Bulimia more common in poor, minority girls than previously thought

I don't have much time right now, but I couldn't let this one pass by without making immediate comment: a new decade-long study has just been released that tracked bulimic symptomatology among adolescent girls of varying racial and socioeconomic groups. And the results blow any notion that eating disorders are a rich, white girl's disease straight out of the water.

In a survey of 2300 girls from around the country, a team of researchers led by USC economist Michelle Goeree and economist John Ham of the University of Maryland, found that

"girls who are African American are 50 percent more likely than girls who are white to be bulimic, the researchers found, and girls from families in the lowest income bracket studied are 153 percent more likely to be bulimic than girls from the highest income bracket."

Furthermore, African American girls measured higher on a clinical index of bulimia severity than their white counterparts. Overall, 2.2% of the girls had clinical bulimia nervosa, equivalent to other population estimates.

Many measures of eating disorders depend on rates of diagnosis; however, given the secretive and shameful elements of eating disorders, combined with mental health stigma and the expense of care, the population of sufferers presenting for treatment is not necessarily the same as the total population of people suffering from bulimia. This research, which surveyed girls annually and asked questions relating to ED symptoms, body image, and depression, paints a much more heterogeneous picture of sufferers than those that appear in the popular media.

"The results illustrate the importance of having objective information on behavior rather than relying solely on data on diagnoses," Ham says.

According to Goeree, past research has over-relied on hospital admission data, creating a "sample selection bias" that overlooks those who exhibit bulimic behavior but do not receive — or have the means to receive — professional help.

"One explanation is straightforward: Girls with an eating disorder who are African American or come from low-income families are much less likely to be diagnosed. Who goes to the hospital? Those who have insurance. Who tends to have insurance? Wealthier, better-educated people," Goeree says, noting that another part of the difference may be due to parents' sensitivity to bulimic behaviors.

The findings also affect educational spending: "What we thought was that bulimia affects high income, high education white women. And, if that's the case, then you should try to tailor educational programs — because education is expensive — to the group that it will help the most," Goeree explains. "Now we're finding that it's really important to reach a completely different group than we thought."

And these results have implications for treatment.

"Based on their findings about the persistence of bulimic behavior and who is afflicted, the researchers argue that bulimia, which is currently classified as a disorder, would perhaps be more accurately described — and treated — as an addiction. As with drug and alcohol addictions, this would mean more federal, state and local treatment programs and fewer out-of-pocket insurance costs."

The summary didn't show what, if any, correlations were found between measures of depression, body image dissatisfaction, and bulimic behaviors, which was about the only thing missing. The main message? EDs don't discriminate.


Just Eat It! said...

It was quite a revelation for me, after going to an expensive facility with mostly caucasian females, when I went to a center with males and non-caucasian people. Up until then, I thought that eating disorders were for the "upper middle class white girls." This study proves that it is not the case, and hopefully will educate other people to this fact.

fighting_forever said...

I really hope people in charge follow the advice on reclassifying bulimia as an addiction. There's no doubt in my mind that it is and maybe this would help shift some of the belief that eating disorders are just girls being silly.

The fact that disorders are common in all groups doesn't surprise me. I spent time in Finland where they have, in general, the healthiest approach to food and exercise I've seen anywhere. But they did a survey that showed a higher rate of anorexia than in the US. My opinion as to why? It was a nationwide survey; it didn't just rely on the small group that actually owned up to behaving in an embarassingly messed up way with regards to food.

ja said...

It's not news to me. It's a well kept secret among African American communities. Oh, and Medicaid doesn't cover treatment for eating disorders. Nice. So although bulimia can affect people of different socioeconomic classes, the "upper middle class white girls" are more likely to have the means to get treatment. I'll be honest, I still have a thing against anorexics although I'm trying to change.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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