Since first being described in literature just over two hundred years ago, eating disorders have largely been viewed as a women’s issue. A large number of studies regarding eating disorders consist solely of female test subjects, as eating disordered males are often considered anomalous. Indeed, some researchers and physicians have questioned whether men truly suffer from the same disorder or simply an analogous condition exclusive to males. Yet why is it that eating disorders have come to be considered female maladies? And if they truly are as such, why are women more vulnerable to them? The answer lies both within the unique nature of the female sex and gender—sex being defined as genetics and gender as acquired characteristics—and the nature of modern society. In other words, as with many other mental health issues facing women today, due to a combination of innate biology and a multitude of social pressures, women suffer from a far greater prevalence of eating disorders than do men.

In order to fully understand the significance of the attribution of eating disorders to women, one must understand the nature of eating disorders themselves. According to a 2008 article by Daniel Le Grange and Ivan Eisler, although they were first described in a medical journal in 1873 by Sir William Gull, eating disorders were not widely acknowledged by the general populace until a century later in 1973 with the 1973 release of Hilde Bruch’s novel Eating Disorders: Obesity, Anorexia Nervosa, and the Person Within. Defined by the Merriam-Webster dictionary as “any of several psychological disorders characterized by serious disturbances of eating behavior,” eating disorders encompass a wide range of symptoms from extreme starvation and vomiting after food intake to compulsive overeating. In medical literature, according to the National Institutes of Health (NIH), eating disorders are traditionally separated into three general diagnoses: anorexia nervosa, bulimia nervosa, and binge eating disorder. The NIH explains that anorexia nervosa, the most deadly, is characterized by “extreme thinness,” “intense fear of gaining weight,” “distorted body image,” “lack of menstruation,” and “extremely restricted eating.” According to the NIH, bulimia nervosa manifests itself as episodes of extreme overeating followed by episodes of purging through vomiting or the use of laxatives, and when combined with anorexia nervosa, it can result in disastrous health-related symptoms. Finally, according to the NIH, binge eating disorder is characterized by a loss of control over eating, often coupled with a feeling of shame that spawns further episodes of bingeing.

A 2003 study of 1,960 Norwegian boys and girls aged fourteen to fifteen showed that the lifetime prevalence of eating disorders was 17.9% in females and 6.5% in males. Males made up 10% of cases of anorexia and bulimia and 25% of cases of binge eating disorder. Males also reported significantly lower levels of body dissatisfaction than females, and while only 2.6% of females were truly overweight, 32.3% reportedly considered themselves obese. Furthermore, of those who considered themselves obese, 73.4% were actually underweight. The National Eating Disorders Association highlights other statistics that suggest women may have a disproportionately poor body image. For instance, 55% of American women are dissatisfied with their weight, compared to 41% of men. Additionally, 44% of teenage girls and 38% of adult women are trying to lose weight, compared with 15% of teenage boys and 24% of adult men. Taken together, these statistics indicate an extreme gender disparity in the prevalence of eating disorders and eating disorder behaviors. Indeed, an association of eating disorders with the female sex is present even in the National Institute of Mental Health’s definition of anorexia nervosa, in that one of the criteria for diagnosis is the loss of the menstrual cycle.

A study conducted in 2002 at Harvard University asked groups of males and females to complete an Eating Disorders Questionnaire to evaluate their explicit opinions regarding their attitudes towards “fatness” and their weight identity or how they defined themselves with respect to their weight. Women consistently described themselves as fatter than did their male size counterparts, indicating a “greater tendency for women to be critical of their weights even when they are normal weights.” In addition, a correlation between explicit and implicit self-evaluation and between weight and identity existed for women but not for men. According to the authors of the study, men’s “ability to view the self as light regardless of actual weight would also protect men from developing eating disorders because this is almost the opposite of the body image disturbance experienced by patients with anorexia nervosa in which they see themselves as fat despite being underweight.”

In an attempt to explain this type of disparity in eating disorder behaviors and the psychological differences associated with them, many studies have focused on biological differences between the sexes, particularly in the brain. One such difference is the way the two sexes process beauty. According to a 2009 study, brain activity in the parietal region differed significantly across the genders when patients were asked to judge the beauty of stimuli. Men showed increased activity localized to the right hemisphere of the brain, while activity in women was bilateral. In this regard, the different pathways in the processing of beauty between men and women could contribute to differences between men and women’s judgments of their own beauty, leading to the differential prevalence of eating disorders. Another important area of study is hormonal dissimilarities. A 2011 study of female sex hormones showed a distinct correlation between ovarian hormones (namely estradiol and progesterone) and body dissatisfaction. This positive association between female sex hormones and eating disorder behaviors could indicate another instance of female biological susceptibility to eating disorders.

While inherent biology seems to be a significant factor in the gender disparity in the prevalence of eating disorders, it is also important to recognize the impact of environment on the cognitive state of patients. Psychologists have extensively researched the societal stressors that result in the development of eating disorders. Key figures in the results of these studies have been the social prejudices or biases against women and the excessive media portrayal of the ideal female body. Traditionally, women have been cast in roles of social inferiority, which can translate into decreased self-esteem and an increased prevalence of eating disorders. In addition, according to a paper by Marika Tiggerman and Amanda S. Pickering, because women are typically portrayed as weaker or more emotionally vulnerable, eating disorders are diagnosed more often in women than in men. This means that clinicians may be biased to believe that eating disorders are associated with a characteristic female weakness and thus are less likely to diagnose eating disorders in men, instead writing them off as mere manifestations of depression.

An important focus of studies of eating disorders has been the media and pop culture. The Barbie Doll, for instance, made its debut on the pop culture stage in 1959 with a target audience of girls aged three to twelve. Since then, Barbie has become an idol for young American girls, each owning on average seven dolls, and extreme amounts of controversy have arisen over the correlation of aspiring to be like Barbie and the development of eating disorders. According to a fact sheet compiled by Margo Maine, Barbie, when imagined to scale, would not have the minimum BMI required to menstruate and would be significantly underweight. Young girls aspiring to be “like Barbie” are thus aspiring to be overly thin. In explaining the mentality behind her eating disorder in an interview with MSNBC, one girl declared in reference to Barbie, “I’m blond and blue-eyed, and I figured that was what I was supposed to look like. She was my idol. It impacted the way I looked at myself.” Also according to the fact sheet, another controversy arose when Slumber Party Barbie was released and came with a copy of a book entitled “How to Lose Weight.” One of the tips in the book was “Don’t Eat,” and Mattel, the manufacturer of Barbie, received strong criticism as a result of their blatant advertisement of an ideal of losing weight.

Two other contributors to the media portrayal of the female thin ideal are the magazine industry and television. According to the National Eating Disorders Association, 60% of Caucasian middle school girls read fashion magazines regularly, and 74% of magazine articles cite “to become more attractive” as a reason to lose weight.  Furthermore, women watch on average three to four hours of television per day, and one in 3.8 commercials have “attractiveness” messages—messages promoting the “ideal” body type—leading women to receive 5,260 attractive messages per year. A study of the ten most popular magazines for men and women between the ages of eighteen and twenty-four showed that women are exposed on average to 10.5 times more material promoting weight loss than are men, and most related material in men’s magazines promoted shape change as opposed to weight change. As for the effect of television messages, a study by psychologists at Brown University evaluated adolescent girls living in Fiji in 1998, three years after the introduction of television to the isolated island. No cases of eating disorders had been documented in Fiji prior to 1995, and girls generally demonstrated high levels of body satisfaction, despite having higher average weights than girls in other societies. In 1998, several cases of eating disorders had been diagnosed and girls reported that they felt compelled to reshape their bodies as a result of exposure to television that portrayed the ideal female body type.

As the research above shows, the root causes of eating disorders seem to be varied and complex. It is seemingly impossible to pinpoint precisely what causes each sufferer’s eating disorder to develop, and without this knowledge it is difficult to find the exact source of the disparity in eating disorder prevalence across the genders. One thing that is clear, however, is that there are evident biological and social factors that render women more vulnerable to eating disorders. In other words, perhaps these behaviors result from an intricate combination of both whom people are born to be and whom society instructs them to be. It will be up to future researchers to tease out the contributions of each key factor and to translate this knowledge into new and effective treatments.

References:

[1] Le Grange, Daniel, and Ivan Eisler. Family Interventions in Adolescent Anorexia Nervosa. National Eating Disorders Association. 2008. Web. 18 Feb. 2012. <http://www.nationaleatingdisorders.org/uploads/file/research/family%20interventions%20in%20AN.pdf>.

[2] “Eating Disorder.” Def. 1. Merriam-Webster. Encyclopaedia Britannica. Web. 18 Feb. 2012. <http://www.merriam-webster.com/dictionary/eating%20disorder>.

[3] United States. National Institute of Health. Health and Human Services. Eating Disorders. National Institute of Mental Health, 2011. Web. 18 Feb. 2012. <http://www.nimh.nih.gov/health/publications/eating-disorders/complete-index.shtml>.

[4]Kjelsås, Einar, Christian Bjørnstrøm, and K. G. Götestam. “Prevalence of Eating Disorders in Female and Male Adolescents (14–15 Years).” Eating Behaviors 5.1 (2004): 13-25. ScienceDirect. Web. 18 Feb. 2012. <http://www.sciencedirect.com/science/article/pii/S1471015303000576>.

[5] Shiltz, Tom. “Males and Eating Disorders: Research.” National Eating Disorders Association, 2005. Web. 18 Feb. 2012. <http://www.nationaleatingdisorders.org/nedaDir/files/documents/handouts/MalesRes.pdf>.

[6] Grover, Vishal P., Pamela K. Keel, and Jason P. Mitchell. “Gender Differences in Implicit Weight Identity.” International Journal of Eating Disorders 34.1 (2003): 125-35. Wiley Online Library. Web. 16 Feb. 2012. <http://onlinelibrary.wiley.com/doi/10.1002/eat.10167/pdf>.

[7] Ayala, Francisco J. “Sex-related Similarities and Differences in the Neural Correlates of Beauty.” Proceedings of the National Academy of Sciences of the United States of America 106.10 (2009): 3847-852. National Academy of Sciences. Web. 16 Feb. 2012. <http://www.pnas.org/content/106/10/3847.full?sid=e57c1c07-582e-44b3-a463-8535201f07ba>.

[8] Racine, S. E., Culbert, K. M., Keel, P. K., Sisk, C. L., Alexandra Burt, S. and Klump, K. L. (2011), Differential associations between ovarian hormones and disordered eating symptoms across the menstrual cycle in women. International Journal of Eating Disorders. doi: 10.1002/eat.20941

[9] Tiggemann, M. and Pickering, A. S. (1996), Role of television in adolescent women’s body dissatisfaction and drive for thinness. International Journal of Eating Disorders, 20: 199–203. doi: 10.1002/(SICI)1098-108X(199609)20:2<199::AID-EAT11>3.0.CO;2-Z

[10] Maine, Margo. “”Get Real Barbie” Fact Sheet.” National Eating Disorders Association, 2000. Web. 16 Feb. 2012. <http://www.nationaleatingdisorders.org/uploads/file/BarbieFacts.pdf>.

[11] Marsh, Lisa. “Life-Size Barbie Gets Real Women Talking.” MSNBC Today. MSNBC Interactive, 14 Apr. 2011. Web. 16 Feb. 2012. <http://today.msnbc.msn.com/id/42595605/ns/today-today_people/t/life-size-barbie-gets-real-women-talking/#.T0qj683CSah>.

[12] The Media, Body Image and Eating Disorders. Rep. National Eating Disorders Association. Web. 18 Feb. 2012. <http://www.nationaleatingdisorders.org/nedaDir/files/documents/handouts/MediaBI.pdf>.

[13] Andersen, A. E. and DiDomenico, L. (1992), Diet vs. shape content of popular male and female magazines: A dose-response relationship to the incidence of eating disorders?. International Journal of Eating Disorders, 11: 283–287. doi: 10.1002/1098-108X(199204)11:3<283::AID-EAT2260110313>3.0.CO;2-O

[14] Becker, Anne E. “Television, Disordered Eating, and Young Women in Fiji: Negotiating Body Image and Identity During Rapid Social Change.” Culture, Medicine and Psychiatry 28 (2004): 533-59. Brown University. Web. 16 Feb. 2012. <http://www.brown.uk.com/eatingdisorders/becker.pdf>.