Risk of disordered eating attitudes and its relation to mental health among university students in ASEAN

  • Supa Pengpid
  • Karl Peltzer
Original Article



Since there is a lack of information on eating disorders attitudes in Association of Southeast Asian Nations (ASEAN), the aim of this study was to explore the prevalence of eating disorder attitude and its relation to mental distress among university student populations in Indonesia, Malaysia, Myanmar, Thailand and Vietnam.


A cross-sectional questionnaire survey and anthropometric measurement were conducted with undergraduate university students that were randomly recruited. The Eating Attitudes Test (EAT-26) was utilized to determine the prevalence of disordered eating attitudes. The sample included 3148 university students, with a mean age of 20.5 years, SD = 1.6.


Using the EAT-26, 11.5% of the students across all countries were classified as being at risk for an eating disorder, ranging from below 10% in Indonesia, Thailand and Vietnam to 13.8% in Malaysia and 20.6% in Myanmar. In multivariable logistic regression analysis, sociodemographic factors (wealthier subjective economic status, and living in a lower middle income country), underweight and overweight body weight perception, psychological factors (depression symptoms and pathological internet use), and being obese were associated with eating disorder risk.


Relatively high rates of eating disorder risk were found. This result calls for increased awareness, understanding of eating disorders and related risk factors and interventions in university students in ASEAN.

Level of evidence

Level V, descriptive cross-sectional survey.


Eating disorder risk EAT-26 Body weight perception Mental health University students ASEAN 



The following colleagues participated in this ASEAN student health survey and contributed to data collection (locations of universities in parentheses): Indonesia: Erna Rochmawati (Yogyakarta), Malaysia: Wah Yun Low (Kuala Lumpur); Myanmar: Hla Hla Win (Yangon); Thailand: Niruwan Turnbull (Maha Sarakham); Vietnam: Thang Nguyen Huu (Hanoi).


Partial funding for this study was provided by the South African Department of Higher Education.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interests to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Pike KM, Hoek HW, Dunne PE (2014) Cultural trends and eating disorders. Curr Opin Psychiatry 27(6):436–442. CrossRefPubMedGoogle Scholar
  2. 2.
    Pike KM, Dunne PE (2015) The rise of eating disorders in Asia: a review. J Eat Disord 3:33. (eCollection 2015) CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Thomas JJ, Lee S, Becker AE (2016) Updates in the epidemiology of eating disorders in Asia and the Pacific. Curr Opin Psychiatry 29(6):354–362. CrossRefPubMedGoogle Scholar
  4. 4.
    Pengpid S, Peltzer K, Ahsan GU (2015) Risk of eating disorders among university students in Bangladesh. Int J Adolesc Med Health 27(1):93–100. PubMedCrossRefGoogle Scholar
  5. 5.
    Liao Y, Knoesen NP, Castle DJ, Tang J, Deng Y et al (2010) Symptoms of disordered eating, body shape, and mood concerns in male and female Chinese medical students. Compr Psychiatry 51(5):516–523CrossRefPubMedGoogle Scholar
  6. 6.
    Tao ZL (2010) Epidemiological risk factor study concerning abnormal attitudes toward eating and adverse dieting behaviours among 12- to 25-years-old Chinese students. Eur Eat Disord Rev 18(6):507–514CrossRefPubMedGoogle Scholar
  7. 7.
    Yu J, Lu M, Tian L, Lu W, Meng F, Chen C, Tang T, He L, Yao Y (2015) Prevalence of disordered eating attitudes among university students in Wuhu, China. Nutr Hosp 32(4):1752–1757. PubMedCrossRefGoogle Scholar
  8. 8.
    Naeimi AF, Haghighian HK, Gargari BP, Alizadeh M, Rouzitalab T (2016) Eating disorders risk and its relation to self-esteem and body image in Iranian university students of medical sciences. Eat Weight Disord. PubMedCrossRefGoogle Scholar
  9. 9.
    Gan Nm, Hazizi Z (2011) Disordered eating behaviors, depression, anxiety and stress among Malaysian university students. College Student J 45:296–302Google Scholar
  10. 10.
    Memon AA, Adil SE, Siddiqui EU, Naeem SS, Ali SA, Mehmood K (2012) Eating disorders in medical students of Karachi, Pakistan-a cross-sectional study. BMC Res Notes 5:84CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Suhail K, Zaib-u-Nisa (2002) Prevalence of eating disorders in Pakistan: relationship with depression and body shape. Eat Weight Disord 7(2):131–138CrossRefPubMedGoogle Scholar
  12. 12.
    Jennings PS, Forbes D, McDermott B, Hulse G, Sato J (2006) Eating disorder attitudes and psychopathology in Caucasian Australian, Asian Australian and Thai university students. Aust N Z J Psychiatry 40:143–149CrossRefPubMedGoogle Scholar
  13. 13.
    Pattanathaburt P, Somrongthong R, Thianthai C (2013) Prevalence of disordered eating behaviors, body image dissatisfaction, and associated factors among Thai female undergraduate students. Int J Health Promot Educ 51(3):151–160. CrossRefGoogle Scholar
  14. 14.
    Ko N, Tam DM, Viet NK, Scheib P, Wirsching M, Zeeck A (2015) Disordered eating behaviors in university students in Hanoi, Vietnam. J Eat Disord 3:18. (eCollection 2015) CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Culbert KM, Racine SE, Klump KL (2015) Research review: what we have learned about the causes of eating disorders—a synthesis of sociocultural, psychological, and biological research. J Child Psychol Psychiatry 56(11):1141–1164. (Epub 2015 Jun 19) CrossRefPubMedGoogle Scholar
  16. 16.
    Smink FR, van Hoeken D, Hoek HW (2012) Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 14(4):406–414CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Becker AE, Tayyeb S, Baki A, Sarker S, Zabeen B et al (2011) Social network media exposure and adolescent eating pathology in Fiji. Br J Psychiatry 198(1):43–50CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Makino M, Hashizume M, Tsuboi K, Yasushi M, Dennerstein L (2006) Comparative study of attitudes to eating between male and female students in the People’s Republic of China. Eat Weight Disord 11(3):111–117CrossRefPubMedGoogle Scholar
  19. 19.
    Puccio F, Fuller-Tyszkiewicz M, Ong D, Krug I (2016) A systematic review and meta-analysis on the longitudinal relationship between eating pathology and depression. Int J Eat Disord 49(5):439–454. CrossRefPubMedGoogle Scholar
  20. 20.
    Swinbourne JM, Touyz SW (2007) The co-morbidity of eating disorders and anxiety disorders: a review. Eur Eat Disord Rev 15(4):253–274CrossRefPubMedGoogle Scholar
  21. 21.
    Chen J, Wang Z, Guo B, Arcelus J, Zhang H et al (2012) Negative affect mediates effects of psychological stress on disordered eating in young Chinese women. PLoS One 7(10):e46878. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Gan WY, Mohd Nasir MT, Zalilah MS, Hazizi AS (2011) Direct and indirect effects of sociocultural influences on disordered eating among Malaysian male and female university students. A mediation analysis of psychological distress. Appetite 56(3):778–783. CrossRefPubMedGoogle Scholar
  23. 23.
    Canan F (2016) The relationship between internet addiction and eating disorders. Eat Weight Disord 21(1):137–138. CrossRefPubMedGoogle Scholar
  24. 24.
    Tao ZL, Liu Y (2009) Is there a relationship between Internet dependence and eating disorders? A comparison study of Internetdependents and non-Internet dependents. Eat Weight Disord 14(2–3):e77-83PubMedGoogle Scholar
  25. 25.
    Rouzitalab T, Pourghassem Gargari B, Amirsasan R, Asghari Jafarabadi M, Farsad Naeimi A, Sanoobar M (2015) The relationship of disordered eating attitudes with body composition and anthropometric indices in physical education students. Iran Red Crescent Med J 17(11):e20727. (eCollection 2015) CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Garner DM, Olmsted MP, Bohr Y, Garfinkel PE (1982) The eating attitudes test—psychometric features and clinical correlates. Psychol Med 12(4):81–87CrossRefGoogle Scholar
  27. 27.
    Kaewporndawan T, Pariwatcharakul P, Pimratana W (2013) Criterion validity study of the Eating Attitudes Test-26 (EAT-26 Thai version) among Thai females. J Psychiat Assoc Thailand 58(3):5–10Google Scholar
  28. 28.
    Steptoe A, Wardle J (1992) Cognitive predictors of health behaviour in contrasting regions of Europe. Br J Clin Psychol 31:485–502CrossRefPubMedGoogle Scholar
  29. 29.
    The World Bank (2016) New country classifications by income level. Accessed 10 March 2017
  30. 30.
    Lee RD, Nieman DC (1993) Nutritional assessment. Brown & Benchmark, OxfordGoogle Scholar
  31. 31.
    Kanazawa M, Yoshiike N, Osaka T, Numba Y, Zimmet P, Inoue S (2005) Criteria and classification of obesity in Japan and Asia-Oceania. World Rev Nutr Diet 94:1–12PubMedGoogle Scholar
  32. 32.
    Andresen EM, Malmgren JA, Carter WB, Patrick DL (1994) Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med 10(2):77–84CrossRefPubMedGoogle Scholar
  33. 33.
    Kimerling R, Ouimette P, Prins A, Nisco P, Lawler C, Cronkite R, Moos RH (2006) Brief report: Utility of a short screening scale for DSM-IV PTSD in primary care. J Gen Intern Med 21(1):65–67CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Young KS (1999) Internet addiction: Symptoms, ealuation and treatment. Innovations in clinical practice. A Source Book 17:19–31Google Scholar
  35. 35.
    Siomos K, Floros G, Fisoun V, Evaggelia D, Farkonas N, Sergentani E, Lamprou M, Geroukalis D (2012) Evolution of Internet addiction in Greek adolescent students over a 2-year period: the impact of parental bonding. Eur Child Adolesc Psychiatry 21(4):211–219. CrossRefPubMedGoogle Scholar
  36. 36.
    Durkee T, Kaess M, Carli V, Parzer P, Wasserman C, Floderus B, Apter A et al (2012) Prevalence of pathological internet use among adolescents in Europe: demographic and social factors. Addiction 107(12):2210–2222. CrossRefPubMedGoogle Scholar
  37. 37.
    Madanat HN, Hawks SR, Novilla ML (2006) A comparison of disordered eating attitudes and behaviors among Filipino and American college students. Eat Weight Disord 11(3):133–138CrossRefPubMedGoogle Scholar
  38. 38.
    Fragkos KC, Frangos CC (2013) Assessing eating disorder risk: the pivotal role of achievement anxiety, depression and female gender in non-clinical samples. Nutrients 5(3):811–828. CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Edman JL, Yates A (2004)) Eating attitudes among college students in Malaysia: an ethnic and gender comparison. Eur Eat Dis Rev 12:190–196CrossRefGoogle Scholar
  40. 40.
    Goodman A, Heshmati A, Koupil I (2014) Family history of education predicts eating disorders across multiple generations among 2 million Swedish males and females. PLoS One 9(8):e106475. (eCollection 2014) CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Spoor STO, Bekker MHJ, Van Strien T, Van Heck GL (2007) Relations between negative affect, coping, and emotional eating. Appetite 48:368–376CrossRefPubMedGoogle Scholar
  42. 42.
    Tavolacci MP, Grioni S, Richard L, Meyrignac G, Déchelotte P, Ladner J (2015) Eating disorders and associated health risk among university students. J Nutr Educ Behav 47(5):413–420CrossRefGoogle Scholar
  43. 43.
    Harrop E, Marlatt G (2010) The comormidity of substance use disorders and eating disorders in women: Prevalence, etiology, and treatment. Addict Behav 35:392–398CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.ASEAN Institute for Health DevelopmentMahidol UniversityNakhonpathomThailand
  2. 2.Department of Research and InnovationUniversity of LimpopoSovengaSouth Africa
  3. 3.Department for Management of Science and Technology DevelopmentTon Duc Thang UniversityHo Chi Minh CityVietnam
  4. 4.Faculty of PharmacyTon Duc Thang UniversityHo Chi Minh CityVietnam

Personalised recommendations