Conventional wisdom says that anorexia nervosa is largely confined to white, affluent, Western women. Recent evidence suggests otherwise.
On July 5, 2000, BBC Online reported a study of female secondary students in rural Ghana which found that six out of 668 subjects showed signs of anorexia. The study was conducted by doctors from the University of Edinburgh, who screened the girls for height, weight, and other diagnostic criteria.
According to the article, the six who had anorexia-like symptoms said they dieted for religious reasons, especially in stressful situations, and to gain more self-control.
The BBC quotes University of Edinburgh psychiatrist Dr. Alan Carson as saying, “The girls did not present with symptoms of classical anorexia nervosa, but the study does suggest that perhaps it is not confined to the Western world.”
These results should be interpreted with caution. First, the effect is small–less than one percent. Secondly, Dr. Carson, according to the BBC, noted that it is inconclusive. Thirdly, although the subjects came from a variety of backgrounds, the article notes that they were not poor, and food was available to them. The study, therefore, did not address the question of whether anorexia can exist in the lowest socioeconomic strata.
In addition, the report did not discuss the health of the subjects. Ghana, a developing country in Northwest Africa, has a population of approximately 12 million. There are several parasites in that part of the world which, in large enough quantities, can produce anorexia nervosa, including hookworm and hymenolepiasis nana, the smallest common tapeworm capable of living in the human gut. For a further discussion of these and other diseases of the region, click here.
Still, the Ghana study is one of several in recent years that have challenged traditional notions about anorexia and race. In the United States, black women have usually been excluded from studies because of the assumption that the African-American community’s acceptance of larger figures protects its females from eating disorders1. However, a study of 613 white and black pre-adolescent girls at Wesleyan University in Middletown, Connecticut found that the black girls had a significantly greater drive for thinness than the white girls on four standardized measures and a three-day food diary2. The researchers note that the results are “provocative” because, statistically, black girls show more obesity and less anorexia than their white counterparts3.
The evidence seems to indicate, at least in the United States, that both white and non-white women who develop anorexia are influenced by similar factors. A computer-based literature search conducted at the Department of Family and Community Medicine at the University of Arizona came to this conclusion. In this study, the researchers found that eating disorders are equally common among white and Hispanic females, greater among Native American women, and less frequent among black and Asian-American women4. The investigators observed that minorities were at greater risk for developing eating disorders if they were younger, heavier, better educated, and identified more with white, middle-class values5. A brief literature review on the Something Fishy Website comes to similar conclusions.
Studies outside the United States also challenge the traditional notion that eating disorders are a white, Western girl’s problem. Researchers at the University of Capetown administered a questionnaire to 1,435 South African college students, 739 Caucasians and 696 non-Caucasians, from six universities in two large cities. According to the researchers, black students scored significantly higher on standardized measures of eating disturbances than the other ethnic groups tested6. In addition, the investigators found that a similar percentage of black and white females had scores within the clinical range for eating disorders7.
A paper from the University of Hong Kong, Shatin, hypothesizes that anorexics belong to an international social group found in many developing parts of the world8. It cites the “globalization of fat phobia,” increased affluence, and the spread of biomedical technology as factors influencing the proliferation of eating disorders throughout the planet9.
Clearly, more work needs to be done in this area. But the data presented are food for thought.