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

From: Eating disorders in the Arab world: a literature review

Country/Population Authors (year) Participants Study design Measures Risk factors M (SD)/ OR [95% CI]/ r
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
  1. Note: BSQ Body Shape Questionnaire, EAT Eating Attitude Test, EDE-Q Eating Disorder Examination Questionnaire, FRS Figure Rating Scale, EDI 2 DT Eating Disorders Inventory 2 Drive for Thinness Scale, SCID Structured Clinical Interview for DSM IV, SCOFF Sick, Control, One, Stone, Fat, Food