Prevalence and Factors of Eating Disorders Among High School Students
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PREVALENCE AND ASSOCIATED FACTORS
OF EATING DISORDERS AMONG SENIOR
HIGH SCHOOL STUDENTS IN THE HOHOE
MUNICIPALITY
1
DEPARTMENT OF FAMILY AND COMMUNITY HEALTH, SCHOOL
OF PUBLIC HEALTH, UNIVERSITY OF HEALTH AND ALLIED
SCIENCES, HO, VOLTA REGION, GHANA.
2
DISCIPLINE OF PSYCHOLOGY, SCHOOL OF APPLIED HUMAN
SCIENCES, UNIVERSITY OF KWAZULU-NATAL, SOUTH AFRICA.
Emmanuel Adzani AMEKPEWU
1
(BPH) and Nuworza KUGBEY
1,2
(MPhil)
Table of content
Background
Objectives
Methods
Results
Discussion
Conclusion
Recommendation
References
Background
Eating disorders are abnormal eating habits that put the
health and life of an individual at risk.
According to the Center for Eating Disorders [CED] (2015),
biopsychosocial factors such as genetics, biology, trauma,
sociocultural ideals, dieting, and the family contribute highly
to the development of eating disorders.
Background cont.
The American Psychological Association [APA]
(2017), revealed that eating disorders have the highest
mortality rate of any mental illness.
Four main types of eating disorders have been
identified; anorexia nervosa, bulimia nervosa, binge
eating, and unspecified eating disorder (APA, 2017)
Background cont.
Individuals with eating disorders may present with
signs like anxiety about eating certain foods,
preoccupation with body shape and size, avoidance of
situations that may involve food, excessive exercise,
cutting out foods that was previously enjoyed, and
social isolation (Beezley, 2016).
Background cont.
Again, individuals with eating disorders experience
higher rates of other mental disorders with reports
indicating that up to 97% of these people are having a
comorbid condition (National Eating Disorder
Collaboration [NEDC], 2012).
The National Eating Disorder Collaboration (2012),
also reported that the onset of anorexia occurs most
commonly during adolescence or young adulthood.
Background cont.
Although a lot of papers have been published on
eating disorders in other parts of the world, only a few
known papers have been published in Ghana and
Africa as a whole with focus on adolescents.
It is therefore imperative to identified the proportion of
senior high school students who are affected by eating
disorders and some possible risk factors that were
associated with eating disorders.
Objectives
To estimate the proportion of students with eating
disorders in the Hohoe municipality.
To identify which gender groups of students are mostly
affected with eating disorders in the municipality.
To ascertain the relationship between eating disorders,
depression and anxiety disorders.
To examine risk factors associated with eating disorders.
Method
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The study population consisted of both males and
females students in the School who were 14 years and
above.
A descriptive cross-sectional survey was conducted
among the senior high school students.
Method cont.
A simple random sampling technique was employed
in this study to select one school out of 10 Senior High
Schools in the Hohoe municipality.
The sample size for this study was 307.
Method cont.
The questionnaire used to collect data comprised of
the Eating Attitude Test-26 [EAT-26], Depression,
Anxiety and Stress Scale [DASS] (only depression and
anxiety sections were used), and self-designed
questionnaire on demographics and risk factors of
eating disorders.
Method cont.
Generated data was analyzed with the use of the
Statistical Package for Social Sciences (SPSS)
software, version 22.
Ethical approval for this study was sought from the
Ghana Health Service Ethical review committee.
Limitations
Data was not collected from Form three (3) students
since they had completed school at the time of the data
collection process.
Also, only one senior high school was selected due to
resource constraints.
Results
A total number of 307 students’ data was used in this
study, with 46.3% (142) males and 53.7% (165)
females.
The highest and the lowest age of respondents were
26 and 15 years which produced a mean age of the
17.8 .
Results cont.
The prevalence of eating disorders identified among
the 307 students was 46.9% (144).
This also indicated a 22.5% (69) prevalence of eating
disorders within students in SHS one and a 24.4% (75)
prevalence of eating disorder within students in SHS
two respectively.
Results cont.
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Results cont.
Out of the 144 students with eating disorders, 68.1% (98) of
them were depressed and 71.5% (103) were anxious.
The chi-square test of independence indicated that,
depressed students 68.1% were significantly more likely to
develop eating disorder as compared to non-depressed
students 31.9% (χ² (1) = 9.93, p = 0.002).
Anxiety disorder recorded no significant relationship
between eating disorder among the students (χ² (1) = 3.54, p
= 0.06).
Results cont.
In examining some factors associated to eating disorders, a
significant association was found between eating disorder
and a student’s family history of eating disorder, with
students who reported having a family history of eating
disorders, 60.4% (29) were more likely to be affected with
eating disorder than their counterparts who reported having
no family history of eating disorder, 44.4% (115) all within the
students identified to be suffering from eating disorders (χ²
(1) = 4.171, p = 0.041).
Results cont.
56.5% (74) of students with eating disorders changed
their eating habit due to television shows on body size
as compared to 39.8% (70) of students with eating
disorder who did not change their eating habit due to
television shows on body size (χ² (1) = 8.426, p =
0.004).
Results cont.
There was no statistical significant link between
eating disorder and these factors; peer influence to
change body shape (χ² (1) = 0.57, p = 0.45), family
member’s influence to modify body form (χ² (1) =
2.393, p = 0.122), students who have been abused (χ²
(1) = 0.158, p = 0.691), students who have ever used
illicit substances (χ² (1) = 1.25, p = 0.263), students
having a family member suffering from mental illness
(χ² (1) = 2.613, p = 0.106).
Discussion
The results of previous studies are inconsistent with
prevalence of eating disorder (46.9%) identified in this study.
For instance, Solmi (2014), identified 21.3% of the general
population in United Kingdom and Finland to be affected with
eating disorder.
Consistent with other previous studies, females (49.1%)
were more affected with eating problems than males (44.4%).
Nishizawa et al. (2003) found 2.4% males and 11.2% females
of high school students to have eating disorders.
Discussion cont.
There was a significant association between
depression and eating disorder in the results
of this study.
Similarly, Ulfvebrand, Birgegård, Norring,
Högdahl and Hausswolff-Juhlin (2015) found a
significant association between major
depression and anorexia nervosa; bulimia
nervosa; and binge eating disorder among
females.
Discussion cont.
The findings of this study reported no significant link
between eating disorder and anxiety disorder.
On the contrary, previous studies have identified a
significant link between eating disorder and anxiety
disorder.
For instance, the prevalence rate of anxiety disorder
among bulimia nervosa and binge eating disorder
patients has been estimated to be between 60 -70%
(Swanson, 2011).
Conclusion
This study produced a high prevalence of eating disorders
of 46.9% among students in the Hohoe municipality which is
inconsistent with other previous studies among the general
population.
Also, the proportion of female students affected by eating
disorders was greater than that of males which is similar to
other studies.
Conclusion cont.
Moreover, students who reported having a “family
history” of eating disorders were more likely to be
affected by eating disorders as compared to those who
reported having “no family history” of eating disorders.
Majority of the students affected by eating disorders
were also largely influenced by television shows on
modelling and body ideals.
Recommendation
An intense education is needed to create the
awareness of students on the negative impacts of
eating disorders on their health.
Also, a well-functioning mental health unit should be
set up in senior high schools to assist students with
eating disorders.
R
E
F
E
R
E
N
C
E
S
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). American
Psychiatric Pub.
American Psychiatric Association. (2017). Eating disorders. Retrieved February 5, 2017, from
http://www.apa.org/topics/eating/index.aspx
Beezley, R. (2016). Nutrition students and eating disorders: Are you at risk? Retrieved March 21, 2017, from
perspectives, http://thenutritionpress.com/nutrition-students-and-eating- disorders/
Center for Eating Disorders. (2015). Underlying causes of eating disorders. Retrieved February 13, 2017, from
https://www.eatingdisorder.org/eating-disorder-information/
Underlying-causes/
National Eating Disorder Collaboration. (2012). An Integrated Response to Complexity National Eating Disorders
Framework.
Nishizawa Y, Kida K, Nishizawa K, Hashiba S, Saito K, Mita R. (2003). Perception of self physique and eating behavior of
high school students in Japan.
Psychiatry Clin Neurosci, 57,
189-196.
Swanson, S.V. (2011). Prevalence and Correlates of Eating Diso ders in Adolescents. Arch Gen Psychiatry 2011;
68:714-723.
Thank You
Eating disorders pose serious risks to individuals, influenced by various factors such as genetics, trauma, and sociocultural ideals. The disorders, including anorexia nervosa and bulimia nervosa, have high mortality rates and often coexist with other mental conditions. Recognizing signs like body image concerns and food avoidance is crucial in adolescence where onset is common.
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PREVALENCE AND ASSOCIATED FACTORS OF EATING DISORDERS AMONG SENIOR HIGH SCHOOL STUDENTS IN THE HOHOE MUNICIPALITY Emmanuel Adzani AMEKPEWU1 (BPH) and Nuworza KUGBEY1,2 (MPhil) 1DEPARTMENT OF FAMILY AND COMMUNITY HEALTH, SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF SCIENCES, HO, VOLTA REGION, GHANA. HEALTH AND ALLIED 2DISCIPLINE OF PSYCHOLOGY, SCHOOL OF APPLIED HUMAN SCIENCES, UNIVERSITY OF KWAZULU-NATAL, SOUTH AFRICA.
Table of content Background Objectives Methods Results Discussion Conclusion Recommendation References
Background Eating disorders are abnormal eating habits that put the health and life of an individual at risk. According to the Center for Eating Disorders [CED] (2015), biopsychosocial factors such as genetics, biology, trauma, sociocultural ideals, dieting, and the family contribute highly to the development of eating disorders.
Background cont. The American Psychological Association [APA] (2017), revealed that eating disorders have the highest mortality rate of any mental illness. Four main types of eating disorders have been identified; anorexia nervosa, bulimia nervosa, binge eating, and unspecified eating disorder (APA, 2017)
Background cont. Individuals with eating disorders may present with signs like anxiety about eating certain foods, preoccupation with body shape and size, avoidance of situations that may involve food, excessive exercise, cutting out foods that was previously enjoyed, and social isolation (Beezley, 2016).
Background cont. Again, individuals with eating disorders experience higher rates of other mental disorders with reports indicating that up to 97% of these people are having a comorbid condition (National Collaboration [NEDC], 2012). Eating Disorder The National Eating Disorder Collaboration (2012), also reported that the onset of anorexia occurs most commonly during adolescence or young adulthood.
Background cont. Although a lot of papers have been published on eating disorders in other parts of the world, only a few known papers have been published in Ghana and Africa as a whole with focus on adolescents. It is therefore imperative to identified the proportion of senior high school students who are affected by eating disorders and some possible risk factors that were associated with eating disorders.
Objectives To estimate the proportion of students with eating disorders in the Hohoe municipality. To identify which gender groups of students are mostly affected with eating disorders in the municipality. To ascertain the relationship between eating disorders, depression and anxiety disorders. To examine risk factors associated with eating disorders.
Method The study was conducted in the Hohoe Evangelical Presbyterian Senior High School [HEPSS] within the Hohoe Municipality of the Volta Region. The study population consisted of both males and females students in the School who were 14 years and above. A descriptive cross-sectional survey was conducted among the senior high school students.
Method cont. A simple random sampling technique was employed in this study to select one school out of 10 Senior High Schools in the Hohoe municipality. The sample size for this study was 307.
Method cont. The questionnaire used to collect data comprised of the Eating Attitude Test-26 [EAT-26], Depression, Anxiety and Stress Scale [DASS] (only depression and anxiety sections were used), and self-designed questionnaire on demographics and risk factors of eating disorders.
Method cont. Generated data was analyzed with the use of the Statistical Package for Social Sciences (SPSS) software, version 22. Ethical approval for this study was sought from the Ghana Health Service Ethical review committee.
Limitations Data was not collected from Form three (3) students since they had completed school at the time of the data collection process. Also, only one senior high school was selected due to resource constraints.
Results A total number of 307 students data was used in this study, with 46.3% (142) males and 53.7% (165) females. The highest and the lowest age of respondents were 26 and 15 years which produced a mean age of the 17.8 .
Results cont. The prevalence of eating disorders identified among the 307 students was 46.9% (144). This also indicated a 22.5% (69) prevalence of eating disorders within students in SHS one and a 24.4% (75) prevalence of eating disorder within students in SHS two respectively.
Results cont. Eating disorder distribution among gender and age groups Variable Eating Disorder n (%) NO YES Gender Male 79 (48.5%) 63 (43.8%) Female 84 (51.5%) 81 (56.2%) Age group in years 15-19 150 (92.0%) 124 (86.1%) 20-24 13 (8.0%) 18 (12.5%) 25-25 0 (0%) 2 (1.4%)
Results cont. Out of the 144 students with eating disorders, 68.1% (98) of them were depressed and 71.5% (103) were anxious. The chi-square test of independence indicated that, depressed students 68.1% were significantly more likely to develop eating disorder as compared to non-depressed students 31.9% ( (1) = 9.93, p = 0.002). Anxiety disorder recorded no significant relationship between eating disorder among the students ( (1) = 3.54, p = 0.06).
Results cont. In examining some factors associated to eating disorders, a significant association was found between eating disorder and a student s family history of eating disorder, with students who reported having a family history of eating disorders, 60.4% (29) were more likely to be affected with eating disorder than their counterparts who reported having no family history of eating disorder, 44.4% (115) all within the students identified to be suffering from eating disorders ( (1) = 4.171, p = 0.041).
Results cont. 56.5% (74) of students with eating disorders changed their eating habit due to television shows on body size as compared to 39.8% (70) of students with eating disorder who did not change their eating habit due to television shows on body size ( (1) = 8.426, p = 0.004).
Results cont. There was no statistical significant link between eating disorder and these factors; peer influence to change body shape ( (1) = 0.57, p = 0.45), family member s influence to modify body form ( (1) = 2.393, p = 0.122), students who have been abused ( (1) = 0.158, p = 0.691), students who have ever used illicit substances ( (1) = 1.25, p = 0.263), students having a family member suffering from mental illness ( (1) = 2.613, p = 0.106).
Discussion The results of previous studies are inconsistent with prevalence of eating disorder (46.9%) identified in this study. For instance, Solmi (2014), identified 21.3% of the general population in United Kingdom and Finland to be affected with eating disorder. Consistent with other previous studies, females (49.1%) were more affected with eating problems than males (44.4%). Nishizawa et al. (2003) found 2.4% males and 11.2% females of high school students to have eating disorders.
Discussion cont. There was a significant association between depression and eating disorder in the results of this study. Similarly, Ulfvebrand, Birgeg rd, Norring, H gdahl and Hausswolff-Juhlin (2015) found a significant association depression and anorexia nervosa; bulimia nervosa; and binge eating disorder among females. between major
Discussion cont. The findings of this study reported no significant link between eating disorder and anxiety disorder. On the contrary, previous studies have identified a significant link between eating disorder and anxiety disorder. For instance, the prevalence rate of anxiety disorder among bulimia nervosa and binge eating disorder patients has been estimated to be between 60 -70% (Swanson, 2011).
Conclusion This study produced a high prevalence of eating disorders of 46.9% among students in the Hohoe municipality which is inconsistent with other previous studies among the general population. Also, the proportion of female students affected by eating disorders was greater than that of males which is similar to other studies.
Conclusion cont. Moreover, students who reported having a family history of eating disorders were more likely to be affected by eating disorders as compared to those who reported having no family history of eating disorders. Majority of the students affected by eating disorders were also largely influenced by television shows on modelling and body ideals.
Recommendation An intense education is needed to create the awareness of students on the negative impacts of eating disorders on their health. Also, a well-functioning mental health unit should be set up in senior high schools to assist students with eating disorders.
REFERENCES REFERENCES American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub. American Psychiatric Association. (2017). Eating disorders. Retrieved February 5, 2017, from http://www.apa.org/topics/eating/index.aspx Beezley, R. (2016). Nutrition students and eating disorders: Are you at risk? Retrieved March 21, 2017, from perspectives, http://thenutritionpress.com/nutrition-students-and-eating- disorders/ Center for Eating Disorders. (2015). Underlying causes of eating disorders. Retrieved February 13, 2017, from https://www.eatingdisorder.org/eating-disorder-information/Underlying-causes/ National Eating Disorder Collaboration. (2012). An Integrated Response to Complexity National Eating Disorders Framework. Nishizawa Y, Kida K, Nishizawa K, Hashiba S, Saito K, Mita R. (2003). Perception of self physique and eating behavior of high school students in Japan. Psychiatry Clin Neurosci, 57, 189-196. Swanson, S.V. (2011). Prevalence and Correlates of Eating Diso ders in Adolescents. Arch Gen Psychiatry 2011; 68:714-723.
