Predictors of bulimia among young women were studied based on symbolic interaction theory. Womens' feelings about being overweight were explored and an explanatory model developed which represented hypotheses among six dimensions: adolescent and current overweight body image, self-esteem, social support, depression, and bulimia. One thousand registered nurses and nursing students from four states were surveyed using the Total Design Method (Dillman, 1978). Complete cross-sectional data were provided by 782 nurses.

Structural equation modeling, using LISREL VI, was used to test the theoretic measurement model, first as six submodels and then combined in a stepwise fashion. The final confirmatory factor analysis model demonstrated strong fit statistics (adjusted goodness-of-fit index (AGFI) =.972). Subsequent tests of the structural model demonstrated a good fit of the model to the observed data (AGFI =.972); 79 percent of the variance in the levels of bulimia was explained.

Qualitative analyses of responses tapping the meaning women attribute to being overweight revealed overwhelmingly negative responses, including unattractiveness of body image, attenuated self-esteem, feelings of depression, and negative responses from others. However, these women generally had moderate to high levels of self-esteem, were happy, and felt supported by family and close friends. A subgroup of nurses reporting significantly higher levels of bulimic behaviors, when compared to the typical women in the study, viewed themselves as fatter, more unhappy, less effective, and less supported by significant others.

As predicted, adolescent overweight body image directly influenced current overweight body image, and both dimensions directly influenced the degree of bulimia. Adolescent overweight body image also negatively influenced both self-esteem and social support, while self-esteem negatively influenced depression and bulimia. Unexpectedly, social support did not directly effect depression among these women. While depression and bulimia covaried in tests of the hypothesized model, a rival model wherein depression influenced bulimia directly was also confirmed.

Overall, the study confirmed that how women perceive their body image influences their self-esteem and feelings of depression, how they interact with and are supported by others, and how they attempt to control their weight and eating behaviors. Accordingly, both research and clinical implications were explored.