Psychology
2012. Vol.3, No.6, 507-512
Published Online June 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.36073
Preoccupation with Weight and Eating Patterns of
Lebanese and Cypriot Female Students
Ioanna Katsounari1, Nadine Zeeni2
1Social Work Department, Frederick University, Nicosia, Cyprus
2Department of Natural Sciences, School of Arts and Sciences,
Lebanese American University, Byblos, Lebanon
Received January 12th, 2012; revised February 13th, 2012; accepted March 12th, 2012
This comparative cross-cultural study explores the prevalence of preoccupation with weight and eating
patterns among female university students in two distinct cultural contexts, Cyprus and Lebanon. Data
was collected by means of self-administered questionnaires to 200 students from each culture. To gather
the data for this study, the Dutch Eating Behavior Scale was used for the assessment of eating behaviors.
Body Mass Index (BMI) and Weight directed behavior were also calculated. The Pearson Product-
Moment Correlation Coefficient was used to determine whether there is a linear relationship between
students’ BMI and eating behaviors. Findings suggested that with respect to culture and pre-occupation
with weight, Cypriot students are more pre-occupied with their weight. However, Lebanese students re-
ceived higher emotional and external eating scores. In addition, a positive relationship between Body
Mass Index, restrained and emotional eating was found in both cultures Also, in both cultures there was a
significant positive relationship between restrained and emotional eating, emotional and external eating.
These findings suggest that in the Lebanese culture, eating dysfunction among women may be due to re-
sponsiveness to external and emotional cues while in the Cypriot culture may be due to an over
pre-occupation with weight fuelled by sociocultural agents. Understanding the underlying causes of eating
deviations and the existing elements in each culture which promote these deviations could lead to better
prevention efforts in two societies where the rise in eating disturbances has been alarming.
Keywords: Cross-Cultural Study; Weight Directed Behavior; Eating Behaviors
Introduction
Eating in response to environmental cues and emotions has
been recognized as a prominent aspect of eating behaviour which
is common but also as leading to problematic eating behaviors
such as excessive eating, binge-eating and clinically diagnos-
able eating disorders such as bulimia nervosa (Lindeman &
Stark, 2001). Although the documentation of these eating be-
haviours as problematic has been increasing, empirical investi-
gations of these phenomena in different cultural groups have
been limited.
Three prominent eating responses which have been recog-
nized to be implicated in pathological eating behaviors are
emotional, external, and restrained eating. Different theories have
described these responses to environmental cues which can be
classified as individual eating patterns or behaviors.
Psychosomatic theory defines “emotional eating” as the con-
sumption of food which occurs when an individual responds to
arousal states such as anger, fear, or anxiety by excessive eating
(e.g. Polivy, Herman, & McFarlane, 1994; van Strien, Frijters,
Bergers, & Defares, 1986). It further states that obese persons
engage in excessive eating in response to negative emotions,
while normal weight persons have more adaptive coping me-
chanisms and do not eat in response to emotional distress (Faith
et al., 1997). Therefore, emotional eating has been linked with
various forms of overeating such as obesity and bulimic ten-
dencies (e.g. Eldredge & Agras, 1996; van Strien, 1996) and
emotional eating research has often focused on obese popula-
tions. Ogden (1993) argued that emotional eating might be a
consequence of the general psychological vulnerability related
to eating disorder psychopathology.
Recent research has indicated that people in different cultures
respond to emotional experiences through different forms of
eating behaviours and that emotional-eating patterns have con-
nections with obesity, anorexia nervosa, and bulimia (Butler,
Lee, & Gross, 2007; Luomala, Sirieix, & Tahir, 2009, Macht &
Simons, 2000; Geliebter & Aversa, 2003). Despite indications
that emotional eating is problematic, empirical documentation
of this phenomenon is not as extensive (Nquyen-Rodriguez,
Unger, & Spruizt-Metz, 2009). It has been argued that the lack
of specificity of emotion inhibits detailed study of the psycho-
logical precursors to overeating (Arnow, Kenardy, & Agras,
1995).
Externality theory focuses on “external eating” which is eat-
ing in response to food-related stimuli regardless of the internal
state of hunger or satiety (Schachter, Goldman, & Gordon,
1968). Both theories view an individual’s misperception of
his/her internal state prior to eating as a contributing factor in
the development of obesity (Robbins & Fray, 1980). However,
the relationship between emotional and external eating has not
been confirmed through correlational studies so far (Ogden,
1993).
Finally, individuals may react to being overweight by con-
sciously restricting their food intake regardless of whether they
are emotional or external eaters (Rodin, 1978). Restrained eat-

I. KATSOUNARI, N. ZEENI
ing is defined as a persistent fixation on dieting and weight, and
the amount of food eaten is restricted for the purpose of weight
loss or maintenance. Restrained eaters commonly experience
weight fluctuations due to alternations between dieting and
pronounced lapses in dietary adherence (Ruderman, 1985). In
addition, research indicates that when exposed to significant
stressors, restrained eaters’ eating becomes disinhibited, result-
ing in the consumption of significantly larger quantities of food
than when not distressed (Heatherton, Striepe, & Wittenberg,
1998; Oliver, Huon, Zadro, & Williams, 2001; Tanofsky-Kraff,
Wilfley, & Spurrell, 2000). Dietary restriction has been impli-
cated as a risk factor in the development of obesity, binge-eat-
ing, and clinically diagnosable eating disorders, such as bulimia
nervosa (Stice, Presnell, & Spangler, 2002). As such, restricted
eating should be studied with the ultimate goal of preventing
eating disorders.
The relationship between emotional eating patterns and Body
Mass Index (BMI) has been studied before with conflicting
findings.
A cross-sectional study in the Netherlands assessed over-
weight-level and overeating in relation to dietary restraint,
emotional eating and external eating, using the Dutch Eating
Behaviour Questionnaire (DEBQ). It was found that an indi-
vidual’s final level of body weight may possibly be determined
more by people’s tendency toward emotional eating than by
people’s sensitivity to environmental food cues. Specifically, it
was found that dietary restraint and emotional eating moderated
the relationship between overconsumption and overweight.
Therefore, dietary restraint may prevent people who overeat
from getting overweight (van Strien et al., 2009).
Pothos, Tapper, and Calitri (2009), examined the possible
correlation of BMI with the DEBQ measures. Contrary to ex-
pectations from related literature, for females there was a nega-
tive correlation between BMI and external eating.
Nolan, Halperin, and Geliebter (2010) studied the responses
of 232 male and female participants using the Emotional Appe-
tite Questionnaire (EMAQ) which includes ratings of tendency
to eat in response to both positive and negative emotions and
situations. Emotional eating significantly correlated with BMI.
As BMI increased so did reported negative emotional and situ-
ational eating whereas as BMI decreased, reported positive
emotional and situational eating increased. In this study, eating
more under negative emotions may contribute to being over-
weight whereas eating under positive emotions may contribute
to being underweight.
Therefore, from empirical investigations conducted so far,
emotional eating has been found to be an implicating factor in
body weight and BMI either by moderating the relationship
between overconsumption and overweight or leading to higher
BMI while external eating appears to have a less stronger in-
fluence on overeating and body weight.
In exploring emotional eating in different cultures, Luomala,
Sirieix, and Tahir (2009) found that Finns react to negative
emotional experiences by excessive, indulgent, and luxurious
food treats and to positive emotions with solitary eating pat-
terns. In contrast, Pakistani students associate a social and eve-
ryday eating activity to both positive and negative emotions. As
for French students, they associate social and luxurious eating
patterns with positive emotions, and, in the case of negative
emotions, they prefer solitary eating activities. The authors
suggested that the role culture plays in emotional eating activi-
ties is difficult to establish and is probably more subtle and
indirect in emotional eating.
Other studies have also investigated the relationship between
culture, emotional patterns and eating behaviours. Hawks et al.
(2003) found that women in the US were more likely to initiate
eating for emotional reasons, while women in Japan were more
likely to eat for physical or environmental reasons. These re-
sults suggest that national differences in the cultural environ-
ment may impact individual motivations for eating.
The aim of the present study was to examine weight-directed
behaviour and eating behaviours as they relate to BMI in a
European country, Cyprus and a Middle Eastern country, Leba-
non. These two countries share many similarities, including
their small size, the emphasis on extended family, the central
role of religion, the importance of food in family life, and the
prominent portrayal of western ideals in the way of living. Le-
banon and Cyprus have strong western influences since both
were ex-colonies of France and Great Britain respectively. Also,
both countries suffered from war which resulted in the dis-
placement of a number of citizens. In addition, both countries
are multi-cultural, enjoying a wealth of cultural and religious
traditions.
However, Lebanon and Cyprus represent very different cul-
tures mainly with respect to language and religion. In Lebanon,
the religious division is 60% Muslims and 40% Christians,
while in Cyprus the division is 20% and 80% respectively.
Reports of eating disturbances in the Middle East were rare
in the past (Abdollahi & Mann, 2001; Afifi-Soweid, Najem
Kteily, & Shediac-Rizkallah, 2002; Al-Adawi et al., 2002.)
However, this has changed and reports of risky eating behaviors
have appeared in Middle Eastern countries. Indeed, Afifi-
Soweid, Najem Kteily, and Shediac-Rizkallah (2002) found
alarming rates of preoccupation with weight and disordered
eating behaviours in Lebanese female students just beginning
their college education. BMI was found to significantly influ-
ence eating and weight directed behaviours. They suggested
that this population may be more at risk than that of Saudi Ara-
bia, because of its longer westernization history; therefore, the
seeming higher risk for students in Lebanon could possibly
support the “westernization” hypothesis.
Also, more recently, Tamim et al. (2006) investigated risky
weight control measures (vomiting or pills) among university
students in Lebanon and assessed their relation to demographic,
scholastic, and health risk behavioral characteristics. Among
participating students, 6.1% reported practicing risky weight
control measures. Analysis indicated that females constituted
the majority of adolescents using risky weight control measures
(74%), as they have been acculturated into the dominant phi-
losophy in which a strong emphasis is placed on thinness, and
because of the media influence on remodeling their life styles.
Research suggests that rates of eating disturbance in Euro-
pean countries are consistent with rates within the United States
(Tiggermann, Verri, & Scaravaggi, 2005). Cyprus has wit-
nessed a noticeable rise in eating disorders during the last few
years. Several newspaper articles have noted the increase as
well as the absence of specialized treatment in the country.
Nevertheless, research on eating disorders among young Cyp-
riot females has been limited.
Katsounari (2009) conducted a cross-cultural study investi-
gating self-esteem, depression in relation to eating disordered
attitudes in Cyprus and Great Britain. Results revealed higher
rates of eating disordered attitudes and depressive tendencies in
Cypriot women. According to Katsounari, there are many rea-
508

I. KATSOUNARI, N. ZEENI
sons which could explain these findings including cultural,
climate-linked, economic factors and changes in body shape
values.
Both Lebanese and Cypriot societies are exposed to rapid so-
cial changes including, changing roles for women (e.g., Silver-
stein & Perlick, 1995) and Western media, with its portrayals of
thin female bodies (e.g. Becker, 2004; Levine & Smolak, 1998).
Through the modernization process, these societies have lost
some of the social norms that have traditionally protected
women from weight concerns. As excessive weight concerns
appear to be a proximal risk factor for maladaptive dieting be-
haviours and the development of eating disorders, it is impor-
tant to uncover the factors that contribute to the development of
these attitudes in young girls and adult women.
The current cross-cultural study was designed to examine
pre-occupation with weight and eating behaviours (emotional,
external, restrained eating) and their relationship to BMI in two
distinct cultural contexts. Given the general eating disorder
vulnerability in the Cypriot culture and the mediational factors
which promote the risk for body dissatisfaction among Cypriot
women (Katsounari, 2009), it was hypothesized that Cypriot
women are more likely to engage in weight-directed behaviors
as well as emotional, external and restraint eating compared to
Lebanese women.
Methods
Participants
The study included 398 female undergraduate students aged
17 - 25 from the humanities and health sciences. The Lebanese
volunteers (N = 198) were recruited from two campuses of the
Lebanese American University, one in the center of Beirut and
one in the North (Byblos), and had a mean age of 19.6 years
(SD = 1.48). The Cypriot participants (N = 200) were recruited
from Frederick University in Nicosia and had a mean age of
20.03 years (SD = 1.86). These ages reflect the typical age at
which students attend university in these two countries.
Lebanese and Cypriot participants completed the question-
naires after class. The two groups represented universally dis-
tinct cultures since all the Lebanese and Cypriot participants
were born and raised in Lebanon and Cyprus respectively.
Before engaging in the main study, a pilot study with ten
participants having similar characteristics to the participants
used in the main study was conducted in Cyprus. The pilot
study was carried out in order to assess the comprehensibility of
the translated items and their cultural relevance. Therefore, a
few items were changed after feedback from participants indi-
cated confusion about the meaning of these items in the par-
ticular context. Additionally, a pilot study was also conducted
with a Lebanese sample in order to make sure that participants
properly understood the vocabulary used.
The present study was approved by the Ethics Committee of
Frederick University and the Committee on Human Subjects in
Research (CHSR) of the Lebanese American University. Stu-
dents were informed of the goal of the study, that participation
was voluntary and that information would be kept confidential.
Measures
Measures included the BMI and the Dutch Eating Behavior
Questionnaire (DEBQ) for Assessment of Restrained, Emo-
tional, and External Eating Behavior (van Strien, Frijters,
Bergers & Defares, 1986a).
Weight directed behavior was determined by four statements
indicating whether participants were trying to lose weight, gain
weight, maintain their weight or not trying to do anything about
their weight.
Body Mass Index (BMI; weight in kg/height in metres2) was
calculated using self-reported height and weight.
The Dutch Eating Behaviour Scale (DEBQ; van Strien, Fri-
jters, Bergers, & Defares, 1986) was developed originally in
Dutch as a measure of several aspects of eating behavior. It
consists of restrained, emotional, and external eating subscales.
The response options range from (1) never to (5) very often,
and scores are averaged across subscales with higher scores
indicating high levels of restrained, emotional, or external eat-
ing. Factor analyses showed that all items on restrained and
external eating have high loadings on one factor. For emotional
eating behavior, two dimensions were studied: one dealing with
eating in response to diffuse emotions (e.g. eating when feeling
lonely, idle or bored) and the other with eating in response to
clearly labeled emotions (e.g., eating in response to anger or
irritation) (van Strien, Frijters, Bergers, & Defares, 1986). The
DEBQ was reported to select for exclusively restricting dieters
(van Strien, 1986). Ogden (1993) evaluated the concept of re-
straint as measured by the restrained eating scale of the DEBQ.
The study found that the term restraint is best conceptualized in
terms of both attempts at dieting and successful dieting. In the
current study, the DEBQ showed good internal reliability for
restrained eating (α = .93), external eating (α = .82), and emo-
tional eating (α = .95).
Instruments that have been previously validated in both
populations would have been preferable, but was not available
at the time of the study. A formal back translation was used to
ensure the accuracy of the Greek translation used in the Cyprus
sample. Because Lebanese American University largely oper-
ates in English, most participants were comfortable completing
the materials in English. As participants’ actual weight mea-
surements could not be taken, their reported measurements
were used for analyses.
Statistical Analysis
Data obtained were statistically analysed with the SPSS pro-
gram for Windows, version 18.0 (SPSS, Inc., 2009). Descrip-
tive data are presented as means ± SEM. Analyses of frequen-
cies were performed and contrasted for the two populations in
the study. The Pearson’s Correlation Statistical Test was carried
out in order to establish whether there was a relationship be-
tween each of the three eating behaviours (external eating, emo-
tional eating and restrained eating), BMI and eating behaviour
in each group. Independent samples t-tests were carried out to
confirm whether the difference between the means of the two
samples was statistically significant. Tests applied were two-
tailed and statistical significance was defined as p < .05.
Results
Demographics
The Lebanese and Cypriot female university students ranged
in their studies from first to fifth year. The largest portion of the
Lebanese sample were second year students (33.5%) while the
largest portion of the Cypriot sample were first year students
(37.5%). The mean weight of the Lebanese participants was

I. KATSOUNARI, N. ZEENI
57.8 ± .6 kg while it was 59.1 ± .8 kg for the Cypriots. The
mean for BMI in the two samples was 21 ± .2 and 22 ± .29
kg/m2 respectively. It should be noted that both samples fell
toward the lower end of the range (20 - 25) considered normal
(Garrow & Webster, 1985). With respect to weight-directed be-
haviour, a higher percentage of Cypriot students was trying to
lose weight (56.0%versus 45.5% for the Lebanese sample),
trying to gain weight (4.5% and 3.2% respectively), and trying
to maintain weight (26% and 17.6% respectively). On the con-
trary, a higher number of Lebanese students were not trying to
modify their weight (33.7% versus 13.5% respectively).
Eating Behaviors
Regarding the eating behaviour patterns in the two cultures
(Table 1), the emotional eating scores (t (394) = 3.98, p < .001,
r = .2) and the external eating scores (t (392) = 3.46, p = .001, r
= .17) were lower in the Cypriot sample compared to the Leba-
nese sample. There was no significant difference in the restraint
eating scores of the two cultures. A positive correlation be-
tween restrained eating and emotional eating was found in Cy-
prus and in Lebanon (r = .19, p = .007 and r = .22, p = .002
respectively) as well as between emotional eating and external
eating (r = .31, p < .001 and r = .32, p < .001 respectively).
External eating was found to be negatively correlated with re-
straint eating only within the Cypriot sample (r = –.2, p = .006).
In both cultures, BMI was found to be correlated with the re-
straint eating score (p < .001 for both cultures) and the emo-
tional eating score (p = .005 for Cyprus and p = .01 for Leba-
non). No correlation was found between BMI and external eat-
ing scores.
Discussion
With respect to culture and weight-directed behavior, Cypriot
students are more pre-occupied with their weight either by try-
ing to gain, lose or maintain their weight. This finding confirms
the hypothesis that Cypriot students would be more concerned
with efforts to control their weight and confirms previous re-
search which indicated Cypriot students’ dissatisfaction con-
cerning their weight which often leads to eating pathology
(Katsounari, 2009). The presence of high concern with weight
in a population is a function of its sharing some sociocultural
elements that are determinant in this kind of behaviour (Bo-
jorquez & Unikel, 2004). Cyprus has a longer westernization
history than Lebanon. Therefore, this pre-occupation can be
largely attributed to unique sociocultural factors and particu-
larly to the impact of Western influences on the way young
Cypriots perceive the ideal female figure. Other significant so-
ciocultural influences include the media, the comparison of
Cypriots’ figures with those of migrant women (e.g. Eastern
European), and the contrast between a fast-paced, modernized
way of living and the conservatism of the Cypriot society,
which leads to the stigmatization of obesity (Katsounari, 2009).
Ruggiero (2001a) suggests that Italy, like other Mediterranean
countries, has imported Western cultural standards and modern
social habits while at the same time attempting to retain its
traditional values. Thus, the psychological demands resulting
from cultural change influences young women’s concern about
their weight and subsequently their attitudes towards food and
eating.
In terms of cultural differences in eating behaviors, our re-
Table 1.
Scores on eating behaviours in Lebanon and Cyprus. Data is expressed
at mean ± SEM. *p < 0.05.
Eating Beh aviors Lebanon Cyprus
Restrained Eating Score 29.20 ± .71 28.14 ± .67
Emotional Eating Score 37.76 ± .98* 32.27 ± .97
External Eating Score 33.33 ± .51* 30.83 ± .51
sults indicated that Lebanese female students are more likely to
respond to either diffuse or clearly labeled emotional states
(such as anger, anxiety, fear) by excessive eating (Bruch, 1961,
1964; Kaplan & Kaplan, 1957) or as a response to external
food-related stimuli regardless of the internal state of hunger or
satiety. This finding is in disagreement with the second hy-
pothesis of the study. It appears that although less Lebanese
female students engage in behaviors which aim to control or
direct their weight, they are more vulnerable than Cypriot stu-
dents to engage in eating behaviors which were shown to be
predictive of problematic eating (van Strien, Frijters, Bergers,
& Defares, 1986). These findings indicate that eating behaviors
are an issue in both cultures, however their aetiology seems to
be different. Specifically, Cypriot female students have a higher
intention of modifying their body weight while Lebanese fe-
male students are more inclined to regularly engage in emo-
tional and external eating.
In both samples, there was a significant positive relationship
between BMI, restraint and emotional eating. These findings
are in agreement with expectations from related literature and
confirm Nolan, Halperin, & Geliebter’s (2010) findings. Spe-
cifically, both emotional and restraint eating have been linked
with various forms of overeating such as binge eating and bu-
limic tendencies. These forms of overeating are not only contri-
buting factors for obesity but also have connections with ano-
rexia and bulimia nervosa. These findings are also in accord
with literature suggesting that an individual’s final level of
body weight may be determined more by people’s tendency
toward emotional eating than by people’s sensitivity to environ-
mental food cues (van Strien, Herman, & Verheijden, 2009).
In addition, a significant positive relationship was found be-
tween emotional and external eating in both cultures, a finding
which is in agreement with theory which views these types of
eating as related. Therefore, according to our findings and re-
lated research, individuals who respond to environmental cues
by eating are more likely to respond to emotions by overeating
as well.
Also, in both samples, there was a significant positive rela-
tionship between restraint and emotional eating. Previous stu-
dies found moderate to low associations between these two pa-
tterns of eating (van Strien, Frijters, Bergers, & Defares, 1986;
van Strien, 1996; van Strien, Frijters, Roosen, Knuiman-Hijl, &
Defares, 1985; Waller & Osman, 1998). Our findings agree
with Herman and Polivy’s viewpoint that emotional eating is
more closely related to dieting (often related to overeating) than
to overeating per se (e.g. Herman, Polivy, Pliner, Threlkeld, &
Munic, 1978) and that emotional eating may characterize only
some dieter subtypes (Lindeman & Stark, 2001). This is in
agreement with the theory of Restraint eating which views
emotional eating as a consequence of intense dieting.
510

I. KATSOUNARI, N. ZEENI
Conclusion
Female students in both cultures show a high concern for
their weight, however, Cypriot students indicate a higher con-
cern with efforts to control their weight. In contrast, Lebanese
students engage in emotional and eating behaviors more often,
behaviors which have been linked with eating disorder psycho-
pathology. Findings indicate that external and emotional eating
styles are related, therefore, students in these two cultures may
show vulnerability towards both eating styles. In addition, in-
tense dieting efforts may lead to relapses and particularly, in-
crease the likelihood to eat in response to emotional cues. Fur-
thermore, level of body weight in these two cultures is related
to emotional and restraint eating styles.
To conclude, this study suggests that a general vulnerability
towards eating disorder psychopathology exists in both cultural
groups, but the pathways which reinforce this vulnerability
differ. In Cypriot students, a higher pre-occupation with weight,
which is mediated by sociocultural agents specific to this cul-
ture, is the contributing factor to eating disorder psychopa-
thology. In Lebanese students, a higher tendency towards emo-
tional and external eating may create a higher vulnerability
towards dysfunctional eating.
Results of this study must be interpreted with caution and
taking into consideration the differences between the two popu-
lations under study. First, many women in these cultures are
reluctant to admit to eating behaviours which may be viewed by
others as dysfunctional because of the stigma associated with
eating pathology. Second, a student sample may reflect traits
that are characteristic of a student population, but cannot be
generalized to the general population. In addition, participants
are drawn from different departments (health sciences and hu-
manities), therefore differences in their responses may be due to
the fact that health science students have knowledge of implica-
tion of body weight on the health. Last, the utilization of self
reported height and weight may cause subjectivity of data
which in return may affect the relationship between BMI, re-
straint and emotional eating.
In conclusion, this cross-cultural study explores eating be-
havior and patterns of preoccupation with weight in Lebanese
and Cypriot students. Results indicate that eating behavior pat-
terns present an important issue in these two cultures and can
help us to better understand the rise of eating pathology in these
two cultures. The findings of this study present a base for fur-
ther investigation in larger studies where the etiology of the
dominant eating behaviors in each culture is explored taking
into account other cultural variables such as religion and the
degree of westernization.
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