Eating disorders and personality profile of female secondary schools students in Benin Metropolis, Nigeria.

This paper investigated the prevalence of eating disorders of female students and the consequence on their personality profile. Three research questions were raised and one hypothesis formulated. One thousand seven hundred and sixteen (1716) students whose ages ranged from 13-17 years were drawn from secondary school female students in Benin metropolis, using the multistage sampling technique. Female adolescent students eating disorder questionnaire (FASEDQ) was used to generate data. It is made of two parts. Part one comprised of ten main questions, grouped into five sub-areas and part two comprised fifteen questions grouped into five sub-areas.

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The questionnaire was subjected to a split-half reliability test using person product moment coefficient of correlation (PPMCC) which yielded a psychometric value of an (r) of 0.86. The findings revealed that the students used unsafe weight losing methods to remain slim. The motivational factors were the electronics media and the friends they keep. The chi-sq ([x.sup.2]) value obtained were not significant at P < 0.05, [x.sup.2] = 9.488, df = 4. This led to the conclusion that the use of unsafe weight losing method would significantly result in change in personality profiles. The personality changes include feelings of inadequacy; lower self esteem, moodiness, fear and anxiety; and compensatory acts of obessional responses. The paper recommended the use of nutrition education programmes in schools to help the students develop healthy eating behaviours.

Introduction

In the traditional Benin Community, the eating order is heavy breakfast, sometimes light lunch and heavy dinner. This order sometimes disregards the nutritional values of eating. Emphasis is on eating of carbohydrates. Worse still is the practice, which deny children the right of eating enough meat. Occasionally when they do, they are served, pieces that are ridiculously low.

The essence of eating among the people is mainly to gain weight. The contention is that a well fed child can hardly fall sick. Women with significant fat are considered physically attractive and sexually desirable. The era of snack bars and junk food created more problems of weight gains. With the advent of technology, this belief is giving way to building good body image, which involves working to become slim. People are getting to be more concerned with losing weight. Sometimes this involves the use of unconventional methods.

Concern about body image and losing weight can have adverse consequences some of which include depression from low body esteem, low self worth, poor nutrition from extensive dieting, inadequate calcium and iron intake, under-nutrition; anorexia or bulimia etc. (Edlin, golanty and Brown, 2000). Today there seems to be a change in peoples' eating pattern. Taking diet that is rich in nutritional values in the right proportion is now seriously imbibed. People are becoming increasingly concerned about their body image and problem of overweight. This has led to a compulsive desire to be slim through manipulating eating order and sometimes resorting to physical exercise.

The issue of overweight is concerned about being accumulating excess fat. Body fat is made up of two parts; essential fat for normal physiological functioning and storage fat as depot fat (Edlin, Golanty and Brown, 2000). Essential fat comprises about 10%--12% of body weight in women. However, storage body weight of some people can range between 40%-50% (Edlin et al, 2000). This portends a serious health problem for the people.

Many people whose body weights do not predispose to health problems seem to be weight conscious, primarily for cosmetic reasons. Their goal is to achieve a body size and shape that meets society's standards of perfection. No wonder that many people in Benin community now views any amount of visible fat on their body as irritable, especially in this modern world. This seems to have become a part of the female adolescents especially students because of craze for beauty and elegance.

In the Nigerian social scene, "slimness and beauty" have become qualities seen by young adults and adolescents as characteristics of world beauty queens. These youths, male or female see shedding weights as qualities that must be vigorously pursued if they must attract promising opposite sex and also prepare those who are interested in beauty pageants and modeling.

Healthy eating patterns in childhood and adolescence promote optimal adulthood, growth, and intellectual development. It prevents immediate health problems such as iron deficiency anemia, obesity, dental caries etc. It may prevent long term health problems such as cardiac problem (USAD, 1996). Regrettably, many youths and adolescents are either not exposed to good eating habits or are seriously involved in eating disorders at the ignorance of the resultant effects on personality changes.

Eating disorder affects adolescents with increasing frequency. It ranks as the third (3rd) most common chronic illness in adolescents females (Whitaker, 1992). It has an incidence of up to 5% prevalence rate in any given population (Stein, 1991; Drewmowski, Hopkins and Kessier 1982). Two major types are recognized in school children; t hey are the restrictive form in which food intake is seriously limited, (Anorevic Nervosa) and that in which binge eating episodes are followed by attempts to lose weight through vomiting, cathartics, exercise and fasting (Bulimic Nervosa) (Adolescent Medicine Committees, 1998).

Personality changes usually accompany eating disorders. These include introversion, anxiety, social dysfunction, osteoporosis, depression, fear, obsessional behaviour of cleanliness, and orderliness (Edlin, Golanty and Brown; 2000 and Rowan, 2004). The victim becomes less outgoing, show less assertiveness, low body esteem and low self worth. Severe complications and mortality rates for these disorders are among the highest for any psychiatric disorder (Edlin, Golanty and Brown & Co, 2000; Rowan, 2004).

In recent times, a religious incursion into the episodes of eating disorder has been observed. Female adolescents indulge in wet ordry fasting practices to minimize the effects of overeating. It entails skipping breakfast and eating late in the afternoons or evenings and at times taking nothing for days on the minimum of three to five days. This practice negates the importance of nutrition education as a major educational component of all-child nutrition programme offered in schools. The importance of breakfast has been seriously addressed by Owie (2003) as a practice that can add more years to ones living. Mandell's (1993) studies also reported on the importance of breakfast. He said that school students who participated in school breakfast programme performed better in learning and in health over those who did not participate.

Nutrition education refers to a broad range of activities that promote healthy eating behaviour. This include health education; healthy environment; health services; counselling; and school based health promotion for faculty and staff (USAD, 1996). The national health promotion and disease prevention objectives also encourage schools to provide nutrition education from preschool through the 12 grade (USAD, 1996).

In Nigeria, there may have been published studies that have examined the prevalence of eating disorders in clinic-based samples. There are no available data on the prevalence of eating disorder(s) in mainstream school children and adolescents in Benin metropolis. Children and adolescents may be aware of the general relationship between nutrition and health, but are less aware of the relationship between unsafe weight loss methods and health. Similarly, adolescents may be well informed about good nutrition and health but are not using their knowledge in making use of healthy eating behaviour. There is need to close the gap.

Schools are a critical part of the social environment that shapes young persons behaviour. It is expected therefore, that it should play a large role in helping to improve students' eating behaviour. The school however, cannot do this without knowing the prevalence of eating disorders among the students. Thus, the study attempted to identify the eating disorders among secondary school female students of Benin metropolis. To achieve this, the following research questions were asked

Research Questions

1. Do secondary school female students in Benin metropolis feel satisfied about their body image?

2. What unsafe weight losing methods do students adopt in getting slim?

3 What nutrition education services do the schools provide?

One main hypothesis posited and tested was that: the use of unsafe method in losing weight will not significantly result in change in personality profile.

It is hoped that the study will be useful to students, parents and health personnel in health training against eating disorders. Schools are a crucial part of the social environment that shapes young persons behaviour; it is hoped that schools should be able to promote healthy eating behaviours through nutrition education.

Method of the Study

Research Design: A descriptive survey design was adopted for the study. This is considered suitable because the collection and analysis of data from a few people or items in a given population will serve as a representation of the population.

Population: The population was made up of all adolescent female students in the senior secondary schools in Benin metropolis in the 2004/2005 academic session.

Samples and Sampling technique: A total of 1716 respondents comprising female adolescents from twelve schools (seven public and five private schools) constituted the sample for the study. One hundred and sixty seven (167) respondents whose ages ranged from 13-17 years (with a mean age of 15 years) were drawn from each school. A multistage sampling technique was adopted in selecting both the samples of schools and the respondents. Informed consents were obtained from the school heads and children.

Instrument

The main instrument for the data collection was the Female Adolescent Students' Eating Disorder Questionnaire (FASEDQ) constructed by the researchers. It is made of two sections. Section one comprised 10 main questions grouped into 5 sub-sections. The sections are body image, eating disorders, motivational factors, unsafe weight losing method and personality changes. Each subsection demanded information on a sub-theme of the topic. Section two was a modified version of personality assessment instrument by Robinson, Shaver and Wrightsman (1991). It comprised 15 questions made up of 5 subsections/ The questionnaire was validated by a medical doctor, a physical educator, a nutritionist and a health educator. Their corrections and observations formed the basis for the modification and development of the final questions. The questionnaire was subjected to a split-half reliability using Pearson Product Moment Coefficient of Correlation (PPMCC) which yielded an (r) of 0.86.

Data Collection: A total of 2000 copies of the questionnaire were distributed to the respondents out of which 1716 (85.8%) were retrieved.

Method of data analysis: The data were analyzed, using percentages, chi-square ([x.sup.2]) and mean (x) scores. The mean (x) scores for the acceptance level of the body sizes were determined. Scores above the determined mean scores, were accepted and below were not accepted.

Results: The results of the research questions are presented in tables 1-3 of this section.

Research Question 1: Do secondary school students in Benin metropolis who practice eating disorder feel satisfied with their body image?

In table one, the mean score analysis of appreciation of body image were presented. The body parts were classified into upper, middle and lower extremities; and the body types, into slim, average and fat body sizes. The respondents were quite satisfied with their upper and middle extremities for slim body as well as in their general appearance. As for the average body size, only few respondents (846) appreciated their body part (thighs). The responses for fat body size revealed that 537 respondents appreciated the size of their chest/breast as well as their feet, legs and ankles with 810 and 803 responses respectively.

Research question 2:

What unsafe methods of weight losing do students practise to get slim?

Table 2 presents the different methods used to reduce weight. The analysis revealed that fifty-three (53.0%) skipped breakfast regularly, while fifty-one point six percent (51.6%) sometime skipped lunch; while skipping dinner as a practice, with forty-three point seven percent (43.7%) was not regularly used.

The use of fasting in item 2 revealed that thirty-four point one percent (34.1%) respondents engaged in dry fasting regularly; while fifty-one point nine percent (51.9%) sometime did. Thirty-three point six percent (33.6%) claimed that they take to wet fasting regularly; and forty-three point seven percent (43.7%) said they sometimes did; while twenty-two point seven percent (22.7%) respondents did not.

In item 3, twenty-three point five percent (23.5%) respondents regularly exercise; while forty-six percent (46.0%) sometimes did. In item 4, seventeen point three percent (17.3%) induced vomiting regularly; while ten point seven percent (10.7%) regularly used drugs and substances. This involves inserting soap or waterleaf plant (tanilium trangulare) into their anus, or use it as soup that would loosen their bowel and stimulate frequent stooling. Walking long distance to school was regularly done by fifty-seven point four percent (57.4%) respondents; while twenty-seven point two percent (27.2%) sometime did; and fifteen point four percent (15.4%) did not engage, in walking.

Research Question 3: What Nutrition education services do the schools render to students? (Scores in parentheses are percentages.)

Table 3 presents the analysis of nutrition education services provided by the schools. Of the six variables provided, only Health Services, with 1362 representing (79.0%) response was reported to have been provided. On the other hand, Health Education with 1132 (66.0%), Health Environment with 1456 representing (84.8%); mid day meal with 1625 representing (94.7%); counseling with 1404 representing (82.0%) and Health Promotional Programmes with 956 (55.8%) were minimally provided.

The findings revealed that Nutrition Education is not adequately considered in the school system. This finding is corroborated by Idehen (2004) who stated that school Health Education Curriculum is not implemented in Edo State Secondary Schools. This could account for the poor eating habits put up by students.

Hypothesis 1

The use of unsafe methods in losing weight will not significantly result in a change in personality profile.

Table 4, presents the chi-square ([x.sup.2]) analysis of the health consequences resulting in changes in the personality profile due to unsafe methods of losing weight. Five health consequences resulting from the unsafe methods, each representing the personality profiles were presented. The chi-square values were testedat p > 0.05 significant level. The calculated chi-square values of the health consequences were higher then the chi-square table value of 9.488. The research hypothesis which states that the use of unsafe weight losing method will not significantly result in personality change was rejected. The conclusion therefore was that the use of unsafe weight losing method would result in change in the personality profile of secondary schools in Benin metropolis.

This finding corroborates the earlier studies of Edlin, Golanty and Brown (2000), which opined that excessive concern of weight loss will result in health consequences namely depression, fear and anxiety, compensatory acts. This is not surprising because slimness as one of the characteristics of beauty is seriously pursued by the adolescent.

Discussion

Question I sought to find out if students felt satisfied with their body image. Ten body profiles were investigated. The students appreciated seven out of the ten parts investigated. Over and above, their postures and general attractiveness were their pre-occupation. This could explain their cosmetic reasons for appreciating their body weight.

A good number of the students preferred to be slim. This wish is deliberate, hence they could have resorted to the practice of eating disorders and use of strenuous exercises. The motivational factors for these could be the type of friends they keep and the social pressure of becoming a beauty queen. The schools may not directly or consciously inculcate this into the students but organisation of cultural dances as in the schools where slim adolescents are picked, seem to doing this unconsciously.

Students indulge in dangerous projects for losing weight by inducing vomiting and inserting soap or other substances into their anus to stimulate stooling. Similarly the nutritional use of water -leaf is sometimes abused to stimulate frequent stooling. Also is the habit of skipping meals, especially breakfast. The studies of Owie (2003) and Edlin (2000) have emphasized the importance of breakfast in promoting good health. It would not be surprising if the adolescents who get involved in eating disorders suffer from some health impairment.

The personality profiles of the students were investigated. The analysis revealed that the adolescents who have eating disorders could be involved in compensatory acts of obsession-compulsive reactions. They could lose contact with friends without regrets and may not be assertive. These are indices of mental illness. The displayed personality profile changes are indications that the students would suffer from the problems of low self-esteem, and feeling of inadequacy, anxiety, social dysfunction, depression and moodiness. These qualities are at variance with the qualities of mental health practices in the studies of Owie (2003). This is corroborated in the studies of public health service; (Healthy People, 2000).

Implications for Health Education

The National Associations of Health Educators (NAHE) and the Nigeria School Health Association (NSHA) should jointly pursue the effective implementation of the School Health Curriculum that will focus on Nutrition Education. The personality profile changes are indices of mental illness. A further studies of the mental health situations of the students should be investigated. The insertion of substances into anus to induce stooling can degenerate to annal fistula, haemorrhoid and cancer of the anus. A study should be conducted to investigate these in the students.

Conclusion and Suggestions

Eating disorders among secondary school students is on the increase, judging from the findings. This would go a long way in affecting the personality of the school adolescents. School health based programmes in the form of mid-day meals and Nutrition education are absent from most school health programmes. This is an indication that school health education curriculum in Edo State has not been seriously implemented Nutrition Education that would promote healthy eating behaviours should be encouraged by school authorities. This will go a long way in counselling the students against the problems of eating disorders.

Schools are a critical part of the social environment that shapes young persons behaviours and should therefore play a vital role in helping to improve their diets. Coordinated school nutrition policy that promotes good eating behaviour and a supportive school environment should be encouraged. School nutrition policy for schools should be enacted. The policy should describe the importance of nutrition component within the comprehensive school health programme. Organization of school mid-day meals would be considered as a right direction.

References

Adolescent Medicine Committee (1998). Eating disorders in adolescents: Principles of diagnosis and treatment. Canadian Pediatric Society, 3(3) 189-92.

Drewmowski, A; Hopkins, S.A. and Kessier RL. (1988). The prevalence of bulimia nervosa in the US college student population. America Journal of Public Health, 78, 1322-5.

Edlin, G, Golantry E and Brown K.M (2000). Essentials for Health and Wellness (2nd ed) Jones and Barleft publishers, Singapore.

Idehen, C.O. (2004). Implementation of the national heath education curriculum in secondary schools in Edo State. Unpublished Ph.D. Thesis, University of Benin.

Mandell, R.J. (1993). The strategic plan for nutrition education: Promoting healthy eating habits for our children. Washington DC: US Department of Agriculture, Food and Nutrition Service, Nutrition and Technical Service Division.

Owie, I. (2003). Adding Years to your life: An invitation from Queen Hygeia. University of Benin Inaugural lecture Series 68.

Robison, J. P., Shaver, P. R., & Wrightsman, L. S. (1991). Measures of Personality and Social Psychological attitude. New York, Academic Press

Stein, D.M. (1991). The prevalence of bulimia: A review of the empirical research. Journal of Nutrition Education, 23 (205), 13.

U.S. Department of Agriculture and Nutrition Education (1996). Guidelines for school health programmes to promote lifelong healthy eating. MMWR (RR-a) 1-33.

Whitaker, A.H. (1992). An epidemiological study of anorevic and bulimic symptoms in adolescent girls: Implications for pediatrician. Pediatric Annal, 21, 752-9.

Dr. T.I. Izevbigie and Professor I. Owie, Department of Physical and Health Education, University of Benin, Benin City, Nigeria.

Correspondence concerning this article should be addressed to Dr. T.I. Izevbigie at [e-mail].

Table 1
Mean Score Analysis of Appreciation of Body Image
N = 1710

Body Image          Appreciation of Body Types
(Body profiles)
                    Slim Body   Average Body   Fat body
                    Quite       Some what      Some what
                    Satisfied   satisfied      dissatisfied

Upper Extremities   X = 706     X = 626        X = 400
--Hair              851 *       570            289
--Chest/breast      713 *       460            537 *

Middle
--Waist             814 *       621            275
--Buttocks          824 *       611            275
--Hips              829 *       600            281

Lower Extremities
--Feet              327         577            810 *
--Legs and Ankles   320         587            803 *
--Thighs            608         846 *          256

* = accepted

Table 2
Percentage Analysis of Weight Losing Method
N = 1716
                                          % Distribution

S/    Weight Losing                       Some     Not at        No
No.   Process               Regularly     time       all     responses

1.    Skip food at:
      (i) Breakfast           (53.0)     (32.2)    (11.8)       2.9
      (ii) Lunch              (31.5)     (51.6)    (14.4)       2.5
      (iii) Dinner            (24.5)     (31.8)    (43.7)        --

2.    Fasting:
      --Dry Fasting           (34.1)     (51.9)    (14.0)        --
      --Wet Fasting           (33.6)     (43.7)    (22.7)        --

3.    Take part in
      strenuous Jogging
      Exercise                (23.5)      (46)     (27.2)      (3.3)

4.    Induced vomiting
      after meal              (17.3)     (33.3)    (49.3)        --

5.    Use drugs/
      substances              (10.7)     (35.8)    (53.0)      (0.6)

6.    I walk to school
      even when I have
      the fare                (57.4)     (27.2)    (15.4)        --

Table 3
Percentage Analysis of Nutrition Education Rendered by Schools
N = 1716

      Variable                            Responses

                                          Highly         Minimally
S/N   Nutrition Education Programmes      Provided       Provided
1.    Health Education                    584 (34.0)     1132 (66.0)
2.    Health Environment                  260 (15.2)     1456 (84.8)
3.    Organisation of mid day meals       91 (5.3)       1625 (94.7)
4.    Health Service                      1362 (79.0)    354 (20.6)
4.    Counselling                         309 (18.0)     1404 (82.0)
6.    Health Promotional Programmes       758 (44.2)     956 (55.8)

Table 4
Summary of Chi-square ([chi square]) Analyses of Change in Personality
Profile Due to Unsafe Methods of Losing Weight

S/N   Health Consequences      [x.sup.2]          Decision
                            Cal. Chi Sq. Values

1     Depression                   102.2             S
2     Low self esteem              138.1             S
3     Fear and anxiety             52.4              S
4     Low body esteem              58.8              S
5     Compensatory acts            122.5             S

df = 4; [chi square] = 9.488; p < 0.05; S = significant