SWAG stereotypes are still prevalent.
It remains the case that most people with EDs will not be treated. This probably reflects issues with case-finding, with potential patient awareness of ED, and with treatment access. One more reason, according to Drs. Kendrin Sonneville and S.K. Lipson of the University of Michigan School Of Public Health, Ann Arbor, is the persistence of antiquated ideas about who develops an eating disorder. Historically, EDs have been relegated to the realm of skinny, white affluent girls, a group popularly referred to as “SWAG.”
A study of 1,747 students
The Michigan researchers designed a study to evaluate variations on perceived need for ED treatment, ED diagnosis, past year treatment for an eating disorder, and barriers to receiving treatment, according to weight, race/ethnicity, socioeconomic status, and gender (Int J Eat Disord. 2018; DOI: 10.1002/eat.22846). The authors turned to data from the Healthy Bodies Study, taken from two academic years, 2013-2014 and 2014-2015.
A student’s perception of the need for eating disorder treatment was elicited with the following question: “Over the last 12 months, do you think you needed help such as counseling or therapy for issues related to eating and/or body image?” The students who responded were then asked about any counseling or treatment they had subsequently received. The study also asked about prior ED diagnosis. The authors also collapsed self-reported race/ethnicity responses into two major categories, white students and students of color. Socioeconomic status was determined by questions about the student’s family financial situation growing up, and several categories were offered: well to do, comfortable, enough to get by, very poor, and not having enough to get by. Students who responded to the question of gender with answers other than male or female were excluded from the final study group.
Certain disparities by race, weight, and gender emerged
When the authors analyzed their data from 1,747 students with symptoms of an eating disorder, they found that participants with EDs were mostly white (79.9%) and female (84.9%), but most were not affluent (only 19.9% were). Notably, only 2.0% were underweight. Underweight students were far more likely to perceive that they needed treatment, to have received a diagnosis, and to have been treated for their disorder.
White students were more likely to have received a diagnosis than were students of color. Socioeconomic background was involved with perception of a need for treatment and for receiving treatment during the past year; affluent students were far more likely to have received treatment than were poorer students.
When students were asked their reasons for not seeking treatment, 28.1% said they preferred to deal with health issues by themselves. Other responses included not needing counseling or therapy (23.9%), and uncertainty about how serious was their need for treatment or counseling (23.9%).
Students with symptoms of threshold AN were significantly more likely to perceive that they needed treatment, to receive a diagnosis, and to be treated, compared with individuals with other types of eating disorders. The authors stress that their results point to the importance of not perceiving need, rather than traditionally considered barriers such as cost.
Drs. Sonneville and Lipson noted that ED researchers often rely on studies based on clinical rather than community samples, which may perpetuate the myth that there is an increased prevalence of eating disorders among more affluent groups.
As for gender discrepancies, the authors point out that most studies of ED-specific treatment-seeking among community samples do not include men. These are critically important insights. Historically, important ED studies have been conducted with women participants in clinical settings, often in what are likely to be relatively high socioeconomic settings. Each of these factors has shaped our understanding of EDs.
A call for better screening
According to the authors, the results point to the need for examining ways to address the inequities in diagnosis and treatment of EDs, including work to dispel the stereotypes and myths about who gets an ED. Better screening, including universal screening, could be more fully adopted in clinical and community settings, such as at colleges and universities which usually add targeted screenings.