A True Picture of Eating Disorders Among African American Women: A Review of Literature

The exclusion of women from prominent research studies, such as research on heart disease, cancer, and aging, has been well documented. This exclusion has resulted in the development of research and clinical studies, which specifically concentrate on women. When examining studies conducted on eating disorders, there is a major focus on infants, children, and adult women, Caucasian women. There is a deficit of research studies, which evaluate the prevalence of eating disorders among African-American women. Upon evaluation of the literature, there is reason to question if a true picture of eating disorders among African-American women has been identified.

Principles and Practice of Psychiatric Nursing (Stuart & Laraia, 2001) defines eating disorders as the use of food "... to satisfy unmet emotional needs, to moderate stress, and to provide rewards or punishments". Further, "the inability to regulate eating habits and the frequent tendency to overuse or under use food interferes with biological, psychological, and sociocultural integrity" (Stuart & Laraia, 2001, p. 526-527). Anorexia nervosa, bulimia nervosa, and binge eating disorder are illnesses associated with maladaptive eating regulation responses and are most commonly seen in women. Decisive factors for anorexia nervosa established by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) include extreme weight loss, fear of fat, and loss of menstruation. Bulimia nervosa is defined by self-esteem that is unduly influenced by weight and shape and both binge eating and inappropriate compensatory behaviors (e.g., self-induced vomiting) at specified frequencies. Binge eating disorder not otherwise specified (EDNOS) is appropriate for "disorders of eating that do not meet the criteria for any specific Eating Disorder" (American Psychiatric Association, 1994, p. 550). DSM-IV (1994) lists six examples of EDNOS, including meeting all the criteria for anorexia except loss of menstruation, meeting all the criteria for bulimia except frequency, use of inappropriate compensatory behaviors after eating small amounts of food, and binge eating in the absence of inappropriate compensatory behaviors (binge-eating disorder). Eating disorders in the United States is experienced about the same among Hispanics and whites, is more common among Native Americans, and is less common among blacks and Asians (Stuart & Laraia, 2001). Because many women do not meet diagnostic criteria, yet are symptomatic by occasionally engage in behaviors characteristic of eating disorders, including self-induced vomiting, use of laxatives, and binge eating, it is important to evaluate women who are symptomatic of eating disorders.

In "Prevalence of Eating Disorders Among African American Women" (Mulholland & Mintz, 2001), a significant study was conducted at a large public university in the Midwestern United States that identified two percent (2%) of African American women participants as eating disordered. In contrast, "A Comparison of Black and White Women With Binge Eating Disorder" (Pike, Dohm, Stiegel-Moore, Wilfley, & Fairburn, 2001) evaluates differences in Caucasian and African American women with an eating disorder; the research showed that the women differ in all aspects of binge eating disorder. Further inspection of these clinical studies is necessary to evaluate whether eating disorders in African American women exists, and whether significant support is available to identify prevalence of eating disorders among this subgroup.

Even though very few studies have been conducted on African American women and eating disorders, there is a significant push to cover the prevalence of eating disorders among minority women. Amy M. Mulholland, and Laurie B. Mintz (2001) conducted a survey to examine the effect of maladaptive eating regulation responses among African American women. Their study's purpose was "... to examine prevalence rates of anorexia, bulimia, and especially EDNOS" as well as ..." prevalence rates for women considered symptomatic (i.e., those that had some symptoms but no actual disorders)" (Mulholland & Mintz, 2001). The sample of the survey was obtained from African American females attending a predominantly Caucasian university in the Midwestern United States. The results of the survey was reported in "Prevalence of Eating Disorders Among African American Women" (Mulholland & Mintz, 2001) and identified that two percent (2%) of the 413 viable participants were classified as eating disordered with all of the eating disordered women having one of the four types of EDNOS. Twenty-three percent (23%) of non-eating disordered participants were symptomatic and seventy-five percent (75%) were asymptomatic. The findings are reflective of a group of African American women who are a minority in their environment.

According to The Journal of Blacks in Higher Education (2002), which collects statistics bearing on the relative status of blacks and whites, the number of African Americans enrolled in college was 1,640,700 in 1999. Currently, African Americans represent only eleven percent (11%) of all undergraduates (U.S. Department of Education). Therefore, a true representation of the sample of African American women in the Mulholland & Mintz study is minimal to the broader population of African American women in the United States. The study does recognize "... findings of less eating-disorder symptoms among African American women at predominantly Black versus predominantly Caucasian universities" (Gray et al., 1987; Williams, 1994), but without acknowledging the probable effects of acculturation of those women surveyed. If the African American women surveyed sought to assume the values, attributes, and behavior of their Caucasian peers in order to become an accepted members of the culture, in this case the University, then how can a true prevalence of the eating disorders among the African American subgroup be identified? The small percentage of African American women identified as being eating disordered (2%) and those non-eating disordered participants identified as symptomatic (23%) may have been influenced by the activities of their Caucasian peers who are eating disordered.

The study excludes external influences that African Americans face; it does not address the day-to-day discrimination African American women face in American society. Further study is needed to examine how stressors such as racism, classism, and sexism influence maladaptive eating regulation responses among African American women and other minorities. As the study implies, there is vast emerging literature on the unique factors associated with eating disorders among African Americans women, which needs to be shared with young women.

As "A Comparison of Black and White Women With Binge Eating Disorder" (Pike et al., 2001) has identified when surveying women diagnosed with binge eating disorder, African American women reported less concern with body shape, weight, and eating than their Caucasian counterparts. This study identified that African American culture impacts attitudinal concern of body image among African American women; African American society is more accepting of larger body shapes and less concerned with dietary restraint. The women recruited for the study were limited; "exclusion criteria were age over 40 and under 18 years, physical conditions know to influence eating habits or weight, current pregnancy, presence of psychotic disorder, not being white or black, or not being born in the United States" (Pike et al., 2001). The study identified that the African American women surveyed experienced higher weight and more frequent binge eating; however, sources of the stressors which stimulate binge eating was not identified. An evaluation of degree of acculturation and other stressors such as racism, classism, and sexism on African American women and their eating disorder was identified by the study as an area of further investigation though not evaluated in the comparison.

Women have been consistently excluded from research studies, and the impact of this phenomenon on African American women is substantial. African American culture is steeped in family and has a strong matriarch thread. African American women are demonstrative and favor conveying love through food. Meals and times of breaking bread are avenues of socialization in African American families and communities.

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As African Americans enter mainstream American via work and school, the acculturation phenomenon invades the most sacred of African American culture--food. The prevalence of eating disorders among African American women has not reached epidemic proportions; however, the potential is there. African American women face stressors tri-fold; racism, classism, and sexism have long been recognized as stressors unique to African American women compared to their Caucasian counterparts. The research must then follow to examine how African American women respond, and if maladaptive eating regulation responses are identified then counseling programs need to be available to African American women--the barriers to healthcare must be superceded to empower African American women to nourish future generations of physically sound men and women.

by Indira D. Tyler

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