Table 4 Cross-sectional research

Baxter [142]

BN, AN (TRH)

Mental health conditions among Māori participants in Te Rau Hinengaro

CIDI for DSM-IV

2595

60% F

40% M

16+

100% Māori (only Māori participants from TRH)

ED lifetime prevalence of 0.7% AN and 2.4% BN

Bensley [143]*

NC (OSSLS2)

Body image among adolescents and association with different lifestyle behaviours

Otago Students Secondary School Lifestyle Survey (OSSLS2): Subscales from the Food, Feelings, Behaviours, and Body Image Questionnaire (FFBBQ), BMI, DQI

681

56% F

44% M

15–18

74% NZ European, 9% Māori, 1% Pasifika, 7% Asian, 8% other

Females had higher scores on all subscales (figure dissatisfaction, fear of weight gain, dietary restraint, and concern about eating and weight), as did those who were overweight and obese. High levels of body dissatisfaction not limited to those who were overweight and obese)

Blackmore [144]*

NC

Explored self-induced vomiting after drinking alcohol in relation to eating disorder pathology among university students

EAT-26, MAST, Drinking Habits Questionnaire, BULIT-R, CES-D, AUDIT

261

59% F

38% M

17–35

Predominantly European

For females, alcohol-related self-induced vomiting was associated with eating disorder pathology

Boyes [145]

NC

Healthy and unhealthy dieting behaviours in university couples

Perceived Relationship Quality Components Scale, RSES, BDI-II, WCBS, additional Likert scales

114

50% F

50% M

15–57

Predominantly European

More body satisfaction among F with higher SE and lower depressive symptoms. More depressive symptoms and relationship dissatisfaction for men associated with more dieting and BD in F partners. M dieted more when F partners higher SE and fewer depressive symptoms

Brewis [146]

NC

Body image in Samoan participants living in Samoa and New Zealand

BMI, custom questionnaires

226

55% F

45% M

25–55

100% Samoan

Body dissatisfaction and slim ideals common, weight loss attempts and body perceptions not different between those above versus below BMI of 27

Bushnell (1990) [147]

Population sample (CPES)

Bulimia prevalence in Christchurch population sample, oversampled for younger women

Diagnostic Interview Schedule

1498

66% F

34% M

18–64

93% European

Widespread disordered eating behaviours/attitudes, cohort effect for younger women

Chan [148]

NC

Relationship between perfectionism and ED symptoms in Chinese immigrants, and the role of ethnic identity

EDI, PANAS, MEIM, MCSDS

301

59% F

41% M

M 22.37

100% reported Chinese ancestry

Relationship between ED symptomatology and perfectionism mediated by cultural identity. Strong sense of belonging and attachment to Chinese culture appears to be protective

Dameh [149]*

AN

Evaluating insight, as well as factors that may affect this, in participants meeting DSM-IV criteria for anorexia nervosa

Markova and Berrios Insight Scale (MBIS), SAI, EAT-26

18

F

17–43

Not stated

Impaired insight in those with AN was associated with features of illness, ED/behaviours and history of abuse

Durso [150]

NC

Testing weight bias scale and associations between self-directed weight bias and other factors

Weight Bias Internalisation Scale

198 (1 NZ participant)

Not specified for NZ

Not stated for NZ

Not stated for NZ

Scale had good internal consistency and linked to other factors related to body image and ED

Fear [151]

NC

Self-reported disordered eating/attitudes in female secondary school students

BMI, EDE-2, BMI

363

F

M 14.9

(SD 0.4)

77% European, 16% Māori, 3% Samoan, 4% other

Most students wished to be smaller size, high prevalence of ED behaviours

Foliaki [152]

Population sample

Prevalence of psychiatric disorders among Pasifika in New Zealand

CIDI

2374

52% F, 48% M

16 + 

100% Pasifika

12-month prevalence 1.5%; lifetime ED prevalence 4.4%

Gendall [153]

NC

Exploring food cravings in young women within the community

DIGS, custom food craving questionnaire

101

F

18–45

98% European

History of cravings common (58%) within this sample. Narrowing definition meant that fewer (28%) met criteria. Multiple core features more common for those with strong cravings

Gendall [154]

NC

Characteristics of individuals who reported cravings for food

DIGS, TCI, EDI

101

F

23–46

Not stated

Food cravings associated with alcohol abuse/dependence and also novelty seeking, high rates of ED symptoms

Gendall [155]

AN

Food cravings and intensity of craving in those with past history of AN and NC

DIGS, TFEQ, TCI

101

F

35 ± 6

Not stated

Greater proportion of those with previous AN reported strong and more intense cravings

Gendall [156]

NC

Can aspects of restrained eating be predicted using the Temperament and Character Inventory (TCI)

DIGS, TCI, TFEQ

101

F

18–45

Not stated

Low self-directedness related to higher TFEQ score, disinhibition, and hunger susceptibility. High self-transcendence related to higher TFEQ score and cognitive restraint

Gendall [157]

NC

Comparing those who crave food and binge eat versus those who crave and do not subsequently binge

Food

223

F

18–46

Not stated

Cravers who binged tended to have higher BMI, higher frequency of diagnosed BN, elevated dietary restraint, and lower self-directedness

Gibson [42]

NC

Body image scores for rugby union players

Body composition, custom version of Low Energy Availability Amongst New Zealand Athletes, EDI-3

26

M

19–28

Not stated

High prevalence of disordered eating behaviours, disturbances in body image

Griffiths [28]

NC

Anabolic androgenic steroid use/contemplation and associations with factors including body dissatisfaction and ED symptoms in sexual minority men

Online survey: Self-report weight/height, sexuality, anabolic steroid use/consideration, MBAS-R, EDE-QS, BBQ

1797 from Aus

514 from NZ

99.1% M, 0.4% other

(same sample in refs 24–26)

18–78 years

Reported as Aus NZ and Non-Aus NZ

ED symptoms and dissatisfaction with muscularity and height more prevalent among those who use AAS, while dissatisfaction with body fat less common in this group

Griffiths [27]

NC (Griffiths et al. [28]sample)

Pornography use and body image, associated behaviours, and quality of life in sexual minority men

Online survey: self-reported weight and height, sexuality, MBAS-R, EDE-QS

1797 from Aus

514 from NZ

99.1% M, 0.4% other

18–78

Not stated for NZ

Increased pornography use was weakly associated with more body dissatisfaction and thoughts of anabolic steroids use

Griffiths [29]

NC (Griffiths et al. (2017) sample) [28]

Social media use and body image, ED symptoms, and steroid use contemplation in sexual minority men

Online survey: self-reported social media/dating use, height/weight, sexuality, use/thoughts of anabolic steroids, MBAS-R, EDE-QS

1797 from Aus

514 from NZ

99.1% M, 0.4% other

18–78

Not stated for NZ

Social media use positively associated with body dissatisfaction, ED symptoms, and thoughts of anabolic steroid use. Some associations strongest for image-centric platforms

Hechler [158]

Clinicians

Assess clinicians understanding of role of physical activity in AN—and describe assessment and management strategies

EDSCS (Eating disorder specialist/clinician survey)

33

Not stated

Not stated

Reported as Aus/NZ

The majority of specialists consider physical activity to be important in EDs, however those from an Asian background considered it to be minor in comparison to other nationalities

Hickman [159]*

BN, NC

Looking at relationships and associated attachments in those with and without BN, within a sample of university students

EDI, Close Relationship Scale, TFEQ, Relationship Satisfaction Scale

123 (unclear how many with BN symptoms)

F

18–40

Not stated

More anxious attachment and dieting in participants with bulimia

Hudson [160]*

NC

Body dissatisfaction, BMI, esteem, eating attitudes

EDE, BSQ, RSES, BMI

36

F

17–55

67% NZ European, 8% Māori,

25% Other

Elevated BMI linked to higher body dissatisfaction

Jenkins [161]*

NC

Eating disorder symptomatology among females in NZ of Chinese and other ethnicities

EAT-40, Eating Disorder Belief Questionnaire, additional custom questions, Perceived Sociocultural Pressure Scale, SEED, ratings of body image figures

116

F

18–47

34% Chinese, 5% Taiwan, 49% NZ European, 8% NZ Māori, 1% Pasifika, 3% Other Ethnicities

More body image dissatisfaction and fear of weight gain in Chinese group. Similar pressure to be thin between groups

Jospe [162]

NC (SWIFT)

Whether association between weight/diet monitoring influenced eating disorder symptoms

EDE-Q, self-reports of ED behaviours

250

62% F, 68% M

< 18

176 European, 18 Māori, 7 Pasifika, 5 Asian

Self-monitoring did not increase ED symptoms

Kessler [1]

TRH (BED data not previously reported)

Assessing prevalence and correlates of binge eating disorder

Composite International Diagnostic Interview

24124 (7312 NZ)

Not specified for NZ

> 18

Not stated

Lifetime prevalence estimates of BED are higher than BN, fewer than half of lifetime BN or BED cases receive treatment

Kessler [26]

BED, BN (TRH)

Compared impairment and role attainment (e.g. employment) between BED and BN

CIDI, WHO-DAS

7312 from NZ (not included in occupation and earnings assessment)

Not specified for NZ

18–98

Not stated

Effects on role attainments similar for BN and BED. F less likely to be currently married, M less likely to be currently employed. Both more higher odds of work disability and more days of work impairment

Kokaua [163]*

BN, AN

Includes prediction of eating disorder prevalence among Cook Islanders in New Zealand

NZMHS, MHINZ

How to report?

How to report?

16+

Cook Island

Any eating disorder 1.4% 12 months prevalence (unadjusted) or 1.1% adjusted. Ethnic differences in eating disorders even after adjustment

Latner [164]

BED, BN, AN

Comparing quality of life ratings in those with subjective versus objective binge eating

EDE-Q, SF-36, BDI-II

53

F

M 26.30 (SD 8.98)

94% European, 2% Asian, 2% Māori, 2% Pasifika

Impaired quality of life for subjective binge episodes and compensatory behaviours. Also accounted for 27% of physical QoL variance

Latner [165]

NC

Associations between body checking/avoidance, quality of life (QoL) and disordered eating

BCQ, BIAQ, BMI, SF-36, EDE-Q, BDI-II

214

F

M 26.3

(SD 8.98)

86% European, 8% Asian, 52% Māori

Both body checking and avoidance associated with lower QoL and higher ED symptoms

Latner [166]

BED, BN, AN, EDNOS

QoL impairment due to features of EDs (e.g. eating concern, restraint, vomiting, excessive weight concerns)

EDE-Q, The Medical Outcomes Short-form Health Survey (SF-36), BDI-II

53 ED

212 NC

F

17–65

88% European, 7% Asian, 5% Māori

More EDE-Q features, particularly shape/weight concerns, were predictive of poorer QoL

Lau [167]*

NC (SuNDiAL)

Desire to lose weight and methods of losing weight, including unhealthy weight loss methods, among adolescents

Weight attitudes and motivations for food choice questionnaire, custom questions about body image and weight loss intentions and methods

370

66% F, 34%M

15–18

72% European, 14% Māori, 13% Asian, 2% Pasifika

High prevalence of weight loss intentions. Weight loss methods more common in females

Leydon [168]

NC

Eating habits among jockeys

EAT, food diaries, menstrual status, DEXA scan, body composition, anthropometry

20

70% F

30% M

Not stated

Not stated

Osteopenia and weight control efforts common among sample of jockeys

Linardon [169]

NC, BED, BN

Participant views of digital interventions for treatment and prevention of eating disorders

Custom questionnaires

722 (133 from Aus/NZ)

95% F

5% M

M 30.25 (SD 8.29)

77.1% European, 0.4%% African American, 8.6% Hispanic, 10.4% Asian, 0.6% Pasifika Island, 2.9% other

Pros and cons identified, cons included concerns about privacy and accuracy of data

Lucassen [170]

NC (YHS)

Comparing body size, weight, nutrition, and activities in sexual and gender minorities (SGM to controls

Custom survey re weight control behaviours, BMI

7769

56% F

(incl. 312 S/GM females)

45% M

(incl. 150 S/GM males)

13–18

49% European, 20% Māori, 13% Pasifika, 12% Asian, 6% other

More issues with nutrition, unhealthy weight control, and inactivity among sexual and gender minorities

Madden [7]

NC

Association between intuitive eating and BMI, and eating behaviours among less intuitive eaters

Intuitive Eating Scale, BMI (self-reported weight/height), Rapid Assessment of Physical Activity, additional selected questions of menopausal status, binge-eating, food intake, and rate of eating

2500

F

40–50

83% European, 11.4% Māori, 3.0% Pasifika, 85% Asian

Intuitive eating inversely associated with BMI. Partial mediation by binge-eating

Maguire [171]

AN

Ability to predict length of inpatient treatment Australasian clinical data

Clinical data

154

98% F

M 21.2

(SD 7.2)

Not stated

Difficulty in predicting length of stay, with only two factors (length of stay, 2–3 previous admissions) independently contributing to this

McCabe [172]

NC

Three studies comparing body image of those within five different countries and cultures (Fijian, Indo-Fijian, Tongans living Tonga, New Zealand Tongan, European Australians)

Interviews and questionnaires about eating behaviours and physical activity, perceptual distortion task

Study 1: 240; Study 2: 3000; Study 3: 300

50% F, 50% M

12–18

Study 1: 48 from each cultural group,

Study 2: 600 from each cultural group,

Study 3:100 from each Fijian cultural group and European Australians

Body image, eating, and physical activity influenced by socio-cultural environment

McCabe [173]

NC (Pacific OPIC Project)

Environmental influences on body change strategies within different cultural groups

Body Image and Body Change Questionnaire

4904 (461 NZ)

48% F, 52% M (NZ 62% F, 38% M)

12–18

Tongan

Differing messages across and within cultural groups

Miller [174]

NC

Body perception in relation to media consumption and societal ideals

The Sociocultural Attitudes Towards Appearance Questionnaire, FRS, Media Time Use, INCOM

181

66% F

34% M

17–30

84% European, 7% Māori, 3% Asian, 2% other

Greater discrepancy between ideal and perceived current body figures for women. Greater thin ideal internalisation for women. Awareness and internalisation of thinness norms predicted body perceptions for women but not men

Moss [175]*

AN, EDNOS

Body dissatisfaction and associated factors in adolescents with eating disorders

EDI-3, CAPS, PSPS, DASS-21

40 (13 AN, 7 EDNOS)

20 NC

F

M 15.75 (SD 1.52)

ED: 80% European 10% Māori, 10% other

CT: 90% European, 10% Māori, 0% other

Higher maladaptive perfectionism and anxiety linked to BD, but didn’t interact as predictors of BD in ED group

Muir [176]*

AN, NC

Whether women with AN differed from low weight women without AN in recognising emotions

Performance on facial emotion recognition test (reaction speed and accuracy)

33

F

18–55

AN: 41.7% NZE, 8% Maori, 4 “other”. NC: 90.5% NZE, 2 British, 1 Russian

Shorter response time for AN group, no difference in accuracy measures

Mulgrew [177]

NC

Weight control behaviours and associated factors in young people

BAQ, MBAS-R, PHQ, modified WCBS, BMI, weight management questions

1082

75% F

25% M

18–30

79% NZEO

More weight control behaviours among females. Feelings of fatness a key predictor of weight control

Ngamanu [178]*

NC

Compared levels of body image dissatisfaction and eating pathology in Māori and Pakeha women, also examining whether the ethnic attachment of participants was associated with the body image

BMI, MEIM, FRS, EAT-26

100

F

18–50 + 

34% Pakeha, 66% Māori

Body image dissatisfaction and eating pathology did not differ between groups. Level of ethnic attachment also did not impact body image satisfaction

Browne [179]

BN, AN (TRH)

Lifetime prevalence/risk of psychiatric disorders in the New Zealand population

Survey

12, 992

57% F

43% M

16+

20% Māori, 17% Pasifika, 63% Other (Part 1), 22% Māori, 18% Pasifika, 60% Other (long-form sample)

Any ED 1.7%CI 1.5, 2.1) LT prevalence

AN 0.6 (CI 0.4,0.8): BN 1.3 (1.1,1.5):

Females: 2.9 (CI 2.3,3.5); Males 0.5 (CI 0.3, 0.9)

O'Brien [6]

NC

Body image and self-esteem in physical education (PE) university students

Demographic questionnaires, self-reported BMI, BES, EAT-26, global self-esteem scale from the SDQIII

228

F

PE 18: 34 ± 0.64,

Psychology 18: 46 ± 0.78,

Year 3 PE 21:.0 ± 1.18,

Year 3 Psychology20: 9 ± 1.06

Not stated

Year 3 PE students had lower self-esteem and more disordered eating

O'Brien [180]

NC

Psychosocial characteristics among those in a weight loss programme

Custom questions on reasons, MBSRQ, single item self-esteem scale

106

86% F

14% M

M 41.9

(SD 10.8)

Not stated

Key reasons for wanting to lose weight were mood, appearance, and health. Poorer self-image/self-esteem for those citing mood reasons

Overton [181]

Clinical

Comparing emotional experience of women with EDs to NC controls

EDI-2, YSQ-SI, DES-IV

130 (30 ED)

F

Cases:

M 28.1

NC

M 23.8

Not stated

Use of disordered eating behaviours to manipulate both positive and negative emotional states, should be recognised as an important maintenance factor

Reynolds [182]

Clinicians

Whether health professionals felt orthorexia should be recognised as an eating disorder

Custom online survey and qualitative text boxes

52

96% F

4% M

41.2 ± 11.9

Not stated

Most clinicians (71%) felt that orthorexia should be recognised as a distinct ED

Robertson [183]*

NC

Associations between body image, self-esteem, and peer and romantic relationships

Body Image and Body Change Questionnaire, Physical Attractiveness Scale, Body Image Behaviour Scale, Social Physique Anxiety Scale, Physical Appearance Comparison Scale, RSES, Self-Description Questionnaire III, Perceived Relationship Quality Components Scale

91

80% F, 20% M

17–69

Not stated

Positive relationship between body-image and self-esteem, and between body image and quality of romantic relationships. Positive relationship between self-esteem and relationships (peer and romantic). Body image predicted self-esteem and quality of peer-relationships Self-esteem predicted romantic relationship quality

Rodino [184]

Clinicians

Fertility specialists' knowledge and practices relating to eating disorder

Adapted online questionnaire

106

51% F, 49% M

25 + 

Not stated

Knowledge around relevant symptoms of eating disorders, but uncertainty around ED detection. Many not satisfied with training in this area, or not confident in ability to recognise symptoms. Large majority indicated need for further education/guidelines

Rosewall [185]

NC

Risk factors for body dissatisfaction in girls

NZSEI, EAT-26, Stunkard Body Figure Drawings, EDI, CAPS, RSES, Sociocultural Influences on Body Image and Body Change Questionnaire (Perceived Pressure to Lose Weight subscale), PANAS, POTS

231

F

14–18

73.7% NZ European, 10.3% Māori, 5.6% Asian, 2.6% Pasifika and 3% Other

Risk factors for higher levels of body dissatisfaction were perfectionism, perceived media pressure, and low self-esteem

Rosewall [186]

NC

Exploring moderations of association between body dissatisfaction and disordered eating behaviours

NZSEI, ChEAT, Collins Body Figure Perceptions, EDI, CAPS, RSE, PANAS-C, Sociocultural Influences and Body Change Questionnaire, POTS (weight-based teasing subscale)

169

F

10–12

84.0% NZ European, 11% Māori, 6% Asian, 2% Pasifika, 1% Other

Body dissatisfaction and disordered eating association were moderated by personal (e.g. perfectionism, self-esteem) and environmental factors (e.g. teasing, perceived media pressure)

Rosewall [187]

NC

Psychopathology factors related to links between BMI and body dissatisfaction, and between body dissatisfaction and disordered eating

BMI, BSQ, BIA, BES, EAT-26, PAI

186

F

18–40

78.9% NZ European, 13.3% Asian/part Asian, 3.0% Māori, 1.2% Pasifika Island 3.6% other

Reporting lower BD (than would be predicted by BMI), and less disordered eating (than would be predicted by BD) was linked to lower levels of anxiety/depression and higher mood stability

Shephard [188]*

NC

Influence of family experiences related to food and self-compassion on the association between appearance ideals and body dissatisfaction

SATAQ (Revised—Female Version), BSQ, family Experiences Related to Food Questionnaire (FERFQ), self-compassion scale (SCS)

106

F

18–48

85.8% NZ European, 4.6% NZ European and 'another ethnicity', 3.8% Chinese, 1.9% Māori, 3.8% another ethnicity

Family food related experiences and self-compassion appear to be protective, moderating relationship between body dissatisfaction and thin ideal internalisation

Slater [189]*

NC

Energy intake, activity, and disordered eating behaviours in recreational athletes

EDI-3, LEAFQ

170

64% F

36% M

18–56

Not stated

Low energy availability (LEA) common but no risk of ED for most of those with LEA

Strang [190]*

Restrained eaters

Responses to Stroop test words about food, weight, and shape by restrained eaters versus unrestrained eaters

Stroop test, RS, STAI, BDI

55 (21 restrained eaters)

Only F after initial phase

Restrained: 24.33 (9.80), unrestrained: 21.85 (5.64)

Not stated

No group differences, but may have been due to minimal symptomatology in restrained eating group versus comparison groups

Talwar [12]

NC

Body image and body dissatisfaction among Māori and non-Māori participants

Multigroup Ethnic Identity Measure, BIA-G, BES

45

F

Māori:

M 19.8

(SD 1.2), European: M 19.0

(SD 1.2)

50% Māori

50% European

Lower concern about weight among Māori. Stronger Māori ethnic identity was associated with lower weight concern

Utter [5]

NC

Identifying 'red flag' behaviours for unhealthy weight loss

Youth'07 survey

9107

46% F

56% M

13–18

Māori, European, Pasifika, Asian (% not stated in this paper)

Meal skipping and fasting are 'red flag' behaviours associated with poor mental wellbeing

Vallance [191]

NC

ED symptoms and health related quality of life

SF-36, EDE-Q, EDI-2, BSQ, BCQ, BIAQ, BDI-II, BSI

214

F

17–65

85% European, 7.5% Asian, 6.1% Māori

DE and BD linked to lower quality of life

Vaňousová [192]

NC

Evaluating validity of the Eating Concerns (EAT) scale from the MPPI-3

MPPI-3 (specifically EAT scale), EPSI, EDE-Q, EDDS, BES, BI_AAQ

396

79% F

21% M

17–51

91% European, 12% Maori, 8% Chinese, 4% Indian, 2% Pasifika (some participants more than one)

Scores from new MPPI-3 EAT scale seem promising as a screening measure for eating pathology

Wells [20]

BN, AN (TRH)

Prevalence and severity of different disorders, including eating disorders, within NZ. Oversampled for Māori and Pasifika

CIDI

Short form: 12, 992, long form: 7435

57% F, 43% M

16+

20% Māori, 17% Pasifika, 63% Other (Part 1), 22% Māori, 18% Pasifika, 60% Other (long-form sample)

Any eating disorder 1.7% lifetime prevalence, 0.5% 12-month prevalence

Wells [193]

BN, AN (TRH)

Severity and interference with life for mental health conditions among NZ sample

CIDI, Sheehan Disability Scale

Part 1: 12,992, part 2: 7435

57% F, 43% M

16+

20% Māori, 17% Pasifika, 63% Other (Part 1), 22% Māori, 18% Pasifika, 60% Other (long-form sample)

Prevalence for EDs 0.5% in last 12 months