Not just a western girls' problem: eating attitudes among Israeli-Arab adolescent boys and girls

Abstract

The aim of the study was to compare eating attitudes and behaviours between Israeli-Arab adolescent boys and girls from two religious, age and residential settings subgroups. The sample consisted of 1966 Israeli-Arab adolescents, from Grades 7–12 (42% boys, 93% Muslims and 7% Christians), who completed the Eating Attitude Test (EAT-26), demographic and clinical questionnaires. The girls had significantly higher EAT-26 scores than boys. Of the students, 17.6% (18.7% of girls and 16.4% of boys) had disturbed eating attitudes (EAT-26>20). No significant differences were found between girls and boys in age and religious affiliation subgroups; however, more girls in urban areas had disturbed eating attitudes than boys. The results demonstrate a high prevalence of disturbed eating attitudes among both male and female Israeli-Arab adolescents and emphasise that boys are at risk as much as girls. It is suggested that there are more similarities than differences between boys and girls.

Keywords::

• disturbed eating attitude
• Israel
• Arab
• adolescents
• female and male

Introduction

An increasing body of research in the last four decades indicates a consistent rise in the prevalence of eating disorders, particularly in western society (Herzog et al., 2000; Hoek, 2006; Smink, van Hoeken, & Hoek, 2012). The lifetime prevalence is 0.4–3.7% for anorexia nervosa and 1.2–4.2% for bulimia nervosa (Fairburn & Harrison, 2003). Eating disorders occur equally in males and females before puberty, with the ratio increasing to approximately 1:10 during adolescence and 1:20 during young adulthood (Kohn & Golden, 2001). However, in the last decade, there has been a rise in the prevalence of adolescent males with eating disorders (Cooke & Sawyer, 2004), including 10% with anorexia, 20% with bulimia, and 40% with binge eating disorder (Muise, Stein, & Arbess, 2003).

A partial syndrome or ‘eating disorder not otherwise specified’ occurs more commonly (7–15%) than either anorexia nervosa or bulimia nervosa in adolescents (Fairburn & Harrison, 2003), and represents sub-clinical conditions that do not meet the full diagnostic criteria of either anorexia nervosa or bulimia nervosa. Furthermore, almost one-half of individuals with an eating disorder not otherwise specified may progress to the full syndrome within several years (Cooke & Sawyer, 2004). Disturbed eating attitudes and dieting behaviours in adolescents are widespread, and adolescents are considered an at-risk group for the development of eating disorders. Late adolescence is characterised by widespread symptoms of disordered eating. About 36.4% of girls and 23.9% of boys place a great importance of weight and shape on self-evaluation, and about 41.5% of girls and 24.4% of boys' present body image disturbance (Ackard, Fulkerson, & Neumark-Sztainer, 2007). Additionally, body image disorders have been reported in approximately 60% of adolescent girls as well as 30% of adolescent boys in the United States (Presnell, Bearman, & Stice, 2004).

Disordered eating and disturbed eating attitudes and behaviours are well-documented problems, in particular among adolescent females (Levine & Smolak, 2006; Striegel-Moore et al., 2009). Recently, however, disordered eating has become more prevalent among adolescent males as well (Domine, Berchtold, Akre, Michaud, & Suris, 2009; Gadalla, 2008; Shomaker & Furman, 2009; Stice, Maxfield, & Wells, 2003; Striegel-Moore et al., 2009). A recent study confirms that body image dissatisfaction and eating disturbances are becoming more normative and universal, not just for women but also for men (Tantleff-Dunn, Barnes, & Larose, 2011). This transition is explained by the desired ‘slenderness culture’; that is, the idealised images of beauty and attractiveness that pervade modern society and affect the eating behaviour of both female and male adolescents (Tantleff-Dunn et al., 2011). Research also suggests that there are more similarities than differences apparent in the interpersonal influences on the disordered eating of boys and girls (Ricciardelli & McCabe, 2004).

Most of the studies in the area have shown that disordered eating and disturbed eating attitudes and behaviours occur mainly in western, modern industrial societies (Hay, Mond, Buttner, & Darby, 2008; Hudson, Hiripi, Pope, & Kessler, 2007). As such, disordered and disturbed eating are considered to be culture-bound syndromes of the West (Bradford & Petrie, 2008; Jackson & Chen, 2007; Ricciardelli & McCabe, 2004; Stice, Schupak-Neuberg, Shaw, & Stein, 1994; Witztum, Stein, & Latzer, 2005), where being thin symbolises social acceptance, beauty, and success. In contrast, non-western populations, including Arab societies, are found to idealise plumpness, which symbolises beauty, fertility, and good health (Shuriquie, 1999). Nonetheless, eating disorders and disordered eating have recently begun to emerge in non-western countries as well (Cummins, Simmons, & Zane, 2005; Makino, Tsuboi, & Dennerstein, 2004; Mond, Chen, & Kumar, 2010). In Arab and Muslim countries, such as Pakistan, Egypt, Saudi Arabia, Lebanon, the United Arab Emirates, and Iran, these disorders have been documented mainly among females (Afifi-Soweid, Najem Kteily, & Shediac-Rizkallah, 2002; Al-Issa, 1966; Al-Subaie et al., 1996; Al-Subaie, 2000; Choudry & Mumford, 1992; Eapen, Mabrouk, & Bin-Othman, 2006; Elsarrag, 1968; Kiriike & Nagata, 1997; Mumford, Whitehouse, & Choudry, 1992; Nasser, 1986, 1988, 1994a, 1994b, 1994c; Nobakht & Dezhkam, 2000; Thomas, Khan, & Abdulrahman, 2010).

A similar trend is also apparent in Israel, which is a multicultural society encompassing various ethnic and religious groups and immigrants from many different countries (Latzer & Shatz, 2001; Latzer & Tzischinsky, 2005; Mitrany, Lubin, Chetrit, & Modan, 1995; Scheinberg et al., 1992). Arabs comprise approximately 20% (1.5 million) of the population of Israel, including Muslims (83%), Christians and Druze (8% each), as well as some other groups (Central Israeli Bureau of Statistics, 2009). Whereas the Israeli majority generally represents a modern, western-oriented society, the Arab culture in Israel is still in the process of transition from a more traditional society to a relatively modern and western one (Azaiza, in press). Traditional social norms and customs remain prevalent, with significant differences in basic values and attitudes toward femininity and gender roles, marriage and divorce, family relations, and child-rearing (Barak & Golan, 2000).

In the last three decades, large numbers of Israeli-Jewish adolescents in non-clinical settings have been found to have abnormal eating attitudes and weight concerns (Harel, Ellenbogen-Frankovits, Molcho, Abu-Ashas, & Habib, 2002; Latzer, 2003; Latzer & Tzischinsky, 2003, 2005). Four studies have examined disordered eating attitudes and behaviours among Israeli-Arab adolescent girls in communal samples. The results revealed similar maladaptive eating behaviours among Arab adolescent females and their Jewish peers (Apter et al., 1994; Latzer, Tzischinsky, & Azaiza, 2007; Latzer, Tzischinsky, & Geraisy, 2007).

To the best of our knowledge, most of the studies conducted to date among Arab and Muslim populations have focused on young women and adolescent girls, and only one study has examined disturbed eating attitudes and behaviours among adolescent males. Gan, Mohd Nasir, Zalilah, and Hazizi (2011) examined disordered eating among Malaysian university students (age 18–24, mean age = 20.6), as well as the role of psychological distress in the relationship between socio-cultural influences and disordered eating. Socio-cultural influences were found to have a direct effect on disordered eating among the female students, but not the males. Psychological distress mediated the relationship between socio-cultural influences and disordered eating among the male students. Young men who experienced greater pressure to be thin and a high frequency of teasing reported a higher level of psychological distress, which in turn led to disordered eating.

The aim of the present study was to compare the eating attitudes and behaviours, including weight concerns and dieting behaviour patterns, between Israeli-Arab adolescent boys and girls.

Method

A cross-sectional study conducted in Israel between 2009 and 2010 assessed eating attitudes among Israeli-Arab adolescent boys and girls from two residential settings (urban boys, 31.7% and rural boys, 44.2%), from two age subgroups (12–14.5 and 14.5–18 years old), and from two religious subgroups (Moslems, 38.7% boys; and Christians, 44% boys). The rationale for dividing the subjects into two age groups is that they differ according to developmental stages of adolescence. The rationale for choosing two religious subgroups is the apparent behavioural differences between the two religions in terms of social openness, cultural orientation, and self-perception, especially among the women.

Subjects

The communally based sample consisted of 2024 Israeli-Arab adolescents enrolled in Grades 7–12, of whom 1966 (1142 females and 824 males) completed the study. Participants included 1824 Muslims (93%), 132 Christians and 10 others (7% together), who ranged in age from 12 to 18 (females' mean age = 15.23, standard deviation = 1.37; males' mean age = 15.18, standard deviation = 1.34). The age groups were divided into early adolescence (12–14.5 years old) and late adolescence (14.5–18 years old) in order to account for differences in the developmental stages (Steinberg, 1999). The study was conducted in 36 middle and high public schools that were randomly sampled from urban and rural residential settings from all parts of Israel, using a cluster sampling method. First, the sampled population was divided into four geographical areas of residence clusters. Second, a randomised sample of two religious subgroups (Moslems and Christians) was drawn from each geographical cluster. Third, 36 middle and high schools (age range from 12 to 18 years) were selected at random from each religious subgroup. In the final sample, 39% of the participants were from urban localities and 61% were from rural settings. All of the pupils from the selected schools were asked to complete the research questionnaires.

With regard to parents' level of education, 3.4% of the fathers and 6.3% of the mothers were illiterate, 10.2% of the fathers and 11.3% of the mothers had an elementary school education, 60.9% of the fathers and 59.4% of the mothers had a high school education, and 25.5% of the fathers and 23% of the mothers had a higher education. As for socio-economic status, 47% were moderate-high, 47.8% were moderate, and 5.2% were low.

Measures

The Eating Attitude Test (EAT-26; Garner, Olmsted, Bohr, & Garfinkel, 1982) is a widely used screening instrument for measuring eating attitudes in large non-clinical populations. The EAT-26 consists of 26 items scored on a three-point Likert scale, with a possible total of 0–78 points. A score < 20 is used to identify cases of disturbed eating attitudes. The EAT-26 is used to examine eating disorder risk based on attitudes, feelings, and behaviours related to eating and eating disorder symptoms. It has been confirmed as a reliable and valid instrument in English (Garner et al., 1982), Hebrew (Ianuca, 1990), and Arabic (Al-Subaie et al., 1996; Devlin, 2007; Mousa, Al-Domi, Mashal, & Jibril, 2010; Nasser, 1986).

In this study, the Cronbach alpha correlation for the EAT-26 was 0.89 for females and for males. The clinical data included body mass index (BMI), whether the participants had ever dieted to lose weight, and whether they were dieting at the time of data collection (see Table 1).

Table 1 Clinical characteristics: BMI and dieting behaviour by gender.

	p value	Boys	Girls
Have you ever dieted? Yes (%)	< 0.000	18.6	39.4
Currently dieting? Yes (%)	< 0.000	16.8	36.2
BMI (mean ± standard deviation)	NS	20.81 ± 4.35	20.04 ± 3.38

Procedure

The questionnaires were approved prior to the trial by the Israel Ministry of Education's ethical committee, as well as by the school principals. Research assistants distributed the forms in the classroom, and students were told that they were taking part in a survey about typical issues related to adolescents' eating attitudes. Participation was voluntary and anonymous.

Data analysis

Data were analysed using SASW 19 for Windows. All of the analyses were conducted separately for males and for females. Differences between the groups according to gender, age, religious affiliation, residential setting, and BMI were examined using analysis of variance (ANOVA) for continuous variables and chi-square tests for categorical variables, such as dieting behaviour, religious affiliation, and residential setting.

Results

Age and gender subgroups

Significant differences were found in eating attitude total scores between the boys and the girls (F = 10.17; degrees of freedom [df] = 1; p < 0.001), with the girls having significantly higher scores than the boys, as expected. No significant differences were found between the two age groups (F = 0.08; df = 1; p =  not significant [NS]), but there was a significant interaction between age and gender (F = 3.74; df = 1; p < 0.05). Girls from the younger adolescent group had significantly lower eating attitude scores than girls from the older adolescent group (10.34 ± 11.54 vs. 11.56 ± 12.52, respectively), while the younger boys had higher eating attitude scores than the older boys (9.66 ± 11.13 vs. 8.75 ± 10.34, respectively).

With respect to disturbed eating attitudes, the results showed that 82.3% of the students had a negative EAT-26 score (>20), while 17.7% (girls, 18.7%; boys, 16.4%) had a positive EAT-26 score ( < 20) (F = 1.7; df = 1; p = 0.1). A Fisher exact test revealed no significant differences between gender and age subgroups (12–14.5 years old, 17.8%; 14.5–18 years old, 18.2%) for positive EAT-26 scores ( < 20) (F = 0.074; df = 1; p = 0.4).

Body mass index and dieting behaviour by age and gender

No significant differences were found between boys and girls for BMI (mean BMI was 20.04 ± 3.38 for girls and 20.81 ± 4.35 for the boys; (see Table 1). Additionally, no significant differences were found between the two age groups (F = 3.97; df = 1; p = NS) or between genders (F = 4.23; df = 1; p = NS) for BMI. However, a significant interaction was found between age and gender (F = 12.69; df = 1; p < 0.000). As expected, the 12–14.5-year-olds had the significantly lowest BMI among both the boys and the girls (20.81 ± 4.35 and 20.04 ± 3.38, respectively), while the 14.5–18-year-olds had the highest BMI among both the boys and the girls (22.97 ± 5.83 and 20.76 ± 3.16, respectively).

No significant differences emerged between the two age groups in dieting behaviour. However, there were significant gender differences, with the girls reporting significantly higher dieting behaviour in the past (χ² = 95.03; df = 1; p < 0.001) and in the present (χ² = 85.14; df = 1; p < 0.001), as compared with the boys (see Table 1).

Religious affiliation subgroups by gender

A Fisher's exact test revealed no significant differences between gender and religious subgroups (Muslim, 17.8%; Christian, 23.3%) for positive EAT-26 scores ( < 20) (F = 2.3; df = 1; p = 0.077). An ANOVA showed no significant differences in total EAT-26 scores between the two religious subgroups by gender (F = 14.87; df = 1; p = NS and F = 36.57; df = 1; p = NS) and no interaction (F = 0.05; df = 1; p = NS) (see Table 2).

Table 2 Percentage of positive EAT-26 scores ( < 20) by religious affiliation, residential setting, and gender.

	Boys (%)	Girls (%)
Religious affiliation
Muslims	38.7	61.3
Christians	44	56
Residential setting
Rural	44.2	55.8
Urban	31.7	68.3

Residential setting subgroups by gender

There were significant differences between type of locality (urban, 20.1%; rural, 16.8%) for positive EAT-26 scores ( < 20) (F = 3.3; df = 1; p = 0.039). Eating disturbance scores were higher for participants from urban localities than from rural ones; the disturbed eating attitude was higher among girls than boys in urban localities, and was higher for girls in urban than in rural localities. Percentages of positive EAT-26 scores by religious affiliation, residential setting, and gender can be seen in Table 3.

Table 3 Means and standard deviations of eating attitudes (total EAT-26 score) by religious affiliation, residential setting, and gender.

Religious affiliation	Muslims (n = 300)	Christians (n = 26)	p value
Boys (n = 127)	9.15 ± 10.71	10.38 ± 12.34	NS
Girls (n = 199)	10.87 ± 12.0	11.64 ± 9.13	NS
p value	>0.0020	NS
Residential setting	Village/rural (n = 181)	Urban/city (n = 145)
Boys (n = 127)	9.25 ± 11.21	9.28 ± 10.38	NS
Girls (n = 199)	10.11 ± 11.30	12.01 ± 12.5	>0.02
p value	NS	>0.0013

ANOVA results revealed no significant differences in total EAT-26 scores between urban localities by gender, and no interaction (F = 1.02; df = 1; p = NS; F = 4.12; df = 1; p = NS; and F = 2.81; df = 1; p = NS, respectively; see Table 3 for means and standard deviations).

Discussion

Disordered eating and disturbed eating attitudes and behaviours are well-documented problems, in particular among females in western, modern industrial countries (Hay et al., 2008; Hudson et al., 2007; Striegel-Moore et al., 2009). However, in the past four decades, the prevalence of eating disorders and disordered eating has also risen among adolescent boys (Ackard, Fedio, Neumark-Sztainer, & Britt, 2008; Cooke & Sawyer, 2004; Domine et al., 2009; Gadalla, 2008; Ricciardelli & McCabe, 2004). Although the prevalence of eating disorders is still higher among females, there are many similarities in risk factors for eating disorders shared by both genders (Lock, 2009; Striegel-Moore et al., 2009).

Moreover, these phenomena have also begun to emerge in non-western countries (Cummins et al., 2005; Makino et al., 2004; Mond et al., 2010), including traditionally oriented Arab populations (Domine et al., 2009; Gadalla, 2008). In Saudi Arabia, Al-Subaie et al. (1996) found that 19.6% of girls had abnormal eating attitudes and 0.8% had anorexia nervosa. In Iran, Nobakht and Dezhkam (2000) showed that the lifetime prevalence of bulimia nervosa and anorexia nervosa is 3.2% and 0.9%, respectively, among adolescent females. In Lebanon, approximately 10% of normal-weight female college students had a drive for thinness, were preoccupied with body weight and over-exercising, abused laxatives and diet pills, restricted high-caloric foods, skipped meals, and displayed binge eating behaviour (Afifi-Soweid et al., 2002). In Pakistan, the prevalence of body dissatisfaction among adolescent girls was found to be 11.4% (Mumford et al., 1992). In the United Arab Emirates, 66% of adolescent females (aged 13–18 years) were found to have a drive for thinness (Eapen et al., 2006), and 24.6% of undergraduate students (mean age = 19.84) had an eating pathology (score < 20 on the EAT-26) (Thomas et al., 2010).

The different rates in disordered eating attitudes and pathology may be attributed to the use of different evaluation and assessment measurements. They may also be related to the level of exposure to a westernised environment and the phenomenon of culture clash with western values (Soh, Touyz, & Surgenor, 2006). This tendency extends to Israel, a multicultural western country with various ethnic and religious groups, including Arab Muslims and Christians (Latzer, Tzischinsky, & Azaiza, 2007; Latzer, Tzischinsky, & Geraisy, 2007). Indeed, the prevalence of body dissatisfaction among Israeli-Arab adolescent girls was found to be 13% (Latzer, Tzischinsky, & Azaiza, 2007).

To the best of our knowledge, most of the studies conducted to date in Israel have focused primarily on female adolescents and young adults, both Jewish and Arab (Latzer, Tzischinsky, & Azaiza, 2007). No study has examined disturbed eating attitudes and behaviours among adolescent Arab boys or compared them with those of Arab girls. Thus, the goal of the present study was to investigate the prevalence of disturbed eating attitudes and behaviours, including BMI and dieting behaviour, in a communally based sample of Israeli-Arab male and female adolescents.

As expected, significant differences were found between the boys and the girls in the total scores of disturbed eating attitudes, with the girls having the highest score. Similarly, dieting behaviours (current and past) were significantly higher among the girls than the boys. These results are in line with previous research in western countries (Ackard et al., 2007). Surprisingly, no significant differences were found in disturbed eating attitudes (scores above 20) between the boys and the girls. The prevalence of abnormal eating attitudes (scores < 20) was 17.7% for the full sample, with a breakdown of 16.4% for the boys and 18.7% for the girls.

With regard to the female population, these results are similar to those found in previous communally based samples of Israeli-Jewish female adolescents (18–19%) (Apter et al., 1994; Latzer & Shatz, 2001; Latzer & Tzischinsky, 2003, 2005; Stein et al., 1997), but lower than those found among Israeli-Arab schoolgirls (25%) (Apter et al., 1994; Latzer, Tzischinsky, & Azaiza, 2007). The prevalence rate is also similar to those found in other western countries (Dancyger & Garfinkel, 1995; Lichener, Arnett, Rallo, Srikameswaran, & Vulcano, 1986; Patton, 1988; Patton, Johnson-Sabine, Wood, Mann, & Wakeling, 1990; Scheinberg et al., 1992; Toro, Castro, Garcta, Perez, & Cuesta, 1989; Whitaker et al., 1989; Wichstrom, 1995) and to those found in two studies conducted in Saudi Arabia (19.6% of the sample scored above 20) (Al-Subaie, 1998; Al-Subaie et al., 1996).

As for dieting behaviour, these results are similar to those reported among Iranian schoolgirls (Nobakht & Dezhkam, 2000) and Israeli-Jewish schoolgirls (Harel, Koren, Grinvald, Ben David, & Nave, 2006). The current findings are also in line with recent results found in the same adolescent group, using a different instrument (Eating Disorder Inventory-II; Latzer, Tzischinsky, & Geraisy, 2007).

The existing data suggest more similarities than differences between boys and girls in disturbed eating attitudes. This is particularly surprising, given that this population of boys is comprised of Israeli-Arab boys who generally come from a traditionally oriented culture. The same tendency was also observed when comparing religious affiliation (Muslim vs. Christian) by gender, as no significant differences were revealed. These findings can be partially understood within the context of the exposure of Israeli-Arabs to the predominantly western culture of the Jewish population in the country and the socio-cultural changes that are currently taking place in Arab society (Azaiza, in press; Ben-Ari & Azaiza, 2003).

However, the results of this study are contrary to those found in previous studies, showing that body image disorder was more common among adolescent girls (60%) than boys (30%) in the United States (Presnell et al., 2004). A recent study (Quiles-Marcos et al., 2011) evaluating gender differences between adolescents with a high or low risk of developing eating disorders, as measured by EAT-40, found that 15% of the girls and 6.8% of the boys had disturbed eating attitudes ( ≤ 30).

Thus, the current findings challenge traditional socio-cultural assumptions that the pressure to be thin is more common and relevant only for girls. Our findings indicate that the idealised images of beauty and attractiveness in today's ‘slenderness culture’ influence the eating behaviour of both female and male adolescents (Ricciardelli & McCabe, 2004; Tantleff-Dunn et al., 2011). While girls are more concerned about being thin, boys experience pressure to attain a body type characterised by little body fat and more lean muscle (Cafri, Blevins, & Thompson, 2006; Shomaker & Furman, 2009; Stice et al., 2003; Vincent & McCabe, 2000).

Moreover, gender disparities in the prevalence of disordered eating symptoms have been found to be considerably less extensive when the subclinical, rather than the clinical, level in a community sample is considered and disordered eating is associated with equivalent psychosocial impairment among males and females (Neumark-Sztainer et al., 2002; Neumark-Sztainer & Hannan, 2000). In their sample of male and female college students, Gan et al. (2011) observed a similar tendency for disordered eating and found that psychological distress mediates the relationship between socio-cultural influences and disordered eating. Thus, according to the current results, we cannot consider adolescent boys with pathological eating attitudes and behaviours as a group more at risk for developing eating disorders relative to girls.

Our findings regarding disturbed eating among boys can also be understood within the context of traditional Arab cultural values and norms, which create an expectation for females to stay at home and maintain the traditional roles of wife and mother (Ben-Ari, 1998, 2001; Haj-Yahia, 1997), while the males are responsible for interactions with the outside world. Thus, the current results may be related to the degree of exposure to western values regarding gender roles and the way in which different members of Arab cultures may be influenced by them.

One difference was found between the boys and the girls who took part in this study; namely, a difference based on the type of residential areas in which the participants lived. In urban settings, the girls demonstrated more eating pathology than the boys. Urban girls were also more likely to have eating pathologies than rural girls. These results may be attributed to a higher level of exposure to western values and to a culture clash phenomenon, with those values being more powerful in urban areas than in rural ones (Soh et al., 2006).

Strengths and limitations

This study has several strengths, including the large sample size and the random sampling of male and female adolescents from different areas of Israel, different types of residences, and different religious groups. However, there are also some limitations, and generalisations from this study with respect to eating disorder pathology should be made with caution. First, no clinical assessment was done for eating disorder diagnosis according to the criteria defined in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. It was not feasible to conduct clinical interviews with all the participants who scored above the threshold ( < 20) on the EAT-26. Thus, the method used in this study only demonstrates eating attitudes and weight concerns.

Second, the screening instrument used (EAT-26) was developed for use with western populations; therefore, it cannot be assumed that it will be as efficient in a different cultural context. Although the reliability of most sub-scales of the EAT-26 has been found to be high in a previous study of Arabs in Israel (Latzer, Tzischinsky, & Geraisy, 2007), the items on the questionnaire may be interpreted in a manner different from the one intended. In addition, symptoms associated with eating attitudes in other cultures may not be identified by the items on the questionnaire.

Future research

This study was the first to examine the prevalence of disturbed eating-related attitudes and behaviours among Israeli-Arab adolescents for both males and females. However, further epidemiological studies should be conducted, including clinical interviews. Moreover, further screening and assessment of the prevalence of eating disorder symptoms should be undertaken at primary healthcare clinics for the Arab and Jewish populations, including adolescent boys. The research results point to the need to evaluate the relationship between level of religiosity and disordered eating pathology among both girls and boys in the Arab population. Finally, similar research should be carried out among adolescent boys from other cultural backgrounds, including Israeli-Jewish boys.

Additional information

Notes on contributors

Yael Latzer

Yael Latzer, DSc, is an associate professor at the Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel, and director of Eating Disorders Clinic, Psychiatric Division, Rambam Medical Center, Haifa. Professor Latzer is both nationally and internationally recognised as an expert in the field of eating disorder treatment and research.

Faisal Azaiza

Faisal Azaiza PhD, is full professor and head of the School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.

Orna Tzischinsky

Orna Tzischinsky, DSc³, is an associate professor and head of the department of behavioral science, Emek Yezreel College, Emek Yezreel, Israel. Professor Tzischinsky is both nationally and internationally recognized as an expert in the field of sleeping and eating disorder treatment and research. Since 1995, Professor Yael Latzer and Professor Orna Tzischinsky have collaborated in a pioneering research project on the relationship between eating and sleeping disorders. They are both recognized worldwide as experts in the field and have published more than 20 scientific articles on the topic.