Internet addiction and its relationship with food choice motives and the risk of eating disorders among young adults in Malaysia

The socio-demographic characteristics of young adults are presented in Table 1. Out of the 331 young adults who participated in this study, the majority were females (n = 186, 56.2%), aged between 25 and 30 (n = 236, 71.3%), Malay (n = 189, 57.1%), with a single marital status (n = 237, 71.6%), tertiary educated (n = 294, 88.8%) and earned less than RM 5000 in a month (n = 291, 87.9%).

Figure 2 depicts the prevalence of internet addiction among young adults. Emerging findings reveal that 26.0% (n = 86) did not show signs of internet addiction, while nearly half of the young adults had mild internet addiction (n = 149, 45.0%). Slightly more than one-fourth of young adults experienced moderate internet addiction (n = 93, 28.1%), whereas only 0.9% (n = 3) were classified as severe internet addicts. The prevalence of internet addiction was further categorised into two main groups: normal-to-mild internet addiction (n = 235, 71.0%) and moderate-to-severe internet addiction (n = 96, 29.0%) for path analysis. The risk of eating disorders among young adults is illustrated in Fig. 3. The findings indicated that two-thirds of young adults had no risk of eating disorders (n = 223, 67.3%), while one-third (n = 108, 32.6%) were at risk of eating disorders. Of the 96 young adults who were moderately to severely addicted to the internet, 42 (43.8%) of them were also at risk of eating disorders.

Table 2 shows the food choice motives of young adults by the severity of internet addiction and the risk of eating disorders. In general, young adults in the current study were highly valued for the price (4.23 ± 0.70), sensory appeal (4.21 ± 0.60), and mood (4.16 ± 0.60) when deciding food choices. Interestingly, the top three rated food choice motives varied slightly based on the severity of internet addiction and the risk of eating disorders. Young adults in the categories of  normal-to-mild internet addiction and no risk of eating disorders prioritised price, sensory appeal, and mood when deciding food choices. While price and sensory appeal have remained the top two food choice motives of those with moderate-to-severe levels of internet addiction, they were also found to rely heavily on convenience. Conversely, mood, price, and weight control were the utmost concerns among those at risk of eating disorders. The findings of the independent-samples t-test revealed that young adults in the moderate-to-severe internet addiction category attained significantly higher mean scores in price (t = − 2.188, p = 0.029), convenience (t = − 2.827, p = 0.005), and familiarity (t = − 3.887, p < 0.001) compared to those in the normal-to-mild internet addiction category. Compared to young adults with no risk of eating disorders, significantly higher mean scores in mood (t = − 3.126, p = 0.002), weight control (t = − 6.144, p < 0.001), and familiarity (t = − 2.829, p = 0.005) were observed among those at risk of eating disorders.

Table 3 demonstrates the path analysis of the relationships between internet addiction, food choice motives, and the risk of eating disorders. Moderate-to-severe internet addiction was positively associated with convenience (B = 0.257, p = 0.002) and familiarity (B = 0.352, p < 0.001) (Path a_i). In reference to Path b_i, sensory appeal (B = − 0.706, p = 0.043), health (B = − 1.257, p = 0.006), and convenience (B = − 0.820, p = 0.018) were negatively associated with the risk of eating disorders. Conversely, mood (B = 0.881, p = 0.033), weight control (B = 1.853, p < 0.001), and familiarity (B = 0.621, p = 0.018) were positively associated with the risk of eating disorders. There was also a significant direct effect between internet addiction and the risk of eating disorders (B = 0.793, p = 0.017). The findings of mediation analyses revealed that the relationship between internet addiction and the risk of eating disorders was partially mediated by convenience (b = − 0.211, SE = 0.140, − 0.548 to − 0.016) and familiarity (b = 0.219, SE = 0.122, 0.019 to 0.494) (Table 4).

Discussion

The prevalence of moderate-to-severe internet addiction among young adults in Malaysia was formerly reported as 28.1% (moderate internet addiction = 26.1% and severe internet addiction = 2.0%) prior to the COVID-19 pandemic²¹. The findings in this study are generally in line with that previously reported by Masuri et al. (2019)²¹, in which 29.0% of the young adults were moderately or severely addicted to the internet (moderate internet addiction = 28.1% and severe internet addiction = 0.9%). Although reliance on the internet is projected to increase following the global pandemic outbreak^7,22,23, emerging findings suggest that the prevalence of moderate-to-severe internet addiction during the transition to the endemic phase of COVID-19 was remarkably resilient compared to that of the pre-pandemic level. One of the plausible justifications is that Malaysians are anticipating a return to normalcy through the resumption of daily routines as they had before the outbreak, with the lifting of the Movement Control Order (MCO)²⁴.

Three local studies conducted before the pandemic outbreak delineated that 13.9% to 20.4% of university students, whose age typically falls between 18 and 25 years old, were at risk of eating disorders^16,25,26. The proportion of young adults at risk of eating disorders in this study was 32.6%, which is 1.6–2.3-fold higher than the reported prevalence in university students. Increased psychological distress (such as stress, depression, anxiety, and fear of COVID-19 infection), changes in daily routine and sleep patterns, food insecurity, and increased exposure to weight loss-related content on social media platforms during the pandemic lockdown could be among the factors associated with the surge in the risk of eating disorders^27,28,29,30.

A recent study by Tan et al.⁸ indicated that the COVID-19 lockdown measures have led to a slight change in the food choice motives of Malaysian young adults. Before the emergence of COVID-19, young adults decided their food choices by considering price, sensory appeal, religion, and convenience. During the unprecedented pandemic, mood surpassed religion as one of the top four-rated food choice motives in young adults. The top three-rated food choice motives among young adults in the normal-to-mild internet addiction (price ≈ sensory appeal > mood), moderate-to-severe internet addiction (price > sensory appeal > convenience), and no risk of eating disorders (price > sensory appeal > mood) categories were identical to those previously reported during the pandemic. In addition to price, those at risk of eating disorders were also highly valued for mood and weight control when making food choices. Price was the primary concern of all young adults in this study, irrespective of the severity of internet addiction and the risk of eating disorders. According to the Salaries & Wages Survey Report released in 2021, the median monthly salaries of young adults stood at RM 1468 (15–24 years old) and RM 2001 (25–34 years old) nationally³¹. Young adults with low earnings may have limited purchasing power and be more sensitive to price fluctuations³². In reference to those previously mentioned, the rising global food prices after the pandemic lockdown may trigger young adults to consume small portions or engage in disordered eating behaviour such as meal skipping^33,34,35.

The findings from the independent samples t-test demonstrated that young adults who are moderately to severely addicted to the internet were more sensitive to food prices, opted for a convenient way to acquire food, and were more likely to consume familiar food than their counterparts. Coincidentally, moderate-to-severe internet addiction was also positively associated with convenience and familiarity after adjusting the socio-demographic variations in young adults. Emerging findings are consistent with literature showing that internet addiction leads to poor dietary habits. These habits are often characterised by a higher preference for convenience foods such as fast foods or junk foods that only require minimal preparation time^36,37,38. In China, Zhang et al.³⁹ demonstrated that internet addiction contributes to picky eating behaviour among middle school students aged 11–20. A similar pattern of findings was also observed in the current study, wherein young adults with moderate-to-severe internet addiction had limited food choices and a restricted range of preferred foods.

The current study also revealed that young adults at risk of eating disorders attained significantly higher mean scores in mood, weight control and familiarity than their counterparts. Path analysis further confirmed these trends, showing that food choice motives mentioned earlier were positively associated with the risk of eating disorders after adjusting the socio-demographic variations in young adults. In general, emerging findings support the notion that emotion dysregulation, a stronger desire to lose weight, and a higher preference for familiar food are among the factors driving the incidence of disordered eating in young adults^40,41,42. It is also worth mentioning that young adults who took sensory appeal, health, and convenience into consideration when making food decisions had a lower risk of developing eating disorders (Table 3). These findings translated to the fact that young adults in this study did not succumb to temptation due to good taste, appealing texture, attractive appearance, and pleasant smell⁴³. A lower risk of developing eating disorders was observed among young adults prioritising health because they are more likely to adopt a healthy and balanced diet⁴⁴. Although it has been previously reported that overconsumption of convenience foods such as energy-dense ultra-processed foods contributes to disordered eating⁴⁵, the current finding did not observe such a trend. One of the plausible justifications is that young adults in this study had a stronger preference for healthy convenience foods over unhealthy convenience foods⁴⁵.

The positive direct effect between internet addiction and the risk of eating disorders indicated that young adults with moderate-to-severe internet addiction are more susceptible to disordered eating. Likewise, a meta-analysis by Ioannidis et al.⁴⁶ also stated that problematic internet usage is positively correlated with the general psychopathology of eating disorders, including disordered eating. The unrealistic and distorted body ideals hosted online may prompt individuals with internet addiction to practise restrictive eating, obsessively counting calories or engage in excessive exercise^9,47,48. In addition, the relationship between internet addiction and the risk of eating disorders was partially mediated by convenience (competitive partial mediation) and familiarity (complementary partial mediation). The choice of convenience foods plays a crucial role in determining the relationship between internet addiction and the risk of eating disorders. Choosing healthy convenience foods may potentially reduce the risk of eating disorders, even among young adults with moderate-to-severe internet addiction. On the other hand, moderate-to-severe internet addiction might heighten the risk of eating disorders, primarily because young adults limit their food choices to familiar options.

Several limitations need to be highlighted in this study. First, since this study adopted a cross-sectional design, it cannot establish a cause-and-effect relationship between internet addiction and disordered eating. Second, this study is overly represented by young adults aged 25–30, those with single marital status, and those who earn less than RM 5000 per month. Therefore, the findings in the current study may not be generalisable to all young adults in Malaysia. Third, only three young adults (0.9%) were severely addicted to the internet in this study, which may potentially affect the accuracy of the findings. Fourth, this study did not consider the food intake of young adults when justifying the relationships between internet addiction, food choice motives, and the risk of eating disorders. To address these limitations, further investigation may adopt longitudinal or qualitative approaches, recruiting more young adults in the younger age group (below 24 years old) as well as a larger number of young adults with severe internet addiction and exploring the dietary patterns of young adults to gain better insights into the variables under study. Despite those previously mentioned, this study is the first to investigate the relationships between internet addiction, food choice motives, and the risk of eating disorders among young adults in the aftermath of the COVID-19 pandemic.