adapted eating and exercise behavior questionnaire

Increased affluence: higher affluence leads to slimmer ideal body (81%) and overestimation of own body weight (29%), illiteracy more common in obese group (21.9%).

p < 0.05

UAE

Eapen et al., (2006) [20]

N = 495, female, age 13–18

Cross sectional

EAT 40

BMI, age, Western TV associated with elevated EAT scores.

p < 0.0001

UAE

O’Hara et al., (2016) [74]

N = 420, female, mean age = 23.12, university students

Cross sectional

EAT 26

Teasing frequency from Project eating attitudes and teens

Weight and body related shame and guilt scale

Internalized weight stigma and teased with weight associated with elevated EAT scores

Internalized weight stigma: r = 0.43, p < 0.001, teased with weight: r = 0.19, p = 0.008

UAE

Schulte & Thomas (2013) [89]

N = 361, 77 male, 284 female, age 11–19, university students

Cross sectional

EAT 26

Weight status: overweight: 18.6%, obesity 9.2%

BMI associated with EAT scores in females

BMI: r = 0.184, p = 0.005

UAE

Schulte (2016) [90]

N = 236, mean age = 19.78

Cross sectional

Body esteem scale

PSS

Emotional eating scale,

Weight and body related shame and guilt scale

After correcting for BMI association between perceived stress and binge eating

p = 0.043

UAE

Thomas, Quadflieg, & O’Hara (2016) [40]

N = 94, female, university students

Cross sectional

EAT 26

Implicit out group preference associated with elevated EAT scores

t [91] = 2.83, p < 0.001

UAE

Thomas, O’Hara, et al., (2018) [53]

N = 1069, female, university students

Cross sectional

EAT 26

Religiosity: small effect size for religiosity in the group that scored above clinical cut off on the EAT

U = 91,660, p < 0.001, r = − 0.12

UAE

Thomas, O’Hara, et al., (2018) [18]

N = 209, female, university students

Cross sectional

EAT 26

Westernization: small effect size for out group positivity and higher Western acculturation in the group that scored above clinical cut off on the EAT

Out group positivity: t(206) = 2.49, p = 0.013, d = 0.36. Western acculturation: t(206) = 3.13, p = 0.002, d = 0.46