Eating disorders include anorexia nervosa (self-starvation) and bulimia nervosa (binge-purge syndrome). Although anorexia nervosa and bulimia nervosa represent different types of disordered eating, both entail a distorted body image and fear of fatness.
Specifically, anorexia nervosa involves self-starvation alone or in combination with excessive exercising, occasional binge eating, vomiting, or laxative abuse. An individual with anorexia nervosa refuses to maintain minimum weight for age and height and is at least 15 percent below expected weight. Bulimia nervosa is a pattern of bingeing and self-induced purging. This eating disorder consists of binge eating, followed by vomiting, laxative abuse, enemas, or ipecac use. One’s weight is usually normal or close to normal.
The reported occurrence of eating disorders increased markedly over the past 30 years. Eating disorders do not exist equally across populations; they have very specific patterns of distribution and are most prevalent in certain cultural contexts and sociodemographic categories.
Sociodemographic and Cultural Context of Eating Disorders
In general, eating disorders most commonly occur among young, white, affluent females in modern, industrialized countries. Concerning the gender distribution of eating disorders, 90 percent of individuals with eating disorders are female. Cultural norms of the body are critical to understanding why females are more vulnerable to eating disorders than are males. Specifically, the pervasive thinness norm for women is a major contributor to gender differentiation. The ideal body norm for males, in contrast, is to be muscular and not skinny or weak. Rather than desiring weight loss and thinness, males want to gain weight and size from muscle.
Females perceive themselves as overweight even when they are not. For example, over half of college females believe they are overweight when a much lower percentage actually is. In addition, nearly three out of four college females of normal weight report their wanting to be thinner. This striving for thinness develops early. For example, girls as young as 6 years old choose as ideal image silhouettes of girls who are thinner than they are and already falsely think of themselves as overweight.
The ideal body type of thinness is also crucial to understanding the international distribution of eating disorders. Within developing countries, many people do not get enough to eat; only the affluent can afford to be fat or corpulent. So, fatness becomes a symbol of wealth and an ideal body shape. Therefore, eating disorders, with their fear of fatness, are unlikely. Further, the eating disorder of bulimia nervosa is less likely, due to the expense of buying large quantities of food for bingeing. Also, it seems improbable in a developing country that one would have anorexia nervosa, or deliberate self-starvation, when forced starvation is evident.
In contrast, in modern, industrialized nations, fatness no longer symbolizes affluence because people generally obtain enough to eat. In fact, it is possible to eat too much. Thus, being slim becomes a symbol of discretionary eating, and appearance ideals shift from plumpness to thinness. Affluent groups in particular have the resources to eat as much, as or little, as they want.
In the United States, whites compose most of the affluent classes, which helps to explain why eating disorders are more prevalent among whites. Also, larger-size body norms for women may be more prevalent among certain ethnicities, such as African Americans and Hispanics. Eating disorders are more common among individuals of color as they become more upwardly mobile, and among recent immigrants to the United States who experience acculturation.
Another major sociodemographic pattern in the occurrence of eating disorders concerns age. The teens and early 20s are the most reported ages of onset and prevalence. This time is one in which individuals form their identity and are quite vulnerable to peer group influences and appearance expectations. Problems with self-esteem also occur more often during this age period. Thus, manipulating one’s weight and being extra compliant with thin body norms are more likely occurrences in young age groups.
The Social Construction of Eating Disorders
The great majority of writings on eating disorders focuses on the medical and psychological dimensions of the conditions. This attention facilitates the belief that eating disorders require medical intervention and control, thus viewing anorexia nervosa and bulimia nervosa as illnesses or diseases that need to be treated by the medical profession. Such a construction of eating disorders promotes the medicalization of these conditions. Medical professionals become the experts in treating the conditions, and individuals who have eating disorders become patients. Examining cultural and societal context becomes secondary to medical testing and treatment, and eating disorders become another societal condition that the medical profession can claim as its own. Notably, both eating disorders are included in the Diagnostic and Statistical Manual of Mental Disorders with specific diagnostic features.
In the medicalization of eating disorders, attention is paid to the immediate, medical treatment of the problem and to medical and psychiatric etiology. Many hospitals now have special floors or wings for patients who have eating disorders and often remove these patients from family and friends while they receive psychiatric counseling and medical treatment.
Once released and away from this controlled environment, patients often relapse and find themselves back in the hospital. Other popular medical treatments are drug therapies to deal with the diagnosis of depression that often accompanies eating disorders, as well as with the reported obsessive and compulsive nature of the diseases.
Eating Disorders and Cultural Messages
In contrast to being viewed as grounded in biological processes, eating disorders can be seen as a mirror of culture. Several aspects of the sociocultural context perpetuate attempts to conform to the slim standard and facilitate the occurrence of eating disorders. The factors contributing to eating disorders are heavily engrained in the normative structure of society. Prominent among societal influences are the multimillion-dollar diet industry, the mass media, and role models.
Many women believe it is a role obligation to be visually attractive. On a given day in the United States, more than half of all women report that they are dieting; however, the main reason for dieting is cosmetic concerns, not health or fitness. Dieting has become a cultural preoccupation among females of all ages. Even among 10- and 11-year-old girls, nearly four out of five diet. Not surprisingly, a proliferation of weight-reducing centers and spas, as well as diet drugs, guides, aids, and plans, have emerged. As a weight loss measure, cigarette smoking has increased among teenage girls. Eating disorders represent extreme concern about body shape and weight and are thus extensions of slim body ideals. In fact, a history of dieting is common among anorexics and bulimics.
Concerning the mass media, magazine models are uniformly slim, and dieting and weight-control books and magazines are ubiquitous. Even women’s magazines not devoted to dieting offer a pervasive amount of food ads and articles on dieting and body shape. Such inclusion encourages weight control preoccupation, through the dual emphasis on eating and staying thin. Compared with men’s magazines, women’s magazines include a much larger number of food articles and ads, as well as ads and articles on dieting and body shape. Further, in television programs, most females are thinner than the average woman, and in contrast to males, few female characters are overweight.
Regarding the influence of role models, standards for women generally became less curvaceous in the latter part of the 20th century. Contestants in the Miss America pageant as well as Playboy centerfolds have less of an hourglass shape, which reflects an overall decrease in their bust and hip measurements. In addition, many winners of Miss America are thinner than the average contestant. Further, two thirds of Playboy centerfolds weigh 15 percent or more below expected weight for height, one of the criteria for anorexia nervosa.
Rather than focus on eating disorders as a medical problem, a critical examination would direct attention to the social conditions and cultural context that promote the genesis and maintenance of anorexia nervosa and bulimia nervosa. Eating disorders are most prevalent in societies that both visually objectify females and endorse pervasive, powerful industries and media that support a cult of thinness.
- American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders IV—TR. Washington, DC: American Psychiatric Association.
- Gordon, Richard A. 2000. Eating Disorders: Anatomy of a Social Epidemic. 2nd ed. Oxford, England: Blackwell.
- Morris, Anne M. and Debra K. Katzman. 2003. “The Impact of the Media on Eating Disorders in Children and Adolescents.” Paediatrics & Child Health 8:287-89.
- Sypeck, Mia Foley, James J. Gray, and Anthony H. Ahrens. 2004. “No Longer Just a Pretty Face: Fashion Magazines’ Depictions of Ideal Female Beauty from 1959 to 1999.” International Journal of Eating Disorders 36:342-47.
- Taub, Diane E. and Penelope A. McLorg. 2007. “Influences of Gender Socialization and Athletic Involvement on the Occurrence of Eating Disorders.” Pp. 81-90 in Sociological Footprints: Introductory Readings in Sociology, 10th ed., edited by L. Cargan and J. H. Ballantine. Belmont, CA: Thomson Wadsworth.
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