Abstract
Never before in human history has obesity been as prevalent as it is in today’s society, especially in the United States. In stark contrast society in the United States places extreme pressure on our adolescent youth to achieve an ideal thinness that is unhealthy and usually not achieved by healthy eating patterns. The media is constantly bombarding us with the newest and latest diet and with images of super thin models. With such conflicting issues in society many of our youth are using maladaptive eating patterns to try and achieve this “ideal thinness.” The result is the increasing number of eating disorders among adolescent and college age individuals. While eating disorders primarily affect white females there are a significant number of males also suffering. Over the last twenty years eating disorders have risen in all races, including minority men. Most colleges are now offering screenings for eating disorders and hopefully with early detection the success rate will also increase. Treatment for eating disorders requires the cooperation of many individuals, but most importantly the person suffering needs to want help. If the proper treatment is received there is a fifty percent recovery rate.






Introduction
The unrealistic image of thinness and the excessive value that is placed on weight and appearance in today’s society creates excessive pressure on girls to achieve a body weight and size that is unrealistic, as a result a large group of girls are using unhealthy dieting practices that result in full or partial eating disorders (Pike, 1995). An eating disorder is a psychosomatic illness, which means that emotional distress is expressed through bodily symptoms. Anorexia and bulimia are diseases that affect the mind and body simultaneously. They affect the way people think, perceive, and process information. A core belief in these eating disorders is that a loss of weight will lead to an improved life (Emans, 2000).
Bulimia is a syndrome that is characterized by episodes of binge eating usually followed by purging, or in extreme cases by laxatives or diet pills. Bulimics have knowledge that this eating pattern is abnormal, but fear that otherwise they won’t be able to control their eating. Depression and a negative self-image are also characteristics of bulimia (Lakin and McClelland, 1987). Bulimia is known as the secretive disorder because there are no outward signs or symptoms. Bulimics also tend to be of average weight or above weight. Dentists are usually the first to be able to detect bulimia due to tooth enamel erosion. Bulimia can potentially cause great harm because of electrolyte imbalance, potassium depletion, and kidney disorders (Lakin and McClelland, 1987).
Anorexia is an eating disorder that is characterized by self-imposed starvation. In an attempt to reach their “ideal” thinness anorexics tend to lose between 25 and 50 % of their body weight. Severe anorexic females will even stop menstruating because they do not have the required 15% body fat for menstruation to occur. Malnutrition due to anorexia also causes an extreme sensitivity to cold, brittle hair and nails, hair loss, and fine dark hairs that cover the body. If anorexia continues serious damages can occur, the heart muscle can shrink, the kidneys can fail, loss of bone mass, and eventually death if starvation continues (Berk, 2004).
There are multiple factors that contribute to eating disorders in adolescents. Feelings of isolation, negative body image, and poor family and social connections are just a few. Eating disorders are serious and complex and professional help should be sought.
Discussion
According to Popenoe adolescence and youth are a recent stage of life, only recognized as of the late nineteenth century. Youth has come into being among the middle and upper class. During this period young people are students and are highly influenced by society. This writer believes that eating disorders predominantly affect adolescent females, particularly white and in the middle to upper class (D. Popenoe, 2000).
Pediatrics International wrote that the onset of anorexia typically occurs during adolescence or young adulthood, although manifestations may be apparent later in life or in childhood. It is estimated that 0.48% of 15-19 year olds have anorexia, 1-5% of adolescents have bulimia, and 3-5% of 15-30 year old women have eating disorders not otherwise specified (Emans S.J, 2000).
The British Medical Journal states that about 90% of people diagnosed with bulimia nervosa are women. The same study states that the prevalence of eating disorders such as bulimia nervosa is lower in non-industrial populations and varies across ethnic groups. African-American women have a lower rate of restrictive dieting than white American women but have a similar rate of recurrent binge eating. Young women from the developed world who restrict their dietary intake are at highest risk of developing bulimia nervosa and other eating disorders. One community based case control study compared 102 people with bulimia nervosa with 204 healthy controls and found that people with the eating disorder had higher rates of obesity, mood disorder, sexual and physical abuse, parental obesity, substance misuse, low self esteem, perfectionism, disturbed family dynamic, parental weight/shape concern, and early menarche (Hay P. J, Bacaltuchuk J. 2001).
Journal of the American Dietetic Association examines the prevalence and intensity of dieting and purging behavior in a sample of 1,269 male and female, black and white high school students from 10 schools in the greater Cleveland, Ohio area. Data was collected using self-administered questionnaires, which 72% of the sample completed. The study compares black and white boys and black and white girls, respectively, and shows a higher prevalence of dieting and purging behavior than has been reported in other research. Forty-one percent of black boys, 42% of white boys, 61% of black girls, and 77% of white girls dieted. The study revealed that a higher percentage of girls than boys used purging to help them lose weight. Significantly more black girls than white girls used laxatives (18% vs. 7%) and diuretics (11% vs. 7%) where as significantly more white girls than black girls used vomiting (16% vs. 3%). Black and white boys were similar in dieting and purging behavior. Thus, race appears to be an unimportant factor in boys in studies of this kind; the same is not true for black and white girls (Emmons L., 1992).
Harvard Mental Health Letter states that about 3 percent of women and one-tenth the number of men have suffered from bulimia or binge eating disorder at some time. More than two-thirds of college women indulge in an eating binge at least once a year, and more than fifteen percent have deliberately induced vomiting or used laxatives afterward. This article states that about 40% of people with severe bulimia have a history of anorexia, and many suffer from a mixture of anorexic and bulimic symptoms.
The above literature indicates that eating disorders are more prevalent in females than in males, more specifically in females’ high school and college years. It also supports that it is more common amongst white middle to upper class adolescent females. An interesting fact from the above article is that bulimic behavior varies in white and black females. White females use purging as a way to lose weight and black females use diuretics and laxatives, the ratio appears to be very significant.
Etiology
There are many hypotheses as to the etiology of eating disorders. Among the

key factors reported in the literature are social and cultural issues involving

women in our society, dysfunctional interpersonal relationships with family

members, traumatic experiences including sexual abuse, difficulty with identity

formation, and biological and genetic predisposition (Grothaus, 1998).

The feminist perspective argues that female slenderness has been

imposed on women by society through the media by newspapers, magazines, and

television. By the economy through women?s clothing and beauty products.

Slenderness is thought to be the magical clue to happiness and success. The

ideal shape of women in the media has become thinner over the last two decades,

whereas the weight of the average adult woman has increased (Grothaus, 1998).

This hypothesis is based on the assumption that social conditioning results in

the repression of certain individual needs and aspects and is symbolized by

disturbed eating. The perplexing phenomenon is that most females are

subjected to these influences, however, only a small number develop an eating

disorder.

While much has been written about the families of anorexic

patients, less has been published about the families of bulimic patients. In

1992, Vanderlinden, Norre, and Vandereycken (as cited in Grothaus, 1998),

reported the following about bulimia nervosa families: they often belong to a

higher social class; eating disorders, somatic diseases, affective disorders,

and addictions occur frequently in close relatives; and family interactions are

characterized by control and emotional dependence, accompanied by strong

tensions and conflicts not openly or directly expressed. In a study conducted

in 1990 by Blouin, Zuro, and Blouin (as cited in Grothaus) bulimic patients

perceived their families as less cohesive, less encouraging of independent

behavior, less expressive, less oriented toward recreational pursuits, more

oriented toward achievement, and more controlling than non-eating-disordered

women.

It has been long known that many psychiatric illnesses do not

strike at random but are related to biological changes in the individual or to

alteration in the environment, or both. Cultural and social factors are of

paramount importance in the understanding of the development of eating

disorders (Horesh, Apter, Ishai, Danzinger, Miculincer, Stein et al., 1996).

Inappropriate parental pressure was specific only for the subjects with eating

disorders. These results by Horesh et al., support the growing literature on

the interrelationship between disordered family relationships and eating

disorders. This study also showed that sexual abuse was more common in the

eating disorder group than the healthy controls. Sexual abuse in families is

not a rare phenomenon. As Popenoe (2000) reported in his book, at least 22%

of all children in America are estimated to be victims of sexual abuse. Most

often, the abuse occurring in the child?s home, neighbors? house, or at a

day-care center. It might also be speculated that negative emotional family

tone may lead to defective eating attitudes even in those adolescents

without actual eating disorders. Thus eating disorders may be related to a

conflict between premature exposure to the world of adults and the fear of

what that world entails.

Male perspective

Young men despair in not improving their performance in the gym and resort to

anabolic steroids. Males predominately in the age group of 15 -22 are mostly affected.

The term Anorexia Nervosa means loss of appetite for nervous reasons, and is a psychiatric disorder characterized by abnormal eating behaviors that can result in significant eight loss and serious medical consequences. Bulimia is an eating disorder of binging and purging episodes in which compulsive overeating, or binge eating in a short period of time is followed by purging, or self-induced vomiting of food through laxatives, diuretics, exercising compulsively, and / or fasting. (1). Bruch (1973).
Anabolic steroids are hormones that promote growth of muscle tissue. Clinical
Muscle tissue. Clinical manifestations reveal that male anorectic represents specific populations, and reveal differences from female counterparts, such as;
Male patients are more active: These accounts for the male desire to be bigger and stronger, as compared to the female preference for slimness. They like to run marathons and have a bizarre preoccupation with food, even when they achieve a lean body mass of 95% with only 5% body fat; they would aim for 4% body fat. Men fear thinness and strive for increased muscle mass as a sign of conquering and body control.
Anorexia Nervosa and Bulimia are abnormal eating behaviors believed to be caused by psychological illnesses including depression, anxiety, personality disorder and substance abuse. Eating disorders in males do not appear to be different from female eating disorders, except that males are reluctant to confess what has been known as a ‘teen-age girls’ problem. (2). Bruch (1979).
Number of males having eating disorders: Today researches find that for every four females with anorexia, there is one male, and for every 8- 11 females with bulimia, there is one male. (3). (AJP 2001). More than 90 % of individuals with eating disorders are female. In cases of Anorexia occurring before puberty, boys constitute 20-25 % of diagnosed cases. The gender gap is not as large among boys and girls as it is in adolescence and young adulthood. (4). Roth G. (1984). This disorder is found predominately in white, middle and upper- socioeconomic classes for whom thinness is emphasized and highly valued. It appears that health professionals do not expect to see eating disorders in male and may underdiagnose them. Also, males are not as likely to fell guilty or anxious after a binge, (compulsive eating), as females do.
Risk factors for males v. females.

• Males are more at risk than females with eating disorders. The goal for females is thinness’ through drastic eating habits. They are encouraged to diet so that they can feel good about themselves, attract friends and romantic partners as shown in popular magazines and TV shows.

• Men, instead, equate thinness with weakness and frailty. They are exhorted to be strong and powerful, to build their bodies and make them large so they can compete successfully, amass power and wealth, and defend and protect their skinny female companions.


• Males participate in sports that demands thinness; they engage in running, playing football; lifting weights; body building to deplete body fat and fluid reserves to achieve high definition.

• Male have a job or profession that demands thinness. Male models, actors, gymnasts, skaters, and entertainers seem to be at higher risk than the general population.

Psychological characteristics of male anorexia: Societal influences and cultural expectations of man’s primary role in the family as provider. (5). Popenoe Sociology (2000)., and increased job responsibility have becoming anorexic. Overwhelming stress such as divorce or family member illness increasing pressures, causing men to hide their feelings and becomes confused about their emotions. Alcohol and drug abuse also appear to increase emotional disturbances leading to anorexic behavior.
Identity crises in adolescent eating disorders: The teenage years are a precarious time, full of confusion, self-doubt and the search for identity, further compounded by dramatic physiological changes in the body. An eating disorder may keep the adolescent stuck in childhood and remain dependent on the parents without facing the challenges of adult responsibilities. Social skills acquired through peer group relationships are most important and loyalty to peers is a common trademark for adolescents which can work against them and compound the eating disorder. (6). Michel & Willard (2003).

The Sociological Perspectives on Eating Disorders
This writer believes that the Functionalist, Conflict, and Interactionist sociological theories can be thought of as different looking glasses—the way in which we view the same situation from different perspectives. Each complements the others by looking at a related aspect of the same social reality (Popenoe 2000). p18
The functionalist perspective emphasizes the way in which each part of a society contributes to the whole so as to maintain stability (Popenoe 2000) p16. This writer believes that when researching the impact of social forces on attractiveness in relation to eating disorders, the functionalist perspective would persuade people that important social forces such as the mass media are educational and essential to communicate important messages. They would also believe that social forces do not have a negative effect on everyone. However, sociocultural influences, which contribute to eating disorders, cause dysfunction in society, strain our health care resources, and raise the cost of health insurance for everyone.
The conflict perspective emphasizes struggle over limited resources, power, and prestige as a permanent aspect of societies and a major source of social change (Popenoe 2000) p16. Instead of viewing how the elements of social structure work together to create stability, conflict theorists propose that certain institutional arrangements enable the domination of the strong over the weak and the rich over the poor (Popenoe 2000). p16 This writer believes that when researching the conflict perspective in relation to eating disorders, the institutional powers of the weight-loss industry, medical professionals who maintain that fat is by definition unhealthy, and the advertising industry with conflicting messages of thin, glamorous models in one advertisement and large portioned, luscious food in another perpetuate the prevalence of eating disorders. Society and the mass media send messages that slimness can bring success, happiness, and upward social mobility.
Functionalist and Conflict theory focus on large groups as a whole (macro level perspectives) that examine large-scale social phenomena, such as social change and stratification, as well as the impact of social structures on individuals, groups, and institutions.
Another prominent perspective within sociology differs from those just discussed in that it is concerned mainly with the micro level of society—social interaction and the individual as a social being. This perspective, known as the interactionist perspective, focuses on how people interact in their everyday lives and how they make sense of this interaction (Popenoe 2000). p17 This writer believes that according to the interactionist perspective, people interpret situations according to their interactions with others. This identity process depends on status cues in the social environment, which are messages that indicate to a person how others perceive him or her to be (Degher and Hughes 1991). P3 Interpreting Weight Individuals form their sense of self-identity through this process. People manage their appearance, particularly their weight, in order to make attractive social presentations and obtain positive social reactions. Many strive to manage appearance through weight control because thinness is widely valued and rewarded in contemporary postindustrial societies (Maurer and Sobal 1999). P3 Interpreting Weight This writer believes that because body image is interdependent with identity, and identity is impressed upon by cultural expectations as well as biological and physiological factors, it is not surprising that eating disorders are on the increase because of the value society places on being thin.
What can be done to help people with an eating disorder?
Seeking treatment for an eating disorder is a personal decision. A person must want to address the problem and get professional help. Family plays an important role in this matter. They can provide their loved ones with an environment in which to develop healthy eating habits and can help to change existing unhealthy habits. As with any disorder, a strong support system is crucial for recovery from an eating disorder.
How are eating disorders treated?
• Anorexia nervosa - The first goal for the treatment of anorexia is to ensure the person's physical health, which involves restoring a healthy weight (NIMH, 2002). Reaching this goal may require hospitalization. Once a person's physical condition is stable, treatment usually involves individual psychotherapy and family therapy during which parents help their child learn to eat again and maintain healthy eating habits on his or her own. Behavioral therapy also has been effective for helping a person return to healthy eating habits. Supportive group therapy may follow, and self-help groups within communities may provide ongoing support.
• Bulimia nervosa - Unless malnutrition is severe, any substance abuse problems that may be present at the time the eating disorder is diagnosed are usually treated first. The next goal of treatment is to reduce or eliminate the person's binge eating and purging behavior (NIMH, 2002). Behavioral therapy has proven effective in achieving this goal. Psychotherapy has proven effective in helping to prevent the eating disorder from recurring and in addressing issues that led to the disorder. Studies have also found that Prozac, an antidepressant, may help people who do not respond to psychotherapy (APA, 2002). As with anorexia, family therapy is also recommended.
Recovery and Outcome
Approximately 1/3 of bulimics and anorexics will recover after an initial episode with an eating disorder, approximately 1/3 will fluctuate between recovery and relapse, and the remaining 1/3 will suffer chronic deterioration (Ice 2000). We must address this important issue from the perspective of the societal components as well as from the perspective of the individual. Although the prevalence of eating disorders has doubled since the 1960’s, also on the rise is the increase in awareness and educational outreach. Many organizations offer information, education, professional care, and support to help people with eating disorders. The National Eating Disorders Association is the largest non-profit eating disorders prevention and advocacy organization in the nation dedicated to promoting public understanding of eating disorders and access to treatment. Many College campuses now offer eating disorder screenings usually during National Eating Disorders Awareness Week (NEDAW) celebrated the last week of February for the past 17 years. The sooner these disorders are diagnosed and treated, the better the outcomes are likely to be. For some, finding help early can make a difference between life and death.

Conclusion
Research has shown that over the last twenty years there has been a steady increase in the occurrence of anorexia and bulimia among adolescent and college age individuals. Once considered to be primarily a white female dilemma, the increase has been shown to affect every nationality, including the males in every race. Steps are now being taken to try and diagnose people suffering from an eating disorder in the early stages in hopes of avoiding serious health affects. Most colleges now offer screenings for eating disorders and help to those who need it. The prognosis is good for those who are diagnosed early and receive treatment. Treatment is multi-faceted usually involving nutritionists and psychologist, even counselors. Those who continue to receive the help they need and receive support from family and loved ones have a good chance of overcoming an eating disorder. The biggest obstacle to overcome is societies image of thinness. The media continues to perpetrate this ridiculously unhealthy vision of the “ideal woman”, usually by deceiving society into thinking that these women are healthy and maintain nutritionally sound eating habits. If we want our adolescents to be healthy and happy then we need to present them with role models that envision the same ideal. There also needs to be easy access to receiving help and information as to where they can get help. Adolescents need to receive accurate and achievable nutritional information. Most importantly they need to be surrounded with love and people to confide in, and embraced eating disorders and all.
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References:

Bruch, H. (1973). Eating Disorders: Obesity, Anorexia, and the Person Within.
New York: Basic Books. 1.

Bruch, H. (1979). The Enigma of Anorexia Nervosa. Cambridge, MA: Harvard
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Carlat, Camargo, Carlos, and Iterzog (2001). The American Journal of Psychiatry
154. (8) August pp. 1127 – 1132. 3.

Michel, D., & Willard, S., (2003). When Dieting Becomes Dangerous. New Haven
and London; Yale University Press. 6.

Popenoe, D. (2000) Sociology: The Family P.312- 313. Prentice Hall, Inc N. J. 5.

Roth, G. (1984) Breaking Free from Compulsive Eating. New York: Penguin. 4.

Emmons L. (March 1992). Dieting and purging behavior in black and white high school
students. Journal of the American Dietetic Association.
Harvard Mental Health Letter (2002). Treatment of Bulimia and Binge Eating.
Emans S.J. (2000). Eating Disorders in adolescent girls* Pediatrics International 42, 1-7
Hay P. J, Bacaltuchuk J. (2001). Bulimia Nervosa. (Extracts from “Clinical Evidence”) British Medical Journal.

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