Look past the color of my skin and how much money I make: Look at ME

Fort Worth, TX

5/27/2009

The stereotype may be only affluent White females suffer from eating disorders/disordered eating and pressure to attain the thin ideal reflected in Western-based values, but recent studies have found it’s not uncommon for persons of color to develop them, too. There are even conflicting studies about which race or ethnic group is more at risk for eating disorders, excessive dieting, and body dissatisfaction issues.

When researchers dig into the etiology of eating disorders by race, they find the root of problem may be in the development of two types of outcomes: diagnosable eating disorders and eating disorder symptoms. Diagnosable eating disorders are generated from the Diagnostic and Statistical Manual of Mental Disorders and the criteria and symptomology generated from different eating disorder sources are inadequate for non-Western or non-White populations because they are based on early research of predominately White women in colleges and treatment centers. This leads to underreporting and under-diagnosing of other populations.

In addition, researchers know individuals who self-identify as Hispanic, Asian, or Black make fewer doctor visits and are less likely to carry health insurance. Therefore, less information is documented about eating and body image issues among persons of color, which contributes to a deceptively low 3-5% prevalence rate for patients of color in eating disorder clinics. Eating disorders often go unrecognized in persons of color or are only acknowledged once they have progressed to more severe stages.

A more recent investigation of race and ethnicity differences found behavioral and psychological characteristics associated with diagnosing eating and body image issues. However, different races used different characteristics to control their lives. There’s growing awareness that current research models are lacking and may benefit by incorporating risk and protective factors such as body esteem, cultural identity, and addressing heterosexist biases.

Eating Disorder Symptomology

Several symptoms can be observed when examining eating disorders, including dietary behaviors, binge-eating behaviors, and purging behaviors. Studies have examined and compared dieting behaviors---dieting, restrictive eating, dietary restraint, fasting---among at least three different racial categories. White individuals engaged in dieting behaviors/dietary restraint significantly more than others and dietary restraint predictors have been reported as body image dissatisfaction, perfectionism, depression, peer insecurity, lack of control, and history of abuse. Body image dissatisfaction and impulsivity predicted dietary restraint in Hispanic females, while body image dissatisfaction predicted dietary restraint in Black females. Racial differences seem to be more commonly tied to emotional/affect issues such as perfectionism, lack of control, and impulsivity.

Many studies demonstrate similar frequencies of binge-eating behaviors across groups, with a few studies indicating bingeing more prevalent in White females. While bingeing is predicted by dietary restraint, anxiety, and body image dissatisfaction in White females, anxiety is a predictor for Hispanic females and acculturated stress and peer insecurity are predictors for Black females.

These differences are noteworthy because prevailing models used in the treatment of eating disorders---cognitive-behavioral and dual pathway models---emphasize the importance of negative affect in identifying and treating eating disorders. Findings demonstrate that each group represents a unique etiology for preventing and treating certain types of eating disorders and body image issues.

Some researchers found there were no significant differences in purging behaviors, including vomiting, laxatives, diuretics, across White, Asian, American Indian, Hispanic, and Black populations, although predictors of purging for racial groups differed. While dietary restraint and binge eating predict purging for White individuals, only dietary restraint and to a lesser degree body image dissatisfaction predict purging in Hispanic and Black females.

That bingeing has not predicted purging behaviors among persons of color is noteworthy, raising questions about clinical models of the binge-purge cycle. Studies show White individuals seem to be more prone to dieting behaviors---dieting, restrictive eating, fasting, and dietary restraint. Persons of color appear more at risk for binge eating and purging behaviors.

Risk or Protective Factors

Some risk and protective factors for eating disorders include body image dissatisfaction, body mass index, socioeconomic status, self-esteem, acculturation, and poor sense of control over one’s life associated with experiences of marginalization. Body image dissatisfaction is one of the most well established risk factors in the development of eating disorders.

Not all individuals who report intense body dissatisfaction meet the criteria for eating disorders. Body dissatisfaction appears to be so prevalent among non-clinical and clinical populations that some researchers have argued that moderate amounts of body dissatisfaction should be considered normative among women, while more recent researchers have argued that body dissatisfaction is still important enough to identify as a precursor to an eating disorder, especially when racial differences are considered.

Body image differs among racial groups. Charts used by physicians to determine weight and height range do not fit different perceived healthy race standards for body size. On average, Black women consider the ideal weight to be 139 pounds, while White women consider it to be 128. Black women also reported feeling more attractive at higher weights than White women.

Hispanics traditionally idealize a more overweight, more curvaceous physique and value interdependent, close family relationships and community values. When traditional values are compromised and cultural norms become less meaningful, a Hispanic female may be more predisposed to developing problems.

The medical community seems to be more accepting of weight concerns of Asian females and seems to expect them to be more petite and less vulnerable to eating disorder issues. When Asian females become conflicted with traditional values and feel they do not meet a particular weight or body standard for their culture, they are more vulnerable to eating disorders.

In studies, women with lower levels of emotional expression reported higher levels of body dissatisfaction and individuals who suppressed anger expression were more inclined to show bulimic behaviors and attitudes. Anorexic patients reported more inhibition of negative emotions than patients diagnosed with other psychological disorders. White and Hispanic females reported only negative self-esteem as the predictor of body image dissatisfaction, whereas negative self-esteem, peer insecurity, and anxiety contributed to body image dissatisfaction in Black females. These findings suggest the emergence of body image dissatisfaction in Black females is contingent upon an interaction of psychological and social difficulties.

Black females reported higher self-esteem than White or Hispanic females in studies. Since high self-esteem has been found to be protective against a variety of emotional and behavioral problems, it would seem logical that Black females would manifest fewer eating-disordered behaviors than others. This seems to hold true for dieting, but not for binge eating or purging behaviors and may be because self-esteem among Black females is less affected by perceived ideal weight and more affected by feelings of inadequacy or acculturated stress. Black women binge rather than use dietary restraint as a result of feelings of ineffectiveness. Future research should focus more on other emotional and psychological issues such as ineffectiveness, inadequacy, worthlessness, and lack of control as they relate to eating disorders.

As much as Black females seem to be protected from anorexia because of culture weight view differences, they still tend to experience a higher prevalence of bulimia and binge-eating disorders. This may be due to stress, including acculturated stress. Conversely, Hispanic populations seem to be more similar to White populations, although White populations are still significantly more at risk of dieting and using pathological weight techniques.

Social Class: Money Matters

The influence of social class on eating disorders and body image issues is difficult to measure. Much of the research has used education and family income as variables to measure social class. Studies indicated factors ranging from body dissatisfaction, body distortion, and restrained eating to eating disorders are more prevalent in higher-class individuals. These used very specific objective and subjective social class questions to obtain their data and found body distortion, restrained eating, and body dissatisfaction were predicted by greater importance placed upon physical appearance, lower value placed on having a family life, and being from a higher social class. Other studies have shown either the reverse relationship or no relationship. Contradictory results may be due to the type of eating disorder or body image issue evaluated with the type of social class questions asked.

Race, ethnicity, and social class are complicated issues for prevention, detection, and treatment of eating disorders. There are important differences that play a part in development of body image and eating disorder issues. We should examine these differences more closely to create effective prevention and treatment strategies for racially and ethnically diverse populations.

Chapter excerpt from “The Hidden Facts of Eating Disorders and Body Image” by Dr. Debbie Rhea, Associate Professor, Associate Dean for Health Sciences and Research in TCU’s Harris College of Nursing & Health Sciences. For more information on the article, contact Dr. Rhea at d.rhea@tcu.edu.

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Shawn Kornegay
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TCU
817-257-5061
s.kornegay@tcu.edu