Prevalence and correlates of chronic dieting in a multi-ethnic U.S. community sample.

Despite the increasing rates of obesity in the U.S. and corresponding rise in weight-related concerns among men and women in all ethnic groups, most research in the U.S. has been conducted using white female samples. This study explored the prevalence and correlates of chronic dieting (high levels of dietary restraint) among a U.S. communitybased sample of Hispanic, Asian, Black, and White women and men (N=1257). Chronic dieting was more common among women than men, and less common among Asians than other ethnic groups. Across the total sample, dietary restraint was positively correlated with weight history, disordered eating attitudes, distorted body experiences, and depression, and was negatively correlated with self-esteem. Female chronic dieters showed the highest degree of disturbance; compared with female non-dieters (and male chronic dieters), they reported lower self-esteem, higher depression, and more disordered eating attitudes. As hypothesized, they also exhibited a higher degree of acculturation to Anglo-American society. Male chronic dieters had more disordered eating attitudes and experienced greater body distortion than male non-dieters. Interestingly, these results were not moderated by ethnicity. Although the prevalence of chronic dieting differs among ethnic groups living in the U.S., the psychological characteristics related to eating and weight appear similar for individuals who diet, irrespective of ethnicity.

Barriers to treatment for eating disorders among ethnically diverse women.

OBJECTIVE: This study examined barriers to treatment in an ethnically diverse community sample of women with eating disorders. METHOD: Participants were 61 women (22 Hispanics, 8 Asians, 12 Blacks, 19 Whites) with eating disorders. Diagnosis was determined using the Eating Disorder Examination. Treatment-seeking history, barriers to treatment seeking, ethnic identity, and acculturation were assessed. RESULTS: Although 85% of the sample reported wanting help for an eating problem, only 57% had ever sought treatment for an eating or weight problem. Individuals who had sought treatment reported being significantly more distressed about their binge eating than those who had not sought treatment and having begun overeating at a younger age. Of those who had sought help, 86% had not received any treatment for their eating problems. The main barriers to treatment seeking were financial reasons. CONCLUSION: Women from minority groups who have eating disorders are underdiagnosed and typically not treated.

Comparison of binge eating disorder and bulimia nervosa in a community sample.

OBJECTIVE: This study examined the relationship between binge eating disorder (BED), a newly proposed eating disorder, and bulimia nervosa (BN). METHOD: Three groups recruited from the community were compared: women with BED (n = 150), women with purging BN (n = 48), and women with nonpurging BN (n = 14). RESULTS: The three groups did not differ significantly in education, weight or shape concern, and current or lifetime prevalence of nine major mental disorders. Women with BED, compared with women with purging BN, were older, less likely to have a history of anorexia nervosa, and less likely to have been treated for an eating disorder. Obesity was more commonly associated with BED than with either subtype of BN. DISCUSSION: Our results lend some support to BED as an eating disorder distinct from purging BN. More research is needed to clarify the position of nonpurging BN relative to BED and purging BN.

Body image, body dissatisfaction, and eating attitudes in midlife and elderly women.

Cohort differences in body image, drive for thinness, and eating attitudes in middle-aged and elderly women were examined. Participants were 125 women between the ages of 50 and 65 (middle-aged group), and 125 women 66 years old and older (elderly group). Instruments used were figure ratings (Stunkard, Sorensen, & Schulsinger, 1983), and scales of the Eating Disorder Inventory (EDI; Garner,Olmstead, & Polivy, 1983). Items were developed to assess fear of aging. The middle-aged group, as compared to the elderly group, had more drive for thinness, disinhibited eating, and interoceptive confusion. The elderly group reported body size preferences and levels of body dissatisfaction that were similar to the younger women. There was a positive relationship between fear of aging and disordered eating. Sociocultural standards of body image and pressures toward thinness affect different generations of older women in similar ways.

Natural course of a community sample of women with binge eating disorder.

OBJECTIVE: A community sample of women with binge eating disorder (BED) was followed for a period of 6 months, in order to examine the natural course of the disorder. METHOD: Baseline, 3-, and 6-month assessments were conducted. The following variables were examined: eating disorder symptomatology, importance of weight or shape, psychopathology, social adjustment, childhood sexual abuse, childhood obesity, parental obesity, and parental psychopathology. RESULTS: After the 3-month follow-up, 10 of the original sample of 31 participants dropped out of the study; drop-outs were more likely to have reported a history of sexual abuse. Of the 21 remaining participants, 11 continued to suffer from full-syndrome BED at 6-month follow-up, while the remaining 10 appeared to be in partial remission. There were no significant baseline predictors of outcome. CONCLUSION: It appears that for some women with BED, the eating disorder improves with a decrease in binge eating and importance of weight or shape. For others, the eating disorder symptoms remain constant.

Beliefs about weight gain and attitudes toward relapse in a sample of women and men with obesity.

OBJECTIVE: The purpose of this study was to examine beliefs regarding reasons for weight gain, likely responses to weight loss relapse, notions of reasonable weight loss, and correlations between beliefs and attitudes in a large nonclinical sample of men and women with obesity. RESEARCH METHODS AND PROCEDURES: Participants were 3,394 white women (n=1,674) and men (n=1,720) with obesity who had responded to a survey about body image and eating behaviors conducted by Consumer Reports magazine. RESULTS: Women and men indicated that the most important reasons for their weight gain were lack of exercise and enjoying eating; the least important reason was a need to avoid social or sexual situations. Both groups reported that their most likely response to relapse is to start watching food intake, whereas their least likely response is to ask a friend, spouse, or family member for help. Women rated depression, stress, low self-esteem, and need to avoid situations as more important reasons for their weight gain than did men, and women were more likely to feel terrible and regain as a response to relapse. There was no relationship between an individual's beliefs about weight gain, responses to relapse, or notions of reasonable weight loss. DISCUSSION: Implications of these findings for the treatment of obesity are discussed.

Is amenorrhea a critical criterion for anorexia nervosa?

The significance of amenorrhea as a criterion for anorexia nervosa was examined. Twelve nonamenorrheic women treated for anorexia were compared with 40 women meeting full DSM-IV criteria. The nonamenorrheic group displayed the same high levels of eating disorder, body-image disturbance, and psychopathology as the amenorrheic group, as measured by the following variables: body-size overestimation on the Image Marking Procedure; body distortion on the Body Distortion Questionnaire; eating disorder on the Eating Disorder Inventory; depression on the Beck Depression Inventory; psychopathology on the MMPI; and external locus of control on the Rotter Locus of Control Scale. Amenorrhea does not appear to be a useful criterion for distinguishing full-syndrome anorexia nervosa from partial-syndrome cases.

Realistic weight perception and body size assessment in a racially diverse community sample of dieters.

Recently, a shift in obesity treatment away from emphasizing ideal weight loss goals to establishing realistic weight loss goals has been proposed; yet, what constitutes "realistic" weight loss for different populations is not clear. This study examined notions of realistic shape and weight as well as body size assessment in a large community-based sample of African-American, Asian, Hispanic, and white men and women. Participants were 1893 survey respondents who were all dieters and primarily overweight. Groups were compared on various variables of body image assessment using silhouette ratings. No significant race differences were found in silhouette ratings, nor in perceptions of realistic shape or reasonable weight loss. Realistic shape and weight ratings by both women and men were smaller than current shape and weight but larger than ideal shape and weight ratings. Compared with male dieters, female dieters considered greater weight loss to be realistic. Implications of the findings for the treatment of obesity are discussed.

Report of the National Institutes of Health (NIH) Workshop on the Development of Research Priorities in Eating Disorders.

The National Institutes of Health (NIH) Workshop on the Development of Research Priorities in Eating Disorders was convened in New York on April 24 and 25, 1996. The goals of the workshop were (1) to identify important unanswered questions in the study and treatment of eating disorders, (2) to discuss potentially fruitful approaches to answering these questions through basic and clinical research, and (3) to assist the NIH and other funding agencies in assigning priorities for research on eating disorders. The program consisted of a series of brief presentations by moderators, each followed by facilitated discussion of the topic with members of the audience. Three reporters (CMG, MJD, FMC) took detailed notes of the proceedings, which have been incorporated into this article. A summary of this workshop is presented, along with recommendations for future research that were identified by workshop participants.