Another major finding of this study is that socio-cultural differences were related to anorexia nervosa. The soundness of the resarch design allowed the authors to gather comprehensive case-findings regarding anorexia incidences. Among the mixed-race population, the anorexia rate was at 9.1 per 100,000. However, it is significant to note that there were no cases of anorexia found among the black population, who constituted the largest racial group in Curacao.

Contrary to the hypothesis, however, Hoek et al. (2005) found no evidence that socioeconomic transition caused the emergence of anorexia nervosa in Curacao. After all, if there was a positive correlation, then the fact that Curacao is a "high income" country would raise its anorexia rate to a level comparable to the United States and the Netherlands. The two latter countries have similar anorexia rates, while Curacao's is much lower.

The authors present three possible explanations for this lack of a positive correlation. First, they consider that economic transition has been fairly recent, and that the effects of affluence will not be felt for a few more years. Their other explanation is that economic affluence is unevenly spread across Curacao society, with the benefits limited only to an elite. Curacao, state the authors, still has a high level of unemployment and a lack of social services.

While both explanations have merit, they do not fully-explain the lower anorexia nervosa rate in Curacao. After all, anorexia nervosa rates did not grow gradually in the United States as the country gained affluence after the war. In fact, the incidences seemed to suddenly spike in the 1980s. Furthermore, uneven affluence, on the other hand, is a characteristic that exists in many Western nations, including...

There is a telling absence of anorexia among the black population, hinting at different cultural interpretations regarding beauty, size and what is considered healthy and attractive. Being heavier or even overweight is more socially-acceptable among the African-Cuban population. These norms remained resilient among the population, in contrast to the emphasis on thinness in American and Dutch media. These local norms therefore may help "protect" young Curacao women from developing anorexia nervosa.
Implications of the study

The findings of the Hoek et al. (2005) study show the importance of looking beyond physiological explanations to address the diagnosis and treatment of a disease. While there are clear biological bases for eating disorders such as anorexia nervosa, the differences in incidence rates between societies and more importantly, within societies, should also be taking into consideration. This research shows, for example, significant differences between anorexia among the white and mixed-race population and the African-Cuban population. While more research is needed to study the effects of other possible variables such as education and income, these findings hint on the importance of emphasizing positive cultural norms.

The replication of this study in the United States and other Western countries also shed light on whether anorexia nervosa presents unevenly across socio-cultural groups. This research therefore has the potential to contribute to a more comprehensive understanding of anorexia nervosa.