Predictors of body image dissatisfaction and disturbed eating attitudes and behaviors in African American and Hispanic girls
Introduction
Unhealthy eating habits, including symptoms of eating disorders, are widespread among girls in the United States (Centers for Disease Control, 1999). Of children in Grades 5–8, 13.3% of children in one study met criteria for an eating disorder not otherwise specified according to a prescreening and interview procedure (Childress, Brewerton, Hodges, & Jarrell, 1993). Although Caucasian and Hispanic girls may be at greater risk for bulimia nervosa Adams et al., 1993, Lachenmeyer & Muni-Brander, 1988, Snow & Harris, 1989, Story et al., 1995, African American girls may be at equal or greater risk for binge eating disorder (Childress et al., 1993). Although no large-scale community-based studies have examined prevalence rates of bulimia nervosa and binge eating disorder among African American and Hispanic children, concern has been expressed that these children may be at greater risk than Caucasian children due to their greater prevalence and degree of overweight (Pike & Walsh, 1996).
Obesity is one of the leading risk factors for eating disorder development (Fairburn, Welch, Doll, Davies, & O'Connor, 1997) and longitudinal research supports the role of obesity as a dispositional variable in the etiology of eating disorders (Thompson, Coovert, Richards, Johnson, & Cattarin, 1995). Preliminary results from the 1999 National Health and Nutrition Examination Survey show that 22% of children between 6 and 11 years of age are overweight and that an additional 10.9% are obese (Troiano, Flegal, Kuczmarski, Campbell, & Johnson, 1995). African American and Hispanic children are at high risk with the prevalence of obesity increasing from approximately 19% at Age 5 to 33% by Age 17, rates much higher than among Asian and Caucasian children (Dounchis, Hayden, & Wilfley, 2001). Childhood obesity places children at risk for a variety of adverse health outcomes including elevated blood pressure, dyslipidemia, insulin resistance, and Type 2 diabetes (Deckelbaum & Williams, 2001). In light of the increasing prevalence of obesity in youth Nicklas et al., 2001, Troiano et al., 1995, it becomes increasingly important to understand the associations between being overweight and developing an eating disorder.
One of the leading mechanisms thought to explain the association between being overweight and the development of eating disorders is body image dissatisfaction (Leon, Fulkerson, Perry, & Cudeck, 1993). One longitudinal study showed that over a 2-year time period, baseline body dissatisfaction was a significant predictor of eating disturbances at follow-up (Attie & Brooks-Gunn, 1989). Likewise, a 2-year study comparing dancers and nondancers showed that eating disturbances at follow-up among dancers were most strongly predicted by baseline body image dissatisfaction, followed by baseline eating disturbances (Brooks-Gunn, Attie, Burrow, Rosso, & Warren, 1989). Among nondancers, a baseline eating disturbance was the best predictor, followed by body image dissatisfaction, although the latter accounted for relatively little of the overall variance. Finally, the data from two 3-year studies were consistent with structural equation models positing body image dissatisfaction as a precursor of eating disorder development Cattarin & Thompson, 1994, Thompson et al., 1995.
A second promising predictor of disordered eating development is sensitivity, or an unwarranted and excessive awareness and sensitivity to the feelings and actions of others Boyce & Parker, 1989, Steiger et al., 1999, Striegel-Moore et al., 1993. According to Atlas (1994), sensitivity to criticism includes an increased likelihood of perceiving criticism and of experiencing a negative emotive response to the perceived criticism. Girls who are more sensitive may be more likely to endorse being teased and to report a greater negative emotional impact (Atlas, 1994). Among Caucasian children, sensitivity is associated with body image dissatisfaction (Vander Wal & Thelen, 2000).
Results from research on the association between teasing and body image dissatisfaction and eating disorder development show that perceptions of teasing and the emotional impact of teasing, possible manifestations of excessive sensitivity, are associated with body image dissatisfaction and eating disturbances. For example, a 3-year longitudinal study found that girls' perceptions of teasing about weight and size at baseline predicted the development of eating disturbances at follow-up Cattarin & Thompson, 1994, Thompson et al., 1995. Similarly, Oliver and Thelen (1996) found that children's perceptions of peer influence were associated with eating and body image concern. The observation that the emotional impact of teasing is more strongly associated with eating disturbances than teasing frequency (Taylor et al., 1998) suggests that the degree to which teasing is emotionally hurtful is more important than the amount of teasing actually received.
A third promising predictor of disordered eating development is poor coping skills. Coping styles are a predictor for body image dissatisfaction that may lead to future eating disorders in college women Koff & Sangani, 1997, Mayhew & Edelmann, 1989. There are two broad categories of coping strategies: problem-focused and emotion-focused coping. Among adult women, the use of emotion-oriented coping is strongly associated with negative body image (Koff & Sangani, 1997). In a study conducted by Garcia-Grau, Fuste, Miro, Saldana, and Bados (2002), women who have poor coping skills, such as avoiding problems or ignoring their feelings, are more likely to develop eating disorders than women with healthy coping strategies. However, the relationship between coping and body image dissatisfaction and eating disturbances is not documented in children. In general, the literature suggests that avoidance or emotion-focused coping strategies are associated with increased distress and behavior problems among children, while problem-focused or active coping strategies are associated with positive behavioral outcomes Compas et al., 2001, Compas et al., 1996. These studies suggest that further investigation of the association between coping and body image dissatisfaction and disturbed eating attitudes and behaviors among girls is needed.
To date, the associations between disturbed eating attitudes and behaviors, body image dissatisfaction, weight classification, and fears of negative evaluation have been examined among largely Caucasian groups of children. The relationships between disturbed eating attitudes and behaviors, body image dissatisfaction, and coping skills have not been investigated among children. Hence, the purpose of the present study is to (a) compare the disturbed eating attitudes and behaviors, body image dissatisfaction, weight classification, fears of negative evaluation, and coping skills of African American and Hispanic girls in Grades 4 and 5; (b) determine the associations among these variables; and (c) compare girls with probable eating disorders to those without probable eating disorders on these variables.
Section snippets
Participants
One hundred thirty-nine girls in Grades 4 and 5 from two inner-city public schools were recruited for participation. One school was chosen because of its location in a predominantly African American section of the city whereas the other school was chosen because it was located in a largely Hispanic section. The socioeconomic status of the two schools' systems is highly similar with median income levels of US$12,143 and US$13,689, respectively (1990 U.S. Census Data). The participation rate at
Preliminary analyses
An analysis of variance was conducted to determine whether there were any significant differences between grades or between African American and Hispanic girls on disturbed eating attitudes and behaviors, body image dissatisfaction, weight classification, fear of negative evaluation, cognitive behavioral problem solving, or cognitive avoidance. Results showed a significant main effect of school for body image dissatisfaction, F(1,116)=13.19, P<.001, with African American girls having less body
Discussion
This is the first study to examine the associations among disturbed eating attitudes and behaviors, body image dissatisfaction, weight classification, fear of negative evaluation, and coping skills in African American and Hispanic girls. It is essential to identify and document the levels of body image dissatisfaction and the prevalence of disturbed eating attitudes and behaviors in these groups to dispel the myth that eating disorders are limited to Caucasian populations. It is equally
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