Eating behaviour and attitudes to weight and shape in British women from three ethnic groups

The optimal cut-off score of the Eating Attitude Test-26 for screening eating disorders in Japan

PURPOSE

The Eating Attitude Test-26 (EAT-26) is a screening tool for eating disorders (EDs) in clinical and non-clinical samples. The cut-off score was suggested to be varied according to target population. However, no studies have examined the appropriateness of the originally proposed score of 20 for screening DSM-5 eating disorders in Japan. This study aimed to identify an appropriate cut-off score to better differentiate clinical and non-clinical samples in Japan for EDs.

METHODS

The participants consisted of 54 patients with anorexia nervosa restricting type, 58 patients with anorexia nervosa binge-eating/purging type, 37 patients with bulimia nervosa diagnosed according to DSM-5 criteria, and 190 healthy controls (HCs). Welch's t test was used to assess differences in age, body mass index (BMI), and total EAT-26 scores between HCs and patients with EDs. Receiver operating characteristic (ROC) analysis was conducted to identify the optimal cut-off score.

RESULTS

The HCs had significantly higher BMI and lower total EAT-26 mean scores than patients with EDs. The area under the ROC curve was 0.925, indicating that EAT-26 had excellent performance in discriminating patients with EDs from HCs. An optimal cut-off score of 17 was identified, with sensitivity and specificity values of 0.866 and 0.868, respectively.

CONCLUSIONS

The result supports the suggestions that optimal cut-off score should be different according to target populations. The newly identified cut-off score of 17 would enable the identification of patients with EDs who have been previously classified as non-clinical samples in the EAT-26 test.

LEVEL OF EVIDENCE

III: evidence obtained from case-control analytic study.

Self-perceived food addiction: Prevalence, predictors, and prognosis

Food addiction is controversial within the scientific community. However many lay people consider themselves addicted to certain foods. We assessed the prevalence and characteristics of self-perceived "food addiction" and its relationship to a diagnostic measure of "clinical food addiction" in two samples: (1) 658 university students, and (2) 614 adults from an international online crowdsourcing platform. Participants indicated whether they considered themselves to be addicted to food, and then completed the Yale Food Addiction Scale, measures of eating behavior, body image, and explicit and internalized weight stigma. Participants in the community sample additionally completed measures of impulsivity, food cravings, binge eating, and depressive symptomatology. Follow-up data were collected from a subset of 305 students (mean follow-up 280 ± 30 days). Self-perceived "food addiction" was prevalent, and was associated with elevated levels of problematic eating behavior, body image concerns, and psychopathology compared with "non-addicts", although individuals who also received a positive "diagnosis" on the Yale Food Addiction Scale experienced the most severe symptoms. A clear continuum was evident for all measures despite no differences in body mass index between the three groups. Multinomial logistic regression analyses indicated that perceived lack of self-control around food was the main factor distinguishing between those who did and did not consider themselves addicted to food, whereas severity of food cravings and depressive symptoms were the main discriminating variables between self-classifiers and those receiving a positive "diagnosis" on the Yale Food Addiction Scale. Self-perceived "food addiction" was moderately stable across time, but did not appear predictive of worsening eating pathology. Self-classification as a "food addict" may be of use in identifying individuals in need of assistance with food misuse, loss-of-control eating, and body image issues.

The Mental Health Status of South Asian Women in Britain

This article reviews the research on the mental health status of South Asian women living in UK. It reports on the findings from epidemiological studies of the prevalence of depression, suicide, parasuicide, deliberate self-harm and eating disorders in this community. Focus is on research studies that describe cultural influences on conceptualisations and expressions of distress, help seeking behaviours and alternative coping strategies. The influence of acculturation and “culture conflict” as they impact upon women's mental health is also highlighted. The review concludes by considering, first, salient cultural and religious concepts identified in studies that may facilitate understanding South Asian women's mental ill health, and second, the urgent need to develop gender, linguistic and culturally sensitive mental health services for women of South Asian origins now citizens of UK.

Evaluation of Body Shape, Eating Disorders and Weight Management Related Parameters in Black Female Students of Rural and Urban Origins

This study examined body shape dissatisfaction, eating disorder and weight management-related parameters as well as assimilation of Western cultural norms regarding body shape in black female students of urban and rural origins. Subjects (n=180; 20 ± 4,4 years old) were weighed, their height was measured and they completed the Body Shape Questionnaire, EAT-26, Eating Inventory (restraint scale), Adolescent Self-Concept Scale and a questionnaire concerning weight management behaviours. Main findings include lower prevalences of overestimation of body weight and body shape dissatisfaction, similar prevalences for dieting and the use of Hazardous weight reduction methods, and higher prevalences for overweight, obesity, disordered eating attitudes and behaviours, and dietary restraint among subjects than among similar white groups. Furthermore, those with urban origins were more likely to be restrained eaters, to have attempted weight reduction, to aim for weight loss and to fear weight gain. These data indicate that there are signs of more realism concerning weight status among black female students. However, there are also signs of assimilation of Western cultural norms concerning body shape, eating attitudes and behaviours and weight management. This diversity in the black student population in South Africa needs to be recognized when planning interventions to address eating related problems.

Body Image Perception among Women of African Descent: A Normative Context?

The purpose of this article is to integrate research from across the social sciences in order to understand Black women's body image perceptions. To accomplish this goal, the effects of race, ethnicity, class and culture are examined. Cultural differences between African Canadians/Americans and Blacks living in Africa and the Caribbean are outlined and their effects on Black women's experiences of weight and eating are also discussed. Some of the historical underpinnings, and several aspects of the current social context within which Black women live are explored in order to explain body image perceptions.

The female athlete triad and endothelial dysfunction

A tremendous increase in the number of female athletes of all ages and abilities has occurred in the past 35 years. In general, sports and athletic competition produce healthier and happier women. However, explosion in participation has revealed clear gender-specific injuries and medical conditions unique to the female athlete. This article focuses on the latest advances in our knowledge of the female athlete triad and the relationship between athletic-associated amenorrhea and endothelial dysfunction. Treatment of vascular dysfunction with folic acid is also discussed.

Perception of overweight and self-esteem during adolescence

OBJECTIVE

To examine sex- and race/ethnicity-specific relationships between adolescents' self-esteem and weight perception.

METHOD

Descriptive analysis and logistic regression of Wave II of the National Longitudinal Study of Adolescent Health (N = 6,427 males, 6,574 females; ages 11-21) examined associations between low self-esteem and perceived overweight within body mass index (BMI) percentile categories, controlling for sociodemographics and stratified by sex and race/ethnicity.

RESULTS

25.1% and 8% of normal weight females and males, respectively, perceived themselves as overweight, with variation by race/ethnicity. Low self-esteem was most strongly associated with misperceived overweight in moderate BMI percentile categories (males: OR = 2.34; 95% CI: 1.60-3.41; females: OR = 2.39; 95% CI: 1.82, 3.16). Odds of correctly perceived overweight were higher for low (versus high) self-esteem in white and black females but not males of any race/ethnicity.

DISCUSSION

Understanding subgroup differences by race/ethnicity in perceived overweight-self-esteem relationships may inform eating disorders' prevention strategies.

Ethnic origins of patients attending specialist eating disorders services in a multiethnic urban catchment area in the United Kingdom

OBJECTIVE

This study considered the impact of ethnicity on the referral process for patients with eating disorders, at the levels of referral rate, diagnosis, and treatment offered.

METHOD

A catchment area cohort of 648 patients was referred and assessed at specialist eating disorders services in a multiethnic urban area (all boroughs in South London, UK). Each patient was diagnosed and offered treatment (or an alternative appropriate end-point to the referral), and self-identified their ethnicity. For comparison purposes, the local ethnic minority population was taken from census data.

RESULTS

Ethnic minority patients were substantially less likely to be referred to the services than white patients, relative to the local population. The ethnic minority group were more likely to suffer from bulimia nervosa, and less likely to be found to have no eating disorder. However, the treatments offered did not differ substantially across the ethnic groups.

DISCUSSION

Referrals to specialist eating disorder services do not reflect local populations' ethnic composition, though this disparity seems to be less by the time that the patient is offered treatment. It will be important to determine the source of these ethnic differences, and to take steps to reduce them.

Are There Ethnic Differences in Positive Body Image Among Female British Undergraduates?

Numerous studies have examined ethnic differences in body image, although the literature has tended to focus on a negative orientation toward one’s body. The present study examined whether there were differences in positive body image among 131 Caucasian, 122 South Asian, 67 African Caribbean, and 67 Hispanic female undergraduates in Britain. Participants completed several scales measuring body appreciation, societal influence on body image, and self-esteem. Results showed that, after controlling for age, Hispanic women had the highest body appreciation scores, followed by African Caribbean, Caucasian, and South Asian women, respectively. Results also showed that Hispanics had the lowest score on media influence and the highest self-esteem. Finally, regressional analyses showed that self-esteem was a strong predictor of body appreciation, over-and-above ethnic affiliation. These results are discussed in relation to the extant literature on ethnic differences in body image.

A comparison of ethnic groups in the treatment of bulimia nervosa

This exploratory study investigated whether White and ethnic minority bulimic participants differ on key features of eating psychopathology and treatment outcome. Data from a randomized controlled multi-site study comparing the efficacy of either cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT) for 219 women with bulimia nervosa were analyzed. A significant baseline ethnic difference for body mass index (BMI) (p<.001) was found as well as an ethnicity by center interaction for a prior history of depression (p<.05). In addition, there was a significant ethnic difference for the Weight Concerns subscale of the Eating Disorder Examination (EDE). However, once BMI was controlled, this difference did not retain significance. At post-treatment, while all ethnic groups responded with higher abstinence rates to CBT than IPT, an ethnicity by treatment effect was found for the reduction of objective binge eating episodes. Black participants, compared to other groups, showed greater reductions in binge eating episodes when treated with IPT than CBT. Other findings related to secondary outcome measures, though limited by small sample size, are discussed as providing directions for future research.

'Why I won't eat': patient testimony from 15 anorexics concerning the causes of their disorder

The following article describes the reasons given by 15 anorexic patients for their illness. The patients were asked the following question in an open-ended interview-'What would you say were the causes of your illness?' In reply detailed complex narratives were gathered from which a number of themes could be identified. These included unhappiness, control, being in a downward spiral, obsession and perfectionism. Most patients, for example explained that they were unhappy. To address their unhappiness, they adopted a strategy of control over food. Being able to exert this control gave patients a sense of enjoyment and pride and enabled them to address their underlying fear that a loss of control may be just around the corner. This pride persuaded patients to restrict further their food in the hope they would experience even greater enjoyment. Patients were thus caught in a dangerous 'spiral' of restriction, weight loss, euphoria and further food refusal. This spiralling behaviour resulted in many patients describing their illness as an obsession. Several patients equated this obsessional behaviour with a perfectionist trait in their personalities. In the following article, these themes of unhappiness, control, spiral, obsession and perfectionism, are presented, along with the patient testimony on which each theme was based.

Cultural correlates of eating attitudes: a comparison between native-born and immigrant university students in Israel

OBJECTIVE

This study explores the association between gender and exposure to Western culture and attitudes toward eating.

METHOD

Four hundred and ninety-nine university students participated in the study: 216 Israeli natives, 153 new immigrants (3 years or less since immigration) from the Former Soviet Union (FSU), and 130 veteran immigrants from FSU (4-15 years since immigration). Attitudes toward eating were measured using the Eating Attitude Test - EAT-26.

RESULTS

Israeli born women had higher weight and body mass index (BMI) than did new immigrant women. Higher scores on the EAT-26 were found among women than among men. Among women only, native-born Israelis and veteran immigrants were more likely to have positive EAT-26 scores (19.6%, 18.8%) than were new immigrant women (7.9%), indicating disordered eating attitudes. Part of the differences in EAT-26 scores was explained by differences between the groups on age and BMI; however, even after adjustment the differences remained significant on the bulimia subscale.

CONCLUSION

The results suggest a rapid cultural effect in attitudes toward eating that may reflect a tendency toward eating disorders as well as a difference in the proportion of obesity. It seems that the veteran immigrants have adopted Western cultural norms and eating patterns in a way that has erased the differences in tendency toward eating disorders between them and the Israeli born women.

Acculturation and eating disorders in Asian and Caucasian Australian university students

This study aimed to compare the attitudes and psychopathology of eating disorders of Asian and Caucasian university students using a survey method. The study also investigated the relationship between acculturation, attitudes and psychopathology of eating disorders in sub-groups of Asian girls. There were 130 Asian and 110 Caucasian adolescent girls, aged 18-24 who were screened using the Eating Attitudes Test (EAT-26), the Eating Disorders Inventory (EDI-2) and an Acculturation Index. The Asian group did not have higher mean EAT score than the Caucasian group, but had higher mean score in some sub-scales of the EDI-2. Eating disordered attitudes and psychopathology was not significantly different in the low compared to the high accultured Asian girls. This study suggests that Asian and Caucasian university students in Western Australia are equally susceptible to eating disorders, and that the level of acculturation does not modify the susceptibility of Asian students for eating disorders.

Adolescent depression: challenges and opportunities: a review and current recommendations for clinical practice

Many aspects of the treatment for adolescent depression are still uncertain. However, our body of knowledge continues to accumulate, and our approaches continue to be refined. When we remember that 40 years ago the field was still arguing about the existence of depression in youth, it is clear that significant progress has been made. Recent controversies have provided another opportunity to step back and re-evaluate. Given the chronicity, morbidity, and mortality associated with adolescent depression, the risks of doing nothing are too great. Evidence-based research has provided us with some direction during this unsettling time. After careful reviews, the major professional organizations representing pediatric medicine and psychiatry all support the continued use of SSRI antidepressant medications but emphasize close monitoring. The debates also have heightened interest in effective psychotherapy approaches, particularly CBT and IPT. Given the risk for suicidality in depressed adolescents, assessment and management of safety concerns remain critical, regardless of medication usage. Above all, it is most important that we remain hopeful about our ability to guide adolescents and families through the struggles with depression toward recovery.

Eating disorders in Asian populations: a critique of current approaches to the study of culture, ethnicity, and eating disorders

There is increasing evidence that eating disorders are present among ethnically diverse populations, and researchers have suggested that investigations in this area may inform the field's understanding of how sociocultural factors are related to the development of eating disorders. Although it is generally accepted that sociocultural factors are key in eating disorder etiology, knowledge on how best to study these influences in diverse groups is still limited. In this article, the authors review how the research literature has explored relationships among culture, ethnicity, and eating disorders in Asian populations and critically examine strategies that have been used to investigate these issues across 1 ethnic/racial group. The methodological challenges encountered in these approaches are identified and considered in the provision of recommendations for future endeavors to improve the field's understanding of how culture is related to eating disorders.

Eating disorder and depressive symptoms in urban high school girls from different ethnic backgrounds

This study examined ethnic group differences in the rates of eating disorder symptoms (EDS) and depressive disorder symptoms (DDS) with respect to ethnic identity, relative body weight, and abnormal eating behaviors among adolescent girls. A district-wide sample of high school girls (N = 1445) from different ethnic backgrounds was surveyed. EDS were assessed with the Eating Attitudes Test-26, abnormal eating behaviors with the Eating Behaviors Survey, and DDS with the Short Mood and Feelings Questionnaire. Two dimensions of ethnic identity, ethnic identity achievement and other group orientation, were assessed with Multi-Group Ethnic Identity Measure. Hispanic and non-Hispanic white girls had the highest and African-American (AA) and Caribbean girls the lowest rates of EDS. Asian girls reported the highest and AA girls the lowest rates of DDS. Early dieting was associated with EDS and DDS in Caribbean, non-Hispanic white, and mixed background girls. Relative body weight was related to EDS in all ethnic groups except in non-Hispanic white and mixed background girls. The authors did not find an effect of ethnic identity achievement on psychopathology, but there was an effect of other group orientation on both EDS and DDS. Clinicians should inquire about EDS and DDS in girls of all ethnic groups. Prevention efforts to delay unsupervised dieting may protect adolescent girls from the development of EDS and DDS.

Eating attitudes in a diverse sample of Israeli adolescent females: a comparison study

OBJECTIVES

To estimate the eating attitudes in Israeli Jewish female adolescents.

METHODS

A representative sample of 1270 females in grades 7-12 from five different Israeli schools from five different residential areas were assessed by EAT-26.

RESULTS

Of the total sample, 19.5% were identified as having abnormal eating attitudes. In terms of age, the 16 year olds were found to have the significantly highest rate of total and positive EAT-26 scores. As for school subgroups, the secular boarding schools had the significantly highest rate and the kibbutz had the lowest rate of positive EAT-26 scores for the total and for all subscales.

DISCUSSION

EAT-26 was found to be a useful tool for screening and identifying at-risk groups in a large adolescent Israeli population.

Acculturation and eating disorders in Asian and Caucasian Australian adolescent girls

The present study aimed to compare the attitudes and psychopathology of eating disorders between Asian and Caucasian adolescent girls; and investigate the relationship between acculturation and the attitudes and psychopathology of eating disorders in subgroups of Asian girls. Two groups of non-clinical adolescent girls in Perth, Western Australia, were compared using a survey method. There were 17 Asian and 25 Caucasian adolescent girls, aged 14-17 drawn from private high schools in Perth who were screened using the Eating Attitudes Test (EAT-26), the Eating Disorders Inventory (EDI-2), and an acculturation index. The psychopathology scores for eating disorders of the Asian group were significantly higher than that of the Caucasian group in terms of total EDI-2 score, Interpersonal Distrust, Maturity Fears, Impulse Regulation and Social Insecurity subscales. Eating attitudes measured by Dieting subscale of the EAT-26 was significantly different. Within the Asian group, the less acculturated girls had higher scores on the EAT-26 and the EDI-2 than the more acculturated. Less acculturated Asian girls appeared to have unhealthier attitudes and psychopathology toward eating.

Body weight, body image, and eating behaviours: relationships with ethnicity and acculturation in a community sample of young Australian women

A study was conducted to investigate associations between ethnicity and acculturation status and risk factors for eating disorders among young adult women. A community sample of 14,779 women aged 18-23 completed a comprehensive mail-out survey, which incorporated questions on country of birth, length of time spent in Australia, body weight, weight dissatisfaction, dieting, binge eating, and compensatory disordered eating behaviours. Results showed that risk factors for eating disorders were present across a range of ethnic groups. Further, a strong acculturation effect was observed, such that the longer the time spent in Australia, the more women reported weight-related values and behaviours similar to those of Australian-born women. Results challenge claims that risk factors for disordered eating are restricted to Caucasian females in Western societies. Implications for understanding ethnic and sociocultural influences on body weight, dieting, and disordered eating are considered.

Eating attitudes across age and gender groups: a Canadian study

OBJECTIVE

The purpose was to examine the eating attitudes across gender and age groups.

METHOD

The study included 343 individuals over 18 years of age (range: 18 to 94 years; mean 48 +/- 22), who were divided into 3 age categories: 18 to 34 years, 35 to 64 years and 65 years and above with a distribution of 35% (119), 37% (128) and 28% (97) respectively. The participants completed a background questionnaire and the Eating Attitudes Test (EAT-26).

RESULTS

A total of 30 participants (8.7%) scored above the cut-off point on the EAT-26 which is indicative of potential eating disturbances. Only statistically significant gender differences were observed in the total EAT-26 scores. Factor analysis revealed three subscales of EAT-26, food preoccupation, image preoccupation, and external focus or social pressure, with acceptable level of reliability and these were used for age and gender comparison. Age and gender differences were observed in the food and image preoccupation subscales only.

DISCUSSION

Although EAT-26 is widely used in clinical and non-clinical population, age and gender comparisons have not been made in a population-based sample. Use of the subscales of eating attitudes should help health professionals better identify those at risk for eating disturbances and provide the opportunity for intervention.

Asian body image satisfaction: ethnic and gender differences across Chinese, Indo-Asian, and European-descent students

This study extends previous research on ethnocultural differences in body image satisfaction by comparing two distinct Asian groups with a European descent group (N = 1471). Canadian undergraduates completed self-report body image measures. Participants descended from China reported the lowest levels of body satisfaction. Body satisfaction of participants descended from Indo-Asia was the next lowest, significantly lower than their European descent counterparts. The body satisfaction of women was lower than that of men across all groups and all participants expressed a desire to be thinner. The results suggest that one cannot generalize across Asian populations, as there may be significant differences between various ethnic minority groups.

Nutritional aspects of eating episodes followed by vomiting in Brazilian patients with bulimia nervosa

BACKGROUND

The clinical aspects of bulimia nervosa (BN) are similar in countries with different sociocultural backgrounds, but less is known about dietary composition in patients from developing countries. Little is also known about the role that nutritional aspects may play in behaviours aimed at counteracting the effects of binge eating.

OBJECTIVES

To describe the daily energy intake and eating behaviour of BN patients in Brazil and compare the dietary patterns of the patients who terminated eating episodes by vomiting and those patients who did not.

METHODS

Thirty patients from an eating disorders programme in a university-affiliated hospital completed a 14-day dietetic diary; the data were analysed using nutritional software.

RESULTS

Mean age and BMI of the patients were respectively 27.2 +/- 9.6 years and 25.5 +/- 6.7 Kg/m2. The patients in the vomiting subgroup ate more irregularly and consumed a more variable number of meals per day than those in the non-vomiting subgroup. The daily energy intake of the patients as a whole was 2,202 kcal, with a macronutrient composition of 53% carbohydrates, 31% fats and 17% proteins. The mean energy intake of the eating episodes followed by vomiting was 1,331 kcal with a macronutrient profile of 51% carbohydrates, 36% fat and 14% protein. Intake and eating patterns were characterised by between- and within- individual variability, and so no significant differences were found in the subgroup comparisons. Foods with a high energy density were preferred during the eating episodes followed by vomiting.

CONCLUSIONS

The results indicate that patients who vomit have a more irregular and variable eating pattern than those who do not vomit, but their daily nutrient content is comparable.

Nutrition intervention in ethnic minority groups

Development of effective intervention strategies to meet the needs of people with ethnic minority origins is dependent on two factors: an understanding of the modifiable risk factors which can form the basis of intervention; an understanding of the relevant health behaviours so that appropriate strategies can be designed. The present paper briefly reviews the evidence concerning the part that nutritional and dietary factors play in the aetiology of the observed patterns of disease in these groups and the limitations of the data as a basis for intervention. Consideration is also given to the available information concerning factors influencing health behaviour (particularly eating behaviour) and the applicability of commonly-used models of behaviour change to people of ethnic minority origin. Finally, the results of nutrition intervention programmes will be examined with a view to identifying lessons for the future.

Body image and weight consciousness among South Asian, Italian and general population women in Britain

Italians in Britain have low rates of coronary heart disease while South Asians have high rates, which correspond to a tendency to central abdominal fat deposition and overweight. World variations in attitudes to body size are thought to be related to economic security. This cross-sectional study employed a range of measures including photographic silhouettes of known BMI to investigate the attitudes of 259 South Asian, Italian and general population women (aged 20-42 years) towards body size. Migrants are compared with British-born minority members. Our results indicate that although migrant South Asians were less happy with their weight than migrant Italians, fewer had tried to lose weight in the past or had experienced external pressures to change their bodies. More migrant South Asians than Italians or general population women equated one of the four largest shapes (BMI 28-38) with health and successful reproduction. All groups wanted to resemble one of the two thinnest shapes, equating them with longevity, likelihood of marriage and job success. British-born South Asians generally showed a considerable degree of convergence towards general population women's negative attitudes to large body size, but British-born Italians' attitudes were significantly more negative even than general population women. The study's conclusions were that South Asian health beliefs are an important focus of resistance to slimness. The tendency of migrant South Asians to equate large size with health contrasts with the opposing views of Italian and general population women. British-born South Asians' views are modifying from those of migrants, but significant differences remain when compared with general population women and British-born Italians. Present differences in economic security offer only a partial explanation; South Asian attitudes may be explained by economic insecurity in the past.

The roles of ethnicity and culture in the development of eating disturbance and body dissatisfaction: a meta-analytic review

This meta-analysis involved 35 studies examining eating disturbance and body dissatisfaction in white and non-white populations and the role of acculturation in the development of eating-related psychopathology. While the role of acculturation in predisposing non-whites to eating disorders remains to be determined, mean effect sizes indicate that whites report more eating disturbance than non-whites. Differences are greatest when studies compare black and white college samples on measures of subclinical eating pathology, like dietary restraint, ideal body shape, and body dissatisfaction. They are weakest when non-clinic populations and clinical forms of eating disturbance, like bulimia nervosa, are examined. These findings suggest that the current literature may be incorrect in its view that subclinical and clinical forms of eating disturbance represent the poles of a single continuum. In addition, they call into question the belief that SES influences the development of eating pathology.

An ethnic comparison of eating attitudes and associated body image concerns in adolescent South African schoolgirls

OBJECTIVE

The purpose of this study was to investigate whether differences exist in eating attitudes and body shape concerns amongst adolescent schoolgirls representing South Africa's ethnically and culturally diverse population currently undergoing epidemiological transition.

METHOD

A questionnaire survey, including the Eating Attitudes Test, Body Shape Questionnaire and a Body Silhouette Chart, was administered to 228 South African schoolgirls (60 black, 83 mixed race and 85 white) aged 15-18 years from five secondary schools in the greater Cape Town area.

RESULTS

Black girls had significantly higher mean BMI values (24.1 (3.3)) than either white (21.9 (3.0)) or mixed race girls (22.1 (3.7)) (P < 0.05). Controlling for differences in BMI, white subjects scored significantly higher on the Body Shape Questionnaire than did mixed race or black subjects, whereas no ethnic differences were found for Eating Attitude Test scores. A comparable percentage (mean = 18.8%) of black, mixed race and white girls had scores indicative of eating disorder pathology on the Eating Attitudes Test, while a higher percentage of white, compared to mixed race and black, girls had abnormal scores on the Body Shape Questionnaire (33%, 26% and 20%, respectively; P < 0.05). The ideal body size desired by white girls was significantly smaller than that of the mixed race or black samples. Dissatisfaction with present body size was significantly higher in white, compared to black or mixed race girls (P < 0.001).

CONCLUSION

These findings suggest that the prevalence of abnormal eating attitudes is equally common in South African schoolgirls from different ethnic backgrounds. White girls exhibit greater body image concerns and body image dissatisfaction than mixed race or black individuals. These findings reinforce the notion that eating disorders are culture-reactive rather than culture-bound phenomena and provide insight into the extent of eating-related problems and body image issues in developing societies.

Weight-related body image concerns among 18-24-year-old women in Canada and India: an empirical comparative study

OBJECTIVE

Sociocultural factors are important in the pathogenesis of eating disorders. We examined some core (DSM IV) features of eating disorders, i.e., drive for thinness and dissatisfaction with the weight of the abdomen, hips, and thighs among women in Canada and India.

METHODS

A total of 65 Canadian (mean+/-S.D. age: 21.4+/-2.0 years) and 47 Indian (mean+/-S.D. age: 18.7+/-4.1 years) women completed the Drive for Thinness (DT) and Body Dissatisfaction (BD) subscales of the Eating Disorder Inventory (EDI) and in addition rated the degree to which they believed all major regions of their body were overweight.

RESULTS

After the effects of body mass index (BMI) were partialled out statistically, the DT (EDI) and BD (EDI) scores were not significantly different between the two countries. In both groups, concerns about the weight of the abdomen, hips, thighs, and legs loaded on a factor that essentially described the 'body dissatisfaction' construct. After the effects of BMI were partialled out, however, the factor scores from this factor correlated with BD (EDI) in the Canadian but not the Indian sample.

DISCUSSION

In contrast to the Canadian women, the Indian women did not overestimate the 'fatness' of their abdomen, hips, thighs, and legs. Among the Indian women, concerns about the weight of the upper torso (i.e., face, neck, shoulders, and chest) emerged as a distinct body image construct. In conclusion, after the effect of BMI was controlled for statistically, the Canadian and Indian women scored similarly on some of the core features of eating disorders, as measured by the DT (EDI) and BD (EDI) subscales, however, the nature of the underlying body image construct was different between the two groups.

A cross-cultural study of parental conflict and eating disorders in a non-clinical sample

Previous British studies have found that EAT scores of second generation British Asian schoolgirls are higher than those of White schoolgirls (Furnham & Husain, 1999; McCourt & Waller, 1995; Mumford et al., 1991), and that these scores are positively associated with parental over-protection (Furnham & Hussain, 1999). This study looked at the relationship between parental conflict and parental overprotection and EAT scores in three cultures. The three groups, all of late adolescent females, were British Caucasians (N=116), immigrant British Asians from Pakistan (N= 118), and Pakistanis tested in Pakistan (N=114). A 22 item conflict questionnaire was constructed and administered to 355 participants, along with the PBI, EAT-26, and Body Shape Belief Scale (BSBS). It was predicted that the British Asians would have higher EAT, parental protection and conflict scores than the other two groups. It was also predicted that EAT scores would be highly correlated with conflict scores. All hypotheses were supported, and over-protection scores were noticeably highest in the British Asian group. They also had a significant amount of more conflict with parents than any of the other cultural groups. EAT scores were associated with conflict and over-protection. Results are discussed in terms of the literature in the field.

Ethnic differences in the association between pubertal status and symptoms of depression in adolescent girls

PURPOSE

To examine the importance of chronologic age versus pubertal status in predicting adolescent girls' depressive symptoms in different ethnic groups.

METHODS

A national probability sample was used to obtain a representative cohort of 3216 adolescents, 5th through 8th grades. Subjects completed a questionnaire, which included a modified version of the Children's Depression Inventory (CDI) and an assessment of timing of menarche.

RESULTS

Among Caucasians, post-menarcheal adolescent girls had higher depression scores than did same-aged pre-menarcheal girls. Boys and pre-menarcheal girls had similar depression scores in most age groups. Among African-Americans and Hispanics, there were no menarche-associated differences in depressive symptoms.

CONCLUSION

In early adolescence pubertal status is a better predictor of depressive symptoms than chronological age in Caucasian, but not African-American or Hispanic girls.

Intraethnic comparison of eating attitudes in native Koreans and Korean Americans using a Korean translation of the eating attitudes test

Although Asian samples have been studied using the Eating Attitudes Test (EAT-26), the literature lacks data on Korean samples. Furthermore, although cross-cultural studies of eating disorders have been done, intraethnic studies are lacking. This study concerns an intraethnic Korean comparison of eating attitudes. The EAT-26 was translated into Korean and validated by back-translation and by a preliminary study on 32 bilingual (Korean and English-speaking) Korean women. The validated Korean translation was completed by a sample of 195 native South Koreans (NKs) and the original version by a sample of 39 Korean Americans (KAs). EAT-26 scores seemed to indicate that the NKs had more disordered eating attitudes. Furthermore, the KAs appear to be a low-risk sample for eating disorders. Implications for further research are discussed.

Detection of intra- and cross-cultural non-equivalence by simple methods in cross-cultural research: evidence from a study of eating attitudes in Nigeria and Britain

The desiderata for cross-cultural research are reviewed showing how this is dominated by the presumption of transcultural equivalence hidden by the technical problems of translation. This model requires intensive translation work on measures to preserve "equivalence". This work can be prohibitively intensive, might lead to spurious evidence of "equivalence" and has not produced much evidence of equivalence to date. A psychometric axiom--that a measure with low reliability cannot have validity--suggests a pragmatic way to explore these issues and current statistical software and personal computers make this feasible. We recommend that all cross-cultural research should present the internal reliability of the data as this will expose all but one theoretical problem in the detection of "equivalence". We also suggest that non-equivalence may indicate cross-cultural differences in the dimensionality of eating and body image concerns rather than just a problem to be exorcised by more translation work or to be hidden by not reporting reliability. These issues are not specific to work across languages but also apply to comparisons between any social groups within cultures. This is shown using data from questionnaires in their original English with respondents who were fluent in that language.

Ethnicity and body dissatisfaction: are Hispanic and Asian girls at increased risk for eating disorders?

PURPOSE

To compare prevalences and correlates of body dissatisfaction among white, Hispanic, and Asian girls.

METHODS

A total of 939 6th and 7th grade girls (mean age 12.4 years) attending four middle schools in northern California completed self-administered assessments of age, ethnicity, desired body shape, parent education levels, mother's and father's body shapes, pubertal stage, and body dissatisfaction. Body dissatisfaction was assessed with the Body Dissatisfaction scale of the Eating Disorder Inventory. Height, weight, triceps skinfold thickness, and waist and hip circumferences were measured by trained examiners.

RESULTS

Hispanic girls reported significantly greater body dissatisfaction than white girls, with Asian girls in-between. After adjustment for body mass index (weight/height), normal and overweight white, Hispanic, and Asian girls reported similar levels of body dissatisfaction. However, among the leanest 25% of girls, Hispanics and Asians reported significantly more body dissatisfaction than white girls. Body mass index was the strongest independent predictor of increased body dissatisfaction in all three ethnic groups. Shorter height among white girls and taller height among Asian girls also made significant independent contributions. Parent education level, a measure of socioeconomic status, was not significantly associated with body dissatisfaction.

CONCLUSIONS

Body dissatisfaction is not limited to white girls in middle and upper socioeconomic strata. These findings suggest Hispanic and Asian girls may be at greater risk for adopting eating disorder behaviors than previously recognized.

Validity of the Arabic version of the Eating Attitude Test

OBJECTIVES

To assess the validity of the Eating Attitude Test (EAT-26) in Arabic as a screening instrument in nonclinical populations.

METHODS

A representative sample of Grade 7-12 female students in Riyadh, Saudi Arabia, was selected randomly but proportional to various social classes. The girls were independently assessed by the EAT-26 and a structured clinical interview.

RESULTS

One hundred twenty-nine subjects were included. Twenty-five were identified by EAT-26 as having abnormal eating attitudes. One case was identified as anorexia nervosa by the interview and no cases of bulimia were found.

DISCUSSION

EAT-26 was found to be highly sensitive and reasonably specific. Like some other studies in non-Western populations, it yielded a high false positive rate and a low positive predictive value. Because of its low cost and practicality, EAT-26 might be a useful tool in screening large populations for eating disorders.

Epidemiology of anorexia nervosa

Findings of epidemiological studies of the rates, incidence, and prevalence of eating disorder over time and in different populations are reviewed. Risk factors for anorexia nervosa and bulimia nervosa are also addressed. Methodological recommendations for future directions in epidemiological studies of eating disorders are presented.

Abnormal eating attitudes and behaviours in two ethnic groups from a female British urban population

African-Caribbean (N = 136) and White British (N = 192) female family planning clinic attenders were administered the Bulimic Investigatory Test, Edinburgh (BITE) and the General Health Questionnaire (GHQ-28). A proportion of the participants were subsequently interviewed. The African-Caribbeans were found to have both significantly more disordered eating attitudes and a significantly higher level of abnormal eating behaviour than the White British. Although the African-Caribbean group had a significantly higher mean Body Mass Index this did not mediate the difference in levels of eating attitudes. When compared with the White British group more African-Caribbean women reported feelings of failure, guilt, abnormality and self-consciousness concerning their eating habits. The results indicate that eating problems may be highly prevalent in this ethnic minority population and suggest that there may be differences in the nature of eating disorder psychopathology between ethnic groups.

Binge eating in ethnic minority groups

Eating disorders have generally been considered uncommon among ethnic minorities. However, there are data that suggest bulimia nervosa may not be all that rare in some minority groups. Furthermore, emerging data on binge eating disorder (BED) have indicated high rates in some ethnic groups, and these data prompt reconsideration of the view that minority populations are protected from eating disorders. The current report reviews data on bulimia nervosa and BED in ethnic minority groups. Ramifications of a broader diversity of affected individuals on our understanding of eating disorders will be addressed, and directions for further research will be discussed.

Anorexia nervosa in 'non-white' populations

BACKGROUND

Comparisons were made between two groups of anorectic patients, 'non-white' and 'white', on a variety of clinical and social characteristics.

METHOD

The study is based on a 34-year long database (1960-93) associated with a national tertiary referral centre. Thirty-six non-white patients meeting DSM-III-R criteria for anorexia nervosa (AN) and five with 'partial syndrome' are compared with a white group comprising 944 patients with full syndrome.

RESULTS

The main finding is clinical similarity between the two groups, extending to social class and pathological patterns of family relationship. The non-whites are shorter in stature (P = 0.004) and report earlier menarche (P = 0.004); they are younger at presentation (P < 0.001), somewhat less emaciated, and practice veganism slightly more commonly; they less often acknowledge sensitivity to 'fatness' (P < 0.003). This sensitivity was exposed later whenever treatment involved substantial weight gain. The proportion of non-white cases accepted for assessment has not changed in respect of year of onset (around 6%) for the last 20 years, or year of presentation (around 6-7%) over the last 15 years. There was a tendency for non-white patients to be referred earlier in their illness.

CONCLUSIONS

The clinical and background profiles of non-white and white anorectics are generally similar. The numbers arising and presenting have not changed recently. Non-white patients apparently have as ready access as white patients to assessment and treatment by us.

Bulimia nervosa in two cultures: a comparison of Austrian and American college students

We compared 33 college women meeting DSM-III-R criteria for bulimia nervosa, recruited at Leopold Franzens Universität in Innsbruck, Austria, with 33 bulimic women recruited by identical methods at Northeastern University and Boston University in Boston, Massachusetts. Bulimia nervosa showed striking stereotypy across the two cultures. Austrian and American subjects reported similar demographic features, bulimic symptoms, severity and chronicity of illness, associated personal and familial psychiatric disorders, upbringing and family environment, and frequency of childhood sexual abuse. Only two variables, substance abuse and satisfaction with body image, differed markedly between the two groups. These differences appear to represent ambient differences between American and Austrian culture as a whole, rather than specific features of the bulimic syndrome.

Developmental role of perceived parental control in the eating psychopathology of Asian and Caucasian schoolgirls

It has been suggested that the relatively high levels of eating psychopathology among Asian schoolgirls living in the United Kingdom are due to "culture clash," but this construct needs further definition. A recent study has shown that perceived control by family members is important in determining the relatively unhealthy eating attitudes of Asian adolescents. However, that study focused on older adolescents (aged 14-15 years). The present study examines the development of that effect in a sample of Asian and Caucasian adolescent girls with a broader range of ages (aged 12-16 years). Again, the unhealthy eating attitudes of Asian girls were partly explained by their high levels of perceived maternal control. However, this effect was particularly strong among the older girls, suggesting a developmental trend through adolescence. There might be clinical benefits of addressing perceived or actual maternal control in these girls.