Cultural considerations for treating Hispanic patients with eating disorders: A case study illustrating the effectiveness of CBT in reducing bulimia nervosa symptoms in a Latina patient.

Eating disorders (ED's) are the deadliest of all mental disorders, yet there is a paucity of research examining the clinical presentation of eating disorders in Hispanic populations and limited guidelines for culturally sensitive treatment. Given the rapid growth of Hispanic communities in the U.S., it is important to acknowledge the unique clinical profile of patients within this demographic and examine eating pathology within this socio-cultural context. This case study aims to illustrate the utility, relevance, and effectiveness of cognitive behavioral therapy (CBT) on alleviating eating disorder symptoms in an adult Latina patient with bulimia nervosa to understand the broader implications of applying manualized treatments to diverse populations. We outline the strengths of CBT in quickly modifying problematic thought patterns and decreasing pathological behaviors while raising questions about cultural generalizability. In addition, we explore CBT's limitations in addressing certain underlying ED pathology-driving and maintaining factors for minority individuals.

Overlaps and Disjunctures: A Cultural Case Study of a British Indian Young Woman's Experiences of Bulimia Nervosa.

Eating disorder diagnoses are characterised by a pattern of disordered eating behaviour alongside symptoms such as body dissatisfaction and preoccupation with food, weight or shape (APA in Diagnostic and statistical manual of mental disorders, DSM-5, APA, Washington, DC, 2013). Incidence rates for eating disorders have increased during the last 50 years. However, epidemiological studies have suggested that such trends may not be a true representation of the occurrence of these illnesses in the general population, with figures underestimated due to reduced help seeking and poor access to care, particularly amongst ethnic minorities. This case study explores the experiences of a young British Indian woman with bulimia nervosa. Arising from an in-depth semi-structured interview, analysed with interpretative phenomenological analysis, her narrative offers a critical lens onto how diverse fragments of cultural practices and meanings come together to produce the clinical category of 'bulimia.' It thereby offers an alternative portrait of relationships between eating disorders and 'culture,' one that goes beyond a framing of these illnesses as culture inscribed on the body. Interrogating relationships between culture and the development, expression and maintenance of bulimia is suggested to be key to forging culturally-sensitive understandings of this illness; this paper begins to provide the evidence base for the design and development of appropriate support services, thereby aiming to contribute to a reduction in health inequalities and barriers to treatment.

Distinct and Untamed: Articulating Bulimic Identities.

Bulimia nervosa and anorexia nervosa are inextricably linked, with substantial clinical and epidemiological overlaps. Yet, while anorexia has been analyzed extensively in medical anthropology, bulimia remains under-theorized. This is, perhaps, because, compared to self-starvation, binge eating presents a logic of practice that is difficult to reconcile with culturally reified notions of self-control, transcendence, and hard work. Thus, although anthropologists have analyzed anorexic subjectivities as imbued with a sense of cleanliness and purity, moral superiority, and heroics, similar analyses have not been extended to bulimic subjectivities; instead, bulimia has been subsumed, as a tangential disorder, into analyses of anorexia. In this paper, I aim to move bulimic identities from the margins to the centre of anthropological analysis. Based on participant narratives, I analyze bulimic identity as articulated by six Israeli women who identified as bulimic and received treatment for bulimia. The women's narratives show that bulimic identity is aligned with concepts of distinct selfhood. For these women, to be bulimic was to be framed as 'abnormal'; but this 'abnormality', albeit a source of social stigma and shame, held meanings that went beyond pathology. Through the claiming of bulimic identity, the women positioned themselves as untamed, non-conforming subjects, who acted against gendered and classed expectations-and even against the limitations of the body. Their constructions of bulimic distinction highlight the need for anthropological work that situates bulimia not as a footnote to anorexia, but as a structurally and culturally meaningful condition in its own right.

Associations between meal patterns, binge eating, and weight for Latinas.

Establishing a regular pattern of eating is a core element of treatment for binge eating, yet no research to date has examined meal patterns of Latina women. OBJECTIVE: Compare eating patterns of Latinas who binge eat and those who do not, and examine associations between meal patterns and binge episodes, associated distress and concerns, and body mass index (BMI). METHOD: One-hundred fifty-five Latinas [65 Binge Eating Disorder (BED), 22 Bulimia Nervosa (BN), 68 with no eating disorder] were assessed with the Eating Disorder Examination. RESULTS: There were no significant differences in eating patterns between groups. Breakfast was the least and dinner the most consumed meal. For the BED group: greater frequency of lunch consumption was associated with higher BMI while more frequent evening snacking was associated with lower BMI and with less weight importance; more frequent breakfast consumption, mid-morning snack consumption and total meals were associated with greater distress regarding binge eating. For the BN group, evening snack frequency was associated with less dietary restriction and more weight and shape concern; total snack frequency was associated with more weight concern. Regular meal eaters reported more episodes of binge eating than those who did not eat meals regularly. DISCUSSION: Associations with meal patterns differed by eating disorder diagnosis. Study findings mostly are not consistent with results from prior research on primarily White women. CBT treatments may need to be tailored to address the association between binge eating and regular meal consumption for Latinas. Culturally, appropriate modifications that address traditional eating patterns should be considered. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:32-39).

Factors associated with self-identification of an eating disorder history among Latinas meeting criteria for past or current eating disorders.

OBJECTIVE: This paper compared Latinas who self-identified as having had an eating disorder (ED) with those who did not (despite both groups meeting criteria for an ED history) on ED pathology and mental health stigma. METHOD: Seventy-seven Latinas completed an online survey. RESULTS: All 77 participants met criteria for lifetime EDs, and 92% met current criteria for an ED; however, 47% did not report having an ED history vs. 53% did report an ED history. There was no difference on binge eating frequency. Those who endorsed an ED history engaged in more compensatory behaviors, had higher EAT-26 scores, and were less fearful of stigmatization due to seeking mental health treatment. Those reporting an ED history were more likely to have met criteria for anorexia nervosa or bulimia nervosa, generally more recognizable EDs than binge eating disorder and other specified feeding or eating disorders, than those who did not report an ED history. DISCUSSION: Latinas with certain patterns of eating pathology and those with less fear of being stigmatized due to seeking mental health treatment were more likely to endorse an ED history, which has implications for treatment seeking. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1032-1035).

"Las penas con pan duelen menos": The role of food and culture in Latinas with disordered eating behaviors.

This study elucidated the experiences of eighteen Latina adults (mean age = 38.5 years) from "Promoviendo una Alimentación Saludable" Project who received nutritional intervention as part of the clinical trial. Half of the participants were first generation immigrants from Mexico (50%), followed by U.S. born with 16.7%. Remaining nationalities represented were Bolivia, Colombia, Guatemala, Honduras, Peru, and Venezuela with 33.3% combined. The average duration of living in the U.S. was 11.1 years. The mean body mass index (BMI) at baseline was 36.59 kg/m(2) (SD = 7.72). Based on the DSM-IV, 28% (n = 5) participants were diagnosed with binge-eating disorder, 33% (n = 6) with bulimia nervosa purging type and 39% (n = 7) with eating disorder not otherwise specified. Participants received up to three nutritional sessions; a bilingual dietitian conducted 97.8% of sessions in Spanish. In total, fifty nutritional sessions were included in the qualitative analysis. A three step qualitative analysis was conducted. First, a bilingual research team documented each topic discussed by patients and all interventions conducted by the dietitian. Second, all topics were classified into specific categories and the frequency was documented. Third, a consensus with the dietitian was performed to validate the categories identified by the research team. Six categories (describing eating patterns, emotional distress, Latino culture values, family conflicts associated with disturbed eating behaviors, lack of knowledge of healthy eating, and treatment progress) emerged from patients across all nutritional sessions. Considering the background of immigration and trauma (60%, n = 15) in this sample; the appropriate steps of nutritional intervention appear to be: 1) elucidating the connection between food and emotional distress, 2) providing psychoeducation of healthy eating patterns using the plate method, and 3) developing a meal plan.

Different yet similar: Examining race and ethnicity in treatment-seeking adults with binge eating disorder.

OBJECTIVE: This study examined racial/ethnic differences in demographic variables and the clinical presentation of treatment-seeking adults with binge eating disorder (BED) who participated in treatment research at a medical school-based program. METHOD: Participants were 775 (n = 195 men, n = 560 women) treatment-seeking adults with DSM-IV-defined BED who self-identified as Black (n = 121), Hispanic (n = 54), or White (n = 580). Doctoral-level research clinicians assessed participants for BED and for eating disorder psychopathology using the Structured Clinical Interview for DSM-IV Disorders and the Eating Disorder Examination (EDE) interview, and measured height and weight. Participants also completed established self-report measures. RESULTS: Black participants had a greater proportion of women than White participants and White participants had higher education than Black and Hispanic participants. Black participants had higher body mass index (BMI) and reported more frequent binge eating episodes than White participants but eating-disorder psychopathology (EDE scales and Global Severity) did not significantly differ across racial/ethnic groups. Black participants had lower levels of depression than Hispanic and White participants. These differences in clinical presentation remained unchanged after adjusting for age, education, sex, and BMI. White participants had younger ages of onset for dieting, binge eating, and obesity, but not BED, than Black and Hispanic participants. CONCLUSION: There are some racial/ethnic differences in the developmental trajectories and clinical presentation of treatment-seeking adults with BED that remain unchanged after adjusting for demographic differences. Black participants presented for treatment with higher BMI and binge eating frequency than White participants and with lower depression than White and Hispanic groups, but associated eating disorder psychopathology levels were similar across racial/ethnic groups.

Effectiveness of lifestyle interventions to reduce binge eating symptoms in African American and Hispanic women.

OBJECTIVE: Lifestyle interventions that promote physical activity and healthy dietary habits may reduce binge eating symptoms and be more feasible and sustainable among ethnic minority women, who are less likely to seek clinical treatment for eating disorders. The purpose of this study was to investigate (1) whether participating in a lifestyle intervention is a feasible way to decrease binge eating symptoms (BES) and (2) whether changes in BES differed by intervention (physical activity vs. dietary habits) and binge eating status at baseline (binger eater vs. non-binge eater) in African American and Hispanic women. METHOD: Health Is Power (HIP) was a longitudinal randomized controlled trial to promote physical activity and improve dietary habits. Women (N = 180) who completed anthropometric measures and questionnaires assessing fruit and vegetable and dietary fat intake, BES and demographics at baseline and post-intervention six months later were included in the current study. RESULTS: Over one-fourth (27.8%) of participants were categorized as binge-eaters. Repeated measures ANOVA demonstrated significant two- and three-way interactions. Decreases in BES over time were greater in binge eaters than in non-binge eaters (F(1,164) = 33.253, p < .001), and women classified as binge eaters who participated in the physical activity intervention reported greater decreases in BES than non-binge eaters in the dietary habits intervention (F(1,157) = 5.170, p = .024). DISCUSSION: Findings suggest behavioral interventions to increase physical activity may lead to reductions in BES among ethnic minority women and ultimately reduce the prevalence of binge eating disorder and health disparities in this population.

Cross-cultural examination of beliefs about the causes of bulimia nervosa among Australian and Japanese females.

OBJECTIVE: To identify similarities and differences in beliefs about the causes of Bulimia Nervosa (BN) held by Asian (Japanese) women and Western (Australian) women, and hence, to examine the applicability of belief models of eating disorders (ED) across different cultures. METHOD: Four hundred three Japanese and 256 Australian female university students (aged 17-35 years) completed a questionnaire that gauged beliefs about the causes of BN. RESULTS: Among the Australian women, the four-component structure of perceived causes (dieting and eating practices, family dynamics, socio-cultural pressure, and psychological vulnerability) found in Dryer et al. (2012) was replicated. Among the Japanese women, however, a three-component structure (without the psychological vulnerability component) was obtained. The groups also differed in the causal component they most strongly endorsed, that being socio-cultural pressure for the Australian women, and dieting and eating practices for the Japanese women. DISCUSSION: The Japanese participants were found to endorse three out of the four Western-based causal explanations for BN, but the relative importance they placed on those explanations differed from that of the Australian participants. Further research is needed, particularly to establish whether Japanese women simply fail to see psychological vulnerability as a viable cause of BN, or there are in fact cultural differences in the extent to which such vulnerability causes BN.

Eating disorder symptoms among Japanese female students in 1982, 1992 and 2002.

To study transcultural differences in eating disorders, we examined eating disorder symptoms and point prevalence of eating disorders among Japanese female students in 1982, 1992 and 2002. In 1982, 1992 and 2002, a total of 10,499 Japanese female students, aged 16-23 years, were asked to complete a self-administered questionnaire. Diagnosis of an eating disorder was made on the basis of DSM-IV criteria. On almost all measures, there were significant increases of a disordered attitude about fear of gaining weight, body perception disturbance and problematic eating behaviors over time. The point prevalence of anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified significantly increased over time. These results suggest that the prevalence of eating disorder symptoms and the point prevalence of eating disorders were increasing among Japanese female students in 2002. Changing socio-cultural factors in Japan may explain the dramatic increase of eating disorders over time.

Nutrição e transtornos alimentares na adolescência / Nutrition and alimentary disorders in adolescence

Atualização dos principais aspectos relativos à nutrição na infância e adolescência, com particular enfoque nos principais distúrbios alimentares encontrados nessa faixa etária, anorexia nervosa e bulimia nervosa e abordando os recursos diagnósticos e a conduta terapêutica.

Eating disorder features in indigenous Aboriginal and Torres Strait Islander Australian peoples.

BACKGROUND: Obesity and related cardiovascular and metabolic conditions are well recognized problems for Australian Aboriginal and Torres Strait Islander peoples. However, there is a dearth of research on relevant eating disorders (EDs) such as binge eating disorder in these groups. METHODS: Data were obtained from interviews of 3047 (in 2005) and 3034 (in 2008) adults who were participants in a randomly selected South Australian household survey of individuals' age > 15 years. The interviewed comprised a general health survey in which ED questions were embedded. Data were weighted according to national census results and comprised key features of ED symptoms. RESULTS: In 2005 there were 94 (85 weighted) First Australian respondents, and in 2008 65 (70 weighted). Controlling for secular differences, in 2005 rates of objective binge eating and levels of weight and shape influence on self-evaluation were significantly higher in indigenous compared to non-indigenous participants, but no significant differences were found in ED features in 2008. CONCLUSIONS: Whilst results on small numbers must be interpreted with caution, the main finding was consistent over the two samples. For First Australians ED symptoms are at least as frequent as for non-indigenous Australians.

Disordered weight control behaviors in early adolescent boys and girls of color: an under-recognized factor in the epidemic of childhood overweight.

OBJECTIVES: Ethnic disparities in childhood overweight are well-documented. In addition, disordered weight control behaviors (DWCB) have been linked to overweight and weight gain in multiple ways, but little is known about DWCB in youth of color, especially boys. We examined the distribution and determinants of ethnic and gender disparities in DWCB in early adolescents. METHODS: In fall 2005, 47 Massachusetts middle schools participating in the Healthy Choices overweight prevention study administered a self-report baseline survey assessing student sociodemographics, height, weight, and DWCB (vomiting or use of laxatives or diet pills in the past month to control weight). Data from 16,978 girls and boys were used in multivariate logistic regression models to estimate the odds of DWCB in youth of color compared with their white peers, controlling for individual- and school-level factors. RESULTS: Among white youth, 2.7% of girls and 2.3% of boys reported DWCB. The odds of DWCB were elevated 2-10 times in most ethnic groups relative to whites. Disparities were attenuated but persisted after controlling for multiple individual- and school-level factors. CONCLUSIONS: Ethnic disparities in DWCB must be considered in efforts to address the epidemic of childhood overweight.

Validity and reliability of the Chinese language version of the eating disorder examination (CEDE) in mainland China: Implications for the identity and nosology of the eating disorders.

PURPOSE: To investigate the crosscultural validity and reliability of the Chinese Language version of the Eating Disorder Examination (CEDE) in Wuhan, China, and to examine the psychopathological profile of eating disorder patients in central Mainland China. PARTICIPANTS AND METHOD: We administered the CEDE to 41 eating disorder patients (anorexia nervosa and bulimia nervosa) with 43 non-eating disorder controls. Specialists in eating disorders made the clinical diagnosis according to DSM-IV criteria. CEDE data between the two groups were compared. RESULTS: The CEDE demonstrates good internal consistency, test-retest reliability, and inter-examiner reliability. All CL-EDE subscales discriminated between patients with anorexia nervosa or bulimia nervosa from non-eating disordered controls. The CEDE has satisfactory sensitivity, specificity, and positive and negative predictive values. DISCUSSION: The CEDE is a useful instrument for the study of the growing clinical problem of the eating disorders in Mainland China. The finding that the characteristic fat phobia is prominent in this population of eating disordered patients and its implication on the identity and classification of the eating disorders are discussed.

Body dissatisfaction, ethnic identity, and disordered eating among African American women.

Initial research suggested that only European American women developed eating disorders (Garner, 1993), yet recent studies have shown that African American women do experience them (e.g., Lester & Petrie, 1998b; Mulholland & Mintz, 2001) and also may be negatively affected by similar sociocultural variables. In this study, we examined a sociocultural model of eating disorders for African American women but included the influences of ethnic identity (e.g., Hall, 1995; Helms, 1990). Participants (N = 322) were drawn from 5 different universities. They completed measures representing ethnic identity, societal pressures regarding thinness, internalization of societal beauty ideals, body image concerns, and disordered eating. Structural equation modeling revealed that ethnic identity was inversely, and societal pressures regarding thinness directly, related to internalization of societal beauty ideals. Societal pressures regarding thinness was also related to greater body image concerns. Both internalization of societal beauty ideals and body image concerns were positively associated with disordered eating (R² = .79). Overall, the final model fit the data well, supporting its generalizability and the importance of ethnic identity in determining risk.

Characteristics of black treatment seekers for eating disorders.

OBJECTIVE: This study sought to investigate differences in eating psychopathology between black and white treatment seekers at a specialty eating disorders (EDs) center. METHOD: Participants were drawn from 1680 individuals (n = 32 blacks; n = 1648 whites) who received treatment for an ED at a specialized center between 1979 and 1995, and had completed the EDs Questionnaire. The 32 black participants were matched to 153 white participants for ED diagnosis, year of presentation, and gender. RESULTS: The majority of the participants were diagnosed with eating disorder not otherwise specified (EDNOS). No black participants met criteria for anorexia nervosa (AN). Black participants reported more body dissatisfaction and a higher percentage fulfilled the obesity criterion compared to white participants. There were few differences in reported history of previous treatment. DISCUSSION: Black and white participants with EDs appeared similar in most respects, but AN was notably absent among black participants. In contrast to previous research, body dissatisfaction was surprisingly higher in black than in white participants.

Fatores preditivos para transtornos alimentares em universitárias do curso de nutrição da Unijuí, Ijuí,RS / Predictive factors for eating disorders in the course of university nutrition at Unijuí, Ijuí, RS / Los factores predictivos de los trastornos alimentarios en el curso de nutrición universitaria en Unijuí, Ijuí, RS

Introdução: Os transtornos alimentares são definidos como desvios do comportamento alimentar que podem levar à caquexia ou à obesidade, entre outros problemas físicos e incapacidades sócio-ocupacionais. Objetivo: Avaliar a presença de fatores preditivos de transtornos alimentares em estudantes de nutrição da Universidade Regional do Noroeste do Estado do Rio Grande do Sul- UNIJUI. Método: Foi aplicado o questionário Eating Attitudes Test (EAT), instrumento que contém 26 perguntas sobre o comportamento alimentar e imagem corporal, podendo variar de 0 a 78 pontos, sendo que foi considerado risco para transtorno um somatório > a 20. Dados como massa corporal e estatura foram auto-referidos. Resultados: Participaram do estudo 116 universitárias, destas 18,1% consideradas EAT (+) e 81,9% EAT(-), na faixa etária entre 20 e 30 anos, com renda entre 3 a 4,9 salários mínimos. A massa corporal nas EAT(+) variou de 44 a 80kg e nas EAT9-) variou de 43 a 82kg. Tanto EAT(+) quanto EAT(-) encontram-se em eutrofia, sendo 81% e 82,1%, respectivamente. Os principais fatores preditivos para transtornos alimentares citados pelo maior número de estudantes com EAT(+) foram: preocupação com a gordura corporal (100%), pavor com o excesso de peso (90,5%), conhecimento sobre o número de calorias dos alimentos que comem (85,7%), preocupação com o desejo de ser mais magra (80,9%). Conclusão: Conclui-se que há um valor expressivo de estudantes de nutrição com fatores preditivos para transtornos alimentares.

Introduction: Eating disorders are defined as deviations in eating behavior that can lead to cachexia or obesity, among other physical and socio-occupational disabilities. Objective: To evaluate the presence of factors predictive of eating disorders in students of nutrition at the University of the West Regional of Rio Grande do Sul-UNIJUÍ. Method: We used the questionnaire Eating Attitudes Test (EAT), an instrument that contains 26 questions on eating behavior and body image, ranging from 0 to 78 points, and was considered a risk for disorder sum> 20. Data such as body mass and height were self-referred. Results: Participants were 116 university students, 18.1% of these considered EAT (+) and 81.9% TSS (-), aged between 20 and 30 years, with income between 3 to 4.9 minimum wages. Body mass in EAT (+) ranged from 44 to 80kg and the EAT9-) ranged from 43 to 82kg. Both EAT (+) and EAT (-) are eutrophic, 81% and 82.1%, respectively. The main predictive factors for eating disorders cited by the largest number of students with EAT (+) were concerned with body fat (100%), with fear being overweight (90.5%), knowledge about the number of calories from eat foods (85.7%), concern the desire to be thinner (80.9%). Conclusion: We conclude that there is a significant value for students of nutrition with predictive factors for eating disorders.

Introducción: Los trastornos alimentarios se definen como las desviaciones en la conducta alimentaria que puede conducir a la caquexia o la obesidad, entre otras discapacidades físicas y socio-laborales. Objetivo: Evaluar la presencia de factores predictivos de los trastornos alimentarios en estudiantes de nutrición de la Universidad de la Regional Oeste de Río Grande do Sul-UNIJUÍ. Método: Se utilizó el cuestionario de Actitudes Comer prueba (EAT), un instrumento que contiene 26 preguntas sobre la conducta alimentaria y la imagen corporal, que van de 0 a 78 puntos, y fue considerado un riesgo para el trastorno de suma> 20. Datos como la masa corporal y la altura se auto-referencia. Resultados: Los participantes fueron 116 estudiantes universitarios, el 18,1% de estos considera EAT (+) y TSS 81,9% (-), con edades comprendidas entre 20 y 30 años, con ingresos entre 3 a 4.9 salarios mínimos. De masa corporal en el EAT (+) es de 44 a 80 kg y el EAT9) varió de 43 a 82kg. Ambos EAT (+) y EAT (-) son eutróficos%, el 81 y el 82,1%, respectivamente. Los principales factores predictivos de los trastornos alimentarios citados por el mayor número de estudiantes con EAT (+) se refiere a la grasa corporal (100%), con el miedo el exceso de peso (90,5%), el conocimiento sobre el número de calorías de comer alimentos (85,7%), la preocupación del deseo de ser delgado (80,9%). Conclusión: Se concluye que existe un valor significativo para los estudiantes de la nutrición con los factores predictivos de los trastornos alimentarios.

The metabolic syndrome and behavioral correlates in obese patients with binge eating disorder.

This study examined the frequency of the metabolic syndrome (MetSyn) and explored behavioral eating- and weight-related correlates in obese patients with binge eating disorder (BED). Ninety-three treatment-seeking obese BED patients (22 men and 71 women) with and without the MetSyn were compared on demographic features and a number of current and historical eating and weight variables. Sixty percent of the obese patients with BED met criteria for the MetSyn, with men and whites having significantly higher rates than women and African Americans, respectively. Patients with vs. without coexisting MetSyn did not differ significantly in self-reported frequency of binge eating or severity of eating disorder psychopathology. Multivariate hierarchical logistic regression analysis revealed that, after controlling for gender, ethnicity, and BMI, fewer episodes of weight cycling and regular meal skipping were significant predictors of the MetSyn. These findings suggest that lifestyle behaviors including weight loss attempts and regular meal consumption may be potential targets for prevention and/or treatment of the MetSyn in obese patients with BED.

Patterns and prevalence of disordered eating and weight control behaviors in women ages 25-45.

OBJECTIVE: The current study describes detailed eating behaviors, dieting behaviors, and attitudes about shape and weight in 4023 women ages 25 to 45. METHOD: The survey was delivered on-line and participants were identified using a national quota-sampling procedure. RESULTS: Disordered eating behaviors, extreme weight loss measures, and negative cognitions about shape and weight were widely endorsed by women in this age group and were not limited to White participants. Thirty-one percent of women without a history of anorexia nervosa or binge eating reported having purged to control weight, and 74.5% of women reported that their concerns about shape and weight interfered with their happiness. DISCUSSION: Unhealthy approaches to weight control and negative attitudes about shape and weight are pervasive even among women without eating disorders. The development of effective approaches to address the impact of these unhealthy behaviors and attitudes on the general well-being and functioning of women is required.