EDs and DEBs are health problems related to body image and weight dissatisfaction facing adolescents and young adults worldwide. These disorders may affect the growth process, and consequently lead to wasting, stunting, and micronutrient deficiencies.
To assess the prevalence of EDs and DEBs among Saudi Arabian youths, and elucidate the epidemiology of these conditions, a group of researchers performed a systematic review on 14 papers published from 2000 onwards.
The studies involved participants aged between 10 and 24 years, who were studying in schools and universities across Saudi Arabia.
The Eating Attitudes Test (EAT-26) was the predominant tool used for evaluating aberrant eating behaviours. Among the 11 studies that used this tool, there was a high prevalence of EDs and DEBs ranging from 10.2% to 48.1%.
In addition, the overall prevalence was found to be highest in the eastern region (29.4% to 65.5%), followed by the northwestern region (48.1%), while the lowest prevalence was found in the northern regions (25.4%).
“Despite the differences in size, climate and population count, the included cities all demonstrated a high prevalence of EDs and DEBs. The central region has the highest levels of urbanisation and affluence, although this was not projected in the prevalence rates. The findings were unexpected and are worth further investigation,” the authors wrote.
The majority of studies recruited female students, with only four studies including male students.
“The results are not conclusive, but it is important to note that EDs and DEBs are common among male Saudi youths, and may be underreported. Some of them said that the feminised cultural constructs of EDs inclined them, as well as those around them such as relatives, peers, and even health and education experts, to ignore symptoms.”
In terms of age, older adolescents have higher prevalence of EDs and DEBs, compared to younger adolescents. Specifically, the reported prevalence ranged from 10.2% to 42.5% for secondary and intermediate school students, and 29.4% to 65.5% for university students.
“Saudi older female students indicated higher prevalence rates of DEB (43.8%) than younger students (29.4%). These findings support conclusions stating that the peak of DEB occurs in late adolescence and early adulthood.”
Impact of mindset shifts on dietary habits
The negative attitudes towards food and unhealthy habits of DEB sufferers, such as binge eating, purging, fasting and use of laxatives, can occur in individuals who have not been diagnosed with a specific ED.
As adolescents have increased nutrient requirements, failure to meet these needs can impair normal growth and sexual maturation. Energy-restriction diets may also lead to binge eating and a heightened risk of EDs.
According to the authors, the Middle East and North Africa (MENA) countries, which are experiencing significant transitions in culture, diet and gender roles, have widely documented DEBs among the young populations.
For instance, a study investigated the eating attitudes of 4,698 adolescents aged 15 to 18 years as part of the ARAB Eating Among Teens project in seven MENA locations, namely Algeria, Jordan, Kuwait, Libya, Palestine, Syria, and the UAE.
The results showed that DEBs were highly prevalent in both male (13.8% to 47.3%) and female (16.2% to 42.7%) adolescents.
Based on this review, Saudi Arabia’s prevalence estimates tend to be higher than those reported in other Asian countries.
“Several studies on Turkish school and university students revealed that the prevalence of DEB ranged from 9.8% to 22.8%. In Japan, the local version of EAT-26 found that 11.2% of females had eating problems. In Korea and Taiwan, disturbed eating attitudes were recorded in 10.3% and 10.4% of students respectively.
“There is no clear rationale to explain the marked rise in EDs and DEBs in Saudi Arabia, as it relies on complex interactions between genetic, social, cultural, and psychological causes. Nevertheless, many researchers have delineated the phenomenon to be influenced by Westernisation.”
Traditionally, Arab populations value plumpness as they believed it symbolises fertility, wealth, and health.
“Due to the dramatic economic developments and sociocultural shifts in the last decades, younger generations in the region are increasingly adopting Western concepts in relation to weight and physical appearance. They are preoccupied with the thin-body ideal rather than the culturally preferred fuller figure, which may raise their susceptibility to EDs.”
It should be noted that the cross-sectional nature and sample size of the studies increase the possibility of bias, and may limit the generalisability of the review’s findings.
“Further research on adolescent males and young people is essential to fill the gaps in the present epidemiological evidence.
“Moreover, the noticeable increase in EDs and DEBs in Saudi Arabia must motivate researchers, physicians and dietitians to develop scientifically based guidelines for assessing, evaluating and treating these conditions. Awareness of healthy food consumption and the potential consequences of eating disorders should also be raised among youths,” the authors concluded.
“Prevalence of Eating Disorders and Disordered Eating Behaviours amongst Adolescents and Young Adults in Saudi Arabia: A Systematic Review”
Authors: Azzah Alsheweir, et al