Prevalence and predictors of disordered eating behaviors: a cross-sectional study across 15 campuses in the Saudi electronic university

Abstract

Background: Disordered eating behaviors (DEBs) and eating disorders (EDs) are increasingly recognized as significant public health concerns among university students worldwide. Although research from the Middle East and North Africa (MENA) region has expanded in recent years, comprehensive population-based studies using standardized assessment tools remain limited. This study aimed to examine the prevalence and predictors of disordered eating attitudes and behaviors among students enrolled at the Saudi Electronic University (SEU), encompassing 15 campuses across Saudi Arabia. Methods: A cross-sectional, survey-based study was conducted between February and March 2025. The study utilized Arabic-adapted versions of the Eating Attitudes Test-26 (EAT-26) and Behavioral Questions (BQ), prepared through forward–backward translation and pilot testing for cultural and linguistic appropriateness. These instruments were used to assess attitudinal and behavioral aspects of eating risk. Multivariable logistic regression identified independent predictors of disordered eating risk. Results: Among 771 participants (mean age: 25.1 ± 6.3 years; 69.7% female), 27.1% exceeded the EAT-26 clinical threshold (> 20), indicating risk for eating disorders, and 44.2% reported at least one disordered eating behavior. Prior ED diagnosis (OR = 3.33; 95% CI: 1.90–5.85), recent weight loss ≥ 10 kg (OR = 2.75; 95% CI: 1.83–4.13), higher BMI (OR = 1.05; 95% CI: 1.03–1.08), and younger age (OR = 0.94; 95% CI: 0.91–0.98) were significant predictors of elevated EAT-26 scores. For behavioral risk, recent weight loss (OR = 2.22; 95% CI: 1.51–3.27) and higher BMI (OR = 1.02; 95% CI: 1.00–1.05) remained significant. Conclusions: Disordered eating behaviors are prevalent among university students in Saudi Arabia, with notable proportions meeting clinical risk thresholds. These findings underscore the need for early identification, targeted screening, and culturally sensitive interventions within university health services, while recognizing the predominance of female respondents as a study limitation. Addressing this overlooked public health concern aligns with Saudi Arabia’s Vision 2030 goals to promote youth mental health and strengthen preventive care initiatives.