Introduction

Risky eating behaviors (REB) are partial or subclinical manifestations of eating disorders, which occur with less intensity and frequency, and whose presence may be prior to the onset of the last one¹. In Mexico, eating disorders have increased 300% in the last 20 years, with higher prevalence in adolescents and women, mainly between the ages of 14 and 19 of age^1,2. On other hand, the most frequent REB are worry over getting fat, eating too much and, losing control over what is ingested².

Formerly research on eating disorders and REB was mainly conducted in women and adolescents³. However, it presence has been reported in men³ and university students^4,5. Regarding the presence of REB in young adults, several studies have been conducted in the center of the country^1,6. Likewise, some authors have theorized that eating disorders and REB might be present in those who begin their university career given the stress derived from making key decisions for their future^4,6.

The state of Veracruz ranks 5^th nationally in the number of people with obesity⁷. This nutrition disorder has been widely related to REB¹; however there are scarcely reports on the prevalence of REB for this state. Likewise, it has been described that increased body mass index is directly related to body dissatisfaction. Also, people with obesity or overweight reported higher body dissatisfaction scores^1,8.

Body dissatisfaction is characterized by value judgments about one's own body, which often do not conform to reality. It is influenced by social and cultural factors, among which body aesthetic models are the most important⁹. Body dissatisfaction is considered a risk factor for the development of risky eating behaviors and an important factor in the origin and maintenance of eating disorders.

Several authors recognized adolescence as the most critical period of life for body dissatisfaction, since the stresses of pubertal development plus the aesthetic ideal of their own social context could trigger eating disorders, at this or subsequent life stages. However, recent studies showed emerging adulthood can also be a risky stage due to the psychological and social instability of this phase⁶.

Based on the foregoing, we conducted this study to determine the correlations among the presence of REB, nutritional status and body dissatisfaction for incoming university students.

Methodology

A cross-sectional study was carried out new university students, who voluntarily agreed to participate and were in the age range of 18 to 29 years. The study was carried out in the Area of Nutrition of the Center for Studies and Health Services (CESS), under the criteria indicated by the Research Committee and the Ethics Committee of the CESS. The protocol was registered in the University Linking System and in the Research Registration and Evaluation System following the administrative procedures of the University.

Results

A total of 1,399 students participated, of whom 1,378 completely answered the questionnaires on risky eating behavior and body satisfaction/dissatisfaction, and 21 of the participants did not have complete data, and were not considered in the statistical analysis. Thus, the final sample consisted of 1,378 subjects of which 49.5% are male and 50.5% female. Women had a frequency of 7.2% of high-risk eating behaviors and men of 5.0%, without statistical differences. The scores of the main variables analyzed are shown in Table 1. We also found that the percentage of overweight/obese men was much higher (45.75%) than women (36.27%), without statistically significant differences.

Statistically significant differences among the percentages of body dissatisfaction were found when compared according to the risk of developing risky eating behaviors (No risk, Moderate risk, High risk). The latter group showed the highest percentages of body dissatisfaction, and the most problematic areas were: abdomen (71.4%), waist (61.9%), arms and face skin (47.6%) and hips (45.2%). (Supplementary Table 1).

People with obesity had a higher mean in REB and lower score on global body satisfaction, satisfaction with arms, abdomen and waist, compared to those with a different nutritional status (Table 2).

Risky eating behaviors, body mass index, body fat percentage and waist circumference showed positive significant correlations of medium magnitude. On the other hand, major scores on global body satisfaction and body satisfaction of different body parts were inversely associated with lower risk on REB; these correlations were stronger in the case of waist and abdomen (Table 3).

Poisson model revealed that body mass index, body fat percentage, satisfaction with hands, abdomen, waist and legs are the best predictors of risky eating behaviors (Supplementary Table 2).

Discussion

Research on eating disorders and risky eating behaviors (REB) have increased over time, due to their prevalence and health consequences, mainly in the young population^1,17. According to the National Health and Nutrition Survey concerns about gaining weight, losing control over eating and overeating were the most frequent REB in the Mexican adolescent population. Particularly the latter was reported with higher frequency by both genders. Meanwhile, in the Mexican university population, a prevalence of REB of 7.9-18.9% has been reported for women, and 4.2-13.0% for men^5,6,18. However, these studies are limited to the center of the country. Thus, greater recognition and exploration of REB prevalence is required, as well as the identification of possible predictive factors.

In an effort to expand data on the prevalence of REB and possible predictive parameters for them, we conducted a study on university students (n=1399; aged 18 to 29) of the southeast of Mexico. The results revealed a prevalence of high-risk eating behaviors (7.2% for women and 5.0% for men) similar to other studies¹⁹. For a long time, the belief that women were the most susceptible population to develop REB or eating disorders, dominated the literature. However, current national and international reports show the male population is not exempt from developing them, but it is necessary to document the facts, and even modify the measurement scales for men^4,5,20.

Going deeper into the results, we found participants with high-risk EB showed greater body dissatisfaction (BD), focusing on the waist and abdomen (Supplementary material). These two body areas are central points in the predominant aesthetic ideal: a slender, proportionate and harmonious body, with a small waist (for women) and a flat abdomen (for men and women) and an imposed eternal youth appearance, as a synonym of beauty^12,21. This physical model permeates mainly in young people (such as those in our sample), driving obsession to rectify those “imperfections” not attached to the model. These obsessions can manifest through behavioral disorders such as bigorexia, orthorexia or REB^12,22,23.

Analyzing data of participants categorized as obese, a high prevalence of REB and low body satisfaction, with the lowest satisfaction score for the waist and abdomen was found.

Since REB are actions carried out mostly in an attempt to control body weight, it is expected that individuals far from the “ideal” weight will perform them, and at the same time find themselves dealing with the acceptance of their own bodies²⁴. Likewise, it has been described obesity can be a predictor of dissatisfaction with the body image (in adolescents)¹. This dissatisfaction is linked to the mental representation of their physical appearance, which is distorted because of the imbalance in the perceptual, cognitive-affective, and behavioral components of the self-image, plus social criticism. This imbalance can lead to the execution of behaviors such as REB^21,22.

On the other hand, in our sample, there is a direct correlation among high scores of REB, higher body mass index, and greater amount of body fat. In this regard, several articles have reported more frequently the relationship between body mass index and REB^1,5,6. Instead, this is the first report that mentions the correlation of a higher percentage of body fat and greater waist circumference with REB. In the literature, the increase in body mass index over time has been associated with the development of REB¹. Therefore, if we use this indicator, plus the other two mentioned above, we could have more reliable data for early interventions with people who show other signs of REB.

This last result was corroborated by performing the multivariate analysis of our data since we found that body mass index, body fat percentage, satisfaction with hands, abdomen, waist, and legs are the best predictors of REB development. The body mass index had already been previously reported as a predictor, but not the other variables^5,8. Furthermore, a previous study showed that body dissatisfaction with the abdomen is present in both genders¹². It noteworthy that the body areas identified in our study as REB predictors: abdomen, waist and legs, are focal points of the ideal aesthetic image that prevails in the advertising media and in society. Particularly, a slender figure, with a delineated waist, shapely legs and a body that is not excessively muscular, is appreciated by women¹⁹. The internalization of these parameters can generate dissatisfaction. It has been widely discussed in the literature that individuals who are dissatisfied with their body image do not see the real image when they view their own body⁸. Instead, they see an image that is influenced and “modified” by personal perceptions of the perfect body. This distortion of body image plus body image dissatisfaction has been linked to eating disorders⁹. Although REB, are at a midpoint between “normal” eating behaviors and eating disorders, their presence reveals psychological features of the individual that presents them, because it is associated with problems of self-perceived image distortion, leading to low rates of body satisfaction and low self-esteem, which favors the execution of REB^1,25. Likewise, REBs are a health risk for those who practice them, since they have been associated with the appearance of chronic degenerative diseases²⁰ and the permanent risk of developing eating disorders and their consequences (weakness and loss of muscle mass, osteoporosis, electrolyte deficiency, renal failure, heart failure, etc.).

Some authors agree that the clearest manifestations of REB occur in adolescence¹. If we consider that the analyzed population ranged between 18-29 years, we could assume that the factors associated (for example, low self-esteem, low body satisfaction, etc.) with REB were present, and their influence was accentuated by the new challenges of this age segment (emerging adults), who are under the demands of adequate performance at university, new residence, starting a family (for some), etc. In addition to the prior sentences, in our country and the state of Veracruz, the prevalence of overweight and obesity, also present in the emerging adults surveyed, affects the risk of developing REB.

This study is the first of its kind in the southeast of the country, and was conducted at the largest university in this area, which made it possible to work with data from 1,378 students who were entering university for the first time. With these data we were able to identify predictor variables REB in the sample. As a limitation of our study, since we could not guarantee the participation of all the newly admitted students who belonged to the study region, approximately 40% were surveyed; 21 of these cases did not have complete answers, thus this data were eliminated for statistical analysis. Likewise, an age range (18-29 years) was established as a requirement to be surveyed, so that new students outside the range could have been discarded.

Another no less important complication was that we did not find any report on the validation of the Body Satisfaction-Dissatisfaction Scale. However, when carrying out a preliminary analysis with the 1378 available cases, we found that there is a Cronbach's Alpha of 0.93, for the satisfaction measurement (in which values from 0 to 10 are assigned). A similar scale obtained a Cronbach's Alpha of 0.87 when it was applied to 452 students between 15 and 19 years of age²⁶. We also carry out an analysis of the reliability of the scale where the problematic body parts are indicated, obtaining 0.85 reliability with the Kuder-Richardson formula 21 (KR -21)²⁷. Therefore, we consider it as a next step to validate the scale, to avoid the instrument's reliability bias.

Conclusions

This study shows the correlation between risky eating behaviors, nutritional status and body satisfaction in a sample of incoming university students from the largest university in southeastern Mexico. These behaviors are linked to body dissatisfaction in specific areas, so their observation and attention could help in the prevention of REB or the possible installation of eating disorders. Research in this field should also continue in different regions of the country and by population segments (e.g., rural vs. urban population) to reinforce conclusions.