Change in binge eating and binge eating disorder associated with migration from Mexico to the US

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Abstract

Exposure to Western popular culture is hypothesized to increase risk for eating disorders. This study tests this hypothesis with respect to the proposed diagnosis of Binge Eating Disorder (BED) in an epidemiological sample of people of Mexican origin in Mexico and the US. Data come from the Mexico National Comorbidity Survey, National Comorbidity Survey Replication, and National Latino and Asian American Survey (N = 2268). Diagnoses were assessed with the WMH-CIDI. Six groups were compared: Mexicans with no migrant family members, Mexicans with at least one migrant family member, Mexican return-migrants, Mexican-born migrants in the US, and two successive generations of Mexican-Americans in the US. The lifetime prevalence of BED was 1.6% in Mexico and 2.2% among Mexican-Americans. Compared with Mexicans in families with migrants, risk for BED was higher in US-born Mexican-Americans with two US-born parents (aHR = 2.58, 95% CI 1.12–5.93). This effect was attenuated by 24% (aHR = 1.97, 95% CI 0.84–4.62) with adjustment for prior-onset depressive or anxiety disorder. Adjustment for prior-onset conduct disorder increased the magnitude of association (aHR = 2.75, 95% CI 1.22–6.20). A similar pattern was observed for binge eating. Among respondents reporting binge eating, onset in the US (vs. Mexico) was not associated with prevalence of further eating disorder symptoms. Migration from Mexico to the US is associated with an increased risk for BED that may be partially attributable to non-specific influences on internalizing disorders. Among respondents reporting binge eating in either country, similar levels of further symptoms were endorsed, suggesting some cross-cultural generalizability of criteria.

Introduction

Binge Eating Disorder (BED), a diagnosis described provisionally in the appendix to DSM-IV and proposed for inclusion in DSM-5, is characterized by recurrent episodes of binge eating, i.e. eating objectively large amounts of food with loss of control. To meet the diagnostic criteria, the episodes of binge eating must be accompanied by further symptoms, such as eating much more rapidly than usual and eating alone due to embarrassment, and marked psychological distress (American Psychiatric Association, 1994, American Psychiatric Association DSM-5 Task Force, 2010). Epidemiological studies have found BED to be associated with a broad range of comorbid psychiatric disorders, including mood, anxiety, impulse control and substance use disorders (Hudson et al., 2007, Preti et al., 2009, Swanson et al., 2011), role impairment (Hudson et al., 2007, Preti et al., 2009, Swanson et al., 2011), and suicidality (Swanson et al., 2011). There is some evidence that, as has been found for other eating disorder symptoms (Becker et al., 2002, Becker et al., 2011), binge eating episodes are associated with exposure to popular culture of the US and other Western countries in which thin bodies and strict weight management are strongly valued. Notably, among Latinos in the US, risk for binge eating is less common among immigrants to the US than among the US-born (Alegria et al., 2007). This is of particular concern since there is also evidence that the prevalence of binge eating is higher among Latinos than among Non-Hispanic Whites (Marques et al., 2010). To date, however, binge eating and BED have not been examined in cross-national studies that would provide a clearer test of their hypothesized association with exposure to particular cultural influences.

This study examines the association of binge eating and BED with migration between Mexico and the US in a unique transnational general population sample. We test the hypothesis that exposure to the US is associated with higher risk by comparing successive generations of Mexican-Americans in the US with the migrant source population in Mexico. In addition, we address two further issues. First, we examine whether the association between migration and risk for binge eating or BED is attributable to prior onset psychiatric disorders. Previous research has found a strong association between migration to Western countries and increased risk for a broad range of psychiatric disorders, including many types of internalizing and externalizing disorders (Alegría et al., 2008, Breslau et al., 2008, Cantor-Graae and Selten, 2005, Fearon and Morgan, 2006); further research supports strong associations between BED and comorbid mood/anxiety and impulse control disorders (Hudson et al., 2007, Preti et al., 2009, Swanson et al., 2011, Wonderlich et al., 2009). This is an important hypothesis to test because the influence of migration on BED might result from generalized effects on psychopathology rather than factors hypothesized to have specific effects on disordered eating. The environment brings exposure to many factors beyond just eating habits and body image ideals, and it has not been previously explored whether an association between eating disorders and exposure to Western culture is best accounted for by such specific factors or some general set of factors associated with psychopathology broadly. Second, we examine whether migration is associated with differences in cognitive and behavioral symptoms of BED and other eating disorders among people who report binge eating. Such differences might indicate cultural variation in psychiatric implications of binge eating that should be taken into account in the design of the DSM-5 criteria. The pertinence of specific symptoms among people with episodes of binge eating has not been previously examined in cross-cultural epidemiological data.

Section snippets

Sample

Data come from surveys conducted in Mexico and the US using the same face-to-face interview, the World Mental Health version of the Composite International Diagnostic Instrument (WMH-CIDI; Kessler an Ustun, 2004). The Mexican National Comorbidity Survey (MNCS; Medina-Mora et al., 2005), is based on a stratified, multistage area probability sample of household residents in Mexico aged 18–65 years, who lived in communities of at least 2500 people. 5782 respondents were interviewed between

Results

Demographic information on the 2268 respondents who were assessed for eating disorders is presented in Table 1 by the six migrant groups (n = 600, 564, 70, 524, 254, and 256, respectively). There are significant sex differences across these groups (p = 0.0019), with males being overrepresented (79.2%) in Group 3, return migrants, compared to other groups. We further observe significant differences by age cohort (p < 0.001), with younger respondents overrepresented in Group 5, the US-born with

Discussion

Cultural differences in eating habits and body image ideals have been hypothesized to affect risk for eating disorders, with greater emphasis on control of eating and value of thinness hypothesized to lead to higher prevalence of eating disorders in Western countries (Becker et al., 2002, Becker et al., 2011, Becker et al., 2003, Lynch et al., 2007, Mousa et al., 2009, Toro et al., 2006). This hypothesis has received support from studies of exposure to Western popular media in Fiji (Becker

Funding

Research reported in the article was funded by the US National Institutes of Health (NIH). NIMH R01 MH082023 (PI Breslau).

Author disclosure

Ms. Swanson, Ms. Saito, and Drs. Borges, Benjet, Aguilar-Gaxiola, Medina-Mora, and Breslau report no competing interests.

Acknowledgments

The authors wish to acknowledge Daniel Tancredi for his comments on this manuscript.

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    This paper was presented at the 17th annual Eating Disorder Research Society (EDRS) meeting in Edinburgh, Scotland in September, 2011.

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