Eating attitudes and their psychological correlates among Turkish adolescents

Adolescence, Fall, 2004 by Murat Bas, F. Hulya Asci, Efsun Karabudak, Gul Kiziltan

During adolescence, attitude toward personal appearance plays an important role in self-esteem. Many adolescents become preoccupied with their body weight and attempt to achieve the ideal physique because of social and cultural norms, reinforced by media messages emphasizing a thin and physically fit body. This preoccupation influences their dieting and eating behaviors (Rus-Makaovec & Tomori, 2000; Hausenblas & Mack, 1999).

There has been a significant increase in the incidence of eating disorders in the past twenty years. Nattiv and Lynch (1994) estimated that 1-3% of the general Western female population meet formal criteria for disordered eating, with higher prevalence among adolescent and young adult women. It has been estimated that 15% or more of college women meet diagnostic criteria for anorexia nervosa or bulimia nervosa (Borgen & Corbin, 1987), and the prevalence of anorexia nervosa has been reported at 0.1-4% and bulimia at 18-20% of school-aged females (Anstine & Grinenko, 2000).

Eating disorders in general, and anorexia and bulimia nervosa in particular, are complex problems, involving behavioral, cognitive, and emotional issues (Bussolotti, Fernandez-Aranda, Solano, Jimenez-Murcia, Turon, & Vallejo, 2002). For example, Fisher, Schneider, Pegler, and Napolitano (1991) studied suburban female high school students and found strong intercorrelations among abnormal eating attitudes, low self-esteem, high anxiety, and increased weight concerns. In addition, Spink (1992) found a relationship between self-presentational concern (i.e., social physique anxiety) and eating disorder correlates. Bulik, Beidel, Duchmann, Welltzin, and Kaye (cited in Hausenblas & Mack, 1999) suggested that eating disordered individuals have a fear of negative evaluation, specifically a fear that their weight or physical appearance will be perceived by others as falling outside of social norms. Further, it has been reported that women with eating disorders tend to have high need for social approval and experience high social anxiety and low self-esteem (American Psychiatric Association, 1994; Gross & Rosen, 1988; Katzman & Woichik, 1984).

Generally, disordered eating patterns have been studied more among females than males, with many studies examining self-esteem and anxiety. Recently, researchers have examined social physique anxiety in relation to disturbed eating behaviors. The present study was conducted to answer three questions: (1) What percentage of female and male university students would be found to have disturbed eating behaviors? (2) Would the prevalence of disturbed eating attitudes for females differ from that of males? (3) Would there be differences in psychological characteristics (i.e., self-esteem, trait anxiety, and social physique anxiety) between those with different eating attitudes?

METHOD

Participants

The participants consisted of 457 female (mean age = 18.25 [ or -] 0.71 years) and 326 male (mean age = 18.23 [ or -] 0.66 years) university students in Turkey. Mean body mass index (BMI) was 22.2 [ or -] 2.90 for males and 20.7 [ or -] 2.58 for females; 21.5% of males and 42.9% of females had a BMI below 20.0 (underweight); 65.6% of males and 50.1% of females had a BMI of 20.0-24.9 (normal weight); 11.3% of males and 6.3% of females had a BMI of 25.0-29.9 (overweight), and 1.5% of males and 0.7% of females had a BMI of 30.0-34.9 (obese).

Instruments

Eating Attitudes Test. The Eating Attitudes Test (EAT) is a widely used self-report measure of eating disorders. It was developed by Garner and Garfinkel (1979) to examine symptoms of anorexia nervosa. The EAT-26, used in the present study, is based on the original Eating Attitudes Test (EAT-40). The Turkish version of the EAT-40 (Savasir & Erol, 1989) measures disturbance in eating attitudes and behaviors. The reliability of the EAT-26 was examined in a pilot study in which fifty university students participated; the internal consistency (Cronbach's alpha) was .70 and the interclass correlation coefficient was .98. In the present study, participants who scored 20 or above were placed in the "abnormal eating behavior" category and those scoring below 20 were placed in the "normal eating behavior" category (see Garner, Olmstead, Bohr, & Garfinkel, 1982).

Rosenberg Self-Esteem Scale. The Rosenberg Self-Esteem Scale is a widely used measure of global self-esteem in adolescents. This self-report instrument consists of 10 items rated on a 4-point Likert scale, with responses ranging from strongly agree to strongly disagree. The reliability and validity of the instrument for Turkish adolescents has been established by Cuhadaroglu (1986).

Social Physique Anxiety Scale. The Social Physique Anxiety Scale (SPAS) is designed to determine the degree to which people became anxious in regard to the real or perceived evaluation of their physique by others (Hart, Leary, & Rejeski, 1989). The SPAS is a self-report inventory where participants respond to 12 items on a 5-point Likert scale. Reliability and validity of the SPAS for Turkish university students were supported by Mulazimoglu and Asci (unpublished data). The test-retest reliability of the SPAS was .92 for females and .76 for males, and internal consistency was .89 for females and .86 for males (Cronbach's alpha).