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Published in final edited form as:

Am J Health Behav. 2021 November 15; 45(6): 1050–1058. doi:10.5993/AJHB.45.6.9.

Individual and Family Factors in Disordered Eating Patterns of

Mexican-American Women
Becky Marquez, PhD, MPH,
Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA,
United States.

Tanya Benitez, PhD, MSW

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School of Public Health, Brown University, Providence, RI, United States.

Abstract
Objective: In this study, we examined the contribution of individual- (acculturation, body
mass index, and body size satisfaction) and family- (maternal weight-related messages and
disordered eating patterns) level factors in predicting bulimic and dieting behaviors in young
Mexican-American women with overweight or obesity.

Methods: We recruited adult Mexican-American mother-daughter dyads from the community.

We conducted correlational analysis and hierarchical regression.

Results: Daughters who were less satisfied with their body size reported higher symptoms of
bulimic (r = −.34, p < .01) or dieting behavior (r = −.36, p < .01). Daughters who received more
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positive maternal messages on eating and weight had mothers with lower symptoms of bulimic (r
= −.43, p < .01) or dieting behavior (r = −.30, p < .05). Maternal symptoms of bulimic behavior
were the strongest predictor of daughters’ bulimic behavior (ß = .379, p = .007), and body size
satisfaction was the strongest predictor of daughters’ dieting behavior (ß = −.372, p = .008) in
adjusted models.

Conclusion: Mexican-American women who are less satisfied with their body size and have
mothers with elevated symptoms of bulimic behavior are at risk for disordered eating patterns.
Intervening at the individual level on body image and family level on maternal modeling of eating
behavior may help support healthy weight management behaviors.

Keywords
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disordered eating pattern; body size satisfaction; maternal weight-related messages; mother-
daughter dyads; Mexican-Americans

Despite the high prevalence of obesity in Mexican-American women, disordered eating

patterns have been understudied in this group.1 Obesity is associated with binge eating,

Correspondence Dr Marquez; bemarquez@ucsd.edu.

Human Subjects Approval Statement
All study participants provided written informed consent. The study was approved by the institutional review board by UC San Diego.
Conflict of Interest Disclosure Statement
The authors have no conflict of interest to disclose.
 Marquez and Benitez Page 2

bulimia, and other unhealthy dieting behaviors.2–4 Binge eating involves consumption of
large amounts of food in short periods of time with a sense of loss of control.5 Bulimic
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behaviors include binge eating along with compensatory acts such as self-induced vomiting
to prevent weight gain.5 Dieting refers to intentional restriction of calories for the purpose
of losing weight. Dieting increases the likelihood of bulimic behaviors in young adults.3
There is some evidence suggesting that Latinas experience higher prevalence of eating
disorders such as bulimia but are less likely to seek treatment compared to non-Latino
Whites.6–10 Given the disproportionate health burden of obesity and the scarcity of research
on intervention targets to address related disordered eating patterns in young Mexican-
American women, this study drew on the socio-ecological model, which asserts that
multiple levels of behavioral influence should be considered,11 to examine individual- and
interpersonal-, specifically family-, level factors associated with disordered eating patterns.

Individual-level factors such as acculturation, body mass index (BMI), and body image
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have been linked to disordered eating patterns. Mexican-American women with higher
acculturation are more likely to prefer thinner figures as ideal body size,7 report greater body
or weight dissatisfaction,12–14 attempt weight loss,15 and endorse more severe disordered
eating patterns12 than those with lower acculturation. Acculturation also has been associated
with higher BMI and risk for obesity.16 Body dissatisfaction is shown to predict disordered
eating17 and is associated with increased BMI and obesity.18

Family-level factors associated with disordered eating patterns in women have focused on
family interactions involving weight-related communication. Maternal messages of weight
loss predict body dissatisfaction and disordered eating in adult daughters.19 Specifically,
teasing and negative comments are associated with body dissatisfaction.20 The effect of
comments on body shape from family on daughters’ bulimic symptoms is shown to act
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indirectly through body dissatisfaction such that comments increase body dissatisfaction,
which in turn, elevates bulimic symptoms.20 Among Latinas, both maternal criticism
on appearance and weight as well as body dissatisfaction predict disordered eating.21
Interpersonal factors like family interactions have been suggested to be more salient than
personal factors in predicting disordered eating patterns in Mexican-American women.22

Another family-level factor predictive of disordered eating patterns in women is maternal

modeling of weight control behaviors.23 Adult daughters tend to resemble their mothers in
BMI, body image, and disordered eating symptoms.19,24,25 Whereas maladaptive eating in
mothers is associated with body image dissatisfaction and disordered eating symptoms in
daughters,19,24 research on maternal modeling associated with disordered eating patterns,
specifically in young Mexican-American women, is limited. It is unclear if this relationship
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holds among Mexican-American mothers and daughters given that different level of
acculturation between them may translate into different body image attitudes and eating
behaviors. On the other hand, Mexican-Americans endorse high familism (ie, strong
identification and attachment to family)26 which may facilitate maternal transmission of
weight control attitudes and behaviors. Furthermore, given that onset of disordered eating
patterns related to binge eating and bulimic behaviors generally occurs during emerging and
early adulthood, understanding maternal influences on young adult daughters is warranted.2

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The purpose of this study was to examine the contribution of individual- and family-level
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factors associated with disordered eating patterns in young Mexican-American women

with overweight or obesity. We hypothesize that individual-(daughters’ acculturation, BMI,
and body size satisfaction) and family- (maternal weight-related messages and maternal
symptoms of bulimic and dieting behaviors) level factors are independently associated
with symptoms of bulimic and dieting behaviors in adult daughters. Based on previous
research,22 we also expect that family-level factors will be more predictive of disordered
eating patterns than individual-level factors.

METHODS
Participants
Con MIHA (Communication on Mothers Inspiring Healthy Actions) was a mixed-methods
study examining weight-related communication and behaviors in Mexican-American
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mothers and adult daughters (N=59 dyads) with overweight or obesity. The study provided
formative data for the development of a lifestyle intervention with a focus on improving
family functioning. Women were recruited via local media outlets (newspaper, radio, or
Web-based advertisements), community events such as health fairs or conferences, and
flyers posted at university and community sites. Women were deemed eligible to participate
via a telephone screener if they self-identified as Mexican or Mexican-American, were
18 to 65 years old, had a BMI of 25 to 50 kg/m2, were English or Spanish language
literate, resided in San Diego County, and had a mother or daughter who also met the
same eligibility criteria. After providing written informed consent, participants completed
questionnaires and had their height and weight measured. Participants were compensated
$30 for their time.
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Measures
Demographics.—Dyads provided information on age, education, employment, nativity
status, and country of birth.

Acculturation.—Dyads completed the Brief Acculturation Scale (BAS), which was used
to measure acculturation.27 This 4-item scale assesses language use in different contexts
(α = .94). Items are rated on a 5-point Likert-type scale with responses ranging from only
Spanish to only English. A composite BAS score was calculated by adding responses to each
of the 4 items. Higher BAS score represented higher acculturation.

Body mass index (BMI).—Dyads had their height and weight objectively measured using
standard procedures while participants wore light clothing and no shoes. BMI was calculated
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in kg/m2.

Body size satisfaction.—Daughters answered a single-item question assessing body size

satisfaction, “How satisfied are you with your body size?” an item adapted from previous
studies.28,29 The item was rated on a 5-point Likert-type scale. Responses ranged from not at
all satisfied to extremely satisfied.

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Maternal weight-related messages.—Daughters completed the Parental Eating and

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Weight Messages survey which assesses frequency of comments or verbal messages they
received from their mother while growing up.30 It consists of 2 subscales that measure
maternal negative messages (α = .93; eg, “You need to lose weight” or “If you eat that,
you’ll get fat”) and maternal positive message (α = .78; eg, “Your health is what is
important, not your weight” or “Are you eating well enough, I want to make sure you
are eating properly?”). The survey was previously tested among adolescents and young
adult women and is predictive of elevated eating disturbance and dissatisfaction with current
weight. The 24-item scale is rated on a 5-point Likert-type scale with responses ranging
from never to always.

Disordered eating patterns.—Dyads completed the Eating Attitudes Test (EAT-26)

which assesses eating disorder symptomology.31 Two subscales, “bulimia and food
preoccupation” and “dieting,” were used as they have been associated with bulimia or
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body dissatisfaction. The “bulimia and food preoccupation” scale measures behaviors such
as eating binges and vomiting as well as thoughts and feelings about food (α = .70). The
“dieting” scale measures avoidance of high-calorie foods and desire to be thinner (α = .78).
Items are rated on a 5-point Likert-type scale with responses ranging from never to always.

Data Analysis
We used descriptive statistics to summarize characteristics of participants (N=118). We
conducted paired t-tests to determine differences within dyads (N=56). We used correlation
analysis to identify relationships among study variables.

To determine the relative contribution of individual- (daughters’ acculturation, BMI, and

body size satisfaction) and family- (maternal weight-related communication and disordered
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eating patterns) level factors in predicting disordered eating patterns in daughters, we

conducted a series of hierarchical regression analyses. We tested separate models predicting
scores on “bulimia and food preoccupation” and “dieting.” Variables were included in
hierarchical regression models as follows: Step 1 acculturation, Step 2 acculturation and
BMI, Step 3 acculturation, BMI, and body size satisfaction, Step 4 acculturation, BMI, body
size satisfaction, and maternal negative and positive weight-related messages, and Step 5
acculturation, BMI, body size satisfaction, maternal negative and positive weight-related
messages, and maternal disordered eating patterns.

RESULTS
Participants
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Daughters’ mean age was 25.1 ± 5.9 years with mothers aged 49.8 ± 7.3 years. Most
daughters (84%) and less than half of mothers (47%) had a high school diploma. Almost
half of daughters (47%) and mothers (48%) had full- or part-time employment.

Daughters were predominately born in the United States (64%) whereas mothers were
mostly born in Mexico (89%). More daughters (39%) than mothers (10%) spoke primarily
English at home. BAS scores were higher for daughters (9.2 ± 3.7) than for mothers (3.7 ±
4.3).

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There was no significant difference within dyads in BMI (daughters 33.9 kg/m2 ± 6.7 and
mothers 35.7 kg/m2 ± 7.6). Weight status was also similar. BMI categories for daughters
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indicated 29% with overweight and 71% with obesity; for mothers, these figures were 24%
with overweight and 76% with obesity.

Correlates
Table 1 shows the results of the bivariate correlation analysis of variables. Daughters’
acculturation positively correlated with maternal symptoms of bulimic behavior. Daughters’
body size satisfaction negatively correlated with their own symptoms of bulimic or dieting
behavior. Maternal positive weight-related messages inversely correlated with maternal
symptoms of bulimic or dieting behavior. Daughters’ and mothers’ symptoms of bulimic
behavior correlated with their own symptoms of dieting behavior.
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Hierarchical Regression Models

Table 2 presents the results of the hierarchical regression analyses of variables. In the model
predicting symptoms of bulimic behavior in daughters, R2 improved with each of the 5
steps; however, body size satisfaction made the largest contribution to explained variance
(ΔR2 = .131), followed by maternal symptoms of bulimic behavior (ΔR2 = .111). Body
size satisfaction (ß = −.373, p = .004) and maternal symptoms of bulimic behavior (ß
= .379, p = .007) were predictive of symptoms of bulimic behavior independent of all
other factors. Maternal symptoms of bulimic behavior comprised the strongest predictor of
daughters’ symptoms of bulimic behavior, although ß for body size satisfaction was just
slightly smaller. In the model predicting symptoms of dieting behavior in daughters, R2
improved with each step until Step 4 when maternal weight-related messages were entered.
Body size satisfaction made the largest contribution to explained variance (ΔR2 = .070) and
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was the only predictor of symptoms of dieting behavior (ß = −.372, p = .008) independent of
all other factors.

DISCUSSION
Individual and family-level factors were associated with disordered eating patterns in young
Mexican-American women, supporting our hypothesis. However, only daughters’ body size
satisfaction and mothers’ disordered eating patterns were predictive of daughters’ disordered
eating patterns. Daughters who were less satisfied with their body size and had mothers
with higher symptoms of bulimic behavior reported elevated symptoms of dieting or bulimic
behavior, respectively, independent of other factors. Whereas body size satisfaction emerged
as the strongest predictor of symptoms of dieting behavior, maternal symptoms of bulimic
behavior emerged as the strongest predictor of symptoms of bulimic behavior in daughters.
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Women with higher acculturation had mothers with elevated symptoms of bulimic behavior;
however, acculturation was unrelated to daughters’ own symptoms of bulimic or dieting
behavior. This finding was unexpected but could reflect a limitation of language-based
acculturation measures. Acculturation has been associated previously with disordered eating
patterns12 and preference for thinner figures7 in Mexican-American women. Acculturation
may contribute to eating pathology and body dissatisfaction through greater awareness

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and internalization of white American values of appearance.32 The family environment

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alters this process as familism moderates the relationship between acculturation and body
dissatisfaction in Mexican-American women.33 The few studies available examining eating
disorder symptoms in mother-daughter dyads of Mexican-American background have
focused on children and adolescents. Findings reveal that young daughters who perceived
thinner figures as their ideal body had mothers with higher acculturation,34 suggesting
that maternal acculturation may influence risk for disordered eating in daughters. Hence,
elevated symptoms of bulimic behavior in mothers may be indicative of higher maternal
acculturation in the current study of adult daughters.

Body size satisfaction, but not BMI, was related to symptoms of bulimic or dieting behavior.
Interestingly, BMI was not linked to body size satisfaction. Our sample, which consisted
predominantly of women with obesity, may have had less variability in BMI than studies
that included participants across a broader BMI range. Studies of women with excess weight
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also have reported no relationship between BMI and body dissatisfaction.35 Alternatively,
given the low prevalence of body satisfaction among women with obesity,36 the lack of a
relationship could reflect the idea that additional weight may not further exacerbate already
poor body image held by these women.37 We found that daughters with lower body size
satisfaction had greater symptoms of bulimic and dieting behaviors. This is consistent with
previous studies.36 For example, women who are less satisfied with their weight are more
likely to attempt weight loss through dieting.28 Given the limited research on this topic
among Mexican-American women, future studies should consider examining the role of
maternal body image on daughters’ body image and eating behaviors.

Maternal negative messages were unrelated to daughters’ disordered eating symptoms of

bulimic or dieting behavior. A possible explanation for this finding may be poor construct
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validity due to culture, as weight-related comments may not be perceived by some daughters
as negative, but rather, as expressions of maternal caring (eg, “Have you gained weight?”).
Nonetheless, several prior studies have shown a link between parental comments on
weight during childhood and weight dissatisfaction, extreme weight control practices, and
overweight status in young women.38–40 Negative verbal messages on weight, such as
teasing, criticism, and encouragement of weight loss, may be a means by which mothers
transmit their own weight concerns to daughters.41 For example, mothers who engage in
dieting behaviors are more likely to make comments to daughters regarding their weight42
and this has been associated with poor body image and eating pathology.19 Notably, we
found that daughters who reported receiving more positive messages on eating and weight
while growing up, had mothers with lower symptoms of bulimic and dieting behaviors.
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As expected, symptoms of disordered eating of mothers predicted that behavior among

daughters. Specifically, daughters who had mothers with elevated symptoms of bulimic
behavior were at higher risk for bulimic behavior themselves which further supports the
idea of intergenerational transmission. Eating pathology is often related in mothers and
daughters.19,41 Mother-daughter dyads with bulimia share similar high levels of body
dissatisfaction.24 Mothers in particular shape weight-related behaviors of daughters that
track into adulthood.41 Hence, family modeling is implicated as a major contributor of
eating behavior in young women.43 Unlike symptoms of bulimic behavior, dieting behavior

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in mothers and daughters was unrelated in our study. This could be because of different
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attitudes (eg, desire to be thin vs not overweight) or specific approaches (eg, reduce dietary
calories vs fat) towards dieting between Mexican-American mothers and daughters, which
may be partly due to acculturation differences.44

This study should be considered in light of limitations. The cross-sectional design does
not permit inferences of causality but supports the need for further research using a
longitudinal design. The sample size is relatively small and is comprised of Mexican-
American women, which limits the generalizability of results to other Latina subgroups.
In terms of assessment, EAT-26 measures eating disorder symptoms and is not a clinical
diagnostic of eating disorders. Additionally, measurement was limited to symptoms of
bulimic and dieting behaviors and did not include others such as binge eating. Finally,
unidimensional measurements of acculturation and body size satisfaction were used, which
do not provide comprehensive assessments of related attitudes and behaviors.
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Despite these limitations, the study has several strengths worth highlighting. The sample
consists of Mexican-American women with overweight or obesity, which is an understudied
group in the field of eating disorders. The examination of a community (non-clinical) sample
is also important as it offers greater understanding of disordered eating risks in a group that
is less likely to seek treatment. The dyadic design of data collection directly from mothers
and daughters allowed the investigation of family concordance in eating behavior. The study
also contributes to the literature by focusing on adult children and examining multiple-level
(ie, individual and family) and culturally-relevant (ie, language-based acculturation) factors
associated with disordered eating patterns which have implications for identification of
intervention targets to improve eating behavior.
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Conclusion
Consistent with the socio-ecological perspective, individual- and family-level factors
contribute to disordered eating patterns. Mexican-American women who are less satisfied
with their body size and have mothers with elevated symptoms of bulimic behavior
are at risk themselves for disordered eating patterns. Given that body image and eating
behaviors improve after participation in lifestyle programs based on empirically supported
cognitive and behavioral modification strategies in women with obesity,45,46 greater efforts
to include Mexican-American women in lifestyle interventions are needed. Intergenerational
interventions in particular also should be considered as they may help promote positive
communication and modeling of weight-related behaviors in mothers and daughters with
overweight or obesity.
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Acknowledgements
The study was supported by the following grants: NCI U54CA153511/U54CA132379/U54CA132384 and NHLBI
K01HL130726.

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Table 1

Correlates among Variables

1 2 3 4 5 6 7 8 9
1. Daughter acculturation -
2. Daughter body mass index (BMI) −.107 -
Marquez and Benitez

3. Daughter body size satisfaction −.156 −.159 -

4. Maternal negative weight-related messages −.026 .211 −.190 -
5. Maternal positive weight-related messages −.237 −.238 .111 −.047 -

6. Daughter bulimia symptoms .045 −.138 −.340** .097 .106 -

7. Daughter dieting .097 −.095 −.361** .099 .169 .552** -

8. Maternal bulimia symptoms .281* .036 −.025 −.094 −.431** .233 .103 -

9. Maternal dieting −.019 .086 .154 −.025 −.307* .039 −.064 .575** -

*
p < .05,
**
p < .01

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Table 2

Hierarchical Linear Regression Analyses Predicting Symptoms of Bulimic or Dieting Behavior in Daughters

Bulimic behavior Dieting behavior

B SE β R2 B SE β R2
Step 1 .009 .030
Marquez and Benitez

Acculturation .118 .166 .094 .472 .363 .173

Step 2 .022 .034
Acculturation .097 .168 .077 .447 .369 .164
BMI −.076 .087 −.118 −.092 .193 −.064
Step 3 .153 .166
Acculturation .009 .161 .007 .254 .353 .093
BMI −.120 .083 −.186 −.189 .184 −.133

Body size satisfaction −1.754** .609 −.372** −3.866** 1.335 −.375**

Step 4 .170 .216
Acculturation .052 .169 .042 .430 .362 .157
BMI −.107 .089 −.165 −.117 .193 −.082

Body size satisfaction −1.713** .623 −.363** −3.806** 1.338 −.369**

Maternal negative weight-related messages .023 .042 .070 .048 .092 .067
Maternal positive weight-related messages .093 .105 .120 .388 .226 .229
Step 5 .281 .216
Acculturation −.027 .161 −.021 .429 .366 .157
BMI −.102 .083 −.158 −.119 .196 −.083

Body size satisfaction −1.759** .586 −.373** −3.836** 1.380 −.372**

Am J Health Behav. Author manuscript; available in PMC 2023 March 10.

Maternal negative weight-related messages .035 .040 .108 .048 .093 .067
Maternal positive weight-related messages .211 .107 .273 .395 .238 .234

Maternal bulimic behavior .387** .138 .379** - - -

Maternal dieting behavior - - - .013 .126 .014

**
p < .01
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