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Cited by 40Eating Disorders and BehaviorsObesity, Physical Activity, DietNutrition, Health and Food Behavior

Cumulative exposure to state-level structural sexism and risk of disordered eating: Results from a 20-year prospective cohort study

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Beccia, Ariel L., Austin, S. Bryn, Baek, Jonggyu, Agénor, Madina, Forrester, Sarah, Ding, Eric Y., Jesdale, William M., Lapane, Kate L.·2022·Social Science & Medicine
DOI 10.1016/j.socscimed.2022.114956PMC PMC9167701
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Abstract

Background Gendered inequities in disordered eating are well-documented, yet few studies have examined their structural drivers. To help fill this gap, we investigated whether cumulative exposure to state-level structural sexism from childhood through young adulthood potentiates differences in disordered eating risk between cisgender girls/women and boys/men.Methods Participants came from the Growing Up Today Study (N = 16,875), a cohort of children aged 9-14 years in 1996 who we followed through 2016. Using a composite index of relevant state policies and social inequalities from the Institute for Women's Policy Research, we categorized states as having high or low levels of structural sexism and summed the number of years participants had lived in a high structural sexism state during the study period to quantify their cumulative exposure. We fit sequential conditional mean models to estimate the effect of cumulative exposure on risk of four outcomes (chronic dieting, purging, binge eating, and overeating), controlling for individual- and state-level confounders via propensity scores. We then tested whether effects differed between girls/women and boys/men by including cumulative-exposure-by-gender-identity interaction terms and calculating the relative excess risk due to interaction (RERI).Results In the full sample, each additional year of living in a high structural sexism state was associated with a 5% increased risk of purging (95% confidence interval (CI): 3%, 7%), an 8% increased risk of binge eating (95% CI: 6%, 10%), and a 9% increased risk of overeating (95% CI: 8%, 11%). Risk increases were larger on average for girls/women than for boys/men, and girls/women who had lived in a high structural sexism state for four or more years had excess risk of chronic dieting (RERI: 0.64, 95% CI: 0.18, 1.10), purging (RERI: 2.64, 95% CI: 1.24, 4.30), and binge eating (RERI: 2.21, 95% CI: 0.93, 3.50).Conclusions Structural sexism may contribute to inequities in disordered eating between cisgender girls/women and boys/men. Future research should include transgender and gender diverse participants, explore intersectional effects, and identify underlying mechanisms to inform policy-oriented interventions.

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  1. Halekoh U, Højsgaard S, Yan J, 2006. The R package geepack for generalized estimating equations. J. Stat. Software 15 (2), 1– 11.
  2. Thompson BW, 1996. A Hunger So Wide and So Deep: A Multiracial View of Women’s Eating Problems. University of Minnesota Press, Minneapolis, MN.

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Authors
Beccia, A. L., Austin, S. B., Baek, J., Agénor, M., Forrester, S., Ding, E. Y., Jesdale, W. M., & Lapane, K. L.
Affiliations
  • University of Massachusetts Chan Medical School (US)
  • Brigham and Women's Hospital (US)
  • Brown University (US)
Corresponding author
Beccia, Ariel L.
ORCID
Venue
Social Science & Medicine
Publisher
Elsevier BV
Published
2022-05
Volume
301
Pages
114956
ISSN
0277-9536 (ISSN-L)
DOI
10.1016/j.socscimed.2022.114956
PMC
PMC9167701
OpenAlex
W4223906773
Cited by
40
References
59
Citations by year
2026: 9 · 2025: 12 · 2024: 10 · 2023: 7 · 2022: 2
FWCI
7.07
Type
journal article
Language
en
Open access
Licence
Locations
  • Social Science & Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
Funders
  • National Heart, Lung, and Blood Institute (U01HL145386)
  • National Institute on Minority Health and Health Disparities (F31MD015203)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
structural sexism, disordered eating, cumulative exposure, state policy, gender inequality, purging, binge eating, overeating, sex differences, Growing Up Today Study, relative excess risk due to interaction, childhood to young adulthood, social determinants of health, gender equity policy, intersectionality, health disparities, eating disorder prevention
MeSH terms
Adult, Feeding and Eating Disorders, Bulimia, Child, Female, Humans, Male, Prospective Studies, Cohort Studies, Young Adult, Sexism

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