Understanding eating disorders in the Middle East: body dissatisfaction and westernization in Saudi Arabia and Turkey

Abstract

Introduction: Body dissatisfaction is one of the maintaining factors of eating disorders and a well-known risk factor for their development. It was assumed that body dissatisfaction did not afflict non-Western countries. However, body dissatisfaction is reported in non-Western countries, and to what extent westernization is associated with body dissatisfaction and subsequent eating disorders is unknown. The purpose of the present study is to examine the association between Western acculturation and body dissatisfaction in Saudi Arabia and Turkey, and to determine the measurement invariance of the Body Shape Questionnaire. Methods: The Body Shape Questionnaire and the adapted version of the Acculturation Rating Scale for Mexican–Americans II were administered to convenience samples in Saudi Arabia (n = 746) and Turkey (n = 363). A hierarchical multiple linear regression analysis was conducted with body dissatisfaction as the dependent variable and cultural orientation as the independent variable. Citizenship status, BMI, and sex were included as covariates. A multi-group CFA compared the item intercepts of the Body Shape Questionnaire in the two non-Western samples with a Dutch community sample (n = 1651). Results: The Body Shape Questionnaire scores differed (p = 0.036) between individuals who had lived abroad in a Western country (M = 88.2, SD = 38.1) for at least six months and those who had not (M = 82.0, SD = 36.5). The BMI, but not cultural orientation, was associated with body dissatisfaction (B = 2.4, R = 0.4, R square = 0.18; p < 0.001). The multi-group CFA indicated that the Body Shape Questionnaire had a single-factor structure, and the item intercepts were similar across samples (CFI = 0.92; RMSEA = 0.059; RMSEA 90% CI 0.50-0.68; SRMR = 0.07). Discussion: Future research should evaluate preventative programs targeting westernization-driven sedentary lifestyles. The Body Shape Questionnaire can be utilized across cultures and may help further the understanding of body dissatisfaction and eating disorders in the Middle East.