«Adolescents and Eating Disorders:: Gender, Racial, Ethnic, Sociocultural, and Socioeconomic Issues Delores D. Walcott, Helen D. Pratt and Dilip R. ...»
Journal of Adolescent Research
Adolescents and Eating Disorders:: Gender, Racial, Ethnic, Sociocultural, and Socioeconomic Issues
Delores D. Walcott, Helen D. Pratt and Dilip R. Patel
Journal of Adolescent Research 2003; 18; 223
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ARTICLEJOURNALal. / ADOLESCENTSRESEARCH / May 2003 10.1177/0743558403251867 Walcott et OF ADOLESCENT AND EATING DISORDERS
Adolescents and Eating Disorders:
Gender, Racial, Ethnic, Sociocultural, and Socioeconomic Issues Delores D. Walcott Western Michigan University Helen D. Pratt Dilip R. Patel Michigan State University Little is known about the incidence and prevalence of eating disorders among adolescents of color who are poor or identify themselves as gay or lesbian. Among American women, eating disturbances are equally as common among Native, Asian, or Hispanic Americans as they are among Caucasians. African Americans were at hi
cultural, and socioeconomic factors and their relationship to the preponderance of data on Caucasian upper middle-class women who live in Western countries. First, we briefly reviewed the common assumptions and knowledge about eating disorders. Next, we reviewed and compared recent research that is beginning to address underrepresented groups of color. We conclude with a brief statement of our findings, the implications of eating disorders on a national level, and the raising risk to teenagers.
HISTORICAL AND CURRENT TRENDS
Historically, researchers have focused on convenience participants, primarily Caucasians. Specifically, participants were recruited from inpatient or outpatient settings or from college or university settings. In general, researchers believed only Caucasian, upper middle-class women who lived in industrialized or westernized countries developed eating disorders. The historical exclusion of minorities, men, and people from nonwestern or nonindustrialized countries as research participants was based on Fenwick’s (1880) original observation that anorexia nervosa (AN) was more commonly found in wealthier classes of society than among laborers or lower classes (as cited in Gard & Freeman, 1996).
Current research supports this conclusion for AN but not for bulimia nervosa (BN) or the newly proposed binge-eating disorders (BED). Women of color around the world and male athletes are increasingly being diagnosed with BN and BED. These disorders occur more frequently than does AN in these special populations (Comerci & Greydanus, 1997; Striegel-Moore, Wilfley, Pike, Dohm, & Fairburn, 2000; Warheit, Langer, Zimmerman, & Biafora, 1993).
Because of the previously mentioned trend, most of the literature available today examines concerns associated with Caucasian American adult women with eating disorders who attend college, who are seen in inpatient and outpatient treatment settings, or who live in areas where large university-based research-oriented hospitals operate (e.g., Minnesota or New York). Today, studies on people of color (men or women) or about subgroups (adolescents or homosexuals) are emerging that focus on the incidence of eating disorders and maladaptive eating patterns. We know little about how eating patterns effect the development of eating disorders in these special populations.
Recent literature shows that the detection of eating disorders (full syndromes or partial syndromes) and disordered patterns of eating have increased among people of color (men and women) and among prepubertal girls in all social classes and within all regions of the United States and coun
tries around the world (Golden, 1997; Morande’, Celada, & Casas, 1999;
Mukai & McCloskey, 1996; Nadaoka, Oiji, Takahashi, Morioka, & Kashiwakura, 1996; Rosenvinge & Gresko, 1997; Striegel-Moore, 1995).
A total of 90% to 95% of patients diagnosed with eating disorders are women (American Psychiatric Association, 2000). The remaining 5% to 15% of men are given a diagnosis of either AN or BN. Of the men diagnosed, adolescent boys and young adult men account for 0.2% of cases of eating disorders (Carlat & Camargo, 1991; Golden, 1997). Given that men do not have one of the major symptoms for AN, namely amenorrhea, they are often excluded from investigation (Ziesat & Ferguson, 1984). This exclusion has a significant negative impact on detection rate of AN among men.
Leon, Fulkerson, Perry, and Early-Zald (1995) conducted a 3-year study of predominately Caucasian (89%) female (843) and male (797) students who lived in a Minnesota suburb and were in Grades 7 through 10. They concluded that (a) once a student is initially identified as being at high risk, that risk status remains stable over time for all participants; (b) being Caucasian and having poor interoceptive awareness at Year 2 were significant predictors of disordered eating at Year 3 for women; and (c) a significantly greater proportion of girls than boys endorsed behaviors that were similar to behaviors that met diagnostic criteria for eating disorders (Leon et al., 1995).
Data from studies of adult men diagnosed with eating disorders indicated that the onset tends to occur at a later age than for women, that they have a higher prevalence of premorbid obesity, and that they are less concerned with strict weight control (Carlat & Camargo, 1991). Olivardia, Pope, Mangweth, and Hudson (1995) also found that men with eating disorders have characteristics that appear strikingly similar to those of women with eating disorders.
For example Sharp, Clark, Dunan, Blackwood, and Shapiro (1994) reported that around half of the male sufferers endorsed bingeing and vomiting behavior coupled with frequent endorsement of excessive exercising. Depressive and obsessive symptoms and a strong family history of affective disorders and alcohol abuse were also endorsed (Sharp et al., 1994).
Data on the relationship between homosexuality and eating disorders come from studies with adult gays and lesbians. However, little is known Downloaded from http://jar.sagepub.com at SIMMONS COLLEGE LIBRARY on October 28, 2009 226 JOURNAL OF ADOLESCENT RESEARCH / May 2003 about the incidence and prevalence of eating disorders among adolescents who identify themselves as gay or lesbian, and the overall relationship between eating disorders and homosexuality among adults or adolescents remains unclear.
Bradford, Ryan, and Rothblum (1994) analyzed data for the National Lesbian Health Care Study (1984-1985). Information was collected on 1,925 lesbians from all 50 states. The researchers examined eating behaviors of adult lesbians. These women were more likely to report overeating and vomiting (approximately 66%) than undereating (33%). Of the entire sample, 4% said they binged and purged. It is interesting that African American lesbians reported a much higher rate (19%) of bingeing and purging. Reports of undereating were more likely to occur among younger African Americans as well as with women from lower incomes (Bradford et al., 1994).
Siever (1994) and Bergeron and Senn (1998) presented views on the relationship between eating disorders and sexual orientation from a different perspective. Siever contended that homosexual men and heterosexual women diagnosed with eating disorders share concerns about physical attractiveness and thinness based on a desire to attract and please men. He posited that such concerns make these two populations more vulnerable to eating disorders.
However, Bergeron and Senn analyzed data that looked at lesbian and heterosexual male relationships and eating disorders and found that lesbians and heterosexual men were less concerned with physical attractiveness as a way of pleasing men. Therefore, they were less vulnerable to developing eating disorders (Siever, 1994).
Unfortunately, like most research that focuses on this population, important links between eating disorders and “homosexuality” have been overlooked for two reasons (Remafedi, 1994). First, political forces might be at work to suppress the collection or publication of information that has been perceived to benefit homosexual communities. Second, adolescents may keep their sexual orientation hidden, therefore identifying representative samples of gays, lesbians, and bisexuals has been difficult in the climate of American society.
Cantrell and Ellis (1991) included older adolescents in their study of gender role and eating disorders. They studied 103 male and 134 female undergraduate student volunteers, ranging in ages from 17 to 33 years (modal age 18 years): Of this population, 85.9% were unmarried Caucasians. These investigators concluded there was a relationship between gender and gender Downloaded from http://jar.sagepub.com at SIMMONS COLLEGE LIBRARY on October 28, 2009 Walcott et al. / ADOLESCENTS AND EATING DISORDERS 227 role. They suggested that masculine women had the greatest risk of manifesting eating dysfunction versus any other gender role group (Cantrell & Ellis, 1991). The authors also suggested that the preponderance of women diagnosed with eating disorders may not be a function of their being female but may be significantly affected by the complex transitions of the female role in our culture (Cantrell & Ellis, 1991).
Zhang and Snowden (1999) analyzed epidemiological data and found lower rates of AN among African Americans compared with Caucasians.
However, African Americans were at higher risk of developing eating disorders than were Hispanic and Asian Americans. There were no differences in rates of AN between Caucasian and Asian Americans (Zhang & Snowden, 1999). Crago, Shisslak, and Estes (1996) supported these findings by concluding that AN and eating disorders were less common among African Americans than among Caucasian Americans, but eating disorders are equally as common among Native Americans and Hispanics as among Caucasians (Crago et al., 1996). Other researchers found a higher incidence of eating disorder symptoms among African American women compared with women belonging to other ethnic groups (Langer, Warheit, & Zimmerman, 1992; Warheit et al., 1993). Pumariega, Gustavson, and Gustavson (1994) concluded that African American women are more likely to develop BM than AN and are more likely to purge with laxatives than by vomiting.
Fitzgibbon, Spring, Avellone, and Blackman (1998) compared the severity and correlates of binge eating in Caucasian (55), African American (179), and Hispanic American (117) women. They concluded that binge-eating symptoms were more severe in Hispanic Americans versus African Americans or Caucasian women. All participants who binged more were heavier and more depressed and preferred a slimmer body than those who did not (Fitzgibbon et al., 1998). The severity of symptoms was predicted by weight and depression in Hispanic Americans and by depression in Caucasians. The authors found that none of the factors they examined significantly influenced binge-eating symptoms in African Americans (Fitzgibbon et al., 1998).
Striegel-Moore, Wilfley, and colleagues (2000) studied more than 5,000 women, including 1,500 African American women, and found that African American and Caucasian women engaged in binge-eating behavior at approximately the same rate (8% for each group). Although the researchers acknowledged that binge-eating behavior is not the same as binge-eating disorder, their data provide a much needed picture of eating patterns among a Downloaded from http://jar.sagepub.com at SIMMONS COLLEGE LIBRARY on October 28, 2009 228 JOURNAL OF ADOLESCENT RESEARCH / May 2003 large sample of women, especially women of color. African American women and Caucasian women have the same rates (3%) of either BN or BED (Striegel-Moore, Wilfley et al., 2000). African American women who binge eat suffer similar emotional problems as do Caucasian women who binge eat (Striegel-Moore, Wilfley et al., 2000). Researchers have not adequately studied eating disorders in ethnic groups such as Hispanic or Asian Americans.
An analysis of the National Heart, Lung, and Blood Institute Growth and Health Study allowed researchers to look at adolescent female students enrolled in high schools (public and parochial) in Berkeley, California;
Cincinnati, Ohio; Rockville, Maryland; and Bethesda, Maryland (StriegelMoore, Schreiber et al., 2000). The researchers examined the longitudinal cohort of risk factors for their participants: African American (11,212 in Year 1 and decreased to 5,995 by Year 7) and Caucasian (1,166 Year 1 and decreased to 907 by Year 7). The Eating Disorders Inventory (EDI; Garner, Olmsted, & Polivy, 1983) was used as the main assessment instrument.