Appetite 56 (2011) 778–783

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Appetite
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Research report

Direct and indirect effects of sociocultural influences on disordered eating among

Malaysian male and female university students. A mediation analysis of
psychological distress
Wan Ying Gan, Mohd Taib Mohd Nasir *, Mohd Shariff Zalilah, Abu Saad Hazizi
Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia

A R T I C L E I N F O A B S T R A C T

Article history: This study aimed to examine the role of psychological distress in the relationships between sociocultural
Received 6 January 2011 influences (social pressure to be thin and weight teasing) and disordered eating. Data were collected
Received in revised form 9 March 2011 from 584 university students (59.4% females and 40.6% males), aged 18–24 years old (M = 20.6, SD = 1.4),
Accepted 16 March 2011
selected from four universities in the Klang Valley, Malaysia. Participants completed four standardized
Available online 22 March 2011
questionnaires which measured social pressure to be thin, weight-related teasing, psychological distress
and disordered eating. A good fit structural equation modeling (SEM) model was developed for both
Keywords:
sexes. For males, the SEM model revealed that sociocultural influences showed an indirect effect on
Disordered eating
Psychological distress
disordered eating through psychological distress. For females, the model showed an indirect effect of
Weight-related teasing sociocultural influences on disordered eating through psychological distress, as well as a direct effect of
Pressure to be thin sociocultural influences on disordered eating. In conclusion, psychological distress mediated the
Direct and indirect effects relationships between sociocultural influences and disordered eating in both males and females. Our
Structural equation model results suggest that disordered eating intervention programs on reducing psychological distress in
university students may be beneficial.
ß 2011 Elsevier Ltd. All rights reserved.

Introduction differences in the development of disordered eating should be

Disordered eating refers to troublesome eating behaviors, such
as restrictive dieting, bingeing, or purging, which occur less
frequently or are less severe than those required to meet the full
criteria for the diagnosis of an eating disorder and it is considered
as an early warning sign of an eating disorder (U.S. Department of
Health and Human Services, 2005). Numerous studies have shown
that these abnormal eating behaviors and eating disorders
particularly binge eating and bulimia nervosa frequently occur
in Western countries (Hay, Mond, Buttner, & Darby, 2008; Hudson,
Hiripi, Pope, & Kessler, 2007) but are beginning to emerge in non-
Western countries especially among Asian countries (Cummins,
Simmons, & Zane, 2005; Makino, Tsuboi, & Dennerstein, 2004;
Mond, Chen, & Kumar, 2010). Disordered eating is more prevalent
among female university students than adolescent girls (Erol,
Toprak, & Yazici, 2006). However, it is not only a problem for
females but males as well. Studies have found that there was an
increased in eating problems among males (Dominé, Berchtold,
Akré, Michaud, & Suris, 2009; Gadalla, 2008). Therefore, sex
* Corresponding author.
E-mail address: nasir@medic.upm.edu.my (M.T. Mohd Nasir).
explored.
University students often claim to experience high level of
psychological distress, such as depression, stress and anxiety that
can have an adverse effect on their academic performance,
emotion, and health (Tosevski, Milovancevic, & Gajic, 2010).
University students may also eat more than usual when they
experience these unpleasant emotional experiences (Cooley,
Toray, Valdez, & Tee, 2007). A significant comorbid relationship
between disordered eating and psychological distress has been
found in both men and women in various studies (Green, Scott,
Cross, et al., 2009; Green, Scott, Hallengren, & Davids, 2009; O’Brien
& Vincent, 2003). The associations between psychological distress
and disordered eating are likely to be bi-directional (Bradford &
Petrie, 2008). Other studies found that these two variables share
some similar risk factors, such as low self-esteem, body
dissatisfaction (Berg, Frazier, & Sherr, 2009; Cooley et al., 2007;
Green, Scott, Cross, et al., 2009; Thomas, Khan, & Abdulrahman,
2010), pressure to be thin, and weight-related teasing (Benas &
Gibb, 2008; Benas, Uhrlass, & Gibb, 2010; Gilbert, Crump, Madhere,
& Schutz, 2009). Yet, most of these studies focus on women but not
men (Santos, Richards, & Bleckley, 2007).
Many hypothesized models emphasized sociocultural influ-
ences in the development of disordered eating (Bradford & Petrie,

0195-6663/$ – see front matter ß 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.appet.2011.03.005
 W.Y. Gan et al. / Appetite 56 (2011) 778–783
2008; Jackson & Chen, 2007; Rodgers, Paxton, & Chabrol, 2009),
particularly social pressure to be thin (i.e., pressure from parents,
peers, and media) and weigh-related teasing. Sociocultural
pressure to be thin has been found to be related to depression
and stress and disordered eating among young women (Stice,
Maxfield, & Wells, 2003). For example, media influence and
feedback about appearance from significant others such as family,
friends and partner, have substantial influences on disordered
eating (Stice et al., 2003). A 12-month prospective study done by
Shomaker and Furman (2009) revealed that social pressure to be
thin uniquely contributed to the prediction of disordered eating
over time among late adolescents. Pressure to be thin was also
found to be directly associated with depression in females but not
males (Chaiton et al., 2009). The mediation effect of depression in
the relationship between social pressure to be thin and disordered
eating has been explored which mainly focused on adolescent girls
(Stice, 2001).
Weight-related teasing, for example, by family and friends, is
one type of teasing which is very common among young adults,
especially overweight young adults (Libbey, Story, Neumark-
Sztainer, & Boutelle, 2008). It is believed that frequent weight-
related teasing during childhood may contribute to the develop-
ment of disordered eating (Benas & Gibb, 2008), depression (Roth,
Coles, & Heimberg, 2002; Storch et al., 2004), and anxiety later in
life (Libbey et al., 2008; Storch et al., 2004). Furthermore, Suisman,
Slane, Burt and Klump (2008) hypothesized that weight-related
teasing may increase negative emotions, which in turn, may lead to
binge eating in girls. Yet, research on the mediation role of
psychological distress in the link between weight-related teasing
and disordered eating among males is scarce.
Social pressure to be thin and weight-related teasing signifi-
cantly predicted both psychological distress and disordered eating
(Libbey et al., 2008). Hypothesized models on the influences of
sociocultural factors in the development of disordered eating were
developed mainly for female adolescents in Western societies or
developed countries. These models may not necessarily apply to
Eastern societies or developing countries (Chen, Gao, & Jackson,
2007). Consequently, this study aimed to examine the role of
psychological distress in the relationship between sociocultural
influences and disordered eating among university students. It was
hypothesized that psychological distress (i.e., depression, anxiety
and stress) is one of the possible mediator in the relationship
between sociocultural influences and disordered eating among
male and female university students.
Methods
Participants
Multistage random sampling approach was deployed whereby
four universities in Klang Valley were randomly selected. One
faculty was randomly selected for each field of study (i.e., arts,
sciences, and technical fields) in each university. All students in the
selected faculties were invited to participate in this study.
Notifications about the study were made via posters, leaflet
distributions and announcement made during lecture time by the
lecturers. Participation in this study was fully voluntary and no
monetary reimbursement was made. The study participants were
sampled based on the sex and fields of study compositions of the
actual Malaysian university student population according to the
Ministry of Higher Education, Malaysia in the year 2009. A total of
584 university students (59.4% females and 40.6% males), aged
between 18 and 24 years (M = 20.6, SD = 1.4), from different ethnic
groups (44.7% Malay, 44.5% Chinese, 9.9% Indian, and .9% others),
participated in the present study. Out of 584 participants, 41.3%
779
were from the arts and social sciences, followed by 31.0% from the
sciences, and the remaining 27.7% from the technical field.
Procedures
Data collection was conducted from October to December 2009
by using a Malay language self-administered questionnaire. Prior
to data collection, the Perceived Sociocultural Pressure Scale,
Perception of Teasing Scale, and Eating Attitudes Test-26 were
translated into Malay language except for Depression, Anxiety and
Stress Scale-21 as there is a validated Malay version of DASS-21 for
Malaysians (Ramli, Mohd Ariff, & Zaini, 2007). The questionnaires
were translated into Malay language by two postgraduate students
who are fluent in both English and Malay languages and back-
translated into English by another bi-lingual student. This English
back-translation was compared with the original English version of
the scales and appropriate amendments were made.
The Medical Research Ethics Committee, Faculty of Medicine
and Health Sciences, Universiti Putra Malaysia, and the Ministry of
Higher Education Malaysia approved the study protocol. Permis-
sion to conduct the survey was granted from each of the selected
universities prior to data collection. Participants were given an
information sheet explaining the purpose of the study. After
providing written consent, participants took approximately
30 min to complete a questionnaire specifically designed for the
purpose of the study.
Measures
Perceived Sociocultural Pressure Scale
The Perceived Sociocultural Pressure Scale (PSPS) is an 8-item
scales used to assess the perceived pressure to be thin from
significant others (family, friends, and partner) and the media
(Stice, Ziemba, Margolis, & Flick, 1996). Participants responded on
a 5-point Likert scale rating from ‘‘strongly disagree (1)’’, ‘‘disagree
(2)’’, ‘‘neither agree nor disagree (3)’’, ‘‘agree (4)’’, to ‘‘strongly agree
(5)’’. All items were summed up for analyses with higher scores
denoting greater pressure to be thin. In the present study, its
internal consistency was good for both sexes. The Cronbach’s alpha
coefficients for females were .92 for the total score, .87 for friends,
.89 for family, .93 for partner, and .92 for media subscales. In males,
the Cronbach’s alpha coefficients for the total score were .95, .87
for friends, .91 for family, .87 for partner, and .88 for media
subscales.
Perception of Teasing Scale
The weight-related teasing frequency subscale of the Percep-
tion of Teasing Scale (POTS) is a 6-item subscale used to assess the
frequency of weight-related teasing on the individual while
growing up (Thompson, Cattarin, Fowler, & Fisher, 1995). Each
item rated on a 5-point Likert scale ranging from ‘‘never (1)’’,
‘‘seldom (2)’’, ‘‘sometimes (3)’’, ‘‘often (4)’’, to ‘‘very often (5)’’.
Higher scores indicate greater frequency of teasing during
childhood or adolescence. This scale had demonstrated excellent
reliability for both females (a = .95) and males (a = .93) in the
present study.
Depression, Anxiety and Stress Scale-21
The Depression, Anxiety and Stress Scale-21 (DASS-21) is a 21-
item self-reported instrument designed to measure three negative
affect states, namely depression, anxiety, and stress with seven
items in each subscale (Lovibond & Lovibond, 1995). Participants
were asked to rate the extent to which they experienced each state
in the previous week. Items were rated on a 4-point Likert scale
780 W.Y. Gan et al. / Appetite 56 (2011) 778–783
rating from ‘‘did not apply to me at all (0)’’, ‘‘applied to me to some
degree, or some of the time (1)’’, ‘‘applied to me to a considerable
degree, or a good part of time (2)’’, to ‘‘applied to me very much, or
most of the time (3)’’. A high score indicates frequent negative
mood. This scale had good internal consistency in the present
study for both sexes. In females, the Cronbach’s alpha coefficients
were .91 for DASS-21 total score, .83 for DASS-Depression scores,
.73 for DASS-Anxiety scores, and .80 for DASS-Stress scores. In
males, the Cronbach’s alpha coefficients were .93 for DASS-21 total
score, .86 for DASS-Depression scores, .77 for DASS-Anxiety scores,
and .84 for DASS-Stress scores in the present study.
Eating Attitudes Test-26
The Eating Attitudes Test-26 (EAT-26) is a 26-item scale used to
assess ‘‘eating disorder risk’’ based on attitudes, feelings, and
behaviors related to eating and eating disorder symptoms (Garner,
Olmsted, Bohr, & Garfinkel, 1982). It consists of three subscales
which are dieting, bulimia and food preoccupation, and oral
control. Items in the scale are rated on a 6-point Likert scale:
‘‘always (1)’’, ‘‘usually (2)’’, ‘‘often (3)’’, ‘‘sometimes (4)’’, ‘‘rarely
(5)’’, and ‘‘never (6)’’. For all items except item 26, the responses
‘‘sometimes’’, ‘‘rarely’’, and ‘‘never’’ receive a score of 0 and the
responses ‘‘always’’, ‘‘usually’’, and ‘‘often’’ receive a score of 3, 2,
and 1, respectively. Scoring for item 26 is in the reverse manner.
Scale scores are the sum of all items in each subscale with a
possible scores ranging from 0 to 78. Participants who scored 20 or
more were considered as having a high level of concern about
dieting, body weight or problematic eating behaviors. Meanwhile,
participants who scored less than 20 were considered as having no
symptoms of eating disorder. In the present study, the internal
consistency reliability of the EAT-26 was good for females (a = .77)
and males (a = .83).
Data analysis
Statistical analyses were performed using PASW Statistics 18.0
(SPSS Inc., Chicago, IL, USA) and AMOS 18.0. All the analyses were
conducted separately for males and females. The correlations
between the independent variables (social pressure to be thin and
weight-related teasing), proposed mediator (psychological dis-
tress) and dependent variable (disordered eating) were identified
using Pearson’s product moment correlation. Preacher and Hayes
(2004) developed a SPSS macro to test the simple mediation
analysis. The total, direct and indirect effects of social pressure to
be thin and weight-related teasing on disordered eating were
calculated.
A mediator (M) or an intervening variable is a third variable that
links the independent variable (IV) to the dependent variable (DV)
(Baron & Kenny, 1986) in which in our study, it conveys the effects
of sociocultural influences on disordered eating. The indirect effect
involves the direct effects from the IV on M and from M to DV,
while the total effect denotes as the sum of direct effect of IV on DV
and the indirect effect. An indirect effect was considered to be
significant at the .05 level if the 95% confidence interval (CI) from
5000 bootstrap samples does not include zero (Preacher & Hayes,
2004). The method of Preacher and Hayes (2004) was used in this
study as it could assess the indirect effect more efficiently by using
bootstrapping than the method of Baron and Kenny (1986). In a
comparison study of the methods used to test the statistical
significance of indirect effect recommended that bootstrapping
was a superior method as it was less likely to lead to Type I error,
had high statistical power, and did not require the assumption of
normal distribution (MacKinnon et al., 2002).
Furthermore, the Structural Equation Modeling (SEM) using
maximum likelihood estimation was conducted by using AMOS
18.0 to test for the validity of the mediation model. The SPSS macro
was used prior to the use of the AMOS to specifically define and test
an alternative theoretical model by not only rely on AMOS to
suggest a model with pathways that yielded strong goodness of fit.
The model fit to the data was evaluated using the ratio of chi-
square and degree of freedom, comparative fit index (CFI), Tucker–
Lewis index (TLI), and root-mean square error of approximation
(RMSEA) with its 90% CI. The ratio of chi-square and degree of
freedom < 5.0, CFI and TLI > .9, and RMSEA < .08 indicate the
model has an acceptable fit to the data (Kline, 2005). No covariates
had to be controlled in the mediation analysis as no ethnicity and
age effects were found for the variables.
Results
Correlation findings
All of the variables were found to be significantly and positively
correlated in both males (ranged from .17 to .44) and females
(ranged from .19 to .49).
Testing the mediation effect of psychological distress
The mediation effects of psychological distress between social
pressure to be thin and disordered eating for males and females are
presented in Fig. 1A and B respectively. The total effect of social
pressure to be thin on disordered eating was significant in males
(B = .18, SE = .07, t = 2.68, p = .008) and females (B = .26, SE = .06,
t = 4.36, p < .001). Social pressure to be thin also revealed a
significant effect on psychological distress (males: B = .54, SE = .19,
t = 2.83, p = .005; females: B = .55, SE = .15, t = 3.61, p < .001)
which, in turn, was predictive of disordered eating (males:
B = .13, SE = .02, t = 5.90, p < .001; females: B = .18, SE = .02,
t = 9.90, p < .001). After controlling for psychological distress,
the direct effect of social pressure to be thin on disordered eating
was reduced to not significant in males (B = .11, SE = .07, t = 1.75,
p = .082) but significant in females (B = .16, SE = .05, t = 2.96,
p = .003). A significant bootstrapped indirect effect was shown
(males: B = .07, SE = .03, 95% CI = .01–.14; females: B = .10, SE = .03,
95% CI = .04–.16). These results indicate that social pressure to be
thin predicted disordered eating indirectly through psychological
distress in both male and female university students. However,
direct effect was only seen in females.
Psychological distress in its role as a mediator between
weight-related teasing and disordered eating for males and
[()TD$FIG]females are presented in Fig. 2A and B respectively. The total
A Psychological distress
.54 ** .13**
Total = .18**
Pressure to be thin Disordered eating
Direct = .11; Indirect =.07¥
B Psychological distress
.55 ** .18**
Total = .26**
Pressure to be thin Disordered eating
Direct = .16**; Indirect =.10¥
Fig. 1. The mediation model by psychological distress between social pressure to be
thin and disordered eating for males (A) and females (B). Unstandardized estimates
are shown. Dashed line indicates non significant path. *p < .05, **p < .01,
¥
significant indirect effect.
[()TD$FIG] W.Y. Gan et al. / Appetite 56 (2011) 778–783 781

A Psychological distress B = 1.22, SE = .29, t = 4.19, p < .001; females: B = .83, SE = .20,
t = 4.13, p < .001) which, in turn, was predictive of disordered
1.22 ** .12**
eating (males: B = .12, SE = .02, t = 5.55, p < .001; females: B = .18,
SE = .02, t = 9.81, p < .001). After controlling for psychological
Total = .37** distress, the direct effect of weight-related teasing on disordered
Weight teasing Disordered eating
Direct = .22*; Indirect =.15¥ eating was significant (males: B = .22, SE = .10, t = 2.20, p = .029;
females: B = .18, SE = .07, t = 2.59, p = .010). A significant boot-
strapped indirect effect was shown (males: B = .15, SE = .04, 95%
CI = .06–.24; females: B = .15, SE = .04, 95% CI = .07–.24). These
B Psychological distress
results indicate that weight-related teasing predicted disordered
.83 ** .18** eating among male and female university students both directly
and indirectly through psychological distress.
Total = .34**
Weight teasing Disordered eating SEM models for males and females
Direct = .19*; Indirect =.15¥

Fig. 2. The mediation model by psychological distress between weight-related
teasing and disordered eating for males (A) and females (B). Unstandardized
estimates are shown. *p < .05, **p < .01, ¥significant indirect effect.
effect of weight-related teasing on disordered eating was
significant (males: B = .37, SE = .10, t = 3.57, p < .001; females:
B = .34, SE = .08, t = 4.28, p < .001). Weight-related teasing also
revealed a significant effect on psychological distress (males:
[()TD$FIG]
The sociocultural influences, psychological distress, and disor-
dered eating variables were analyzed simultaneously in SEM. For
males, the hypothesized model provided a good fit to the data (x2/
df = 2.02, CFI = .97, TLI = .96, RMSEA = .07 with 90% CI = .04–.09).
However, the path from sociocultural influences to disordered
eating was not significant (b = .10, p = .397). Therefore, it was
deleted from this model. The respecified model for males
demonstrated a good fit to the data (x2/df = 1.99, CFI = .97,

Fig. 3. Structural equation model representing the relationships between sociocultural influences, psychological distress, and disordered eating. Significant standardized
[()TD$FIG]
estimates and squared multiple coefficients are indicated for the male participants.

Fig. 4. Structural equation model representing the relationships between sociocultural influences, psychological distress, and disordered eating. Significant standardized
estimates and squared multiple coefficients are indicated for the female participants.
782 W.Y. Gan et al. / Appetite 56 (2011) 778–783
TLI = .96, RMSEA = .06 with 90% CI = .04–.08), accounting for 4.0%
of the variance associated with psychological distress and 25.9% of
the variance associated with disordered eating (Fig. 3). All of the
pathways were significant in this final model. Sociocultural
influences had a positive relationship with psychological distress
(b = .20) and, in turn, psychological distress had a positive
relationship with disordered eating (b = .51). In the SEM model
for males, sociocultural influences showed indirect effects (b = .10)
on disordered eating through psychological distress.
For females, the hypothesized model showed a good fit to the
data (x2/df = 3.33, CFI = .93, TLI = .91, RMSEA = .08 with 90%
CI = .07–.09), accounting for 5.3% of the variance associated with
psychological distress and 67.5% of the variance associated with
disordered eating. All of the pathways were significant. Thus, no
respecification of model was required. As seen in Fig. 4,
sociocultural influences showed direct (b = .29) and indirect
effects (b = .16) on disordered eating through psychological
distress in female university students.
Discussion
Our study examined the influences of social pressure to be thin,
weight-related teasing, and psychological distress on disordered
eating among male and female Malaysian university students. The
results highlight the mediating effect of psychological distress in
the relationships between sociocultural influences and disordered
eating but in different ways for males and females.
Consistent with previous studies (Rodgers, Paxton, & Chabrol,
2010; Suisman et al., 2008), the sociocultural influences, which
were social pressure to be thin and weight-related teasing were
found to be significant predictors of disordered eating for both
sexes. These results suggest that sociocultural influences predicted
disordered eating among university students not only in Western
cultures but also in non-Western cultures.
Furthermore, the SEM model for males revealed that sociocul-
tural influences showed an indirect effect on disordered eating
through psychological distress. No significant direct effect of
sociocultural influences on disordered eating in males was found,
which showed that psychological distress was a complete
mediator in the relationships between sociocultural influences
and disordered eating in males. Males who experienced a higher
pressure to be thin and a higher frequency of teasing reported a
higher level of psychological distress, which in turn leads to
disordered eating. On the contrary, the model for females showed
an indirect effect of sociocultural influences on disordered eating
through psychological distress, as well as a direct effect of
sociocultural influences on disordered eating. Psychological
distress partially mediated the relationships between sociocultural
influences and disordered eating in females. Our results suggest
that sociocultural influences may be an important factor which
may increase psychological distress and in turn increase the eating
problems in university students.
In the present study, when variables were analyzed simulta-
neously in SEM, there was a significant direct effect of
sociocultural influences on disordered eating in female university
students but not significant in males. These findings further
support the findings of Rodgers, Paxton and Chabrol (2010), which
suggested that sociocultural influences, particularly social pres-
sure to be thin, revealed strong direct relationship with
disordered eating among females, but weaker direct effect on
disordered eating among males. It seems possible that social
pressure to be thin was not as a salient predictor of disordered
eating among males as it is among females. Male students with
disordered eating were found to be less obsessed with their
weight as compared to the female students with disordered
eating. On the contrary, male students seem to be more concerned
with their muscle size than female students with disordered
eating (Ousley, Cordero, & White, 2008). In other words, male
students were more likely to desire for a bigger muscle size while
female students were more likely to desire for a thinner body
shape. Therefore, male students may be less likely to be influenced
by social pressure to be thin as they were more likely to perceive
no messages about appearance than were females (Gillen &
Lefkowitz, 2009). Previous studies (Bradford & Petrie, 2008;
Shomaker & Furman, 2009; Stice & Shaw, 2002) also included
body dissatisfaction in the study of the relationships between
social pressure to be thin and disordered eating among
adolescents and young women. Future studies could explore
body dissatisfaction in these relationships in the context of
Malaysian university students.
Our study found that weight-related teasing was significantly
related to psychological distress and disordered eating among
male and female university students. This finding is consistent
with a study by Libbey et al. (2008) which reported that higher
frequency of teasing was related to higher levels of depression and
anxiety and severe binge eating behaviors. The SEM model in our
study also corroborates the ideas of Suisman et al. (2008), who
suggested that weight-related teasing significantly predicted both
binge eating and negative affect in adolescents, in which negative
affect partially mediated the relationship between weight-related
teasing and binge eating. Haines and Neumark-Sztainer (2006)
also hypothesized that weight-related teasing may result in
depressive symptoms or body dissatisfaction, which may lead to
binge eating behavior, and in turn, can lead to an increased risk of
obesity.
Several limitations of the present study should be noted. First,
the findings may not be generalized to the whole population of
university students in Malaysia. A different sample should be
employed to further confirm the findings. Second, the temporal
relationship could not be established due to the nature of a cross-
sectional study design used in this study. The results in our study
do not imply that these are the only valid models for the
development of disordered eating in university students although
the models hypothesized in this study provided a good fit to the
data (Kline, 2005). It would be helpful to consider alternative
models that might also provide a good fit to the data, for example,
models that included body weight and/or body dissatisfaction as
covariates or associations in different directions. A longitudinal or
prospective study is required to further confirm and test the
pathways proposed in this study. Third, sociocultural influences
cover a wide range of factors which include weight teasing,
pressure to be thin, thin-ideal internalization, and social compari-
son (Chen et al., 2007). However, only two factors (i.e., pressure to
be thin and weight-related teasing) were examined in our study.
Further research should investigate other sociocultural influences
in the development of disordered eating among university
students. Apart from this, there are several other factors which
may influence disordered eating such as biological and psycho-
logical factors were not examined in our study due to limitations in
terms of time and financial resources.
Conclusion
In conclusion, our results suggest that psychological distress
was a potential mediator in the relationships between sociocul-
tural influences and disordered eating, in which it was a partial
mediator for females and a complete mediator for males. This
study indicates that the link between sociocultural influences and
disordered eating can be explained by psychological distress.
Teasing and comments about body weight should be discouraged
(Chen et al., 2007). Intervention and educational programs
focusing on issues related to social pressure to be thin, weight-
 W.Y. Gan et al. / Appetite 56 (2011) 778–783
related teasing and psychological distress may be useful in
preventing disordered eating among university students.
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