Jan. 15, 2001 -- This is how Eve Vance spent much of her high school years: binging and purging during the day, and locked in a closet at night so she couldn't get to the refrigerator.
Her mother, a first generation Chinese-American, locked her up because she thought her daughter's extra five to 10 pounds was a bad reflection on the family, says Vance, now 32 and a business analyst in Miami.
"Being Chinese, the thinking is you can be smarter, you can be better, you can be thinner. There's very, very high standards. In every aspect, I had to be perfect," she says.
The pressure got so intense that Vance entered the private, painful world of eating disorders. Throughout high school and college, she binged and purged, taking up to 30 laxatives a day and shrinking her 5'9" frame to under 100 pounds.
Anorexia and bulimia traditionally have been thought to affect only American-born white women and girls. But other racial and ethnic groups are suffering from the eating disorders in what psychologists say is often a desperate attempt to fit into white middle-class society.
Just how many minorities suffer from eating disorders is not known. For many years, women of color were not thought to be prone to the disorder and therefore were not targeted in studies, says Jonelle C. Rowe, MD, a senior advisor on adolescent health in the Office on Women's Health of the U.S. Public Health Service. The office now is trying to raise awareness that ethnic girls also are susceptible by sending information packets on the issue to middle schools.
Indeed, counselors at the Renfrew Center, an eating disorder clinic with facilities in the Northeast and Florida, report an increase in the number of Asian, Latino, and African-American women seeking treatment. Overall, women make up more than 90% of those with eating disorders.
As minority women become more mainstreamed into American society, they become more susceptible to eating disorders, says Gayle Brooks, PhD, a psychologist and clinical director of the Renfrew Center in Florida.
"Some of the pressures that white women experience, women of color feel tenfold -- feeling their bodies are not acceptable, attempting to become part of a culture that is very different, and where the message is that to be beautiful is to be blond, white, and thin," Brooks tells WebMD.
Even though African-American and Latino women tend to be heavier than their white counterparts, according to studies they generally have better body self-images and may be less likely to have eating disorders. For example, in one published in March 1995 in the International Journal of Eating Disorders, researchers from Virginia's Old Dominion University reported that black women might be less prone to eating disorders than white women at least in part because they felt less social pressure to be thin. That finding was reinforced by the fact that black men surveyed in the study felt they would be less likely to be ridiculed than did white men if they dated a woman who was larger than the ideal.
Another study published by University of Maryland researchers in the July 1993 issue of the same journal found that adapting to "mainstream culture" (with its likely increase in social pressure) was correlated with an increased likelihood of eating disorders among black women college students.
Similarly, plumpness traditionally has been accepted in Asian cultures as a sign of prestige and affluence. But that, too, is changing.
Latino and African-American women are catching up with their white counterparts when it comes to certain types of eating disorders, particularly binge eating and the use of laxatives, psychologists say. And once unheard of in Asian countries, eating disorders are spreading rapidly throughout Japan, South Korea, and parts of China.
"Right now, there is such an obsession with thinness, yet they have not been educated about the dangers. It's so trendy. Everyone is just dieting and purging, "says Hue-Sun Ahn, PhD, a psychologist and outreach coordinator at Princeton University Counseling Center.
The percentage of people suffering from eating disorders in South Korea is the about the same as in the U.S., Ahn says, yet "they didn't even have a word for eating disorders until two years ago."
Ahn and other specialists say that just like white teenagers, young minority girls aspire to be like the skinny models and actresses they see in the media. A Harvard Medical School study done on the South Pacific island of Fiji found that three years after television was introduced, teenage girls started to show symptoms of eating disorders for the first time.
"Prior to then, no one knew what a diet was, and in 1998, 69% had been on a diet," says Anne Becker, MD, author of the Fiji study and director of research at the Harvard Eating Disorders Center. She presented the findings in May 1999 at the American Psychiatric Association's annual meeting. "Eighty-three percent said TV influenced the way they felt about their bodies. They wanted to be thin. They wanted to look like Heather Locklear."
"For 2,000 years, people were encouraged to be filled out and robust, and in three years, teenagers did an about face and developed this pathology," Becker says.
Some high schools and youth groups have started support groups for first-generation American students and other immigrants who are concerned about their body image. In Karen Hough's group at George Washington Middle School in Alexandria, Va., last year, the Spanish-speaking students worried they wouldn't fit in because they were overweight.
"They would make comments about how they hated how they looked, that they didn't look like the American girls," says Hough, an English-as-a-second-language counselor. "One of the hardest things to teach the girls is that the way they look is normal in their country. Just because it's not normal in America doesn't mean it's wrong."
Some parents, especially those from poor countries where food is scarce, see self-starvation as a personal rejection of their cultures. "When the girls don't want to eat, they push food on them," Rowe says.
In other cases, upwardly mobile African-American families may put pressure on their children to be thinner, says Brooks. "They can't protect them from racism, but they can protect them from being ostracized for being fat," she says.
Brooks and other experts say minority girls often feel a distinct kind of pressure to conform to American beauty standards because they look different from the majority of the population.
Asian-American women often feel compelled to fit into the stereotype of them as submissive geisha girls, exotic beauties, or delicate China dolls, says Ahn. Complicating matters are strong family bonds that require daughters to "look a certain way ... otherwise, you're shaming the whole family."
That was Vance's problem. Her grandmother, who came from China, was repulsed by overweight people, a prejudice that she passed on to her daughter, Vance's mother. "In my family, you really can't be too thin," Vance says.
Being tall made it even harder, since she didn't fit the Chinese stereotype of being "five feet tall and weighing 90 pounds. People are quick to comment on my appearance, whether it's I'm tall, or thin, or overweight," she says.
After her mother locked her in the closet, she began binging and purging to lose weight. At times, she took so many laxatives, she could hardly walk from the stomach pains. She told no one of her secret, certainly not her mother or later her boyfriend at college. At Stetson University in DeLand, Fla., eating disorders were so prevalent, they seemed almost normal. "Everybody was bulimic and anorexic," she says.
Vance's weight fluctuated wildly between about 100 and 200 pounds. Eight years ago, she was hospitalized after passing out at work from intensive dieting. For the preceding two months, she had eaten less than 400 calories a day and lost 50 pounds.
Over the years, she developed numerous physical ailments. She lost her gallbladder, has brittle bones, suffers from irritable bowel syndrome, and an uncontrollable reflux problem. Though Vance recently completed an intensive 30-day outpatient program at Renfrew, she still struggles with her food compulsions. So does her family, she says. Two days after she checked out of Renfrew, a relative warned her not to gain weight, even though doctors said she was 20 pounds too thin.
Nevertheless, Vance says she is proud of her heritage and remains close to her mother.
"There must be something born in Chinese people that makes them respect their elders," says Vance, who is married and has an adopted 2-year-old daughter from China. "No matter what they've done to me, it's important for me to respect them."