Disordered eating patterns have existed on some level for centuries (Bemporad, 1996), but
the research indicates an increase in this phenomena in the latter part of
the 20th century, especially in the early 1980's (Hawkins, Fremouw, and Clement, 1983). Young
adolescent and college females have been considered one of the
highest risk categories. Some authors believe that early studies regarding eating disorder
prevalence contained flawed methodology (Fairburn and Belgin, 1990;
Crowther, Wolf, and Sherwood, 1992) and, consequently, produced a wide range of estimates for
young adult women. Some reported 5 percent to 90 percent with
eating disorder symptoms (Bemporad, 1996), while others focused on bulimia nervosa, reporting
8 to 19 percent of university women being affected (Pyle,
Halvorson, Neuman, and Mitchel, 1986; Halmi, Falk, and Schwartz, 1981). Although later studies
with more stringent guidelines and sampling methods have
actually indicated the prevalence of bulimia to be less than 5 percent and probably closer to 1-2
percent (Drewnowski, Yee, and Krahn, 1988; Schotte and Stunkard,
1987), some research still reports extremely high estimates-- claiming bulimia to be as high as 20
percent among college populations (Kessler, Gilham, and Vickers,
1992) and stating that over 90 percent of college women having symptoms of binge eating
(Streigel-Moore, Silberstein, Frensch, and Rodin, 1989).
Many recent studies are showing an increase in disordered eating patterns (Eagles, Johnston,
Hunter, Lobban, and Millar, 1995; Hoek, et al., 1995) while one study
has shown a decrease in the past ten years. This study indicated a drop in bulimia nervosa from
7.2 percent to 5.1 percent for women and 1.1 percent to .4 percent
for men. In addition, there were significant declines in almost all measures regarding problematic
eating behaviors, and disordered attitudes about body, weight and
shape (Heatherton, Nichols, Mahamedi and Keel, 1995). Although not a comparison study, the
most recent national comprehensive study of college students also
revealed lower percentages for disordered eating behaviors. To lose weight or prevent weight
gain, 2.6% of the college students surveyed had either vomited or
taken laxatives in the last thirty days and 4.3% had taken diet pills in the last thirty days (Centers
for Disease Control and Prevention, 1997).
To lose weight or prevent weight
gain, 2.6% of the college students surveyed had either vomited or taken laxatives in the last thirty
days and 4.3% had taken diet
pills in the last thirty days
|
Some subpopulations of the university community are considered at higher risk for disordered
eating patterns than others, namely female athletes and women in
sororities. The evidence supporting this idea, however, is discrepant. Some evidence exists that
athletes' preoccupation with body size and eating patterns are in
direct correlation with their involvement in a lean body type sport (such as swimming or
gymnastics) versus a sport that improved performance does not require
such a physique (Sungot-Borgen, 1994; Beals and Manore, 1994; Davis and Cowles, 1989).
Conversely, other studies show no difference between lean-sport
athletes, regular athletes, and non-athletes. (Ahsley, Smith, Robinson, and Richardson, 1996;
Warren, Stranton, and Blessing, 1990). Meilman, van Hippel and
Gaylor's and Crandall's studies (as cited in Schulken, et al., 1997) examining sororities, disordered
eating and dissatisfied body image have shown some relation
between these three components. However, this issue have not been extensively studied and has
been considered a serious omission given the large percentage of
women involved in the Greek system (Schulken, et al., 1997).
Another factor affecting disordered eating patterns is ethnicity. Hispanic Americans females
typically present an equal number of disordered eating patterns
compared to Caucasian Americans (Crago, Shisslak, and Estes, 1996); whereas, Black American
females usually have a lower body dissatisfaction and fewer
disordered eating patterns than Caucasians (Ashley, et al., 1996, Crago, et al. 1996). Some
researches have found that black women and girls often consider large
body types attractive, discuss beauty in terms other than physical (Flynn and Fitzgibbon, 1996)
and have more flexible ideals about attractiveness (Parker, et al.,
1995).
With the abundance of conflicting data concerning prevalence rates, this study sought to
determine the disordered eating habits of the specified population. In
addition, the participants' perceptions about their body shapes were explored. With the results of
this study, the researchers plan to develop more effective
prevention and intervention programs concerning eating disorders and body image for this
population.
The study used a quantitative, one-shot case study research design. The purpose of this study
was to document disordered eating patterns and prevalence rates to
accurately assess the extent of the problem and compare prevalence rates of this specific
population to national averages. The Boynton Health Service Student
Health Survey (Meath, 1996) was adapted to create the GSU Undergraduate Student
Health Risk Appraisal Survey. The instrument consisted of 98 total
questions. The Disordered Eating Subscale consisted of 19 total questions: 11 self-reported
behaviors, 3 perception questions, 1 calculated variable (BMI) and 4
demographic determinants.
In Winter Quarter 1997, a survey was administered to undergraduate college students at a
major university in the Southeastern United States. A systematic
probability sampling technique for this study involved a randomized stratified sample of college
students. Total number of participants was 320. Sample size was
determined by minimum sample size to test for level of significance determined by population
parameter (Issac & Micheal, 1993).
Randomized stratification was achieved by systematic sampling of a cross section of intact
undergraduate classes currently enrolled at the university. Institutional
Review Board (IRB) granted approval of the study contingent on strict adherence to maintaining
participants' anonymity. Some questions elicited information on
activities that could be self-incriminatory, thus professors were not allowed to view documents
and surveys were destroyed upon completion of data analysis.
Representatives of the Health Education Office visited the randomly generated courses,
distributed the surveys with envelopes to participants and collected the
sealed completed instruments. Instrument completion time ranged from 12-15 minutes. Body
Mass Index (BMI) was subsequently calculated by the researchers
from self-reported data of height and weight.
The Disordered
Eating Subscale consisted of 19 total questions: 11 self-reported behaviors, 3 perception
questions, 1 calculated variable (BMI)
and 4 demographic determinants.
.
|
Validity and Reliability
The GSU Undergraduate Student Health Risk Appraisal Survey was piloted
tested in Winter Quarter 1997 (n=50) among like students in an environment that
would match study conditions (for copies of the instrument, please contact Sara Oswalt or Helen
Welle-Graf). Consensual content validity was obtained through a
panel of experts and the pilot study. The series of questions and checklists were demonstrated to
accurately measure behavioral patterns and perception of this
population. Reliability for this study was ascertained by calculating Cronbach Alpha. Cronbach
Alpha determines internal consistency of an instrument and should
be minimally 0.60. (Sarvela & McDermortt, 1993). The Cronbach Alpha for this instrument
was 0.7341, which is considered adequate.
Table 1 depicts frequencies and percentages for demographic variables represented in this
survey. Statistics revealed that participants of the study were
representative of the students attending the institution. The majority of the participants were
female (n=183, 59.4%) and Caucasian (n=216, 70.4%). A relatively
even distribution among class ranking was realized: freshman (n=65, 21.2%), sophomore (n=96,
31.3%), junior (n=86 , 28.0%) and seniors (n=58, 18.9%). The
mean age of participants was 20.98 years old, ranging from 17 to 47 years.
| Table 1.
Demographic Data for Overall Sample (n=320) |
|
|
Reporting |
| Variable |
|
Overall
Frequency |
Percentage |
| Gender |
|
|
|
|
Male |
123 |
(39.9%) |
|
Female |
183 |
(59.4%) |
| Age |
|
|
|
|
Mean |
20.98 yrs |
|
| Ethnic Background |
|
|
|
|
African American |
80 |
(26.1%) |
|
Caucasian |
216 |
(70.4%) |
|
Other |
7 |
( 3.6%) |
| Class Ranking |
|
|
|
|
Freshmen |
65 |
(21.2%) |
|
Sophomores |
96 |
(31..3%) |
|
Juniors |
86 |
(28.0%) |
|
Seniors |
58 |
(18.9%) |
|
Graduates |
2 |
(0.7%) |
The survey was designed to elicit four types of information in a self-report manner: (1)
previously diagnosed illnesses, (2) behavioral disordered eating patterns, (3)
pictorial body typology perception assessment and (4) demographics.
Statistical analysis reported frequency data and rates for the following five
components of the
Disordered Eating Subscale : (1) laxative use, (2) diet pills, (3) binge eating, (4) induced
vomiting,
and (5) fasting greater than 24 hours. Five point graduated
response options were provided to the participant (never, 1-6 times per year, monthly,
weekly and daily). Descriptive data were also reported for body typology
perception as reported by frequency and means. One-way Analysis of Variance (ANOVA)
determined significant differences for: (1) key demographical variables and calculated Body Mass
Index and (2) current and desired body type.
The primary purpose of this study sought to document disordered eating patterns and
prevalence rates to assess the current extent of the problem. These data
would be utilized to compare rates between this specific population and national averages. When
asked about previously diagnosed illnesses, less than two percent
(n=5, 1.65%) of the participants self-reported a positive previous diagnosis of bulimia, and the
rates dropped for anorexia (n=3, 0.99%).
Behavioral assessment of disordered eating patterns indicated rates to be somewhat higher,
yet still lower than the estimated national average. Disordered eating
patterns included laxative use, diet pill usage, binge eating, induced vomiting, and fasting for more
| Table 2. Descriptive statistical data of self-reported behaviors from the
Disordered Eating
Subscale |
| Question |
Never |
1-6/yr. |
Mthly |
Wkly |
Daily |
|
n (%) |
n (%) |
n (%) |
n (%) |
n (%) |
| Laxatives |
251 (81.2) |
39 (12.2) |
15 (4.9) |
2 (0.6) |
2 (0.6%) |
| Diet
Pills |
270 (87.1) |
18 (5.6) |
7 (2.3) |
7 (2.3) |
8 (2.5) |
| Binge
Eating |
255 (82.3) |
29 (9.1) |
16 (5.2) |
8 (2.6) |
0 (0%) |
| Induced
Vomiting |
286 (92.6) |
17 (5.3) |
3 (1.0) |
3 (1.0) |
0 (0%) |
| Fast > 24
hrs. |
264 (85.2) |
25 (7.8) |
8 (2.6) |
12 (3.9) |
1 (0.3) |
| Total
Average |
265 (85.7) |
26 (8.0) |
10 (3.2) |
6 (2.1) |
2 (0.7) |
than 24 hours. Participant frequency parameters of disordered
eating patterns were classified as: never, one to six times per year, monthly, weekly, and daily.
Overall prevalence rate for those participants who never engaged in
any of these behaviors is 85.7% (n=265), ranging from 81.2%(n=81.2%) per laxative use to
92.6% (n=286) for induced vomiting (see Table 2). Combining the last
two columns, to report approximate behavioral eating patterns in the last 30 days, gave tabulated
totals to compare to national averages. Laxative use among this
population was reported as 81.2% never, 12.2% as 1-6 times per year, 4.9% monthly, and 1.2%
weekly/daily. Diet pill usage among respondent was reported as
87.1% never, 5.6% at one to six times per year, 2.3% monthly, and 4.8% as weekly/daily. Binge
eating behavior pattern was reported as never by 82.3% of the
population, 9.1% stated they did binge eat one to six times per year, 5.2% as monthly, and 2.6%
as weekly/daily. Induced vomiting recorded one of the lowest
prevalence rates of all the eating disordered patterns. Almost 93% replied that they never used
this behavior, 5.3% as one to six times per year, monthly rates were
1.0% and weekly/daily at 1.0%. Participants that reported fasting for more that 24 hours were
85.2% as never, 7.8% as one to six times per year, 2.6% monthly,
and 4.2% as weekly/daily. Daily reported rates of behavioral eating patterns were: laxatives
0.6%, diet pills 2.5%, binge eating 0%, induced vomiting 0% and
fasting 0.3%. Rank ordering of disordered eating patterns manifestations in the last 30 days
determined a hierarchical system as: diet pills (4.8%, n=15), fasting >
24 hrs (4.2%, n=13), binge eating (2.6%, n=8), laxative use (1.2%, n=4) and induced vomiting
(1.0%, n=3). Although not part of the Disordered Eating Subscale,
the researchers examined exercise rates of this population. Almost 5% (n=15) of the respondents
reported never exercising, while 64.7% (n=197) indicated a
exercise rate of at least several times per week.
| Table 3. Statistical Significance of Differences Among Body Mass Index
and Demographical Variables. |
|
One-way Analysis of
Variance |
| Source of Variation |
|
BMI
(kg/m2) |
F |
Prob>F |
| Ethnicity |
|
African American |
24.79 |
1.56 |
0.1849 |
|
Asian/Pacific
Islander |
28.99 |
|
Hispanic
American |
22.46 |
|
Caucasian |
23.68 |
|
Other |
22.90 |
| Class
Ranking |
|
Freshman |
23.46 |
0.96 |
0.4277 |
|
Sophomore |
23.73 |
|
Junior |
24.10 |
|
Senior |
24.82 |
| Gender |
|
Male |
25.22 |
13.69 |
0.003* |
|
Female |
23.14 |
| *p<.05, yet both within "average"
range |
| Note:
Range for BMI numbers: |
|
|
|
|
<19 underweight |
|
|
|
20-25
average |
|
|
|
26-27 moderately
overweight |
|
|
|
> 27
overweight |
|
| McArdele, W.D., Katch, F.I. & Katch, V.L. (1991). Exercise
Physiology. Philadelphia, PA: Lea & Febiger
Publishers. |
In pictorial body type assessment, 92.6% (n=275) identified themselves within the normal
body type range (as denoted by numbers two through six). Although
there was an overall reported desire to lose weight (current x=3.28, desired 2.72), no statistically
significant difference in current and desired body type was found
(p=0.1066). Sixty-seven percent (n=202) classified their current weight as about average or
underweight. There is a positive correlation between body type
perception and researcher calculated Body Mass Index (r=0.71), indicating an accurate perception
as perceived body type and actual body type.>
Variations in Body Mass Index among key demographically determinants were reported by
means. Average Body Mass Index means range from 20 to 25 kg/m2.
One-way analysis of variance (ANOVA) was utilized to determined if significant differences
existed between ethnicity, class ranking and gender. No significant
differences were reported among race (p=0.1849) or class ranking (p=0.4277); all means in these
groups were within the normal range. Statistically significant
differences in BMI were found between males and females (p=0.003), yet the means for both male
(25.22 kg/m2) and females (23.14 kg/m2) were within the normal
range and this variation was expected.
| Figure 1. Descriptive
statistics report of body perception
typologies (n=320). |
| Body
Perception |
N |
Frequency |
Overall
Mean |
| Body Type Actual |
|
|
| 1 |
21 |
7.1% |
3.28 |
| 2 |
70 |
23.6% |
|
| 3 |
84 |
28.3% |
|
| 4 |
69 |
23.2% |
|
| 5 |
35 |
11.8% |
|
| 6 |
17 |
5.7% |
|
| 7 |
1 |
0.3% |
|
| Body Type Desired |
|
|
| 1 |
23 |
7.5% |
2.72 |
| 2 |
124 |
40.5% |
|
| 3 |
93 |
30.4% |
|
| 4 |
51 |
16.7% |
|
| 5 |
13 |
4.2% |
|
| 6 |
1 |
0.3% |
|
| 7 |
0 |
0.0% |
|
| Weight Self-Classification |
|
|
| Over-weight |
100 |
33.1% |
1.72 |
| Average |
187 |
61.9% |
|
| Under-weight |
15 |
5.0% |
|
| Cohn, L & Adler, N. (1992). Female and male perception of ideal
body shapes, Psychology of Women Quarterly, 16, 69-79.
|
The most glaring conclusion from the Disordered Eating Subscale is a noticeably small
number of disordered eating patterns among this college population. The
magnitude of projected problematic eating disorders among a population determined "at risk" by
current knowledge were not found in this study (Schotte and
Stunkark, 1987; Drewnowski, Yee, and Krahn, 1988; Kessler, Gilham and Vickers, 1992; Hoek,
et al., 1995; Bemporad, 1996, CDC 1997). Researchers would
argue that due to a strong research methodology, the results of this study will be similar in
other like institutions. There are no previous data about this specific
population, thus it is difficult to determine if this is a decline in this behavior or if it is consistent
with the region and specific population. Another result of the study
was that the majority of participants' body perceptions had a relationship to calculated BMI (i.e.
selection of a silhouette figure that was one that was consistent or
closely related to their actual body typology). Because a large percentage of the sample was Black
American, differences between ethnicity concerning BMI measurements and disordered eating
patterns were examined;
however, no significant differences were found. Likewise, there were no significant differences
determined between class ranking with regards to BMI levels. These
results run contrary to existing research and researchers must ask if current projections and
prevalence rates of disordered eating patterns are correct. Although not
part of the Disordered Eating Subscale, the researchers examined and analyzed exercise patterns
of the participants. Rates were higher than national estimates that
37.6% of college students exercise more than 3 times per week (Centers for Disease Control
& Prevention, 1997). Compulsive exercising was considered a concern
given the high exercise rates; however, because of the data revealing correlated body perceptions
and calculated BMI rates of acceptable range, it was discounted by
the researchers. A hypothesis generated by the study is that eating disorders and negative body
image perceptions only effect a very small, select group within the
general population.
Although continuing to increase the
general awareness about eating disorders is important, once the disordered eating populations are
more clearly identified
through subsequent, focused studies; creating educational and interventions that target those
populations should be considered
as a better use of limited resources.
|
There were several methodological limitations to this study. For example, a possible threat to
the validity of the findings was the reliance on self-reported behaviors
and anthropological measurements. Participant reactivity might have been introduced into the
study. Replication of this study could include complimenting the self-reported data with
interviews and physical examinations. Another possible limitation to this study was the absence of
questions regarding extracurricular activities
(i.e. sororities, intercollegiate athletics). Such questions were not included in the instrument given
its extensive length; however, they may have illuminated the
current, albeit limited, disordered eating occurring at this particular university. Although
continuing to increase the general awareness about eating disorders is
important, once the disordered eating populations are more clearly identified through subsequent,
focused studies; creating educational and interventions that target
those populations should be considered as a better use of limited resources. In addition, the
survey revealed that many individuals had an accurate perception of their
body size. This might be a result of effective positive body acceptance programming on campus.
Continued like programming which reinforces positive body
concepts should be considered.
This research suggests that eating disorders among college populations is much lower than
what has been documented through literature. If these study results are
replicated at other like institutions throughout the United States, then health education and
nutrition professionals have been successful in lowering the overall
incidence rate of eating disorders and/or these problems have shifted to a different population.
Important programmatic decisions and resource allocations for
health educational efforts are based upon prevalence studies. Future studies should seek to
verify these results and make recommendations based on the findings.
Eating disorders prevalence rates should be documented among high-school students and
pre-teens. Appropriate health education interventions need be aligned
with all populations that are determined to be "at risk".
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