Denise E. Wilfley

The influence of sexual orientation on body dissatisfaction in adult men and women

OBJECTIVE Whereas gay cultures presumed emphasis on physical appearance may potentiate body dissatisfaction, lesbian cultures seeming lack of emphasis on appearance may protect against body dissatisfaction. We examined body dissatisfaction, associated psychosocial variables, and affiliation with the gay and lesbian community. METHOD Self-report measures were administered to 257 subjects (69 lesbians, 72 heterosexual women, 58 gay men, and 58 heterosexual men). RESULTS Compared with heterosexual men, gay men reported significantly more body dissatisfaction and more distress in many of the psychosocial areas related to body dissatisfaction. In contrast, lesbians and heterosexual women did not differ in these areas. Although affiliation with the gay community was associated with body dissatisfaction in gay men, affiliation with the lesbian community was unrelated to body dissatisfaction in lesbians. DISCUSSION It seems that aspects of the gay community increase vulnerability to body dissatisfaction, yet the values of the lesbian community do not seem to be protective against body dissatisfaction.

Teasing, body image, and self-esteem in a clinical sample of obese women☆

This study examined the relationship of physical-appearance-related teasing history to body image and self-esteem in a clinical sample of adult obese females. The frequency of being teased about weight and size while growing up was negatively correlated with evaluation of ones appearance and positively correlated with body dissatisfaction during adulthood. Self-esteem was unrelated to teasing history but covaried significantly with body image measures. Subjects with early-onset obesity reported greater body dissatisfaction than did subjects with adult-onset obesity. The findings suggest that being teased about weight/size while growing up may represent a risk factor for the development of negative body image and that self-esteem and body image covary.

Binge eating in an obese community sample

OBJECTIVE The present study sought to examine the validity and utility of diagnostic criteria for binge-eating disorder (BED) by replicating and extending a study reported by de Zwaan and colleagues (International Journal of Eating Disorders, 15, 43-52, 1994). METHOD Four groups of obese individuals were selected from a large community-based sample of men and women: 33 women and 20 men with BED, 79 women and 40 men with subthreshold BED, 21 women and 39 men who reported recurrent overeating, and 80 female and 80 male normal controls. The groups were compared on measures of body image concern, dieting behavior, and associated psychological distress. RESULTS Individuals with BED were distinguishable from overeaters and normal controls on a number of psychological and behavioral variables. Few differences were found between subthreshold and full-syndrome BED, raising questions about the diagnostic validity of the frequency threshold. Men with BED did not differ from women with BED above and beyond the gender-related differences observed across all four groups. DISCUSSION Our findings support the view of BED as a distinct syndrome.

Eating disturbance and body image: A comparison of a community sample of adult black and white women

OBJECTIVE This study examined racial differences in eating disorder symptomatology in a community-based sample of middle-aged adult Black and White women and investigated predictors of body image dissatisfaction in these two different racial groups, since most research has focused on young adult White women. METHOD Subjects (538 Black and White women) completed the Eating Disorder Inventory and measures of social pressures about thinness and negative attitudes about overweight. RESULTS Black and White women reported comparable levels of eating disturbance. However, after controlling for degree of overweight, White women had significantly greater rates of body dissatisfaction than Black women. Nonetheless, both racial groups reported considerable body image dissatisfaction and similar factors were found to predict body dissatisfaction for Black and White women. DISCUSSION Our data and other recent data indicate that eating disturbance occurs across a much broader age, race, and socioeconomic distribution than previously suspected. Research implications are discussed.

Relationship of weight, body dissatisfaction, and self‐esteem in African American and white female dieters

OBJECTIVE The present study examined the relationship among weight, body dissatisfaction, and self-esteem in a large group of African American and white female dieters who were generally overweight and of middle to high socioeconomic status. METHOD Subjects were participants in a survey of dieting practices undertaken by Consumer Reports magazine. Major outcome measures included the Rosenberg Self-Esteem Scale and an assessment of shape and weight attitudes. RESULTS No significant differences between African American and white women were found for body dissatisfaction, self-esteem, discrepancies between actual and ideal weight and shape, or the relationship between self-esteem and body dissatisfaction. Body mass index contributed less to body satisfaction scores in African American than in white women. DISCUSSION This study provides a comparison of African American and white women in the upper social classes, and raises the possibility that previous findings of less body concern in African American women reflect class rather than race effects.

Age of onset for binge eating : Are there different pathways to binge eating ?

OBJECTIVE In examining individuals with binge eating disorder (BED), we aimed to determine whether their binge eating preceded their first diet or their first diet preceded their binge eating, the age of their first diet, the age of their first binge, and the age when they met DSM-IV criteria for BED. Additionally, we aimed to identify psychological factors that may distinguish the two groups. METHODS Eighty-seven individuals with BED (19 men and 68 women) were administered the Eating Disorders Examination, the Structured Clinical Interview for DSM-III-R, and several other measures of psychological functioning and psychiatric disturbance. RESULTS Forty-five percent of the subjects reported that dieting preceded their first binge episode (dietfirst) and 55% reported that binge eating preceded their first diet (bingefirst). There were no significant differences in current eating disturbance, body mass index (BMI), or age for these two groups, but they differed on the age of the first episode of binge eating and the age when binging met BED criteria. The group reporting having binged first had a younger age of onset of binge eating and a younger age at which binge eating met diagnostic criteria than the dietfirst group. The bingefirst group also had a history of more psychiatric problems and were more likely to have an Axis II personality disorder. DISCUSSION Age of onset of the first binge and BED is markedly different depending on whether an individual began dieting or binging first. These findings suggest that there may be important etiological differences between individuals who binge first and those who diet first. Moreover, individuals who binge first may be at greater risk for psychiatric disturbance.

Drive for thinness in black and white preadolescent girls

This study examined racial differences in drive for thinness, a motivational variable implicated in the etiology of eating disorders. Subjects included 613 black and white preadolescent girls from one of three National Heart, Lung, and Blood Institute (NHLBI) Growth and Health Study centers. Instruments included the Drive for Thinness Scale, a Criticism about Weight scale, the Self-Perception Profile for Children, a Sexual Maturation index, and 3-day food diaries. Black girls reported significantly greater drive for thinness than white girls. Drive for thinness was significantly associated with adiposity in both groups; additional predictors included criticism about weight for black girls and dissatisfaction with physical appearance for white girls. Correlations between drive for thinness and nutrient intakes were not significant. The finding of a greater drive for thinness among young black girls is provocative, given the higher prevalence of obesity and the lower prevalence of anorexia nervosa among black women. Longitudinal follow-up will examine the significance of drive for thinness in the development of weight and eating disorders in this cohort.

Comparison of men and women with binge eating disorder

OBJECTIVE This study examined gender differences in individuals with binge eating disorder (BED) on eating-related psychopathology and general psychological functioning. METHOD Subjects were age-matched men (n = 21) and women (n = 21) with BED who were administered the Eating Disorders Examination (EDE), the Structured Clinical Interview for DSM-III-R (SCID) and SCID II, and who completed the Emotional Eating Scale (EES) and other questionnaires regarding psychological functioning. RESULTS Men and women did not differ on measures of eating disturbance, shape and weight concerns, interpersonal problems, or self-esteem, but more men than women met criteria for at least one Axis I diagnosis and had a lifetime diagnosis of substance dependence. Women were more likely to report eating in response to negative emotions, particularly anxiety, anger and frustration, and depression. DISCUSSION Results from our study suggest that while men and women presenting for treatment for BED are very similar, males may have more Axis I psychiatric disturbance and less emotional eating than their female counterparts. These findings are discussed in terms of the role of gender in BED and possible treatment implications are explored.

Binge Eating Among the Overweight Population: A Serious and Prevalent Problem

Obesity is a major public health problem in the United States and is now recognized as a heterogeneous condition. This suggests that treatment effectiveness may be improved with an increased understanding of the multiple factors contributing to obesity. Recent data clearly indicate that one common and serious factor among a subset of the overweight population is binge eating. Dietitians in research settings, clinical settings, or private practice are likely to treat obese patients who are seeking weight-related treatment. This article provides an overview of current knowledge about obese persons who binge eat and recommends that dietitians who treat patients for weight-related conditions take a proactive role by screening them for binge eating problems or, at a minimum, screen those who are suspected of binge eating and then refine treatment approaches accordingly.

Self-directed hostility and family functioning in normal-weight bulimics and overweight binge eaters

The aim of this study was to examine whether overweight binge eaters demonstrate similar perceptions of family interactions and views of the self as do normal-weight bulimics. We compared 37 obese binge eaters and 37 normal-weight bulimics to 38 normal-weight non-bulimic controls, and 10 overweight nonbulimic controls on the Bulimia Test (BULIT). Profile of Mood States (POMS), Structural Analysis of Social Behavior (SASB) Short Form, which includes measure of hostility of family interactions and self-directed hostility; the Family Interaction Survey (FIS), and a measure of history of physical and sexual abuse and familial psychopathology. Both normal-weight bulimics and overweight binge eaters differed from nonbulimic controls across all measures of symptomatology, family functioning, history of abuse, familial psychopathology, and self-directed hostility. Normal-weight bulimics demonstrated significantly higher BULIT scores and self-directed hostility than did overweight binge eaters. Post hoc analysis showed that among binge eaters and bulimics, self-directed hostility accounted for a significant percentage of the variance of BULIT scores when controlling for the effects of age, BMI, family hostility, and mood. The possible role of self-directed hostility in the maintenance of bulimic symptomatology is discussed.