Abstract:Objective: This study examined barriers to treatment in an ethnically diverse community sample of women with eating disorders. Method: Participants were 61 women (22 Hispanics, 8 Asians, 12 Blacks, 19 Whites) with eating disorders. Diagnosis was determined using the Eating Disorder Examination. Treatment-seeking history, barriers to treatment seeking, ethnic identity, and acculturation were assessed. Results: Although 85% of the sample reported wanting help for an eating problem, only 57% had ever sought treatment for an eating or weight problem. Individuals who had sought treatment reported being significantly more distressed about their binge eating than those who had not sought treatment and having begun overeating at a younger age. Of those who had sought help, 86% had not received any treatment for their eating problems. The main barriers to treatment seeking were financial reasons. Conclusion: Women from minority groups who have eating disorders are underdiagnosed and typically not treated.

Results support clinical impressions that eating disorders largely go undetected and untreated. Nonspecialists may be likely to fail to detect eating disorders.

Cohort differences in body image, drive for thinness, and eating attitudes in middle-aged and elderly women were examined. Participants were 125 women between the ages of 50 and 65 (middle-aged group), and 125 women 66 years old and older (elderly group). Instruments used were figure ratings (Stunkard, Sorensen, & Schulsinger, 1983), and scales of the Eating Disorder Inventory (EDI; Garner,Olmstead, & Polivy, 1983). Items were developed to assess fear of aging. The middle-aged group, as compared to the elderly group, had more drive for thinness, disinhibited eating, and interoceptive confusion. The elderly group reported body size preferences and levels of body dissatisfaction that were similar to the younger women. There was a positive relationship between fear of aging and disordered eating. Sociocultural standards of body image and pressures toward thinness affect different generations of older women in similar ways.

2002;10:158 -166. Objective: Obesity is most common in the United States among women of ethnic minority groups (black and Hispanic). Researchers have hypothesized that these subcultures are more accepting of overweight figures. The purpose of this study was to examine body image and body size assessments in a large community sample of men and women. Research Methods and Procedures: Participants were 801 women and 428 men: 23% Asian, 45% Hispanic, 17% black, and 15% white. The figure rating scale was used to rate: body dissatisfaction, attractive male and female shapes, acceptable female size, and perceptions of underweight to obese female figures. Results: Controlling for age, education, and body weight, no ethnic differences were found for men. Asian women reported less body dissatisfaction than the other groups. Women were more dissatisfied with their size than men and chose thinner female figures as attractive and acceptable. Discussion: Ethnicity, independent of age, education, and body weight, does not influence preference for female and male shapes or tolerance for obesity.

The purpose of this study was to examine disordered eating, acculturation, and treatment‐seeking in a community sample of Hispanic, Asian, Black, and White women. Participants were 118 women with disordered eating (49 Hispanic, 21 Asian, 23 Black, and 25 White) and 118 healthy controls. Interviews were conducted to assess eating and weight‐related behaviors, psychiatric symptoms, acculturation, and health care usage. Results indicated that the four ethnic groups were equally likely to present behavioral symptoms of bulimia, anorexia, or a binge‐eating disorder. Hispanics were the most likely to use diuretics, and Black women were the most likely to use laxatives. Despite psychological distress among the eating disorder group, only a small percentage had received treatment during the past year; the eating disorder group was more likely than the controls to report that they had been denied treatment. More acculturated individuals were more likely to suffer from eating problems, and among the eating disorder group, less acculturated individuals were less likely to have received treatment.

Objective This study examined the relationship between binge eating disorder (BED), a newly proposed eating disorder, and bulimia nervosa (BN). Method Three groups recruited from the community were compared: women with BED (n = 150), women with purging BN (n = 48), and women with nonpurging BN (n = 14). Results The three groups did not differ significantly in education, weight or shape concern, and current or lifetime prevalence of nine major mental disorders. Women with BED, compared with women with purging BN, were older, less likely to have a history of anorexia nervosa, and less likely to have been treated for an eating disorder. Obesity was more commonly associated with BED than with either subtype of BN. Discussion Our results lend some support to BED as an eating disorder distinct from purging BN. More research is needed to clarify the position of nonpurging BN relative to BED and purging BN. © 2001 by John Wiley & Sons, Inc. Int J Eat Disord 29: 157‐165, 2001.

The objective of this study is to provide a comprehensive review of empirical research exploring barriers to and facilitators of initial treatment seeking ("first contact") from professional health care providers by adults and young adults with eating disorders (EDs). A search of databases PsycINFO and MEDLINE using the terms "treatment" and "eating disorder*" yielded 9,468 peer-reviewed articles published from January 1945 to June 2016. Screening identified 31 articles meeting the following criteria: (1) participants were 16 or older and presented with a self-reported or clinically diagnosed ED; (2) studies focused on (a) initial treatment seeking (b) for an ED (c) from professional health care providers; (3) articles were empirical, and (4) peer reviewed. Quantitative studies revealed few consistent correlates of treatment seeking, perhaps because most variables were examined in only one or two investigations. Variables with some degree of predictive utility (i.e., produced significant results in multiple studies) were age (older), ethnicity (nonethnic minority), ED type (anorexia, purging BN), specific ED-related behaviors (i.e., purging), and time spent on a treatment waitlist following referral (less). Although BMI was one of the most investigated variables, it did not predict treatment seeking. Qualitative studies revealed the following perceived barriers: (1) personal feelings of shame/fear, (2) ED-related beliefs/perceptions, (3) lack of access/availability, and (4) aspects of the treatment process. Perceived facilitators included (1) health-related concerns, (2) emotional distress, and (3) social support. Implications for clinical practice and areas for further research are discussed. Results highlight the need for shared definitions and methodologies across studies of treatment seeking.

A major developmental challenge for adolescent girls in Western industrialized countries is to come to terms with the biological changes accompanying pubertal development. Puberty is associated with considerable weight gain, and this physical change occurs in a cultural context that upholds a female beauty ideal of extreme thinness. Hence, the physical changes of puberty are at odds with the cultural norms of female beauty.As described in detail by Striegel-Moore (1993), the tension between the cultural ideal of female beauty and the physical reality of the female body is magnified by two aspects of female gender role expectations. One, female identity is defined in relational terms, and two, beauty is a core aspect of female identity. Girls are expected to be interpersonally oriented, to care about others' feelings, needs, and interests, and, as a result, girls are more vulnerable than boys to others' opinions of them and behaviors toward them (Kaplan, 1986).