Disordered eating, self-esteem, and physical activity among Tunisian adolescents: public health insights and validation of the Arabic Ede-Q.

BACKGROUND

Disordered eating behaviors are a growing public health concern among adolescents, with implications for both physical and psychological well-being. The availability of culturally valid assessment tools is critical for early identification and prevention.

OBJECTIVES

This study aimed to (i) examine how self-esteem, sport participation, and Body Mass Index (BMI) predict eating disorder symptoms in a large cohort of Tunisian schoolchildren, and (ii) assess the psychometric properties of the Arabic version of the Eating Disorder Examination Questionnaire (EDE-Q).

METHODS

A total of 1,748 adolescents (629 boys, 1119 girls; mean age ≈ 16.8 years) from Zaghouan, Tunisia, completed self-report assessments of BMI, self-esteem (Rosenberg Self-Esteem Scale), physical and sports activity, and disordered eating (Arabic EDE-Q). Correlation, regression, and confirmatory factor analyses were conducted.

RESULTS

Eating disorders were negatively associated with physical activity (boys: r = -0.456; girls: r = -0.260; p < 0.01) and self-esteem (β = 0.651; p < 0.001) and positively associated with BMI (β = 0.219; p < 0.001). The Arabic EDE-Q demonstrated a robust four-factor structure and high internal consistency (CFI = 0.996; RMSEA = 0.026). Gender differences were observed, with girls reporting higher disordered eating scores.

CONCLUSIONS

Self-esteem and BMI are significant predictors of disordered eating, underscoring the need for integrated public health strategies that promote mental well-being and healthy body image among adolescents. The validated Arabic EDE-Q offers a reliable tool for screening and monitoring disordered eating in Arabic-speaking youth populations, enabling early intervention in school-based mental health programs.