Arab Journal of Nutrition and Exercise (AJNE) | AJNE: Vol 1, No 2 (2016) | pages: 62-76

and

1. Introduction

Eating disorders are defined as a group of serious conditions caused by preoccupation with food and weight that might threaten individual's health and quality of life [3]. The Diagnostic and Statistical Manual for Mental Health Fifth Edition (DSM V) classifies them into: Pica, Rumination Disorder, Avoidant/ Restrictive Disorder, Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder [2]. The link between these disorders and several serious physical and psychological complications, such as amenorrhea, osteoporosis, heart diseases, depression, and death in some cases is established [3,23].

Increasing evidence supports the link between having disordered eating attitudes and the likelihood of developing eating disorders which makes studying the former a predictor of the latter [22]. Extreme dieting behaviors such as restricted food intake and compulsive physical activity have been associated with abnormal eating attitudes and are worth in-depth study [14,33]. It is important to note that studying these attitudes is preferred using a multi-dimensional perspective, since a number of interpersonal, psychological and social risk factors have been linked to its development [18,24]. For example, the history of abuse and disturbed personal relationships, having low self-esteem, stress, depression, lack of control and being from a culture where “thinness” is glorified were found to increase the likelihood of eating disorder development [18,24].

Physical activity is linked to positive outcomes and proposed as a treatment method for individuals with eating disorders [3]. The association between physical activity and many positive outcomes such as decreased risk of obesity, chronic diseases and improved psychological health is documented [29]. A positive relationship between increased obsession about physical activity and eating disorders has been found, especially among athletes and known as “anorexia athletica” [14,33][27]. Studies highlight that in most cases this obsession becomes dysfunctional, leading to spending hours in exercising, mood changes and withdrawal symptoms, such as missing social gatherings frequently, as well as physical and psychological problems. This phenomenon was described by earlier studies as “Exercise Dependence” [33,19].

The Academy of Eating Disorders estimates that one in five women struggle either with eating disorders or disordered eating attitudes [1]. In the UAE, a study by Thomas, et al. found 24.6% of the surveyed undergraduate Emirati females with abnormal eating attitudes and 74.8% were dissatisfied with their body size [25]. Zmijewski, Howard and Musharrafieh, et al. found a positive relationship between disordered eating attitudes, hours spent in exercise and exercise-dependent symptoms among university students [33,16]. Nevertheless, this relationship needs to be investigated among the UAE population before accepting it.

The United Arab Emirates (UAE) is a young country with more than one third of its population considered overweight and obese, not to mention cardiovascular diseases and type2 diabetes, the leading causes of death, that are linked to obesity in the country [11]. Growing evidence shows increased physical inactivity among UAE population and high levels of disordered eating attitudes among young females [17,25,26,28,29]. This is clearly concerning, but little is known about the activity level of those with disordered eating attitudes and their dieting behavior. This study aims to provide better insights into undergraduate university student's disordered eating attitudes in relation to exercise behavior and the effect of selected social factors on student dieting behavior.

2. Methododology

2.1. Study Design

A cross-sectional study was used to explore the relationship between eating attitudes and exercise behavior among Emirati college students attending a public university in Dubai during October- November 2014. An ethical clearance was obtained from the university's Research Ethics Committee; an informed consent that stated the purpose of the study, benefits and the right to withdraw at any stage was attached to the study questionnaire. The questionnaire was translated into Arabic and piloted on a group female students who are not included in the analysis for this study. IBM SPSS Statistics v.21 was used for analysis. The Chi-square test was employed to compare frequencies. Significance level was set at 0.05.

2.2. Sample Selection

A systematic random recruitment of classes was used as a sampling method. A list of all the classes offered by University College in fall 2014 semester at the Dubai campus was imported from the University's Banner Web. There were 180 classes and it was estimated that each class has approximately 22 students. Every 6th class was contacted to take part in the study. A total of a sample of 365 participants was reached from the responses. This was filtered by the inclusion criteria (females, UAE citizens, aged 17-25 years old, free from diseases and in the first or second year of college) to reach a net sample of 242.

2.3. Instrument

A 7-page self-administered questionnaire was distributed. The cover page entailed formal informed consent. The following six pages consisted of four sections: personal information, eating attitudes, physical activity level and exercise dependence.

2.3.1. Section 1

Sought to explore demographic information such as age, year of study, residency, etc. Also, it looked at different personal and social factors that might influence levels of physical activity and eating attitudes.

2.3.2. Section 2

Was a pre-validated, widely used reliable screening tool for eating attitudes, EAT26. Eating Attitudes Test- 26 (EAT26) was first developed in 1993, and aims to identify the risk of developing eating disorders among adolescent and adult age groups through a set of 26 items and five behavioral statements [9]. Items in this test cover four main areas: dieting scale, bulimia and food preoccupation scale, oral control subscale and behavioral questions. EAT-26 has been used as a screening tool for eating disorders and reported an accuracy of 90% when compared against a diagnostic interview by a qualified professional [13]. In EAT26, respondents are asked to respond to the given behaviors/thoughts by choosing the frequency of their occurrence in the past six months (scale: always to never). Then a certain scoring protocol is followed. Participants who score above 20 and others who answer positively to one or more of the behavioral statements are advised to go through a clinical interview by a qualified professional for further investigation [9,13].

2.3.3. Section 3

Aimed to explore the level of physical activity using an English and Arabic version of the short International Physical Activity Questionnaire (IPAQ). Developed in 1998 and tested for years among many countries for reliability and validity, the short IPAQ was found to be an acceptable measure for physical activity practices in cross-sectional studies when direct measurements of physical activity are not feasible [5,12]. The IPAQ measures the level of physical activity based on a recall of all activities performed in the past seven days. The level of physical activity is expressed by the MET-minute/week, which is calculated based on the type of activity, its duration and number of days/week they exercise. In this study, participants' level of activity was classified based on cutoff points: MET= 600 and 1200 for young adults and adolescents respectively. These points were calculated based on meeting the international recommendations of physical activity (30 minutes for adults and 60 minutes for adolescents of moderate physical activity for at least five days a week) [29].

2.3.4. Section 4

Consisted of a pre-validated Exercise Dependence Questionnaire (EDQ). The original EDQ was developed by Ogden, et al. [19]. It consists of 29-items that measure nine areas: interference with social/family life, positive reward, withdrawal symptoms, exercise for weight control, exercise for health reasons, insights into the problem, exercise for social reasons and stereotyped behavior [19]. Participants are asked to state their level of agreement with certain statements using a 7-point Likert scale (1 = Strongly disagree, 7 = Strongly agree) [33,19]. For the purpose of this study, only questions related to positive reward, withdrawal symptoms, exercise for health reasons and interference with social/family life were included.

3. Results

The participants' mean age and standard deviation (Mean ± SD) was 19 ± 1.3. The prevalence of disordered eating attitudes among the surveyed sample was 31.4% (n = 76). Table1 presents the sample's main characteristics and their relation to eating attitudes measured by EAT-26. The p-value describes the level of significance when chi-square test was used. The effect of age, marital status, number of children, employment status, and year of study was found to be insignificant. However, having a membership in a gym or health club was found to be significantly related to disordered eating attitudes (p< 0.01).

Table 1

Sample main characteristics in relation to Eating Attitudes Test scores. *Chi-square test was used.


Eating Attitudes P- value
Total N = 242 Normal N = 166 Disordered N = 76
N(%) N (%) N (%)
Age 17-19 72 (71.1) 121 (70.3) 51 (29.7)
20-25 70 (28.9) 45 (64.3) 25 (35.7) 0.357
Marital Status Single 216 (90.0) 149 (67) 67 (31)
Engaged 10 (4.2) 8 (80) 2 (20) 0.617
Married 14 (5.8) 8 (57.1) 6 (42.9)
Number of Children 0 7 (50) 4 (57.1) 3 (42.9)
1 3 (21.4) 2 (66.7) 1 (33.3)
2 2 (14.3) 1 (50) 1 (50) 0.614
3 2 (14.3) 2 (100)
Employment Status Full time 1 (0.4) 1 (100)
Part time 6 (2.6) 2 (33.3) 4 (66.7)
Not employed 226 (97) 157 (69.5) 69 (30.5) 0.26
Year of Study 1st 138 (57.2) 96 (69.6) 42 (30.4)
2nd 103 (42.8) 69 (67) 34 (33) 0.726
GYM membership Present 57 (23.6) 30 (52.6) 27 (47.4)
No membership 185 (76.4) 136 (73.5) 49 (26.5)

A significant positive correlation was found between EAT-26 scores and Body Mass Index (BMI)(r2=0.181, p<0.01, a two-tailed bivariate correlation), meaning that the increase in BMI was associated with increased risk of developing disordered eating attitudes (Table 2).When examining the correlation between the various EAT-26 scales and the level of reported physical activity, we found a strong positive correlation between higher scores on the dieting scale and a higher level of physical activity (r2=0.193, p= 0.006, two tailed bivariate correlation). Indicating that the higher engagement in dieting behaviors was linked to more hours spent exercising. Bulimia, food preoccupation and oral control subscale were not found to have an effect on the level of physical activity expressed by MET (p> 0.05) (Table 2).

Table 2

Body Mass Index Classification in relation to Eating Attitudes Test Score. The table is based on two tailed bivariate correlation test.


Eating Attitudes Test (EAT-26) Score classification Body Mass Index Classification
n = 239 p - value (r2)
Underweight Normal Overweight Obese
Disordered Eating Attitudes 3 (4%) 56 (74.7%) 6 (8%) 10 (13.3%)
<0.01
Normal Eating Attitudes 18 (11%) 130 (79.3%) 12 (7.3%) 4 (2.4%) -0.181

Table 3 presents the associations concerning behaviors with dieting as measured by EAT-26. All of the surveyed behaviors were performed at a higher frequency among the sub-sample with disordered eating attitudes. In addition, a higher level of physical activity was found to be correlated with a higher frequency of engagement in behaviors examined by the EAT-26, such as use of laxatives and over- the-counter supplements and exercising for more than 60 minutes daily to control weight in the past six months (r2 = 0.191, p < 0.05, a two-tailed bivariate correlation).

Table 3

Frequency of engagement in concerning behaviors in the past 6 months measured by Eating Attitudes Test.


Concerning behaviors as measured by EAT-26 Sample engagement in concerning behaviors in the past 6months measured by Eating Attitudes Test (EAT-26)
All sample (N=242) Sub-sample with disordered eating attitudes (n=76)
Never Once a month or less 2-3 times/
month
Once a week 2-6 times a week Once a day or more Never Once a month or less 2-3 times/ month Once a week 2-6 times a week Once a day or more
Frequent binge eating episodes 100 (41.3%) 62 (25.6%) 23 (9.5%) 31 (12.8%) 15 (6.2%) 11 (4.5%) 19 (25%) 22 (28.9%) 8 (10.5%) 13 (17.1%) 8 (10.5%) 6 (7.9%)
Vomiting to control weight or shape 218 (90.1%) 11 (4.5%) 3 (1.2%) 2 (0.8%) 3 (1.2%) 5 (2.1%) 59 (77.6%) 7 (9.2%) 3 (3.9%) 2 (2.6%) 2 (2.6%) 3 (3.9%)
Use of laxatives or Over The Counter weight loss supplements 209 (86.4%) 11 (4.5%) 4 (1.7%) 5 (2.1%) 6 (2.5%) 7 (2.9%) 51 (67.1%) 8 (10.5%) 3 (3.9%) 4 (5.3%) 5 (6.6%) 5 (6.6%)
Exercise >60minutes to burn off calories 81 (33.5%) 48 (19.8%) 20 (8.3%) 25 (10.3%) 46 (19%) 22 (9.1%) 14 (18.4%) 18 (23.7%) 6 (7.9%) 8 (10.5%) 16 (21.1%) 14 (18.4%)
Significant weight loss (10kg or more) Yes No Yes No
38 (15.8%) 203 (83.9%) 19 (25%) 57 (75%)

To understand the behaviors of those who reported higher levels of physical activity and disordered eating attitudes, we examined some addictive behaviors related to exercise explored by the Exercise Dependence Questionnaire (EDQ) [19]. Increased time spent in exercise was found to be linked to interference with social life – meaning that participants would miss social events in order to exercise— and withdrawal symptoms such as irritability if they were unable to exercise (two tailed t-test, p< 0.05). There was no strong significant correlation between exercising to feel better or for health reasons and the time spent in exercise (Table 4).

Table 4

The correlation between the main variables of the study and Exercise Dependence Questionnaire categories. The test was performed using a two tailed bivariate correlational test.


Study's main variables
Exercise Dependence Questionnaire categories Level of exercise Eating attitudes scores
N = 193 N = 193
Interference with social life
Pearson Correlation 0.155 0.209
Significance (2 tailed) <0.05 <0.01
Positive reward
Pearson Correlation 0.147 0.167
Significance (2 tailed) <0.05 <0.05
Withdrawal Symptoms
Pearson Correlation 0.21 0.322
Significance (2 tailed) <0.01 0
Exercise for health reasons
Pearson Correlation 0.079 0.089
Significance (2 tailed) 0.277 0.218

In addition, correlational tests were run to examine if social factors related to family and peers' diets and expressing negative comments about participant's weight influenced participants' eating attitudes, but there was no significant correlation.

Figure 1 highlights participants' responses to the given statements related to diet behaviors and social support. About one third of sub-population at risk to eating disorders stated that they heard negative comments about their weight from peers and family members, indicating social pressure; surprisingly, some 70% of them were convinced about the need to be thin on their wedding night.

Figure 1

Level of agreement with statements related to social factors that might influence participants' eating attitudes.

fig-1.jpg

4. Discussion

Disordered eating attitudes measured by EAT-26 have been used as an indicator of eating disorder development risk, and studies validated its use in the mild cases of eating disorders [13,20]. The prevalence of eating disorders risk found in this study (31.4%) is higher than what was reported by number of earlier studies targeting the UAE population; there, scores above the EAT-26 cutoff did not exceed a quarter of the surveyed population [7,25,26]. It is also higher than reported scores among university students in other countries such as Malaysia and the Academy of Eating Disorders estimates (21.3%, 20% respectively) [1,8]. The only study with a similar prevalence in the UAE found 33.5% of the surveyed adolescent females (n = 243) with abnormal eating attitudes [15].

Although Thomas, et al [17] focused on female university students with a similar sample size, the higher prevalence of abnormal eating attitudes found in this study (31.4% compared to 24.6%) could be due to a change in the attitudes of students towards dieting. It can also be related to greater accuracy in responding to the EAT-26 statements, since Arabic translation was provided in this study, a limitation cited in the former study.

The comparatively high socio-economic status that many Emiratis experience and their increased exposure to media ideals, especially in a rapidly developing city like Dubai (where most of the participants live) could have increased the risk of eating disorders by creating a disturbed self-image [10,24]. This can be supported by the high level of body dissatisfaction reported in earlier studies [25,26]. Little has been reported about the behaviors measured by EAT-26 in the literature, but the findings of the study in this area are alarming. Knowing that 9.9% and 13.6% of the whole sample used potentially damaging methods to control weight, such as vomiting and laxative consumption, emphasizes the need for intervention strategies to tackle these behaviors.

Social factors related to eating and exercise behavior were explored in this study to some extent to gain a better understanding of the population. No significant correlation found between the given statements and studied variables might be related to reporting bias or a low level of influence of these factors. The younger generation might be more influenced by media, as Swami, et al. [17] state, a factor that was not explored in this study. However, the level of agreement with exposure to peers and family negative comments was high among those with disordered eating attitudes, indicating some level of association between these variables as suggested by the National Eating Disorders Academy [18].

A significant positive correlation was found between BMI and EAT-26 scores, indicating a higher risk for developing eating disorders in those who are overweight or obese. The correlation can perhaps be justified by the UAE culture of modern body image, that is increasingly promoting a lean body, as suggested by studies and local reports [4,6,21,25].

The significant relationship between dieting behavior and level of exercise examined in this study implies the presence of some symptoms associated with anorexia nervosa. The level of exercise dependence and its association with the time spent in exercise matches the findings of earlier studies, indicating that addictive behavior can appear among those who spend a lot of time in exercise to a level that impairs their social lives [14,27,33].

5. Conclusion

High levels of abnormal eating attitudes and engagement in behaviors deemed concerning were found in this study, along with some level of exercise addiction among those who meet the international recommendation for physical activity. It is important to note that abnormal eating attitudes do not necessarily mean a probable development of eating disorders. However, the presence of the former, increase the likelihood of the latter [3,22]. Considering the devastating health effects associated with eating disorders, such as risk of heart disease, renal failure and other diseases, intervention is urgently needed [2,25]. Effective interventions should be applied at an institutional level to guarantee better results. General campaigns in public places could help in raising awareness about eating disorders and their complications.

Integrating courses or specific lessons in high school curricula and university courses in regard to self-image acceptance, healthy weight loss methods, problem- solving skills, basic exercise knowledge and practices can greatly help in preventing eating disorders and exercise dependence among the general population as stated by the National Eating Disorders Academy [18]. In addition, frequent assessment should be done for students to detect abnormal trends, while the availability of trained psychologist is needed to help those with eating disorders in overcoming this problem.

Finally, the field of mental health and eating disorders is still new in the UAE; further research is needed to understand at a deeper level the reasons behind the increase in disordered eating attitudes among Emiratis such as found in this study and some of the correlates related to it.

The main limitation of this study is the reliance on self-reported behaviors and the lack of evidence to determine the direction of causality between disordered eating attitudes and the other characteristics measured. The nature of this study being a cross-sectional gives us information about the present behaviors and attitudes at the time of filling the survey only. Thus, our conclusions are speculations based on available evidence from the literature and observation.

6. Competing Interests

The authors declare that they have no competing interests

References

1 

Academy for Eating Disorders. Prevalence of Eating Disorders [Data file], Eating Disorder Statistics, Year: 2011, Available form: https://www.uni.edu/wellrec/sites/uni.edu.wellrec/files/documents/EDstats.pdf

2 

American Psychiatric Association , Diagnostic and Statistical Manual of Mental Disorders fifth edition [DSM-V]. Arlington: USA; 2013.

3 

American Psychological Association (APA) , Eating Disorders; 2014. Available from: http://www.apa.org/topics/eating

4 

Bell J., Parents’ pressure on eldest child increase the risk of eating disorders. The National 2014. Retrieved from LexisNexis

5 

Booth M. L., Assessment of physical activity: an international perspective, Research Quarterly for Exercise and Sport, Year: 2000, Volume: 71, Issue: 2, Page: 114-120. DOI: 10.1080/02701367.2000.11082794

6 

Dajani H., Body image pushing girls to attempt suicide. The National, 2000. Retrieved from LexisNexis

7 

Eapen V., Mabrouk A. A., Bin-Othman S., Disordered eating attitudes and symptomatology among adolescent girls in the United Arab Emirates, Eating Behaviors, Year: 2006, Volume: 7, Issue: 1, Page: 53-60. DOI: 10.1016/j.eatbeh.2005.07.001

8 

Gan W., Nasir M., Zalilah S., Hazizi A., Disordered eating behaviors, depression, anxiety and stress among Malaysian University students. The College Student Journal, Disordered eating behaviors, Year: 2011, Volume: 45, Issue: 2, Page: 296-309.

9 

Garner DM., Self-report measures for eating disorders, Social and Behavioral Sciences, Year: 1993, Volume: 5, Issue: 20, Page: 12-15.

10 

Gordon R. A., Eating Disorders East and West. Eating Disorders and cultures in transition. Brunner-Routledge: New York, 2001

11 

Health Authority Abu Dhabi [HAAD] Health Statistics, Available at http://www.haad.ae/HAAD/LinkClick.aspx?fileticket=JY0sMXQXrOU%3dtabid=1243

12 

Lee P. H., Macfarlane D. J., Lam T. H., Stewart S. M., Validity of the international physical activity questionnaire short form (IPAQ-SF): a systematic review, International Journal of Behavioral Nutrition and Physical Activity, Year: 2011, Volume: 8, article 115, DOI: 10.1186/1479-5868-8-115

13 

Mintz L. B., O'Halloran M. S., The eating attitudes test: Validation with DSM-IV eating disorder criteria, Journal of Personality Assessment, Year: 2000, Volume: 74, Issue: 3, Page: 489-503. DOI: 10.1207/S15327752JPA7403_11

14 

Modoio V., Antunes H., de Gimenez P., Santiago M., Tufik S., de Mello M., Negative addiction to exercise: are there differences between genders?, Clinics, Year: 2011, Volume: 66, Issue: 2,

15 

Musaiger A. O., Al-Mannai M., Tayyem R., Al-Lalla O., Ali E. Y. A., Kalam F., Benhamed M. M., Saghir S., Halahleh I., Djoudi Z., Chirane M., Risk of disordered eating attitudes among adolescents in seven Arab countries by gender and obesity: A cross-cultural study, Appetite, Year: 2013, Volume: 60, Issue: 1, Page: 162-167. DOI: 10.1016/j.appet.2012.10.012

16 

Musharrafieh U., Tamim H. M., Rahi A. C., El-Hajj M. A., Al-Sahab B., El-Asmar K., Tamim H. M., Determinants of university students physical exercise: a study from Lebanon, International Journal of Public Health, Year: 2008, Volume: 53, Issue: 4, Page: 208-213. DOI: 10.1007/s00038-008-7037-x

17 

Muttappallymyalil J., Mathew E., Sreedharan J., Sharbatii S. A., Shaikh R. B., Basha S. A., Self reported physical activity among University Students in Ajman, UAE, Pakistan Journal Of Medical Sciences, Year: 2010, Volume: 26, Issue: 4, Page: 782-786.

18 

National Eating Disorders Association [NEDA] , Eating disorders and their precursors [Data file], 2005. Available at: https://www.uni.edu/wellrec/sites/uni.edu.wellrec/files/documents/EDstats.pdf

19 

Ogden J., Veale D., Summers Z., The development and validation of the exercise dependence questionnaire, Addiction Research & Theory, Year: 1997, Volume: 5, Issue: 4, Page: 343-356. DOI: 10.3109/16066359709004348

20 

Scheinberg Z., Koslowsky M., Bleich A., Mark M., Apter A., Danon Y., Solomon Z., Babur I., Sensitivity, Specificity, and Positive Predictive Value as Measures of Prediction Accuracy: The Case of the Eat-26, Educational and Psychological Measurement, Year: 2016, Volume: 53, Issue: 3, Page: 831-839. DOI: 10.1177/0013164493053003027

21 

Sean , (Dec, 13,2012). --- Research: Western culture to blame for body dissatisfaction in the UAE. 7 Days. Retrieved from LexisNexis

22 

Smink F. R. E., van Hoeken D., Hoek H. W., Epidemiology of eating disorders: incidence, prevalence and mortality rates, Current Psychiatry Reports, Year: 2012, Volume: 14, Issue: 4, Page: 406-414. DOI: 10.1007/s11920-012-0282-y

23 

Steinhausen H.-C., Outcome of Eating Disorders, Child and Adolescent Psychiatric Clinics of North America, Year: 2009, Volume: 18, Issue: 1, Page: 225-242. DOI: 10.1016/j.chc.2008.07.013

24 

Swami V., Frederick D. A., Aavik T., Alcalay L., Allik J., Anderson D., Andrianto S., Arora A., Brännström Å., Cunningham J., Danel D., Doroszewicz K., Forbes G. B., Furnham A., Greven C. U., Halberstadt J., Hao S., Haubner T., Hwang C. S., Inman M., Jaafar J. L., Johansson J., Jung J., Keser A., Kretzschmar U., Lachenicht L., Li N. P., Locke K., Lönnqvist J.-E., Lopez C., Loutzenhiser L., Maisel N. C., McCabe M. P., McCreary D. R., McKibbin W. F., Mussap A., Neto F., Nowell C., Alampay L. P., Pillai S. K., Pokrajac-Bulian A., Proyer R. T., Quintelier K., Ricciardelli L. A., Rozmus-Wrzesinska M., Ruch W., Russo T., Schütz A., Shackelford T. K., Shashidharan S., Simonetti F., Sinniah D., Swami M., Vandermassen G., van Duynslaeger M., Verkasalo M., Voracek M., Yee C. K., Zhang E. X., Zhang X., Zivcic-Becirevic I., The attractive female body weight and female body dissatisfaction in 26 countries across 10 world regions: results of the international body project I, Personality and Social Psychology Bulletin, Year: 2010, Volume: 36, Issue: 3, Page: 309-325. DOI: 10.1177/0146167209359702

25 

Thomas J., Khan S., Abdulrahman A. A., Eating attitudes and body image concerns among female university students in the United Arab Emirates, Appetite, Year: 2010, Volume: 54, Issue: 3, Page: 595-598. DOI: 10.1016/j.appet.2010.02.008

26 

Schulte S. J., Thomas J., Relationship between eating pathology, body dissatisfaction and depressive symptoms among male and female adolescents in the United Arab Emirates, Eating Behaviors, Year: 2013, Volume: 14, Issue: 2, Page: 157-160. DOI: 10.1016/j.eatbeh.2013.01.015

27 

Weik M., Hale B. D., Weik M Hale B. D., Contrasting gender differences on two measures of exercise dependence, Br J Sports Med, Year: 2009, Volume: 43, Issue: 1, Page: 204-207.

28 

Wen Ng S., Zaghloul S., Ali H., Harrison G., Yeatts K., El-Sadig M., Popkin B., obesity, diet and physical activity in the United Arab Emirates (UAE), FASEB journal, Year: 2011, Volume: 25, Page: 591-595.

29 

World Health Organization [WHO] , (February, 2014). Physical Activity fact sheet N385. Available at: http://www.who.int/mediacentre/factsheets/fs385/en/

30 

World Health Organization [WHO] , (August, 2014). Obesity and Overweight fact sheet N311. Available at: http://www.who.int/mediacentre/factsheets/fs311/en/

31 

World Health Organization [WHO] , Global Recommendations on Physical Activity for Health. Available at: http://www.who.int/dietphysicalactivity/factsheet_recommendations/en/

32 

World Health Organization [WHO] , Physical Inactivity: A Global Health Problem, (2014). Available at: http://www.who.int/dietphysicalactivity/factsheet_inactivity/en/

33 

Zmijewski C. F., Howard M. O., Exercise dependence and attitudes toward eating among young adults, Eating Behaviors, Year: 2003, Volume: 4, Issue: 2, Page: 181-195. DOI: 10.1016/S1471-0153(03)00022-9

FULL TEXT

Statistics

  • Downloads 14
  • Views 438

Article Tools

Navigation

Refbacks



ISSN: 2518-6590