Research on the etiology, prevalence and treatment of eating disorders (ED) in diverse and minority populations is severely lacking. Eating disorder and body image (BI) research in general is under-funded and therefore under-studied, and most of the research done on eating disorders is done on cisgender, straight white women in their adolescence or young adulthood. The following information is what research suggests are emerging trends and findings on eating disorders and body image disturbance in diverse populations.
It’s estimated men account for 10-15% of eating disorder diagnoses yet continue to face tremendous stigma regarding eating and body image concerns. Binge eating disorder is the most common eating disorder in men, although all eating disorders are certainly under- and mis-diagnosed in men.
The concept of “muscle dysmorphia”, while not a clinical diagnosis, is a term often used when discussing men with eating disorders/body image concerns and refers to a desire to increase muscle size/mass in an attempt to influence body weight/shape. It was first termed “reverse anorexia nervosa” in 1993. The relationship between body dysmorphia and muscle dysmorphia is under-studied.
- Men feel too heavy at 130% of their ideal body weight (IBW) while women feel too heavy at 90% of their IBW
- Men are more concerned with their body shape than their body weight (i.e. may be more concerned with their body fat percentage than their scale weight)
- Men exhibit a drive for muscularity rather than a drive for thinness
- Compulsive and excessive exercise is more common as a symptom in men
- It is an (insidious) myth that men with eating disorders are gay
According to the National Eating Disorder Association, 1/3 of inpatient hospital admissions for specialized eating disorder treatment in 2003 were people 30 years of age or older. It is commonly thought that eating disorders and body image disturbance occur primarily in adolescent and young adult women, which is simply untrue. The average age of a client receiving treatment at The Center for Balanced Living in Columbus, Ohio is 38 years old.
- Eating disorders and body image disturbance are pervasive across the lifespan and body image dissatisfaction during midlife doubled from 1972 to 1997
- Midlife precipitating events include financial stress/unemployment/retirement, “empty nest” or “bounce back” children, infidelity, illness, perimenopause (under-studied biological factor), death of a loved one and trauma.
Race & Ethnicity
Relatively little research has been done on eating disorders and body image disturbance in ethnic and cultural minority groups — attributed to the long-standing myth that these issues affect only White women. Many studies lump a variety of non-White ethnic/cultural groups into one category and obscure ethnic group differences.
- Non-White women and girls are “insulated” against unhealthy body image and eating disorders due to non-White cultures valuing different body types that are more attainable for women
- Other studies have found that as non-White groups are acculturated into mainstream U.S. culture, non-White groups’ risks for ED and BI dissatisfaction look similar to the majority population
- All ethnic groups are eventually exposed to the far-reaching, mainstream media thin-ideal and unrealistic standards of beauty
- The Minnesota Adolescent Health Study found that dieting was associated with weight dissatisfaction, perceived overweight, and low body pride in all ethnic groups
- The chronic stress of trying to assimilate into a dominant culture while being devalued by the dominant culture, make ethnic minorities vulnerable to eating disorders
Like other minority and diverse populations, research in this area is scant and conflicting. It is probably accurate to conceptualize eating disorders and body image disturbance in this population a hidden epidemic.
- There may be similar prevalence of eating disorders amongst heterosexual, bisexual and lesbian women
- GENERALLY speaking, gay men:
- idealize a thinner body size
- are more concerned about their weight
- are more afraid of becoming fat than straight men
- share the drive for muscularity with straight men
- However, subcultures exist within the LGBT community and not all emphasize thin body types
- Contributing and complicating factors in this population include:
- Coming out
- Internalized negative messages about LGBT, non-conforming gender expression or sexuality
- Violence and PTSD
- Gender dysphoria
- Homelessness (especially youth)
- Lack of family/social support
- Subcultures within the LGBT community
- Access to services and culturally-competent providers who understand the intersection of these identities and concerns