Revista Mexicana de Trastornos Alimentarios (2017) 8, 97---104

http://journals.iztacala.unam.mx/index.php/amta/

ARTICLE

Eating disorder symptomatology: Comparative study

between Mexican and Canadian university women
Teresita de Jesús Saucedo-Molina a,∗ , Jessica Zaragoza Cortés a , Lita Villalón b

a
Área Académica de Nutrición, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Hidalgo, México
b
École des Sciences des Aliments, de Nutrition et d’Études Familiales, Faculté des Sciences de la Santé et des Services
Communautaires, Université de Moncton, Moncton, Canada

Received 1 March 2017; revised 24 April 2017; accepted 30 May 2017

Available online 20 June 2017

KEYWORDS Abstract The objectives of this study were: (1) to compare Mexican and Canadian university
Disordered eating students regarding disordered eating behaviors (DEB), body thin-ideal internalization (BTHIN),
behaviors; and body image dissatisfaction (BID); and (2) to examine the relationship of these three variables
Body thin-ideal to body mass index (BMI) and waist circumference (WC). This cross-cultural study was carried
internalization; out in a sample of 129 university women students aged from 18 to 25 years (M = 20.18, SD = 1.59):
Body image 52% were Canadian (Moncton University [MU]) and 48% were Mexican (Universidad Autónoma
dissatisfaction; del Estado de Hidalgo [UAEH]). The Brief Questionnaire for Disordered Eating Behaviors and
Body weight; Attitudes Towards Body Figure Questionnaire were applied while the BID was evaluated using a
Mexico---Canada continuum of nine silhouettes. In addition, the weight, height and WC of each participant were
recorded. Mexican students had greater values of overweight, obesity, abdominal obesity and
DEB, with 4.6 times greater risk than UM students. In contrast, the presence of BTHIN and BID
was similar between samples. Considering these findings, women from at least two different
ethnic groups are vulnerable to the development of eating disorder symptomatology.
© 2017 Universidad Nacional Autónoma de México, Facultad de Estudios Superiores Iztacala.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/).

PALABRAS CLAVE Sintomatología de trastornos alimentarios: Estudio comparativo entre mujeres

Conductas universitarias mexicanas y canadienses
alimentarias
de riesgo; Resumen Los objetivos de este estudio fueron: 1) comparar entre estudiantes universitarias
Interiorización mexicanas vs. canadienses respecto a conductas alimentarias de riesgo (CAR), interiorización
del ideal de de la figura corporal delgada (IFCD) e insatisfacción con la imagen corporal (ISC); y 2) examinar
delgadez;

∗ Corresponding author.
E-mail address: saucemol@hotmail.com (T. J. Saucedo-Molina).
Peer Review under the responsibility of Universidad Nacional Autónoma de México.
http://dx.doi.org/10.1016/j.rmta.2017.05.002
2007-1523/© 2017 Universidad Nacional Autónoma de México, Facultad de Estudios Superiores Iztacala. This is an open access article under
the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
98 T. J. Saucedo-Molina et al.

la relación de esas tres variables con el índice de masa corporal (IMC) y la circunferencia
Insatisfacción de cintura (CC). En este estudio transcultural participaron 129 estudiantes universitarias de
corporal; 18 a 25 años de edad (M = 20.18, DE = 1.59): 52% canadienses (Universidad de Moncton [UM])
Peso corporal; y 48% mexicanas (Universidad Autónoma del Estado de Hidalgo [UAEH]). Fueron aplicados el
México---Canadá Cuestionario Breve para medir Conductas Alimentarias de Riesgo y el Attitudes Towards Body
Figure Questionnaire, mientras que la ISC se evaluó mediante un continuo de nueve siluetas.
Además se registró el peso, la talla y la CC de cada participante. Las estudiantes mexicanas
registraron significativamente mayor presencia de sobrepeso, obesidad, obesidad abdominal y
CAR, con 4.6 veces mayor riesgo que las estudiantes de la UM. Por el contrario, la presencia de
IFCD y de ISC fue similar entre las muestras. Con base en estos hallazgos se puede concluir que
las mujeres de dos grupos étnicos diferentes son vulnerables al desarrollo de sintomatología de
trastornos alimentarios.
© 2017 Universidad Nacional Autónoma de México, Facultad de Estudios Superiores Iztacala.
Este es un artículo Open Access bajo la licencia CC BY-NC-ND (http://creativecommons.org/
licenses/by-nc-nd/4.0/).

Introduction The transcultural literature, has proposed that globaliza-

tion and enhanced individual mobility have raised levels of
Over the years, eating disorders (ED) have received atten- ED symptoms and increased the risk of developing an ED
tion as an important mental health problem (Klump, Bulik, in several Western countries as well as in socioeconomic
Kaye, Treasure, & Tyson, 2009; Vandereycken, 2002). Pre- groups previously thought to be immune to such patholo-
viously, the stereotypical ED patient was depicted as gies (Katzman & Lee, 1997; Soh et al., 2006). Acculturation
young, North-European Caucasian, female, well-educated has been assumed to be one of the major risk factor for the
and from the upper socio-economic class of Western increase of ED symptomatology (Culbert, Racine, & Klump,
cultures (Von Ranson & Wallace, 2014). However, some 2015). Acculturation has been defined as ‘‘the process of
data have found differences in prevalence of ED and its psychosocial change that occurs when a groups or individual
symptomatology within countries and communities belon- acquires the cultural values, languages, norms and beha-
ging to these Western societies (Soh, Touyz, & Surgeron, viors of dominant society’’ (Wildes, Emery, & Simons, 2001,
2006). p. 524). It has been linked with international migration,
The comparison of ED symptomatology across cultu- however, it has also been proposed that it is enough to
res is complicated and contradictory. Mautner, Owen, and have proximity or contact with the dominant culture mainly
Furnham (2000) found no cultural differences in college through mass media (Gómez & Acosta, 2000), or by being
females from Western cultures (USA, Italy and England) a member of multicultural societies, and thereby acquiring
in the relationship among body image disturbance. Anot- those traditions, customs, habits and values (Marin, 1992).
her cross-cultural study between two Spanish-speaking Diverse works have found that higher levels of accultura-
countries (Spain and Mexico) revealed that there were no tion are associated with higher levels of antifat attitudes,
significant effects by country in the ED symptomatology body dissatisfaction and eating concerns (Ayala, Mickens,
and sociocultural influences (Mancilla-Díaz et al., 2010). Galindo, & Elder, 2007; Chamorro & Flores-Ortiz, 2000;
Other studies have shown statistically significant differen- Katsounari, 2009; Pepper & Ruiz, 2007). A recent meta-
ces between nationalities in body image, dieting and binge analysis evidenced a considerable association between ED
eating behavior (Gómez & Acosta, 2000; Gómez-Peresmitré psychopathology and culture change/acculturation (Doris
& Acosta, 2002; Gómez-Peresmitré et al., 2013; Gupta, et al., 2015). In addition, has been said that cultures may
Chaturvedi, Chandarana, & Johnson, 2001) as well as natio- be vulnerable to acculturation and to symptomatology of ED
nalities and gender (Acosta & Gómez, 2003; Acosta, Llopis, when they suffer discrimination, or when they are members
Gómez, & Pineda, 2005; Mancilla-Díaz et al., 2010). The fin- of a devalued group or culture (Kempa & Thomas, 2000).
dings of a study comparing Canadian versus Indian females Rathner et al. (1995) suggested that over-identification with
indicated that both scored similarly on some of the core fea- Western norms and values eating pathology increased.
tures of eating disorder-related pathology, measured by the Several studies have identified more prevalence or
Drive for thinness and Body dissatisfaction subscales of the positive association between disordered eating behaviors
Eating Disorder Inventory (Garner, Olmsted, & Polivy, 1983), (DEB), body thin ideal internalization, body dissatisfac-
the nature of the underlying body image disturbance was tion and body mass index (BMI) (Argyrides & Kkeli, 2015;
different between the two groups. The Indian females ten- Chávez-Hernández, Saucedo-Molina, Peña, & Unikel, 2015;
ded to have a less distorted perception of their ‘‘level of López-Aguilar et al., 2010; Mancilla-Díaz et al., 2010;
fatness’’ than the Canadian females (Gupta et al., 2001). Saucedo-Molina & Unikel, 2010). Also, it has been repor-
Furthermore, there are studies that have produced mixed ted that adolescents with large waist circumference most
results among Western and non-Western society even using often declare to use slimming diets (Piotrowska, Broniecka,
the same methodology (Podar & Allik, 2009; Soh et al., Biernat, Wyka, & Bronkowska, 2015). Additionally, binge
2006). eating and loss of control over eating (the experience of
Eating disorder symptomatology and body image: Mexico vs. Canada 99

being unable to control one’s intake of any amount of food), a four-point scale (1 = never to 4 = very often), with a cut-off
has been associated with excess BMI and adiposity (Stojek score ≥37, obtained a sensitivity of 0.80 and specificity of
et al., 2016; Tanofsky-Kraff et al., 2009). 0.80.
Canada and Mexico are cultures immerse in the thin- Body Image Dissatisfaction (BID) was measured by a visual
ness Western culture (Grogan, 2008) in which attractiveness scale for females with nine body images ranging from very
is associated to thinness, beauty, control, power and free- thin to very obese, randomly ordered (Gómez, Granados,
dom, as well as with professional, social and even to sexual Jáuregui, Pineda, & Tafoya, 2000). The scale was showed
success (Español & De la Gándara, 2008; Gordon, Castro, at two points: the first time to select the current body
Sitnikov, & Holm-Denoma, 2010; LeBlanc, 2014). shape and the second for selection of the ideal shape. Zero
The literature has reported that Mexico (Gutiérrez et al., difference between the actual body shape and the ideal
2012; Olaiz et al., 2006) and Canada (LeBlanc, 2014; McVey, shape is classified as satisfaction; a positive difference indi-
Tweed, & Blackmore, 2004), have increased the prevalence cates dissatisfaction in the sense of wanting to be thinner,
of ED and its symptomatology, mainly DEB (Grogan, 2008; and negative difference is classified as dissatisfaction in the
McVey et al., 2004; Unikel-Santoncini et al., 2010), body sense of wanting to be stouter.
thin-ideal internalization and body image dissatisfaction Body mass index (BMI) was calculated by weighing and
(Chaker, Chang, & Hakim-Larson, 2015; Chávez-Hernández measuring each subject. To classified participants, values
et al., 2015; Saucedo-Molina & Unikel, 2010). From revie- recommended by the World Health Organization ([WHO],
wing cross-cultural studies among different countries about 2000) were used. The students were asked to come as
these component symptoms of ED, we did not found any early as possible, in fasting state and wearing clothes that
between Mexican and Canadian women. were light as leggings, pants and shirts; they were asked to
Given this lack, the objectives of the current study were: remove their shoes and any accessories that might affect
(1) to examine and compare disordered eating behaviors, their weight or height (cell phones, belts, keys, tiaras,
body thin-ideal internalization (BTHIN), and body image comb, etc.).
dissatisfaction (BID) in Mexican and Canadian university Waist circumference (WC) is an index of the abdominal
women; and (2) to identify and describe its relationship adiposity. It was measured at the end of a normal expira-
with body mass index (BMI) and waist circumference (WC). tion to the nearest 0.1 cm at the mid-point between the
This study is exploratory rather than involving directional last floating rib and the top of the iliac crest; the cut-
hypotheses. off points for women proposed by the WHO (2000) were
used.
Method Questionnaires were translated to French by a Cana-
dian native; then they were reviewed by bilingual
(French/Spanish) experts in the topics. The questionnaires
Participants
achieved adequate values of internal consistence (BQDEB:
˛ = 0.71; ATBF: ˛ = 0.94) for the UM sample, as well as
A cross-cultural descriptive and comparative field research for UAEH sample (BQDEB: ˛ = 0.73; ATBF: ˛ = 0.95). Fina-
was carried out in a sample of 129 women volunteers: 52% lly, an exploratory factor analysis with a varimax rotation
being Canadians from University of Moncton (UM) and 48% was carried out with the Canadian sample. After four
Mexicans from Universidad Autónoma del Estado de Hidalgo iterations, BQDEB attained the same three factors than
(UAEH), ages 18---25 (M = 20.18, SD = 1.59) all of them from the Spanish version (Binge eating/purging behaviors, with
Health Sciences Faculties/Schools and from urban zone. ˛ = 0.68; Compensatory behaviors, with ˛ = 0.89; and Res-
tricting behaviors, with ˛ = 0.75), explaining 67.5% of the
Instruments variance. With respect to the ATBF, the same two factors
of the Spanish version (Internalization, with ˛ = 0.89; and
Brief Questionnaire for Risky Eating Behaviors (BQDEB) was Beliefs, with ˛ = 0.91) were obtained after three iterations;
developed and validated in Mexico in adolescents and young and 63.3% of the variance was explained.
women (Unikel-Santoncini, Bojórquez-Chapela, & Carreño-
García, 2004). It consists of 10 questions that are scored
using a four-point Likert-type scale with four response Procedure
options from 0 (never or rarely) to 3 (very often/more than
twice a week). A cut-off score of >10 was used to identify Participants completed the questionnaires in the class-
women at risk for DEB. The questionnaire showed a high room. In order to take the anthropometric measures and
reliability (Cronbach ˛ = 0.83) and the cut-off score obtained to ensure students’ privacy, each participant chose in a
the best results for sensitivity of 0.81 and specificity of 0.78. pre-established schedule the day, time and specific class-
The questionnaire assesses DEB such as binge eating/purging room when she would be available to attend individually.
behaviors, restricting behaviors and compensatory beha- Two female trained nutritionists took these measures. All
viors over the past three months. participants signed a consent form. The project was appro-
Attitudes Towards Body Figure Scale (ATBF) was used to ved by the Comité d’éthique de la recherché avec les êtres
measure the BTHIN. It was validated and developed on the humains de la Faculté des études supérieures et de la recher-
basis of the experience with Mexican students and patients ché, Université de Moncton, Canada and by the Comité de
between the ages of 15 and 24 years old with ED (Unikel, Ética del Área Académica de Medicina and by the Comité
Juárez, & Gómez, 2006), showing adequate values of inter- de Investigación del Instituto de Ciencias de la Salud, UAEH,
nal consistency (˛ = 0.93). The scale consists of 15 items on México.
100 T. J. Saucedo-Molina et al.

Table 1 Percentage distribution of body mass index and waist circumference by university: UAEH-Mexico vs. UM-Canada.
UAEH (n = 62) UM (n = 67) Total (N = 129)
Body mass index
Underweight 1.6% 3.0% 2.3%
Normal weight 40.3% 77.3% 59.4%
Overweight 43.5% 13.6% 28.1%
Obesity 14.5% 6.1% 10.2%
X2 = 20.05, df = 3, p < 0.001
Waist circumference
Healthy waist circumference (<80 cm) 24.2% 86.6% 56.6%
Abdominal obesity (≥80 cm) 32.3% 4.5% 17.8%
Excess of abdominal obesity (≥88 cm) 43.5% 9.0% 25.6%
X2 = 51.14, df = 2, p < 0.001
Notes. UAEH = Universidad Autónoma del Estado de Hidalgo; UM = University of Moncton.

Statistical analysis times higher risk than UM students (X2 = 5.86, df = 1, p = 0.02;
95% CI: 1.22---17.37).
The software used was SPSS version 22 for Windows. For Findings of BMI showed that UAEH participants reached
comparison between groups, Student t test and X2 were a higher percentage of overweight and obesity than UM stu-
applied. Spearman’s correlation coefficients were used to dents with a statistically significant difference (X2 = 20.05,
identify the relationship between DEB, BTHIN and the df = 3, p < 0.001). With respect to WC, UAEH students achie-
nutritional status indicators. A multivariate analysis of cova- ved the highest percentage of abdominal obesity (32.3% and
riance (MANCOVA) was performed to find out what factors 43.5%, respectively) with statistically significant difference
predicted DEB, BTHIN and BID. In these analyses, the regres- (X2 = 51.14, df = 2, p < 0.001). These findings are displayed in
sion model was adjusted, independently, by BMI and WC. Table 1.
A Bonferroni post hoc was used to account differences. In Table 2 shows a very low percentage of UAEH students
order to accomplish the risk analysis, odds ratio (OR) was who are satisfied versus almost three times of the UM stu-
performed with 2 × 2 contingency tables and statistical sig- dents who are satisfied. In both samples, dissatisfaction in
nificance was determined by X2 analysis. The significant the sense of wanting to be thinner was very similar (54.1%
levels were set at p ≤ 0.05. UAEH vs. 54.5% UM). However, it is interesting to comment
that UAEH women with normal BMI are the most dissatis-
fied in the sense of wanting to be thinner; meanwhile, UM
students with overweight and obesity reported the highest
Results percentages of dissatisfaction in this sense. Other results
that must be commented are the high percentage of UAEH
According to the cut-off score of the BQDEB (>10), in UAEH participants with overweight and obesity who want to be
sample 17.7% reported risk to develop DEB versus 4.5% of UM stouter.
sample, with statistically significant difference (X2 = 5.86, The correlations in both samples indicated that higher
df = 1, p < 0.01). Taking into account the cut-off score ≥37 levels of DEB were related to higher levels of BTHIN. This
of the ATBS, the percentage was very similar between the latter variable and the anthropometric indicators showed
samples: 30.5% in UAEH women and 28.8% in UM women. Risk modest but statistically significant correlations in both
analysis by university identified only a significant association samples. In general, was observed that values in the UM
for risk to develop DEB. Specifically, UAEH students are at 4.6 students were higher than in UAEH students. Additionally,

Table 2 Percentage distribution of the dissatisfaction/satisfaction with body image by university (UAEH-Mexico vs. UM-
Canada), and by body mass index.

University Body image dissatisfaction Body mass index

Under weight Normal weight Over weight Obesity Total

UAEH To be robust 0.0% 8.0% 53.8% 44.4% 32.8%
Satisfied 100% 20.0% 7.7% 0.0% 13.1%
To be thinner 0.0% 72.0% 38.5% 55.6% 54.1%
UM To be robust 0.0% 11.8% 0.0% 0.0% 9.1%
Satisfied 100% 41.2% 11.1% 0.0% 36.4%
To be thinner 0.0% 47.2% 88.9% 100% 54.5%
Notes. UAEH = Universidad Autónoma del Estado de Hidalgo; UM = University of Moncton.
Eating disorder symptomatology and body image: Mexico vs. Canada 101

cultural pressure to conform to mainstream USA culture in

Table 3 Correlations between disordered eating beha-
which there is a strong emphasis on thinness (Ayala et al.,
viors, body thin ideal internalization and anthropometric
2007; Doris et al., 2015; Katsounari, 2009; Pepper & Ruiz,
indicators by university: UAEH-Mexico vs. UM-Canada.
2007) and accordingly they report more behaviors and
University BMI WC DEB attitudes concerning eating (Culbert et al., 2015).
UAEH (n = 62) DEB .26*
NS
The authors also suggest that this finding may be asso-
BTHIN .30** .28* .72**
ciated with the acculturative stress. According to Gowen,
BMI .74**
Hayward, Killen, Robinson, and Taylor (1999), acculturative
UM (n = 67) DEB .49** .43**
stress occurs when an individual tries to fit into a culture
BTHIN .32** .30* .67**
that is different from their culture of origin, which can
BMI .76**
lead to maladaptive coping behaviors such unhealthy weight
regulation. Previous studies have reported that higher levels
Notes. BMI = body mass index; BTHIN = body thin ideal inter- of acculturative stress are associated with higher levels
nalization; DEB = disordered eating behaviors; NS = no signifi-
of eating disorder symptoms (Gordon et al., 2010; Perez,
cant; UAEH = Universidad Autónoma del Estado de Hidalgo;
Voelz, Pettit, & Joiner, 2002; Reddy & Crowther, 2007).
UM = University of Moncton; WC = waist circumference.
* p < 0.05. Kroon, Tartakovsky, Stachon, Pettit, and Perez (2014) stu-
** p < 0.01. died the relationship between acculturative stress and ED
symptoms among different ethnic groups, finding that accul-
turative stress significantly predicts bulimic symptoms in
UM students reported a statistically significant association Latina women. Thus, future research must test these pos-
between DEB and WC. These results are showed in Table 3. sibilities to clarify the nature of the relationships between
Risk analysis in the total sample by BMI identified that acculturative stress and eating disorder symptoms among
overweight/obesity subjects compared to under/normal Mexican and Canadian women.
weight participants were at 7.3 times higher risk to develop Both samples showed important BTHIN values. In the case
DEB (X2 = 10.8, df = 1, p = 0.001; 95% CI: 1.93---27.85) and 3.4 of Mexican women, this is probably due to the attempt to
times more likely to have BTHIN (X2 = 8.9, df = 1, p = 0.003; achieve the ideal of a blonde, white girl, with long and
95% CI: 1.5---7.8). With respect to WC, women with abdo- full-bodied hair, who is tall, thin and perfect, in order
minal obesity (≥ 80 cm and ≥ 88 cm) compared to healthy to be beautiful and successful (Gordon et al., 2010; Von
WC participants, have 3.8 times greater risk to develop DEB Ranso & Wallace, 2014), whereas in Canadians, the rea-
(X2 = 5.02, df = 1, p = 0.02; 95% CI: 1.11---12.68) as well as 2.4 son is merely to maintain this ideal figure. Given these
times more likely to have BTHIN (X2 = 4.58, df = 1, p = 0.03; findings, we propose that the culture change/acculturation
95% CI: 1.07---5.4). promoted by globalization (Doris et al., 2015) has exten-
In order to compare the dependent variables (DEB, ded this ideal model even in developing countries such
BTHIN, BID) a MANCOVA analysis was used adjusting by BMI as Mexico (Littlewood, 1995), although this is difficult to
or WC when comparing scores between universities. BMI achieve among the Mexican population.
explained both DEB (F = 10.86, df = 1, p < 0.01, 2 = 0.09) and Dissatisfaction in the sense of wanting to be thinner was
BTHIN (F = 11.88, df = 1, p = 0.05, 2 = 0.09), meanwhile WC very similar in both samples. This data supports the idea that
explicated the three dependent variables: DEB (F = 5.35, cultural pressures on physical appearance and body image,
df = 1, p < 0.05, 2 = 0.04); BTHIN (F = 7.69, d f = 1, p < 0.01, impact young females worldwide as a result of globalized
2 = 0.06); and BID (F = 4.03, df = 1, p < 0.05, 2 = 0.03). Uni- culture in all social and racial contexts (Gómez-Peresmitré
versity of origin explained only BID in both situations. With & Acosta, 2002; Soh et al., 2006). Only 36.4% of UM women
respect to DEB, Bonferroni post hoc test with BMI categories, and 13.1% of UAEH women were satisfied with their body
showed statistically significant differences only between image, although 77.3% and 40.3% of respondents, reported
normal weight and overweight subjects (p < 0.01). By univer- normal weight. This finding is similar to other studies in
sity of origin, t Student test confirm a statistically significant which Hispanic, Latina and Mexican American females repor-
difference in the BID (F = 23.04, df = 126, p < 0.01). ted higher levels of dissatisfaction compared with White
females (Chamorro & Flores-Ortiz, 2000; Gómez & Acosta,
Discussion 2000; Gordon et al., 2010; Grogan, 2008).
In the UAEH sample, the percentages of dissatisfaction
This research includes the first exploratory study of ED in the sense of wanting to be stouter were unexpected. A
variables comparing female Mexican and Canadian univer- total of 53.8% of overweight and 44.4% of obese respon-
sity students, providing a novel approach to the topic and dents want to be stouter. These data suggest that Mexican
the possibility to support the general rule that Western par- women may respond in this way to counter the negative
ticipants, regardless of their socioeconomic level, language effects of the weight stigma, defined as negative attitu-
and nationality, score high in ED symptomatology. des and beliefs directed toward individuals with overweight
DEB was significantly greater in Mexican females pro- or obesity usually expressed though stereotypes, prejudi-
bably because they suffer more body image discrimination cial attitudes, and discriminatory behaviors. If they admit
(Kempa & Thomas, 2000) since they are a long way from the that their body appearance is undesirable and unacceptable
Caucasian model promoted by Western culture. Findings (overweight/obesity), they would be internalizing feelings
also suggest that UAEH students could be more vulnerable of shame and inferiority togheter with negative qualities
to the mainstream thin ideal by the globalization as Gómez (e.g. laziness, lack of intelligence and self-discipline) (Puhl
and Acosta (2000) has proposed, and are under more & Heuer, 2009). Moreover, available evidence indicates that
102 T. J. Saucedo-Molina et al.

once weight stigma is internalized stronger associations clinical eating disorder may be different between the sam-
emerge with psychological correlates such as non-adherence ples from the two countries. In light of these findings, it is
with medication, problems of self-esteem, perceived stress, clear that women from at least two different ethnic groups
antisocial behavior, substance use and poor exercise beha- are vulnerable to the development of ED symptomatology.
vior (Papadopoulos & Brennan, 2015). Clinicians should be sensitive to, and assess for, cultural
It should be noted that both samples are drawn from variables that may put ethnic and racial minority women
Health Sciences Faculties/Schools. These students often at particular risk for eating disorders and as Gordon et al.
have to meet all kinds of family demands together with (2010) have proposed, ‘‘it may be beneficial to use inter-
intellectual, work and physical prototypes that have been ventions that couple standard psychoeducation about the
associated with ED or their symptomatology (McVey et al., health risks of internalizing the overly thin ideal with discus-
2004) regardless of ethnicity, race, socioeconomic level or sions about the potential value of maintaining some values of
nationality, and particularly in women (Chaker et al., 2015; one’s culture of origin’’ (p. 142). Although it is impossible to
Gupta et al., 2001; LeBlanc, 2014). It has been identified reach firm conclusions about the relevance of these findings
that schools may be stressful environments that contribute prevention programs and therapy for ED and its sympto-
to the emergence of ED or their symptomatology (Levine, matology should take these cross-cultural differences into
Smolak, Moodey, Shuman, & Hessen, 1994). It has also account.
been proposed that students are more exposed to media
messages that influence their eating behaviors and beliefs Ethical disclosures
(Barriguete-Meléndez et al., 2009). Another explanation
may be associated with the consequences of the weight Protection of human and animal subjects. The authors
stigma (Papadopoulos & Brennan, 2015; Puhl & Heuer, 2009). declare that no experiments were performed on humans or
All these could explain the high female percentages with animals for this study.
normal BMI who reported high levels of BID.
We confirmed a higher risk of developing DEB and BTHIN
Confidentiality of data. The authors declare that no patient
in overweight/obese subjects (7.3-times higher risk to deve-
data appear in this article.
lop DEB and 3.4-times more likely to have BTHIN). While
higher levels of DEB and BTHIN significantly correlated with
BMI, higher levels of BTHIN correlated with higher DEB. Right to privacy and informed consent. The authors have
These results are in line with existing research on nonclini- obtained the written informed consent of the patients or
cal (Argyrides & Kkeli, 2015; Chávez-Hernández et al., 2015; subjects mentioned in the article. The corresponding author
López-Aguilar et al., 2010; Saucedo-Molina & Unikel, 2010), is in possession of this document.
and clinical populations (Podar & Allik, 2009), which found
the same associations. Sponsors
Agreeing with other research (Piotrowska et al., 2015;
Stojek et al., 2016; Tanofsky-Kraff et al., 2009), our findings Jessica Zaragoza Cortes was a Master’s student grant holder
confirm that large waist circumference as measure of abdo- by the Consejo Nacional de Ciencia y Tecnología (CONACYT,
minal adiposity is associated at higher risk of DEB and BTHIN. México) and beneficiary of the program ‘‘Stays abroad’’. The
In addition, WC explained BID in both samples. research stay of PhD. Saucedo-Molina in the University of
The current study has limitations. First, the cross- Moncton was carried out thanks to the resources provided
sectional study design means that causal relationships by Consorcio de Universidades Mexicanas (CUMEX).
cannot be established. Second, the findings cannot be
generalized because the study was not carried out with pro-
Conflict of interest
babilistic samples from each country. Third, we did not use
a specific instrument to evaluate either acculturation or
The authors declare no conflict of interest.
acculturative stress. However, we know that both countries
belong to Western societies and share a common experience,
a colonial history and border with one of the most powerful Acknowledgements
countries in the world, the United States of America (USA),
which has frequently been cited as having one of the hig- To Amanda Peña Irecta (RIP) for her professional collabo-
hest prevalences of ED and its symptomatology (Smink, van ration in data collection. We express our gratitude to all
Hoeken, & Hoek, 2012). The equivalence of translations and participants in this research.
the adaptation to the original instruments was modesty tes-
ted. However, we should point out that this study represents
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