Development of weight and shape concerns in the aetiology of eating disorders

Abstract

Background: Concerns about weight and shape are thought to precede the development of eating disorders such as anorexia and bulimia nervosa and are included in the ICD-10 and DSM-IV criteria for these disorders. The etiology of such eating disorders, however, has yet to be fully determined. Aims: The goals of this research were to (1) determine if prior weight and shape concerns were necessary for the development of eating disorders, (2) trace the pathway from concern about appearance to eating behaviors to disorders, and (3) identify the source of anxiety that may lead to eating disorders. Method: A review using the keywords eating disorder, weight concern, shape concern, and aetiology was conducted of the MEDLINE and Psychlit databases. Studies were included on the basis of recent publication, strength of quantitative findings, and originality of ideas. Results: Concerns about weight and shape usually, but not always, precede development of eating disorders. These concerns stem from biological factors (e.g., changes in percentage of body fat in girls during adolescence, presence of obesity), family factors (e.g., attitudes about eating and presence of eating disorders in parents and siblings, feeding practices), and sociocultural factors (e.g., social class, media influence). Although concern about appearance often leads to dieting, few individuals who diet later develop eating disorders. In addition, factors associated with need for restraint (such as perfectionism, moral and religious beliefs, and impulsivity), rather than with concern about appearance, may also lead to the development of eating disorders. Conclusions: Eating disorders tend to follow concerns about weight and appearance but also may stem from an individual's perceived need for restraint in some area of his or her life. Interventions that target the concerns that precede dieting and development of eating disorders may prove fruitful.