IDEAS home Printed from
   My bibliography  Save this paper

Caught in the Bulimic Trap? Socioeconomic Status, State Dependence, and Unobserved Heterogeneity


  • Michelle S. Goeree
  • John C. Ham
  • and Daniela Iorio


Eating disorders are an important and growing health concern, and bulimia nervosa (BN) ac- counts for the largest fraction of eating disorders. Health consequences of BN are substantial and especially serious given the increasingly compulsive nature of the disorder. However, remarkably little is known about the mechanisms underlying the persistent nature of BN and the socioeconomic groups that are most likely to be at risk. Using a unique panel data set on young women and instrumental variable techniques, we document that unobserved heterogeneity plays a role in the persistence of BN, but strikingly up to two thirds is due to true state dependence. Our results, together with support from the medical literature, provide strong evidence that bulimia should be considered an addiction. We also fi…nd that African Americans are more likely to exhibit and persist in bulimic behavior than Whites; as are girls from low income families compared to middle and high income families. These results stand in stark contrast to the popular conceptions of who is most likely to experience BN, and we argue that this is due to differences in the diagnosis across racial and income classes. Our …findings have important implications for public policy since they i) provide direction to policy makers regarding which adolescent females are most at risk for BN, and ii) suggest that the timing of the policy is crucial: preventive educational programs should be coupled with more intense (rehabilitation) treatment at the early stages of bingeing and purging behaviors. Our results are robust to different model speci…cations and identifying assumptions.

Suggested Citation

  • Michelle S. Goeree & John C. Ham & and Daniela Iorio, 2009. "Caught in the Bulimic Trap? Socioeconomic Status, State Dependence, and Unobserved Heterogeneity," Working Papers 386, Barcelona Graduate School of Economics.
  • Handle: RePEc:bge:wpaper:386

    Download full text from publisher

    File URL:
    Download Restriction: no

    References listed on IDEAS

    1. Timothy J. Richards & Paul M. Patterson & Abebayehu Tegene, 2007. "Obesity And Nutrient Consumption: A Rational Addiction?," Contemporary Economic Policy, Western Economic Association International, vol. 25(3), pages 309-324, July.
    2. Andrew M. Jones & José M. Labeaga, 2003. "Individual heterogeneity and censoring in panel data estimates of tobacco expenditure," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 18(2), pages 157-177.
    3. Michelle S. Goeree & John C. Ham & Daniela Iorio, 2009. "Caught in the bulimic trap? Persistence and state dependence of bulimia among young women," IEW - Working Papers 447, Institute for Empirical Research in Economics - University of Zurich, revised Jul 2012.
    4. Rashad, Inas, 2006. "Structural estimation of caloric intake, exercise, smoking, and obesity," The Quarterly Review of Economics and Finance, Elsevier, vol. 46(2), pages 268-283, May.
    5. Donna B. Gilleskie & Koleman S. Strumpf, 2005. "The Behavioral Dynamics of Youth Smoking," Journal of Human Resources, University of Wisconsin Press, vol. 40(4), pages 822-866.
    6. John C. Ham & Daniela Iorio & Michelle Sovinsky, 2013. "Caught in the Bulimic Trap?," Journal of Human Resources, University of Wisconsin Press, vol. 48(3), pages 736-767.
    Full references (including those not matched with items on IDEAS)

    More about this item


    Bulimia Nervosa; Demographics; State Dependence; Instrumental Variables; and Dynamic Panel Data Estimation; addiction;

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health


    Access and download statistics


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:bge:wpaper:386. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Bruno Guallar). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.