The Association between Disturbed Eating Behavior and Socioeconomic Status: The Online Korean Adolescent Panel Survey (OnKAPS)

Abstract

BackgroundA limited amount of research, primarily conducted in Western countries, has suggested that higher socioeconomic status (SES) is associated with higher risk of eating disorders (EDs). However, little is known about this association in Asian countries. We examined the association of SES with disturbed eating behavior (DEB) and related factors in Korean adolescents.SubjectsA nationwide online panel survey was conducted in a sample of adolescents (n = 6,943, 49.9% girls). DEB was measured with the 26-item Eating Attitudes Test (EAT-26). Participants who scored ≥20 on the EAT-26 were considered to have DEB. Participants’ SES was determined based on self-reported household economic status.ResultsThe prevalence of DEB was 12.7%: 10.5% among boys and 14.8% among girls. Both boys and girls with DEB were more likely to perceive themselves as obese, experience higher levels of stress, and have lower academic achievement. The risk for DEB was significantly higher in boys of higher SES than in those of middle SES (OR = 1.45, 95%CI = 1.05–1.99 for high SES; OR = 5.16, 95%CI: 3.50–7.61 for highest SES). Among girls, higher risk of DEB was associated with the highest and lowest SES (OR = 1.52, 95%CI: 1.13–2.06 for lowest SES; OR = 2.22, 95%CI: 1.34–3.68 for highest SES).ConclusionsDespite the lower prevalence of obesity in Korea compared with Western countries, the prevalence of DEB in Korean adolescents was high, especially among girls. Moreover, the association between SES and DEB followed a U-shaped curve for girls and a J-shaped curve for boys.

Risk factors for disordered weight control behaviors among Korean adolescents: Multilevel analysis of the Korea Youth Risk Behavior Survey

“…Our analysis found overall 6.2% of prevalence of DWCB among Korean adolescents (9.0% of girls and 3.7% of boys), consistent with a previous study (Lee et al, ), showing that the ratios of the prevalence of DWCB between Korean and U.S. adolescents (i.e., 16.7% among 9th–12th graders from the YRBSS) ranged 1:2.4 to 1:2.7. This aligns with findings from recent studies showing comparable prevalence of disordered eating behaviors (DEB), defined by the Korean translated EAT‐26 scores of 20 or above, among Korean adolescents (14.8% in girls and 10.5% in boys) to that among U.S. adolescents (14.4% in girls and 3.8% in boys) (Lee et al, ), greater level of body dissatisfaction among Korean young women than U.S. young women (Jung & Forbes, ), and substantial number of ED cases among Korean women (Kim et al, ). Moreover, our study adds to the current literature by documenting the prevalence of one‐food diet in Korean youth (overall 2.7%, girls 4.0%, boys 1.5%), which may be a Korea‐specific DWCB.…”

“…For instance, recent studies have found that the preference toward thin body is the strongest in South Korea compared to all other countries participating in the worldwide Project Implicit (Marini et al, ) and the per capita cosmetic surgery rate was the highest in South Korea around the world in 2011, according to the International Society of Aesthetic Plastic Surgeons (Holliday & Elfving‐Hwang, ; You, Shin, & Kim, ). Relatedly, studies have found that the level of body dissatisfaction was greater among Korean young women than U.S. young women (Jung & Forbes, ) and the prevalence of disordered eating behavior, defined as the 26‐item Eating Attitude Test (EAT‐26) score of 20 or above, among South Korean adolescents (12.7%) was comparable to that among U.S. adolescents (14.4%) (Lee et al, ).…”

“…Despite the growing body of evidence concerning increase in ED risk in Asian countries, prior Korean studies have largely focused on individual‐level risk factors (Lee et al, ), or school‐level influences on related outcomes such as obesity (Choi, Park, & Behrman, ) and weight misperception (Kim & Kawachi, ). However, there has been a dearth of evidence pertaining to social contextual factors for DWCB among Korean youth.…”

School Achievement and Risk of Eating Disorders in a Swedish National Cohort

“…13 However, a Korean study reported that the association between SES and risk of eating disorders among girls was U-shaped, with increased risk among those with either lowest or highest SES. 20 …”

Disturbed eating tendencies, health-related behaviors, and depressive symptoms among university students in Korea

“…A higher score indicates more abnormal eating attitudes and behaviors. In this study, scores of 20 or more indicated disturbed eating behavior [22,23]. The Cronbach's alpha of this test was 0.84.…”