In Saudi Arabia, the prevalence of obesity has increased to 35.6%, compared to the global rate (1). The World Health Organization defines obesity as a body mass index (BMI) of 30 kg/m² or higher, while a BMI of 25.0–29.9 kg/m² is classified as overweigh (2). Obesity can increase the risk of other co-morbidities, such as heart disease and type 2 diabetes mellitus (2, 3). Beyond cardiometabolic consequences, weight status may be associated with eating-related concerns that influence nutrition and wellbeing. Excess body weight and obesity may be associated with disordered eating attitudes and behaviors, which represent an important and often under-recognized dimension of nutrition- and weight-related health (4).

Accordingly, examining eating attitudes across BMI categories provides important insight into the psychosocial dimensions of excess body weight beyond its metabolic consequences. Understanding how eating attitudes vary by BMI, alongside sociodemographic and health-related factors, may help identify groups at increased risk for maladaptive eating-related concerns. Such evidence is essential to inform targeted, culturally appropriate prevention and intervention strategies that address both nutritional health and psychological wellbeing among Saudi adults.

Eating attitudes such as excessive preoccupation with food, restrictive dieting, fear of weight gain, or compensatory behaviors may occur across the weight spectrum and can influence dietary quality, psychological wellbeing, and health behaviors. The Eating Attitudes Test (EAT-26) is a widely used self-report screening tool designed to identify individuals with elevated risk of disordered eating based on attitudes, feelings, and behaviors related to eating (5, 6). It involves three subscales: dieting, bulimia and food preoccupation, and oral control, which provide a structured assessment of eating-related concerns commonly associated with disordered eating risk (5). In Saudi Arabia, the Arabic EAT-26 was validated in a large non-clinical Saudi sample, which supported its use for assessing disordered eating attitudes and behaviors in Saudi populations (7). Given its established validity within the Saudi context, the Arabic EAT-26 provides a suitable framework for examining eating attitudes across different BMI categories in this population. Applying this tool allows for the assessment of how specific eating attitude subscales relate to body weight status and sociodemographic characteristics.

Research has linked excess body weight to the risk of eating disorders and disordered eating through a complex interplay of psychological, behavioral, and sociocultural factors (8). For example, in Saudi Arabia, the disordered eating attitude score was higher in females university members with obesity compared to other BMI categories (9). Additionally, among Saudi female university students, a notable prevalence and associations with body image concerns, dieting behaviors, and psychosocial risk factors were observed (10). Using the EAT-26 scale, more than one-fourth of the participating female students at Jazan University were at risk for eating disorders (EDs), in particular bulimia nervosa and binge eating disorder (11). An eating disorder (ED) is a mental health condition involving unhealthy eating behaviors and concerns about food, weight, or body shape that affect physical and psychological wellbeing (8). BMI was associated with the risk of EDs in this population (11).

Recent studies in Saudi Arabia highlight notable regional and population-level variations in the prevalence of disordered eating and its association with body weight and lifestyle factors.

A systematic review found that the prevalence of EDs and disordered eating behaviors in the eastern region of Saudi Arabia was higher among older school students compared to other regions (12). However, the relationship between different BMI categories and EAT-26 subscales; specifically dieting, bulimia and food preoccupation, and oral control, needs further investigation. Another study found that obesity among Saudi medical students was associated with a higher risk of disordered eating behaviors, based on validated screening tools (13). Interestingly, a considerable prevalence of disordered eating, with significant associations with gender, body mass index, and lifestyle factors are found among Saudi Electronic University students (14). These findings suggest the need for further research to better understand eating attitudes across BMI categories and their potential implications for prevention and support strategies within Saudi settings.

Understanding and addressing barriers to healthy eating among adults, while considering cultural factors, is an important area for investigation (15). Awareness is another important factor to consider, as Alhelal and Tami (16) assessed Saudi adults' awareness of caloric intake and weight management, and identified gaps that may contribute to unhealthy eating behaviors and obesity. Additionally, a recent cross-sectional study in Jeddah found that over half of adolescent girls scored at or above the EAT-26 cutoff, and that social media negatively influenced eating attitudes among approximately half of participants (17, 18). However, the relationship between BMI categories and the subscales of eating attitudes in the Saudi Arabian context needs further investigation. Addressing this gap is essential to better understand how eating attitudes vary across weight categories within the Saudi population. Examining these relationships may help identify early psychosocial risk factors and inform culturally sensitive strategies to promote healthier eating behaviors and weight management.

Accordingly, we hypothesized that individuals with obesity would demonstrate higher scores on disordered eating subscales, particularly anorexic and bulimic attitudes, compared with participants with normal body weight. This study aimed to (1) determine the prevalence of EDs among BMI categories in Saudi adults; (2) evaluate the relationship between BMI, and eating attitude; and (3) identify sociodemographic and health-related factors associated with eating attitudes in the study population, including variables such as age, gender, education level, social status, ED status, and metabolic disorders.

In our study, we found that eating disorder risk status showed a selective association with BMI category among Saudi adults. Relative to participants with no possible eating disorder, those with a possible eating disorder status had a significantly higher relative risk of being overweight compared with normal weight, and this association remained consistent across multinomial models accounting for age, sex, socioeconomic factors, and medication use. In contrast, the association with obesity did not reach conventional statistical significance, although the direction and magnitude suggested a borderline trend. No meaningful association was observed for underweight category. When disordered eating attitudes were examined dimensionally, most EAT subscales were not independently associated with BMI after adjustment. Two domains demonstrated the most consistent relationships. The impact of others' perception was inversely associated with BMI across models, indicating that social evaluative concerns and self-regulatory aspects of eating were the attitudes most closely linked to weight status in this population.

These findings suggest that psychosocial and social evaluative dimensions of eating, rather than classical behavioral or pathological eating disorder constructs, are most relevant to BMI differences in this sample. The prominence of the impact of others' perception indicates that how individuals experience social scrutiny, internalize external expectations, and regulate their eating behavior may play a more important role than overt restrictive, bulimic, or dieting behaviors captured by traditional EAT subscales. This pattern aligns with psychosocial models that emphasize the influence of social norms, appearance-related expectations, and internalized evaluation on eating-related cognition and behavior, particularly in societies undergoing rapid cultural and lifestyle transitions (19, 20). The inverse association between the impact of others' perception and BMI suggests that individuals who are more sensitive to social judgment surrounding eating may engage in greater self-monitoring of food intake, which could function as a protective factor against higher BMI (21, 22). Prior research has shown that social evaluation and perceived surveillance can influence eating behavior in complex ways, acting either as a source of distress or as a regulatory mechanism depending on how such pressures are internalized (20, 23). This social evaluative dimension appears more closely aligned with regulation than with pathology.

The absence of independent associations for other EAT subscales, including anorexic attitudes, dieting behaviors, and bulimic tendencies, further reinforces the conclusion that BMI differences in this population are not primarily driven by classical eating disorder psychopathology. Instead, the findings may point to a more nuanced psychosocial pathway in which social perception, self-evaluation, and regulatory attitudes toward eating play central roles. This perspective may also help explain why eating disorder risk status was most strongly associated with being overweight rather than obese. Individuals in the overweight range may remain closer to socially defined norms of acceptable body size and therefore be more responsive to social comparison and perceived scrutiny. In contrast, obesity is likely characterized by greater heterogeneity in biological, psychological, and social influences that may attenuate the observable impact of eating-related attitudes alone (24, 25).

Clear differentiation was also observed across BMI categories. The absence of a clear association with underweight may indicate that the EAT constructs examined in this study are not equally related to all departures from normal weight (26). Rather than reflecting a linear relationship across the BMI spectrum, the findings indicate a category-specific pattern in which overweight occupies a distinct psychosocial position (26). Individuals in this category may experience heightened body awareness and social evaluation without the degree of metabolic or health-related burden often associated with obesity, making eating-related attitudes more influential at this stage of weight status (27).

Subgroup analyses provided further insight into potential differences in associations across age and sex groups; however, these results should be interpreted with caution due to limited statistical power within strata. The negative association between the impact of others' perceptions and BMI was more pronounced among younger individuals and those in early adulthood, suggesting that perceived social evaluation and external judgment may play a greater role in shaping eating-related attitudes during earlier stages of adulthood (28). This pattern aligns with developmental evidence showing that appearance concerns, social comparison, and peer acceptance are especially influential during early life stages when self-concept is shaped by social feedback (29, 30). Sex-stratified analyses indicated a borderline inverse association among females but not males, potentially reflecting sex differences in body image norms and societal expectations related to eating and appearance (31, 32). Nevertheless, the exploratory nature of these analyses and the lack of consistent statistical significance underscore the need for cautious interpretation.

These subgroup patterns may be understood within the broader sociocultural context of Saudi Arabia, where rapid social change and increasing exposure to Western media and beauty standards have altered perceptions of body image and eating behavior (33, 34). As traditional cultural values intersect with contemporary ideals of appearance, individuals may experience tension between established norms and emerging expectations (35). Such cultural dissonance may be particularly relevant for adults in the overweight range, who may perceive themselves as misaligned with shifting social standards and therefore be more sensitive to external evaluation (36). Heightened attention to eating and body-related concerns may reflect efforts to negotiate social conformity rather than the presence of classical eating disorder psychopathology (32, 37).

The importance of cultural context is further underscored by evidence that Westernized body ideals, media exposure, and diet-related norms are increasingly shaping eating-related attitudes across Middle Eastern populations (38). These transitions may intensify social comparison processes and internalized appearance standards, leading eating-related attitudes to be driven more strongly by perceived social scrutiny and self-regulation than by overt disordered eating behaviors. Greater sensitivity to social judgment and stronger regulatory control overeating may function as adaptive responses to evolving social expectations rather than inherently pathological traits (39). These findings suggest that body-respectful messaging and culturally sensitive nutrition counseling may be especially relevant in contexts of heightened weight-related social evaluation.

The results indicate that psychosocial factors related to eating may be more pronounced during the early phases of weight gain, particularly among individuals classified as overweight, suggesting the importance of early detection and preventive efforts that go beyond clinically apparent eating disorder symptoms. Incorporating brief psychosocial screening measures into routine weight-related evaluations may assist in identifying individuals who could benefit from timely, culturally sensitive support before biological or medical complications emerge. At the population level, public health strategies that address weight-related stigma and foster supportive social environments—especially for younger adults and women—may help promote healthier weight outcomes within the Saudi context.

This study includes several strengths that support the clarity and interpretation of its findings. Notably, the use of a validated Arabic version of the EAT-26 ensured linguistic and cultural relevance when assessing eating attitudes within a Saudi population. Nonetheless, several limitations should be considered. The cross-sectional design limits the ability to draw conclusions regarding causality or temporal relationships. Reliance on self-reported data may introduce reporting or social desirability bias, particularly in contexts where disordered eating may be stigmatized or underrecognized. Additionally, online recruitment may have contributed to selection bias, as participants with higher health awareness or interest in nutrition-related topics may have been more likely to participate, potentially affecting generalizability. The observed sex imbalance in the sample may also have influenced the findings, given established sex differences in eating attitudes and body image concerns. Finally, while subgroup analyses offered exploratory insights, smaller subgroup sizes may have limited statistical power, and findings should therefore be interpreted with caution.

In a region where overweight and obesity continue to pose significant public health challenges, this study provides important insight into the psychosocial dimensions associated with BMI among Saudi adults. These findings demonstrate that eating disorder risk is selectively associated with overweight status, while obesity shows only a borderline association, and underweight shows no meaningful relationship. Moreover, the results indicate that most classical eating disorder attitudes are not independently linked to BMI, with social evaluative concerns emerging as the most consistent correlates of weight status. These patterns suggest that eating-related attitudes in this population reflect broader psychosocial and self-regulatory processes rather than disordered overeating psychopathology. Acknowledging the influence of social evaluation and behavioral regulation on weight status may support the development of more refined and culturally responsive strategies for screening, prevention, and intervention that extend beyond weight-focused frameworks and attend to the psychological contexts shaping eating behaviors.