Eating disorders and the cultural forces behind the drive for thinness: are African American women really protected?

Negative emotional eating patterns in general Chinese adults: A replication and expansion study examining group differences in eating disorder symptomatology, psychosocial impairment, and emotion regulation difficulties

Previous research identified four patterns of negative emotional eating in American and Chinese university students and proposed future directions (e.g., exploring potential differences in emotion regulation across patterns and replicating the patterns in a general, non-student population). Furthermore, prior research has not explored group differences in muscularity-oriented eating disorder symptomatology or psychosocial impairment. Therefore, the present study addressed these gaps in a sample of general Chinese adults, further testing group differences in typical and muscularity-oriented eating disorder symptomatology, psychosocial impairment, and emotion regulation difficulties across patterns of negative emotional eating. A total of 600 Chinese adults were recruited. Latent class analysis (LCA) was used. Results replicated the four patterns of negative emotional eating in previous research, including non-emotional eating (non-EE), emotional over- and under-eating (EOE-EUE), emotional over-eating (EOE), and emotional under-eating (EUE). Significant class differences were identified in eating disorder symptomatology, psychosocial impairment, and emotion regulation difficulties. Specifically, individuals with EOE and EOE-EUE patterns exhibited higher eating disorder symptomatology, higher psychosocial impairment, and more emotion regulation difficulties than those with non-EE and EUE patterns. Therefore, these two classes (i.e., EOE and EOE-EUE), especially the poorly researched EOE-EUE group, should be further examined to elucidate research and clinical applications. Furthermore, findings underscore the role of emotion regulation difficulties in further describing the differences across these negative emotional eating patterns, which can be considered in future interventions for reducing negative emotional eating.

Longitudinal Stability of Disordered-Eating Symptoms From Age 12 to 40 in Black and White Women

The purpose of the current study was to test the longitudinal association between disordered eating symptoms (body dissatisfaction, drive for thinness and bulimia) in adolescence (ages 12, 14, 16, 18, 19) and adulthood (age 40) in a sample of 883 white and Black women. We also investigated moderation by race. Adolescent symptoms at each time point significantly predicted adulthood symptoms for the body dissatisfaction and drive for thinness subscales, for both Black and white women. Bulimia symptoms in adolescence predicted symptoms in adulthood; however, the effect was largely driven by white women. Although moderation was non-significant, among white women, bulimia symptoms at all adolescent time points predicted adulthood bulimia, but among Black women, only symptoms at ages 18 and 19 were predictive of adulthood bulimia. Results suggest that both Black and white women are susceptible to disordered eating and that symptoms emerging in adolescence can potentially follow women into midlife.

Characterizing eating disorder psychopathology and body image related constructs in treatment-seeking Black individuals with binge-eating spectrum disorders

PURPOSE

Black individuals are at risk for developing eating disorders (EDs), while also facing an increased mental health burden as a marginalized group. However, few studies have examined whether treatment-seeking Black individuals with EDs present with different symptom profiles than White individuals. This study sought to characterize baseline ED symptomatology in Black participants with bulimia nervosa spectrum or binge eating disorder spectrum pathology compared to White participants in a treatment-seeking sample.

METHODS

The sample consisted of 33 Black participants and 126 White participants who participated in a clinical trial at a mid-Atlantic University from 2015 to 2020. Data was analyzed using chi-square and independent samples t-tests.

RESULTS

Black participants were much less likely to engage in self-induced vomiting, despite being just as likely to meet criteria for a bulimia nervosa spectrum diagnosis and having similar rates of binge-eating and distress towards body image concerns. Black participants were more likely to experience obesity but maintained similar levels of body image concerns as White participants.

CONCLUSION

Given the evidence that Black participants often are under-diagnosed, particularly with bulimia nervosa spectrum disorders, these results could suggest that weight biases and/or expectations that patients with bulimia nervosa spectrum disorders will primarily present with self-induced vomiting could be contributing to these diagnostic errors.

LEVEL OF EVIDENCE

Level I, randomized controlled trials.

Binge eating and binge-eating disorder in Black women: A systematic review

OBJECTIVE

Although several effective behavioral treatments for binge-eating disorder (BED) exist, there are racial disparities in treatment access, with African-Americans and/or Black individuals having some of the lowest rates of access to care. Little is known about the experience and treatment of binge eating (BE) and BED among Black women.

METHOD

This systematic review, conducted according to PRISMA guidelines, synthesizes information related to BE and BED in Black women.

RESULTS

A total of N = 38 studies met our eligibility criteria. We did not identify any systematic risk of bias across studies. The majority of included studies used cross-sectional survey methodology, and relied on interview (EDE) and self-report measures (particularly the Binge Eating Scale, BES) for the assessment of BE. Outcomes were inconsistently measured across trials, and there are limited data on the results of evidence-based treatments for BE/BED in Black women.

DISCUSSION

Although Black women have similar or higher rates of BE than White women, most research on BE and BED has focused on White women, with Black individuals underrepresented in clinical trials. Future research should examine evidence-based treatments to prevent and treat BED in this population.

OBJETIVO

Aunque existen varios tratamientos conductuales que son efectivos para el Trastorno de Atracones (BED, por sus siglas en inglés), existen disparidades raciales en el acceso a tratamiento, con individuos Afroamericanos y/o personas de color teniendo algunas de las tasas más bajas de acceso al cuidado de la salud. Se sabe muy poco acerca de la experiencia y tratamiento del comer en atracones (BE, por sus siglas en inglés) y BED entre mujeres afroamericanas y/o de color. MÉTODO: Esta revisión sistemática, realizada bajo lineamientos de las guías PRISMA, sintetiza información relacionada con BE y BED en mujeres afroamericanas y/o de color.

RESULTADOS

Un total de N = 38 estudios cumplieron con nuestros criterios de elegibilidad. No identificamos ningún riesgo sistemático de sesgo entre los estudios. La mayoría de los estudios incluidos utilizaron una metodología de encuesta transversal y se basaron en la entrevista (EDE) y las medidas de autoinforme (en particular, la Binge Eating Scale, BES) para la evaluación de BE. Los resultados se midieron de manera inconsistente entre los ensayos, y hay datos limitados sobre los resultados de los tratamientos basados en la evidencia para BE/BED en mujeres afroamericanas y/o de color. DISCUSIÓN: Aunque las mujeres afroamericanas y/o de color tienen tasas similares o más altas de BE que las mujeres blancas, la mayoría de las investigaciones sobre BE y BED se han centrado en las mujeres blancas, con individuos afroamericanos y/o de color subrepresentados en ensayos clínicos. La investigación futura debería examinar los tratamientos basados en la evidencia para prevenir y tratar el BED en esta población.

Intersectionality in the Liminal Space: Researching Caribbean Women's Health in the UK Context

African Caribbean women in the UK who are diagnosed with chronic illnesses that are related to overweight and obesity are more likely to experience poorer outcomes than their White British counterparts. It is then important to increase understandings of how women from this ethnic group perceive health with relation to body shape and size so that interventions can be developed to prevent the development of such conditions and to improve outcomes. As such, it is important to develop research methodology that encourages participation in health research from African Caribbean women and enables the capture of in-depth data that gives insight into the nuances of health understandings related to the body and the social realities in which they exist. This paper details the methodological framework of The Big Talk project, an investigation that sought to develop a novel approach to conducting health research with seldom heard communities. The concept of intersectionality, as used in Critical Race Theory, was applied as a theoretical tool for exploring the dynamics of societal power and where this power intersects across the lived realities of race, ethnicity, gender, sexuality, (dis)ability, and class. For this research, these intersections are explored for African Caribbean women and how they relate to concepts of health, body shape, and size. This research study was conducted in spaces identified as liminal spaces for African Caribbean women: talk radio programmes; hairdressing salons and; local community groups. A Black feminist epistemological approach was used to facilitate the collection of data. The data that emerged from these liminal spaces are not necessarily definitive answers on health for African Caribbean women, but rather illuminate alternative ways of understanding the social world from the perspective of those subject to power. This phenomenon makes liminal spaces intersectional in their construction and in taking such an approach to analysis could enable finely grained details of discourses regarding health, wellness and the body to be gathered. The importance of this understanding can help to improve preventive health interventions for African Caribbean women.

Strong, female and Black: Stereotypes of African Caribbean women’s body shape and their effects on clinical encounters

The aim of this article is to explore how tendencies to stereotype minority ethnic groups intersect with lay discourses about them in ways that can reproduce cultural prejudices and reinforce inequalities in access to services and health outcomes. Drawing upon Black feminist and cultural studies literature, we present a theoretical examination, the stereotypes of the Black woman as ‘mammy’ and ‘matriarch’. We suggest that the influence of these two images is central to understanding the normalisation of the larger Black female body within African Caribbean communities. This representation of excess weight contradicts mainstream negative discourses of large bodies that view it as a form of moral weakness. Seeking to stimulate reflection on how unacknowledged stereotypes may shape clinical encounters, we propose that for Black women, it is the perception of strength, tied into these racial images of ‘mammy’ and ‘matriarch’ which may influence when or how health services or advice are both sought by them and offered to them. This has particular significance in relation to how body weight and weight management are/are not talked about in primary care-based interactions and what support Black women are/are not offered. We argue that unintentional bias can have tangible impacts and health outcomes for Black women and possibly other minority ethnic groups.

Body Mass Index, Self-Esteem, and Suicide Risk in Clinically Depressed African American and White American Females

Self-esteem and depression, as well as depression and body mass index (BMI), have consistently been found to be significantly associated for African American and White American females. The results are dissimilar when BMI and self-esteem are studied. Historically, the relationship between BMI and self-esteem is weak or nonexistent for African American females; however, for White American females, the relationship is usually significant. The goal of this study was to determine whether clinically depressed, healthy-weight, overweight, and obese females would differ significantly on self-esteem and suicide risk measures. In a voluntary hospital-based inpatient psychiatric unit, 165 clinically depressed females completed the self-esteem rating scale and the suicide risk scale. Healthy-weight, overweight, and obese African American females did not differ significantly on measures of self-esteem and suicide risk. However, depressed, obese White American females had significantly lower self-esteem and increased suicide risk than depressed healthy-weight and overweight White American females. Implications of the current results are discussed.

African American Women’s Sexual Objectification Experiences

The purpose of our study was to investigate African American women’s experiences with sexual objectification. Utilizing grounded theory methodology as well as Black feminist thought and objectification theory as the research lenses, the results of this study uncovered how racist, sexist, and classist ideologies contributed to sexual objectification experiences (SOEs) among African American women. Twenty African American female graduate students and others recruited from a campus community participated in semistructured interviews. Data revealed a number of different sociocultural factors that contributed to the sexual objectification of African American women (i.e., historical influence of slavery, sexualized views and images of African American women, and patriarchal social structure). These factors were observed to contribute to different forms of sexual objectification, ranging from comments and objectifying gazes to more extreme forms, such as sexual abuse. Participants described a number of effects of sexual objectification, including self-objectification, physical safety anxiety, eating concerns, psychological/emotional, and interpersonal. Participants also described how they coped with and grew from these experiences. Psychologists and mental health professionals are encouraged to consider how African American women’s SOEs are rooted in racism, sexism, and classism. Furthermore, these practitioners are urged to develop an awareness of how these oppressions intersect and contribute to the sexual objectification of African American women.

Race, weight, and correlates of binge eating in female college students

This study examined the correlates of race, weight status, and binge eating among 715 female undergraduate students (77% Caucasian; 13% African American) enrolled at an urban university. Approximately 21.7% of Caucasians and 36.8% of African-Americans (AA) were overweight/obese. Higher BMI was associated with BED, and severity of binge eating symptoms. After removing participants who endorsed compensatory behaviors ≥ 1×/week from the analyses, 8.4% of the sample met criteria for BED (2.4% of the AA and 9.9% of the Caucasian students) and 44% reported severe binge eating symptoms. AA students were less likely to have BED than Caucasian students and reported less severe binge eating symptomatology. For Caucasian students, mood, cognitive restraint, drive for thinness, and BMI all contributed significant individual variance in binge eating severity. For African Americans, mood, body image dissatisfaction, and drive for thinness were found to be unique contributors. For those meeting criteria for BED, retrospectively recalled predictors of binge eating included negative affect (e.g., self-anger, worry, guilt), but not hunger. Behavioral triggers for binge behavior differed by race, as well, with African American students retrospectively reporting lower levels of anxiety prior to bingeing. Results from this study suggest that there are racial differences in binge eating behaviors. Future studies are needed to examine differences in eating practices among racial groups (e.g., grazing, large portions, high fat food preparation) that may contribute to early onset weight gain and obesity. The results suggest the importance of sensitive tailored weight and disordered eating interventions for college women from diverse backgrounds.

Are All Minority Women Equally Buffered from Negative Body Image? Intra-Ethnic Moderators of the Buffering Hypothesis

Body dissatisfaction is normative among European American women, and involvement with predominant culture or linking self-worth to weight may intensify the association between body dissatisfaction and drive for thinness for women of color. Our study investigated whether orientation to other ethnic groups (Multigroup Ethnic Identity Measure) and weight-based contingency of self-worth moderate the relationship between body satisfaction and drive for thinness (Eating Disorder Inventory) among college-age African American, Asian American, and European American women. Survey responses from undergraduates ( N = 905) were collected, and multiple regression analyses showed that, for African Americans, appearance esteem was positively associated with drive for thinness among those who defined their self-worth as contingent on weight or who identified with ethnic outgroups. Appearance esteem was independently associated with drive for thinness among Asian Americans and European Americans, but no moderation was found. European American women who define self-worth as contingent on weight were higher in drive for thinness, regardless of their body mass index or appearance esteem. Identifying the mechanisms through which some women may be at risk for internalizing restrictive body ideals is key for understanding experiences of the body for diverse women.

Studying a population undergoing nutrition transition: a practical case study of dietary assessment in urban South African adolescents

The South African Medical Research Council food frequency questionnaire (FFQ) and protocol was used to determine food intake in 83 adolescents from the Birth To Twenty study. The FFQ was piloted on a small group (n=8). Specific problems which resulted in overestimation of energy intake were identified. The protocol was modified and administered to the remainder of the adolescents and their caregivers. Reasonable energy intakes were obtained, and time spent completing the FFQ was reduced. The modified protocol was more successful in determining habitual food intake although it would benefit from validation against other dietary intake techniques.

Embodied drawings as expressions of distress among impoverished single Bedouin mothers

This paper demonstrates how marginalized, Bedouin, single mothers define pain through different depictions of their bodies and their embodied experience. Using visual data generated through an empowerment group with single Bedouin women living in the Negev, illustrative pictures were selected. The potential of drawing as an indirect, but deeply communicative symbolic vehicle with which to express the women's pain and struggle as marginalized and impoverished women is demonstrated through themes that emerged from a content analysis of the women's art and their verbal comments about what they had drawn. A central theme identified pain due to painful life circumstances, rather than due to inherent sickness or weakness. Other themes identified included the body as a site for cultural transition, power negations with men, intellectual development, and the struggles of motherhood. This shows how the visual depiction of pain on the page offers a socially critical, yet potentially mental health promoting medium that locates women's distress, not as the result of personal and physical weakness, but as the result of social oppression. The implications for the use of art with socially marginalized women are discussed.

Tendency toward deliberate food restriction, fear of fatness and somatic attribution in cross-cultural samples

OBJECTIVE

To compare Omani and western teenagers attending schools in Muscat, Sultanate of Oman and Filipino teenagers residing in Manila, Philippines on indices of deliberate food restriction and dieting behavior.

METHODS

The sample consisted of 444 students who were assessed using the cross-culturally valid measure, Eating Attitude Test-26, a subscale of Eating Disorder Inventory to gauge the presence of the drive for thinness or 'fat phobia' and the Bradford Somatic Inventory to elicit the presence of somatization.

RESULT

Significant differences in attitudes to eating, body image and somatization between the western and non-western teenagers were found.

CONCLUSION

This paper suggests that trajectories of eating disorder, such as body image disturbances as expressed in fat phobia and somatization, tend to vary from culture to culture and underscore the view that some of the health related behavior among adolescents need to be examined within socio-cultural contexts.

Urbanization and obesity in The Gambia: a country in the early stages of the demographic transition

OBJECTIVE

To investigate the distribution of overweight and obesity and its relationship with socio-economic and behavioural factors in a developing-country population undergoing rapid nutritional transition.

DESIGN

Cross-sectional house-to-house survey in urban Gambia.

SUBJECTS

Four groups of 50 subjects were sampled as follows: young men (YM, 14-25 years), young women (YW, 14-25 years), older men (OM, 35-50 years) and older women (OW, 35-50 years).

MEASUREMENTS

Several socio-economic and behavioural factors were investigated. Composite indices for socio-economic status, education, healthy lifestyle and western influences were created. Body weight, height, waist and hip circumferences were measured and body mass index (BMI) was calculated. Body composition was assessed by leg-to-leg bioimpedance. Overweight was defined as BMI=25.0-29.9 kg/m(2) and obesity as BMI>or=30.0 kg/m(2).

RESULTS

There were highly significant gender and age differences in overweight (YM=0%, YW=10%, OM=6% and OW=34%) and obesity (YM=0%, YW=4%, OM=6% and OW=50%). Only 16% of OW were neither overweight nor obese compared to 88% of OM. OW had a higher fat mass percent (38.4%) than other groups, while fat-free mass (kg) was significantly higher in males than females with YW having the lowest value. Young generations were more educated and more influenced by western ideals than OM and OW. Weight gain was not always associated with weight concern and many overweight/obese subjects did not perceive themselves as overweight.

CONCLUSION

Social and behavioural changes are already creating a perceptible 'generational gap' among this population undergoing rapid transition. The improved education and current lean status of the younger adults offers opportunities for preventative interventions. These need to be specially targeted at women.

Weighing both sides: morality, mortality, and framing contests over obesity

Despite recent and growing media attention surrounding obesity in the United States, the so-called obesity epidemic remains a highly contested scientific and social fact. This article examines the contemporary obesity debate through systematic examination of the claims and claimants involved in the controversy. We argue that four primary groups-antiobesity researchers, antiobesity activists, fat acceptance researchers, and fat acceptance activists-are at the forefront of this controversy and that these groups are fundamentally engaged in framing contests over the nature and consequences of excess body weight. While members of the fat acceptance groups embrace a body diversity frame, presenting fatness as a natural and largely inevitable form of diversity, members of the antiobesity camp frame higher weights as risky behavior akin to smoking, implying that body weight is under personal control and that people have a moral and medical responsibility to manage their weight. Both groups sometimes frame obesity as an illness, which limits blame by suggesting that weight is biologically or genetically determined but simultaneously stigmatizes fat bodies as diseased. While the antiobesity camp frames obesity as an epidemic to increase public attention, fat acceptance activists argue that concern over obesity is distracting attention from a host of more important health issues for fat Americans. We examine the strategies claimants use to establish their own credibility or discredit their opponents, and explain how the fat acceptance movement has exploited structural opportunities and cultural resources created by AIDS activism and feminism to wield some influence over U.S. public health approaches. We conclude that notions of morality play a central role in the controversy over obesity, as in many medical disputes, and illustrate how medical arguments about body weight can be used to stymie rights claims and justify morality-based fears.

Drive for thinness and fear of fat: separate yet related constructs?

The terms drive for thinness and fear of fat are consistently used in the literature to describe eating disorders in their clinical and sub-clinical forms, yet distinct definitions of each are not provided. Although similar on first examination, these terms may represent two distinct constructs in the motivational factors of persons at risk for developing eating disorders. The following article presents the notion that drive for thinness and fear of fat are separate yet related constructs, perhaps representing approach and avoidance mechanisms in persons at risk. The implications for counseling and practice and directions for further research are provided.

Development of weight and shape concerns in the aetiology of eating disorders

BACKGROUND

Although weight and shape concerns are considered to be integral to the psychopathology of anorexia and bulimia nervosa, uncertainties remain about developmental aspects of the aetiology of these concerns and their relationship to eating disorders.

AIMS

To review the recent literature on weight and shape concern, with particular emphasis on aetiology, to identify a possible developmental pathway from weight concern through abnormal eating behaviour to disorder.

METHOD

Literature review of Medline and Psychlit databases using the keywords 'eating disorder', 'weight concern', 'shape concern' and 'aetiology'. Inclusion criteria were based on the strength of quantitative research findings, originality of ideas and recent publication.

RESULTS

Weight and shape concerns follow a developmental pathway arising before the typical age for the development of eating disorders. The origins are multifactorial, with biological, family and sociocultural features predominating.

CONCLUSIONS

Although weight and shape concern seems commonly to underlie the development of eating disorders, an alternative pathway appears to exist through impulsivity and fear of loss of control. Prevention strategies may usefully focus on the attitudes and concerns that lead to dieting behaviour.

Eating disorders in adolescents with type 1 diabetes. A closer look at a complicated condition

The cultural drive to be thin can lead to eating disorders in many women and girls. In adolescent females with diabetes, the increased focus on eating and the weight gain associated with good glycemic control likely increase their susceptibility to abnormal eating. It is clear that nonspecified and subthreshold eating disorders, and possibly bulimia and anorexia, are more common in this group of patients. Good nutritional counseling to help patients avoid weight gain and family counseling to improve communication between patients and their families may help decrease this risk. Intentional insulin omission is a frequent means of preventing weight gain or increasing weight loss in adolescent females with type 1 diabetes. Eating disorders should be suspected in patients with recurrent diabetic ketoacidosis or poor glycemic control that is resistant to attempts at improvement. Treatment includes decreasing dietary restraint, promoting healthy eating, and either psychiatric counseling or psychologic intervention, or both.