A cross-cultural study on eating attitudes and behaviours in two Spanish-speaking countries: Spain and Mexico

European Eating Disorders ReviewEur. Eat. Disorders Rev. 9, 53±63 (2001)

Paper

A Cross-cultural Study on Eating Attitudes andBehaviours in Two Spanish-speaking Countries:Spain and Mexico

R. M. Raich1*, M. Mora1, D. SaÂnchez-Carracedo1, J. Torras1,M. C. Viladrich1, L. Zapater1, J. M. Mancilla3, R. VaÂzquez3 andG. AÂ lvarez-RayoÂn3

1Department of Health Psychology and Social Psychology, AutonomousUniversity of Barcelona, Spain2Department of Psychobiology and Methodology of Health Sciences,Autonomous University of Barcelona, Spain3Nutrition Research Centre of the ENEP, Autonomous NationalUniversity of Mexico, Mexico

Cross-cultural studies can provide important data on the in¯uence of cultural factors inthe growth and control of eating disorders and their symptoms. If, moreover, thosestudies deal with the same language but different contexts, the comparison may bericher and the knowledge derived more signi®cant. The main aim of the present study isto identify the prevalence of eating disorder and body dissatisfaction symptoms, aswell as the factors which may in¯uence them, in two samples of ®rst-year femaleuniversity students from the UAB (Spain) and the UNAM (Mexico). The results ofthis study show more eating disorder symptoms and body dissatisfaction in Spainthan in Mexico and also that the level of perfectionism is much higher among theMexican students. Copyright # 2001 John Wiley & Sons, Ltd and Eating Disorders

Association.

European Eating Disorders ReviewCopyright # 2001 John Wiley & Sons, Ltd and Eating Disorders Association. 9(1), 53±63 (2001)

* Correspondence to: R. M. Raich, Departament de Psicologia de la Salut i Psicologia Social, Facultatde Psicologia, Universitat Autonomia de Barcelona, Edi®ci B, 08193 Bellaterra, Barcelona, Spain.E-mail: [email protected]

Contract/grant sponsor: DGICYT (DireccioÂn General de InvestigacioÂn CientõÂ®ca y TeÂcnica);Contract/grant number: PB94-0677.

Keywords: cross-cultural-study; eating-disorder-symptoms; college-students

INTRODUCTION

Cross-cultural studies on eating behaviour disturbances can shed light onvarious questions. First, they can show the role played by culture inencouraging or promoting the various eating disorders or eating disordersymptoms. Research into the prevalence of eating disorders is of interest for atleast two reasons: to obtain basic information on the epidemiology of thedisorders and also to formulate hypotheses concerning the social factors thatmay contribute to their etiology.

Various studies have focused on this aspect, ®nding a higher level of thesedisorders in countries whose cultures are modelled on the so-called westernworld than in other countries (Rathner et al., 1995; Lee et al., 1997). Other studieshave compared the different sub-groups in US society, such as the prevalenceof eating behaviour disorders among white and black US citizens (Nevo, 1985;Gray et al., 1987; Gross and Rosen, 1988). Recently, these studies (Caldwell et al.,1997) have, despite some limitations, shown that socio-economic status is amore important factor than ethnic origin, and that the most important factormay be a cultural one.

By using the same instrument in different cultures, different results will beobtained, these being attributable to cultural differences. However, Lee et al.(1997) argue that the problems of interpretation and translation of items differfrom one culture to another. In this case, we need not translate the assessmentinstruments because we are using the same language.

Another important reason for carrying out cross-cultural studies is thepaucity of published research comparing Spanish-speaking countries indifferent contexts such as America and Europe. In our search for studies ofthis kind, we found that those focused on Spanish-speaking countries werealmost non-existent in the English language and in international journals, butexist in Spanish (Tena and Holtz, 1995; Vivas and Lugli, 1997; Mancilla et al.,1998; VaÂzquez et al., in press).

Because of their age and sex, female university students can be considereda group at risk (Crowther et al., 1992), particularly during their ®rst yearat university, which involves a stressful situation in which they mustadapt to a new context (Phelps and Wilczenski, 1993; Rathner et al., 1995;Kashubeck and Mintz, 1996; Lee et al., 1997; Vivas and Lugli, 1998; Mancillaet al., 1998).

The chief aim of this study is to identify the prevalence of eating attitudesand behaviours at risk in two samples of female university students, throughthe same instruments, in two different countries: Spain and Mexico (UABÐ

R. M. Raich et al. Eur. Eat. Disorders Rev. 9, 53±63 (2001)

Copyright # 2001 John Wiley & Sons, Ltd. and Eating Disorders Association. 54

Spain and UNAMÐMexico), and also to study the factors which may lead toeating disorder risk.

METHOD

Subjects

The sample consisted of 826 ®rst-year university women students from variousfaculties in their respective countries. The ®rst group of 334 students werestudying in faculties of the Universidad AutoÂnoma de Barcelona (Spain): 18.3%Veterinary Medicine; 16.2% Pedagogy; 10.8% Medicine; 6.3% Mathematics;14.1% Psychology; 6.3% Geography; 7.5% Law and 20.7% Labour Relations. Thesecond group of 492 students were studying at the Universidad NacionalAutoÂnoma de MeÂxico: 12.6% Medicine; 51% Psychology; 16.9% Dentistry; 13.4%Nursing and 6.1% Biology.

The average age of the Spanish sample was 18.9 years (SD = 1.5; IC95%: 18.7to 19.1) and that of the Mexican sample, which was slightly older, was around19.6 years (SD = 1.6; IC95%: 19.4 to 19.7).

Instruments

We used available instruments to measure height and weight of subjects. Inorder to analyse the distribution of BMI among the two samples, the latterwere divided into six categories according to weight/height (Williamson,1990): seriously underweight (< 18), underweight (18±20), normal weight(21±25), overweight (26±30), moderately obese (31±40) and seriously obese(> 40).

To detect disturbances in eating behaviour and attitudes towards nutrition, weused the Spanish adapted version of Castro et al. (1991) of Eating Attitudes Test(EAT; Garner and Gar®nkel, 1979, 40 items). The adapted version showedpsychometrical goodness (sensitivity 67.9% and especi®city 85.9%; reliability 0.79).We took as a cut-off point EAT scores � 30.

An effective psychometric measuring instrument to detect body shapedissatisfaction is the adapted version (Raich et al., 1996) of the Body ShapeQuestionnaire (BSQ; Cooper et al., 1987), which is designed to assess theconstruct of weight and body dissatisfaction in general. Our cut-off point in theBSQ was a score� 105. This version showed psychometrical goodness, internalconsistency 0.95 and good correlation with EAT (r�0.71) and with EDI-bd(r�0.78). These measurements were used in conjunction with the Spanishversion of GuimeraÁ and Torrubia (1987) (with good intrenal consistency

Eur. Eat. Disorders Rev. 9, 53±63 (2001) Cross-cultural Study


and test-retest reliabilities) of the Eating Disorder Inventory (EDI; Garner et al.,1983).

Procedure

The groups participating in the study were chosen at random among the classgroups. All the participants were ®rst-year female students enrolled at variousfaculties in their respective countries.

The questionnaires were distributed without prior warning during thenormal class timetable and subjects were asked to participate on a voluntarybasis. They were informed of the nature of the study being carried out and toldthat it was part of a research project on eating habits. Since participation wasvoluntary, those who did not wish to take part left the classroom at the sametime as the male students. The tests were carried out on different days,depending on the timetable of each of the groups involved.

Statistical analysis

A multivariate covariance analysis (MANCOVA) was carried out to measurethe effect of each of the variables in relation to the country in question, whilst atthe same time checking the possible distortion effect of the age and BMIvariables. The statistical analysis carried out to establish the differencesbetween both countries in terms of the prevalences of eating disorders and BMIcategories consisted of a comparison of the distributions de®ned by the variouscut-off points in the questionnaires: EAT, BSQ, and EAT � BSQ, using the �2

test.

RESULTS

Table 1 shows the mean values and standard deviations found for all theparameters studied. As can be seen from these results, the mean scoresobtained for most of the measurements are slightly higher among the Spanishstudents.

Prevalence study

The body mass index (BMI) presented a high number of spoiled sample cases(262, all from the Mexican sample). Their BMI distribution among the twogroups is as follows: average�21.84 (DS�2.76; IC95%: 21.54 to 22.14) in the



Table 1. Mean and standard deviation of the scores for the different variables in the Spanish and Mexican samples

AGE BMI EAT BSQ EDI DT B BD II MF IN P ID

Spain N�331 N�331 N�334 N�334 N�331 N�334 N�334 N�333 N�333 N�334 N�334 N�333 N�334��18.90 ��21.84 ��15.01 ��83.05 ��32.58 ��3.60 ��1.04 ��9.92 ��3.37 ��4.74 ��2.70 ��3.96 ��3.10SD 1.49 SD 2.76 SD 11.15 SD 32.30 SD 19.58 SD 5.24 SD 2.69 SD 6.61 SD 4.06 SD 3.92 SD 3.34 SD 3.35 SD 3.23

Mexico N�492 N�233 N�492 N�490 N�490 N�490 N�490 N�490 N�490 N�490 N�490 N�490 N�490��19.58 ��23.06 ��14.75 ��75.81 ��28.27 ��3.70 ��0.59 ��4.94 ��3.19 ��3.92 ��1.77 ��6.44 ��3.72SD 1.56 SD 3.17 SD 8.16 SD 25.64 SD 16.51 SD 3.85 SD 1.45 SD 4.72 SD 3.53 SD 3.56 SD 2.92 SD 3.31 SD 3.23

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Table 2. Results of the comparison between countries using the covariance analysis

Country (Spain and Mexico) Age covariant BMI covariant Global values

IC 95% of b Value t p IC 95% of b Value t p IC 95% of b Value t p R2 Global F p

EAT 1.09/2.36 0.723 N.S. 0.69/0.35 0.646 N.S. 0.10/0.66 2.675 0.01 0.015 2.883 0.05

BSQ 10.4/0.8 2.288 0.05 2.5/0.4 1.467 N.S. 2.8/4.4 8.971 0.001 0.128 27.187 0.001

EDI-dt 0.5/1.1 0.657 N.S. 0.4/0.1 1.18 N.S. 0.2/0.5 5.507 0.001 0.056 11.062 0.001

EDI-b 0.7/0.1 1.66 N.S. 0.2/0.1 0.808 N.S. 0.05/0.18 3.6 0.001 0.026 4.843 0.01

EDI-bd 5.95/3.99 9.923 0.001 0.63/0.04 2.202 0.05 0.5/0.84 8.387 0.001 0.219 51.681 0.001

EDI-ii 0.5/0.82 0.433 N.S. 0.56/0.16 3.538 0.001 0.04/0.18 1.32 N.S. 0.024 4.503 0.01

EDI-mf 0.84/0.52 0.466 N.S. 0.36/0.05 1.516 N.S. 0.06/0.2 0.880 N.S. 0.006 1.079 N.S.

EDI-in 1.2/0.07 2.213 0.05 0.4/0.02 2.211 0.05 0.01/0.2 1.77 N.S. 0.023 4.375 0.01

EDI-p 2.64/3.82 10.738 0.001 0.28/0.08 1.106 N.S. 0.11/0.09 0.199 N.S. 0.178 39.84 0.001

EDI-id 0.53/1.69 3.769 0.001 0.44/0.1 2.989 0.01 0.04/0.2 1.078 N.S. 0.038 7.282 0.001

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Spanish women, and slightly greater among the Mexican women, with anaverage�23.06 (DS�3.17; IC95%: 22.65 to 23.46).

Most of the students were within the normal weight limits in both samplegroups (62.8% of the Spanish students and 67% of the Mexican students). TheSpanish students weigh less than the Mexican ones (23.3% as compared to11.6%) and have a greater percentage of underweight students (3% ofSpaniards and 0.9% of Mexican ones). In the overweight categories, therewere more Mexican students (18% Mexicans compared to 8.8% Spanish). 2.1%of students in both the Mexican and the Spanish samples fell within themoderately obese category, while only one seriously obese subject was found inthe Mexican group (0.4%) (�2�24.22; p< 0.001).

For the EAT score, Spanish students show a tendency to present higher rateof eating disorder symptoms (EAT> 30): 9.9% as compared to 6.3% for theMexican group (�2�3.57; p�0.59; IC95% diff.�ÿ0.3 to 7.4).

As regards of body dissatisfaction, the results show a higher rate in the BSQscores (BSQ> 105) among the Spanish students than among the Mexicanstudents: 21% as opposed to 14.6% (�2�5.59; p< 0.05; IC95% diff.�0.96 to11.7). This were signi®cant differences.

When the same analysis was carried out on both questionnaires (EAT> 30plus BSQ> 105), an 8.1% degree of pathological eating attitudes was detectedamong the Spanish students, as compared to 4.9% among the Mexicanstudents, these differences verging on the signi®cant (�2�3.53; IC95%�0.3 to6.7).

Covariance analysis

A covariance analysis was then carried out with each of the scores from thequestionnaires administered (dependent variables): total EAT, total BSQ andtotal EDI, together with the eight subscales of the latter. The country variablewas considered independently, in order to verify the possible differencesbetween them; two covariants, age and BMI, were considered in each of theanalyses. The results obtained are shown in Table 2.

All the variables showed some signi®cant effect except for the EDI subscale`maturity fear'. As for the age covariant, we found that the overall EDI scoreand the subscales bd, ii, in and id obtained signi®cant effects. A negativerelationship was found in each of them: the greater the age, the lower the scorefor each of the tests. As regards the BMI covariant, this was found to havesigni®cant effects on the scores of those tests which evaluate aspects relating toeating attitudes or body dissatisfaction (EAT, BSQ, general EDI, dt, b and bd)whereas there were no signi®cant effects in the case of those variables whichmeasure aspects of personality (the remaining EDI subscales). The relationshipfound was a positive one: the greater the BMI, the higher the score in thevarious questionnaires.



As for the independent variable (country), the table shows that the onlymeasurement with a signi®cant effect attributable entirely to differencesbetween Spain and Mexico is perfectionism (EDI-p) on behalf of the Mexicanstudents. Furthermore, when the effects of the age and BMI covariants wereisolated, signi®cant differences were found between the two countries in theBSQ scores, as well as in the EDI subscales bd, in and id.

Complementary to these analyses, checks were carried out on the possibleinteractions between the two covariants and the independent variable(age�country and BMI�country), no signi®cant difference being found ineither case.

DISCUSSION

First of all it is necessary to keep in mind that our samples may show a selectionbias because female students could chose to opt out with the men in therecruitment process. This is a risk in all the studies on general population butthe proportion of students who dropped out was actually very small:approximately 1%. It is a weakness of our study, as well as the high numberof spoiled cases of BMI from the Mexican sample. In spite of this, the remainignumber (n�230) was large enough to be compared to the Spanish sample;moreover, we have made sure that there were no differences between theMexican sample with BMI and the Mexican sample without BMI by comparingthe other measures we have age, weight, EAT and EDI scores and there were nosigni®cant differences.

As regards the BMI, we found that the weight distribution of the Mexicanfemale students tended to register higher values than that of the Spanishstudents. Although the difference in scores prevalences in the EAT> 30indicates a greater tendency to eating disorder attitudes in Spain it is notstatistically signi®cant. What is clear, however, is that the BMI bears asigni®cant relationship to the EAT score, irrespective of the age and country ofthe subjects concerned. The greater the BMI, the greater also is the number ofeating disorder symptoms, as is commonly re¯ected in the literature.

Regarding the prevalence of body-shape dissatisfaction this was found to begreater among the Spanish women students. Despite the lower BMI in Spain,when we examined the effect of the differences in BMI between Spain andMexico, we found that there was greater body-shape dissatisfaction in theformer country (BSQ and EDI-bd) than in the latter. As early as 1988, Toro et al.,reported increased advertising pressure in favour of thinness in Spanishsociety, a pressure which since that time appears to have increased still further.Moreover, it is well known that body-shape dissatisfaction is not alwaysassociated with greater body weight in the individual, but rather with thelatter's perception of being overweight, or with a greater pressure in favour ofthe slim body image and factors involving self-esteem (French and Jeffery,1994). It may be due to the fact that the slender ideal of physical beauty is more



widespread in the Spanish population, whereas Mexican society has preservedcultural features that act as a protective shield in this respect.

The most striking feature of the study was the great difference in theperfectionism variable (EDI-p) between the two countries. Although the scoresfor the perfectionism scale were greater in the Mexican sample (between 2.64and 3.82 points higher) than in the Spanish sample, the latter obtained higherEAT scores. These results do not bear out the perfectionism variable as a meansof predicting eating disorders (Davis, 1997), although another type of analysisis required in order to provide further explanation criteria. Nevertheless, thisresult can partly be explained by the following factors: the subjects in the studyare female university students. In Mexico, university entrance is dif®cult. Onlyone in ten applicants is accepted. Furthermore, the UNAM is the most soughtafter university in the country. In addition, for cultural and historical reasonsthat are easy to understand, it is harder for women to study at university.Finally, Mexico has high levels of poverty. It therefore follows that thosewhose ®nancial resources are limited are unlikely to gain access to uni-versity. For all these reasons, we assume that those women who do succeed instudying at university have demonstrated that they have set themselves highpersonal standards which are likely to be more closely related to academicachievement than to eating disorders.

If we compare the mean scores in other student samples such as thosepresented by Ratner et al. (1995), Kashubeck and Mintz (1996), and Lee et al.(1997), we ®nd that the Mexican female students obtain the highestperfectionism scores (EDI-p), which are comparable only to those of theStockholm female students (Phelps and Wilczenski, 1993), although it shouldbe pointed out that the Swedish girls in the aforementioned study also obtainhigher scores on all subscales of EDI than the Mexican students, which leads usto think that in this case perfectionism is indeed related to disturbances ineating behaviour. Moreover the degree of body-shape dissatisfaction (EDI-bd)in the Spanish female students is among the highest of those reported and issimilar to that found in the Swedish, Chinese and Hungarian female students.

By way of general conclusion, in our study we have found that Mexican andSpanish students show the same results in different factors but Mexicans aremuch more perfectionist are less worried about their looks than Spaniards.

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A cross-cultural study on eating attitudes and behaviours in two Spanish-speaking countries: Spain and Mexico