Perceived body image, ideal body image and eating disorder features in Saudi Arabia.

Abstract
The present study examines the relationship between real body image and the ideal body image with to the features of eating disorders. As hypothesized, people who have two different images about the body are more likely to show patterns of symptoms of eating disorders. for the purpose of the research , data are be collected by 200 Saudi male/female participants from 18 to 50 years old, by using the Body Shape Questionnaire, Eating Disorder Examination Questionnaire and the Figure Rating Scale. This sample randomly includes men and  women from different areas, for example from PNU, public places such as Malls, parks, etc. The aim of this study is to  investigate the relationship between Ideal body image/Body image in developing of eating disorder symptom in KSA, to discover the prevalence of eating disorders, and which type of eating disorders is most likely in KSA, and Since there are not many researches and studies about eating disorders in Saudi Arabia.
 
 
 
 
 
 
 
 
 
 
 
 
Introduction
Eating disorders (ED) are illnesses manifested through irregular eating habits (taking excessive or inadequate food) or any form of eating disturbances. The most common types of eating disorders are binge eating disorder (BED), bulimia nervosa  (BN), and anorexia nervosa (AN). People with binge eating disorder have no control over their eating, and many of them become obese and at the risk of suffering from other diseases, such as heart diseases (Fairburn & Harrison, 2003). In binge eating disorder weight is  a sign, some people with binge eating disorder weigh within the normal weight range .(normal BMI) Counter wise,  some obese people don’t suffer from BED. Those who suffer from this kind of eating disorder don’t have distorted body image perception.  Even while being overweight, they aware of their body shape and appearance and criticize themselves (“Binge Eating Symptoms and Effects”, n.d.).  Bulimia nervosa is more of a repeated binge eating disorder, but the overeating is compensated for by behaviors such as excessive exercise, forced vomiting, and extreme use of laxatives (Cooper & Fairburn, 1989). Bulimia can cause severe hydration, gastrointestinal problems and heart problems. People with bulimia nervosa are of normal or slightly overweight. They have feelings of worthlessness and loathing and have a continuing desire to be thin. For this reason, they center on self-image in addition to their food and weight (“Bulimia Symptoms and Effects”, n.d.). Anorexia nervosa is characterized by fear of weight gain and/ or weight loss. Unrealistic perceptions of body image.” Anorexia nervosa has two sub types, restricting type, which is the most commonly known type of Anorexia Nervosa whereby a person severely restricts their food intake.  Restriction may take many forms (e.g. maintaining very low calorie count; restricting types of food eaten; eating only one meal a day) and may follow obsessive and rigid rules (e.g. only eating food of one color), Binge-eating or purging type, it is less recognized; a person restricts their intake as above,  but also during some bouts of restriction the person has regularly engaged in binge-eating or purging behavior (e.g. self-induced vomiting, over-exercise, misuse of laxatives, diuretics or enemas).” (Midlarsky & Nitzburg, 2008). Anorexia can cause brain damage, bone loss, infertility, heart difficulties, and multi-organ failure. Generally, eating disorders are characterized by severe distress and concern about body image and weight (Williamson, 1995).
Body image is how one thinks of himself or herself and what one sees after looking in the mirror. Body image is about appearance, weight, and shape. Appearance and shape depend on a person’s, thoughts. Whereas weight is measurable (Cash, 2004). For this reason, Body Mass Index (BMI) is used as a feature of body image. “BMI is a value that is measures by dividing a person’s mass in kilograms by the square of his or her height in meters. If BMI is less than 18.5, the person is underweight and if BMI is between 18.50 and 24.99, the person has normal weight. If BMI is between 25.00 and 29.99, the person is overweight and the BMI is more than 30.00, the person is said to be obese “(Obesity and overweight, 2012)..  Peoples’ opinions of the desirable body differ based on gender, culture and media representation more than genes or evolution. The term “ideal body image” that comes from peoples’ perceptions and could differ from “Ideal body” which based on high standards (Alexander, 2016).
An ideal body image is the body shape one’s desire to have. For females, an ideal body is rather thin than plump. For men, the ideal body is in general low fat and muscular body (Ahern & Hetherington, 2006; Olivardia, 2004; McGuinness & Tailor, 2016). People may have an ideal body image in mind that is not matching with their actual body image (Martin,2010).
“We live in an image conscious culture, which urges all of us (especially women) to improve our appearance. The messages sent by magazines, TV, and other media include “buy certain clothes and products; straighten and whiten your teeth; get rid of your wrinkles; and most commonly, lose weight and you will be happy, admired, and loved.” The recent and recurrent debate concerning the unhealthy, a stick thin model used in the fashion industry is a perfect example of how strongly entrenched our notion of “thinness equals happiness” has become.”(Engel, Reiss, & Dombeck, 2007).
People’s habits are different in the style of their lives in various fields, including eating. Some people aim to get the perfect shape, some hope and some might not care. Concern arises from body shape pushed towards a non-wanted food consuming ways may generate undesirable disturbance. This disturbance is raised due to some behavioural, emotional and psychological characteristics that also contribute to this disturbance condition. For instance, some people experience feeling of being out of control in their eating pattern so eating a large amount of food and because their self-esteem overly related to their body image so they try intentionally to prevent gain weight by sort of disturbance behaviors like vomiting. In contrast, some people do not realize they have a problem, or even if they do they will not want to give up their behavior thus keep continuing their eating pattern without behaviors to prevent weight gain. Such these people express symptoms of eating disorders.
Body image affects one’s attitudes, perceptions, self-esteem, and general aspects in life. People may have a negative body image that forces them strive to their ideal body. In the process of trying to achieve their ideal body image, they maintain unhealthy eating habits such excessive dieting, skipping meals, or overfeeding, (Polivy & Herman, 1985). They prevent themselves from essential nutrients then they may develop eating disorders. Eventually ending up damaging their bodies. (Goldfield, 2010)
In fact, disordered eating behaviors have been documented in most parts of history calls into question the assertion that eating disorders result of the current social pressures. Scrutiny in historical patterns has led to the suggestion that these behaviors and flourished during affluent periods in more egalitarian societies. (Bemporad, 1997).This study is interested to answer the question: how can the conflicts between the real body image and the ideal body image relate to the symptoms of eating disorders in Saudi Arabia?
The importance of this study is the infrequent studies of this topic in the same time; there are changes in the area related to life style for the last forty years (Zaidi, Awad, Abdelsalam, Qasem, & Kayal, 2015) in Middle East and specifically in Saudi Arabia. KSA represents the largest population in the gulf. Additionally, most researchers in the Gulf focused in their studies on eating disorder symptoms in teenagers (Sarwer, Thompson, & Cash, 2005; McGuinness & Tailor, 2016; Midlarsky & Nitzburg, 2008), and this study will provide bigger age range population. The research can be useful and important to the people of Saudi Arabia and the rest of the region because it creates awareness about the symptoms of eating disorders and their relationship with body image. Moreover, this thesis will give a general idea about the prevalence of eating disorder symptoms among Saudis, and eventually finding rehabilitation centers specialized in eating disorder.
Present study
This research will be done to investigate whether there is a relationship between ideal body image and body image withe eating disorder symptoms Research Question: Perceived body image, ideal body image and future of eating disorder symptoms in Saudi Arabia?
General objective: to asses weather Saudi male and female who are having more conflict between body image and ideal body image showing more eating disorders symptoms compared to who having less to no conflict between the two variables.
 
Specific objective: to asses if the BMI related to eating disorder symptoms
To identify if high BMI related to eating disorder symptoms.
To identify if the low BMI related to eating disorder symptoms.
If the BMI is actually has no relationship with eating disorder symptoms.
To assess how the body image and ideal body image related to eating disorder symptoms.
To identify if conflict between body image and ideal body image related to eating disorder symptoms.
 
Hypothesis
There is a relationship between body image and ideal body image with eating disorder symptoms.
BMI is related to eating disorder symptoms.
 
 
Methodology
Research Design
The research has a correlational. It helps study demographic variables from the same group of subjects and, after this, to determine if there is a relationship between these variables (ideal body image, real body image, and eating disorder symptoms).
Participants
The number of participants in this study is about 200 male and female participants. They meet the following criteria, they are between 18 and 50 years old, they are literate (which means they can fill out the survey), and they got Saudi nationality. The sample randomly includes men women from different areas, for example from PNU, public places such as Malls, parks.. There will be no rewards or money for those who will participate in this research. Participants were allowed to stop from the survey at their will.
Following acceptable standards in psychological research a significance level of α = 0.05 and as type-II error of 0.20 level is generally considered acceptable (Shen, Kiger, Davies, Rasch, Simon & Ones, 2011). The effect size parameters are generally considered 0.10 as small,  0.30 as medium and 0.50 as large (Cohen, 2016).  Based on these parameters for acceptable effect size and power in psychological correlational research a calculated minimum amount of 86 participants is necessary. In the current research when comparing two groups we want to double the amount of participants. Therefore the goal for this research is to include at least 200 participants. Considering some might need to be excluded the aim is a conservative N of 200 participants in the research.
 
 
 
 
 
Data Collection/Procedure
Online survey will be used to collect data. The online survey was spread through social media. Online surveys were also handed in public places like malls. The results will be obtained as soon as the required number of surveys completed.
Before the handing in the questionnaires to the participants, instructions will be given. Firstly, explaining to them that the questionnaire is needed for a bachelor project and that information that the participants would give would be kept strictly confidential. To each participant, a general idea will be given of what the research studies is about, which is the relationship between our body image and unhealthy eating behaviours. Secondly, the online survey will start with asking to confirm if they met the inclusion criteria. If they did meet these criteria, the system asked them to either agree or disagree to sign the consent form by checking empty boxes.
Materials   
Participants will provide demographic data information such as, age, gender, nationality, it is important because non Saudis will be excluded.
Eating Disorder Examination questionnaire EDE-Q (Fairburn, Beglin,1994). And Body Shape Questionnaire BSQ (Cooper, Fairburn. 1987) are tools to measure the variables of this research which are, ideal body image, body image, and eating disorder symptom. EDE-Q is known as an acceptable alternative tool of the traditional EDE interview (Fairburn and Copeer,1993). EDE-Q has 28 items, and the questions are concerned about the last four weeks (28 days).It has four subscales which measures  restrained, eating concern, shape concern, and weight concern. Examples of EDE includes” have you felt fat” and “have you had a strong desire to lose weight “and the answer options will be “not at all, slightly, moderately, and markedly”. EDE-Q shows good validity and reliability (Fairburn, Beglin, 2008).
BSQ developed by it measures participants stratification of their body and anxiety related to their appearance. BSQ has 34 items concerning the last four weeks. Examples of BSQ include “Has feeling bored made you think about your shape?” “Have you been so worried about your shape that you have been feeling you ought to die?” answers options will be “never, rarely, sometimes, often, very often, always”. The BSQ is valid questionnaire, internal validity of BSQ in Jordanian sample was remarkably high (Mousa, Mashal, Al- Domi, & Jibril, 2010). BSQ shows good validity and reliability in Iraqi sample, which is the closest sample to this research sample. Internal validity of the BSQ is (0.93) and for the internal consistency is was (0.97). This means that the internal validity and consistency are high in the Iraqi sample competed to western samples (Medya, Dzayee, Azniza, & Ishak 2016).
The type of questions that the two questionnaires had is Likert scale which means the participants can answer the questions by selecting from 0 to 6, option number 0 stands for “never” and 6 stands for “always”. Arabic translation is made by reseachers. They were applied to 60 participants to measure reliability.
Using the Figure Rating Scale (FRS), also known as Stunkard Scale to measure the individuals’ evaluation of their physical appearance.  The outcomes are compared later with BMI to test the degree of correlation between them. The Stunkard scale is a figure which presents nine male and nine female schematic silhouettes, increasing gradually in size from very thin (a value of 1) to very obese (a value of 9). The process of doing this measurement is by asking the participant to choose the figure that represents their current body image and choose the figure that reflects ideal body image (Stunkard et al., 1983). “The Figure Rating Scale is a valid measure of body image when used in Brazil” (Scagliusi et al.,2006).
The 9-figure body size scale of Stunkard et al.
 
 
Statistical Procedure
The variables that were investigated in this research were the body image and the ideal body image.
In order to analyse the relationships of, a correlation coefficient will be conducted. The method of analysis measures the strength of linear relationship between the three variables in two parts, relationship between body shape and (BMI) and eating disorder symptoms, and relationship between ideal body image and eating disorder symptoms. The analysing part will contain Spearman’s rank correlation coefficient, it assess the monotonic linear of the two variables. Pearson’s correlation coefficient, it assesses the linear relationship itself. Survey monkey and SPSS are the tools for calculation that this research will use.
Task management
The data collection and analysis for 200 participants will take approximately two months (February and March) from the research project plan. After finalizing the results, thesis need to be finalized also by writing the result and discussion section in the whole April. drafts and supervision feedback of results analysis and discussion section will take a place in that same period of time. Submission of the final version of the bachelor thesis will be in the 30th of April 2017.
Ethical consideration
Prior to conducting the study, ethic approval from IRB in PNU was sought . Before giving the participants the questionnaires, informed consent will be taken which include the procedure and purpose of the study, The participants were given the choice as to whether they wanted to be involved in the study or not. Before surveys used in the current study were distributed, participants were informed that participation will cause no harm and that it was completely voluntary and anonymous, only the researchers will have access to their questionnaires. Furthermore, participants were informed how their participation was going to help in the conclusion of the study.
 
 
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