The Role of Ethnicity and Culture in Body Image and Disordered Eating Among Males

Practice Guideline for the Treatment of Patients with Eating Disorders

Once concentrated among adolescent Caucasian females in high-income Western countries, today, eating disorders (EDs) are truly global. Building upon previous work describing the rise of EDs among cultures in transition, we contextualize the emergence of EDs in Asia by locating this development within the broader discourse about the processes of change that have radically transformed Asian societies over the last three decades. By identifying where EDs are emerging in the region, and by examining their particular expression, our aim is to explicate a fuller story of the relationship between culture and eating disorders. Much of the discussion of EDs in non-Western societies is predicated upon the assumption that an increase in EDs is the by-product of “Westernization”, the term used to describe the process by which increased cultural contact with the West results in the transmission of so-called ‘Western’ ideas and cultural norms to a non-Western culture. While the Westernization literature represents a historical anchor in our understanding of EDs in Asia, we propose that this analysis is incomplete in that societal change in the form of industrialization and urbanization occurring independently from, or in tandem with, “Western” influence are critical factors contributing to the rise of EDs in Asia. Further, our review of eating disorders in Asia suggests that an understanding of the diversity and distinctiveness of the individual countries and cultures that comprise ‘Asia’ is crucial to understanding the emergence and rise of EDs across this vast region, suggesting that eating disorders are not culture-bound or culture-specific, but rather culture-reactive. Taking into account both the historical influence of Western culture and the more contemporary effects of Asian industrialization and urbanization, key distinctions among respective Asian cultures expands our understanding of the development and expression of EDs globally.

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The rise of eating disorders in Asia: a review

This manuscript reviews the literature involved with the Eating Attitudes Test (EAT), first developed in the late 1970s as a self-report, indicative of the symptoms of eating disorders. The EAT has good psychometric properties of reliability and validity, and reasonable sensitivity and specificity for the eating disorders, but very low positive predictive value because eating disorders are relatively uncommon. In addition they exist on a continuum, because of denial and social desirability, the results of a self-report instrument may be affected. A very large literature has documented the use of the EAT in a variety of cultures. It is used to screen eating disturbances in general as the first part of a two-part diagnostic screen, as an ability to compare across groups and to measure change between groups and over time.

The eating attitudes test: twenty-five years later.

Objective
The current study was designed to examine the relationships among the variables of body mass index (BMI), interpersonal teasing, media internalization, body dissatisfaction, and drive for thinness in samples of young adult and middle school females from India.

Method
Ninety-six adolescent and 93 adult females from Bombay, India, completed measures of body dissatisfaction, restriction, teasing history, and internalization of media images. Correlational and path analytic procedures were used to examine the data.

Results
Path analyses indicated that teasing and internalization mediated the effect of BMI on body dissatisfaction and in certain cases influenced drive for thinness.

Discussion
These findings replicate and extend previous work with U.S., Australian, and Swedish samples, suggesting that there are similar potential risk factors, cross-culturally, that may explain the development of eating and shape-related problems. © 2004 by Wiley Periodicals, Inc. Int J Eat Disord 35: 198–203, 2004.

Body image and eating disturbance in India: media and interpersonal influences.

In a study of eating disorders, 297 Australian and 249 Indian university students completed the Eating Attitudes Test (EAT-26; Garner, Olmsted, Bohr, & Garfinkel, 1982) and the Goldfarb Fear of Fat Scale (GFFS; Goldfarb, Dykens, & Gerrard, 1985). Contrary to predictions, the Indian participants scored significantly higher than the Australian participants on both measures. The Indian women scored significantly higher than the Australian women on the EAT-26 but not on the GFFS. The Australian men showed significantly fewer symptoms than all other groups. The Indian men did not differ from the Australian or Indian women on either the EAT-26 or GFFS. The urban Indians did not differ from their rural counterparts on the GFFS, but the rural Indians had significantly higher EAT-26 scores than the urban Indians.

John P. Sjostedt

Papers

Eating disorders among Indian and Australian university students.