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Contributor: Staff at McCallum Place
For a long time, it was believed that eating disorders were a culture-bound phenomenon of the young, middle-class, Caucasian female demographic.
While research on eating disorders in minority populations remains sparse, and there is some disagreement in the numbers, it is clear that the roots of disordered eating habits no longer solely belong to the aforementioned population.
Some studies indicate that in Asian American populations, the prevalence of eating disorder symptomatology is actually equal to or higher than that of other ethnic groups . Furthermore, a recent study stated that the number of eating disorders reported among female college students in China is now comparable to their Western counterparts .
In addition, a particularly interesting study found that in comparison to white women, Asian women exhibited higher levels of disordered eating behavior such as excessive weight and dieting concerns, restrictive eating, and body dissatisfaction, as well as a smaller ideal body and reported weight .
Many blame this epidemic on the rising influence of dominant American culture in the global market and the perpetuation of its values and preferred physical aesthetic. However, it is newly apparent that in addition to Western ideals of thinness, Asian American women are equally affected by aspects of their own culture, and there are a number of factors that appear to facilitate the development of eating disorder symptomatology.
A recent qualitative research study by Javier & Belgrave (2018) utilized grounded theory research with focus groups comprised of 26 Asian American women in order to understand and categorize these factors. Thus, the Asian American Body Image Evolutionary Model (AABIEM) was formed, focusing on the influence of societal, interpersonal, and intrapersonal factors .
Society at Large
Many studies have examined the impact of culture on the development of eating disorder symptoms. While much research has been completed on the impact of the American “thin ideal,” for Asian American women, it appears that the true complications arise in the space between cultures, in the clash of ideals that exist between identities.
The internal conflict that arises in this gap can be classified as acculturation stress. This term explains the rise of disordered eating that is a maladaptive means of coping in response to one’s rapidly changing cultural identity and when subject to conflicting standards of beauty.
For example, it is often valued in U.S. society to be thin, tan, and athletic, which may contrast with more traditional Asian ideals and expectations that are often contradictory in their own right (e.g., appear to be small and skinny, but eat copiously).
This is all in addition to American stereotypes that often expect Asian women to be “exotic,” rounding out the trifecta of impossible standards. The resulting stress is specifically thought to encourage bulimic, bingeing-and-purging-type symptoms that give its victims some semblance of control in a chaotic, ever-changing world.
The second factor identified in the AABIEM describes the interpersonal influence of family and close others. As a collectivist culture, there is a great deal more focus on the family as a unit and on the role of elders, in addition to a certain reverence given to the nonimmediate, extended family.
Also present within this culture is a specific ease or boldness to freely discuss someone’s weight or appearance, often upon greeting, and not always in a positive light. Whether it is encouraging one’s daughter to “eat more!” immediately following a statement about them putting on weight, or making direct comparisons to others, research discovered that, often, older Asian generations perpetuate specific norms of dysfunction in gossiping about others in the family regarding their appearance or eating behaviors.
Along these lines of generational differences in maintaining eating disorder symptomatology is the Confucian idea that one must avoid bringing shame upon themselves or upon the family at all costs. Traditional values of first-generation immigrants such as these often find themselves at odds with younger generations seeking more body-positive messages of their peers. Left unbalanced, these messages and internalized shame usually serve to increase mental health concerns and other methods of maladaptive coping.
When considering the cultural stigmatization of mental illness in many Asian cultures, and what appears to be cultural mandates to dismiss, deny, or neglect problematic symptoms, it is not hard to imagine many Asian women’s fears in seeking support from their family. Despite the likelihood of positive treatment outcomes, some estimates claim that Asian Americans are three times less likely to seek treatment than their white counterparts, and the pressure to adhere to family morals continues to be one of the largest barriers to treatment-seeking behaviors from this population .
The final factor indicated in the AABIEM describes the extent to which one internalizes the messages of both society at large and opinionated others in their life. Associated with an increase in symptomatology is the endorsement of these ideas as the foundation of one’s own value system or view of themselves.
Allowing these messages to persist often leads to the development of anxiety, poor self-esteem, a feeling of a lack of control, or helplessness about other aspects of one’s minority status that they can do little about (e.g., skin tone, facial features).
The number one thing that counteracts these cultural messages is body positivity or positive peer support. When individuals are able to successfully counteract the influence of these messages along with negative perceptions of body image, they are more likely to avoid disordered eating behaviors.
Body-positive movements in American culture have shown to be especially helpful in this goal, as is cultural inclusion and societal progress toward evaluating a greater variety of body types as attractive.
 Cummins, L. H., & Lehman, J. (2007). Eating Disorders and Body Image Concerns in Asian American Women: Assessment and Treatment from a Multicultural and Feminist Perspective. Eating Disorders, 15(3), 217-230. doi:10.1080/10640260701323474
 Tong, J., Miao, S., Wang, J., Yang, F., Lai, H., Zhang, C., . . . Hsu, L. K. (2013). A two-stage epidemiologic study on prevalence of eating disorders in female university students in Wuhan, China. Social Psychiatry and Psychiatric Epidemiology, 49(3), 499-505. doi:10.1007/s00127-013-0694-y
 Wildes, J. E., Emery, R. E., & Simons, A. D. (2001). The roles of ethnicity and culture in the development of eating disturbance and body dissatisfaction: A meta-analytic review. Clinical Psychology Review, 21, 521–551. http://dx.doi.org/10.1016/S0272-7358(99)00071-9
 Javier, S. J., & Belgrave, F. Z. (2018, December 27). “I’m Not White, I Have to Be Pretty and
Skinny”: A Qualitative Exploration of Body Image and Eating Disorders Among Asian American
Women. Asian American Journal of Psychology. Advance online publication.
Nicdao, E. G., Hong, S., & Takeuchi, D. T. (2007). Prevalence and correlates of eating disorders among Asian Americans: Results from the national Latino and Asian American study. International Journal of Eating Disorders, 40(S3). doi:10.1002/eat.20450
About The Sponsor
McCallum Place is an eating disorder treatment center with locations in St. Louis, Missouri, and Kansas City, Kansas. We provide comprehensive treatment for adolescents and adults. We also offer a specialty treatment program for athletes who are living with eating disorders. Our experienced treatment team works closely with each patient to ensure that they play a central role in their recovery process. We offer a full range of services to meet the unique needs of each patient and address all issues related to the treatment of eating disorders.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on April 8, 2019.
Reviewed & Approved on April 8, 2019, by Jacquelyn Ekern, MS, LPC
Published on EatingDisorderHope.com