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Eating Disorders, Race, and Mythology
Arch Fam Med. 2000;9:88.
A COMMON myth is that eating disorders are restricted to middle- and upper-class white females. Ask someone to describe a patient with eating disorders, and she is likely to be characterized as a high-achieving white teenager or young adult—perhaps a college student.
To some degree, these stereotypes are rooted in reality. Between 90% and 95% of those with anorexia nervosa or bulimia nervosa are female.1 Among those with binge eating disorder, in which binge eating occurs in the absence of compensatory behaviors, such as vomiting, there is less of a female predominance, with about a 3:2 female-to-male ratio.2
Some of these stereotypes, however, are less well grounded. Eating disorders are frequently described as occurring primarily in whites and in those of higher socioeconomic classes.3-4 However, the studies underlying this claim have significant limitations.1 For example, some were carried out on college campuses where few minority students were enrolled; others among those seeking treatment, often at referral centers. Studies done on such populations, which may be more likely to be white and of higher socioeconomic status, have limited generalizability. More recent studies have found that minority populations are substantially affected by eating disorders.5 For example, Fitzgibbon and colleagues6 found that the prevalence of binge eating was similar among Hispanic, non-Hispanic white, and African American women, but that binge eating symptoms were more severe among the Hispanic group.
In this issue of the ARCHIVES, Striegel-Moore et al7 present the results of a telephone survey conducted in a community-based sample of black and white women to determine the prevalence of binge eating and extreme weight control behaviors. Although the study was limited to women in the northeastern United States, the areas selected include women of diverse socioeconomic backgrounds living in urban, suburban, and rural populations; this should be representative of women encountered in primary care settings.
Striegel-Moore et al found that African American women were as likely as white women to report binge eating. In this community-based sample, they were even more likely than white women to report recurrent binge eating and the use of some extreme methods for weight control. The idea that African American women are protected against the development of eating disorders is simply not true. These findings have implications for both assessment and treatment of patients in the primary care setting.
While most overweight people do not suffer from an eating disorder, a substantial minority do. Eating disorders are not benign conditions. Extreme weight control behaviors, such as vomiting and laxative/diuretic abuse, can lead to electrolyte abnormalities, abnormal bowel function, and death.4 Numerous studies have shown an association between binge eating and other psychiatric conditions, including mood disorders.8-9 Binge eating is also associated with increased body weight.8 Psychological therapies targeted to treat the eating disorder can reduce binge eating, but unless patients also receive concomitant weight loss treatment, most researchers find that individuals with binge eating disorder will not lose weight. However, one study has found that subjects who were able to abstain from binge eating after cognitive-behavioral treatment for binge eating disorder were more likely to sustain long-term weight loss.10 Ideally, early treatment of binge eating may also help to prevent weight gain and the development of increasingly severe obesity.
The realization that patients belonging to racial and ethnic minority groups may be at equal risk for disordered eating as the white majority should prompt the primary care physician to inquire about symptoms of disordered eating in patients of all races and ethnicities. Such questioning need not be time-consuming or intrusive. For those with minimal symptoms, self-help approaches may be sufficient,11 while patients with more severe or long-standing problems may require specialized treatment by an experienced mental health professional. Recognition that eating disorders are color-blind can ensure that appropriate recognition and treatment are available to all patients at risk.
Susan Z. Yanovski, MD
Obesity and Eating Disorders Program
National Institute of Diabetes and Digestive
and Kidney Diseases
Building 45, Room 6AN-18
Bethesda, MD 20892-6600
(e-mail: sy29f{at}nih.gov)
REFERENCES
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1. Hsu LK. Epidemiology of the eating disorders. Psychiatr Clin North Am. 1996;19:681-700.
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2. Spitzer RL, Devlin M, Walsh BT, et al. Binge eating disorder: a multisite field trial of the diagnostic criteria. Int J Eat Disord. 1992;11:191-203.
3. American Psychiatric Association. Practice guideline for eating disorders. Am J Psychiatry. 1993;150:212-228.
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4. Fairburn CG, Beglin SJ. Studies of the epidemiology of bulimia nervosa. Am J Psychiatry. 1990;147:401-408.
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5. Field AE, Colditz GA, Peterson KE. Racial/ethnic and gender differences in concern with weight and in bulimic behaviors among adolescents. Obes Res. 1997;5:447-454.
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6. Fitzgibbon ML, Spring B, Avellone ME, Blackman LR, Pingitore R, Stolley MR. Correlates of binge eating in Hispanic, black, and white women. Int J Eat Disord. 1998;24:43-52.
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7. Striegel-Moore RH, Wilfley DE, Pike KM, Dohm F-A, Fairburn CG. Recurrent binge eating in black American women. Arch Fam Med. 2000;9:83-87.
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8. Telch CF, Agras WS, Rossiter EM. Binge eating increases with increasing adiposity. Int J Eat Disord. 1988;7:115-119.
9. Yanovski SZ. Binge eating disorder: current knowledge and future directions. Obes Res. 1993;1:306-324.
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10. Agras WS, Telch CF, Arnow B, Eldredge K, Marnell M. One-year follow-up of cognitive-behavioral therapy for obese individuals with binge eating disorder. J Consult Clin Psychol. 1997;65:343-347.
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11. Carter JC, Fairburn CG. Cognitive-behavioral self-help for binge eating disorder: a controlled effectiveness study. J Consult Clin Psychol. 1998;66:616-623.
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Recurrent Binge Eating in Black American Women
Ruth H. Striegel-Moore, Denise E. Wilfley, Kathleen M. Pike, Faith-Anne Dohm, and Christopher G. Fairburn
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Recurrent Binge Eating in Black American Women
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