Eating attitudes across body mass index categories in Saudi Arabia: a cross-sectional study

Introduction Body weight is linked to disordered eating through psychological, behavioral, and sociocultural mechanisms. Studies in Saudi Arabia reported increased eating disorder risk, particularly among female university students; however, associations between body mass index (BMI) categories and specific EAT-26 subscales remain underexplored. This study assessed eating attitudes among Saudi adults with different BMI categories, examining associations with BMI, and identifying sociodemographic and metabolic risk factors. Methods This cross-sectional study surveyed Saudi adults (≥18 years) using convenience sampling via social media between May 30, 2021, and May 22, 2024. Body mass index (BMI) categories were defined as overweight (25.0–29.9 kg/m 2 ) and obesity (≥30 kg/m 2 ). Eating attitudes were assessed using the validated Arabic EAT-26. Multinomial logistic regression examined associations between eating disorder status and BMI categories with sequential adjustment for demographic and health-related factors. Linear and multinomial regression models evaluated relationships between EAT-26 subscales and BMI as continuous and categorical outcomes using SPSS version 27. Results Among 404 Saudi adults, mean BMI was higher in males than females (26.5 ± 5.4 vs. 24.7 ± 5.5 kg·m −2 , p 0.001). In age- and sex-adjusted multinomial logistic regression, participants with a possible eating disorder had a higher relative risk of being overweight compared with normal weight (RRR = 5.90, 95% CI: 1.30–26.83). In linear regression analyses, higher scores for others' perception and oral control were inversely associated with across the full BMI distribution. Discussion/conclusion These findings underscore the influence of sociocultural change in Saudi Arabia on eating attitudes, where Westernized body ideals and evolving social expectations shape body image concerns. Eating-related attitudes, particularly among individuals in the overweight range, may reflect heightened social sensitivity and self-regulation rather than pathological disordered eating. Culturally sensitive psychosocial screening and stigma-reducing, body-respectful public health strategies may support psychological wellbeing and healthier weight trajectories.