OLAWALE MICHAEL AYENI

EATING DISORDERS

Contents Page

1. INTRODUCTION 2

2. DSM-5 DIAGNOSTIC CRITERIA OF EATING DISORDERS 2

2.1 ANOREXIA NERVOSA 3

2.2 BULIMIA NERVOSA 4

2.3 BINGE-EATING 6

3. DEVELOPMENTAL STAGE ISSUES OF CLINICAL POPULATION OF ADOLESCENTS AND

UNIVERSITY STUDENTS……………………………………………………………..7

4. THE IMPACT OF MEDIA ON ACCULTURATION TO WESTERN IDEALS ……10

5. THE IMPACT OF URBANISATION, ECONOMIC FACTORS, AND THE DIFFERENCES IN

RURAL AREAS ………………………………………………………………………..13

6. CONCLUSION 14

7.REFERENCES 14

1|Pa ge
1. INTRODUCTION

An eating disorder is defined as an “unhealthy eating pattern that can develop

primarily among women, but is seen in men as well. The combination of cultural
messages (where thin is the only acceptable body size), psychological issues, and
low self-esteem can set the stage for developing an eating disorder” (The American
Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders,
1994:76 cited in Schoeman & Vogel, 2005, p. 28)

Eating disorders have been described in South Africa since the 1970s (Norris, 1979
cited in Agberotimi et al., 2023, p. 496). However, eating disorders have traditionally
been associated with the white community in South Africa (Christopher Paul Szabo
& Clifford W. Allwood, 2006). In 1995, the first descriptions emerged of eating
disorders in black females in South Africa (Szabo, 1999; Szabo et al., 1995 cited in
Agberotimi et al., 2023, p. 496). Greater numbers of black women have since
presented for treatment of eating disorders (Szabo & Allwood, 2004 cited in
Agberotimi et al., 2023, p. 496). The emergence of eating disorders among blacks in
the mid 1990’s appeared to signal a demographic shift. Subsequent data suggested
that eating disorders would increase in prevalence amongst black South Africans
(Christopher Paul Szabo & Clifford W. Allwood, 2006). The purpose of this essay is
to provide and differentiate the diagnostic criteria and hallmark features of Anorexia
Nervosa, Bulimia Nervosa and Binge-eating disorder among female adolescents and
university students in South Africa within a cross cultural context.

2. DSM-5 DIAGNOSTIC CRITERIA OF EATING DISORDERS

Eating disorders (anorexia nervosa, bulimia nervosa and binge-eating) are typified by body image
concerns and preoccupation with food, in differing degrees, in addition to abnormal eating
behaviors. For anorexia nervosa and bulimia nervosa, the fear of gaining weight is a core
diagnostic feature and the associated eating behaviors revolve around preventing weight gain
(Claudino et al., 2019; Hay, 2020 cited in Agberotimi et al., 2023, p. 473).
Anorexia nervosa is characterised by notably low body weight as a consequence of limiting the
intake of energy relative to the energy needed, the extreme fear of weight gain, and a disturbed
self-perception of body shape or weight (American Psychiatric Association, 2022; World Health
Organization, 2022 cited in Agberotimi et al., 2023, p. 473). Bulimia nervosa comprises recurrent
episodes of binge eating and associated compensatory behaviors that are inappropriate attempts
2|Pa ge
to avoid weight gain. With bulimia nervosa, the evaluation of self is disproportionally by body
weight and shape (American Psychiatric Association, 2022; World Health Organization, 2022 cited
in Agberotimi et al., 2023, p. 473). The determination to be thin is the driving force behind anorexia
nervosa and bulimia nervosa. A binge-eating episode can be defined as a discrete time period
when the person experiences a sense of loss of control over their eating behaviour, being unable
to stop eating or control the amount or type of food they consume. The person often experiences
their binge-eating behaviour as very upsetting, with feelings of shame, guilt and disgust serving to
further break down their self-evaluation. Bulimia nervosa is diagnosed regardless of the person's
weight status (World Health Organization, 2022 cited in Agberotimi et al., 2023, p. 508). We will
look to the DSM-5 diagnostic criteria for each disorder in the following sections.

2.1 ANOREXIA NERVOSA

The term ‘anorexia nervosa’ means ‘nervous loss of appetite. The key feature of
anorexia nervosa is a significantly low body weight for the person’s height, age
and developmental stage that is not due to another health condition or lack of
food; in adults a body max index (BMI) of below 18.5kg/m2 and in children and
adolescents a BMI-for-age under the fifth percentile. It is distinguished by an
ongoing behavior that avoids restoration of normal weight by means of
restriction of energy intake or increasing energy expenditure. It is characterized
by fear of gaining weight and by self-perception being tied to a low body weight
or shape, with an accompanying disturbance in self-perception of body shape
and size (De Witt and Attia, 2017; World Health Organization, 2022 cited in
Agberotimi et al., 2023, pp. 502-503).

Furthermore, anorexia nervosa is characterised by deliberate weight loss

through avoiding fattening foods; whilst bulimia nervosa is characterised by
repeated bouts of over-eating and intense preoccupation with controlling body
weight. Sufferers of both these conditions may make themselves sick, take
laxatives and exercise excessively in order to lose weight (the desire to lose
weight is intense). These symptoms are not primarily about food. Food-related
behaviour is symptomatic of underlying emotional and psychological difficulties.
This is the way some people cope with difficult feelings and unresolved
problems (The American Psychiatric Association’s Diagnostic and Statistical
Manual of Mental Disorders 1994 cited in Schoeman & Vogel, 2005, p. 28)

3|Pa ge
As tabularized in Agberotimi et al. (2023), the diagnostic criteria for anorexia nervosa
from the DSM-5-TR are as follow:

A. Restriction of energy intake relative to requirements, leading to a significantly

low body weight in context of age, sex, developmental trajectory, and
physical health. Significantly low weight is defined as weight that is less than
minimally normal or, for children and adolescents, less than that minimally
expected.

B. Intense fear of gaining weight or of becoming fat, or persistent behavior that

interferes with weight gain, even though at a significantly low weight.

C. Disturbance in the way in which one's body weight or shape is experienced,

undue influence of body weight or shape on self-evaluation, or persistent lack
of recognition of the seriousness of the current low body weight.

The ICD-10-CM code depends on the subtype below:

Specify whether:
F50.01 Restricting type: During the last 3 months, the individual has not
engaged in recurrent episodes of binge-eating or purging behavior (i.e., self-
induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype
describes presentations in which weight loss is accomplished primarily through
dieting, fasting, and/or excessive exercise.

F50.02 Binge-eating/purging type: During the last 3 months, the individual has
engaged in recurrent episodes of binge-eating or purging behavior (i.e., self-
induced vomiting or the misuse of laxatives, diuretics, or enemas).

Specify if:
In partial remission: After full criteria for anorexia nervosa were previously met,
Criterion A (low body weight) has not been met for a sustained period, but either
Criterion B (intense fear of gaining weight or becoming fat or behavior that
interferes with weight gain) or Criterion C (disturbances in self-perception of
weight and shape) is still met.

In full remission: After full criteria for anorexia nervosa were previously met,
none of the criteria have been met for a sustained period of time.
4|Pa ge
Specify current severity. The minimum level of severity is based, for adults, on
current body mass index (BMI) (see below) or, for children and adolescents, on
BMI percentile. The ranges below are derived from World Health Organization
categories for thinness in adults; for children and adolescents, corresponding
BMI percentiles should be used. The level of severity may be increased to reflect
clinical symptoms, the degree of functional disability, and the need for
supervision.
Mild: BMI ≥17 kg/m².
Moderate: BMI 16-16.99 kg/m².
Severe: BMI 15-15.99 kg/m².
Extreme: BMI <15 kg/m².

2.2 BULIMIA NERVOSA

The literal translation of 'bulimia' is 'ox hunger', which means any great,
ravenous hunger; the term refers to the binging behaviour associated with this
disorder (Linville, 1998 cited in Agberotimi et al., 2023, p. 508). The pivotal
aspects of the diagnosis of bulimia nervosa are frequently recurring episodes of
overeating or 'binging'. The binge-eating episode is closely followed by attempts
to evade weight gain by means of inappropriate compensatory behaviours such
as self-induced vomiting and/or purgative use. Self-evaluation that
overemphasises body weight and shape is present. The person feels notable
distress about their pattern of binging and compensating or it causes marked
impairment in functioning (American Psychiatric Association, 2022; World Health
Organization, 2022 cited in Agberotimi et al., 2023, p. 508).

The diagnostic criteria for bulimia nervosa from the DSM-5-TR as tabularized in
Agberotimi et al. (2023) are as follow:

A. Recurrent episodes of binge eating.

An episode of binge eating is characterized by both of the following:
(1) Eating, in a discrete period of time (eg, within any 2-hour period), an amount
of food that is definitely larger than what most individuals would eat in a similar
period of time under similar circumstances.
(2) A sense of lack of control over eating during the episode (e.g., a feeling that

5|Pa ge
one cannot stop eating or control what or how much one is eating).

B. Recurrent inappropriate compensatory behaviors in order to prevent weight

gain, such as self- induced vomiting; misuse of laxatives, diuretics, or other
medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur, on

average, at least once a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of anorexia

nervosa.

The minimum level of severity is based on the frequency of inappropriate

compensatory behaviors. The level of severity may be increased to reflect other
symptoms and the degree of functional disability.
Mild: An average of 1-3 episodes of inappropriate compensatory behaviors per
week.
Moderate: An average of 4-7 episodes of inappropriate compensatory behaviors
per week.
Severe: An average of 8-13 episodes of inappropriate compensatory behaviors
per week.
Extreme: An average of 14 or more episodes of inappropriate compensatory
behaviors per week.

2.3 3 BINGE-EATING
According to Agberotimi et al. (2023), binge-eating disorder Binge-eating
disorder (BED) is characterised by episodes of binge eating that cause
significant distress for the individual, but the person does not engage in
compensatory behaviours. This diagnosis was included in the DSM-5 as a new
disorder.

The diagnostic criteria for bulimia nervosa from the DSM-5-TR as tabularized in
Agberotimi et al. (2023) are as follow:

A. Recurrent episodes of binge eating. An episode of binge eating is

characterized by both of the following:

6|Pa ge
 (1) Eating, in a discrete period of time (e.g., within any 2-hour period), an
amount of food that is definitely larger than what most people would eat in a
similar period of time under similar circumstances.
(2) A sense of lack of control over eating during the episode (e.g., a feeling that
one cannot stop eating or control what or how much one is eating).

B. The binge-eating episodes are associated with three (or more) of the
following:
(1) Eating much more rapidly than normal.
(2) Eating until feeling uncomfortably full.
(3) Eating large amounts of food when not feeling physically hungry.
(4) Eating alone because of feeling embarrassed by how much one is eating.
(5) Feeling disgusted with oneself, depressed, or very guilty afterward.

C. Marked distress regarding binge eating is present.

D. The binge eating occurs, on average, at least once a week for 3 months.

E. The binge eating is not associated with the recurrent use of inappropriate
compensatory behavior as in bulimia nervosa and does not occur exclusively
during bulimia nervosa or anorexia nervosa.

3. DEVELOPMENTAL STAGE ISSUES OF CLINICAL POPULATION OF

ADOLESCENTS AND UNIVERSITY STUDENTS
Body shape dissatisfaction, disordered eating, inappropriate weight management
practices and clinical eating disorders represent significant health concerns among
students on university campuses. Although it is generally accepted that the etiology
of eating-related disorders is multifactorial, there has been increasing interest in the
role that social and cultural norms and consequent pressures play in either
protecting against or causing these problems. It has been argued that the process
of normal gender-role socialization leads women to be particularly concerned about
their physical appearance as a means of gaining approval from others. Therefore, in
Western societies where thinness is indisputably a strived for beauty ideal, young
women in the process of establishing their identity are especially vulnerable to
dissatisfaction with their shape and the pursuit of thinness through dieting, and
consequently the development of eating disorders. The situation at a university
7|Pa ge
campus can intensify this process, as it presents a community context within which
students live, it embeds the social values that shape their choices about weight
control, and it provides a context within which weight-related behaviors are enacted
(Senekal et al., 2001).

Hartmann (2003:1 cited in Schoeman & Vogel, 2005, p. 29) describes society’s
obsession with thinness and body shape as body fascism, and asserts that it is part
of every school’s hidden curriculum. According to Hartmann (2003:4-5 cited in
Schoeman & Vogel, 2005, p. 29) body fascism may be described as “the severe
intolerance in self and others of any weight or shape that does not resemble
idealised bodies portrayed in media images... often resulting in the rejection or
bullying of those who do not conform to a specific body type”. This means that many
vulnerable young people will be so affected by the obsession with thinness that they
proceed in developing an eating disorder (Marchuk, 1997:6-8 cited in Schoeman &
Vogel, 2005, p. 29).

The need to be skinny has already caused a lot of eating disorders among young
people in South Africa, starting as young as the senior phase (Grades 7, 8 and 9) of
the general education and training band (Vogel, 2004:8 cited in Schoeman & Vogel,
2005, p. 29). Scholars such as Delaney, Erskine, Langridge, Smith, Van Niekerk,
Winters and Wright (1995:992-993), Norris (1996:39-45), Schutte (2004:9) and
Vogel (2004:9) claim that in every school in South Africa there is a significant
percentage of learners with eating disorders (Schoeman & Vogel, 2005, p. 29).

A close reading of research findings in 1994 reveals that 2,6% white learners and
1,7% non-white learners experienced problems with eating disorders. In comparison
to the 1994 figures, a decade later, in 2004, the situation worsened and 2,8% white
learners and 2,0% non-white learners suffered from an eating disorder (Schoeman
& Vogel, 2005, p. 29). Educators especially are fundamental in developing
intolerance in many areas, which include body fascism and eating disorders (Sours,
1980:121). As sports and physical activities trainers, educators are particularly well
placed to contribute to problems faced by adolescents in this regard, such as the
teasing of overweight learners, the perception that overweight learners will not be
able to achieve high levels of success, etcetera. Learners fear being picked last in a

8|Pa ge
team due to perceived physical unsuitability. Hence, they are self-conscious about
body shape and develop self-esteem that is dependent on body size (Connell,
Turner & Mason, 1985:316-318 cited in Schoeman & Vogel, 2005, p. 29).

There is a tendency for women to judge themselves to be overweight and aspire to

a smaller body size , as well as perceive themselves to be overweight when not
objectively so as measured by their body mass index (BMI). Body dissatisfaction
has been shown to have an important influence on weight control behaviour in
women which may ultimately lead to the onset and development of an eating
disorder or behaviours associated with an eating disorder. Specifically, there
appears to be a compelling link between weight control behaviours e.g. dieting and
the development of eating disorders (Szabo & Allwood, 2006).

Szabo and Allwood (2006) reported that; given the relationship between body
dissatisfaction and eating disorders, an exploration of such feelings is important in
developing an understanding of the emergence of eating disorders. Cross cultural
South African data in this regard is limited. A study involving adolescents
demonstrated that in samples of both urban white and black girls there were
substantially greater numbers with body dissatisfaction than amongst black rural
girls. Urban white girls had the greatest level of body dissatisfaction, black rural girls
the least with black urban girls closer to their white counterparts. More recently, in
an urban setting, it has been found that body dissatisfaction was significantly higher
in white adolescent compared to black adolescent girls. In a multiracial urban
sample of adolescent schoolgirls, it was found that almost 50% perceived
themselves to be overweight yet their mean BMI was 20.01 placing them within a
normal range. The South African data to date suggest that body dissatisfaction
exists amongst a substantial number of adolescent females (both black and white),
specifically in the urban setting.

Grange et al. (2004) surveyed 15–25-year-old high school and college students
representing the ethnic diversity of South Africa. And they demonstrated that the
scores black females achieve on measures of eating disorder pathology are at least
as high as those of Caucasian females. Of specific concern within the South African
context is the emergence of these conditions in our black population. This

9|Pa ge
phenomenon was mentioned in the report by Swartz and Sheward'o and has been
documented clinically." Subsequent to the 3 cases reported by Szabo et al., 11
additional black schoolgirls have been treated at the eating disorder unit at Tara, a
psychiatric facility in Johannesburg, all diagnosed with bulimia nervosa (Szabo and
Hollands, 1997).

Results and conclusions from a preliminary study conducted by Szabo and Hollands
(1997) shows an overall prevalence figure of abnormal eating attitudes of 21.66%
was documented. Black pupils had a higher prevalence than white pupils (37.5% v.
20.67%). The factor profile of respondents with abnormal eating attitudes did not
differ between the race groups, although within the total sample, black respondents
had a significantly stronger drive toward thinness. A significant developmental
continuum was established, with prevalence figures for abnormal eating attitudes
increasing with each standard from Standard 7 onward. The study provides
preliminary epidemiological data on the prevalence of adolescent girls either
Suffering from or at risk of the development of an eating disorder. In addition, the
study also provides evidence of the need for intervention strategies that commence
in the pre-teen years. In addition, sociocultural pressures, such as exposure to
idealized media images, have also been shown to be risk factors for the
development of body dissatisfaction (Field et al., 2001; Groesz, Levine, & Murnen,
2002; Paxton, Eisenberg, & Neumark-Sztainer, 2006 cited in Mwaba and Roman,
2009).

4. THE IMPACT OF MEDIA ON ACCULTURATION TO WESTERN IDEALS

Body dissatisfaction is conceptualized in the literature as a psychologically salient
discrepancy between a person’s perceived body appearance and their ideal body
appearance (Halliwell & Dittmar, 2006 cited in Mwaba and Roman, 2009).
Sociocultural pressures, such as exposure to idealized media images, have also
been shown to be risk factors for the development of body dissatisfaction (Field et
al., 2001; Groesz, Levine, & Murnen, 2002; Paxton, Eisenberg, & Neumark-
Sztainer, 2006 cited in Mwaba and Roman, 2009). There are suggestions that with
increasing influence of Western media and values, more and more South African
women may be falling prey to media portrayed images of “thinness equals beauty”
(Szabo & Allwood, 2006 cited in Mwaba and Roman, 2009). It has been argued that

10 | P a g e
the process of normal gender-role socialization leads women to be particularly
concerned about their physical appearance as a means of gaining approval from
others. Therefore, in Western societies where thinness is indisputably a strived for
beauty ideal, young women in the process of establishing their identity are
especially vulnerable to dissatisfaction with their shape and the pursuit of thinness
through dieting, and consequently the development of eating disorders (Cogan,
Bhalla, Sefa-Dedeh & Rothblum, 1996; Cooper, 1995; Nasser, 1988 cited in
Senekal et al., 2001).

It will be important to note that eating disorders have also captured the South
African public imagination. Images of severely emaciated young women suffering
from anorexia nervosa appear often in glossy women’s magazines and current
affairs programmes, while public disclosure of bulimia nervosa has become
commonplace (Carte Blanche, 2003; Sarie, 2002:18, 22 cited in Schoeman &
Vogel, 2005, p. 28). This publicity tends to obscure the continuing puzzle created by
these enduring, hard-to-treat and sometimes fatal conditions (Nicolls & Bryant-
Waugh, 2003:67-68 cited in Schoeman & Vogel, 2005, p. 28). It is therefore timely
to review the problem of eating disorders, especially among adolescents in South
African public schools (Schoeman & Vogel, 2005, p. 28).

Some research findings indicate that young South African women may be
developing eating disorders as a result of body dissatisfaction (Szabo & Allwood,
2004, 2006; Szabo, Berk, Tlou, & Allwood, 1995 cited in Mwaba and Roman, 2009).
One study found that a significant number of South African female adolescents had
a very negative body image and strong desire to be thinner (Szabo & Allwood, 2006
cited in Mwaba and Roman, 2009). According to the study, most of these
adolescents were in fact trying to lose weight and some were abusing laxatives and
diet pills. The most common reason given by the girls who were seeking to lose
weight was a perception that young males prefer thin women and that losing weight
would enable them to wear modern clothes which are manufactured in smaller sizes
only (Szabo & Allwood, 2006 cited in Mwaba and Roman, 2009).

Studies on body image in South Africa have tended to focus on white women even
though the literature indicates a strong influence of cultural factors on body image

11 | P a g e
(Stice, 2003; Wildes, Emery, & Simons, 2001; Yates, Edman, & Aruguette, 2004
cited in Mwaba and Roman, 2009). However, Wiltley et al. (1996) reported that
black women are not immune to mainstream body image dissatisfaction and eating
disturbances (Wiltley et al., 1996 cited in Senekal et al., 2001). This is supported by
the fact that when persons of different cultural backgrounds internalize the Western
norms (acculturation) of thinness as the ideal, a greater degree of disordered eating
is observed (Akan & Grillo, 1995; Coganet al., 1996; Lee, Leung, Lee Yu & Yeung,
1996; O'Dea, 1995, cited in Senekal et al., 2001). This acculturation process can
occur in ethnic minorities in Western countries and also during the westernisation
and/or urbanisation of total populations, especially through the increased exposure
to Western advertising, marketing, electronic media, entertainment and fashions
(O'Dea, 1995 cited in Senekal et al., 2001).

It is widely accepted that girls are at greater risk of body dissatisfaction and eating
disorders, and that both a low and a high body mass index (BMI) have been shown
to influence weight control behaviours. Underweight boys who experience muscle
dysmorphia may engage in weight control behaviours to gain weight and increase
muscle mass while overweight girls engage in other behaviours to lose weight, both
leading to the development of eating disorders. In addition, body dissatisfaction has
been shown to be strongly related to societal norms, culture and ethnicity.
Increasing globalisation and exposure to a ‘Western’ ideal of thinness through the
media, which often differs from traditional beliefs, creates even greater conflict
within the adolescent (Pedro et al., 2016)

The findings of a study done by Pedro et al. (2016) that aims to examine the
associations between BMI, disordered eating attitude, body dissatisfaction in female
adolescents, and descriptive attributes assigned to silhouettes of varying sizes in
male and female adolescents, aged 11 to 15, in rural South Africa, confirmed the
higher prevalence of combined overweight and obesity in females than males. Their
results highlighted that the majority of rural adolescent girls are dissatisfied with
their body sizes, and this differs by BMI category, but indicates growing desire for
Western ideals of thinness. This is most likely associated with the socio-economic
transition that has taken place in South Africa within the last two decades and
greater exposure to “Western” media. The study findings suggest that many

12 | P a g e
adolescents are struggling with body image and desiring “unhealthy” body shapes,
either too thin or too fat. This necessitates the critical need for policy intervention
which would aim to educate and promote a healthy body size in adolescence and
improve access to adolescent counselling support around eating disorder pathology
and body image dissatisfaction.

5. THE IMPACT OF URBANISATION, ECONOMIC FACTORS, AND THE

DIFFERENCES IN RURAL AREAS
Eating disorders have been described amongst white South Africans since the
1970s with the first description amongst black South Africans in the 1990s.
Subsequent community based, cross-cultural studies of adolescents have
suggested that within urban settings such numbers would increase. Data from a
rural sample suggests that the likelihood of eating disorders emerging in this setting
is less likely (Szabo and Allwood, 2006). However, one multiethnic study in South
Africa found that white girls as well as their mothers were more likely to consider
themselves fat than were black girls and their mothers (Mciza et al., 2005 cited in
Mwaba and Roman, 2009). This finding is consistent with results in other countries
which have shown cultural differences in body dissatisfaction. While eating
disorders in South Africa have traditionally been associated with white women,
there is a concern that the black community may be facing a similar problem among
young people (Mwaba and Roman, 2009).

In the research report of Szabo and Allwood (2006), they stated that; given the link
between weight control behaviours and eating disorders and the increased
likelihood of such behaviours in the urban samples, based on the extent of body
dissatisfaction, the emergence of eating disorders does seem more likely from
urban black than from rural black populations in South Africa. The emergence of
eating disorders among urban black South Africans is the resultant effect
enculturation; the gradual assimilation, absorption, acquisition, emulation of western
ideals, norms, characteristics and of culture. le Grange et al. (1998), in their
research designed to investigate eating attitudes and behaviors in a developing,
ethnically diverse society among South African college students, reported
accordingly: “Our findings unexpectedly revealed that black subjects demonstrated
significantly greater eating disorder psychopathology as measured by the Eating

13 | P a g e
Attitude Test and Bulimic Investigatory Test, Edinburgh, than Caucasian, mixed
race, and Asian subjects. An equal percentage of black and white subjects scored
above the cutoff on these measures. In addition, the percentage of female subjects
who reported irregular menses and who were underweight was meaningful in all
racial groups. Taken together, our findings suggest that significant eating disorder
pathology may be prevalent in developing non-Caucasian societies. In terms of
severity of eating pathology, the majority of high scorers on the Eating Attitude Test
and Bulimic Investigatory Test, Edinburgh, were black and Caucasian females and
were heavier than the rest of the study group. Hence, potential cases of eating
disorder were as likely among black as among Caucasian subjects.”
This findings connotes that adolescents and black female South African students
who are increasingly exposed to western cultures through different media outlets
like magazines, television, and movies are most likely to embrace Western ideas,
values and beliefs of “thinness equals beauty”.

6. CONCLUSION
Szabo and Allwood (2006), demonstrated in their study that the desire to be thinner
is a pervasive, cross-cultural phenomenon in South Africa amongst adolescents.
This has potential implications for the emergence of eating disorders, in different
settings, amongst black, female South African populations. In addition, body image
dissatisfaction has been associated with an increased risk of perceived negative
health generally, amongst adolescents. Therefore, among many other factors that
influences eating disorders such has fear for weight gain, desire to fit in certain
social strata; urbanization has been deemed as a key factor influencing body figure
preference and ultimately body dissatisfaction among whites and specifically urban
black South Africans, evidently leading to eating disorders.

7. REFERENCES

Agberotimi, S., Botha, K., Bezuidenhout, C., du Plessis, E., Foxcroft, C., Jordaan, E.,
Makhafula, K., Moen M., Moletsane, M., Nel J., Olaseni, A., Pillay, B., Stein, D., & Vorster,
A. (2023). Understanding psychopathology (4th ed.). Oxford University.

Le Grange, D., Louw, J., Breen, A., & Katzman, M.A. (2004). The Meaning of ‘Self-
Starvation’ In Impoverished Black Adolescents in South Africa. Culture, Medicine and
14 | P a g e
Psychiatry 28: 439–461.

Le Grange, D., Christy, F., & Tibbs, J. (1998). Eating Attitudes and Behaviors in 1,435
South African Caucasian and Non-Caucasian College Students. Am J Psychiatry 1998;
155:250–254

M. Senekal, N. Steyn, T. Mashego, & Nel, J. (2001). Evaluation of body shape,

eating disorders and weight management related parameters in black female
students of rural and urban origins. S. Afr. J. Psychol, 31 (1), 45-46

Mwaba, K. & Roman, N.V (2009). Body Image Satisfaction Among A Sample Of
Black Female South African Students, 37(7), 905-906.

Pedro, T.M., Micklesfiel, L.K, Kahn, K., Tollman, S.M., Pettifor, J.M., Norris, S.A
(2016). Body Image Satisfaction, Eating Attitudes and Perceptions of Female Body
Silhouettes in Rural South African Adolescents. PLoS ONE 11(5), 1-2.

Schoeman, S. & Vogel, H.M. (2005). Eating disorders among adolescents in South
African public schools – a biblical perspective. Koers 70(1) 27-49.

Szabo, C.P., & Allwood, C.W. (2006). Body figure preference in South African
adolescent females: a cross cultural study. African Health Sciences, Vol 6 No 4,
201-205.

Szabo, C.P., & Hollands, C. (1997). Abnormal eating attitudes in secondary-school

girls in South Africa - a preliminary study. SAMJ PSYCHIATRY, Volume 87 No. 4,
524-525.

15 | P a g e