Anorexia is getting older – and younger – and not just white and female. What's going on?

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Asian and Hispanic Women with Anorexia
Studies have indeed found very few African-American women with anorexia, compared to white, Asian, and Hispanic women. But that doesn't mean that they are free from eating disorders.

"African-American women have been found in some research to have higher levels of laxative abuse for weight control even than white women, which was surprising," says Gayle Brooks, PhD, vice president and clinical director of the Renfrew Center in Florida. "We see high levels of diuretic use as well." Young black women, in short, are more likely to be "bingeing and purging" than they are to be starving themselves with anorexic behavior.

That, too, may be changing. African-American women do get anorexia. A 2001 study, for example, found that 2% of African-American women at a large Midwestern university had the disorder. Kaelyn Carson, a 20-year-old college cheerleader and track star from Michigan, died in the summer of 2001 after a 14-month battle with anorexia.

"Whatever sort of protective function comes from being very culturally connected dissipates over time as pressures rise on women of color, as they do white women, to have their self-esteem determined by body size," says Brooks.

She adds, "the protective qualities of culture become much less influential when a young girl goes into a predominantly white environment, where she's assaulted with images and pressure to look a certain way."

Anorexia: Not Just a Woman's Problem

In the mid-1980s, experts believed that women with anorexia outnumbered men by a factor of 10 to one or more. But in 2001, a Canadian study published in the American Journal of Psychiatry found that female anorexics outnumbered males by only four to one.

"There are a number of treatment centers in the country that specialize in treating men and boys with anorexia, and they seem to be seeing an increase in demand," says Bunnell. Is that because there's been an increase in male anorexia, or simply because doctors are finally recognizing the disease in men? "It's probably a little bit of both."

In 2003, a BBC survey of child and adolescent mental health specialists in Britain found that nearly three-quarters believed that anorexia is underdiagnosed, and not well understood, in males.

What's more, there's no doubt that the pervasive societal pressure about body image has been extended, more and more, to men. For proof, look no further than your nearest magazine stand, where you'll find numerous men's magazines featuring the same kind of unrealistically perfect models that have traditionally been found in Vogue and Cosmo.

"Boys and men are now subjected to increasingly unrealistic expectations about what they should look like, and mixed in with the national antiobesity push, we're seeing more and more tension in boys about their physical appearance," says Bunnell.

Cultural Pressures to Blame?

Experts agree that precious little is still understood about anorexia and other eating disorders in "nontraditional" populations, like men, minority groups, older women, and younger children. But many suggest that it might have to do with the pervasiveness of cultural pressures. "We have a culture that is fat-phobic, that has unrealistic notions of how thin a body type ought to be and at what age," says Mickley.

"One of the things we've been trying to figure out is how much these disorders can be attributed to inherent biological factors, and how much comes from the culture," says Bunnell. (A growing body of studies point to a strong genetic connection for anorexia.)

"The obvious answer is that it's always both. But these days, the cultural pressure about weight is so high, the focus on obesity is so intense, and the culture has broadened so much," he notes. Maybe as the culture has gotten louder and more intense, it exposes more of that latent vulnerability."

next: The Genetics of Anorexia and Bulimia

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Reviewed: 03/2006