One in 10 Girls Engages in Frequent Binge Eating or Purging
Pauline Anderson
June 6, 2008 ? More than 10% of adolescent girls and 3% of boys binge eat or purge at least once a week, according to a new study published in the June issue of the Archives of Pediatric and Adolescent Medicine.
The frequency of this disordered eating is surprising and concerning, said 1 of the study authors, Alison E. Field, ScD, associate professor of pediatrics, in the division of adolescent medicine at Children?s Hospital, Boston, in Massachusetts. "I would believe that 10% [of girls] would at least experiment with these behaviors, but once a week is quite severe."
Dr. Field and her colleagues analyzed data from 6916 girls and 5618 boys who were part of the Growing Up Today Study (GUTS). The subjects, who were aged 9 to 15 years at the start of the study, were children of women participating in the Nurses' Health Study II. The younger participants filled out questionnaires every 12 to 18 months from September 1, 1996 to November 11, 2003, and in 2004, a questionnaire was sent to their mother.
The study found that more girls started to purge at least weekly (5.3%) than started to binge eat (4.3%). In contrast, among boys, binge eating, at 2.3%, was more common than purging, at 0.8%. Interestingly, very few youngsters in the study engaged in both disordered-eating behaviors.
Purging on People's Radar Screen
Dr. Field found the extent of the binge eating to be disturbing, especially with the country facing an obesity epidemic. But perhaps of more concern was the phenomenon of purging. "It's very serious if someone is binge eating weekly, but it's probably much more serious if someone is purging at least weekly," she said. "The purging group is really coming onto people's radar screen right now, and our data suggest it's a really important group to consider."
The study also investigated risk factors for developing these behaviors and found that among girls, frequent dieting, especially in those younger than 14 years, was a predictor of starting to purge or binge eat, as was concern about weight.
Predictor // Purging Odds Ratio (95% CI) // Binge Eating Odds Ratio (95% CI)
Frequent dieting // 7.0 (3.5 ? 14.0) // 2.2 (1.4 ? 3.7)
Concern for weight // 2.3 (1.6 ? 3.2) // 2.7 (1.7 ? 4.4)
Rates of some eating-disordered behavior varied by age. For example, girls younger than 14 years whose mother had a history of an eating disorder were almost 3 times more likely than their peers to start purging at least weekly (OR, 2.8; 95% CI, 1.3 ? 5.9), although maternal history of an eating disorder was not related to an elevated risk among older teens.
Teasing Important Area to Focus On
Teasing was a factor in increased risk for disordered eating, according to the study. Although negative comments about weight from a mother, father, or female friends were not related to binge eating or purging among girls, teasing about their weight by boys did increase their risk of starting to purge. "Influences early in life such as teasing by boys seem to be scaring events," said Dr. Field. Among boys, if their fathers made negative comments about their weight, they were twice as likely to binge eat.
Teasing might be considered a "normal rite of passage," she added, but the study results "suggest that this is an important area to focus on, because you might be able to prevent some children from becoming disordered eaters."
A first step might be for parents to watch what they say about weight issues in front of all their children. "A lot of parents may realize they shouldn't make comments to their daughter about her weight, but our results also suggest they shouldn't make comments to their son about his weight," said Dr. Field.
As for clinicians, Dr. Field stressed the importance of considering bulimic behaviors among male as well as female patients and of talking with all their overweight patients. "It's important to find out if the children are being teased and what's going on in their lives."
It is also important for parents and clinicians to stress healthy behaviors and not overemphasize the issue of weight. "There are a lot of reasons why kids should eat a healthy diet and get rid of the soda and junk food at home," but weight loss should not be the main goal, said Dr. Field.
Media Images Unattainable
The media also play a role in influencing dieting behavior in young people. Girls in the study who strove to look like figures in magazines, on television, and in the movies were about twice as likely to binge eat and were also significantly more likely to purge. "It's really important for young people to realize the print images they see have almost all been touched up, so what they're looking for is completely unattainable," said Dr. Field.
It is an important issue for boys, too, as more and more images of scantily clad males with six-pack abs appear in magazines and on billboards, added Dr. Field.
Approaches to preventing these behaviors might include media literacy and other approaches to make young people less susceptible to the media images they see, the authors write.
The researchers hope to get a better handle on which girls who start to binge or purge continue this behavior, Dr. Field told Medscape Psychiatry. "We're trying to understand now who are the young people who just experiment with the behavior ? say, do it for 1 year and then stop ? vs those who go on to have a very persistent problem."
The researchers are interested in looking more closely at the possible role of genetics in eating disorders and plan to collect DNA from this cohort to try to get some answers, said Dr. Field.
Arch Pediatr Adolesc Med 2008;162:574-579.
Pauline Anderson
June 6, 2008 ? More than 10% of adolescent girls and 3% of boys binge eat or purge at least once a week, according to a new study published in the June issue of the Archives of Pediatric and Adolescent Medicine.
The frequency of this disordered eating is surprising and concerning, said 1 of the study authors, Alison E. Field, ScD, associate professor of pediatrics, in the division of adolescent medicine at Children?s Hospital, Boston, in Massachusetts. "I would believe that 10% [of girls] would at least experiment with these behaviors, but once a week is quite severe."
Dr. Field and her colleagues analyzed data from 6916 girls and 5618 boys who were part of the Growing Up Today Study (GUTS). The subjects, who were aged 9 to 15 years at the start of the study, were children of women participating in the Nurses' Health Study II. The younger participants filled out questionnaires every 12 to 18 months from September 1, 1996 to November 11, 2003, and in 2004, a questionnaire was sent to their mother.
The study found that more girls started to purge at least weekly (5.3%) than started to binge eat (4.3%). In contrast, among boys, binge eating, at 2.3%, was more common than purging, at 0.8%. Interestingly, very few youngsters in the study engaged in both disordered-eating behaviors.
Purging on People's Radar Screen
Dr. Field found the extent of the binge eating to be disturbing, especially with the country facing an obesity epidemic. But perhaps of more concern was the phenomenon of purging. "It's very serious if someone is binge eating weekly, but it's probably much more serious if someone is purging at least weekly," she said. "The purging group is really coming onto people's radar screen right now, and our data suggest it's a really important group to consider."
The study also investigated risk factors for developing these behaviors and found that among girls, frequent dieting, especially in those younger than 14 years, was a predictor of starting to purge or binge eat, as was concern about weight.
Frequent dieting // 7.0 (3.5 ? 14.0) // 2.2 (1.4 ? 3.7)
Concern for weight // 2.3 (1.6 ? 3.2) // 2.7 (1.7 ? 4.4)
Rates of some eating-disordered behavior varied by age. For example, girls younger than 14 years whose mother had a history of an eating disorder were almost 3 times more likely than their peers to start purging at least weekly (OR, 2.8; 95% CI, 1.3 ? 5.9), although maternal history of an eating disorder was not related to an elevated risk among older teens.
Teasing Important Area to Focus On
Teasing was a factor in increased risk for disordered eating, according to the study. Although negative comments about weight from a mother, father, or female friends were not related to binge eating or purging among girls, teasing about their weight by boys did increase their risk of starting to purge. "Influences early in life such as teasing by boys seem to be scaring events," said Dr. Field. Among boys, if their fathers made negative comments about their weight, they were twice as likely to binge eat.
Teasing might be considered a "normal rite of passage," she added, but the study results "suggest that this is an important area to focus on, because you might be able to prevent some children from becoming disordered eaters."
A first step might be for parents to watch what they say about weight issues in front of all their children. "A lot of parents may realize they shouldn't make comments to their daughter about her weight, but our results also suggest they shouldn't make comments to their son about his weight," said Dr. Field.
As for clinicians, Dr. Field stressed the importance of considering bulimic behaviors among male as well as female patients and of talking with all their overweight patients. "It's important to find out if the children are being teased and what's going on in their lives."
It is also important for parents and clinicians to stress healthy behaviors and not overemphasize the issue of weight. "There are a lot of reasons why kids should eat a healthy diet and get rid of the soda and junk food at home," but weight loss should not be the main goal, said Dr. Field.
Media Images Unattainable
The media also play a role in influencing dieting behavior in young people. Girls in the study who strove to look like figures in magazines, on television, and in the movies were about twice as likely to binge eat and were also significantly more likely to purge. "It's really important for young people to realize the print images they see have almost all been touched up, so what they're looking for is completely unattainable," said Dr. Field.
It is an important issue for boys, too, as more and more images of scantily clad males with six-pack abs appear in magazines and on billboards, added Dr. Field.
Approaches to preventing these behaviors might include media literacy and other approaches to make young people less susceptible to the media images they see, the authors write.
The researchers hope to get a better handle on which girls who start to binge or purge continue this behavior, Dr. Field told Medscape Psychiatry. "We're trying to understand now who are the young people who just experiment with the behavior ? say, do it for 1 year and then stop ? vs those who go on to have a very persistent problem."
The researchers are interested in looking more closely at the possible role of genetics in eating disorders and plan to collect DNA from this cohort to try to get some answers, said Dr. Field.
Arch Pediatr Adolesc Med 2008;162:574-579.
