Ethnic differences in eating disorder prevalence, risk factors, and predictive effects of risk factors among young women

A Plea for Diversity in Eating Disorders Research

Eating disorders (EDs) are often stereotyped as affecting the SWAG, that is, as affecting mostly skinny, White, affluent girls. Over the last decade, however, significant progress has been made toward increasing diversity in ED research. There is consensus that EDs affect individuals of all genders, ages, sexual orientations, ethnic, and socio-economic backgrounds, with recent studies exploring social determinants of ED etiology, ED presentation, and developing diversity-affirming ED assessments. This article provides a brief summary of current developments related to diversity as a research theme, and proposes different perspectives toward further improving diversity in ED research. Specifically, we argue for exploring the role of diversity in ED treatment settings and outcomes, for pursuing diversity-oriented research pro-actively rather than as a reaction to issues of under-representation, and for integrating diversity across different areas of medical education and trainings in psychotherapy. Limitations with respect to the paucity of research, and the link between diversity as a research theme and ED-related workforce diversity are discussed.

Effectiveness of the Body Project eating disorder prevention program for different racial and ethnic groups and an evaluation of the potential benefits of ethnic matching

OBJECTIVE

Provide an adequately powered tests of whether a group-delivered dissonance-based eating disorder prevention program (Body Project) is similarly effective for different racial and ethnic groups and evaluate whether an improved match between minority participant race/ethnicity and fellow group members is associated with larger effects.

METHOD

Study 1 examined data from 539 young women from seven high schools and four universities and Study 2 examined data from 1,195 young women and men from 50 universities who completed the Body Project, focusing on pretest-to-posttest reductions in outcomes.

RESULTS

In Study 1, reductions in thin-ideal internalization, body dissatisfaction, dieting, negative affect, and eating disorder symptoms did not significantly differ for White versus Asian, Black, and Native Americans, though we did not have power to contrast racial and ethnic minority groups. In Study 2, only one intervention effect was weaker for a minority group relative to Whites (Black vs. White participants showed smaller reductions in thin-ideal internalization), but there was evidence that intervention effects were significantly larger for Hispanic versus White and Black participants, and to a lesser extent for Hispanic versus Asian and Native Americans; these differences were partially driven by differences in pretest risk across ethnic groups. Ethnic/racial matching was not associated with larger effects.

CONCLUSIONS

Results suggest that the Body Project produced relatively similar effects for racial/ethnic minority groups relative to White participants, that the effects were sometimes larger for Asian and Hispanic participants, and that recruiting Black participants at higher risk may contribute to larger effects for this racial group. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The children's eating attitudes test: French validation of a short version

PURPOSE

Disordered eating attitudes and behaviors (DEAB) in childhood have been prospectively associated with eating disorders and obesity in adolescence. Therefore, evaluating DEAB in children with a reliable, sensitive and well-adapted scale is very important. The Children's Eating Attitudes Test (ChEAT) is one of the most popular measuring tools for DEAB in children, but no French version is available. Moreover, while completion time is an important factor to be considered when working with children, only one recent study proposed a shorter version of the ChEAT. Taking the previous works of Murphy and colleagues (2019) as a starting point, the current study aimed to provide the first French-speaking validated 14-item short version of the ChEAT.

METHODS

A sample of 1092 boys and girls aged between 8 and 12 years old were recruited in two urban areas in the province of Quebec, Canada. They completed the ChEAT, and their height and weight were measured at school. Factorial structure and internal consistency were assessed.

RESULTS

After the initial factorial analysis, two "vomiting (or purging)" items were yielded as problematic and were thus removed from the analysis. The remaining 12 items provided a good fit to the data and a good internal consistency. Moreover, the factorial structure was proved to be invariant across sexes.

CONCLUSION

This study is the first to provide a French assessment of DEAB in elementary school children. The French short version of the ChEAT provided a quick and reliable assessment for DEAB with non-clinical children population and could be used as a screening tool, even though no cut-off was established yet.

LEVEL OF EVIDENCE

Cross-sectional, descriptive study, Level V.

Differential Effects of Intuitive and Disordered Eating on Physical and Psychological Outcomes for Women with Young Children

OBJECTIVES

Pressure to lose weight can increase the risk of developing disordered eating behaviours, negative body image and depressive symptomatology. Eating intuitively may counteract these negative outcomes. This research examined the unique relationship between intuitive eating and disordered eating on body mass index (BMI), body image and depressive symptoms for women of young children.

METHODS

A survey of women with a child aged between six and 48 months, included the Intuitive Eating Scale, Eating Attitudes Test-26, Body Shape Questionnaire and Edinburgh Postnatal Depression Scale. Multivariate analysis of variance (MANOVA) was conducted as an omnibus test to estimate the effect of intuitive and disordered eating on BMI, negative body image and depressive symptoms.

RESULTS

Of the 419 sample (M age = 32.06), 32% were classified with disordered and 32% with intuitive eating. MANOVA and regression analysis found disordered eating positively associated with depressive symptoms, (β = 0.303) and negative body image (β = 0.318). Intuitive eating was associated with lower depressive symptoms (β =  - 0.183) and negative body image (β =  - 0.615). Disordered eating (β =  - 0.194) and intuitive eating (β =  - 0.586) both contributed to lower BMI, with the association stronger for intuitive eating.

CONCLUSION

The early parenting period involves a high risk for developing disordered eating behaviours. Eating patterns are modifiable factors, illustrating the potential for positive and preventive health outcomes through adopting intuitive eating behaviours. There is an opportunity for healthcare professionals to promote physical and psychological health including for women in the early parenting period.

Prediction model for abnormal eating behaviour among hospital nurses: A structural equation modelling approach

BACKGROUND

Nurses are at a high risk of developing abnormal eating behaviour. However, few studies have attempted to identify the factors that influence such behaviour.

AIM

This study identifies factors that can predict abnormal eating behaviour in hospital nurses.

DESIGN

This study adopted a cross-sectional, descriptive correlational research design.

METHODS

A literature review was used to establish a hypothetical model, comprising the eight factors of shift work, job stress, depression, sleep quality, fatigue, coping strategy (active coping and passive coping) and abnormal eating behaviour. A convenience sample of 298 nurses aged less than 45 was recruited from two university hospitals, and structured questionnaire was administered between March and April 2017. The hypothesized model was tested using structural equation modelling.

RESULTS

Sleep quality and passive coping directly affect abnormal eating behaviour, which implies that poor sleep quality and increased passive coping worsens the behaviour. Shift work and depression indirectly affect abnormal eating behaviours.

CONCLUSION

Nursing managers and health policy makers should adopt strategies such as improving the shift-work pattern, providing adequate rest time after a night shift and enabling coping strategies by providing educational programs for hospital nurses.

The implicit association of high-fat foods with shame and its link with eating disorder symptoms: The moderating role of race/ethnicity

BACKGROUND

An interesting debate in the literature is about the role of race/ethnicity not only as a risk factor for eating disorders (EDs), but also as a moderator of the relations between other risk factors and ED symptoms. The following research question was explored: Does race/ethnicity moderate the relations between the implicit belief that high-fat food is shameful and ED symptoms?

METHODS

About 15,000 (N = 14,964) volunteers (67.7% White, 7.7% Asian, 7.4% Hispanic, 6.9% Black) completed the Implicit Association Test (IAT) measuring the implicit associations between high-fat (vs. low-fat) food and shameful (vs. acceptable) on the Project Implicit mental-health website (https://implicit.harvard.edu) between 2011 and 2017. ED symptoms and demographics were measured via self-report.

RESULTS

Race/ethnicity moderated (beta = 0.087, p = .002) the relations between IAT and ED symptoms, adjusting for BMI, age, sex, education, such that the IAT was related to ED symptoms among Whites (r = 0.113, p < .001), Hispanics (r = 0.086, p = .004), and Asians (r = 0.097, p = .001), but not Blacks (r = 0.056, p = .071).

DISCUSSION

Although the effect size was small, findings imply that some ED risk factors may vary among racial/ethnic groups. Future studies should use prospective designs to examine whether implicit biases actually represent a risk factor for ED symptoms and whether this varies by race/ethnicity.

Eating disorder prevalence among multiracial US undergraduate and graduate students: Is multiracial risk different than the sum of each identity?

The number of individuals identifying as multiracial in the United States (US) has significantly increased in the past few decades, yet they are rarely the focus of study in eating disorders (ED) research. The current study is among the first to examine prevalence estimates of ED pathology across several distinct multiracial groups, to contrast prevalence estimates of ED pathology in each multiracial group with those among the corresponding monoracial identities, and to investigate these findings intersectionally with gender identity. Data from 145,379 US students, 11,433 of whom were multiracial, were collected from 199 US colleges and universities participating in the Healthy Minds Study between 2014 and 2019. Elevated ED pathology was defined as a score ≥ 2 on the SCOFF. Multiracial individuals identifying as American Indian/Alaskan Native and Hispanic/Latinx exhibited the highest prevalence estimates of elevated ED pathology (41.4% compared to 23.5% in the full sample). This group, as well as some other doubly marginalized groups (African American/Black and Hispanic/Latinx; African American/Black and Asian American/Asian), exhibited higher prevalence of elevated ED pathology than expected based on the observed prevalence estimates in their corresponding monoracial groups. Across gender identities, greater than expected prevalence estimates of elevated ED pathology were observed among multiracial individuals identifying as African American/Black and White and lower than expected prevalence estimates were observed among multiracial individuals identifying as Middle Eastern/Arab/Arab American and White. These results have important implications for understanding ED pathology in multiracial individuals and should inform intervention and treatment efforts to support individuals from these underserved groups.

Eating disorder symptoms in Asian American college students

Inconsistent information on levels of eating pathology in Asian Americans exist. We investigated whether there were differences in mean scores for eating disorder (ED) symptoms among Whites, Asian Americans, and individuals identifying as another race (i.e., non-Asian people of color [NAPOC]). Participants included 716 college students (M age = 19.23; SD = 1.65) from a southeastern university. ED symptoms were assessed with the Eating Pathology Symptom Inventory (EPSI). Internalizing symptoms were evaluated via the Depression Anxiety and Stress Scale (DASS). One-way ANOVAs investigated mean differences in symptoms between racial groups, with and without adjusting for sex, BMI, and internalizing symptoms. Overall, 16% (n = 114) of the sample identified as Asian American, 67% (n = 477) as White, and 17% (n = 125) as NAPOC. After correcting for multiple testing and adjusting for covariates, Asian Americans reported higher mean scores of purging, muscle building, and cognitive restraint (qs < 0.05) than Whites and NAPOC. Asian Americans also scored higher on restriction compared with Whites (qs < 0.05), as well as body dissatisfaction and negative attitudes toward obesity compared with NAPOC (qs < 0.05). These findings demonstrate the existence of racial differences among specific ED symptoms, highlighting the importance of considering these distinctions when diagnosing and treating EDs among diverse communities.

Black and White women's attributions of women with underweight

Despite the idealization of thin bodies, many people with low body weights report experiencing weight stigma. This stigma might relate to stereotypes about eating disorders (EDs). Specifically, people with lower body weights might be perceived as having EDs, conditions associated with significant stigma. Also, there is considerable pressure for Black women to obtain a curvy ideal, which could lead to anti-thin bias (i.e., the belief that individuals at lower body weights have undesirable characteristics) in this group. The current study evaluated these possibilities via an examination of anti-thin bias in Black and White women. Further, we explored perceived attributions of weight for Black and White women with underweight. Black (n = 96) and White (n = 128) participants read racially concordant vignettes in which characters varied by body mass index (BMI) status (slightly underweight, average weight, and slightly overweight). White women were more likely to ascribe negative personality characteristics to White vignette characters with underweight than to characters with average weight. In contrast, Black women's perceptions of Black vignette characters did not differ according to weight status. Both Black and White participants were more likely to attribute underweight characters' body weight to an ED compared with average weight characters. Results suggest that weight bias literature should incorporate the assessment and impact of weight stigma for individuals across the BMI spectrum.

Eating disorder symptomatology, clinical impairment, and comorbid psychopathology in racially and ethnically diverse college women with eating disorders

OBJECTIVE

To examine eating disorder (ED) symptomatology, related clinical impairment, and comorbid psychopathology in college women with EDs across five racial and two ethnic groups.

METHOD

Participants were 690 women from 28 US universities who screened positive for an ED. Thirteen variables assessing ED symptoms, related clinical impairment, and comorbid psychopathology were compared across racial and ethnic groups using analyses of variance (ANOVAs) and independent samples t-tests.

RESULTS

Across racial groups, significant differences emerged in binge eating and laxative use. Asian women reported significantly more binge eating than White women (p < .01). Individuals self-identified as the "Other" racial group reported greater laxative use than Asian and White women (ps ≤ .01). No other significant differences emerged across all other variables (ps ≥ .13). Across ethnic groups, Hispanic women reported significantly more laxative use (p < .01), and more comorbid insomnia symptoms (p = .03) than non-Hispanic women. No other significant differences were observed (ps ≥ .24).

DISCUSSION

Findings suggest that binge eating, laxative use, and insomnia symptoms differ across racial and ethnic groups in US college women who screened positive for EDs. Findings can inform tailoring of ED screening to reduce current disparities in these underrepresented populations.

An uncontrolled pilot feasibility trial of an intuitive eating intervention for college women with disordered eating delivered through group and guided self-help modalities

OBJECTIVE

College women engage in high rates of disordered eating behaviors (DEBs), and most do not receive treatment. Campuses lack resources to meet this need, thus accessible and affordable treatment options are important. Intuitive eating (IE) is gaining mainstream interest, but intervention research is scarce, with no known clinical trials in college women. This uncontrolled pilot trial examined the feasibility, acceptability, and preliminary efficacy of an eight-week IE intervention delivered through two potentially accessible and affordable modalities: group and guided self-help (GSH).

METHOD

Racially and ethnically diverse college women (N = 71; <50% White) were recruited from a large public Mid-Atlantic university and randomized to group (n = 40) or GSH (n = 31). Assessments occurred at 0 (pre-test), 8 (post-test), and 16 weeks (follow-up). Group participants attended eight weekly 1.5-hour sessions. GSH participants engaged in self-study and had eight weekly 20-minute phone calls.

RESULTS

Both conditions demonstrated feasibility, with superior retention and attendance in GSH. Over 90% of those attending at least one session in either condition were retained through follow-up. Both conditions were highly acceptable, and produced medium to large reductions in DEBs, body dissatisfaction, and weight-bias internalization, and improvements in body appreciation, IE, and satisfaction with life from pre- to post-test, which were maintained at follow-up.

DISCUSSION

Results of this pilot are encouraging and support the development of a larger randomized controlled trial. Avenues for refinement include strategies to improve feasibility of the group condition, and conducting longer-term follow-up to examine maintenance of effects and the intervention's eating disorder prevention potential.

Psychosociocultural Contributors to Maladaptive Eating Behaviors in African American Youth: Recommendations and Future Directions

Childhood overweight and obesity disproportionately affects African Americans, and these children benefit less from standard pediatric weight management treatment programs compared to other racial/ethnic groups. Maladaptive eating behavior has been identified as a behavioral contributor to obesity and is also associated with the development of nonrestrictive eating disorders over time. Unique psychosociocultural factors have been identified that may promote higher risk for maladaptive eating behaviors in African American children beyond the effects of economic disparity. To best treat this group, it is important for practitioners to have a thorough understanding of these factors. We review several of these considerations and describe ways they may interact to contribute to the subsequent development of maladaptive eating behaviors and increased weight. Recommendations are made regarding how attention to these factors could be incorporated into current pediatric weight management treatments to better serve this population via a patient-centered care approach. Future directions will also be discussed.

#foodie: Implications of interacting with social media for memory

BACKGROUND

Social media is an increasingly popular outlet for leisure and social interaction. On many social media platforms, the user experience involves commenting on or responding to user-generated content, such as images of cats, food, and people. In two experiments, we examined how the act of commenting on social media images impacts subsequent memory of those images, using Instagram posts as a test case. This project was inspired by recent findings of laboratory studies of conversation which found that describing a picture for a conversational partner boosts recognition memory for those images. Here we aimed to understand how this finding translates to the more ecologically valid realm of social media interactions. A second motivation for the study was the popularity of food- and dieting-related content on Instagram and prior findings that use of Instagram in particular is associated with disordered eating behaviors.

RESULTS

Across two experiments, we observed that commenting on Instagram posts consistently boosted subsequent recognition and that correct recognition increased with comment length. Stable individual differences in recognition memory were observed, and "unhealthy" food images such as chocolates were particularly well remembered; however, these memory findings did not relate to self-reported eating behavior.

CONCLUSIONS

Taken together, our findings show that the way in which we engage with social media content shapes subsequent memory of it, raising new questions about how our online lives persist in memory over time, potentially shaping future behavior.

Emphasizing the "Cultural" in Sociocultural: A Systematic Review of Research on Thin-Ideal Internalization, Acculturation, and Eating Pathology in US Ethnic Minorities

A large body of research suggests that thin-ideal internalization is a robust predictor of eating pathology in women and, to some degree, in men. Recent research is exploring the relationships between thin-ideal internalization and culture-specific factors that may be salient to women and men who live in the US but are marginalized based on racial or ethnic background, such as acculturation. This systematic review summarizes published articles examining the relationships among thin-ideal internalization, acculturation-related constructs (including assimilation, marginalization, biculturalism, and acculturative stress), and eating pathology in US adults. Following the PRISMA method, 15 empirical studies met inclusion criteria. Although existing literature was sparse and conflicting in large part due to heterogeneity in acculturation measures, results yielded some support for positive correlational relationships between acculturative stress, thin-ideal internalization, and eating pathology for both men and women (in 4 out of 5 relevant studies). Research on other aspects of acculturation (eg, integration, assimilation) is mixed, with some existing research suggesting a positive relationship and other research finding no statistically significant relationship. Future research would particularly benefit from a gold-standard, multidimensional transcultural measure of acculturation to examine how the acculturation process relates to thin-ideal internalization and eating pathology in ethnic and racial minorities in the US.

Measurement invariance of the SATAQ-4 in Black and White undergraduate women

The Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) is a widely used measure of sociocultural factors affecting body image. Despite evidence sociocultural appearance ideals and pressures might differ between White and Black women, the SATAQ-4's invariance has not been formally evaluated. The current study examined its measurement invariance across White and Black college women. Women (N = 730; 68.5 % White, 31.5 % Black), recruited from a large, public university in the United States completed measures online. Confirmatory factor analysis (CFA) showed the original five-factor structure was adequate in each group, and it appeared equivalent across groups. However, full metric invariance was not supported. Factor loadings on one item differed, suggesting differences in how this item contributed to thin-ideal internalization between groups. Similarly, one threshold differed, suggesting Black women who mostly agreed they wanted a "very thin" body had more thin-ideal internalization than White women with the same rating. These results suggest comparisons between these groups on the thin-ideal internalization subscale should be interpreted cautiously, as group differences could reflect some measurement bias. Given appearance pressures and ideals extend beyond thinness, particularly for Black women, future research should consider refining or developing culturally sensitive measures, to enhance relevance between and within racial/ethnic groups.

Racial and ethnic differences in the association between parent-oriented perfectionism and disordered eating in college women

OBJECTIVE

This study examined the associations between parent-oriented dimensions of perfectionism (parental expectations [PE] and parental criticism [PC]) and eating disorder (ED) symptomatology across racial/ethnic groups. It was hypothesized that parent-oriented perfectionism would be positively associated with ED symptomatology for White and Asian American women.

METHOD

Undergraduate women (N = 1,173) completed questionnaires assessing perfectionism, EDs, and demographics. One-way analyses of variance tested differences in PE and PC across racial/ethnic groups; post-hoc Tukey tests probed significant differences. Multiple linear regressions assessed associations between parent-oriented perfectionism and ED symptomatology. Hurdle models tested the association between PE and PC and the frequency and odds of endorsing ED symptomatology.

RESULTS

There were significant group differences in PE and PC. PE was positively linked with various ED symptoms in Latina, Asian American, and multiracial women, and was negatively related to purging in multiracial women. PC was positively associated with body dissatisfaction in White, Black, and multiracial women, but displayed differential associations with ED symptomatology in all racial/ethnic groups.

DISCUSSION

Levels of parent-oriented dimensions of perfectionism, and their relations to ED symptomatology, might vary across racial/ethnic groups. PE, in particular, is both more elevated, and more strongly linked to eating pathology in Asian American women, whereas PC appears to be especially relevant to ED symptoms in Black women. Findings underscore the importance of considering the role of culture in ED symptomatology. Clinicians and researchers might consider incorporating assessments of parent-oriented perfectionism into their practice.

Risk of disordered eating at the intersection of gender and racial/ethnic identity among U.S. high school students

BACKGROUND

Gender and racial/ethnic disparities in disordered eating among youth exist, although whether having multiple marginalized identities disproportionately increases risk is unclear. Therefore, we aimed to quantify the risk of disordered eating associated with intersecting gender and racial/ethnic identities of U.S. adolescents.

METHODS

We analyzed data from 11,514 U.S. high school students identifying as White, Black/African American, or Hispanic/Latino who participated in the 2013 National Youth Risk Behavior Surveillance System. Age-adjusted relative risks (RR) of purging, fasting, diet pill use, and any disordered eating were estimated using log-binomial models. Relative excess risk due to interaction (RERI) was estimated to evaluate the degree to which the combined effect of marginalized gender and racial/ethnic identity was larger than the sum of their individual effects.

RESULTS

Disordered eating was prevalent (girls: 20.4% Black/African American, 29.2% Hispanic/Latina, 21.4% White; boys: 13.4% Black/African American, 12.4% Hispanic/Latino; 8.1% Whites). Girls of all racial/ethnic identities and racial/ethnic minority boys had elevated risks of purging, fasting, and any disordered eating compared to White boys (RR range = 1.57-7.43); Hispanic/Latina and White girls also had elevated risk of diet pill use (RR range = 1.98-3.20). Among Hispanic/Latina girls, positive interaction between gender and race/ethnicity produced excess risk of any disordered eating and purging (RERI: any = 0.42 (95% confidence interval (CI) = -0.02, 0.87); purging = 1.74 (95% CI = 0.06, 3.42).

CONCLUSIONS

Findings illustrate the advantages of adopting an intersectional approach to disordered eating research. Future research should investigate the mechanisms of these disparities.