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New Zealand Statistics
Prevalence studies of anorexia nervosa and bulimia nervosa
Prevalence of disturbed eating habits
Prevalence of disturbed attitudes to food and body dissatisfaction
Ethnicity and eating issues
References
1) Prevalence studies of anorexia nervosa and bulimia nervosa
It is important to remember that prevalence estimates for these kinds of eating disturbances vary according to the type of criteria used to measure them and according to the populations of people who are included in the studies. Most of the studies included below were conducted using the American Psychiatric Association’s DSM-III or DSM-III-R manual of mental disorders (APA, 1980; APA, 1987) criteria for eating disorder which has since been modified. Generally speaking, the prevalence of eating disorders among New Zealand women is comparable to other Western countries. (Fear, Bulik & Sullivan, 1996).
The Christchurch Psychiatric Epidemiology Study (CPES) is the main published New Zealand work on the prevalence of anorexia and bulimia in the general population, however it was conducted over fifteen years ago so may not reflect the current situation. This study found that anorexia nervosa occurs in less than 1 % of all women during their lifetime although this rises to 35 per 100,000 women aged between 15 and 19 years (Wells, Bushnell, Hornblow et al, 1989). Bulimia nervosa was found to affect 2 % of women across the lifespan and was rare in men. The CPES found that women between the ages of 18 and 24 were at the greatest risk of having bulimia with nearly one in twenty in this group having experienced it. (Bushnell, Wells, Hornblow et al, 1990)
Using a narrower definition of bulimia, Welch and Hall (1990) found that 2.5 % of a group of 243 nursing students met the criteria required for diagnosis. This increased prevalence in a group of tertiary students is reflected by other studies and implies an increased susceptibility in these groups. Research conducted in Christchurch with a sample of 243, 17 – 25 year old females who were predominantly university students found that 2.4% met the criteria for bulimia (Smart, 1992).
In a study of referrals to a specialist eating disorder service in the Wellington region, Hall and Hay (1991) found that 343 eating disorder patients were seen between 1977 and 1986. Of those 50% had anorexia nervosa, 37% had bulimia and 13% had atypical eating disorder (Now called Eating Disorder Not Otherwise Specified). 96% of clients were female. The researchers noted that the annual rate of referral for anorexia nervosa remained stable at 34 per 100,000 (females aged 15-29 years) whereas the annual referral rate for bulimia had increased between 1977 and 1986 from 6 to 44 per 100,000 females aged 15-29 years (Hall & Hay, 1991).
Of 69 women presenting for treatment for anorexia nervosa in Christchurch between 1981 and 1984, 54% developed bulimia nervosa over the course of the 15-year follow-up interval. The highest risk period for the development of bulimia was within the first two years after the onset of anorexia (Bulik, Sullivan, Fear & Pickering, 1997).
2) Prevalence of disturbed eating habits
Disturbed eating habits are regarded as major risk factors for the development of eating disorders.
The CPES (Wells, Bushnell, Hornblow et al, 1989) found that in those women who did not conform to the diagnostic criteria for eating disorder, a wide range of disordered eating habits was common. In women aged 18-44 years, lifetime experience of recurrent binge eating was reported by 22.5 %, depressed mood and self-deprecating thoughts after bingeing by 10.6 %, and use of at least three extreme weight loss measures (eg exercising, vomiting or fasting) by 8.2 %.
Welch and Hall (1990) found that of the 243 female tertiary students in their study, 43.6% engaged in binge eating at some stage in the past. Fear, Bulik and Sullivan (1996) reported high rates of disordered eating behaviours among adolescent girls in Christchurch. Of the 363 girls in the study, 54% reported dieting (most having begun before the age of 13), 38% bingeing, 12% purging, 2.5% using laxatives, and 2.2% using diet pills.
3) Prevalence of disturbed attitudes to food and body dissatisfaction
Disturbed attitudes to food and body dissatisfaction are thought to be precursors to the development of eating disorders.
In a sample of Auckland schoolgirls aged 13-17 years, 14 % were found to have the disturbed attitudes to food and eating that suggested a potential eating disorder. (Lowe, Miles & Richards, 1985). In adolescent schoolgirls in Christchurch, 71% of 363 participants, desired themselves to be a smaller size than they perceived themselves to be. (Fear, Bulik & Sullivan, 1996).
Among 157 women attending their general practitioner in Christchurch in 1983 and 1984, 72 % reported wanting to weigh less and 46 % were dissatisfied with their body shape, although only 35 % were overweight for their height (the study utilised the outdated 1959 Metropolitan Life Tables to classify participants into weight categories). 48% of the women dieted at least sometimes with 24% usually or always dieting, and 21% wanted help with their eating or weight problems. (Wells, Wells, McKenzie & Hornblow, 1986).
4) Ethnicity and eating issues
There has been little research into the experiences of Maori and Pacific Island women and girls in the area of eating and body image issues. The rates of referral of these groups to specialist eating disorder services are disproportionately low. Among referrals to the Auckland Eating Disorder Service between 1993 and 1996, 6.3 % were Maori and 1.8 % were Pacific Island people (Cited in Bushnell, 1997).
Despite these findings, in her study of Maori and Pakeha university students, Turangi-Joseph (1998) found no differences between Pakeha and Maori in terms of body image concerns, body dissatisfaction, dieting behaviours and disordered eating attitudes. This finding led Turangi-Joseph (1998) to argue that the popular notion that Maori culture values a fuller body shape may have masked the need to investigate eating difficulties and related issues within this group. She has contended that the prevalence of ‘obesity’ in this group may have led researchers and clinicians to believe that largeness is preferred and therefore, this population were somehow immune to eating disorders, which may have resulted in misdiagnosis and under reporting. Indeed, more recently in their research, Moewaka Barnes & Borell (2002) found that young Maori women associated “skinny” bodies with happiness, confidence, and popularity and fat bodies with low self esteem, feeling ‘down’, less popularity and isolation.
Fear, Bulik & Sullivan (1996) have posited that the rising figures for eating disturbances for Maori might be due to Maori females adopting the pakeha standard of thinness as their ideal despite the fact that they tend to posses larger frames than their Pakeha counterparts. It is important to emphasise that dominant ethno-centric conceptualisations of body dissatisfaction and eating difficulties as the province of white, middle class adolescents and women have functioned to obscure the prevalence and experiences of this distress in other populations. Culturally inappropriate eating disorder instruments, over-reliance on certain diagnostic features, assumptions about the ‘universal’ experience and meanings of eating/body distress and the tendency of health professionals not to recognise eating difficulties in women from ethnically and socio-economically diverse groups, have all contributed to the partial knowledge and biased prevalence statistics that dominate in this field (Waipara-Panapa, 1996).
References
APA. (1987). Diagnostic and Statistical Manual of Mental Disorders. 3rd rev. ed. [DSM-III-R]. Washington, DC: American Psychiatric Association.
APA. (1980). Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. [DSM-III]. Washington, DC: American Psychiatric Association.
Bulik, C. M., Sullivan, P.A., Fear, J. L., & Pickering, A. (1997). Predictors of the development of bulimia nervosa in women with anorexia nervosa. The Journal of Nervous and Mental Disease, 185, 704-707.
Bushnell, J. (1997). Eating Disorders. In Ellis, P. M., & Collings, S. C.D. (Eds.). Mental Health in New Zealand from a Public Health Perspective. (pp327-341). Wellington: Public Health Goup, Ministry of Health.
Bushnell, J. A., Wells, J. E., Hornblow, A. R., Oakley-Browne, M. A., & Joyce, P. (1990). Prevalence of three bulimia syndromes in the general population. Psychological Medicine, 20, 671-680.
Fear, J. L., Bulik, C. M., & Sullivan, P. A. (1996). The prevalence of disordered eating behaviours and attitudes in adolescent girls. New Zealand Journal of Psychology, 25, 7-12.
Hall, A. & Hay, P. J. (1991). Eating disorder patient referrals from a population region 1977-1986. Psychological Medicine, 21, 697-701.
Lowe, H. C., Miles, S. W., & Richards, C. G. (1985) Eating attitudes in an adolescent schoolgirl population. New Zealand Medical Journal, 330-331.
Moewaka Barnes, H. & Borell, B (2002). Not too fat and not too skinny: A study of body perceptions and influences with female rangatahi. Whariki Research Group, Alcohol and Public Health Research Unit. University of Auckland.
Smart, N. L. (1992). Eating disorders of the bulimic type: prevalence and predictive factors in a New Zealand community sample. Unpublished master’s thesis. University of Canterbury, Christchurch, New Zealand.
Turangi-Joseph, A. (1998). Tyranny of appearances: body image, dieting and eating attitudes among Maori and Pakeha students. Unpublished master’s thesis. University of Waikato, Hamilton, New Zealand.
Waipara-Panapa, A, L. (1996). Body and soul: A sociocultural analysis of body image in Aotearoa. Unpublished master’s thesis. University of Auckland, Auckland, New Zealand.
Welch, G., & Hall, A. (1990). Is the prevalence of bulimia nervosa higher among tertiary education populations? New Zealand Medical Journal, 103, 476-477.
Wells, J. R., Bushnell, J. A., Hornblow, A. R. et al. (1989). Christchurch Psychiatric Epidemiology Study: methodology and lifetime prevalence for specific disorders. Australian and New Zealand Journal of Psychiatry, 23, 315-326.
Wells, S., Wells, J. E., McKenzie, J. M., & Hornblow, A. R. (1986). Eating and weight problems among women attending their general practitioner. New Zealand Medical Journal, 99, 671-673.
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