METHODS

We use data from the surveillance and intervention for behavioral risk factors survey (SIBER) of all entering students at the American University of Beirut (AUB), conducted in the autumn of 1998 by the AUB Faculty of Health Sciences.³ Established in 1866 by American missionaries, the AUB is one of the oldest liberal arts regional universities in the Arab world, with an international body of students and faculty. Although most (about 80%) of the students at AUB are Lebanese, it has students from many countries in the region and beyond. A total of 954 eligible respondents aged 16–20 years completed the questionnaire over three consecutive days. The refusal rate was very low (0.9%). A self administered questionnaire was designed to obtain data on a wide range of health risking and other lifestyle behaviour and sociodemographic characteristics of students and their parents. The survey instrument included a direct question on self image of body weight: “Are you trying to lose weight (1), gain weight (2), stay the same (3), or not trying to do anything (4).” In addition, the survey included two items on self reported weight in kg and height in metres to construct a conventional measure of BMI. Following previous studies,^1,4,5 a cut off point of 25 kg/m² was used for adult overweight. Those adolescents with a BMI of less than 19 kg/m² were identified as “underweight”.⁴

We used binomial logistic regression to investigate gender differences in the two binary outcomes, namely “actual” overweight and trying to lose weight. Our primary predictor was gender. Other control variables included age (16–17, 18, 19–20), overweight (25 kg/m²) or body image (trying to lose weight, other), ever lived outside Lebanon for at least one year (yes, no), and several indicators of SES: father’s and mother’s education (school/technical, university), mother’s employment status (employed, unemployed/housewife), pocket money (⩽50 000 LL, >50 000 LL).

RESULTS

Overall, 6.1% of female and 23.8% of male respondents were identified as overweight. However, significantly more women (52.9%) than men (24.5%) wanted to lose weight, and this held true across the actual body weight categories (fig 1). Among the overweight, most men (62%, 95%CI: 0.53 to 0.71) and almost all women (96%, 95%CI: 0.80 to 0.99) expressed a desire to lose weight. The gender gap was even more noticeable for those in the “normal” weight category, in which 61% (95%CI: 0.56 to 0.67) of women compared with only 16% (95%CI: 0.11 to 0.18) of men, wanted to lose weight.

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Figure 1

Trying to lose weight by actual BMI.

The findings (data not displayed) from logistic regression showed that men were surprisingly 4.9 times more likely to be overweight than women (p<0.0000), controlling for age, father’s education, and mother’s employment status, mother’s education, pocket money, and ever lived outside Lebanon. Although previous findings from Western societies showed gender difference in overweight, the gender gap was either in favour of female² for younger adolescents or smaller in magnitude.¹ Other significant predictors of overweight were father’s education and age of respondent. However, women were 10.8 times significantly more likely to perceive themselves as overweight than men (p<0.0000), controlling for their BMI, and the same other covariates. Age, actual BMI, and having lived outside Lebanon were significantly associated with trying to lose weight as would be expected. Among the socioeconomic status variables, only pocket money was positively associated with trying to lose weight, suggesting that the desire for thin bodies is slowly becoming a mass phenomenon.

DISCUSSION

Despite the fact that their BMIs were much less likely to be in the “overweight” range, women in this sample of 16–20 years olds were significantly more likely than men to consider themselves too heavy for their height and hence want to lose weight. Similar findings have been reported in previous studies in Western societies. The striking gender differences in “trying to lose weight,” especially among those with normal weight, suggest that thinness is becoming more desired in Arab society, although reporting bias cannot be ruled out. This study relied on self reports of weights and height rather than actual measurements. We know from previous studies that women tend to underreport their weight as compared with men. Furthermore, the sample was based on a single “westernised” university, and cannot be generalised to other adolescents. However, the results do lend support to general perceptions of shifting desires for extreme thinness in the Arab region in response to the global media and advertisements on the walls by fashion companies. Further research is needed to understand the broader social context and magnitude of this phenomenon in the general population, and to develop appropriate health promotion strategies increasing awareness about appropriate (that is, normal) weight for height, especially for women.