Cultural Aspects of Eating Disorders

Fatness has traditionally been a greater preoccupation in western societies than in third world countries. Women living in third world countries appear much more content, comfortable and accepted with fuller body shapes. In fact the cultural stereotype of attractiveness within these societies includes a fuller figure. Studies have been done observing women from these societies acculturating into areas in which there is a greater preoccupation on thinness and the results appear disheartening. One study by Furnham & Alibhai (1983) observed Kenyan immigrants who resided in Britain for only four years. These women began adopting the British viewpoint desiring a smaller physique unlike their African peers. Another study by Pumariege (1986) looked at Hispanic women acculturating into a Western society finding that they began adopting the more stringent eating attitudes of the prevailing culture within the same time frame as the previous study (Stice, Schupak-Neuberg, Shaw & Stein, 1994; Wiseman, 1992).

These studies suggest that to fit the given cultural stereotype of attractiveness, women may try to overcome their natural tendency toward a fuller figure. It is apparently hard to "just say no" to society. A study by Bulik (1987) suggests that attempting to become a part of a new culture may encourage one to-over-identify with certain aspects of it. He also suggests that eating disorders might appear in different cultures at various times because of enormous changes which could be occurring within that society (Wiseman, Gray, Mosimann & Ahrens, 1992).

Clinicians sometimes fail to diagnose women of color appropriately. This may be due to the fact that eating disorders have been reported much less among African Americans, Asian Americans and American Indians. Incorrect diagnosis' may also come from the widely accepted false belief that eating disorders only affect middle to upper-middle class white adolescent women (. This oversight reflects a cultural bias and unintended yet prevalent bigotry. These unconscious tinges of prejudice can undermine appropriate treatment (Anderson & Holman, 1997; Grange, Telch & Agras, 1997).

Individuals from other cultures should also not be excluded from the possibility of an eating disorder diagnosis. Westernization has affected Japan. In densely populated urban areas it has been found that Anorexia Nervosa affects 1 in 500. The incidence of Bulimia is markedly higher. In a study be Gandi (1991), anorexia has been found within the American Indian and Indian populations. Five new cases were diagnosed out of 2,500 referrals over a four year period. A study by Nasser (1986) looked at Arab students studying in London and in Cairo. It found that while 22% of the London students had impaired eating 12% of the Cairo students also exhibited difficulties with eating. The interesting part of this study pointed out through diagnostic interviews that 12% of the London group met full criteria for bulimia while none of the Cairo students exhibited bulimic symptoms. These results tend to lead one back to the theory of cultural stereotypes and the over-identification which may occur when attempting to acculturate into a new society. No culture appears immune to the possibility of eating disorders. Research seems to point toward more incidences of eating disorders in westernized societies as well as societies experiencing enormous changes (Grange, Telch & Agras, 1997; Wiseman, Gray, Mosimann & Ahrens, 1992).

Middle-aged women as well as children can also develop eating disorders. For the most part the development of these disorders appears linked to the cultural standards. A study by Rodin (1985) states that in women over the age of 62 the second greatest concern for them are changes in their body weight. Another study by Sontag (1972) focuses on the "double standard of aging" and reveals how aging women in Western society consider themselves less attractive or desirable and become fixated on their bodies. The scariest statistics of all are those surrounding 8-13 year old girls. Children as young as 5 have expressed concerns about their body image (Feldman et al., 1988; Terwilliger, 1987). Children have also been found to have negative attitudes regarding obese individuals (Harris & Smith, 1982; Strauss, Smith, Frame & Forehand, 1985), dislike an obese body build (Kirkpatrick & Sanders, 1978; Lerner & Gellert, 1969; Stager & Burke, 1982), express a fear of becoming obese (Feldman et al., 1988; Stein, 1986; Terwilliger, 1987), and do not like to play with fat children (Strauss et al., 1985).

A real tragedy and some of the scariest statistics of all are those surrounding 8-10 year old girls and boys and are presented in a study by Shapiro, Newcomb & Leob (1997). Their research indicates these children at this young age have internalized a sociocultural value regarding thinness on a personal level. Boys as well as girls reported very similar perceived social pressures. The study goes on to state that these children have demonstrated an ability to reduce their anxiety about becoming fat by implementing early weight control behaviors. From this study 10% to 29% of boys and 13% to 41% of girls reported using dieting, diet foods or exercise to lose weight. One concern cited involved the possibility of using more extreme measures, such as vomiting or using medication if the earlier methods fail or the pressure to be thin intensifies.

In a study by Davies & Rurnham (1986) conducted with 11-13 year old girls, one half of the girls wanted to lose weight and were concerned about their stomachs and thighs. Of these girls only 4% were actually overweight but 45% considered themselves as fat and wanted to be thinner and 37% had already tried dieting. At this tender age girls apparently have equated success and popularity with thinness, potentially planting the seeds for the development of an eating disorder.

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