Printer Friendly

Detection of eating disorders in 16-20 year old female students - perspective from Islamabad, Pakistan.

Byline: Masood Ali Shaikh and Ayesha Kayani

Abstract

There are no studies on eating disorders in Pakistani adolescent girls. This study was conducted to determine the opinions, and behaviours pertaining to dieting and body size among 16 to 20 year old female school and college students in Islamabad, Pakistan. This was done through a five-item questionnaire to determine the SCOFF score. The SCOFF acronym has been derived from 'S' from the word "sick" in question number 1. 'C' from the word "control" in question number 2. The 'O' comes from the word 'one' in the original question number 3; this original question number 3 of the SCOFF asks about having lost more than 'one' stone weight in the past three months. This question was rephrased to read as whether more than 15 pounds or 6 kilogrammes have been lost. The two 'F's come from questions number 4 and 5 denoting words "fat" and "food", respectively.

A total of 1,134 female students participated in the study and 736 (64.9%) respondents scored two or higher on the SCOFF scale; 461 (66.5%) out of 693 were aged 16 to 18, while 275 (62.4%) out of 441 were aged 19 to 20. Results indicated a need for developing clinical practice guidelines for general practitioners and paediatricians to proactively identify and treat potential eating disorders in young Pakistani women.

Keywords: Eating disorders, Adolescents, Pakistan.

Introduction

Anorexia nervosa and bulimia nervosa are the two major eating disorders and both primarily manifest in adolescence. Compared to men, women are as much as three times more likely to experience these disorders.1,2 There is dearth of empirical information on eating disorders in Pakistan. A study of 180 female nursing and medical students in Karachi reported a prevalence rate of 21.7% for anorexia nervosa.3 Another study using SCOFF questionnaire reported that 307 out of 446 (68.8%) female university students scored two or higher; indicating potential eating disorders and need for clinical assessment.4 SCOFF is an effective 5-question screening tool to identify individuals for clinical assessment so as to determine the presence of potential eating disorders.5 SCOFF acronym has been derived from 'S' from the word "sick" in question number 1. 'C' from the word "control" in question number 2.

The 'O' comes from the word 'one' in the original question number 3; this original question number 3 of the SCOFF asks about having lost more than 'one' stone weight in the past three months. This question was rephrased to read as whether more than 15 pounds or 6 kilogrammes have been lost. The two 'F's come from questions number 4 and 5 denoting words "fat" and "food", respectively. SCOFF has a high validity, with sensitivity and specificity ranging from 53.3% to 84.6% and 89.6% to 93.2% respectively. Regarding reliability, an overall agreement between the SCOFF administration orally and written questionnaire has been reported to be 88.2% with a kappa coefficient of 0.811.6-8 There are no studies on eating disorders in adolescent girls in Pakistan. This study was conducted to determine the SCOFF scores, opinions and behaviours pertaining to dieting and body size among 16 to 20 year old women in Islamabad.

Methods and Results

The cross-sectional survey with convenience sampling was conducted in January and February 2011 among female school and college students in Islamabad, Pakistan, to detect eating disorders and study beliefs/behaviours on dieting and weight; using a pre-tested questionnaire with close-ended questions answered as either 'yes' or 'no', comprising the SCOFF questionnaire and additional questions. Female lecturers in four schools and colleges approached students in the classes and after obtaining verbal consent and ensuring complete confidentiality, distributed the questionnaires and collected the completed ones. Only those students aged 16 to 20 were invited to participate in the study. Each of five SCOFF questions answered affirmatively was assigned one point; a score of two or above suggests a likely case of either bulimia or anorexia nervosa.

Eating disorders are frequently characterised by and sometimes even presented as severe dieting, dissatisfaction with one's body size, and self esteem determined by one's weight.7,9

Table-1: SCOFF questionnaire results cumulative, and disaggregated by age.###Age

###16###17###18###19###20###Cumulative

###N = 128###N = 225###N = 340###N = 295###N = 146###N = 1134

Question###Yes###No###Yes###No###Yes###No###Yes###No###Yes###No###Yes###No

###(%)###(%)###(%)###(%)###(%)###(%)###(%)###(%)###(%)###(%)###(%)###(%)

Do you make yourself sick because###46###82###103###122###154###186###124###171###48###98###475###659

you feel uncomfortably full?###(35.9)###(64.1)###(45.8)###(54.2)###(45.3)###(54.7)###(42)###(58)###(32.9)###(67.1)###(41.9)###(58.1)

Do you worry you have lost control###46###82###86###139###131###209###106###189###51###95###420###714

over how much to eat?###(35.9)###(64.1)###(38.2)###(61.8)###(38.5)###(61.5)###(35.9)###(64.1)###(34.9)###(65.1)###(37)###(63)

Have you recently lost more than fifteen (15)###19###109###39###186###61###279###49###246###30###116###198###936

pounds or six (6) kilograms in a three month period?###(14.8)###(85.2)###(17.3)###(82.7)###(17.9)###(82.1)###(16.6)###(83.4)###(20.5)###(79.5)###(17.5)###(82.5)

Do you believe yourself to be fat when###42###86###99###126###124###216###132###163###58###88###455###679

others say you are too thin?###(32.8)###(67.2)###(44)###(56)###(36.5)###(63.5)###(44.7)###(55.3)###(39.7)###(62.3)###(40.1)###(59.9)

Would you say food dominates###89###39###140###85###209###131###179###116###89###57###706###428

your life?###(69.5)###(30.5)###(62.2)###(37.8)###(61.5)###(38.5)###(60.7)###(39.3)###(61)###(39)###(62.3)###(37.7)

SCOFF acronym has been derived from 'S' from the word "sick" in question number 1. 'C' from the word "control" in question number 2. The 'O' comes from the word 'one' in the original question number 3; this original question number 3 of the SCOFF asks about having lost more than 'one' stone weight in the past three months. This question was rephrased to read as whether more than 15 pounds or 6 kilogrammes have been lost. The two 'F's come from questions number 4 and 5 denoting words "fat" and "food", respectively.

Table-2: Answers to additional questions, cumulative and disaggregated by SCOFF scores.

###SCOFF Scores

###0###1###2###3###4###5###Cumulative

###N = 132###N = 266###N = 349###N =272###N = 101###N =14###N = 1134

###(11.6%)###(23.5%)###(30.8%)###(24%)###(8.9%)###(1.2%)

###Yes###No###Yes###No###Yes###No###Yes###No###Yes###No###Yes###No###Yes###No

###(%)###(%)###(%)###(%)###(%)###(%)###(%)###(%)###(%)###(%)###(%)###(%)###(%)###(%)

Do you think you should be###12###120###71###195###121###228###111###161###52###49###11###3###378###7 5 6

dieting?###(9.1)###(90.9)###(26.7)###(73.3)###(34.7)###(65.3)###(40.8)###(59.2)###(51.5)###(48.5)###(78.6)###(21.4)###(33.3) (66.7)

Are you dissatisfied with###24###108###86###180###137###212###121###151###59###42###9###5###436###698

your body size?###(18.2)###(81.8)###(32.8)###(67.7)###(39.3)###(60.7)###(44.5)###(55.5)###(58.4)###(41.6)###(64.3)###(35.7)###(38.5) (61.5)

Have you tried dieting###6###126###40###226###80###269###96###176###51###50###11###3###284###850

in the past 12 months?###(4.6)###(95.4)###(15)###(85)###(22.9)###(77.1)###(35.3)###(64.7)###(50.5)###(49.5)###(78.6)###(21.4)###(25)###(75)

Does your weight affect the###23###109###77###189###139###210###134###138###60###41###9###5###442###692

way you think about yourself?###(17.4)###(82.6)###(28.9)###(71.1)###(39.8)###(60.2)###(49.3)###(50.7)###(59.4)###(40.6)###(64.3)###(35.7)###(39)###(61)

SCOFF acronym has been derived from 'S' from the word "sick" in question number 1. 'C' from the word "control" in question number 2. The 'O' comes from the word 'one' in the original question number 3; this original question number 3 of the SCOFF asks about having lost more than 'one' stone weight in the past three months. This question was rephrased to read as whether more than 15 pounds or 6 kilogrammes have been lost. The two 'F's come from questions number 4 and 5 denoting words "fat" and "food", respectively.

We added four more questions on opinions and having actually tried dieting, dissatisfaction with one's body size, and whether weight affects thinking. All questions - with the exception of age - were required to be answered either affirmatively or negatively. Data was analysed using statistical package STATA version 12, applying chi-squared test to determine relationship between proportions of two age groups i.e. 16-18 and 19-20 years, and responses to the questions asked.

A total of 1,134 students aged 16 to 20 participated in the study, with 693 (61.1%) aged from 16 to 18 years, and the rest being aged 19 to 20 years. Responses to each of the five SCOFF questions were disaggregated by age (Table-1).

The responses to the four additional questions were disaggregated by SCOFF scores (Table-2).

Highest number of affirmative responses on the SCOFF scale was for the question on whether food dominates one's life i.e. 706 (62.3%). Only 132 (11.6%) respondents replied negatively to all five SCOFF questions, while merely 14 (1.2%) replied affirmatively to all five SCOFF questions. Cumulatively, 736 (64.9%) respondents scored two or higher on the SCOFF scale; 461 (47.9%) out of 693 aged 16 to 18, while 275 (62.4%) out of 441 aged 19 to 20. Pearson chi-square test, using 95% significance level, revealed statistically significant difference (p=0.039) between the two age groups and dissatisfaction with one's body size; with 19-20 year olds more dissatisfied with their body size compared to 16-18 age group. No statistically significant associations were found between the two age groups and other attributes inquired in the study.

The study raises alarm about the possibility of substantial and unrecognised burden of eating disorders in adolescent and young adult women in Pakistan. Although the study was limited to female students of public-sector schools and colleges in Islamabad, but 736 (64.9%) respondents scored 2 or above on the SCOFF questionnaire. This cut-off score raises the index of suspicion for eating disorders and suggests a need for clinical assessment to identify and, if warranted, treat eating disorders.

Conclusion

General practitioners and paediatricians need to develop practice guidelines so as not to miss an opportunity to address eating disorders when providing consultations to adolescent girls and young adult women. Additionally, health education targeted towards parents of adolescent girls, school teachers as well as adolescents themselves would help address eating disorders in the country. Finally there is a need for nationally representative surveys to determine the prevalence and correlates of eating disorders. It would help ineffectively addressing morbidity associated with eating disorders.

References

1. van Son G, van hoeken D, Aad I, Bartelds A, van Furth E, Hoek H. Time trends in the incidence of eating disorders: a primary care study in the Netherlands. Int J Eat Disord 2006; 39: 565-9.

2. Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007; 61: 348-58.

3. Babar N, Alam M, Ali SS, Ansari A, Atiq M, Awais A, et al. Anorexic behaviour and attitudes among female medical and nursing students at a private university hospital. J Pak Med Assoc 2002; 52: 272-6.

4. Shaikh MA, Shaikh IA, Kamal A, Irfan S. Eating disorders detection in female university students. J Coll Physicians Surg Pak 2011; 21: 134-5.

5. Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ 1999; 319: 1467-8.

6. Hill LS, Reid F, Morgan JF, Lacey JH. SCOFF, the development of an eating disorder screening questionnaire. Int J Eat Disord 2010; 43: 344-51. doi: 10.1002/eat.20679.

7. Parker SC, Lyons J, Bonner J. Eating disorders in graduate students: exploring the SCOFF questionnaire as a simple screening tool. J Am Coll Health 2005; 54: 103-7.

8. Perry L, Morgan J, Reid F, Brunton J, O'Brien A, Luck A, et al. Screening for symptoms of eating disorders: reliability of the SCOFF screening tool with written compared to oral delivery. Int J Eat Disord 2002; 32: 466-72.

9. Rome ES, Ammerman S, Rosen DS, Keller RJ, Lock J, Mammel KA, et al. Children and adolescents with eating disorders: the state of the art. Pediatrics 2003; 111: e98-108. Review.

(Independent Consultant, Block-7, Gulshan-e-Iqbal, Karachi.)

(Islamabad College for Girls (Post-Graduate), Islamabad.)
COPYRIGHT 2014 Asianet-Pakistan
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2014 Gale, Cengage Learning. All rights reserved.

 
Article Details
Printer friendly Cite/link Email Feedback
Publication:Journal of Pakistan Medical Association
Article Type:Report
Geographic Code:9PAKI
Date:Mar 31, 2014
Words:2129
Previous Article:Frequency and clinicopathological correlations of histopathological variants of idiopathic focal segmental glomerulosclerosis in nephrotic...
Next Article:Reproductive and gynaecological issues in Saudi women with End Stage Renal Disease.
Topics:

Terms of use | Privacy policy | Copyright © 2018 Farlex, Inc. | Feedback | For webmasters