Sex and Gender-based Analysis of this topic
Definition
Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge-eating Disorder (BED), and Eating Disorder Not Otherwise Specified (ED-NOS) are the clinical eating disorders that include a variety of symptoms related to the abnormal perception of one’s body image. These disorders may manifest as a result of biological (body weight, energy metabolism), psychological (poor body image), developmental (trauma that affected bodily experiences), and/or social factors (pressures to be thin). Results from the 2002 Canadian Community Health Survey suggest that approximately one in five women (19%) were concerned with their weight[1]. The 1998-1999 National Population Health Survey found that the prevalence of depression among women with AN or BN was twice the rate compared to the general population of women[2]. BC has the highest age-standardized hospitalization rates for eating disorders at 15.9 per 100,000[3]. A history of trauma, including physical and/or sexual abuse, sexual harassment, weight-based teasing, and/or emotional distress may contribute to disordered eating, especially among young women[4].
Sex Issues
Research is inconclusive as to whether or not women and men are affected differently due to biological differences. Individuals with eating disorders display atypical autonomic nervous system responses and limited arousal during standard stress tests, which may be related to anomalies in systems that control motivated behaviours, such as eating[5]. The presence of comorbid conditions may affect the way that men and women experience eating disorders and respond to treatment, with women more likely to have persistent post-treatment symptoms in the case of AN[6].
Gender Issues
Eating disorders predominantly affect young women, however, there is a growing number of men who are experiencing eating disorders, such as gay and trans-gendered men, athletes, and men in the entertainment industries[7]. Findings from a study on weight-loss and weight-gaining behaviours found that both boys and girls as young as 10-14 years report being influenced by media messages on ideal body shapes and weights[8]. Women are 20 times more likely than men to develop anorexia nervosa, and 10 times more likely than men to develop bulimia nervosa [9]. It is estimated that over 70% of Canadian women are dieting and up to 3% will be affected by an eating disorder in their lifetime [9].
Current research suggests that genetic predispositions to eating disorders, which might otherwise lie dormant or unexpressed, may be triggered by social environmental cues, such as the need to be thin[10]. Women may be more vulnerable to media pressure to have a thin body, which may be why women are overrepresented in eating disorder statistics, starting from a young age. Researchers have found that girls as young as 10 years of age are engaging in unhealthy dieting behaviours[11]. Adolescent females with eating disorders place a high level of importance on their physical appearance and self-oriented perfectionism[12]. The 2003 Adolescent Health Survey III on British Columbian students in grades seven through twelve found that 49% of females had dieted in the past year compared to 14% of males[13].
Diversity
LGBTQ women may be more susceptible to cultural body image standards, and thus, eating disorders than previously thought[14]. This may be due to younger generations feeling more pressures to conform to thin body ideals.
Critique
A majority of the data on eating disorders comes from hospitalization records, which fail to capture the scope of eating disorders, such as utilization of outpatient services, clinics, or family physicians, in addition to individuals who do not use any services. Quantitative studies use outcome predictors such as weight, age of onset, laboratory values (e.g., serum, uric acid, and creatinine levels), and psychosocial factors, which fail to capture the lived experiences of women who have eating disorders. Using qualitative research methods to study women’s experiences of eating disorders may be helpful in capturing the complexity of the process, as well as the patient’s perspective of the process. Furthermore, longitudinal data that tracks attitudes and behaviours towards disordered eating is needed in order to assess the degree that girls and women in BC and across Canada are affected.