The relationship between risk of eating disorders, age, gender and body mass index in medical students: a meta-regression
Age, gender and body mass index (BMI) are commonly described risk factors for the development of eating disorders. However, the magnitude of these factors (individually and together) is still not well-defined in some populations.
A systematic search was performed for studies that reported the prevalence of eating disorder risk among medical students using the Eating Attitudes Test-26 (EAT-26) and age, gender and BMI as risk factors. We included studies published in English peer-reviewed journals between 1982 and 2017. A total of 14 studies were included in the analyses, and the meta-regression analyses were performed using mean age (years), gender (proportion of female subjects), and mean BMI (kg/m2) as moderators with the risk of eating disorders measured using EAT-26 as an outcome variable. Four interaction terms were created (1) age × gender (2) age × BMI (3) gender × BMI and (4) age × gender × BMI to assess if two or more independent variables simultaneously influence the outcome variable.
Utilizing the EAT-26, the pooled prevalence of at risk for eating disorders among medical students (k = 14, N = 3520) was 10.5% (95% CI 7.3–13.7%). Meta-regression model of age, gender and BMI alone revealed poor predictive capabilities. Meta-regression model of age × gender × BMI interaction revealed statistically significant results with a covariate coefficient of 0.001 and p value of 0.044.
Results from this sample of medical students provided evidence for the role of interactions between risk factors (e.g., age × gender × BMI) in predicting individuals at risk for eating disorders, whereas these variables individually failed to predict eating disorders.
Level of evidence
Level I, systematic review and meta-analysis.
KeywordsUniversity students High risk Eating disorders Meta-regression Risk factors
HJ and ZS designed the study. HJ coordinated data search, data entry, data cleaning and performed statistical analyses. HJ and ML wrote the first draft, ZS and MF provided intellectual contributions to strengthening the manuscript and suggested additional data analyses. All authors provided critical revisions of manuscript and approved the final version.
No funds were received towards the study at any stage.
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
This article does not contain any studies with human participants performed by any of the authors.
For this type of study formal consent is not required.
- 17.Stice E, Shaw H, Marti CN (2007) A meta-analytic review of eating disorder prevention programs: encouraging findings. Annu Rev Clin Psychol 3:207–231. https://doi.org/10.1146/annurev.clinpsy.3.022806.091447 CrossRefGoogle Scholar
- 19.Shashank J, Praveen G, Chethan T (2016) A crosssectional study to asses the eating disorder among female medical students in a rural medical college of Karnataka state. Natl J Community Med 7:524–527Google Scholar
- 25.Borenstein M, Hedges LV, Higgins JPT, Rothstein HR (2011) Introduction to meta-analysis. Wiley, OxfordGoogle Scholar
- 28.Cleves M, Gould W, Gould WW et al (2008) An introduction to survival analysis using Stata, 2nd edn. Stata, College stationGoogle Scholar
- 29.OpenMeta[Analyst]—CEBM @ Brown. http://www.cebm.brown.edu/openmeta/index.html. Accessed 26 Jan 2018
- 30.Stata MP (2015) 14.0. Coll Stn TX StataCorpGoogle Scholar
- 32.Babar N, Alam M, Ali SS et al (2002) Anorexic behaviour and attitudes among female medical and nursing students at a private university hospital. JPMA 52:272–276Google Scholar
- 38.Haroon S, Usman M, Hafeez M (2016) Eating disorders in medical students of Islamabad Pakistan-a cross-sectional study. Ophthalmol Update 1993–2863:89–92Google Scholar
- 40.Vijayalakshmi P, Thimmaiah R, Reddy SSN et al (2017) Gender differences in body mass index, body weight perception, weight satisfaction, disordered eating and weight control strategies among indian medical and nursing undergraduates. Investig Educ En Enferm 35:276–284. https://doi.org/10.17533/udea.iee.v35n3a04 CrossRefGoogle Scholar
- 45.Levine M, Murnen S (2009) “Everybody knows that mass media are/are not [pick one] a cause of eating disorders”: a critical review of evidence for a causal link between media, negative body image, and disordered eating in females. J Soc Clin Psychol 28:9–42. https://doi.org/10.1521/jscp.2009.28.1.9 CrossRefGoogle Scholar
- 46.Smolak L, Levine M (1996) Developmental transitions at middle school and college. In: Smolak L, Levine MP, Striegel-Moore R (eds) The developmental psychopathology of eating disorders: implications for research, prevention, and treatment. Lawrence Erlbaum Associates, Inc, Hillsdale, pp 207–233Google Scholar
- 50.Stice E (2016) Interactive and mediational etiologic models of eating disorder onset: evidence from prospective studies. Annu Rev Clin Psychol 12:359–381. https://doi.org/10.1146/annurev-clinpsy-021815-093317 CrossRefGoogle Scholar