Eating Disorders in Medical Students of Islamabad, Pakistan (a cross-sectional study)

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Medical students are predisposed to eating disorders due to a combination of biological, psychological and/or environmental factors. In western countries, studies have shown prevalence of anorexia nervosa to range from 0.1%-5.7%, while bulimia nervosa ranged from 0.3%-7.3% in female subjects.  A study conducted on college students reported .8% prevalence of bulimia nervosa in females and 0.2% in males in some other study it was found that 4.7% of female college students with eating disorders. Medical students are associated with high levels of   stress  that stands as a critically important causative factor of eating disorders. Thus, it is quite important to analyze all such instabilities in medical students who are an asset for the future of the country. Studies have been conducted in western scenario to assess eating disorders in medical students. A study from US showed that 15% of the female medical students had history of eating disorders.

 

Dear Readers,

 

Please find below a very informative study from Pakistan, ‘Eating Disorders in Medical Students of Islamabad, Pakistan. We hope you’ll find the study helpful in understanding complexity of Eating Disorders in Muslim cultures and in medical faculties.

 

 

Eating Disorders in Medical Students of Islamabad, Pakistan (a cross-sectional study)

 

 

Abstract

Objective:

To assess the incidence of eating disorders in medical students of Islamabad by using validated self-administered questionnaires.

Introduction:

The numbers of epidemiological studies about eating disorders (ED) in medical students of Islamabad are still limited. This study determined the prevalence of eating disorders in medical students of Islamabad Medical and dentalcollege (IMDC) affiliated with Bahria University Islamabad.

Materials & Methods:

This was a descriptive and cross sectional study in which 75 medical students were selected at Islamabad Medical and dental college. They participants were invited to complete the “Eating Attitude Questionnaire (EAT-26)”. Demographic data and EAT 26 questionnaire was analysed by SPSS version 16 and descriptive statistics using inferential statistics.

Results:

Data was collected using self administered questionnaire the Eating Attitudes Test (EAT-26). According to EAT-26 n=17(22.6%) individuals were found to be at high-risk of eating disorders above the cut off value of EAT 26 score above 20 was found in n=11 (15 %) females and n=6 (male 8%).

Conclusions:

A significant fraction of medical students in our sample from Islamabad Medical and Dental college are at high risk of development of eating disorders, females being more prone than males. Strategies should be designed to diagnose and prevent occurrence of eating disorders among medical students.

Key words:

Eating Disorders; EAT-26; medical students.

 

Details

Disordered eating attitudes and behaviors are common in adolescents. These are group of conditions characterized by abnormal eating habitsthese include binge eating disorder, bulimia nervosa and anorexia nervosa.1 These are included in psychiatric illnesses, and are preoccupation with body weight, shape and diet. These eating disorders frequently are associated with psychiatric illnesses like depression, substance abuse and anxiety disorders.2

Anorexia nervosa is extreme fear of gaining weight, in which people try to maintain a weight far less than normal. Bulimia is characterized by a cycle of binge eating, followed by attempts to remove unwanted calories. People with binge eating disorders often eat an uncontrollable, large amount of food during the binges.3

Students showing eating disorders are associated with different factors, co-relating with socio economic group, ethnicity and relationship status. Early detection of such factors are important at an early stage, remedying to greater efficiency for future physicians.

Medical students are predisposed to eating disorders due to a combination of biological, psychological and/or environmental factors.4 In western countries, studies have shown prevalence of anorexia nervosa to range from 0.1%-5.7%, while bulimia nervosa ranged from 0.3%-7.3% in female subjects.5 A study conducted on college students reported 3.8% prevalence of bulimia nervosa in females and 0.2% in males in some other study it was found that 4.7% of female college students with eating disorders.6 Medical students are associated with high levels of  stress7 that stands as a critically important causative factor of eating disorders. Thus, it is quite important to analyze all such instabilities in medical students who are an asset for the future of the country. Studies have been conducted in western scenario to assess eating disorders in medical students. A study from US showed that 15% of the female medical students had history of eating disorders.8

EAT-26 has not been established as the sole mean of identifying eating disorders, but studies have shown that it can be used as a screening instrument in part of a two-stage process in which individuals who score above 20 are evaluated for eating disorders in a diagnostic interview. In Pakistan, a study conducted in Lahore among 369 school girls and another study conducted in Mirpur among 271 school girls revealed one case of bulimia and no cases of anorexia, although five girls from Lahore also suffered from partial syndrome bulimia nervosa.9,10 Another survey from Lahore among 111 volunteers showed an occurrence of two cases of bulimia nervosa and another two cases of eating disorders not otherwise specified.11

While eating disorders are characterized as a mental health condition, they have the potential to lead to other serious physical health problems. Keeping such ominous medical consequences in view, it is naturally alarming that the future physicians of Islamabad, in a previous study done in Karachi prone to such stressful conditions might be at significantly high risk of contracting eating disorders that would hamper the availability of dependable medical services in future. The earliest these disorders are diagnosed and assessed, the better the chances are for enhanced treatment and better recovery.12 Therefore, we intend to undertake a descriptive study to assess the incidence of high-risk of eating disorders among medical students of Islamabad.

MATERIALS & METHODS

This was a descriptive cross sectional study, conducted in a private medical colleges Islamabad using convenient sampling method after taking ethical permission between 1st January, 2014 and 28th Feb, 2014. The study included 75 preclinical undergraduate medical students. After taking verbal consent students completed english version eating attitude test (EAT-26) the questionnaire were presented to them.

The EAT-26 survey comprised of three sections (A, B, and C). Section A dealt with demographics, section B contained 26 questions relating to eating attitudes and was used to calculate the score by addition of the values of the responses. Questions assessed various aspects of distorted eating behaviour, including bulimic tendencies, body image perception and degree of willful control over eating behavior. A score above 20 for Section B was considered diagnostic of anorexic behaviour. EAT-26 has not been established as the sole mean of identifying eating disorders, but studies have shown that it can be used as a screening instrument in part of a two-stage process in which individuals who score above 20 are evaluated for eating disorders in a diagnostic interview. In this manner, early identification of an eating disorder can lead to earlier treatment thereby reducing morbidity and mortality.

The Eating attitude test-26 (EAT-26) is a validated self-administered questionnaire widely used to measure eating disorders.11 It comprises of 26 questions for which, scoring is done on a 6-point scale from always to never. Total sum of Eat-26 scores range from zero to 78.12,13 The data was entered and analyzed using the Statistical Package for the Social Sciences (SPSS) version 16. Relevant frequency and percentages were calculated for qualitative variables whereas means ± standard deviations were calculated for quantitative variables. P-values were also obtained by t test to determine the significance of the results.

RESULTS

There were 75 second year MBBS students present in the lecture hall completed EAT 26 questionnaire. Among those 51 were female while 24 were male .Figure 1 shows the frequency distribution of EAT 26 scores of the students. This study showed the mean score of EAT 26 in female (n=51) is 14.90+_9.6 SD and in male (n= 24) 15.60 +-9.75 difference between male and female was (p=.000)highly significance. Mean EAT 26 score of the students was 15.13+_9.6 SD which is below cut off value but when we look at histogram, we find 22.3 % cases of EAT scores above cut off value of 20 indicating presence of abnormal eating behavior Which requires further investigations.

The presence of EAT 26 score above cut off value of 20 was found in n=11 (15 %) females and n=6 (8 %) of male students . Cut off score above 20 was present in 22.6% of the students which is quite high.

DISCUSSION

Our study reports that significant proportion of medical undergraduates are at high risk to suffer from eating disorders with (22.6%) individuals scoring above the threshold for EAT-26 questionnaire. This is much more than as compared to recently reported eating disorder symptoms in 9.59% among Latino college students.14 This strengthens the fact that eating disorders are a current mounting concern in our region in relation to other parts of the world. Eating disorders, although relatively uncommon, represent a public health concern because they are frequently associated with other psychopathology and role impairment, and are frequently under-treated.15

EAT-26 is reliable, the factor structure is different from that obtained in clinical groups, and the EAT-26 is significantly correlated with body image, weight, anti diet.16 In a previous population based study it was found that 1200 women aged 15 to 24 years suffer from anorexia nervosa, and around 4700 suffer from bulimia nervosa. Among young people aged 11 to 15 years an estimated 600 girls suffer from an eating disorder. A survey of eating disorders among 271 schoolgirls was conducted in Mirpur, Pakistan, using a new Urdu translation of the Eating Attitudes Test (EAT- 26).11 Individuals scoring above 20 on the EAT were interviewed to determine whether an eating disorder was present. One case of bulimia nervosa (DSM-III-R) was identified. This result is compared with surveys conducted by the authors among Asian schoolgirls in Bradford, UK, and in Lahore, Pakistan.9,18,19 Eating disorders are among the most common psychiatric disorders in young women. Early detection and treatment improves prognosis.20

Our study examined gender differences in eating attitudes and behaviors which is similar to a study done in Karachi in a sample of 471 undergraduate college students. It was found that according to EAT- 26, 22.75% individuals were found to be at high-risk of eating disorders, with 87.9% females and 12.1% males21 Similar to our study in Karachi 21.5 was prevealence of anorexia nervosa22, abnormal EAT scores (>20), were found in 6% of males and 15% of females.23

Eating disorders particularly anorexia nervosa is reported to derange several system with resultant complications ranging from purpura, liver dysfunction, osteoporosis, diabetic complications to acrocyanosis. Particularly, anorectic patients have been reported to die at a premature age possibly from one of the above stated medical complications.24,25 This disconcerting information should come in the knowledge of such individuals suffering from the disorder or at a high risk of developing one, who involve grossly in unhealthy dieting or purging cycle, particularly females.

Limitations: The limitations of our study includes that we have focused only on medicals students in colleges from urban set up. Further studies should be carried out which checks the pattern of eating disorders in rural set up. Furthermore, the most important limitation.

Further surveys needs to be conducted that will corelate socio economic group, ethnicity and relationship status. Early detection of such factors causing eating disorders is important as having a significant impact in treatment of such disorders at an early stage with resultant greater efficiency of performance by future physicians.26

CONCLUSION

Our sample of student show risk of developing eating disorders which should be investigated to find its association of different factors.Further surveys needs to be conducted that will co-relate socio economic group, ethnicity and relationship status. Early detection of such factors causing eating disorders is important as having a significant impact in treatment of such disorders at an early stage with resultant greater efficiency of performance by future physicians.

ACKNOWLEDGEMENT

• Special thanks to our great teacher and mentor Professor Yasin Durrani for critical review of the  article.

• I would like to thank my students who participated in the study.

• I would like to thank the following: Dr. Mohammad Usman for helping in revision of manuscript. Maryam Hafeez 4th year BDS students for assembly and compiling of data. Other authors are equally commendable for their contributions.

Reference

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Islam and Eating Disorders founded in 2012 – run by Maha Khan, the blog creates awareness of Eating Disorders in the Muslim world, offers information and support for sufferers and their loved ones.

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