AMJ Vol 9 No 4 Desember 2022 Final.indd


Althea Medical Journal. 2022;9(4)

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Relationship between the Risk of Eating Disorders and the 
Concentration Capacity of High School Students

Samantha Shania,1 Felicia Kurniawan3
1School of Medicine and Health Sciences Atma Jaya Catholic University of Indonesia, Indonesia, 

2Department of Health Sciences, School of Medicine and Health Sciences Atma Jaya Catholic 
University of Indonesia, Indonesia

Correspondence: Samantha Shania, S.Ked, School of Medicine and Health Sciences Atma Jaya Catholic University of 
Indonesia, Jalan Pluit Raya No. 2, North Jakarta, Indonesia, E-mail: sam.shania@gmail.com

Introduction

Changes in eating behaviors and dietary 
habits are very common in the general global 
population. Unhealthy eating behavior may 
affect daily activities and cause vulnerability 
to various diseases, known as eating 
disorders.1 Eating disorders are a group of 
serious mental disorders, generally leading 
to fatal consequences that cause people to 
become obsessed with weight and body 
shape.2 The disorder is a comprehensive 
spectrum disorder, which is further classified 
into anorexia nervosa (AN), bulimia nervosa 
(BN), binge-eating disorder (BED), avoidant/ 
restrictive food intake disorder (ARFID), and 
pica. Those with an eating disorder who do not 
meet the full criteria for any of the disorders 

above falls into ‘other specified feeding and 
eating disorder’ (OSFED) or ‘unspecified 
eating disorder’ (UFED).3,4 Changes in 
individual eating behavior are designated as 
unhealthy if the effects of these changes result 
in an excessive or inadequate energy intake. 
Three of the most common eating disorders 
are anorexia nervosa (AN), bulimia nervosa 
(BN), and BED.1

Eating disorders are most commonly found 
in women between the ages of 12–35 years, 
although they can also be found in all types 
of individuals.5 Another study has shown that 
this disorder is found primarily in adolescents, 
mainly at 16–24 years old.6 Unhealthy eating 
behavior can be experienced by everyone, 
although it is more commonly found in women 
from adolescence to young adulthood.1,7 In 

Althea Medical Journal. 2022;9(4):212–217

Abstract

Background: Eating disorder is a change in eating behaviour that affects daily activities, resulting in a 
vulnerability towards diseases that have several effects on the organ systems, including the neurological 
system. In teenagers, these disturbances, including a decline in memory, cognitive function, and 
concentration, will significantly affect daily activities, especially in their studies. The objective of this 
study was to determine the relationship between the risk of eating disorders and the concentration 
capacity of high school students aged 12–19 years old. 
Methods: This study was an observational analytic study conducted cross-sectionally among high 
school students. Data were collected from September to October 2019. Data were taken using Eating 
Disorder Examination (EDE) Questionnaire filled out by the respondents, followed by a Stroop test. 
Data analysis was performed by the chi-square test.
Results: Of 294 students, 56.5% had a risk of eating disorder, of whom 66.7% did eating restrain. Of 
all respondents, 54.8% had poor concentration capacity. There was a relationship between the risk of 
eating disorder and concentration capacity (p=0.002).
Conclusion: The risk of eating disorders has a significant relationship with concentration capacity. An 
urgent measurement is needed to promote an eating behaviour among adolescents to increase good 
and productive daily activity.

Keywords: Concentration capacity, eating disorders, EDE-Q, Stroop test

https://doi.org/10.15850/amj.v9n4.2530



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Indonesia, 12–22% of women aged 15–29 
years suffer from chronic energy deficiency 
with a body mass index of <18.5, however, it 
has not been confirmed yet due to a lack of 
prevalence studies conducted.8 Moreover, 
eating disorders prevalence is relatively 
high in adolescents under 18 years old, and 
the prevalence is high in Asia and other 
developing countries.9 This high prevalence 
of eating disorders among adolescents might 
be correlated with the effect of negative body 
image distortion.10

Next to serious mental illness, eating 
disorders affect various organ systems in 
the body, among others cardiovascular, 
gastrointestinal, endocrine, and neurology 
system.11 Food restriction, nutritional 
deficiency, and in other ends also, excessive 
energy intake can cause an individual to 
experience several disruptions in the activities 
of daily living. In adolescents, neurological 
disruption will significantly affect daily 
activities, especially in the study.11 These 
neurological disruptions include dull memory, 
decreased cognitive function that is associated 
with cognitive inflexibility, which is considered 
one factor that worsens prognosis, which 
will be more likely to present resistance to 
therapy,12 and problems with concentration 
or inattention due to alterations of the 
neurotransmission of the brain.11

An individual is described as inattentive 
if he/she has poor concentration capacity, a 
short attention span, and is easily distracted.13 
Several studies have found evidence showing 
a relationship between eating disorders and 
neurological disruption.13 This relationship is 
associated with neurological disruption due 
to either inadequate nutrition intake for the 
body or excessive food intake, which are both 
caused by disordered eating.11

This study focuses on concentration 
problems as one of the consequences of an 
eating disorder due to the high demands for 
good concentration in high school students 
and the high prevalence of eating disorders 
in adolescents in the high school age range. 
Therefore, this study aimed to determine 
the relationship between eating disorders in 
adolescents aged 12–19 years in West Jakarta 
and their impacts on concentration capacity.

Methods

This study was a cross-sectional analytic 
observational study conducted from 
September to October 2019. The sample was 
collected by total sampling. The respondents 

were all junior and senior high school students 
at an international school in West Jakarta, 
Indonesia who met the inclusion criteria. 
Inclusion criteria were students aged 12–19 
years had never done the Stroop test and 
were willing to become respondents by 
signing informed consent. Since they were 
underage, informed consent was signed by 
their parents/guardian and they were asked 
for posible exclusion criteria. Exclusion 
criteria were respondents who were color 
blind, had dyslexia, and had attention-deficit/
hyperactivity disorder (ADHD). Furthermore, 
respondents who experienced non-optimal 
physical conditions that could interfere 
with concentration, such as headache, body 
aches, fatigue due to physical activity, chills, 
fever, cough, and runny nose, were excluded. 
Respondents who were taking drugs that 
stimulated drowsiness were also excluded as 
well as those who were not present on the 
day of data collection. Ethical clearance was 
obtained from the Research Ethics Committee 
School of Medicine and Health Sciences Atma 
Jaya Catholic University of Indonesia with a 
number 02/09/KEP-FKUAJ/2019. 

Data were collected using the EDE-Q 
questionnaire to obtain data on the risk 
of eating disorder and the Stroop test to 
determine the concentration capacity. The 
EDE-Q questionnaire was used to screen 
respondents for eating disorders. The results 
of the questionnaire were divided into 4 
subscales, including restrain, eating concern, 
shape concern, and weight concern. The 4 
subscales were then subdivided to obtain 
the average value or the global score of each 
respondent’s EDE-Q.

The Stroop test used was the Stroop Color 
and Word Test (SCWT). In the Stroop test, 
respondents were asked to read a board 
containing the name of the color (W) printed in 
different ink from the writing (C). For example, 
the word “BLUE” in red ink. This condition will 
cause the participant’s attention to be more 
divided, where tasks that can usually be done 
more automatically, such as reading the color 
of the writing, become obstructed due to the 
respondents being required to name the color 
of the ink instead of reading the word.14

The concentration capacity tested by 
the Stroop test was divided into two parts. 
Initially, the respondents will be asked to read 
aloud the words written on the card while 
ignoring the color of the ink printed on the 
word. Then in the next section, the respondent 
will be asked to name the color of ink used for 
the word, regardless of the word printed on 

Samantha Shania and Felicia Kurniawan: Relationship between the Risk of Eating Disorders and the 
Concentration Capacity of High School Students



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the card. The respondent’s reading time (in 
seconds) was recorded in both steps. Then 
the researcher calculated the interference 
score between these two steps by reducing the 
time recorded in the first step with the time 
recorded in the second step. If the interference 
score was less than 13, the concentration of 
the respondent was categorized as good. If the 
interference score was more than or equal to 
13, the concentration of the respondent was 
considered poor.15

The data were analyzed by univariate 
analysis for the demographic characteristics, 
risk of eating disorders, and concentration 
capacity of the junior and high school students. 
Bivariate analysis was then performed with 
the chi-square test for the relationship 
between the effects of risk of eating disorder 
and concentration capacity. 

Results

This study included 294 junior and high school 
students. The distribution of respondents by 
gender was 179 female (60.9%), and 115 male 
(39.1%). Distribution of respondents who had 
a risk of eating disorders was 56.5%, while 
43.5% did not. The results also showed that 
there were 54.8% with impaired concentration 
capacity, while 45.2% did not (Table 1).

Hence, the risk of eating disorders and 
impaired concentration capacity dominates all 
respondents. Females (60.9%) had more risk 
of eating disorders compared to males (49.6%) 
(Table 2). However, there was no significant 
relationship between gender and risk of eating 
disorder (p=0.056). Interestingly, there was a 
significant relationship between gender and 
concentration disruption (p=0.000).

Althea Medical Journal December 2022

Table 1 Demographic Characteristics, Eating Disorders, and Concentration Capacity of 
Junior and High School Students (n=294)

Variable
Distribution 

n %
Class level
     Grade 7
     Grade 8*
     Grade 9
     Grade 10
     Grade 11
     Grade 12

53
63
62
58
37
21

18.0
21.4
21.1
19.7
12.6
7.1

Gender
     Female*
     Male

179
115

60.9
39.1

Eating disorder
     Risk of eating disorder*
     No risk

166
128

56.5
43.5

Concentration capacity
     Impaired*
     Normal

161
133

54.8
45.2

Note: *Highest percentage

Table 2 Normality Test

Gender
Eating Disorders Concentration Capacity

Risk No risk Impaired Normal
n (%) n (%) n (%) n (%)

Female 109 (60.9) 70 (39.1) 59 (33.0) 120 (67.0)
Male 57 (49.6) 58 (50.4) 102 (88.7) 13 (11.3)



Althea Medical Journal. 2022;9(4)

215Samantha Shania and Felicia Kurniawan: Relationship between the Risk of Eating Disorders and the 
Concentration Capacity of High School Students

In the interpretation results on the EDE-Q 
questionnaire, which were divided into 4 
subscales, it was found that 66.7% had the 
restrain subscale, 69.1% had the eating 
concern subscale, 60.2% had the shape 
concern subscale, and 56.5% had the weight 
concern subscale (Table 3).

There was a significant relationship 
between the risk of eating disorders and 
impaired concentration (p=0.002), and there 
was a significant relationship between eating 
restrictions and the risk of eating disorders 
(p=0.000) (Table 4).

Discussion

The results showed that females had a higher 
risk of eating disorders compared to male, as 
depicted in Table 2. However, the relationship 
between gender and risk of eating disorders 
is not significant (p=0.056). This result is in 
accordance with a study on the risk of eating 
disorders in more respondents, including 
6,140 adolescents. There is a higher number 
of body dissatisfaction in girls compared to 
boys in their adolescence period. However, 
gender as a risk factor for the eating disorders 
could not be determined.16 The results of this 
study are also supported by a meta-regression 
analytical study that refutes gender role 
as a risk of developing an eating disorder. 

Although gender may play a role, it needs 
to be in correlation with other risk factors 
in determining a person’s risk for eating 
disorders.17

Our study also showed that male students 
had more experienced concentration problems 
compared to female students. Gender seems to 
have a role in impaired concentration. Similar 
to another study, the Stroop test is different 
between genders. The response speed in 
women is faster than in men. Therefore, the 
performance of the Stroop test in men has 
worse results.18

There is a significant relationship 
between the risk of eating disorders and the 
concentration capacity of these junior and 
high school students (p=0.002). This result is 
consistent with a study about the physiological 
consequences of eating disorders. Nutritional 
deficits  in eating disorders can cause sufferers 
to become weak and tired easily.11 Eating 
disorder risks in this study were determined 
by disordered eating and dissatisfaction 
with self-perception at least in the last 28 
days. It shows that respondents who have 
been determined to have an eating disorder 
risk changed to abnormal eating patterns. 
This nutritional deficit behavior can cause 
cognitive development disorders, and one 
of the components of cognitive function is 
concentration.10 Furthermore, other studies 

Table 3 Eating Disorder Examination Questionnaire (EDE-Q) Interpretation

Subscale Mean Impairedn (%)
Normal
n (%)

Restrain 1.625 196 (66.7) 98 (33.3)
Eating concern 1.256 203 (69.1) 91 (30.9)
Shape concern 2.258 177 (60.2) 117 (39.8)
Weight concern 1.780 161 (54.8) 133 (45.2)
Global score 1.730 166 (56.5) 128 (43.5)

Table 4 Relationship between Eating Disorders Risk and Concentration Capacity of 
High School Students

Eating Disorders 
Risk

Concentration Capacity
Total
n (%) P-value*Impaired

n (%)
Normal
n (%)

Risk 104 (35.4) 57 (19.4) 166 (56.5) 0.002
No risk 62 (21.1) 71 (24.1) 128 (43.5)
Total 161 (54.8) 133 (45.2) 294 (100.0)



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also state the existence of neurological 
susceptibility in nutritionally restricted 
individuals.19 There is a close relationship 
between impaired concentration/attention 
and restrictive eating patterns.20 Individuals 
with eating disorders have worse performance 
in completing cognitive tasks, inhibitory 
function, planning performances, and worse 
working memory tasks.21 

A significant relationship between 
restrictive eating behavior and the risk 
of eating disorders. In our study also 
shows that there is a relationship between 
restrictive eating behavior on concentration 
capacity. This finding supports the theory 
that restrictive eating behavior may cause 
nutritional deficiencies and thus can interfere 
with concentration capacity.11 These results 
are consistent with a study that assessed 
the relationship of cognitive function with 
restrictive eating behavior such as skipping 
meals. Skipping meals and cognitive function 
has a significant interaction, in which dietary 
restriction impairs the ability to learn and 
encode new information.22

This study has several limitations 
and shortcomings. One of the limitations 
encountered in this study was the location 
where respondents were collected, which 
was only from one school. Therefore, the data 
obtained only describes the results of the risk 
of eating disorders in high school students 
where the majority are from the middle and 
upper socioeconomic status with a Tiong 
Hoa ethnic background. Data collection for 
concentration power also does not exclude 
confounding factors, such as preoccupation 
with gaming addictions, which also have a high 
prevalence in adolescents.

In conclusion, the risk of eating disorders 
has dominated junior and senior high school 
students with the concentration capacity 
mostly disrupted. Counseling about the effects 
of eating disorders and the ease of individuals 
to have the risk of eating disorders is highly 
needed, to reduce the number of students 
who have the risk of eating disorders and to 
reduce individuals who receive the effects of 
unhealthy eating habits.

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Samantha Shania and Felicia Kurniawan: Relationship between the Risk of Eating Disorders and the 
Concentration Capacity of High School Students