Body image perception and Eating attitude amongUndergraduate students of Government Medical college inBengaluru : A Cross-Sectional study

Introduction

The phrase body image was first coined by the Austrian neurologist and psychoanalyst Paul Schilder in his book “The Image and Appearance of the Human Body”. Schilder (1935) defined body image as a person's feelings of the aesthetics and sexual attractiveness of their own body.¹ Body image is a multifaceted concept and person's perception of their own physical image, thoughts and feelings. When a person is able to accept, appreciate and respect their body tend to have a positive perception towards their body image which makes the person more confident improving their self esteem and thus they become more resilient to the development of an eating disorder. Whereas people experiencing body dissatisfaction may end up with intense feelings of disappointment, shame guilt and social withdrawal, ultimately,increase the prevalence of eating disorders. Eating disorders (ED) are one of the most common diagnosed psychiatric problems more common in females, This is characterized by chronicrelapse along with disordered eating behavior, where the patient’s attitude towards weight and shape, as well as their perception of body shape, are disturbed.² International Statistical Classification of Diseases and Related Health Problems (ICD-10)³ classified Eating disorder namely: Anorexia nervosa, Bulimia nervosa and Eating disorders Not Otherwise Specified (EDNOS). Though eating attitude is influenced psychological, behavioural, socioenvironmental factors, its association with body image perception may constitute a risk factor. Hence this study was done with the objective to determine the prevalence of Body image perception and Eating disorders among medical students.

Materials and methods

This cross-sectional study was conducted in a Bengaluru Medical College and Research Institute in Bengaluru in February 2019. The ethical approval for conducting this study was obtained from Institutional Ethics committee. Permission to conduct the study was subsequently obtained from the head of the institution. A sample size of 115 was determined using a confidence level of 95% with 7% of absolute precision and an estimated prevalence of eating disorder to be p=16.9% (Ramaiah et al, 2015).⁵ The study participants were chosen through universal sampling method and they were 3rd year MBBS undergraduates who were present at the time of study. The students were briefed about the objective of the study and written informed consent was taken for their participation. A pretested self-administered semi-structured questionnaire was used for data collection which contained questions on demographic information, body image perception and EAT-26 Scale (Eating Attitude Test-26) .To assess body image perception, there were 3 response “Too thin”, “Normal”, “Too fat”. “Too thin” and “Too fat” were taken as abnormal body image perception. EAT-26 Scale (Eating Attitude Test-26) has been used in research as a validated and reliable measure of identify disordered eating behaviour. Individuals who score 20 or greater (EAT-26 ≥20) are considered to be at risk of having an eating disorder. The scale has 26 questions assessing four dimensions, which include dieting, bulimia, food preoccupation, and oral control. Each item was rated on a scale of 0-3 as follows: never= 0, rarely= 0, sometimes= 0, often= 1, usually= 2, and always= 3. Incompletely filled questionnaires were excluded from the analysis.

Statistical analysis

The data collected were entered in MS Excel and analysed using SPSS version 23. Descriptive statistical measures were expressed as percentage mean and SD. Inferential statistical test namely Chi-square test was applied for association. The association was interpreted statistically significant at P < 0.05 .

Results

All the 115 participants who took part in this study, completely filled in questionnaires. Among these 115 participants, males constituted (45.2%) and females (54.8%). Mean age of students was 21.09±0.823 years.Abnormal body image perception was seen in 49.6% and majority of them were female(33.9%). 34.8% of the students had abnormal eating disorder. Females more than males had disordered eating attitudes and there was a statistically significant association between gender and body perception (p-value = 0.04) gender and eating disorder (p-value = 0.049) (Table 1).

Discussion

In this study, nearly half (49.6%) of the study population had abnormal body image perception. Similar study conducted by Priya et al, 33.3% of their study population were not satisfied with their body image.⁴ Body image dissatisfaction reported internationally ranged from 43.9% (using Figure Rating scale) in a study conducted by Barreto et al was 75.49% in Brazil.⁵ The difference in prevalence can due to the prevailing sociocultural, educational and environmental factors and also because different scales/methods were used to assess body image perception. In this study, abnormal eating attitude was seen in 34.8% of the students. Comparing this results to other studies in India, which reported a prevalence of abnormal eating attitude as16.9% by Ramiah et al,629.2% by Shashank et al7 and only 4.5% in a study conducted by Yu J 8 in China.

Conclusion

There was a high prevalence of abnormal body image perception and disordered eating attitudes in medical students and we also found that females more than males had disordered eating attitudes. Thus giving us a deeper insight when it comes to body image and eating disorder among the younger generation. The study also reported a significant statistical association between gender and EAT-26 score. Preventive efforts and screening at institutional levels should be made to promote a healthy outlook towards body image and eating behaviours.

Limitation

In this study the participants were chosen by universal sampling that was conducted in a single study centre. Hence the obtained findings cannot be generalized to other settings. Anonymous selfadministered questionnaires can lead to biased answers and results and there is a need for further follow up by a qualified professional.