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Ecology of Food and Nutrition Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/gefn20
Evaluating the Relationship of Eating Behaviors of University Students with Body Mass Index and Self-Esteem a
b
b
Nevin Sanlier , Ali Emrah Biyikli & Ezgi Toptas Biyikli a
Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey b
Department of Nutrition and Dietetics, Akşehir Kadir Yallagöz School of Health Sciences, Konya, Turkey Published online: 31 Dec 2014.
Click for updates To cite this article: Nevin Sanlier, Ali Emrah Biyikli & Ezgi Toptas Biyikli (2015) Evaluating the Relationship of Eating Behaviors of University Students with Body Mass Index and Self-Esteem, Ecology of Food and Nutrition, 54:2, 175-185, DOI: 10.1080/03670244.2014.896798 To link to this article: http://dx.doi.org/10.1080/03670244.2014.896798
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [University of Otago] at 23:40 15 March 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Ecology of Food and Nutrition, 54:175–185, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 0367-0244 print/1543-5237 online DOI: 10.1080/03670244.2014.896798
Evaluating the Relationship of Eating Behaviors of University Students with Body Mass Index and Self-Esteem NEVIN SANLIER
Downloaded by [University of Otago] at 23:40 15 March 2015
Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
ALI EMRAH BIYIKLI and EZGI TOPTAS BIYIKLI Department of Nutrition and Dietetics, Ak¸sehir Kadir Yallagöz School of Health Sciences, Konya, Turkey
This study investigated the relationship between eating behaviors (Dutch Eating Behavior Questionnaire–DEBQ), self-esteem (Rosenberg Self-Esteem Scale–RSES), and body mass index (BMI) in university students. A total of 503 students (129 men and 374 women), 18–23 years of age were included in the study. According to BMI, 8.3% of students were underweight; 47.3% were overweight; and 74.4% were of healthy weight. The level of self-esteem of 86.5% of young people was high, 13.5% moderate. The mean score (33.3 ± 11.8) of emotional-eating behavior was higher for women than for men (27.9 ± 10.1) . Recommendations include assessing eating behaviors via longitudinal studies with large samples, and identifying at-risk groups, as useful approaches for informing prevention. KEYWORDS body mass index, Dutch Eating Questionnaire, eating behavior, university students
Behavior
All over the world, the number of individuals developing eating disorders arising from engaging in unhealthy dieting has increased (Granilo, Rodriguez, and Carvajal 2005; Kaye, 2008; Yasuhara et al. 2002; Ba¸s et al. 2004) to the extent that the World Health Organization has identified the prevention and treatment of eating disorders among young people as a situation Address correspondence to Nevin Sanlier, Gazi University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Be¸sevler, Ankara, Turkey. E-mail: [email protected]
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requiring greater global attention (Janout and Janoutova, 2004). Various studies report that the frequency and prevalence of eating disorders is highest among adolescent girls and young women (Kaye 2008; Moreno and Smith 2006; S¸ anlıer, Yabancı, and Alyakut 2008; Vialettes et al. 2006). There is a linear relationship between the diets of young people and their growth (Baysal 2007; Spear 2002). Healthy and unhealthy eating habits acquired in childhood influence the health of individuals lifelong. In most of the studies conducted, it was determined that serious problems were experienced in childhood and adolescence in relation to eating habits; and that young people’s disordered food-consumption practices influenced psychological factors such as perceptions of body image, self-esteem, and gender roles (Bryan and Tiggemann 2001; Bulik et al. 2005; Rosen, Orosan, and Reiter 1995). Individuals’ nutritional habits are closely related to their self-esteem. Low self-esteem is accepted as an important risk factor for eating dysfunction (Button et al. 1996; Wertheimet et al. 1992). Silverstone (1992) suggested that low self-esteem was often observed in those with anorexia nervosa and bulimia nervosa. Socially, being thin frequently gains one recognition, while being obese may be met with exclusion and various negative attitudes. When considering this, self-esteem arises in large part from one’s interpersonal relationships and the meaning one gives to these relationships, receiving negative feedback from one’s environment may serve to decrease one’s selfesteem (Telch and Agras 1994). Nowadays, it is known that many diseases can arise from chronic disordered eating. Recognizing the early onset of eating disorders will prevent the intensity and incidence of such diseases, reduce complications arising from them, shorten the duration of treatments, and improve prognoses. There are some individuals whose struggles with food do not fully meet the criteria to diagnose an eating disorder, however, their eating behavior may exhibit differences when compared with healthy eating behavior. These behavioral differences may be predictors of an eating disorder that could further develop. A number of studies have shown a strong relationship between eating disorder symptoms and self-esteem (e.g., Spulveda, Corrobles, and Gandarillas 2010; Williams et al. 1993). It has also been shown that the best predictors of disordered eating are low self-esteem and high anxiety; and that treatments which are geared toward raising self-esteem may reduce these symptoms (Berg, Frazier, and Sherr 2009). In view of these findings, in order to identify the causes of disordered eating, first of all, individuals’ eating behaviors should be evaluated (Bozan, Ba¸s, and Asçi 2011; Bunnel et al. 1990; Spulveda, Corrobles, and Gandarillas 2010; Van Strein et al. 1986). This study was carried out in order to assess the relationship of young adults’ eating behaviors with the variables of self-esteem, body mass index (BMI), gender, and skipping a meal.
University Students’ Eating, Self-Esteem, and BMI
177
METHODS Participants The research was conducted among 503 university students, 129 men (mean age 20.34 ± 1.33 years) and 374 women (mean age 20.21 ± 1.27 years), between 18 and 23 years old. The study was planned and carried out between April and May 2013. Participants were informed about the subject and purpose of the study. Each student signed a voluntary participation form and filled in the questionnaires in accordance with the declaration of Helsinki (World Medical Association).
Downloaded by [University of Otago] at 23:40 15 March 2015
Personal Information Form The personal information form prepared by the researchers included questions about the participants’ age (years), gender, height (cm), body weight (kg), and the practice of skipping a meal.
Anthropometric Measurements All anthropometric measurements were taken by two trained dieticians. Height was measured to the nearest 0.1 cm, and weight to nearest 0.5 kg in light clothing and without shoes. BMI was calculated as weight (kg)/height (m2 ). Participants were classified according to their BMI into three group as underweight (BMI < 18.5 kg/m2 ), healthy weight (18.5 ≤ BMI ≤ 24.9 kg/m2 ) and overweight (25.0 ≤ BMI ≤ 29.9 kg/m2 ) (WHO 2004).
Instruments ROSENBERG SELF-ESTEEM SCALE (RSES) The Self-Esteem Scale was developed by Rosenberg (1965), and adapted for the Turkish population by Çuhadaro˘glu (1986). The scale, consisting of 63 items, has 12 subscales; the first of these consists of 10 items measuring self-esteem, and is the subscale utilized in our study. Answers are evaluated with a 7-point scale, with 0–1 points indicating “high,” 2–4 points indicating “moderate,” and 5–6 points indicating “low” self-esteem. In our study, the confidentiality coefficient (Cronbach alpha) was found as 0.78. DUTCH EATING BEHAVIOR QUESTIONNAIRE (DEBQ) One of the indexes used to determine eating behaviors is the Dutch Eating Behavior Questionnaire (DEBQ). This index, which was developed by Van Strein and colleagues (1986), is used in a number of countries. The cases of “emotional eating,” “restrained eating,” and “external eating” are assessed.
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Bozan and colleagues (2009), who demonstrated that the DEBQ was a valid and reliable index that is usable in Turkey. The DEBQ consists of 33 items and includes 3 subscales; 10 items among these include the behavior of restrained/restrictive eating, 13 items about emotional eating, and 10 items about external eating. Responses are assessed uisng a 5-point Likert scale (1 = never, 2 = rarely, 3 = sometimes, 4 = frequently, 5 = often). In our study, the confidentiality coefficient of the scale (Cronbach alpha) was found as 0.86.
Downloaded by [University of Otago] at 23:40 15 March 2015
Statistical Analysis All statistical analyses were performed using SPSS software (version 13.0, SPSS Inc., Chicago, Illinois, USA). Continuous variables were presented as mean and standard deviation, whereas categorical variables were presented as frequencies and percentages. Differences between categorical variables were evaluated with Chi-square test. Continuous variables compared with Student’s t-test for two independent groups or one-way ANOVAs followed by Tukey’s post hoc test to compare group means for three groups. A p value of less than .05 was considered to be statistically significant.
RESULTS According to BMI, it was determined that 8.3% of participants were underweight, 17.3% were overweight, and 74.4% were of healthy weight. In the study, 21.1% of the students suggested that they did not skip a meal; 35.4% skipped a meal; and 43.5% sometimes skipped a meal (table 1). The mean DEBQ eating behaviors scores, according to the participants’ gender, BMI, Rosenberg Self-Esteem score, and frequency of skipping a meal, are presented in table 1. When the DEBQ eating behavior scores were evaluated according to the participants’ gender, scores for restrictive eating behavior did not indicate significant differences (p > .05), while scores for emotional eating and external eating behaviors indicated significant difference (p < .05). It was found that the mean score for emotional eating behavior for the women (33.3 ± 11.8) was significantly higher than the mean score for emotional eating behavior for the men (32.1 ± 6.8). In the mean values of external eating behavior, it was identified that the men’s scores were significantly higher (32.1 ± 6.8) compared to the women (30.5 ± 6.9) in this domain. According to BMI groups, from examining DEBQ subscales, it was identified that the scores for restrictive and emotional eating behaviors indicated significant differences compared to BMI groups (p < .05), while the external eating behavior scores did not indicate significant differences (p > .05). The mean score for restrictive eating behavior was 38.4 ± 7.1 in those who
179
University Students’ Eating, Self-Esteem, and BMI TABLE 1 DEBQ Eating Behavior Scores (n = 503) DEBQ Score (X¯ ± SD)
Downloaded by [University of Otago] at 23:40 15 March 2015
Variables Gender Male Female t p BMI (kg/m2 ) Underweight Healthy Overweight F P Frequency of skipping a meal Skips Not skip Sometimes skips F p Rosenberg Self-Esteem Score level High Moderate t p
n (%)
Restrictive
Emotional
External
129 (25.6) 374 (74.4)
24.8 ± 9.9 26.0 ± 7.9 1.301 .194
27.9 ± 10.1 33.3 ± 11.8 4.571
Ecology of Food and Nutrition Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/gefn20
Evaluating the Relationship of Eating Behaviors of University Students with Body Mass Index and Self-Esteem a
b
b
Nevin Sanlier , Ali Emrah Biyikli & Ezgi Toptas Biyikli a
Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey b
Department of Nutrition and Dietetics, Akşehir Kadir Yallagöz School of Health Sciences, Konya, Turkey Published online: 31 Dec 2014.
Click for updates To cite this article: Nevin Sanlier, Ali Emrah Biyikli & Ezgi Toptas Biyikli (2015) Evaluating the Relationship of Eating Behaviors of University Students with Body Mass Index and Self-Esteem, Ecology of Food and Nutrition, 54:2, 175-185, DOI: 10.1080/03670244.2014.896798 To link to this article: http://dx.doi.org/10.1080/03670244.2014.896798
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [University of Otago] at 23:40 15 March 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Ecology of Food and Nutrition, 54:175–185, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 0367-0244 print/1543-5237 online DOI: 10.1080/03670244.2014.896798
Evaluating the Relationship of Eating Behaviors of University Students with Body Mass Index and Self-Esteem NEVIN SANLIER
Downloaded by [University of Otago] at 23:40 15 March 2015
Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
ALI EMRAH BIYIKLI and EZGI TOPTAS BIYIKLI Department of Nutrition and Dietetics, Ak¸sehir Kadir Yallagöz School of Health Sciences, Konya, Turkey
This study investigated the relationship between eating behaviors (Dutch Eating Behavior Questionnaire–DEBQ), self-esteem (Rosenberg Self-Esteem Scale–RSES), and body mass index (BMI) in university students. A total of 503 students (129 men and 374 women), 18–23 years of age were included in the study. According to BMI, 8.3% of students were underweight; 47.3% were overweight; and 74.4% were of healthy weight. The level of self-esteem of 86.5% of young people was high, 13.5% moderate. The mean score (33.3 ± 11.8) of emotional-eating behavior was higher for women than for men (27.9 ± 10.1) . Recommendations include assessing eating behaviors via longitudinal studies with large samples, and identifying at-risk groups, as useful approaches for informing prevention. KEYWORDS body mass index, Dutch Eating Questionnaire, eating behavior, university students
Behavior
All over the world, the number of individuals developing eating disorders arising from engaging in unhealthy dieting has increased (Granilo, Rodriguez, and Carvajal 2005; Kaye, 2008; Yasuhara et al. 2002; Ba¸s et al. 2004) to the extent that the World Health Organization has identified the prevention and treatment of eating disorders among young people as a situation Address correspondence to Nevin Sanlier, Gazi University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Be¸sevler, Ankara, Turkey. E-mail: [email protected]
175
Downloaded by [University of Otago] at 23:40 15 March 2015
176
N. Sanlier et al.
requiring greater global attention (Janout and Janoutova, 2004). Various studies report that the frequency and prevalence of eating disorders is highest among adolescent girls and young women (Kaye 2008; Moreno and Smith 2006; S¸ anlıer, Yabancı, and Alyakut 2008; Vialettes et al. 2006). There is a linear relationship between the diets of young people and their growth (Baysal 2007; Spear 2002). Healthy and unhealthy eating habits acquired in childhood influence the health of individuals lifelong. In most of the studies conducted, it was determined that serious problems were experienced in childhood and adolescence in relation to eating habits; and that young people’s disordered food-consumption practices influenced psychological factors such as perceptions of body image, self-esteem, and gender roles (Bryan and Tiggemann 2001; Bulik et al. 2005; Rosen, Orosan, and Reiter 1995). Individuals’ nutritional habits are closely related to their self-esteem. Low self-esteem is accepted as an important risk factor for eating dysfunction (Button et al. 1996; Wertheimet et al. 1992). Silverstone (1992) suggested that low self-esteem was often observed in those with anorexia nervosa and bulimia nervosa. Socially, being thin frequently gains one recognition, while being obese may be met with exclusion and various negative attitudes. When considering this, self-esteem arises in large part from one’s interpersonal relationships and the meaning one gives to these relationships, receiving negative feedback from one’s environment may serve to decrease one’s selfesteem (Telch and Agras 1994). Nowadays, it is known that many diseases can arise from chronic disordered eating. Recognizing the early onset of eating disorders will prevent the intensity and incidence of such diseases, reduce complications arising from them, shorten the duration of treatments, and improve prognoses. There are some individuals whose struggles with food do not fully meet the criteria to diagnose an eating disorder, however, their eating behavior may exhibit differences when compared with healthy eating behavior. These behavioral differences may be predictors of an eating disorder that could further develop. A number of studies have shown a strong relationship between eating disorder symptoms and self-esteem (e.g., Spulveda, Corrobles, and Gandarillas 2010; Williams et al. 1993). It has also been shown that the best predictors of disordered eating are low self-esteem and high anxiety; and that treatments which are geared toward raising self-esteem may reduce these symptoms (Berg, Frazier, and Sherr 2009). In view of these findings, in order to identify the causes of disordered eating, first of all, individuals’ eating behaviors should be evaluated (Bozan, Ba¸s, and Asçi 2011; Bunnel et al. 1990; Spulveda, Corrobles, and Gandarillas 2010; Van Strein et al. 1986). This study was carried out in order to assess the relationship of young adults’ eating behaviors with the variables of self-esteem, body mass index (BMI), gender, and skipping a meal.
University Students’ Eating, Self-Esteem, and BMI
177
METHODS Participants The research was conducted among 503 university students, 129 men (mean age 20.34 ± 1.33 years) and 374 women (mean age 20.21 ± 1.27 years), between 18 and 23 years old. The study was planned and carried out between April and May 2013. Participants were informed about the subject and purpose of the study. Each student signed a voluntary participation form and filled in the questionnaires in accordance with the declaration of Helsinki (World Medical Association).
Downloaded by [University of Otago] at 23:40 15 March 2015
Personal Information Form The personal information form prepared by the researchers included questions about the participants’ age (years), gender, height (cm), body weight (kg), and the practice of skipping a meal.
Anthropometric Measurements All anthropometric measurements were taken by two trained dieticians. Height was measured to the nearest 0.1 cm, and weight to nearest 0.5 kg in light clothing and without shoes. BMI was calculated as weight (kg)/height (m2 ). Participants were classified according to their BMI into three group as underweight (BMI < 18.5 kg/m2 ), healthy weight (18.5 ≤ BMI ≤ 24.9 kg/m2 ) and overweight (25.0 ≤ BMI ≤ 29.9 kg/m2 ) (WHO 2004).
Instruments ROSENBERG SELF-ESTEEM SCALE (RSES) The Self-Esteem Scale was developed by Rosenberg (1965), and adapted for the Turkish population by Çuhadaro˘glu (1986). The scale, consisting of 63 items, has 12 subscales; the first of these consists of 10 items measuring self-esteem, and is the subscale utilized in our study. Answers are evaluated with a 7-point scale, with 0–1 points indicating “high,” 2–4 points indicating “moderate,” and 5–6 points indicating “low” self-esteem. In our study, the confidentiality coefficient (Cronbach alpha) was found as 0.78. DUTCH EATING BEHAVIOR QUESTIONNAIRE (DEBQ) One of the indexes used to determine eating behaviors is the Dutch Eating Behavior Questionnaire (DEBQ). This index, which was developed by Van Strein and colleagues (1986), is used in a number of countries. The cases of “emotional eating,” “restrained eating,” and “external eating” are assessed.
178
N. Sanlier et al.
Bozan and colleagues (2009), who demonstrated that the DEBQ was a valid and reliable index that is usable in Turkey. The DEBQ consists of 33 items and includes 3 subscales; 10 items among these include the behavior of restrained/restrictive eating, 13 items about emotional eating, and 10 items about external eating. Responses are assessed uisng a 5-point Likert scale (1 = never, 2 = rarely, 3 = sometimes, 4 = frequently, 5 = often). In our study, the confidentiality coefficient of the scale (Cronbach alpha) was found as 0.86.
Downloaded by [University of Otago] at 23:40 15 March 2015
Statistical Analysis All statistical analyses were performed using SPSS software (version 13.0, SPSS Inc., Chicago, Illinois, USA). Continuous variables were presented as mean and standard deviation, whereas categorical variables were presented as frequencies and percentages. Differences between categorical variables were evaluated with Chi-square test. Continuous variables compared with Student’s t-test for two independent groups or one-way ANOVAs followed by Tukey’s post hoc test to compare group means for three groups. A p value of less than .05 was considered to be statistically significant.
RESULTS According to BMI, it was determined that 8.3% of participants were underweight, 17.3% were overweight, and 74.4% were of healthy weight. In the study, 21.1% of the students suggested that they did not skip a meal; 35.4% skipped a meal; and 43.5% sometimes skipped a meal (table 1). The mean DEBQ eating behaviors scores, according to the participants’ gender, BMI, Rosenberg Self-Esteem score, and frequency of skipping a meal, are presented in table 1. When the DEBQ eating behavior scores were evaluated according to the participants’ gender, scores for restrictive eating behavior did not indicate significant differences (p > .05), while scores for emotional eating and external eating behaviors indicated significant difference (p < .05). It was found that the mean score for emotional eating behavior for the women (33.3 ± 11.8) was significantly higher than the mean score for emotional eating behavior for the men (32.1 ± 6.8). In the mean values of external eating behavior, it was identified that the men’s scores were significantly higher (32.1 ± 6.8) compared to the women (30.5 ± 6.9) in this domain. According to BMI groups, from examining DEBQ subscales, it was identified that the scores for restrictive and emotional eating behaviors indicated significant differences compared to BMI groups (p < .05), while the external eating behavior scores did not indicate significant differences (p > .05). The mean score for restrictive eating behavior was 38.4 ± 7.1 in those who
179
University Students’ Eating, Self-Esteem, and BMI TABLE 1 DEBQ Eating Behavior Scores (n = 503) DEBQ Score (X¯ ± SD)
Downloaded by [University of Otago] at 23:40 15 March 2015
Variables Gender Male Female t p BMI (kg/m2 ) Underweight Healthy Overweight F P Frequency of skipping a meal Skips Not skip Sometimes skips F p Rosenberg Self-Esteem Score level High Moderate t p
n (%)
Restrictive
Emotional
External
129 (25.6) 374 (74.4)
24.8 ± 9.9 26.0 ± 7.9 1.301 .194
27.9 ± 10.1 33.3 ± 11.8 4.571
