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Procedia - Social and Behavioral Sciences 187 (2015) 153 157

PSIWORLD 2014

The risk of eating disorders in adolescence and its association with

the impact of the sociocultural attitudes towards appearance
Musta Andreea-Elena*
Bucuresti University,Faculty of Psychology and Education Sciences,90 Panduri Avenue, Bucharest, Romania

Abstract

This paper studies whether there is an association between the risk of developing an eating disorder in adolescence and social
attitudes concerning appearance, especially those circulated in the media. The sample was composed of 119 subjects, and the
instruments used were EAT-26 and SATAQ. The results indicate the existence of statistically significant correlations between the
risk of eating disorders in adolescence and all facets of social and cultural attitudes regarding appearance: importance, pressure,
internalization / TV-magazines, internalizing / athlete, internalizing / comparison, awareness. When statistical analyses are
performed differently in boys and girls, we see the existence of different intensities of these correlations. This result indicates that
future studies could orientate to test the hypothesis of the existence of gender differences in this regard.
2015
2015TheTheAuthors.
Authors. Published
Published by Elsevier
by Elsevier Ltd. Ltd.
This is an open access article under the CC BY-NC-ND license
Peer-review under responsibility of the Scientific Committee of PSIWORLD 2014.
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer-review under responsibility of the Scientific Committee of PSIWORLD 2014.
Keywords: risk of eating disorders; social attitudes towards appearance; adolescence.

1. Theoretical framework

During adolescence the risk of developing an eating disorder may be high; Makino, Tsuboi and Dennerstein
(2006) indicated that Western teenagers, especially girls, display some anomalies in attitude towards food, therefore
we can talk about subclinical eating disorders. Such disturbances in eating behaviour in teenagers, such as: diets,
using laxatives, inducing vomiting, compulsive eating were reported as well by Sepulveda, Carrobles and Gandrillas
(2008). The way the media contribute to lower satisfaction in relation to ones own body, personal satisfaction and
the occurrence of eating disorders symptoms is still debated in the literature, as suggested by Ferguson et al. (2014).

* Corresponding author.
E-mail address: andreeamustata14@gmail.com

1877-0428 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer-review under responsibility of the Scientific Committee of PSIWORLD 2014.
doi:10.1016/j.sbspro.2015.03.029
154 Musta Andreea-Elena / Procedia - Social and Behavioral Sciences 187 (2015) 153 157

Derene and Beresin (2006) found that adolescents are exposed continuously to elusive body images that are
constantly reminded through television, internet, movies and magazines, and media exposure in adolescence is a
predictor of eating behavior disturbance and of a thinner body ideal (Harrison, Hefner, 2006). Although considered
to be specific to Western culture, it seems that eating disorders affect other cultures as well, with the authors stating
that this happens as the relevant cultures take over the ideal of being thin from the Western culture through
facilitating access to media in Western countries (Witcomb et al. 2013). The socio-cultural model of physical
attractiveness in women requires a body as thin as possible and male model requires rather a developed musculature.
In adolescence, both girls and boys begin to gain weight and have more fat deposits, and their body begins to have a
different look than before (Vaughan and Halpern, 2010), which can make this age group more vulnerable regarding
the risk of eating disorders.
Magallares (2013) studied several social risk factors regarding the emergence of eating disorders: social
comparison, social attitudes regarding appearance, social anxiety; the results of the study highlight the positive
direct and indirect correlation (mediated by social anxiety) between social comparisons and the risk of developing
an eating disorder and indirect correlation (through social anxiety) between social attitudes regarding appearance
and the risk of developing an eating disorder. Rodgers, Paxton and Chabrol (2010) describe depression as the
moderator of social and cultural influences regarding the symptoms of eating disorders, in both boys and girls.
Thompson and Stice (2001) showed that the internalization of the thin ideal results from the internalization of
attitudes that are approved by significant people or by people who are respected and valued. Thus the family, friends
and media are such sources from which adolescents can borrow the same attitude. People who internalize the ideal
of being thin develop cognitive schemas which associate thin bodies with positive attributes such as happiness,
desirability and social status (Ahern, Bennett and Hetherington, 2008). Also, programs which emphasize the
idealization of thin bodies can put pressure on teenagers, which could lead to a stronger lack of satisfaction in
relation to ones body and disturbed eating behaviors (Chang et al. 2013).
In boys as well scientific literature indicates a number of social expectations on appearance sent by the media,
and Hatoum and Belle (2004) showed that expectations in the case of boys are for them to be thin and have a smooth
musculature, which may be related to obsessive weight control behaviour and physical strain or the use of steroids.
The study conducted by Calado et al. (2010) reveals that teenagers, both girls and boys, with increased risk of eating
disorders, had an increased exposure to TV programs and magazines related to body image, with a small difference
between the behaviour of girls and boys.

2. Objectives and Hypotheses

2.1. Objectives

This study is aimed to investigate whether there is a correlation statistically significant between the risk of
developing an eating disorder in adolescence and the impact of sociocultural attitudes towards appearance,
particularly those circulating in the media, both at global level and differentiated by gender.

3. Method

3.1. Instruments

The instruments used were EAT-26 (The Eating Attitude Test-26), to assess the risk of developing an eating
disorder, and to assess the impact of social and cultural attitudes to appearance The Sociocultural Attitudes Towards
Appearance Scale (SATAQ) was used, consisting of six subscales: importance, pressure, internalization / TV-
magazines, internalizing / athlete, internalizing / comparison, awareness. The value reported for the English version
is 0.90 (Garner et al., 1982) for EAT-26, value obtained on a sample composed of persons with anorexia nervosa,
the authors noting that the instrument can be used also on non-clinical samples. The Cronbach-Alpha value is 0.96
for SATAQ (Thompson et al., 2004). Because the instruments were translated from English, their internal
consistency was calculated after they had been applied to a sample of 31 subjects, into a previous stage of testing, to
establish the opportunity of their usage inside the study. The values of Cronbach-Alpha for the Romanian version
 Musta Andreea-Elena / Procedia - Social and Behavioral Sciences 187 (2015) 153 157 155

are 0.82 for the EAT-26 and 0.89 for the SATAQ, to which values were calculated on each subscale, that is: 0.85,
0.91, 0.82, 0.87, 0.83, 0.86. These values have supported the use of these instruments inside the study.

3.2. Participants

The research sample consisted of 119 adolescents, 32 boys and 87 girls, aged between 15 and 19 years, which
have never been diagnosed with an alimentary disorder. Data were collected in the high school of the adolescents
who participated in the study, organizing a special hall intended for testing, where the participants were presented
the samples, and also the objectives of the study, having the possibility to accept or not the participation.

3.3. Experimental design

The research design is a correlational one, the risk of eating disorder variable being correlated with each of the
six variables which represented the facets of social attitudes impact on the appearance, expressed by SATAQ
subscales, both globally and differentiated by gender.

4.Results

A descriptive statistical analysis was performed on the risk of developing an eating disorder, and according to the
scores on EAT-26 teens were introduced into one of two categories: high risk persons and low risk persons, with a
cut-off value of 20, as specified by Dotti and Lazzari (1998) and Calado et al. (2010) and behavioural questions
provided in the EAT-26 were also taken into consideration. Thus, from 119 subjects (100%) 16 subjects (13.4%)
had increased risk to both scales, 7 subjects (5.9%) had increased risk only based on the score obtained in EAT-26,
34 subjects (28.6%) had increased risk only in relation to the answers to behavioural questions, and 62 subjects
(52.1%) had low risk. It can be seen that a total of 47.9% of the subjects are at increased risk of eating disorder.
Regarding the descriptive analysis of research variables, Table 1 summarizes the data.

Table 1. Descriptive statistics indicators for the research variables

Variable Mean Confidence Median Variance Standard

interval limits Deviation
Risk of Eating Disorders 12.64 10.95-14.32 11.00 85.39 9.24
Importance 27.24 25.83-28-65 29.00 59.80 7.73
Pressure 16.54 15.26-17.82 16.00 49.39 7.02
Internalization / TV-magazines 18.16 17.09-19.23 18.50 34.27 5.85
Internalization / athlete 8.62 8.02-9.22 9.00 10.94 3.31
Internalization / comparison 10.30 9.41-11.18 11.00 23.47 4.84
Awareness 33.02 31.51-34.53 34.00 68.66 8.28
Hypothesis testing shows that research findings indicate a small correlation, statistically significant between the
risk of eating disorders and importance, which is also significant and moderate in boys and insignificant in girls.
Association with pressure is statistically significant and moderate and substantial in boys and moderate in girls and
regarding the internalizing / TV, magazines, the association is statistically significant and moderate globally as it is
when statistical analysis is performed differently, with girls and boys. The risk of developing an eating disorder is
significantly statistically correlated at a low level with the internalization / athlete variable, but at a moderate level
for boys, and the correlation is not statistically significant in girls. Regarding the internalization / comparison
variable, it is correlated significantly at a global level with eeatind disorder risk, with a low correlation, and the same
thing happens in boys and in girls the correlation is not statistically significant. The association between the risk of
eating disorders and awareness variable is statistically significant, with a low intensity globally and in boys has a
moderate intensity, while in girls is not statistically significant. Table 2 shows the Pearson correlation coefficient
values, the effect size and statistical significance of correlations performed (df = 117).
156 Musta Andreea-Elena / Procedia - Social and Behavioral Sciences 187 (2015) 153 157

Table 2. Values of correlations, their effect sizes and their significance between EAT-26 and SATAQ subscales

Variable with which the risk of developing an Gender r p

eating disorder was correlated
Importance Male 0.4 0.16 0.020
Female 0.16 0.02 0.120
Global 0.24 0.05 0.007
Pressure Male 0.63 0.39 0.001
Female 0.33 0.10 0.001
Global 0.40 0.16 0.001
Internalization / TV-magazine Male 0.50 0.25 0.003
Female 0.42 0.17 0.001
Global 0.45 0.20 0.001
Internalization / athlete Male 0.46 0.21 0.008
Female 0.19 0.03 0.067
Global 0.22 0.04 0.016
Internalization / comparison Male 0.23 0.05 0.200
Female 0.24 0.05 0.020
Global 0.25 0.06 0.006
Male 0.34 0.11 0.050
Awareness Female 0.18 0.03 0.080
Global 0.22 0.04 0.012

5. Conclusions

In conclusion, this research indicates the existence of statistically significant correlations between the risk of
developing an eating disorder in adolescence and the various facets of social attitudes regarding appearance,
transmitted especially in the media. This result is in accordance with the expressed conclusions in the studied
specialized literature regarding the role of social attitudes of appearance and media in the body-image forming and
in the development of a disturbed alimentary behavior. (Derene, Beresin, 2006; Harrison, Hefner, 2006; Vaughan,
Halpern, 2010 Magallares, 2013; Chang et al. 2013). The literature shows that this correlation may be due to
programs and magazine content that promote excessively thin people and are critical in relation to overweight, as
shown in the study conducted by Harrison (2000).
The results of research conducted revealed also some differences between the significance and intensity of these
correlations when they were performed differentially in girls and boys. Have not been studied the statistical
differences between girls and boys in this regard due to samples inequality. This aspect can be the subject of
possible future studies, the present research only indicating that these differences are possible and their adequate
testing can be approached in subsequent studies.
A limit of the study is related to the small volume of the sample and the big difference between the boys and girls
sample volume, so that no statistical procedures were performed to highlight whether the differences between girls
and boys seen in the realized correlations are statistically significant. This may be the subject of future studies,
which could take into account other aspects related to the risk of developing eating disorders and social and cultural
images presented in the media, such as the role of school, family and friends in this relationship. Also future studies
could be focused on how campaigns for preventing obesity can have negative effects on people with normal weight,
who have a vulnerability regarding the risk of developing eating disorders.
These results, along with getting a high percentage of young people who present an increased risk of developing
an eating disorder may have practical implications in that it highlights the need for prevention and intervention
programs that rely on the mass media, programs that are already mentioned in the literature. Their utility is given by
the high internalization of the thin-ideal by the teenagers, as well as other aspects related to media and correlated
with the eating disorders, previous presented (Thompson and Stice, 2001; Ahern, Bennett and Hetherington, 2008;
Calado et al., 2010 ; Hatoum and Belle, 2004 ). Stormer and Thompson (1998) developed a program in this regard,
in which they encouraged young girls who had such problems to have a more critical attitude towards the images
circulated in the media, which led to a more decreased idealization of the thin ideal. Also, Stice et al. (2000)
developed an intervention based on dissonance, which refers to the thin-ideal internalization as well. Wilksh and
Wade (2009) propose a therapeutic intervention based on the analysis of media and awareness of its effects, and
 Musta Andreea-Elena / Procedia - Social and Behavioral Sciences 187 (2015) 153 157 157

Gonzales et al. (2011) develop a program for the prevention of eating disorders in schools by proving that
interventions that combine techniques centered on media and nutrition education can result in lowering the risk of
developing an eating disorder.

Acknowledgements

The author of this study is thankful to prof. dr. Laurentiu Mitrofan for the coordination of the dissertation thesis
of which the present paper was part of.

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