In the United States, 20 million women and 10 million men suffer from an eating disorder at some time in their life. (Wade, 2011) There are several different types of eating disorders, such as Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder. Moreover, there are millions of people in the U.S. who struggle with disordered eating behaviors but may not be diagnosed as readily because their outward appearance or symptoms are not as obvious. However, the physiological impact may be just as serious as that of commonly known eating disorders.
The rate of development of new cases of eating disorders has been steadily increasing since the 1950s (Hudson, 2007; Streigel-Moore, 2003; Wade, 2011), and there has been a significant rise in the incidence of Anorexia in young women ages 15-19 in each decade since the 1930’s (Hoek, 2003). By age 6, it has been shown that girls start to express concerns about their own weight or shape. Other research has shown that approximately 40-60% of elementary school girls (ages 6-12) are concerned about their weight or about becoming too fat, and such concerns may persist through life (Smolak, 2011).
Eating disorder prevalence among men, is particularly elusive. In the past, eating disorders have been characterized as “women’s problems” and men have been stigmatized for having “body issues”. In general, many cases of eating disorders are likely not to be reported. In addition, many individuals struggle with body dissatisfaction and sub-clinical disordered eating attitudes and behaviors, and the best-known contributor to the development of Anorexia Nervosa and Bulimia Nervosa is body dissatisfaction (Stice, 2002).
The stigma and perception that eating disorders are self-inflicted frequently results in poorer outcomes and should addressed during treatment. The fact is eating disorders stem from a combination of biological, psychological and social influencers, which must be addressed in treatment in order for the patient to sustain long-term recovery.
The Path to Disordered Eating is as Unique as the Person Affected
Because disordered eating originates from a combination of genetic, environmental, and individual factors, the path to developing such a disorder is complex, and is likely as unique as each person affected. The presentation of disordered eating is also extremely individualized. For example, some people may appear to eat in a healthy manner, but their extreme exercise habits negatively impact their health and their relationships, as the preoccupation around exercise for weight loss or maintenance becomes the biggest priority in their life. Others may eat very little during the day but eat throughout the evening. Some people may try to compensate for binge eating with strategies such as self-induced vomiting or laxatives, while others compensate for the caloric intake by restricting for days following a binge.
- Many people with eating disorders look healthy, yet may be extremely ill.
- Families are not to blame and can be the patients’ and providers’ best allies in treatment.
- Eating disorders are not based on choice, but a serious mental health illness.
- Eating disorders carry the highest risk for both suicide and medical complications of all mental health disorders.
- Genes and environment both play important roles in the development of eating disorders.
- Eating disorders DO NOT just affect affluent, Caucasian women – eating disorders DO NOT discriminate.
- Males and minorities are less likely to seek treatment than their female and white counterparts, contributing to the perception that the male population is immune to eating disorders.
- Eating disorders affect people of all genders, ages, races, ethnicities, body shapes, weights, sexual orientations and socioeconomic statuses.
- Rates of eating disorders and body dissatisfaction among older populations are on the rise.
- Full recovery from an eating disorder is possible.
- Early detection and intervention are important.
Prevalence of Eating Disorders Among Ethnic Minorities
In the past, eating disorders have been characterized as culture-bound syndromes, specific to Caucasian subjects in Western, industrialized societies (Keel, 2003). This assumption may be due to the fact that they are the most likely to seek treatment. Recent studies demonstrate that eating disorders do affect other cultures, ethnicities and regions as well, and are possibly on the rise (Marques, 2011). However, these groups do not fit the stereotype, and more importantly, do not seek treatment as often, making it more challenging for untrained clinicians to recognize the signs and symptoms.
Some studies suggest that exposure to the Western beauty ideal is a risk factor for the development of Anorexia Nervosa (Hoeken, 2010). While similar findings for the risk of Binge Eating Disorder among Mexican-American immigrants revealed migration from Mexico to the U.S. was associated with an increased risk of Binge Eating Disorder (Swanson, 2012). Furthermore, a recent study comparing the prevalence of eating disorders across ethnic groups in the U.S. reported similar prevalence of Anorexia and Binge Eating Disorder among non-Latino whites, Latinos, Asians and African Americans, and Bulimia was more prevalent among Latinos and African Americans than among non-Latino whites (Marques, 2011). Other studies have shown that the prevalence of eating disorders is similar among Non-Hispanic Whites, Hispanics, African-Americans, and Asians, with the exception that Anorexia Nervosa is more common among Non-Hispanic Whites (Hudson, 2007; Wade, 2011). While more research is needed in this area, we do know that the prevalence of eating disorders is similar among Non-Hispanic Whites, Hispanics, African-Americans, and Asians in the U.S, with the exception that Anorexia Nervosa is more common among Non-Hispanic Whites.
Prevalence vs. Funding
Despite the prevalence of eating disorders, they continue to receive inadequate research funding. Research dollars spent on Alzheimer’s Disease averaged $88 per affected individual in 2011. For Schizophrenia the amount was $81. For Autism $44. For eating disorders the average amount of research dollars per affected individual was just $0.93 (National Institutes of Health, 2011). In spite of the unprecedented growth of eating disorders in the past few decades, eating disorders research continues to be under-funded, insurance coverage for treatment is inadequate, and societal pressures to be thin remain rampant.
Eating disorders are relatively common among young women, however, all individuals of every race, age and color are susceptible. All eating disorders have an elevated mortality risk, with Anorexia having the highest risk. Furthermore, evidence suggests that minority women are less likely to seek treatment than their white counterparts, contributing to the perception of minority women as immune from eating disorders. Men as well, appear less likely to seek treatment, thus, are under-represented regarding prevalence.
In regards to treatment, we must be attentive to factors affecting all populations, including differing worldviews, values, beliefs and patterns of acculturation, effects of oppression, language barriers, and individual differences within every ethnic and racial group.
Hoek, H. W., & van Hoeken, D. (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders, 34(4), 383-396.
Hoeken D, et al. The incidence of anorexia nervosa in Netherlands Antilles immigrants in the Netherlands. Eur Eat Disord Rev J Eat Disord Assoc. 2010;18(5):399–403. doi: 10.1002/erv.1040.
Hudson J. I., Hiripi E., Pope H. G. Jr., & Kessler R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication.Biological Psychiatry, 61, 348-358.
Marques L, et al. Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders. Int J Eat Disord. 2011;44(5):412–20. doi: 10.1002/eat.20787.
National Institutes of Health. (2011). Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC) [Data set].Retrieved from report.nih.gov/rcdc/categories/
Smolak, L. (2011). Body image development in childhood. In T. Cash & L. Smolak (Eds.), Body Image: A Handbook of Science, Practice, and Prevention (2nd ed.).New York: Guilford.
Stice, E. (2002). Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, 825-848.
Streigel-Moore R. H.,&Franko D. L. (2003). Epidemiology of binge eating disorder.International Journal of Eating Disorders, 34, S19-S29.
Swanson SA, et al. Change in binge eating and binge eating disorder associated with migration from Mexico to the U.S. J Psychiatr Res. 2012;46(1):31–7. doi: 10.1016/j.jpsychires.2011.10.008.
Wade, T. D., Keski-Rahkonen A., & Hudson J. (2011).Epidemiology of eating disorders. In M. Tsuang and M. Tohen (Eds.), Textbook inPsychiatric Epidemiology (3rd ed.) (pp. 343-360). New York: Wiley.