Post on 12-May-2023
Eating-style and weight-concerns in young females1
In this study, attitudes towards eating among adolescent school-girls were compared to those among fashion models and eating disorder patients. The results clearly demonstrate a preoccupation with body weight, even in school-girls. A majority of the girls indicated a wish to lose weight, even when the current Body Mass Index was between 20 and 25. Eating disorder patients more commonly reported premorbid overweight. Furthermore, fashion models tended to have an eating-style that was comparable to that of patients with eating disorders. The finding that the mean current body weight of all girls was lower than before suggests that many girls developed a restrained eating style. Vomiting, the use of anorectic drugs and laxatives, eating alone, and counting calories were reported by a substantial proportion of the adolescent girls. Moreover, a substantial proportion of the girls experienced a loss of control over eating. The combination of this eating-style and being overweight, can be considered as risk factor for the development of eating disorders. Introduction
The culture of slimming in Western societies creates an important and
increasing discrepancy between the real shape and the ideal shape (Garner,
Garfinkel, Schwartz, & Thompson, 1980). Preoccupation with body weight
and excessive concerns about body shape may induce eating patterns that
are similar to those of patients with eating disorders. It remains to be
demonstrated under which conditions such eating patterns develop into
eating disorders.
Dissatisfaction with body weight and shape are very common among
preadolescent and adolescent girls. It is particularly concerning that girls
who show relatively unhealthy baseline eating attitudes are more likely to
fit in the category of the partial syndrome of eating disorders (PSED) at
follow-up (Button & Whitehouse, 1981). While PSED is not inevitably
associated with the development of anorexia or bulimia nervosa, it can, at
the least, be regarded as similar to the first stage of Slade's (1987)
1 Vervaet, M., & van Heeringen, C. (2000). Eating Style and Weight Concerns in Young
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developmental model of eating disorders. The danger exists that any girl
who has reached this stage is prone to see low body weight and control as
rewarding, and that she will then go on to develop a more robust disorder as
a consequence.
Thus, cultural factors may be a necessary condition in the
development of eating disorders, or at least act as a facilitating factor,
especially as Western cultures also suggest that success and the approval of
others are solutions for problems (Wooley & Wooley, 1985). To be slim is
a symbol of beauty, sexual attractiveness, and success. Weight control is
considered synonymous with discipline, personal strength and willpower
(Noordenbos, 1990). Contemporary values such as perfectionism and
control and pressure on females to enhance their appearance induce social
stresses. The question remains: To what extent does such an internalisation
process remain adaptive, or proceed beyond a certain limit and develop into
psychopathology? Knowledge of psychological factors contributing to the
development of pathological eating behaviors is indispensable for the
identification of diagnostic criteria of the eating disorders.
This study compared eating styles and weight concerns among
schoolgirls, fashion models, and patients diagnosed as suffering from eating
disorders. The groups were chosen in order to assess the association
between eating behaviour, weight concerns, and eating disorders.
Method
Girls attending the fifth year of two large secondary schools participated in
this study (n=333). Questionnaires were filled in collectively. The
Females. Eating Disorders: The Journal of Treatment and Prevention, 8: 233-240.
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questionnaire was also sent to 20 fashion models of a national agency and to
40 patients with eating disorders (ED) admitted to the Department of Eating
Disorders (University Hospital Gent) in 1993 (31.0% anorectics in
treatment, n = 10; 62.5% bulimics of normal weight, n = 20; 6.3%
overweight (BMI > 25) bulimics, n = 2). Items in the questionnaire covered
age, weight, desired weight, educational level, presence of a boyfriend, use
of anorectic drugs and laxatives, weight and eating problems (defined as
self-criticism on weight and eating patterns, perceived excessive
bodyweight, or lack of control over eating), vomiting, eating-patterns,
thinking about eating (i.e. extent of preoccupation), eating alone (eating in
secret), counting calories, preference for sweet or salty foods, loss of
control, and the frequency (exceptional, sometimes, daily) and severity
(<500Kcal, 1000-2000 Kcal, >2000 Kcal) of this loss of control. Moreover,
the participants were asked to fill in the Dutch Eating Behaviour
Questionnaire (DEBQ; Van Strien, 1986) which consists of the following
subscales: emotional eating (eating elicited by emotional stimuli), restrained
eating (the tendency to eat to lose weight), and external eating (eating
elicited by external stimuli).
Statistical analysis was performed using SPSS 9.0, and included a
comparison of the characteristics between the schoolgirls, models and ED
patients, by means of chi-square analysis for nominal variables and non-
parametric tests for continuous variables.
Results
Questionnaires were returned by 333 schoolgirls (100 %), 11 fashion
models (55 %), and 32 ED-patients (80%). Table 1 shows mean values for
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age, weight, and body mass index (BMI= weight/length x length) in the
three groups.
Table 1: A Comparison of the Mean Values and Standard Deviation for Age, Weight and BMI Among Schoolgirls, Fashion Models, and ED-patients.
Schoolgirls Models ED n = 333 n = 11 n = 32 Mean (SD) Mean (SD) Mean (SD)
_____________________________________________________________ Age (years)1 16.8 (0.8)ab 19 (0.9)ac 24 (5.2)bc
Weight (kg)2 56 (6.4) 57 (3.5) 54 (12.6) BMI3 20 (1.9) 18 (1.O) 19 (4.1) 1One-way ANOVA, F = 262.8; (df = 2); p < .0001 post-hoc comparison (Bonferroni) a p < .000; b p < .000; c p < .000 2One-way ANOVA, F = .765; (df = 2); p = .466 3One-way ANOVA, F = 1.5444; (df = 2); p = .215
There was a significant difference between the three groups in mean age,
but not in mean weight and BMI.
Mean reported former weight was higher than mean current weight
in all three groups (Table 2).
Table 2: A comparison of the Mean and Standard Deviation in Highest Weight, Desired Weight, and Desired BMI among Schoolgirls, Models and ED-patients.
Schoolgirls Models ED n = 333 n = 11 n = 32 _____________________________________________________________ Highest weight1 58 (6.9)ab 61 (5.6)ac 66 (16.5)bc
Desired weight2 54 (5.5) 55 (1.9) 52 (7.7) Desired BMI3 19 (1.5) 18 (0.7) 19 (2.2)
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1One-way ANOVA, F = 12.9; (df = 2); p < .000 post-hoc comparison (Bonferroni) a p = .445; b p = .000 c p = .528 2One-way ANOVA, F = .1.2; (df = 2); p = .297 3One-way ANOVA, F = 2.5; (df = 2); p = .083
On the contrary, girls in the three groups indicated a desired weight that was
lower than the ideal BMI (63,5% of the schoolgirls want to lose weight, n =
212 versus 8,1% who want to gain weight, n = 27; 81,8% of the fashion
models want to lose weight, n = 9 versus 9,1% who want to gain weight, n =
1; 62,5% of the eating disorder group want to lose weight, n = 20 versus
21,9% who want to gain weight, n = 7). Mean reported highest weight was
significantly higher in ED patients than for the other groups. In the eating
disorder group 40.6% (n = 13) reported a premorbid overweight, in contrast
to 1,2% (n = 4) among the schoolgirls and 0% among the fashion models.
Significant differences between the three groups were found for
educational level and for reported weight and eating-problems (Table 3).
Table 3: A comparison of the frequency (%) of the Highest School Level, Relationship, Weight Problems, and Eating Problems Among Schoolgirls, Models and ED Patients. Schoolgirls Models ED X2 p-value _____________________________________________________________ Highest 74.4 27.3 62.5 20.120 0.000 school level Relationship 27.9 54.5 21.9 4.460 0.108 Weight 21.6 27.3 78.1 47.619 0.000 problems Eating 18.3 45.5 90.6 83.060 0.000 problems
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Fashion models had a lower educational level when compared to the other
two groups. Although the mean weight of attending schoolgirls was ideal,
nearly one in four indicated problems with their body weight. One in two
fashion models and one in five schoolgirls experienced eating problems.
No significant association was found between having a boyfriend and
belonging to one of the study groups. It is noteworthy that approximately
10% of the ED patients denied having eating problems.
Table 4 shows the results regarding the use of more drastic methods
to reduce body weight, i.e. anorectic drugs, vomiting, or laxatives. It was
found that 16 % of the schoolgirls used laxatives, compared to 36 % of the
models. Five percent of the schoolgirls used anorectic drugs, while 4 %
reported vomiting.
Table 4: A comparison of the Use of Anorectic Drugs, Vomiting and Laxatives Among Schoolgirls, Models, and ED patients. Schoolgirls Models ED X2 p-value % % % ___________________________________________________________ Drugs 4.8 0 15.6 6.500 0.100 Vomiting 3.9 0 37.5 52.34 0.000 Laxatives 15.9 36.4 46.9 20.83 0.000
Eating patterns also were compared between the three groups. As
shown in Table 5, no significant differences in 'skipping breakfast' and
'experienced loss of control over eating' were found.
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Table 5: Comparison of Eating Pattern Among Schoolgirls, Models and, ED Patients school-girls
% Models
% ED %
X2-test p-value
Skipping breakfast
10.2 18.2 21.9 4.419 0.100
Skipping lunch
2.1 9.1 9.4 6.936 0.030
Skipping dinner
1.2 9.1 9.4 14.67 0.001
Never eating between meals
13.2 27.3 34.4 0.000
Eating alone
23 90.9 62.5 44.03 0.000
Thinking about food
38.9 72.7 90.3 34.13 0.000
Counting calories
12 27.3 50 33.93 0.000
Loss of control
63 72.7 71.9 1.403 0.500
once a day (frequency)
6.3 12.5 30.4 9.885
0.007
>2000Kcal (amount)
21.1 42.9 47.8 6.636
0.030
However, the severity and especially the frequency of loss of control
differed significantly between the groups. ED patients showed more
frequent loss of control over eating and reported the ingestion of larger
amounts of food (in terms of Kcal). The significant character of the
differences regarding the other items was mainly due to a lower frequency
of disturbed eating patterns among the schoolgirls. However, even 12% of
the schoolgirls counted calories, 40% thought about food during the day,
and 23 % reported frequent eating while being alone.
Mean scores on the items of the Dutch Eating Questionnaire are
shown in Table 6.
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Table 6: Comparison of the Mean Scores and Their Standard Deviation on the Dutch Eating Questionnaire Among Schoolgirls, Models, and eating ED Patients. School-girls Models ED _____________________________________________________________ Restrained eating1 2.6 (0.9)ab 3.4 (1.0) ac 3.6 (0.9) bc Diffuse emotions2 2.8 (0.8) ab 3.4 (0.7) ac 3.3 (1.2) bc Clear emotions3 2.1 (0.7) ab 2.1 (0.7) ac 2.7 (1.2) bc Total emotions4 2.3 (0.7) ab 2.5 (0.4) ac 2.8 (1.1) bc External eating5 2.9 (0.5) ab 2.9 (0.5) ac 2.5 (0.7) bc 1One-way ANOVA, F = 16,1; (df = 2); p = .000 post-hoc comparison (Bonferroni) a p = .028; b p =.000; c p =1.000
2 F = .7,8; (df = 2); p = .000 a p = .058; b p =.003 c p =1.000
3 F = 8,7; (df = 2); p = .000 a p = 1.000; b p =.000; c p =.101
4 F = 16,1; (df = 2); p = .001 a p = 1.000; b p =.001; c p =.595
5;F = 16,1; (df = 2); p = .001 a p = 1.000; b p =.001; c p =.265 Significant differences (p = 0.001) in the occurrence of ‘restrained eating’,
‘emotional eating’ and ‘external eating’ were found between schoolgirls
and ED patients, but no significant differences were found between models
and ED patients. The mean score for ‘restrained eating’ was significant
lower for schoolgirls than that of the fashion models.
Discussion and conclusion
This study in a large group of young women suggests a substantial
preoccupation with body weight, not only in patients diagnosed with eating
disorders, but also in fashion models and in schoolgirls. The means of
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desired weight are lower in all three groups so we may hypothesize that a
majority of girls in this study wanted to lose weight, even when their
current BMI could be regarded as ideal. The eating pattern of fashion
models appears to resemble that of eating disordered patients. Schoolgirls
express severe concerns about their body weight, and one in four indicates
problems related to their body weight, although this apparently is not the
case in view of girls’ normal BMIs. The perceived problems induce
counting calories and a restrained eating style, albeit to a lesser extent than
in fashion models and eating disordered patients. The results also show that
fashion models do not report to suffer from an eating disorder in spite of the
fact that their eating patterns closely resemble those of eating disordered
patients. However, even one in ten ED patients does not report to suffer
from a disorder although she is currently being treated. In order to lose
weight models commonly report the use of laxatives while patients
additionally report vomiting. Finally, the results indicate that the highest
ever mean body weight was reported by the patients suffering from an
eating disorder. The finding of a premorbid overweight in eating disordered
patients is in keeping with the results from previous studies.
Two methodological aspects of this study should be addressed. First, the
schools were not randomly selected. Therefore, participating subjects
cannot be considered to be representative of the general population, and
may actually have an increased risk of developing an eating disorder as the
schools were only attended by girls who belonged to higher social classes,
who were obliged to wear uniforms, and who were confronted with a very
competitive spirit. Second, some questionnaires were not returned by the
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fashion models and the patients, so some results may be due to a selection
bias. The low response rate in the model group may be due to distrust or
lack of interest. The higher weight in models in comparison with the
schoolgirls may be due to the significant difference in mean age between
schoolgirls and fashion models. Finally, a number of schoolgirls and
models may have actually been suffering from an eating disorder.
Keeping these methodological limitations in mind, the findings from
this study indicate that the mean body weight in schoolgirls can be regarded
as ideal, as far as the body mass index is a correct index of body weight in
this age group. In any case, the results demonstrate that there are no severe
problems regarding body weight in this group of young females. However,
restrained eating, vomiting, and the use of anorectic drugs or laxatives
appear to be known as weight reducing strategies even among schoolgirls
and nearly one in five schoolgirls reports subjective problems with their
body weight and eating. Moreover, eating alone, thinking about food during
the day, counting calories and experiencing of a loss of control over eating
are commonly experienced. In view of a demonstrated association between
binge eating and psychopathology (Telch and Agras, 1994), the finding that
almost two-thirds of the schoolgirls report a loss of control over eating is
important. Six percent of the schoolgirls even report loss of control to occur
once a day, involving the ingestion of more than 2000 Kcal in more than
20%.
Equally important are the demonstrated similarities between patients
and fashion models, suggesting that the stronger the perceived pressure on
body weight, the higher the risk of developing an eating disorder might be.
The fact that the models do not consider themselves as suffering from a
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disorder may reflect the appreciation associated with their appearance, but
might also be due to a denial of the negative consequences of their job. In
view of the strong impact of pictures of models in fashion magazines (Field
et al., 1999) our current findings indicate the necessity of providing
information about potential negative consequences of a restrained eating
style to become underweight in terms of developing psychopathology. As a
conclusion, the results of this study suggest that being overweight during
adolescence is a risk factor for developing identity related problems in a
Western society with a slimming culture.
During the months following this study, 10 of the participating
schoolgirls attended the outpatient Department of Eating Disorders. Their
symptoms fitted the criteria for an eating disorder according to DSM-IV.
Thus, this study not only resulted in the detection of potential risk factors
for eating disorders among schoolgirls, but also may have lowered the
threshold for seeking treatment.
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References
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: APA. Button, E.J., Withouse, A.(1981). Subclinical anorexia nervosa. Psychological Medicine, 11, 509-516. Field, A.E., Cheung, L., Wolf, A.M., Herzog, D.B., Gortmaker, S.L., Colditz, G.A.(1999). Exposure to the Mass Media and Weight Concerns Among Girls. Pediatrics, Vol. 103, (3), 36-45. Garner, D.M., Garfinkel, P.E., & Olmsted, M.P.(1983). An overview of sociocultural factors in the development of anorexia nervosa. In: Darby, P.L., Garfinkel, P.E., Garner, D.M., & Coscina, D.V.(Eds.). Anorexia Nervosa. Recent Developments in Research (pp. 65-82). New York: Alan R. Liss. Garner, D.M., Garfinkel, P.E., Schwartz, D., Thompson, M. (1980). Cultural expectations of thinness in women. Psychological Reports, 47, 483-491. Noordenbos, G. (1990). Looking for the hidden identity behind a secret disorder. The recovery process of anorexia and bulimia nervosa. In: Petherson, G., Essed, Ph., & Richardson, D. (Eds.), Between Selfhelp and Professionalism ( pp.197-212). Amsterdam: The Moon Foundation The International Congress on Menthal Health Care for Women. Slade, P.D.(1987). Early recognition and prevention: Is it possible to screen people at risk of developing an eating disorder? In: D.Hardoff & E.Chigier (Eds). Eating Disorders in Adolescents and Young Adults. London: Freund. Telch, C.F., Agras, W.S.(1994). Obesity, Binge Eating and Psychopathology: Are They Related? International Journal of Eating Disorders, 15(1), 53-61. Van Strien, T., Frijters, J., Roosen, R., Knuiman-Mijl D., Defares, P.(1986). Eating behavior, personality traits and body mass in women. Wageningen, The Netherlands: Agricultural University . Wooley, S.C., & Wooley, O.W.(1985). Intensive outpatient and residential treatment for bulimia. In: Garner D.M. & Garfinkel P.E.(Eds.). Handbook of psychotherapy for anorexia nervosa and bulimia (p. 391). New York/London: Guilford Press.