Women, weight and eating disorders

Women's..~udieslnt.

Printedin theUSA.

Forum,Vol.14,No.3, pp. 173-191,1991

WOMEN,

WEIGHT

A Socio-Culturai

0277-5395/91$3.00+ .00 © 1991PergamonPressplc

AND

EATING

DISORDERS

and Political-Economic

Analysis*

SHARLENE HESSE-BrnER Department of Sociology, Women's Studies, Boston College, Chestnut Hill, MA 02146, U.S.A.

Synopsis-This article presents a socio-cultural and political-economicperspectiveon eating disorders. We argue that the current outbreak of eating disorders and weight obsession among women is part of a larger historical transformation of women's bodies into commodities through a "marriage" between capitalistic and patriarchal interests. These interests have transformed women's body image increasingly toward an ultra-slender ideal. We explore the relationship between eating disorders and ultra-slenderness by focusing on the eating habits and attitudes of a sample of college students. Results indicate that women were more likely than men to follow an ultra-slender "cultural" model of ideal weight. Women who follow a cultural model were three times more likely to score abnormally high on a standard measure of eating disorders than women who follow a less stringent "medical" model of ideal weight. These results are not confounded with psychological correlates typically associated with clinical eating disorders. We discuss alternative visions and solutions to eating disorders from a socio-cultural and political-economicperspective. Some researchers estimate that in the United States one in every 200-250 women between 13 and 22 years old suffers f r o m anorexia nervosa, and that between 20% to 33% o f college women control their weight through vomiting, diuretics, and laxatives (Levenkron, 1983, p. 1; Squire, 1983). Eating disorders, especially anorexia nervosa, are more c o m m o n a m o n g women, usually develop during adolescence (Bemis, 1978; Bruch, 1973; Crisp, 1970) and, until recently, were more prevalent a m o n g upper- and uppermiddle class women (Bruch, 1973; Crisp, 1965; M o r g a n & Russell, 1975). Moreover, the prevalence o f eating disorders continues to increase in frequency (Halmi, 1974; Jones, Fox, Babigan, & H u t t o n , 1980; Kendall, Hall, Halley, & Babigan, 1973; Sours, 1969). Early theories concerning the etiology o f eating disorders rely on individualistic explanations. The underlying assumption o f an individualistic approach is that an eating disorder reflects differences in women's psychosexual development. Women with eating disorders are said to fear oral impregnation and *The author wishes to thank John Downey, Dr. Alan Clayton-Matthews, Larry Zaborski, Sandi Wang, and Janet Wirth-Cauchon for their research advice, statistical expertise, and support.

reject their sexuality (Bruch, 1973). Other thinking focuses on biological roots o f an eating disorder and links depression (which is caused by a chemical imbalance, especially in women) to eating problems (Pope & H u d son, 1984). Relatively recent thinking on the etiology o f eating disorders provides a systems-oriented analysis. A n eating disorder is the result o f family dynamics and reflects a power struggle between child and parent, especially the mother, leading to rejection o f the mother as role model (Boskind-Lodahl & White, 1978). Systems-oriented theories emphasize relations between persons rather than conflict within a person, but little emphasis is placed on wider structural factors outside the individual family unit. Individualistic approaches imply that the solution to the problem o f eating disorders lies within the individual or the family unit. For the most part, these entities are the locus o f the "problem" and therefore the t a r g e t o f the change. Clearly, efforts to help individuals or families overcome their "personality deficits" and even "chemical deficits" by identifying those individuals and families a t risk is important, but an individualistic approach often amounts to "blaming the victim" (Ryan, 1971). Ryan describes the process o f '°olaming the victim" as follows: 173

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[Victim blamers] must learn how to demonstrate the poor, the black, the ill, the jobless, the slum tenants, are different and strange. They must learn to conduct or interpret the research that shows how "these people" think in different forms, act in different patterns, cling to different values, seek different goals, and learn different truths. Which is to say that they are strangers, barbarians, savages. This is how the distressed and disinherited are redefined in order to make it possible for us to look at society's problems and to attribute their causation to the individuals affected. (Ryan, 1971, p. 10) We will argue that a socio-cultural and political-economic analysis, which focuses on structural features of a given society rather than on individual characteristics, is critical to our understanding of the etiology of eating disorders. The approach targets basic societal institutions, ideologies, and social practices that operate to create a climate ripe for the development of eating problems. This approach focuses on the structure of particular social systems instead of the individual factors, and suggests a different strategy for improving women's relationship to food. Some research is beginning to turn attention to socio-cultural and political-economic dynamics as explanations for women's eating problems. These explanations, however, are often a d d e d on to individualistic theories, almost as an afterthought. Perhaps the best known studies of socio-cultural factors point to the current cultural pressures on women to be thin. Evidence provided points to how American culture has become thin conscious. The best known of these studies is that of Garner, Garfinkel, Schwartz, and Thompson (1980), who determined that the weights of both Playboy centerfolds and Miss America Pageant contestants were less than the American average and, on the whole, declined during the period 1958 through 1978. Furthermore, the winners of the Pageant consistently weighed less than the average contestant in all cases, controlling for height. The authors make a connection between current cultural pressures on women to be thin and the development of eating problems, yet no theoretical or em-

pirical justification for such a linkage is presented. The purpose of this paper is to present a socio-cultural and political-economic analysis of eating disorders. In doing so we will (1) discuss the socio-cultural and political-economic perspective; (2) relate it to the current outbreak of eating disorders since the 1960s; (3) empirically explore the relationship between one socio-cultural factor, the current cultural pressures on women to be thin, and eating disorders among college women. We concentrate on college women because research suggests that this group of women has show the most dramatic increases in eating disorders (Boskind-Lodahl, 1976; Gray & Ford, 1985; Halmi, Falk, & Schwartz, 1981; Hawkins & Clement, 1980; Katzman, Wolchik, & Braver, 1984; Pyle, Halvorson, Neuman, & Mitchell, 1986; Pyle, Mitchell, Eckert, Halvorson, Neuman, & Goff, 1983; Stangler & Printz, 1980). T H E SOCIO-CULTURAL AND POLITICAL-ECONOMIC ARGUMENT

The current outbreak of eating disorders among women is one of the many ways women's bodies have been transformed historically. Women's bodies can be considered cultural artifacts, defined and redefined over time as a result of broad cultural/historical transformations aimed at physical and symbolic subordination (Ehrenreich & English, 1979; Eisentein, 1988; Martin, 1987; Michie, 1987; Rubin, 1975; Ihrner, 1984). An analysis of women's bodies as subject to cultural pressures is consistent with Foucault's historical examination of the transformation of power through the discipline of bodies (Foucault, 1977). Foucault asserts that the body is continually subjected to cultural pressures, norms, and behavioral patterns such that there is no "natural" body; rather it is a central component through which power relations within a society are presented. Such an analysis, notes Smart (1985), raises "the possibility of a 'history of bodies,' of physical characteristics, diet, typical diseases, and conditions, differentiated according to sociohistorical and cultural conditions" (p. 104). Foucault (1977) argues that when societies make the transition from medieval/traditional political-economic systems to modern sys-

Women,Weight,and EatingDisorders

tems, power moves from co/~trol by a central authority (monarch, state, army, etc.) to a more diffuse system of power among various institutions. Diffuse and informal mechanisms of authority over bodies becomes a central means used by modern systems to gain power and control. While Foucault does not directly discuss the effects of such a transformation of power on women, recent feminist analyses have appropriated his Concepts of "discipline" and "normalization" to examine practices of control that are unique to women within a capitalist/patriarchal society. While women are subject to more modern forms of power (which rely less on force and more on social and psychological mechanisms), patriarchal power (for example, the use or threat of violence by men or groups of men), vested primarily within the family unit, also exists within contemporary societies (Diamond & Quinby, 1988). In fact, Walby (1990) makes the point that the site of patriarchy, itself, has shifted in modern society from "private" (where control resides in the husband or father) increasinglytoward "public" patriarchy (the state, the labor market), as women's roles alter from dependent (e.g., private household workers) to independent (e.g., paid workers). Women's situationin contemporary societiestherefore subjects them to a form a dualistic oppression stemming from "disciplinary" and "patriarchal" power. Bartky (1988) specificallyapplies Foucault's analysis of power and disciplineto examine how modern-day transformations of power subordinate women's bodies through a complex set of social practicesthat define" femininity." She notes that the subordination of women's bodies includes: "a regulation of the body's size and contours, its appetite, posture, gestures, and general comportment in space, and the appearance of each of its visibleparts" (Bartky, 1988, p. 80). Bartky provides an important analysis of "femininity as discipline" within contemporary capitalistsociety. However, by focusing on the differentialeffects for w o m e n of a transformation of power, the analysis de-emphasizes the specificchanges in women's position within capitalism over time and the relationshipsof patriarchal and capitalistinterestsin this transition.To fully understand the contemporary culturalcontrol over worn-

175

en's bodies, what is needed is a more historically specific account of the emergence of women's role, primarily as both consumer and as object-commodity within capitalist society. The exercise of a diffuse modernized system of bodily control meshes well with a capitalist political-economic system. Using the body as a central arena of disciplinary power and control allowed nineteenth century capitalism to operate efficiently and profitably. As Dreyfus and Rabinow note: "Without the insertion of disciplined, orderly individuals into the machinery of production, the new demands of capitalism would have been stymied" (1983, p. 135). In addition to increasing capitalism's capacity to mass produce goods, disciplinary control over bodies motivated producers to exploit new markets by stimulating ever-changing consumer needs and buying patterns centered around the body and its functioning. Patriarchal interests, which characterized women primarily as good wives and mothers and the objects of decorative worth, fit the needs of a political economy which required" the economic pattern of individual domestic consumption to fuel its growth" (Ehrenreich & English, 1979, p. 27). In developing a consumer market, the mass media, especially advertising, were crucial for defining women's role primarily as that of consumer, both of household items (important symbols of being a good wife and mother) and of beauty products (signs of one's femininity and ability to "hold on to her man'S. These mechanisms provided an important socio-cultural environment that def'med women's consumption role and attitude toward their bodies. Ewen (1976) notes: In the middle of her mechanically engineered kitchen, the modern housewife was expected to be overcome with the issue of whether her "self," her body, her personality were viable in the socio-sexual market that defined her j o b . . . Women were being educated to look at themselves as things to be created competitively against other women: painted and sculpted with the aids of the modern market. (Ewen, 1976, pp. 179-180) Body insecurity was a key method used by capitalism in partnership with patriarchy for

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SHARLENEHESSE-BmER

creating new needs and desires as "natural beauty became displaced by artificial beauty" (Hansen & Reed, 1986, p. 63). Part of the strategy for creating new needs and desires was for individuals "to adopt a critical attitude toward body, self and life style" (Ewen, 1976, p. 47). Advertising helped to promote feelings of insecurity: "Individuals were made to become emotionally vulnerable, constantly monitoring themselves for bodily imperfections which could no longer be regarded as natural" (Featherstone, 1982, p. 20). For example, the tight cinched waist of the Victorian lady, her paleness and fragility, were important symbols of beauty and status for women during the nineteenth century. Women's waists were braced for many hours a day with devices called corsets (made of whalebone, and later, steel) that were laced tightly. Tight lacing put pressure on the internal organs, often causing pain and distortion of bodily organs and rib cage. The Victorian era was a time of vast economic expansion, as the industrial revolution made it possible for many to become wealthy enough to create a large prosperous middle class. Wives, the chief consumers of early capitalists' products were themselves turned into commodities, prize showpieces of their husbands' fortunes. Restrictions on movement imposed by the corset tended to make wives dependent and submissive toward men (Duffin, 1978; Ehrenreich & English, 1979; Roberts, 1977; Veblen, 1899). "Accounts of nineteenth century house fires reveal that women occasionally went up in flames with the household goods because of immobilizing corsets and skirts too full or too tight to run in" (Weibel, 1977, pp. 178-179). Medical practitioners became primary controllers of women's bodies during the Victorian era (Ehrenreich & English, 1979). The medical profession's diagnosis and treatment of women's complaints reflected specific cultural attitudes concerning femininity and, more specifically, women's sexual identity (Wood, 1973). "Self-sacrifice and altruism on a spiritual level, and childbearing and housework on a more practical one, constituted healthy femininity in the eyes of most nineteenthcentury Americans" (Wood, 1973, p. 36). It was a common belief that women's wombs were being destroyed by their "unfeminine"

behavior. An unfeminine character was described as "sexually aggressive, intellectually ambitious, and defective in proper womanly submission and selflessness" (Wood, 1973, p. 36). The medical community, through its use of the "normalizing gaze" (Foucault, 1977, p. 184), diagnosed females into "normal" and "abnormal" categories on the basis of their cultural beliefs concerning women's proper behavior. The goal of treatment was to return women to their appropriate feminine role. For example, women who showed signs of excessive "sexual excitement" (usually considered a problem of middle and upper middle class women) were prime candidates for treatment. Others subject to medical treatment included those women who showed signs of "troublesomeness," those who were "eating like a ploughman," masturbated, attempted suicide, who suffered from "persecution mania," "simple cursedness" and dysmenorrhea. The cure often involved several of the following techniques: removal of the ovaries and/or clitoris, hot steel applied to the cervix and/or leeches placed on the womb (Ehrenreich & English, 1979 p. 124; Wood, 1973). There were other benefits capitalists derived from their partnership with patriarchal interests, namely, the utilization of women as a reserve army of laborers (Beechey, 1977; 1978). If women are dependent on their spouses for support, this can be a justification for a capitalist to offer them lower wages and can give employers grounds for firing them more easily. While establishing links between social or cultural influences and illness is difficult, it has been suggested that chlorosis reflected the cultural repression women experienced during the Victorian era. Brumberg (1982) notes that this disorder, a form of anemia characterized by weakness, fainting, and passivity, was widespread among young women in the U.S. from 1870 to 1920. Other researchers (Schwartz, Thompson, & Johnson, 1982) suggest that rates of classical conversion hysteria may be another example of the importance of cultural pressures, in this case an environment where sexual repression and dependency were primary characterizations of women's role. The present-day partnership of capitalist

Women, Weight, and Eating Disorders

interests (diet, beauty, cosmetic, toy, and health industries) and patriarchal perspectives (defining women as objects of decorative worth as a means of subverting them to the authority of men) continues to control women's bodies through socio-cultural pressures on women to be thin (Ehrenreich & English, 1979; Ewen, 1976; Hansen & Reed, 1986; Hartmann, 1976; Silverstein, 1984). The women of today, however, achieve this new "ideal" not by external control of the body (the purchase of a corset or girdle), but through internal or self-imposed controls. Such behaviors as dieting, starvation, and exercising reflect the historical transformation of power and change in women's roles during the last several decades from dependent to independent (Brownmiller, 1984; Squire, 1983). Eating disorders (as we will argue later) are the logical conclusion of extreme self-imposed body control to attain the ideal of ultra-thinness (Bordo, 1988; Brumberg, 1988). The move toward ultra-slenderness: Cultural pressures There is substantial evidence from popular culture that the ideal woman's figure has become more slender in recent decades. As a result, women, already the target of society's pressures to look slim, are following an even more dangerously low ideal weight. Banner (1983) traces the roots of the ultra-slender body ideal to the popularity in the 1960s of thin fashion models over the hour-glass-figured movie stars of the 1950s. Other research supports these observations on popular culture. The number of articles in popular magazines devoted to dieting and weight control has increased precipitously since the turn of the century, as listed in the Readers Guide to Periodical Literature (Boskind-Lodahl, 1977). Our update analysis of these listings shows that they have doubled from 1977 to the present time. Finally, content analysis studies by Silverstein, Perdue, Peterson, and Kelly (1986) of magazines and movies from the twentieth century to the present, as well as the "most watched" television programs, suggest that over time these media play an important role in promoting an ever more stringent ideal of thinness, aimed particularly at women (Morris, Cooper, & Cooper, 1989).

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Why ultra-slenderness and why now? Why has ultra-slenderness become the ideal body image and why has it become so prevalent since the 1960s? Ideal body types (and in turn, fashion) vary from one historical time to another and from one culture to another (Clark, 1956). While we can trace ultra-slenderness to the popularity of thin fashion models, fashion is not a power unto itself (Hollander, 1978; Steele, 1985). Broad environmental and biological determinants can operate to determine the ideal body types. In times or places where food is scarce, a plump, even obese, ideal may symbolize the societal desire for abundance. In societies of abundance, the slender body type is more often the ideal (Belier, 1977; Bruch, 1973). Yet additional factors also contribute to determine the ideal body image beyond environmental or biological determinants. Research suggests that women's bodies take on a tubular (slender) image especially in periods where women's status has become more independent and women are asserting their rights, politically, economically, and socially. Just as during the "first wave" of feminism in the 1920s, the demand for women to be ultra-slender coincides with the "second wave" of feminism. During the "first wave" of feminism in the early twentieth century, the tubular image of the "flapper" became the most important symbol of American beauty. Banner (1983) further notes that one way to control women's new-found freedom, especially their sexuality, was to trivialize it in the image of the "flapper":

On the one hand, she indicated a new freedom in sensual expression by shortening her skirts and discarding her corsets. On the other hand, she bound her breasts, ideally had a small face and lips like the steel-engraving lady, and expressed her sensuality not through eroticism, but through constant, vibrant movement • . . The name "flapper" itself bore overtones of the ridiculous. Drawing from a style of flapping galoshes popular among young women before the war, it connoted irrelevant movement and raised the specter of seals with black flapping paws. (Banner, 1983, p. 279)

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There is evidence that during the flapper era, there was a dramatic outbreak of anorecticlike behavior (Ryle, 1936). An empirical test of this theory on changing body image comes from a study by Silverstein, Perdue, Peterson, Vogel, and Fantini (1986). They studied the standards of bodily attractiveness across time and note that over the course of the twentieth century, as the proportion of American women who worked in the professions or who graduated from college increased, the standard of bodily attractiveness became less curvaceous. They note that this occurred especially in the 1920s and during the 1960s. Ironically, when women are "demanding more space,' in terms of equality of opportunity, there is a cultural demand that they "should shrink" (Orbach, 1986, p. 75). Thinness may be considered a sign of conforming to a constricting feminine image, whereas greater weight may convey a strong, powerful image.

Why women? Women are willing to conform to stringent cultural ideals of slenderness because their sense of worth and status is often gained indirectly, through marrying a man who has these resources, or by birth. Women are socialized to rely on their "natural" resources-beauty, charm, nurturance-to gain access to men's resources (Bart, 1975; Bar-Tal & Saxe, 1976; Blumstein & Schwartz, 1983; Elder, 1969; Sontag, 1972). The stakes of physical attractiveness for women are high: appearance is a strong selective factor for social success and body weight is a significant factor in physical attraction (Hesse-Biber, ClaytonMatthews, & Downey, 1987). Such issues can be more central and thus more problematic for them than for men. Many women experience even a few extra pounds as a major problem in their lives; they tend to weigh themselves frequently and report seeking medical help for weight problems more often than men. Weight is a critical factor in a women's sense of social and psychological well-being (Adams, 1977; Millman, 1980; Rodin, Silberstein, & Striegel-Moore, 1984; Simmons & Rosenberg, 1975). Although physical appearance is important for men, their traditional socialization stresses the importance of achievement as a

primary determinant of self image. Chapkis (1986) captures the differential socialization experiences of men and women in this way: While men are busy conquering and controlling nature and women, women are obsessed with controlling their bodies. Man believes he survives through his enduring achievement. Women is her mortal b o d y . . . . A man may sweat, scar and age; none of these indications of physicality and mortality are seen to define the male self. Indeed, those men who take unseemly interest in the body are described as womanly and are presumed to be homosexual. (Chapkis, 1986, pp. 15-16). At first glance, one might assume that dieting and physical fitness are not methods for the subordination of women, like the corset or girdle, but a means whereby women can feel powerful. After all, for many women, feeling fat conjures up images of powerlessness. However, by investing time, money, and energy on attaining a thin body, women may be substituting a momentary sense of power for "real authority" (Brownmiller, 1984; Chapkis, 1986). Orbach (1978) notes that being overweight is one way to say "no" to feeling powerless. A fat person defies western notions of beauty and challenges the "ability of culture to turn women into mere products" (Orbach, 1978, p. 21). Chernin (1981) notes that in a feminist age, men feel drawn to and perhaps less threatened by women with childish bodies because "there is something less disturbing about the vulnerability and helplessness of a small child, and something truly disturbing about the body and mind of a mature woman" (p. 110). THE RELATIONSHIP BETWEEN EATING DISORDERS AND ULTRA-SLENDERNESS: AN EMPIRICAL STUDY OF COLLEGE WOMEN

Despite the flood of research on the topic of eating disorders, there has been no empirical research to date that directly links cultural pressures to be thin with the development of eating disorders. An indirect examination of this causal linkage has been provided by Garner and Garfinkel (1980). They examined two

Women,Weight,and EatingDisorders

socio-cultural subgroups that place extremely high value on thinness. They predicted that the subcultures of dancers and models would place women at a greater risk for developing eating disorders. Therefore, they hypothesized, anorexia nervosa and anorexic behaviors should be over-represented in these subgroups. As expected, dancers and models were found to have significantly higher rates of anorexia nervosa than women from similar age and social class backgrounds. It was also found that in the case of dancers, most of the women developed an eating disorder after they joined their profession and were exposed to the pressures to be thin. (See Vincent, 1979, and Kirkland & Lawrence, 1986, for graphic accounts of the pursuit of the ideal body form among dancers.) Opponents of a cultural interpretation of eating problems may plausibly argue that those women who adhere to the thinnest culture standards of ideal weight may already be suffering from a mild or subsyndromal form of a clinical eating disorder. Distorted images of body shape in anorexia nervosa patients have been well documented (Bruch, 1962; Garner & Garfinkel, 1981; Hsu, 1982; Touyz, Beumont, Collins, McCabe, & Jupp, 1984). Therefore, the endorsement of a thinner ideal of desired weight by women may be confounded with the morbid concern with fat that is the core psychopathology of classic eating disorders, rather than predictive of risk as we suggested above. While it is difficult to disentangle cultural influences from symptomatic psychopathology itself, researchers on the relationship between culture and eating disorders need to examine the issue closely. The present research explores the relationship between ultra-slenderness and the development of eating disorders by focusing on the eating habits and attitudes of a sample of college students from a private New England College. As we explore the link between cultural pressures to be ultra-thin and the development of eating difficulties, we examine the following three questions: 1. Are college-aged women more likely than college-aged men to adhere to society's norm of ultra-slenderness? 2. Are college-aged women who do attempt to follow the cultural norm of ultra-slen-

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derness more at risk for the development of eating problems? 3. Are observed eating problems the result of these cultural pressures or do they reflect psychological factors typically associated with clinical eating disordered patients?

Method Subjects. Questionnaires were distributed to a representative sample (N = 960) of sophomores at a private New England College. The college is the fourth largest private university in New England, with full and part-time enrollment of approximately 14,000 students. In a cover letter students were told that the questionnaire would be confidential and that the questionnaire would cover issues related to eating patterns and college life. A total of 395 questionnaires were returned and analyzed. The resulting response rate was 41%, and the sample consisted of 71% women and 29% men. The study sample appears representative of the general population from which it was drawn with respect to the proportion of students of color, students living off or on campus, and social class (primarily middle class). It is not representative with respect to proportions of men and women; the latter are overrepresented. We have no way to ascertain whether this group of respondents differed in their eating pattern from those who did not respond to the questionnaire. Materials. The self-administered questionnaire examined factors related to eating disorders: social and psychological factors as well as general college environment characteristics. Questionnaires, along with a cover letter and return envelope, were distributed through on-campus and postal service mail. The questionnaire allowed us to identify a range of eating behaviors and related variables. TWo widely used scales, the Eating Attitudes Test (EAT) and the Eating Disorders Inventory (EDI) were administered. The EAT (Garner & Garfinkel, 1979; Garner, Olmsted, Bohr, & Garfinkel, 1982) consists of 26 items designed to evaluate a broad range of behaviors and attitudes characteristic of anorexia nervosa and bulimia; it contalns three scales, diet, bulimia, and oral control. The diet scale relates to an avoid-

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ance of fattening foods and a preoccupation with being thin. The second scale, bulimia, consists of items reflecting thoughts about food as well as thoughts indicating bulimic behaviors. The third measure, oral control, relates to self-control of eating and the perceived pressure to gain weight. Thompson and Schwartz (1982, p. 52) reported the EAT's alpha reliability coefficient to be .79 for anorexic nervosa and .94 for pooled anorexic and normal controls. Although the EAT alone is not a valid diagnostic measure for eating disorders, according to Garner and Garflnkel (1979, p. 7) "it may be successfully used in a non-clinical setting to indicate the presence of disturbed eating patterns." It is important to point out however, that because the EAT and the EDI are paper and pencil measures of eating disorders, it is difficult to assess the full extent and the nature of any observed disorder without a clinical interview. The Eating Disorders Inventory, EDI, (Garner, Olmsted, & Polivy, 1983) is a selfreport measure of the psychological and behavioral pathology associated with eating disorders. An abridged form of the inventory was used containing two behavioral subscales (Drive for Thinness, and Bulimia), and three psychological subscales (Perfectionism, Interpersonal Distrust, and Maturity Fears). Drive for Thinness indicates an over-concern with dieting, preoccupation with weight, and an obsession with the extreme pursuit of thinness. Bulimia indicates a strong tendency to engage in episodes of uncontrolled binge eating followed by a strong desire to vomit. Perfectionism indicates an excessive personal expectation to achieve. Interpersonal Distrust reflects a sense of detachment from others, and Maturity Fears refers to a desire to return to the security of childhood and to avoid the responsibilities of adulthood. Garner and Olmsted (1984, p. 6) report reliability coefficients above .80 for each of the EDI sub-scales using anorexia nervosa samples. Wear and Pratz (1987) report test-retest reliability coefficients for the EDI sub-scales ranging from .97 to .65 (p. 768) using a sample of university undergraduates. The EDI scored well on several indices of validity. Garner, Olmsted, and Polivy (1983) report that the EDI differentiated anorexia nervosa patients from female college subjects using a

cross-validation procedure. The EDI also showed high criterion-related validity. Garner, Olmsted and Polivy (1983) report high agreement between self-report subscale scores and those of clinician's ratings. The self assessment of weight was determined through the student's response to the statement, "Describe your present weight." Although the questionnaire allowed five responses, "very overweight, overweight, just right, underweight, and very underweight," they were divided into three categories for the present analysis, "thin, normal, or obese." The "medical" model of desired weights was assessed using the Metropolitan Life Insurance Company's height and weight chart for men and women• The desirable weights are derived from mortality rates; they are the weights for a given frame and height for which mortality rates are lowest• While this chart is by no means "culture-free," it is based on medical-actuarial studies of insured men and women (Metropolitan Life Insurance Company, 1983) and therefore reflects desirability from a medical standpoint. The "cultural" model of desired weight was measured using a current desirable weight chart from one of the leading and largest diet and weight-loss centers in the United States• This chart is representative of the range of commercial diet charts in the U.S.A. (Rotella & Ortiz, 1984)• Heightweight charts posted at diet centers and which also appear in women's magazines emphasize the new cultural standards of thinness for women• Women's magazines and other forms of popular culture are important avenues that capitalism has for promoting its products and messages concerning women's ideal weight• Ferguson, in a detailed content analysis of women's magazines over the past century, notes: • . . women's magazines collectively comprise a social institution which serves to foster and maintain a cult of femininity. This cult is manifested both as a social group to which all these born females can belong, and as a set of practices and beliefs: rites and rituals, sacrifices and ceremonies, whose periodic performance reaffirms a common femininity and shared group membership. In promoting a cult of femininity, these journals are not merely

Women, Weight, and Eating Disorders

reflecting the female role in society; they are also supplying one source of definitions of, and socialisation into, that role. (Ferguson, 1983, p. 184)

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were following. A medium-size body frame was assumed in our calculations. The "desired" weight of the respondents was measured by the question, "How much weight would you like to lose or gain at this time?" The student's response to the question was added to, or subtracted from, the student's actual weight in order to determine desired weight.

What is even more problematic in this regard is that the magazine industry has become concentrated in fewer and fewer hands (Ferguson, 1983), and thus the power to convey these images has become more centralized. These social and economic changes within the magazine industry and the expanded role of mass communication in defining wants and needs makes magazines (and other print media) a prime socializing influence for young women. A comparison of charts that represent the diet center "cultural" model of ideal weight and the lowest mortality rate or "medical" model of ideal weight reveals a large gap between the two perspectives for women (Figs. 1 and 2). On the average, the difference between the two charts for men is about five pounds, whereas the difference is close to twenty pounds for women. An elaborate analytical procedure involving students' self-reported weight and height and stated desired weights was used to determine the weight model ("cultural" or "medical") students

RESULTS To discover how accurately men and women perceive their own body weight, we compared their self-perceived body weights to the medical and cultural ideals. Table 1 compares men and women's self-perceptions of their own weight with the medical model's evaluation. Men's self-perceptions of their body weight were more in agreement with the medical model of ideal weight than were women's. Of the men, 58% (bold figures on the diagonal, 23 + 23 + 19/112) classified themselves as the medical model classified them; only 32% of the women (bold figures on the diagonal, 8 + 40 + 40/276) did so. This difference between men and women in the proportion of those who perceived their

200-190 180 170

160 ao -~,

140 (~

130

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0 Cultural I

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120

110

I

I

I

.Desired Weight (mean)

- - - Actual Weight (mean)

I

I

I

I

I

I

I

I

I

I

I

I

Height (inches) (;1" 62" 63" 64"

65" 66" 67" 68"

69'

70" 71" 72"

N=

2

11

15

1

5

8

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73" 74"

75" 76"

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Fig. 1. Range of actual and desired body weight of male college sample compared to cultural and medical standards.

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170

!

160 150 140

lot

~

. !-

r~ 130 ~0 120

i o

110

O 100 90

o

oo

8O

I

~. ~ Medical O-~O Cultural Desired Weight (mean)

o

.... I

I

I

I

I

I

I

I

I

ActualWeight(mean) I

I

I

I

I

Height (inches) 58" 59" 60" 61" 62" 63" 64" 65" 66" 6T' 68" 69" 70" 71" 72" 73" 74" N= 0

1

10

10

24

31

44

28

44

32

28

13

8

3

1

Fig. 2. Range of actual and desired body weight of female college sample compared to cultural and medical standards.

weight correctly according to medical standards was significant, t = 4.911, p < .001. Where there was disagreement between men's self-assessment and the medical model, the tendency was for men to both underTable 1. Weight self-assessment compared with the medical model Medical Model Assessmenta Womenc Thin

Normal Obese Total: Mend Thin Normal Obese Total:

SelfoAssessmentb Thin

Normal

Obese

100% (8)

71% (98)

25% (32)

0% (0) 0% (0) 100% (8)

29% (40) 0% (0) 100%(138)

45% (58) 30% (40) 100%(130)

88% (23) 8% (2) 4% (1) 100% (26)

27% (17) 37% (23) 35% (22) 100% (62)

0% (0) 21% (5) 79% (19) 100% (24)

astudents were assigned to one of three categories on the basis of how their actual reported weight compared with the Metropolitan Life Insurance Chart of desirable weights, based on lowest mortality. For e~.mple, a 5"4'" woman who weighs 110 pounds would be considered thin according to the medical model. bStudent's response to a question requesting their subjective view of their weight. CN = 276. d N = 112.

and over-estimate their weight and for women to only over-estimate their weight-related appearance. O f the men, 22.3% (figures below the diagonal, 2 + 1 + 22/112) underestimated their weight, whereas none o f the women did. In contrast, 68.1% of the women (figures above the diagonal, 98 + 32 + 58/276) over-estimated their weight, while only 19.6% o f the men did likewise. These research findings are supported by Drewnowski and Yee (1987) and Silberstein, StriegelMoore, Timko, and Rodin (1988), who found similar gender differences in the direction o f body assessment among undergraduate men and women. Table 2 compares student's self-perceived body weight with the cultural model o f ideal weight. O f the women respondents, 68% (bold figures on the diagonal, 2 + 68 + 118/276) perceived their weight in agreement with the cultural model, whereas 60% o f the men (bold figures on the diagonal, 18 + 31 + 19/112) were in agreement with the cultural standards. It is important to remember that for men, the cultural and medical models do not differ greatly, while the standards for women are divergent (c.f. Figs. 1 and 2). The difference between men and women in the proportion o f those who perceived their

Women, Weight, and Eating Disorders

Table 2. Weight self-assessment compared with the cultural model Cultural Model Assessmenta

Self-Assessmentb Thin

Womenc Thin Normal Obese

25% (2) 75% (6) 0% (0)

Total:

100% (8)

Mend Thin Normal Obese

69% (18) 31% (8) 0% (0)

Total:

100% (26)

Normal 2% (3) 49% (68) 49% (67)

Obese 0% (0) 9% (12) 91%(118)

100%(138) 100%(130) 8% (5) 50% (31) 42% (26)

0% (0) 21% (5) 79% (19)

100% (62) 100% (24)

astudents were assigned to one of the three categories on the basis of how their actual reported weight compared with a chart of desirable weights from a leading weight loss clinic. bStudent's response to a question requesting their subjective view of their weight. car = 276. d N = 112.

weight in agreement with the cultural model was significant, t = 2.22, p < .025. Additional support for the hypothesis that women were adhering to a societal norm of ultra-slenderness was obtained by using a measure of the respondent's desired weight. We compared the average desired weight for each given height with respondent's average actual weight for each given height. Then we plotted these figures against the medical and cultural height/weight charts described above, and also charted the results in Figs. 1 and 2. The following results were highlighted by these figures: 1. The deviation between the respondent's actual and desired mean weights for each given height was much less for men than for women. On the average, there was approximately a one-pound difference for men compared to a 10-pound difference for women. These findings are in agreement with other research. Halmi et al. (1981) have shown that women of statistically normal height and weight label themselves as overweight, and many women who are underweight (statistically) do not see themselves as such (Gray, 1977; Miller, Coffman, & Linke, 1980). It appears that beliefs of being overweight selectively affect females, even though their

183

weight is within or below statistically normal limits (Dwyer, Feldman, & Mayer, 1970; Fallon & Rozin, 1985; Nylander, 1971). 2. Women's average desired weight gravitated toward the cultural model of ideal weight, rather than toward the medical model. 3. For men, the medical and cultural height and weight charts are so similar, and the deviation between actual and desired weight so minimal, that comparisons are difficult to make. Of interest, however, was that for some height categories the men's mean desired weight was heavier than their mean actual weight. The tendency for men to desire a heavier weightrelated appearance is not surprising, given their traditional socialization. Men are taught that being big is one way of being powerful and bigness is sometimes linked with sexual prowess. Furthermore, men often confuse weight with build and may avoid dieting because they believe that it will reduce their strength and virility (Dwyer & Mayer, 1970). The widespread use of steroids by males as a way to increase muscle size and body weight faster, especially among athletes and bodybuilders, is on the rise in communities around the country ("Area police say," 1990, p. 4). Women who followed the cultural standard for weight-related appearance were also found to be more at risk than women who followed the medical model for developing eating problems. Women who followed the cultural model reported a higher percentage of abnormal eating patterns as measured by the Eating Attitudes Test (EAT) devised by Garner and Garfinkel (1979). We analyzed the data for women only, since the percentage of men who scored in the abnormal range on the Eating Attitudes Test was small (20% of women scored in the abnormal range, compared to 1.8% of the men). Table 3 reveals the significant relationship between the weight models and eating disorders. Of the women who followed the cultural model, 23.5% scored in the abnormal range on the EAT, compared to only 8.2% of the medical model women (Chi Square = 6.778, p < .0092, 1 d.f.). Comparing women's perception of their body weight to the cultural and medical charts has provided us with a good measure

184

SF.AI~EI~E HESsE-BmER

Table 3. Weight model compared with women's

eating behavior Eating Behavior a Weight Modelc

Normal

Abnormal

Medical Model Cultural Model

92% (56) 71% (140)

8% (5) 24% (43)b

Note: Chi Square = 6.778, d.f. = 1, p <. 0092. aStudents were classified into one of the two categories on the basis of their score on the EAT. bTwo respondents were missing since they failed to answer enough questions to be classified on the EAT. CThirty students could not be classified into either model. of whether or not women are following a cultural standard o f beauty and weight control. In general, women's perceptions o f themselves were more in line with a cultural than a medical definition of desirable weight. Women who adhered to the cultural definition o f b o d y image were more at risk for the development o f eating difficulties. Women who followed a cultural ideal were less satisfied with their b o d y image and were more concerned a b o u t b o d y weight compared to those women who followed a medical model. M o r e o f the cultural m o d e l followers (34%) report feeling anxious, depressed, or repulsed by their bodies, compared to only 23 % o f medical model followers. Almost half the cultural ideal followers (47%) and approximately one fourth o f the medical followers (26%) report significant to extreme concern a b o u t their b o d y weight. One could argue, however, that those women who follow a cultural model could be doing so because wanting to look thin is part o f the clinical description o f women who are eating-disordered. Yet, there are important differences between the disturbed eating patterns o f women students who score in the a b n o r m a l range on the EAT in our sample and the disorders as clinically defined. We compared our a b n o r m a l sample o f women (those who scored in the a b n o r m a l range on the EAT), and looked at their scores on the EDI. Although women who score in the abnormal range on the EAT displayed the behavioral symptoms associated with anorexia and bulimia, most o f them did not exhibit the constellation o f psychological traits generally associated with these disorders. The E D I (Garner et al., 1983) measures the psy-

chological and behavioral pathology associated with eating disorders. We compared the E D I scores o f the EAT-abnormal women in our group to a clinically diagnosed sample o f female anorexia nervosa patients. We found that our sample o f EAT-abnormal women did not resemble the anorexia nervosa female sample described in the E D I manual (Garner & Olmsted, 1984). The mean E D I scores o f women in our sample were significantly lower than the mean E D I scores o f the anorexia nervosa patients on every subscale, except on the behavioral subscale "Drive for Thinness," where there were not significant differences. The clinical sample scored significantly higher on Bulimia ( M = 8.1 vs M = 3.5, t = 5.19, p < .0001), Perfectionism ( M = 8.6 vs. M = 7.0, t = 2.08, p < .02), Interpersonal Distrust ( M = 6.4 vs. M = 2.1, t = 6 . 1 0 , p < .0001), and Maturity Fears ( M = 5.6 vs. M = 3.5, t = 2.54, p < .006). DISCUSSION I f we were to rely on traditional psychodynamic thinking to explain the current nearepidemic increase in eating disorders a m o n g college women, we would have to assume an increase in the underlying psychodynamic features that produce such symptoms. However, as r0ported, the expected psychological profiles are absent. W h a t we may be witnessing is a pattern o f eating disordered symptoms in otherwise " n o r m a l " women. We argue that this pattern is better understood in terms o f socio-cultural and political-economic perspective. I f this perspective is important for understanding eating disorders, what solutions does it offer? A socio-cultural and politicaleconomic framework examines the structural roots o f eating-disordered behavior. We observed how b o t h patriarchal and capitalistic interests sought to control women through b o d y insecurity. The current structural features o f capitalism which now promote this ideal are the diet, cosmetic, beauty, toy, and health, and mass media industries. These interests continue into the present day, through the p r o m o t i o n o f an ultra-slender conception o f the ideal female body. The ideology of women's independence with grew out o f the 1960s was co-opted by capitalist and patriar-

Women,Weight,and EatingDisorders

chal interests to equate independence with women's responsibility for maintaining an ultra-slender ideal. Ferguson's (1983) content analysis of women's magazines over the past century confirms this movement toward independence. She noted that during the late 70s and early 80's there was an editorial shift "towards greater self-realisation, self-determination and the presentation of a more independent and assertive femininity" (Ferguson, 1983, p. 113). She notes: "this assertive, questing and questioning female was to be found helping herself to cope with life and love, work and p l a y . . . " (13. 111). Ferguson states that while women were urged to achieve their full potential, they were simultaneously presented with a double message: "'Yes, get out there and show the world you are someone in your own right', but also 'Remember you must achieve as a wife and mother, too'" (Ferguson, 1983, p. 189). The uitra-slender ideal is profitable and easy to implement, since this system runs itself. Accompanying the new cultural image of the ultra-thin woman is a vast network of dieting, slimming, exercising, and figuremaintaining products that are making billions of dollars. Market researchers estimate that "Americans spend more than 10 billion dollars a year on diet drugs, exercise tapes, diet books, diet meals, weight-loss classes, fat farms and dancer-like body wraps" (Belasco, 1984; "Ever-fatter business," 1981, p. 28F). The promotion of an ultra-slender norm self-perpetuating: attaining an ultraslender body does not come naturally for most women, but requires going on a diet. Research reveals that, for the most part, diets don't work and those which "succeed" very often require the dieter to be on a life-long "maintenance" program (Bennett & Gurin, 1982). Furthermore, women are locked in a perpetual state of ever-increasing need, since the ideals of beauty have become increasingly stringent and elusive. Women are "in charge" of their own oppression and police each others' weight through a variety of reward and punishment mechanisms. Some women are competitive with each and this helps to promote negative comments concerning other women's body weight. Some women support dieting behaviors through forming mutual diet support groups. Beauty pageants, and

185

successful dieting by celebrities serves to reinforce dieting by equating slenderness with fame and fortune. An ultra-slender ideal body norm for women also meshes well with patriarchal interests: to attain the ultra-slender ideal requires women to consume diet products and spend enormous amounts of time and emotional energy (Attie & Brooks-Gunn, 1987). These activities drain economic and emotional capital away from other investments women might make in, for example, political activity, education, and career advancemerit-activities which would promote empowerment.

Re-visioning femininity To address the specific nature of eating disorders among women, then, requires a critical examination and boycott of the current structural features of capitalism and pat r i a r c h y - t h e diet, cosmetic, beauty, and health and toy industries that oppress women through a variety of social practices. The widespread sale and promotion of the Barbie Doll by the Mattel toy industry is a prime example of how young girls' bodies are shaped and disciplined. Through the purchase of the Barbie doll, young girls are socialized through "play" into acquiring an ultra-slender body norm. It is estimated that ninety-percent of all American girls between the ages of 3 to 11 own one or more Barbie dolls (Stewart, 1989). Barbie is now 31 years of age, and if we were to line up all the Barhie dolls ever made from head to toe, they "would circle the Earth three and a half times" (Stewart, 1989, p. 80). Current efforts to totally medicalize eating problems must also be examined as well as the implications of this for strengthening the partnership of capitalism and patriarchy (Doyal, 1979; Ehrenreich, 1978; Smead, 1983). Currently anorexia and bulimia are labeled as illnesses, requiring medical, psychotherapeutic, and other self-help interventions. Eating disorder clinics promise to be big money-makers and one needs to question whether or not labelling an eating disorder as primarily a medical problem serves the economic interests of the drug and medical communities. The drug companies have come out with an antidepressant drug (fluoxetine) for bulimic women. The underlying rationale

186

SttARI~l~rsHESsE-Bn~R

for taking depression pills is the theory that depression, caused by a chemical imbalance in the brain, is the root cause of bulimia and other eating disorders in women (Pope & Hudson, 1984). Yet a current review of the link between depression and bulimia finds "inadequate support" for this relationship (Levy, Dixon, & Stern, 1989, p. 167). One needs to question the extent to which there is an economic motive on the part of drug companies and some medical researchers (whose research may in fact be supported by the drug companies) to label women's problems with food as depression and to thereby market a "cure for eating problems" that promises to make a good profit for the drug companies. The medicalization of eating disorders can also be a way to socially control women, not unlike the situation women experienced in the late nineteenth and early twentieth centuries (Ehrenreich & English, 1973; 1979; Rothman, 1978). One frightening prediction is that, because of its profitability, ultra-slenderness promises to spread to other sub-populations. There is evidence that advertising's new target for thinness is aimed at the pre-teen market. A recent research study found that preadolescents are joining the diet craze and risking stunting their growth (Meilin, Scully & Irwin, 1986; "Fourth-Grade Girls", 1986, pp. I, 28; Stein & Reichert, 1990). Other research suggests young adolescents are fearful of obesity regardless of their "body weight or nutrition of knowledge" (Moses, Banilivy, & Lifshitz, 1989, p. 393). Still others suggest that men will begin to show more signs of eating problems. The fashion industry is recognizing that changing fashions for men each year is big business. Diet and cosmetic industries have developed market strategies that prey upon men's weight and appearance insecurities. Diet soft drinks are marketed for the male population. According to a socio-cultural analysis, as cultural demands are placed upon men to live up to stringent norms for weight and appearance, one might expect an increase in culturally induced eating difficulties among men. Research findings already suggest that male homosexuals (a subculture that stresses a thin body type and is attentive to fashion and appearance) may be at risk for developing eating problems (Herzog, Norman, Gordon, & Pepose,

1984; Striegel-Moore, Silberstein, & Rodin, 1986). Another important problem is the growing number of teenage women who are taking up smoking. Cigarette smoking is a major cause of cancer in women. It accounts for about one-fourth of cancer deaths in women each year (Ernster, 1987, p. 217). Over the last twenty years the tobacco industry has created a female market of smokers by feminizing certain brands of cigarettes (such as Virginia Slims). Smoking cigarettes is advertised as a way to help women lose weight and suggests that women who quit cigarettes will gain weight. What is ultimately required is a re-visioning of what it means to be feminine. It requires us to look at current socio-cultural norms of femininity. Women need to free themselves from the current definitions of "the feminine" which are dictated by a capitalist/patriarchal social system. This will require that women become politically active in determining their own identities. As Sichtermann (1986) notes: As women and men take a more active role in running their own lives and in political decision-making and as they communicate socially in a wider variety of fields, so private consumption will become less important. For private consumption is secretly malignant consumer democracy and involves the consumption of illusions of attractiveness. (Sichtermann, 1986, p. 53) Re-visioning femininity poses enormous challenges for women as a group, because it goes to the heart of what it means to be "female." Many women may be unwilling to give up the economic and social rewards they have accrued under the existing system. There are some important efforts underway that are beginning to chip away at the current def'mitions of femininity. These strategies range from r a d i c a l - a compete break with the patriarchal/capitalist s y s t e m - t o more conservative strategies that strive to change the system from within. Perhaps the best known of the radical solutions is that proposed by Mary Daly (1979). Daly suggests that only by living apart from men and at one with nature can women free themselves from the patriarchal definitions of

Women, Weight,and Eating Disorders

what it means to be female. Such a "feminine environment" is completely "woman identified" and envisioned as follows: . . . a new, women-identified environm e n t . . , is the becoming of Gyn/Ecology. This involves the dispelling of the mind/spirit/body pollution that is produced out of man-made myths, language, ritual atrocities, and meta-rituals such as 'scholarship', which erase our Selves. It also involves dis-covering the source of the Self's original movement, hearing the moving of this movement. It involves speaking forth New Works which correspond to this deep listening, speaking words of our lives. (Daly, 1979, p. 315) Another exciting development has been undertaken by a group women who have taken their own bodies as objects of study (Hang, 1987). The goal is to "unravel" how gender socialization has created and molded bodies over time. The method involves group members choosing a particular area of the body-hair, legs, and so on- - and then asking group members to recollect events which focus on this body part. Members of the group write down their memories associated with the socialization experiences related to that body part. Group members circulate their written memories to the group, where body socialization stories are "discussed, reassessed and rewritten" (Haug, 1987, p. 13). The goal of the project is to "return to the 'natural' body from which patriarchal civilization is deemed to have isolated women" (pp. 23-24). Another new development is photo therapy. The photo technique is known as "reframing." Photos have been an important mechanism for controlling and defining feminine appearance. The idea is that "each of us has sets of personalized archetypal images 'in memory,' images which have been produced through various photo practices-the 'school p h o t o ' . . , is one example" (Martin & Spence, 1987, p. 268). These photos are often "surrounded by vast chains of connotations and buried memories" (p. 268). Reframing involves a challenge or disruption of "visual discourse" by parody and reversal (Betterton, 1987, p. 209). Through playing with photo images of themselves, women 'retake' old images and thereby gain some con-

187

trol over how they define their physical appearance and sense of self. Other strategies involve organizing women at a grass-roots level to selectively target and boycott consumer goods that are offensive to women's body image. Still others involve a change in women's conception of what is beautiful. One goal of some feminist therapists who support a socio-culturai and political-economic perspective is to start selfhelp groups which offer some alternatives to continued obsessions with patriarchal standards of beauty. Such groups encourage women to give up perpetual diets and to, instead, examine the meaning of food for them. Other therapists have applied a philosophy known as "fat liberation." The goal is to change individuals' attitudes about their own weight by feeling good about one's present body weight (Bergner, Remer, & Whetsell, 1985; Brown, 1985; Schoefielder & Weiser, 1983; Wooley, Wooley, & Dyrenforth, 1979). Perhaps the best example of this effort is an organization known as the National Association to Aid Fat Americans, which was founded in 1969. The objective of all these strategies is to identify and resist those "micro" social practices and relations that emanate from a variety of institutional sites and whose primary goal is the disciplinary control of women's bodies. The ultimate response is to resist those practices at their origin point (for example, t hrough boycotting practices/ products) and their destination (the body) through re-visioning social practices and discourses which promote alternative concepts of "femininity." Consciousness-raising around these issues remains an important feminist goal that needs to be addressed and supported by the feminist community. REFERENCES

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