http://dx.doi.org/10.24016/2020.v6n2.161
ORIGINAL ARTICLE
Risk of eating disorder in
Colombian women who go to the gym
Riesgo de trastorno de la conducta
alimentaria en mujeres colombianas que van al gimnasio
Jorge Emiro Restrepo 1
* y Tatiana Castañeda Quirama 2
1 Tecnológico
de Antioquia, University Institution,
Bogotá, Colombia.
2 Politécnico Grancolombiano, Institución Universitaria, Bogotá, Colombia.
* Correspondence: jorge.restrepo67@tdea.edu.co
Received: May 08, 2020 |
Revised: June 11, 2020 | Accepted: June 28, 2020 | Published
Online: June 29, 2020.
CITE IT AS:
Restrepo, J. & Castañeda,
T. (2020). Risk of eating disorder in Colombian women who go to the gym. Interacciones, 6(2), e161. http://dx.doi.org/10.24016/2020.v6n2.161
ABSTRACT
Background: Mental health in gyms has not been a topic of study in Colombia. Social stereotypes of beauty and dissatisfaction with body image make women a population prone to excessive exercise. This research analyzes the risk of eating disorder in women who attend gyms (comparing ages), its relationship with the frequency of physical exercise and the use of diet to improve physical appearance. Methods: 519 women with ages between 15 and 50 years participated. The EAT-26 Eating Attitude Test was used, a standardized procedure to estimate the frequency of physical exercise and a brief socio-demographic survey. Results: the percentages of women with risk (46.8%) of TBI and without risk (53.2%) are similar, the factor scores and the total of the EAT-26 only show significant differences in the age range 15 -19 and 20-24, no significant correlations were found between the factors and the total score of the EAT-26 and the measure of frequency of physical exercise, and there is an association between the risk of eating disorders and diet to improve physical image. Conclusion: The percentage of women at risk for eating disorders is higher than those reported for high school students, university students, and athletes. A very high percentage of gym users would be compromising their mental health in some way, considering the frequency values of physical exercise.
Keywords: Eating disorder, gyms, physical exercise.
RESUMEN
Introducción: La
salud mental en los gimnasios no ha sido un tema de estudio en Colombia. Los
estereotipos sociales de belleza y la insatisfacción con la imagen corporal
hacen que las mujeres sean una población proclive al ejercico excesivo. Esta
investigación analiza el riesgo de trastorno de la conducta alimentaria en
mujeres que asisten a gimnasios (comparando las edades), su relación con la
frecuencia de ejercicio físico y el uso de dieta para mejorar la apariencia
física. Métodos: participaron 519 mujeres con edades entre los 15 y los 50 años. Se
utilizó el Test de Actitudes
Alimentarias EAT-26, un
procedimiento estandarizado para estimar la frecuencia de ejercicio físico y
una breve encuesta sociomdemográfica. Resultados:
los porcentajes de mujeres con riesgo (46,8%) de TCE y sin riesgo (53,2%) son
similares, las puntuaciones de los factores y el total del EAT-26 solo
presentan diferencias significativas en el rango de edad 15-19 y 20-24, no se encontraron correlaciones
significativas entre los factores y la puntuación total del EAT-26 y la medida
de frecuencia de ejercicio físico, y sí hay asociación entre el riesgo de TCA y
la dieta para mejorar la imagen física. Conclusión: el porcentaje
de mujeres con riesgo de TCA es superior a los reportados para estudiantes de
secundaria, estudiantes universitarias y deportistas. Un
muy alto porcentaje de las usuarias de gimnasio estarían comprometiendo de
alguna forma su salud mental, considerando los valores de frecuencia de
ejercicio físico.
Palabras clave:
Conducta alimentaria, centros de acondicionamiento, ejercicio físico.
BACKGROUND
Concern for, and even rejection of, plumpness and the
ideal of a body adjusted to socially determined aesthetic parameters are
increasingly frequent problems in a society in which cultural stereotypes of
beauty promote thinness and slim-line silhouettes certain models of beauty (Brudzynski and Ebben, 2010; Musaiger
and Al-Mannai, 2014). The desire to achieve an
idealized figure has motivated, in some people, an intensified use of gyms as a
means of improving their appearance and increasing satisfaction with their body
image (Franco, Ayala & Ayala, 2011; Polivy &
Herman, 2002).
Cultural stereotypes of beauty, dissatisfaction with
body image and frequent physical exercise are a combination that has been shown
to be associated with an increased risk of eating disorder (ED) (Granados &
Del Castillo, 2009). Studies carried out with a population at risk of eating
disorders have indicated that acceptance of body image is conditioned by the
assessment of other people and the physical comparisons they make, therefore,
the greater the sociocultural influence, the greater the perception of body
fat, greater dissatisfaction with the image, lower assessment of physical
self-concept and greater need to perform physical exercise (from Sá Resende Santos, Santos, Rodrigues, Falcão
and Mendes, 2019).
Frequent exercise can lead to a decrease or alteration
in diet and nutrition (diets or insufficient intake) with a consequent increase
due to concern about weight and physical appearance. Women who attend gyms
generally have a desire to improve their body image through frequent exercise
and dieting or other modifications in their eating behaviors (Smink, van Hoeken & Hoek,
2012). This combination can increase the risk of eating disorders.
Women and athletes have a high vulnerability to eating
pathologies (Currie, 2010; Niñerola and Capdevila, 2002). Exercising, under certain conditions, can
be a trigger for an eating disorder (Fajardo, Méndez & Jauregui, 2017). It
has been indicated that the sports environment can not only precipitate or
aggravate an eating pathology, but also legitimize it, since these environments
favor competition, overtraining and food restriction, since the ideals of body
image often imply the loss of weight or body fat as a method of looking slim.
Most of the studies on ED in Colombia have been
carried out regularly with high school students (Barrera, Manrique and Ospina,
2013; Fandiño, Giraldo,
Martínez, Claudia and Espinosa, 2007; Moreno et al., 2016; Rodríguez and Mina, 2005;
Rueda et al., 2005). In university students, a prevalence of 44.1% was reported
in women and female gender and the desire to reduce weight were found as
associated factors (Constaín et al., 2014). Mental
health, and its physical implications, in gyms has not, until now, been a topic
of interest in Colombia or, as reflected by the limited literature, in Latin
America. Exercise is health, but certain excesses or associated conditions can
change a healthy practice into an activity that is detrimental to physical and
mental health.
In the results of the study by Sánchez, Miranda and
Guerra (2008) it was reported that 48% of the women evaluated go to the gym to
be in shape. Likewise, the investigation by Dosil and
Díaz (2012) found that there is a high risk of suffering from eating disorders
in women who exercise in gyms (9.20% obtained a score higher than 30 on the
EAT, which is indicating symptoms of a severe ED). In addition, Lentillón-Kaestner (2015) found that 10.31% of women who
attend cardio-fitness classes reached a critical threshold, indicating an
Eating Disorder (EAT-26 score ≥ 20) and reported that the greater the sports
commitment of the users, the greater the risk of suffering from eating
disorders.
In the study by Castrejón
(2018), carried out with gym users, it was found that 14.5% present risky
eating attitudes, the risk being higher in women (16.1%) compared to men (13.0%).
This result agrees with the findings of San Mauro et al. (2014), who found that
more than 50% of the sample studied had concerns about their physical
appearance, the highest percentage being in women (66% in women vs 45% in men),
in addition those evaluated mentioned that the acceptance of their image was
conditioned by the assessment of other people and the physical comparisons they
made, therefore, the greater the sociocultural influence, the greater the
perception of body fat, the greater the dissatisfaction with the image and the
lower the assessment of physical self-concept.
Regarding abnormal eating patterns and compensatory
behaviors used by women suffering from ED, Castrejón
(2018) found that 100% of gym users presented restrictive eating behaviors, 58%
binge-eared and 92% stated having performed compensatory behaviors, such as:
taking laxatives, diuretics or pills to lose weight, in addition to prolonged
fasting (41.6%). In those evaluated, purging had two main functions: to
compensate for binges and to reduce calorie intake, regardless of the amount of
food eaten.
Castro-López, Cachón,
Valdivia-Moral and Zagalaz, (2015) reported that
there were significant differences in the hours spent in the gym between the
subjects who presented greater concern for the image, compared to those who did
not, since the group of Subjects who reported spending more than 21 hours a
week in the gym had a higher risk of eating disorders, a result that is
compatible with the findings of López-Barajas, Castro-Lopez and Zagalaz-Sanchez, (2012), who stated that eating disorders
are related to concern about the increase in hours that must be devoted to
exercise routines in the gym.
It is possible to identify some indicators related to
the risk of suffering from ED in those who practice physical activity, of which
the deficit in self-concept and self-image stands out, since when a distortion
occurs in these self-schemas, there is a greater probability that dependence
will develop physical exercise as a strategy to lose weight and look slim
(Cifuentes, 2016). This is consistent with the results of Chacón
and Moncada (2013), who found in their study that participants with the highest
body fat percentage also had higher body dissatisfaction scores. Baile, González, Ramírez and Suárez, (2011) observed that
gym users who have alterations in their body image also have more altered
eating and exercise habits,
Souza,
Souza, Barroso and Scorsolini-Comin, (2013) highlighted that one of the main reasons why
people start physical activity programs is dissatisfaction with the body, hence
in the results of their research they found that more than half of the women
who were evaluated (54%) and who had a normal body mass index reported that
they wanted to weigh less or that they felt dissatisfied with their weight,
which is why they had a constant fear of gaining weight and exhibited abnormal
eating behaviors.
Knowing the mental health conditions of people who
carry out physical activity will allow the elaboration and implementation of
promotion and prevention programs and strategies aimed at generating behavioral
changes that affect the risk of eating disorders. The general objective of this
study was to analyze this risk in a sample of female gym users in the city of
Medellín, Colombia. According to the literature review, this is the first study
in the country and one of the few in Latin America to address this problem with
this particular population. The research questions that guided the study were:
1.
What is
the prevalence of ED risk in a group of women who go to the gym?
2.
Are there
statistically significant differences in the factor scores and the total risk
score for eating disorders as a function of age?
3.
Are there
any correlations between ED risk and gym frequency self-reports?
4.
Is there
an association between the risk of eating disorders and diet to improve
physical appearance?
METHOD
Design
A cross-sectional ex post
facto investigation was carried out with a quantitative,
descriptive-correlational approach using non-probabilistic convenience
sampling.
Technique for gathering
information
The technique used was the
unstructured interview, which seeks the information that is needed through
defined topics or focuses. Díaz, Torruco, Martinez
and Varela (2013) state that this type of interview is informal and flexible,
whereby it adapts to contextual conditions. However, this does not prevent us
from delving into the subject and detailing relevant aspects for the research.
Through the question and answer, the life reconstruction of the interviewed
person is achieved and in his story the meaning that the person has about an
experience or topic addressed is reflected, in this case the experience of
suffering from Type 2 Diabetes Mellitus.
Participants
The study involved 519
women aged between 15 and 50 years (Me = 23.64; IQR = 20-26). 62.6% of the
women had university education, 17.0% had technical or technological education,
16.4% were high school graduates and 4.0% had postgraduate training. 66.5% were
in the middle socioeconomic stratum (3 and 4), 18.3% in low (1 and 2) and 15.1%
in high (5 and 6). The participants were contacted in 12 gyms in the city of
Medellín, Colombia. They performed different training modalities, such as: CrossFit,
functional training, weightlifting and traditional use of machines. The only
inclusion criterion was that they had been attending the gym for at least three
months. The instruments were completed by self-report.
Instruments
The instruments and
techniques for collecting information were: 1) a sociodemographic questionnaire
that included questions about age, education, socioeconomic status, time
devoted to exercise (total time in months attending, days per week and routine
hours per day) and the consumption of diets to improve body image. 2) The
Eating Attitudes Test (EAT-26): has a validation in the female population of
the city of Medellín (David, et al., 1993) with an appropriate factorial
structure (determinant of the correlation matrix = 0.000000291, Bartlett's
sphericity test = 2.466.48 with a p <0.0001, and Kaiser-Meyer-Olkin measure
of sampling adequacy = 0.90), excellent reliability values (Cronbach's alpha
was 0, 92) and sensitivity (100.0%; 95% CI: 86.3-100.0%), and an adequate
specificity value (85.6%; 95% CI: 77.6-91.5%), appropriate for screening for
possible eating disorders in a population at risk. The risk of eating disorders
is satisfied with a score ≥ 20. It is made up of four factors: diet, bulimia,
preoccupation with food, and oral control. And 3) a measure of the frequency of
physical exercise: the procedure suggested by Davis, Brewer and Ratusny (Campo and Villamil,
2012), which has been used in multiple investigations on the subject, was
adopted. The participant was asked to indicate the following: the number of
weeks of gym attendance during the last 12 months, the average number of
sessions per week, and the average duration (in minutes) of each session (1-30,
30- 60, 60-90, 90-120, 120+).
Analysis plan
The parametric data
(according to the Kolmogorv-Smirnov test in which all variables obtained a
p> 0.05) were systematized and analyzed using the IBM SPSS v. 24 using
descriptive statistics, one-way ANOVA (Tukey's HSD post hoc test), bivariate
correlation analysis (Pearson's correlation coefficient), and chi-square
independence test. The results were considered significant for p values
<0.05.
Ethical aspects
The research was carried
out in compliance with the provisions of Law 1090 of 2006 of the Colombian
College of Psychologists, as well as Resolution 8430 of 1993 of the Ministry of
Health of Colombia. The project was reviewed and approved by the Bioethics
Committee of one of the universities that executed it. The objective of the
project was explained to them and all participants signed the informed consent.
RESULTS
The women had been attending the gym for between 3 and
252 months (Me = 24; IQR = 12-48). Attendance occurred at least one day a week
and maximum every day of the week (Me = 5; IQR = 4-5). The daily routine hours
varied between 1 and 5 (Me = 2; IQR = 1-2). 46.8% of the participants were on a
diet to improve physical appearance.
As can be seen in Table 1,
the percentages with risk and without risk are similar, although the percentage
of participants without risk is higher. In the percentages discriminated by age
ranges, the results are similar, with the exception of the ranges of women with
ages between 30 and 34 years, and the age range equal to or greater than 35
years. Here the percentages at risk are higher than the percentages without
risk.
Table 2 contains the values of the medians and
interquartile ranges of the factors and the total score discriminated by age
ranges. The one-way ANOVA analyzes for all factors and the total score
comparing the ranges only reported statistically significant differences in the
Oral Control factor. Tukey's HSD post hoc test indicated that statistically
significant differences are between the 15-19 and 20-24 ranges.
No statistically
significant correlations were found between the factors and the total score of
the EAT-26 and the measure of frequency of physical exercise (see Table 3). The
chi-square test to analyze the association between the risk of eating disorders
(With risk / Without risk) and the realization of a diet to improve the
physical image reported a positive result (χ² = 6.44; df = 1; p = 0.011). In such a way that there is an
association between the risk of eating disorders and this type of diet.
DISCUSSION
The findings of this study were: first,
the percentages of women at risk of ED and without risk are similar, although
the percentage without risk is higher. Second, the factor scores and the total
of the EAT-26 only present significant differences in the age range 15-19 and
20-24. Third, no significant correlations were found between the factors and
the total score of the EAT-26 and the measure of frequency of physical
exercise. And fourth, there is an association between ED risk and diet to
improve physical image.
In Colombia there are few studies on
eating disorders in female gym users and this prevents comparisons. The studies
that have been carried out have used the general population, regularly
students. In female secondary school students, prevalences
have been reported with a range between 3.5% and 41.3% (Barrera, Manrique and
Ospina, 2013; Fandiño et al., 2007; Moreno et al.,
2016; Rodríguez and Mina, 2005; Rueda et al., 2005). In university students,
the range is from 20.4% to 44.1% (Campo and Villamil,
2012; Fandiño et al., 2007), higher than that of high
school students, but lower than that of gym users, whose percentage is of the
47.5% (Sánchez, Miranda and Guerra, 2008).
The findings on risk factors associated
with the risk of eating disorders suggest that there should be a greater
probability of risk in those who attend gyms. It has been found, for example,
that female gym users who perform sports for aesthetic purposes frequently
alter their eating habits in order to lose fat, weight and flaccidity (Costa,
Fernandes, Matsudo & Cordás, 2008). Almost half
of the women in the present study were dieting to improve physical appearance,
which could eventually be associated with an increased likelihood of ED risk.
Pursuing aesthetic purposes, that is,
seeking to improve physical appearance (body image) is one of the reasons why
some people attend gyms (Baile, González, Ramírez
& Suárez, 2011). This desire has been associated with a negative
self-image. Lentillon-Kaestner (2012) observed that
gym users who have alterations in their body image also have more altered
eating and exercise habits, which supports the hypothesis that the acceptance
or not of body image has a significant impact on the altered eating behaviors
and inappropriate use of the gym.
Previously,
in the same city, but with a smaller sample and from different fitness centers,
Restrepo and Castañeda (2018) had analyzed the
relationship between the risk of eating disorders and the use of social
networks in women. Using the EAT-26 and a questionnaire on the use of social
networks, they reported a risk percentage of 47.5% and a statistically
significant association with some aspects of the use of networks: the group at
risk took more photos to show their progress in the gym, more frequently compared
their photos with those of other people they consider to be a "better
figure" and when they upload a photo to Instagram they expect to have more
likes
and positive comments about how they look.
The
present study found a similar percentage and detected a statistically
significant association between ED risk and diet to improve physical
appearance. This finding is in line with other studies that suggest that there
is an interaction between dissatisfaction with body image, excessive exercise
and the risk of eating disorders (Laus, Braga &
Almeida, 2013). It is likely that the use of gyms is more oriented towards the
search for an aesthetic ideal or the desire to improve body image due to media
and sociocultural pressures (Musaiger and Al-Mannai, 2014). The excessive practice of physical exercise
in this group of Colombian women may be more motivated by the desire to modify
their physical appearance and this motivation, as other research has shown (González-Cutre and Sicilia, 2012)
is a risk factor for the development of an eating disorder or an addiction to
physical exercise.
Although there are reasons and empirical
findings that support the idea of a high prevalence of ED risk in gym users
compared to the general non-clinical population, the results of the studies
remain heterogeneous. In female gym users, prevalences
of 10.31% (Ward, Rodriguez, Wright, Austin and Long, 2019), 16.1% (Castrejón, 2018) and 50% (Baile,
González, Ramírez and Suárez, 2011). The results of the present investigation
are closer to this last study, which was carried out in Brazil. Without a
doubt, the prevalence is higher in gym users compared to the general
population.
In women older than 30 years there is a
higher percentage of risk of eating disorders, but this descriptive information
was not supported by statistical analyzes to detect significant differences,
nor does it coincide with epidemiological reports (Currie, 2010), although
these have been carried out with the general population. Statistically, the age
ranges only differed in the Oral Control factor (ranges 15-19 and 20-24). In
the total score of the instrument, which defines the risk of eating disorders,
there were no differences between the ages. The percentage of prevalence of ED
in women has been reported to increase from 10.3% at 21 years to 19.4% at 40
years (Shroff, Thornton, Tozzi, Klump
& Berrettini, 2006).
The Oral Control factor depends on the
items: "I cut my food into small pieces", "I notice that others
would prefer that I eat more", "Others think that I am too
thin", "I take longer to eat than other people "And" I
notice that others are pressuring me to eat "and is associated with a
concern to reduce the amount of food eaten. This concern, which may be related
to the diet that almost half of the women were doing to improve their physical
appearance, is associated with dissatisfaction with body image and is
associated with the pathogenesis of eating disorders (Granados and Del
Castillo, 2009, Restrepo and Castañeda, 2018). This
finding coincides with the one reported by Castrejón
(2018) in relation to abnormal eating patterns and compensatory behaviors used
by women suffering from ED,
So oral control seems to be a differential
aspect of the eating behavior of women between 15 and 24 years of age.
According to the epidemiological study by Ward et al., (Shroff et al., 2006),
which analyzed the dynamics of ED as a function of age, adolescence and young
adulthood are critical periods for the initial development of an ED, with
almost all cases (95%) occurring for the first time by the age of 25 years.
Thus, they suggest concentrating prevention efforts at these ages. However,
they highlight that, given the risk of relapse and continued prevalence at
later ages, diagnosis and treatment at older ages should also be a priority.
This recommendation is interesting since,
when comparing the risk of ED (with / without) according to age, the group of
women over 30 years of age had the highest percentages in the group at risk. Undoubtedly,
it is an unexpected finding since it does not coincide with the reports in the
literature in which, as stated, a higher prevalence has been detected between
adolescence and young adulthood. However, these reports have been made
predominantly with a population other than gym users. Complementary studies
should be carried out to find out the reasons that motivate the use of the gym
in this age group in order to advance in the understanding of these
differences.
Excessive exercise is a common feature of
eating disorders. Between 21% and 55% of people with eating disorders exercise
excessively, and this is associated with an earlier onset, more symptoms, and a
greater persistence of these disorders (Bratland, Martinsen, Rosenvinge, Ro and Sundgot, 2011).
Other studies (Cook, Hausenblas, Crosby, Cao & Wonderlich, 2015) have also reported that ED symptoms are
positively associated with a weekly amount of vigorous, non-moderate physical
activity; that is, with an excess of physical activity, but they have concluded
that it is more important to analyze the intensity of the exercise and not its
frequency. In the present study, no correlation was found between the risk of
eating disorders and the frequency of exercise. Cook et al. (Ghoch, Soave, Calugi and Dalle,
A descriptive study conducted in the United States between 2011 and
2015 in which more than a million people participated analyzed the association
between physical exercise and mental health and concluded that more exercise is
not always better: extreme ranges of more than 23 times a month, or more than
90 minutes per session, were associated with worse mental health (Ghoch, Soave, Calugi, & Dalle, 2013). According to the authors, exercising beyond 6
hours per week is associated with poorer mental health.
With
these figures as a reference, the women who participated in the present study
would be above, with a frequency of weekly hours of 10 hours (calculated from
the median hours per day and the median days per week). Thus, although only
half are at risk of eating disorders, a very high percentage of gym users would
be compromising their mental health in some way. In this way, gym trainers
should be a target for education on eating disorder risk factors, as they are
potential 'agents' for early detection of eating disorders (Ghoch,
Soave, Calugi and Dalle,
2013).
One
of the main limitations of this study was the failure to form age groups with
the same number of participants. Although it was tried, there are definitely
some age ranges in which there are more women who go to the gym (20 to 30
years). Differences in the frequencies of participants by rank may have
affected the results. Despite this, this is, most likely, the first study on
the risk of eating disorder in Colombian women who attend gyms. It is also one
of the few Latin American studies on mental health in people who are active in
fitness centers. Despite this, it coincides to a very high degree with a study
carried out in Colombia with
university students in which a prevalence of 44.1% was reported in women and
the female gender and the desire to reduce weight were found as factors
associated with the risk of ED (Constaín et al.,
2014).
ORCID
Jorge Emiro Restrepo https://orcid.org/0000-0001-8790-7454
Tatiana Castañeda Quirama
https://orcid.org/0000-0002-1132-4241
FUNDING
This
research was funded by the Tecnológico de Antioquia
-University Institution and the Politécnico Grancolombiano -University Institution
CONFLICTS OF INTEREST
None
of the authors declares a conflict of interest.
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