Eating disorders, body image and media exposure among adolescent girls in rural Burkina Faso

Objective Body dissatisfaction and eating disorders (ED) among young females may increase in limited-resource settings as exposure to media and higher-resource cultures increases. We examined ED prevalence and its predictors among adolescent girls in rural north-western Burkina Faso. Methods Fieldworkers interviewed 696 female adolescents aged 12-20 years in the Nouna Health and Demographic Surveillance System (HDSS). ED were evaluated using the Structured Clinical Interview for DSM-5 (SCID-5), self-perceived appearance and body ideal were measured using Thompson and Gray's Contour Drawing Rating Scale (CDRS) and eating disorder predictors by the Eating Disorder Examination Questionnaire (EDE-Q). We assessed media exposure to magazines, radio, television, and the internet. Results 16% of respondents had a BMI below WHO age-standardised 5th percentile, while 4% were above the 85th percentile; most respondents wanted to be larger. DSM-5 criteria for anorexia nervosa (AN) were fulfilled by four of 696 respondents (0.6%), those for bulimia nervosa by none, and those for binge eating disorder by two (0.3%). In multivariable regression, more AN symptoms were associated with greater EDE-Q body dissatisfaction, desiring a thinner body and a history of sexual harassment or assault, but not with media exposure. A thinner desired body was associated with greater media exposure, higher BMI z-score and greater EDE-Q disordered eating. Conclusion ED were very rare in rural Burkinabe female adolescents, but factors predictive of ED in higher-resource settings were also predictive of ED precursor symptoms here. Our findings suggest that increasing media exposure in resource-limited settings may lead to increased body dissatisfaction, and potentially to increased future ED prevalence.