EMPIRICAL ARTICLE
Predictive Factors of Disordered Eating and Body Image Satisfaction in Cyprus Marios Argyrides, PhD* Natalie Kkeli, MA
ABSTRACT Objective: This study aimed to assess possible relationships and predictor variables between disordered eating attitudes and behaviors, the internalization of the thin ideal construct, body image satisfaction, body image investment, weightrelated anxiety, and body mass index (BMI) among Greek-Cypriot female university students in Cyprus. Method: A total of 243 female university students responded to self-report measures assessing disordered eating, internalization of the thin ideal, body satisfaction, body image investment, and weight-related anxiety. Results: Disordered eating was positively correlated to the internalization of the thin ideal, body image investment, weight-related anxiety, and BMI and negatively correlated with body image satisfaction. The internalization of the thin
Introduction Eating disorders have received significant medical, public, and research attention over the years.1 Numerous research studies attributed the development of eating disorders to three main clusters: sociocultural, familial, and individual factors.2 The sociocultural cluster of factors has been found to be applicable for both adolescents and adults.3 Family and twin studies indicate the familial transmission and genetic risk factors, respectively, in the development of eating disorders.4 In more recent years, the examination of the sociocultural factors cross-culturally has been of great interest.5 When compared with prior beliefs that body image issues and eating disturbances were a problem of the “Western” world, recent prevalence studies indicated that adolescent girls and women from a variety of nonwestern countries Accepted 21 May 2014 *Correspondence to: Marios Argyrides, PhD, Neapolis University Pafos 2 Danaes Avenue, 8042 Pafos, Cyprus. E-mail: [email protected] School of Health Sciences, Department of Psychology, Neapolis University Pafos, Pafos, Cyprus Published online 5 June 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/eat.22310 C 2014 Wiley Periodicals, Inc. V
International Journal of Eating Disorders 48:4 431–435 2015
ideal was also positively correlated to weight-related anxiety and body image investment and negatively correlated to body image satisfaction. Furthermore, weight-related anxiety and internalization of the thin ideal have been found to be significant predictors of disordered eating attitudes. Discussion: Possible explanations and vulnerability factors are addressed, as well as implication for prevention stratC 2014 Wiley egies and future research. V Periodicals, Inc. Keywords: body image; disordered eating; Cyprus; feelings of attractiveness; weight-related anxiety; body image investment (Int J Eat Disord 2015; 48:431–435)
experience significant levels of body image disturbance and eating disorders.6–9 Cyprus is an island country situated on the eastern part of the Mediterranean Sea and belongs to the warmest areas of the Mediterranean region with hot and dry summers and very mild winters. Considering the Cyprus weather as well as Sloan’s10 research supporting that individuals, especially women, who reside in warmer weather climates have significantly more eating disorder pathology and body image dissatisfaction, Cyprus becomes a country of interest to assess these constructs. Furthermore, Cyprus also becomes a country of interest as the Cypriot culture combines both westernized ideas and attitudes and simultaneously more traditional characteristics.11 A literature review concerning the constructs of disordered eating attitudes and body dissatisfaction in Cyprus indicated a significant rise.11 Katsounari and Zeeni12 found that Cypriot female university students were preoccupied with their weight by trying to gain, lose, or maintain it. In addition, sociocultural influences such as the importance of the opinion of one’s mother, male friend and female friend were found to be predictors of disordered eating behavior in Cypriot 431
ARGYRIDES AND KKELI
female students.13 Furthermore, the levels of disordered eating in Cyprus seem to be higher than most countries assessed in the literature. Specifically, a study conducted by Hadjigeorgiou, Tornaritis, Savva, Solea, and Kafatos,14 who conducted a 6year follow-up (2003 and 2010) in a large sample of Greek-Cypriot adolescents, revealed that 18.8% of males and 34.4% of females in 2003 and 18.8% of males and 35.9% of females in 2010 had significant disordered eating attitudes and behaviors (Eating Attitudes Test-26 [EAT-26] score higher than 20).15 The above percentages, especially for females, are higher than Singapore’s 10.5%,16 Saudi Arabia’s 24.6%,17 United Arab Emirates’ 23.4%,18 China’s 10.8%,19 Iran’s 16.7%,20 South Africa’s 21.2%,21 Brazil’s 15.8%,22 Israel’s 32.4%,23 and several other European countries of up to 18%.24–26 In a university-age sample, Katsounari11 found that 28.6% of young females had significant problems with disordered eating attitudes and behavior, and Argyrides27 found that 21.43% of a similar-age sample had these significant problems, all using the same measure (i.e., EAT-26). Despite the above previous research that has been conducted in Cyprus relating to disordered eating pathology, very little research examined the contributing factors that led to the onset of disordered eating attitudes and behaviors. The current study aimed to assess the possible relationships between eating-disordered attitudes and behaviors, the internalization of the thin ideal as presented in the media, body image satisfaction, body image investment, weight-related anxiety, and body mass index (BMI) in Cyprus among Greek-Cypriot female university students. The hypotheses that were developed based on the above were as follows: H1: Eating-disordered attitudes and behaviors will be positively related to the internalization of the thin ideal, body image investment, weightrelated anxiety, and BMI and negatively related to body image satisfaction among Greek-Cypriot females. H2: The internalization of the thin ideal, body image satisfaction, body image investment, and weight-related anxiety will be significant predictors of eating-disordered attitudes and behaviors when the model is adjusted for BMI. The findings of the current study could be used to develop specific prevention strategies to minimize the high body image issues present in the female Greek-Cypriot population.
432
Method Participants A total of 243 undergraduate and graduate-level female university students were recruited for participation in the current study. The age of participants ranged from 18 to 34 years (M 5 26.2; SD 5 3.84). The BMI of the participants was also calculated and ranged from 16.66 to 36.36 (M 5 21.83; SD 5 3.97). Measures Disordered Eating Attitudes and Behavior. The EAT2615 is a widely used instrument that identifies the symptoms of eating disorders according to respondents’ feelings, attitudes, and behaviors and consists of three subscales: (1) Dieting, (2) Bulimia and Food Preoccupation, and (3) Oral Control. The 26 items of the scale are rated on a six-point Likert-type scale ranging from always (1) to never (6) and also create a composite total score. The EAT-26 has reported reliability coefficients ranging from .86 to .90. For the current study, the internal consistency reliability coefficient of the total composite score that was of interest was found to be .87. Internalization of the Thin Ideal. The Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3)28 assesses societal and media influences on body image and specifically the internalization of the thin ideal. The third version of the SATAQ is a 30-item scale with four subscales: Information, Pressure, Internalization-General, and Internalization-Athlete. For the current study, only the nine items of the internalization of the thin ideal subscale (Internalization-General) were used. The items are scored on a five-point Likert-type scale ranging from definitely disagree (1) to definitely agree (5). The internal consistencies of this instrument are very good, and the Cronbach’s alpha coefficients range from .84 to .93. For the internalization subscale of the current sample, the alpha value was .87. Body Image Satisfaction, Body Image Investment, and Weight-Related Anxiety. The Multidimensional BodySelf Relations Questionnaire-Appearance Scale (MBSRQAS)29 evaluates particular attitudinal facets of the body image. The current study used a subset of the shorter, 34-item version of the scale, which evaluates only appearance-related body image constructs. Specifically, the 7-item Appearance Evaluation subscale was used, which measures feelings of physical attractiveness and satisfaction/dissatisfaction with one’s looks, the 12-item Appearance Orientation subscale, which assesses the extent of investment on one’s appearance, and the 4item Overweight Preoccupation subscale, which assesses fat anxiety, weight vigilance, dieting, and eating restraint. All items were rated on a five-point Likert-type satisfaction/dissatisfaction scale. The subscales of the current International Journal of Eating Disorders 48:4 431–435 2015
PREDICTORS OF DISORDERED EATING IN CYPRUS TABLE 1. Correlations between the variables of internalization of thin ideal, body image satisfaction, body image investment, weight-related anxiety, body mass index, and disordered eating attitudes and behavior Variables
1
2
3 c
1. Disordered Eating — .431 2. Thin Ideal Internalization — 3. Body Image Satisfaction 4. Body Image Investment 5. Weight-Related Anxiety 6. BMI
4 b
5 c
6 c
2.215 .413 .677 .351c 2.229b .412c .416c .052 — .071 2.326c 2.273c — .422c 2.169b — .310c —
Notes: Disordered Eating 5 composite score of the EAT-26; Thin Ideal Internalization 5 Internalization General subscale of the SATAQ-3; Body Image Satisfaction 5 Appearance Evaluation subscale of the MBSRQ-AS; Body Image Investment 5 Appearance Orientation subscale of the MBSRQ-AS; Weight-Related Anxiety 5 Overweight Preoccupation subscale of the MBSRQ-AS; BMI 5 body mass index. N 5 243 females. a p < .05 b p < .01 c p < .001.
measure have been found to have good psychometric properties among both genders and different cultural groups. The internal consistencies of the three MBSRQAS subscales used in the current study varied from .77 to .88. Procedure All female university students who participated in the current study were informed of the nature of the study and were asked to sign a consent form. Descriptive statistics were conducted for participants’ age and BMI. Pearson product–moment correlational analyses were conducted to examine possible relationships between all variables of interest. In addition, multiple regressions were conducted to find out what factors predicted disordered eating attitudes and behaviors. In these analyses, the regression model was adjusted for BMI. The significance levels were set at .05.
Results To address Hypothesis 1, Pearson product–moment correlational analyses were used to examine possible statistically significant relationships between disordered eating attitudes and behaviors, the internalization of the thin ideal, body image satisfaction, body image investment, weight-related anxiety, and BMI. The findings indicated that disordered eating attitudes and behaviors were significantly correlated with all the other measures (Table 1). Specifically, disordered eating was positively related to the internalization of the thin ideal, body image investment, weight-related anxiety, and BMI. The current findings indicate that higher levels of eating pathology, as measured by the EAT26, was related to higher weight, higher levels of International Journal of Eating Disorders 48:4 431–435 2015
the internalization of the thin ideal, more investment in one’s appearance, and more anxiety and preoccupation over one’s weight. Furthermore, disordered eating attitudes were negatively correlated with body image satisfaction, indicating that the lower the satisfaction with one’s appearance, the higher were the levels of eating pathology. The internalization of the thin ideal was also positively correlated to weight-related anxiety and body image investment, indicating that the higher the levels of internalization of the thin ideal, the higher were the levels of fat anxiety, weight vigilance, dieting, and eating restraint and investment in one’s appearance. The internalization of the thin ideal was also negatively correlated to body image satisfaction, indicating that the higher internalization of the thin ideal is predictive of lower levels of body image satisfaction. However, there was no significant correlation with BMI. Finally, weight-related anxiety was negatively correlated to body image satisfaction and positively correlated with body image investment and BMI. These results indicate that the more satisfaction was present with one’s appearance, the less anxiety and weight vigilance were present. In addition, more weight-related anxiety related to more investment in appearance and higher body weight levels. As expected based on Cash’s manual29 of the MBSRQ-AS, body image investment, and body image appearance were not correlated as they are considered as independent constructs. Therefore, Hypothesis 1 was supported. To address Hypothesis 2, a stepwise multiple regression analysis was conducted to evaluate how well the rest of the measures predicted disordered eating attitudes. The predictors were the internalization of the thin ideal, body image satisfaction, body image investment, and weight-related anxiety, whereas the criterion variable was the disordered eating attitudes and behaviors. BMI was used as a covariate in this analysis. The analysis (Table 2) revealed that two of the four predictors were significant [F(3,240) 5 89.53, p < .001) and accounted for 52.3% of the variance of disordered eating attitudes and behaviors (R2 5 .529, adjusted R2 5 .523). Disordered eating attitudes and behaviors were primarily predicted by weight-related anxiety (b 5 .663, t 5 11.75, p < .001, R2 5 .508) and to a lesser extent by the internalization of the thin ideal (b 5 .141, t 5 2.73, p 5 .007, R2 5 .529), which added another 2% to the total variance explanation. Therefore, these two factors seem to predict disordered eating attitudes, and Hypothesis 2 was partially supported. Feelings 433
ARGYRIDES AND KKELI TABLE 2.
Summary of multiple regression analysis of participants’ disordered eating attitudes and behavior
Independent predictor variables BMI MBSRQ overweight preoccupation (weight-related anxiety) MBSRQ appearance evaluation (feelings of attractiveness) MBSRQ appearance orientation (investment in appearance) SATAQ-3 internalization of the thin ideal
B
SE
b
t
Significance
20.011 1.982 20.011 0.109 0.196
0.178 0.169 0.142 0.097 0.072
20.004 0.663 2.004 .061 0.141
20.062 11.75 20.078 1.130 2.73
.951 .05).
Discussion The aim of the current study was to assess the relationships between disordered eating attitudes and behaviors, the internalization of the thin ideal, body image satisfaction, body image investment, weight-related anxiety, and BMI among GreekCypriot female university students. The factors that predict disordered eating attitudes and behaviors were also investigated. Findings indicated that higher levels of eating pathology as measured by the EAT-26 significantly correlated with BMI, higher levels of the internalization of the thin ideal, more investment in one’s appearance, and more anxiety over one’s weight. This finding is in line with existing research from nonclinical populations,31,32 which found eatingand shape-related disturbances and body dissatisfaction to be related to the internalization of the thin ideal. Furthermore, lower levels of satisfaction with one’s appearance were related to higher levels of eating pathology. Findings also indicated that higher levels of the internalization of the thin ideal were related to higher levels of weight-related anxiety and investment in one’s appearance and lower levels of body image satisfaction, again in line with previous research.31,32 Moreover, and supported by previous research, satisfaction with one’s appearance was related to less weight-related anxiety.33 Concerning the hypotheses regarding the predictor variables, results indicated that weight-related anxiety and the internalization of the thin ideal were significant predictors of disordered eating attitudes and behaviors. The above predictors are also in concordance with previous research results.34 The findings can be interpreted in several ways, which may explain the relationships between the above-stated variables. Concerning the relationship between disordered eating attitudes and behaviors 434
and internalization of the thin ideal, body image satisfaction, body image investment, weightrelated anxiety, and BMI, two main factors may shed some light: the Mediterranean weather of Cyprus and the post-1974 war economic development. As stated in the “Introduction” section, Cyprus has a year-round warm weather, which usually results in wearing clothes that are lighter and more exposing of body parts.11 In her research, Sloan10 did support that people residing in warmer weather climates tend to have more distorted body image and eating-related disturbances, and this may be the case for Cyprus as well. Furthermore, after the 1974 war, Cyprus experienced a significant increase in its economy with tremendous impact on social behavior.11 This change was so rapid, as Katsounari11 argued that it resulted in Cypriots emphasizing wealth in every aspect of their lives, but notably food consumption, designer clothes, and ownership of expensive properties. This emphasis could result in comparisons at several sociocultural levels such as body image and disordered eating. This association has also been supported by Iancu et al.30 who found that with the increasing affluence of society, more incidents of disordered eating were observed. Cyprus is also characterized by strong interrelations among its citizens, and this may result in the internalization of the thin ideal not being difficult to “penetrate” in the society.27 In addition, the messages from the media in a small nation like Cyprus can be more easily conveyed.27 Therefore, as it has been supported that what is portrayed in the media is unrealistic and in most cases unattainable and leads to feelings of unattractiveness,31 this may also aid in the development of body dissatisfaction in Cypriot women. Based on the results, several prevention programs addressing a healthier body image, a more critical review of the media influences, and healthier eating attitudes should be developed and implemented immediately targeting the university population. The same prevention programs are also needed to target a younger population as International Journal of Eating Disorders 48:4 431–435 2015
PREDICTORS OF DISORDERED EATING IN CYPRUS
another prevention action. Furthermore, it is important to take into consideration the cultural environment and lifestyle, as well as the weather in Cyprus, when designing interventions addressing body image and eating disturbance issues. The current study may be limited by the fact that a college-age sample was used and that results may not be generalizable to other nonclinical populations in Cyprus. A similar study using an adolescent, preferably larger, community sample and a clinical sample is recommended for further investigation. Furthermore, attention should be directed to the item on the EAT-26 concerning periods of fasting, as fasting is quite common in the Cypriot culture and may influence one’s answer and composite score on the EAT-26.
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Predictive Factors of Disordered Eating and Body Image Satisfaction in Cyprus Marios Argyrides, PhD* Natalie Kkeli, MA
ABSTRACT Objective: This study aimed to assess possible relationships and predictor variables between disordered eating attitudes and behaviors, the internalization of the thin ideal construct, body image satisfaction, body image investment, weightrelated anxiety, and body mass index (BMI) among Greek-Cypriot female university students in Cyprus. Method: A total of 243 female university students responded to self-report measures assessing disordered eating, internalization of the thin ideal, body satisfaction, body image investment, and weight-related anxiety. Results: Disordered eating was positively correlated to the internalization of the thin ideal, body image investment, weight-related anxiety, and BMI and negatively correlated with body image satisfaction. The internalization of the thin
Introduction Eating disorders have received significant medical, public, and research attention over the years.1 Numerous research studies attributed the development of eating disorders to three main clusters: sociocultural, familial, and individual factors.2 The sociocultural cluster of factors has been found to be applicable for both adolescents and adults.3 Family and twin studies indicate the familial transmission and genetic risk factors, respectively, in the development of eating disorders.4 In more recent years, the examination of the sociocultural factors cross-culturally has been of great interest.5 When compared with prior beliefs that body image issues and eating disturbances were a problem of the “Western” world, recent prevalence studies indicated that adolescent girls and women from a variety of nonwestern countries Accepted 21 May 2014 *Correspondence to: Marios Argyrides, PhD, Neapolis University Pafos 2 Danaes Avenue, 8042 Pafos, Cyprus. E-mail: [email protected] School of Health Sciences, Department of Psychology, Neapolis University Pafos, Pafos, Cyprus Published online 5 June 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/eat.22310 C 2014 Wiley Periodicals, Inc. V
International Journal of Eating Disorders 48:4 431–435 2015
ideal was also positively correlated to weight-related anxiety and body image investment and negatively correlated to body image satisfaction. Furthermore, weight-related anxiety and internalization of the thin ideal have been found to be significant predictors of disordered eating attitudes. Discussion: Possible explanations and vulnerability factors are addressed, as well as implication for prevention stratC 2014 Wiley egies and future research. V Periodicals, Inc. Keywords: body image; disordered eating; Cyprus; feelings of attractiveness; weight-related anxiety; body image investment (Int J Eat Disord 2015; 48:431–435)
experience significant levels of body image disturbance and eating disorders.6–9 Cyprus is an island country situated on the eastern part of the Mediterranean Sea and belongs to the warmest areas of the Mediterranean region with hot and dry summers and very mild winters. Considering the Cyprus weather as well as Sloan’s10 research supporting that individuals, especially women, who reside in warmer weather climates have significantly more eating disorder pathology and body image dissatisfaction, Cyprus becomes a country of interest to assess these constructs. Furthermore, Cyprus also becomes a country of interest as the Cypriot culture combines both westernized ideas and attitudes and simultaneously more traditional characteristics.11 A literature review concerning the constructs of disordered eating attitudes and body dissatisfaction in Cyprus indicated a significant rise.11 Katsounari and Zeeni12 found that Cypriot female university students were preoccupied with their weight by trying to gain, lose, or maintain it. In addition, sociocultural influences such as the importance of the opinion of one’s mother, male friend and female friend were found to be predictors of disordered eating behavior in Cypriot 431
ARGYRIDES AND KKELI
female students.13 Furthermore, the levels of disordered eating in Cyprus seem to be higher than most countries assessed in the literature. Specifically, a study conducted by Hadjigeorgiou, Tornaritis, Savva, Solea, and Kafatos,14 who conducted a 6year follow-up (2003 and 2010) in a large sample of Greek-Cypriot adolescents, revealed that 18.8% of males and 34.4% of females in 2003 and 18.8% of males and 35.9% of females in 2010 had significant disordered eating attitudes and behaviors (Eating Attitudes Test-26 [EAT-26] score higher than 20).15 The above percentages, especially for females, are higher than Singapore’s 10.5%,16 Saudi Arabia’s 24.6%,17 United Arab Emirates’ 23.4%,18 China’s 10.8%,19 Iran’s 16.7%,20 South Africa’s 21.2%,21 Brazil’s 15.8%,22 Israel’s 32.4%,23 and several other European countries of up to 18%.24–26 In a university-age sample, Katsounari11 found that 28.6% of young females had significant problems with disordered eating attitudes and behavior, and Argyrides27 found that 21.43% of a similar-age sample had these significant problems, all using the same measure (i.e., EAT-26). Despite the above previous research that has been conducted in Cyprus relating to disordered eating pathology, very little research examined the contributing factors that led to the onset of disordered eating attitudes and behaviors. The current study aimed to assess the possible relationships between eating-disordered attitudes and behaviors, the internalization of the thin ideal as presented in the media, body image satisfaction, body image investment, weight-related anxiety, and body mass index (BMI) in Cyprus among Greek-Cypriot female university students. The hypotheses that were developed based on the above were as follows: H1: Eating-disordered attitudes and behaviors will be positively related to the internalization of the thin ideal, body image investment, weightrelated anxiety, and BMI and negatively related to body image satisfaction among Greek-Cypriot females. H2: The internalization of the thin ideal, body image satisfaction, body image investment, and weight-related anxiety will be significant predictors of eating-disordered attitudes and behaviors when the model is adjusted for BMI. The findings of the current study could be used to develop specific prevention strategies to minimize the high body image issues present in the female Greek-Cypriot population.
432
Method Participants A total of 243 undergraduate and graduate-level female university students were recruited for participation in the current study. The age of participants ranged from 18 to 34 years (M 5 26.2; SD 5 3.84). The BMI of the participants was also calculated and ranged from 16.66 to 36.36 (M 5 21.83; SD 5 3.97). Measures Disordered Eating Attitudes and Behavior. The EAT2615 is a widely used instrument that identifies the symptoms of eating disorders according to respondents’ feelings, attitudes, and behaviors and consists of three subscales: (1) Dieting, (2) Bulimia and Food Preoccupation, and (3) Oral Control. The 26 items of the scale are rated on a six-point Likert-type scale ranging from always (1) to never (6) and also create a composite total score. The EAT-26 has reported reliability coefficients ranging from .86 to .90. For the current study, the internal consistency reliability coefficient of the total composite score that was of interest was found to be .87. Internalization of the Thin Ideal. The Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3)28 assesses societal and media influences on body image and specifically the internalization of the thin ideal. The third version of the SATAQ is a 30-item scale with four subscales: Information, Pressure, Internalization-General, and Internalization-Athlete. For the current study, only the nine items of the internalization of the thin ideal subscale (Internalization-General) were used. The items are scored on a five-point Likert-type scale ranging from definitely disagree (1) to definitely agree (5). The internal consistencies of this instrument are very good, and the Cronbach’s alpha coefficients range from .84 to .93. For the internalization subscale of the current sample, the alpha value was .87. Body Image Satisfaction, Body Image Investment, and Weight-Related Anxiety. The Multidimensional BodySelf Relations Questionnaire-Appearance Scale (MBSRQAS)29 evaluates particular attitudinal facets of the body image. The current study used a subset of the shorter, 34-item version of the scale, which evaluates only appearance-related body image constructs. Specifically, the 7-item Appearance Evaluation subscale was used, which measures feelings of physical attractiveness and satisfaction/dissatisfaction with one’s looks, the 12-item Appearance Orientation subscale, which assesses the extent of investment on one’s appearance, and the 4item Overweight Preoccupation subscale, which assesses fat anxiety, weight vigilance, dieting, and eating restraint. All items were rated on a five-point Likert-type satisfaction/dissatisfaction scale. The subscales of the current International Journal of Eating Disorders 48:4 431–435 2015
PREDICTORS OF DISORDERED EATING IN CYPRUS TABLE 1. Correlations between the variables of internalization of thin ideal, body image satisfaction, body image investment, weight-related anxiety, body mass index, and disordered eating attitudes and behavior Variables
1
2
3 c
1. Disordered Eating — .431 2. Thin Ideal Internalization — 3. Body Image Satisfaction 4. Body Image Investment 5. Weight-Related Anxiety 6. BMI
4 b
5 c
6 c
2.215 .413 .677 .351c 2.229b .412c .416c .052 — .071 2.326c 2.273c — .422c 2.169b — .310c —
Notes: Disordered Eating 5 composite score of the EAT-26; Thin Ideal Internalization 5 Internalization General subscale of the SATAQ-3; Body Image Satisfaction 5 Appearance Evaluation subscale of the MBSRQ-AS; Body Image Investment 5 Appearance Orientation subscale of the MBSRQ-AS; Weight-Related Anxiety 5 Overweight Preoccupation subscale of the MBSRQ-AS; BMI 5 body mass index. N 5 243 females. a p < .05 b p < .01 c p < .001.
measure have been found to have good psychometric properties among both genders and different cultural groups. The internal consistencies of the three MBSRQAS subscales used in the current study varied from .77 to .88. Procedure All female university students who participated in the current study were informed of the nature of the study and were asked to sign a consent form. Descriptive statistics were conducted for participants’ age and BMI. Pearson product–moment correlational analyses were conducted to examine possible relationships between all variables of interest. In addition, multiple regressions were conducted to find out what factors predicted disordered eating attitudes and behaviors. In these analyses, the regression model was adjusted for BMI. The significance levels were set at .05.
Results To address Hypothesis 1, Pearson product–moment correlational analyses were used to examine possible statistically significant relationships between disordered eating attitudes and behaviors, the internalization of the thin ideal, body image satisfaction, body image investment, weight-related anxiety, and BMI. The findings indicated that disordered eating attitudes and behaviors were significantly correlated with all the other measures (Table 1). Specifically, disordered eating was positively related to the internalization of the thin ideal, body image investment, weight-related anxiety, and BMI. The current findings indicate that higher levels of eating pathology, as measured by the EAT26, was related to higher weight, higher levels of International Journal of Eating Disorders 48:4 431–435 2015
the internalization of the thin ideal, more investment in one’s appearance, and more anxiety and preoccupation over one’s weight. Furthermore, disordered eating attitudes were negatively correlated with body image satisfaction, indicating that the lower the satisfaction with one’s appearance, the higher were the levels of eating pathology. The internalization of the thin ideal was also positively correlated to weight-related anxiety and body image investment, indicating that the higher the levels of internalization of the thin ideal, the higher were the levels of fat anxiety, weight vigilance, dieting, and eating restraint and investment in one’s appearance. The internalization of the thin ideal was also negatively correlated to body image satisfaction, indicating that the higher internalization of the thin ideal is predictive of lower levels of body image satisfaction. However, there was no significant correlation with BMI. Finally, weight-related anxiety was negatively correlated to body image satisfaction and positively correlated with body image investment and BMI. These results indicate that the more satisfaction was present with one’s appearance, the less anxiety and weight vigilance were present. In addition, more weight-related anxiety related to more investment in appearance and higher body weight levels. As expected based on Cash’s manual29 of the MBSRQ-AS, body image investment, and body image appearance were not correlated as they are considered as independent constructs. Therefore, Hypothesis 1 was supported. To address Hypothesis 2, a stepwise multiple regression analysis was conducted to evaluate how well the rest of the measures predicted disordered eating attitudes. The predictors were the internalization of the thin ideal, body image satisfaction, body image investment, and weight-related anxiety, whereas the criterion variable was the disordered eating attitudes and behaviors. BMI was used as a covariate in this analysis. The analysis (Table 2) revealed that two of the four predictors were significant [F(3,240) 5 89.53, p < .001) and accounted for 52.3% of the variance of disordered eating attitudes and behaviors (R2 5 .529, adjusted R2 5 .523). Disordered eating attitudes and behaviors were primarily predicted by weight-related anxiety (b 5 .663, t 5 11.75, p < .001, R2 5 .508) and to a lesser extent by the internalization of the thin ideal (b 5 .141, t 5 2.73, p 5 .007, R2 5 .529), which added another 2% to the total variance explanation. Therefore, these two factors seem to predict disordered eating attitudes, and Hypothesis 2 was partially supported. Feelings 433
ARGYRIDES AND KKELI TABLE 2.
Summary of multiple regression analysis of participants’ disordered eating attitudes and behavior
Independent predictor variables BMI MBSRQ overweight preoccupation (weight-related anxiety) MBSRQ appearance evaluation (feelings of attractiveness) MBSRQ appearance orientation (investment in appearance) SATAQ-3 internalization of the thin ideal
B
SE
b
t
Significance
20.011 1.982 20.011 0.109 0.196
0.178 0.169 0.142 0.097 0.072
20.004 0.663 2.004 .061 0.141
20.062 11.75 20.078 1.130 2.73
.951 .05).
Discussion The aim of the current study was to assess the relationships between disordered eating attitudes and behaviors, the internalization of the thin ideal, body image satisfaction, body image investment, weight-related anxiety, and BMI among GreekCypriot female university students. The factors that predict disordered eating attitudes and behaviors were also investigated. Findings indicated that higher levels of eating pathology as measured by the EAT-26 significantly correlated with BMI, higher levels of the internalization of the thin ideal, more investment in one’s appearance, and more anxiety over one’s weight. This finding is in line with existing research from nonclinical populations,31,32 which found eatingand shape-related disturbances and body dissatisfaction to be related to the internalization of the thin ideal. Furthermore, lower levels of satisfaction with one’s appearance were related to higher levels of eating pathology. Findings also indicated that higher levels of the internalization of the thin ideal were related to higher levels of weight-related anxiety and investment in one’s appearance and lower levels of body image satisfaction, again in line with previous research.31,32 Moreover, and supported by previous research, satisfaction with one’s appearance was related to less weight-related anxiety.33 Concerning the hypotheses regarding the predictor variables, results indicated that weight-related anxiety and the internalization of the thin ideal were significant predictors of disordered eating attitudes and behaviors. The above predictors are also in concordance with previous research results.34 The findings can be interpreted in several ways, which may explain the relationships between the above-stated variables. Concerning the relationship between disordered eating attitudes and behaviors 434
and internalization of the thin ideal, body image satisfaction, body image investment, weightrelated anxiety, and BMI, two main factors may shed some light: the Mediterranean weather of Cyprus and the post-1974 war economic development. As stated in the “Introduction” section, Cyprus has a year-round warm weather, which usually results in wearing clothes that are lighter and more exposing of body parts.11 In her research, Sloan10 did support that people residing in warmer weather climates tend to have more distorted body image and eating-related disturbances, and this may be the case for Cyprus as well. Furthermore, after the 1974 war, Cyprus experienced a significant increase in its economy with tremendous impact on social behavior.11 This change was so rapid, as Katsounari11 argued that it resulted in Cypriots emphasizing wealth in every aspect of their lives, but notably food consumption, designer clothes, and ownership of expensive properties. This emphasis could result in comparisons at several sociocultural levels such as body image and disordered eating. This association has also been supported by Iancu et al.30 who found that with the increasing affluence of society, more incidents of disordered eating were observed. Cyprus is also characterized by strong interrelations among its citizens, and this may result in the internalization of the thin ideal not being difficult to “penetrate” in the society.27 In addition, the messages from the media in a small nation like Cyprus can be more easily conveyed.27 Therefore, as it has been supported that what is portrayed in the media is unrealistic and in most cases unattainable and leads to feelings of unattractiveness,31 this may also aid in the development of body dissatisfaction in Cypriot women. Based on the results, several prevention programs addressing a healthier body image, a more critical review of the media influences, and healthier eating attitudes should be developed and implemented immediately targeting the university population. The same prevention programs are also needed to target a younger population as International Journal of Eating Disorders 48:4 431–435 2015
PREDICTORS OF DISORDERED EATING IN CYPRUS
another prevention action. Furthermore, it is important to take into consideration the cultural environment and lifestyle, as well as the weather in Cyprus, when designing interventions addressing body image and eating disturbance issues. The current study may be limited by the fact that a college-age sample was used and that results may not be generalizable to other nonclinical populations in Cyprus. A similar study using an adolescent, preferably larger, community sample and a clinical sample is recommended for further investigation. Furthermore, attention should be directed to the item on the EAT-26 concerning periods of fasting, as fasting is quite common in the Cypriot culture and may influence one’s answer and composite score on the EAT-26.
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