Sociocultural Factors

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It has been proposed that''dieting disorders'' is a more proper term than ''eating disorder'' because the underlying essential feature of anorexia nervosa, bulimia nervosa, and associated conditions is the ''inappropriate and excessive pursuit of thinness'' (32). For individuals with either anorexia nervosa or bulimia nervosa, attempts at weight loss and dietary restriction (often severe) almost invariably precede the development of the significant symptoms of disordered eating. The current cultural milieu, in which thinness, fitness, and body shapes that are impossible for most women to obtain are prized, no doubt contributes to the dissatisfaction with body size and shape that is normative among women. While most women have tried to lose weight, relatively few develop eating disorders, leading some investigators to suggest that dieting may be a ''necessary, but insufficient'' condition for the develop- 5 ment of eating disorders (33). The relationship between | dietary restraint and binge eating is complex, and many factors, including the type and degree of dietary restraint, individual psychological and biological predis positions, and the sociocultural milieu, may contribute to binge eating in the susceptible individual.

The link between dieting and the development of disordered eating is even less in binge eating disorder than in anorexia or bulimia nervosa. A recent review of the literature by the National Task Force on the Prevention and Treatment of Obesity concluded that ''moderate caloric restriction, in combination with behavioral weight loss treatment does not seem to cause clinically significant binge eating in adults pre-existing binge eating problems and might ameliorate binge eating, and least in the short term, in those reporting recurrent binge eating before treatment'' (34). Studies to date have indicated that binge eating precedes or occurs at approximately the same time as first attempts of weight loss in about half of all subjects (22,27,35); however, these studies have the disadvantage of being retrospective. Berkowitz et al. (36) have evaluated obese adolescent girls, many of whom had not previously attempted weight loss, and found a significant percentage who nonetheless reported serious difficulties with binge eating. Some studies suggest that, rather than being ''restrained'' eaters obese binge eaters exhibit high levels of disinhibition, or loss of control due to affective, pharmacological, or cognitive stimuli (32, 33,35,37-39). Marcus et al. (40) have found that, when compared to bulimia nervosa patients, obese binge eaters report less dietary restraint, but score similarly on other measures of eating disorders psychopathology regarding weight and shape (40). This finding has implications for the modification of treatments developed for bulimia nervosa to address the special needs of non-purging obese binge eaters.

The evidence that dieting plays a causal role in the night eating syndrome is even weaker than in binge eating disorder. Although stress appears to play a role in precipitation night eating, dieting does not appear to contribute to this stress (41).

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