Culture, Ethnicity and Treatment of Binge Eating

Culture and ethnicity can affect a person’s feelings of embarrassment, guilt, loss of control, and distress. Because of this, the emotions associated with binge eating may be experienced differently by individuals from specific ethnic-racial groups within the U.S., according to results of a recent study (Int J Eat Disord 2007; 40:454).

Sarah Bennett, MPhil and Tonya Dodge, PhD, examined a sub-sample of 5,726 women between 19 and 27 years of age who participated in the National Longitudinal Study of Adolescent Health (Add Health). Five ethnic-racial groups were included: Hispanic, non-Hispanic White, non-Hispanic Black, Non-Hispanic Asian, and non-Hispanic Native American. Self-reported height and weight were used to calculate body mass index (BMI) for participants.

To measure embarrassment, the following item was rated as yes or no: “In the past seven days have you eaten so much in a short period that you would have been embarrassed if others had seen you do it?” Fear of losing control was measured with the following statement (yes or no): “In the past seven days, have you been afraid to start eating because you thought you wouldn’t be able to stop or control your eating?”

Analysis of the ethnicity of the group showed that the sample was 69.1% White (n=3,956), 15.3% Black (877), 0.6% Native American (34), 3.3% Asian (189), and 11.7% Hispanic (670). The mean BMI was 25.49, which is in the overweight range. The median annual household income was: $40,000 for Whites and Asians, $30,000 for Hispanics and Blacks, and $24,000 for Native Americans.

Embarrassment and fear of losing control

Feelings of embarrassment over eating too much in the past seven days were greatest among Native Americans (13.5%), followed by Asians (11.3%), Whites (7.1%), Hispanics (7.0%), and Blacks (6.8%).

Hispanic women had a greater fear of losing control than did the other groups. In this analysis, 5.6% of Hispanics reported they would not be able to stop eating once they started, followed by Asians (3.6%), Native Americans (3.0%), Blacks (2.7%), and Whites (2.6%).

The relationship between embarrassment and fear of losing control was positively correlated but the correlation was low, suggesting there is considerable independence between feeling of embarrassment and fear of losing control over binge eating. This independence is further supported by the finding that ethnic-racial groups differentially endorse a fear of losing control and feelings of embarrassment related to binge eating.

Considering the effects of ethnicity

The authors note that the findings of the study have several important implications for clinicians who diagnose and treat patients with binge eating disorder (BED). Feelings of embarrassment experienced by Asian and Native American women may keep them from seeking help, and the diagnosis of BED may be overlooked in these groups. The emotional aspects of BED may serve as a barrier to treatment for these women.

Treatment programs that target the specific needs of each population may improve outcome. For example, addressing the embarrassment felt with binge eating may be a priority in treating Asian and Native American women, whereas greater attention may be given to targeting the fear of losing control experienced by Hispanic women. One limitation of the study was that it relied upon self-reports by the women.