Where Do Concerns About Shape and Weight Come From?

Clients with anorexia nervosa and bulimia nervosa are known to have a range of abnormal attitudes and behaviors related to their weight and shape. Where do these concerns begin, and is there a clear pathway from concern to abnormal behavior to development of the disorder? Are weight and shape concerns universal among persons with eating disorders? Drs. Simon G. Gowers and Alison Shore at the University of Liverpool, England, sought to answer some of these questions (Br J Psychiatry 2001; 179:236).

Concerns arise late in childhood

In their review of the literature, the researchers found that weight and shape concerns follow a developmental pathway that arises before the typical age for developing an eating disorder. Such concerns commonly arise late in childhood and develop throughout adolescence. The origins of concern about shape and weight are many, including , family attitudes and beliefs, adverse experiences, and the effects of sociocultural factors. They also suggest that although weight and shape concerns often underlie the development of an eating disorder, an alternative pathway may be impulsivity and fear of loss of control.

To recognize and prevent development of an eating disorder, the authors suggest that clinicians focus on attitudes and concerns that lead to dieting behaviors, rather than zeroing in only on dieting.