Relationship between early menarche, obesity, and disordered eating behaviors: a school-based cross-sectional survey in Northern Saudi Arabia

Mashael Almuhlafi,1 Khalil Abu Jamilah,1 Adel F Almutairi,2 Mahmoud Salam2 1Department of Family Medicine, North West Armed Forces Hospital, Tabuk, Saudi Arabia; 2Science and Technology Unit, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia Background: Obesity and disordered eating (DE) behaviors are serious health concerns, regularly observed among female adolescents, which could progress to adverse psychological and nutritional sequels. Aim: The aim of this study was to determine the prevalence of obesity and the self-reported DE behaviors among high school female students and to evaluate their self-perception of body image, peer pressures, and need for dietary consultation. Methods: This is a school-based cross-sectional study conducted in 2018. Self-administered surveys and anthropometric measurements were obtained from adolescent females, randomly selected from eight schools in northern Saudi Arabia. Sample characteristics were age, menarche, and DE behaviors (binge eating, self-induced vomiting, and usage of laxatives). Body mass index was converted to percentiles using the age-to-gender scale. Self-perception of body image, perceived peer pressures, and the Eating Attitude Test-26 (EAT-26) were scored, summated, and then presented in percentage mean scores (PMSs) and mean scores (MSs). Results: Sample comprised 399 participants. One hundred twenty-eight (32.1%) participants reported early age of menarche (≤12 years). Sixty-five (16.3%) participants reported the prevalence of overweight/obesity, 123 (30.8%) participants reported binge eating, 28 (7.0%) participants reported self-induced vomiting, and 21 (5.3%) participants reported usage of laxatives. The PMS of self-perception of body weight and peer pressure was 68.7±27.1 and 41.9±23.5, respectively. One hundred ninety-two (48.1%) participants needed professional dietary help. Students with early age of menarche were 1.7 times more likely to be overweight/obese (adjusted [adj] P=0.018) compared to others. Overweight/obese participants had significantly poorer self-perception of body image (PMS =47.4±25.0) and higher perceived peer pressure (PMS =49.5±23.1) compared to underweight/normal weight students (PMS =72.8±25.6 [P<0.001] and PMS =40.5±23.3 [P=0.005], respectively). Participants with early age of menarche complained of higher perceived peer pressure compared to others (P=0.045). Participants with DE behaviors had higher peer pressure (PMS =46.8±23.5) and higher scores on E-26 (MS =22.2±11.4) compared to their counter groups (P=0.002 and 0.016, respectively). Conclusion: The high rate of overweight/obesity and DE behaviors among female adolescents is alarming. Special consideration should be made for those with early menarche who were more prone to overweight/obesity. Keywords: adolescent, peer, E-26, body image, binge, self-induced vomitin