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SHORT REPORTS: GABRIËLLE E. VAN SON, DAPHNE VAN HOEKEN, AAD I. M. BARTELDS, ERIC F. VAN FURTH, and HANS W. HOEK Urbanisation and the incidence of eating disorders The British Journal of Psychiatry 2006; 189: 562-563 [Abstract] [Full text] [PDF]

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Increased Bulimia in Urban Areas may be due to Testosterone

James M. Howard   (6 December 2006)

Socio-cultural rather than socio-economic aetiology influence on bulimia nervosa.

Karl H Marlowe   (20 December 2006)

EATING DISORDERS-INFLUENCE OF WESTERNISATION AND URBANISATION

LAKSHMIPRABHA RAMASUBRAMANIAN   (1 February 2007)

Increased Bulimia in Urban Areas may be due to Testosterone 6 December 2006
James M. Howard, Biologist independent Send letter to journal: Re: Increased Bulimia in Urban Areas may be due to Testosterone jmhoward{at}anthropogeny.com James M. Howard	Bulimia has been connected with increased testosterone (Neuropsychobiology. 2000;42(2):58-61). A report comparing rural areas and a large city found that testosterone is higher in the large city (Folia Histochem Cytobiol. 2001;39 Suppl 2:38-9) I suggest the findings of Van Son, et al., may be due to testosterone levels in bulimics and urban living.
Socio-cultural rather than socio-economic aetiology influence on bulimia nervosa. 20 December 2006
Karl H Marlowe, Consultant Psychiatrist THEIS, ELCMHT, Royal London Hospital (St Clements) Send letter to journal: Re: Socio-cultural rather than socio-economic aetiology influence on bulimia nervosa. karlmarlowe{at}doctors.org.uk Karl H Marlowe	Dear Sir, The paper by Van Son et al (2006) is a welcome addition to the literature on the social aetiology of eating disorders. As a continuation of the original study of Hoek et al (1995), urbanisation seems to have a dose dependent association with the development of bulimia nervosa but not for anorexia nervosa. The absence of this association for anorexia nervosa needs further comment. The epidemiology in non- dieting cultural settings have reported that anorexia nervosa is more likely to be found, with similar prevalence to that of Western Societies, but that bulimia nervosa is noted by its absence, even at an attitudinal level (Marlowe, 2005; Hoek et al, 1998). The environmental influence mediated by urbanisation can be seen by the reported unstable incidence rates over time for bulimia nervosa. Anorexia may be subject to more intrinsic (interpersonal) factors compared to bulimia nervosa, which has a greater dose response to extrinsic (social judgements, norms of body size influenced by the media) factors. Soico- economic aetiology would drive anorexic behaviours while socio-cultural aetiology would have a greater influence for bulimia nervosa and have greater temporal plasticity. The three arbitrary levels of urbanisation associated with a dose response to bulimic aetiology can be seen as a proxy for socio-cultural factors, with the report by Van Son et al (2006) confirming such an aetiological association. The implications for public health campaigns are that socio-cultural changes would have little impact on anorexia nervosa when compared to bulimia nervosa. Reference: Hoek, H.W., Bartelds, A.I., Bosveld, J.J. et al (1995) Impact of urbanisation on detection rates of eating disorders. American Journal of Psychiatry, 152, 1272-1278. Hoek, H.W., Van Harten, P.N., Van Hoeken, D. et al (1998) Lack of relation between culture and anorexia nervosa- results of an incidence study on Curacao. New England Journal of Medicine, 23, 338, 1231-1232. Marlowe, K. (2005) A preliminary study of EAT and BITE scores for one school year in Bermuda: increased early anorexic measures related to socio -economic factors. International Journal of Social Psychiatry, 51, 5-12. Van Son, G. E., Van Hoeken, D., Bartelds, A.I.M. et al (2006) Urbanisation and the incidence of eating disorders. British Journal of Psychiatry, 189, 562-563.
EATING DISORDERS-INFLUENCE OF WESTERNISATION AND URBANISATION 1 February 2007
LAKSHMIPRABHA RAMASUBRAMANIAN, senior house officer 5 BOROUHS PARTNERSHIP NHS TRUST Send letter to journal: Re: EATING DISORDERS-INFLUENCE OF WESTERNISATION AND URBANISATION gautamprabha{at}aol.com LAKSHMIPRABHA RAMASUBRAMANIAN	Sociocultural change includes westernisation and urbanisation.Tsai et al suggested that westernisation is defined as "a historical shift driven by technological development in social and family structure where personal status is determined by kinship and more contractual and individualised roles". With greater geographical and social mobility and less ascription to identity through race,kinship or gender we are now placing more value on self determination,achievement and motivation. In this context i would like to highlight the increase in prevalence of eating disorders in asian girls.Gone are the days when obesity was thought to be a symbol of wealth and there was no tendency to view thinness as beauty. Internationalised socioeconomic stratum found in many rapidly urbanising parts of the world is also contributing to increase in eating disorders in non western countries even though they present differently in different cultures.