Cultural Considerations in Eating Disorder Treatment

“Culture” is one of the most complex concepts in the world, a combination of values, beliefs, language, social norms, and other considerations that touch on nearly everything a person mentally and physically consumes, how they present themselves, and how they live. 

The culture one grows up in or identifies with often has a deep impact on perceptions, attitudes, and even subconscious desires. And frequently, this includes ideas about diet, food, and beauty.

It’s no surprise, then, that culture is often intertwined with body image and can act as a contributing factor toward disordered thoughts and behaviors. That’s why cultural considerations should be a crucial aspect of eating disorder treatment and recovery.

Culture and Body Image

Body image is generally understood as a combination of an individual’s thoughts, feelings, and perceptions about their own body and overall physical appearance. It can be negative, positive, or neutral, but, in any case, culture has been found to have a powerful impact on these attitudes.¹

Everything—from the level of satisfaction or dissatisfaction someone has about their physical appearance to the amount of time they spend thinking about their body—has been tied to cultural influence.¹ These ideas interplay with the idea of beauty as a social construct—or, something that is influenced by societal norms and upheld, to some extent, by various social institutions.¹

In other words, people are regularly presented with ideas of “ideal beauty,” which vary from culture to culture. These images may come through social media, television shows, advertisements, movies, and many other forms of media. As one takes in these images, it’s natural to internalize the messages and beauty standards they present.

It can be challenging, if not impossible, to distinguish between the concepts of cultural norms, body image, and beauty standards. But it is possible to find pockets within certain cultures that emphasize body positivity and other ideas that help work against the negative impact cultural beauty standards can have on mental health.¹

Culture and Eating Disorders

While cultural norms work toward shaping body image, they can also have a significant impact on the development of eating disorders. Studies have shown that the Westernized ideal of thinness can indirectly encourage eating disorders in different cultural groups.²

Other examinations on the topic found that assimilation to Western culture—and Westernized beauty ideals—also frequently led to body dissatisfaction. This trait has been closely tied to the development of disordered thoughts and behaviors around food, eating, and body image.³

Older studies tracking the global rise of anorexia nervosa (AN) and bulimia nervosa (BN) surmised that this trend was, in part, due to the exportation of Western culture and ideals.⁴ These studies may not reflect the most recent understanding of cultural influence on eating disorder behaviors, however.

Indeed, much of the previous research on eating disorders has been conducted on white Westernized women, which several studies have warned could lead to cultural blind spots in ongoing research. These kinds of oversights are another reason why cultural considerations must be taken into account when treating eating disorders.

Identity, Body Image, and Eating Disorders

Aside from the culture in which someone is raised or with which they closely identify, someone’s sense of identity is also closely connected to the formation of body image.

How individuals perceive their bodies is often intimately shaped by their gender identity, whether they are cisgender, transgender, non-binary, or any other type of gender. And how they identify through the groups they choose to participate in can also play a role in shaping body image.⁵

LGBTQIA+ Individuals

Research has shown that gender identity and sexual orientation play a role in many aspects of body image, and certain categories of sexuality and gender are linked to higher rates of disordered eating and eating disorders. 

One study found anorexia nervosa, bulimia nervosa, and binge eating disorder (BED) to occur at exceptionally high rates among transgender men and women, when compared to cisgender peers.⁵

Another showed that people of specific sexual orientations were more likely to physically compare themselves to others and experience body dissatisfaction, with researchers suggesting that different cultural standards among the LGBTQIA+ community may play a role.⁶

Athletes

Athletes also face significant pressure to maintain a specific body type or weight for optimal performance, whether it’s an emphasis on a slimmer body, a more muscular body, or a particular body shape that’s revered in a specific sport.

A constant focus on physical health, exercise, and diet can also play a role in developing an eating disorder or making an eating disorder worse. In fact, athletes tend to have higher rates of disordered eating behaviors when compared to other populations, with one study finding that up to 8% of male-identifying athletes and 33% of female-identifying athletes screened positive for disordered eating behaviors. These rates were also deemed higher than those in non-athletes.⁷

Once again, recognizing the impact of these particular issues and the different ways they may influence different groups is critical in developing more inclusive and effective treatments for eating disorders. 

Cultural Considerations for Eating Disorder Treatment

Each individual has unique cultural and identity-related factors influencing their experiences and perspectives. By considering these factors, treatment providers can create more effective and culturally sensitive treatment plans that cater to each patient’s needs. 

Cultural Beliefs and Practices Related to Food

Food plays a significant role in many cultures, and certain foods may hold specific symbolic or spiritual meanings. Treatment providers must understand these cultural beliefs and practices, as they can impact personal views and interactions with food. 

For example, if a patient is a practicing Muslim, treatment providers should take care to consider religious observances like fasting during Ramadan or incorporating halal foods into meal plans. If a patient is from a culture that tends to eat large meals late at night, that should also be considered when building a recovery meal plan. 

Understanding these cultural nuances can help treatment providers create meal plans and nutritional guidelines that are not only more culturally appropriate but more likely to resonate with each patient’s unique lifestyle and needs.

Family Dynamics and Support Systems

Cultural norms and expectations can also influence family dynamics and social support systems. These concepts are also central to an individual’s eating disorder recovery.

Some cultures are much more communal than others. There is generally more support for a person, not just from immediate family members, but also from cousins, neighbors, and other community members. This can create a more supportive environment in which to go through the ups and downs of recovery. 

On the other hand, seeking help for mental health is heavily stigmatized in some cultures. Some may not even openly recognize the significance or existence of eating disorders. This can create a difficult barrier to treatment, leading someone to continue struggling in silence.

Taking the time to understand each patient’s family dynamics and support systems is a crucial aspect of holistic health and key to ensuring long-term recovery. Involving family members in the treatment process can also be an important part of treatment.

Creating Culturally Sensitive Treatment Plans

A treatment plan for an eating disorder should be as individual as the person receiving it, and the beliefs and experiences of various cultural groups should be a major consideration when developing these roadmaps to healing.

Treatment providers should strive to understand how cultural identity, cultural attitudes, and body image impact each patient’s relationship with food and their own body, and adjust treatment plans accordingly.

Providers should also look out for potential blind spots in the research, including the different ways certain eating disorders or disordered eating attitudes may manifest in different cultures.

It’s important to understand that anyone can develop eating disorders. But by incorporating these considerations into treatment plans, care providers can create more inclusive and practical strategies tailored to best serve each patient’s unique needs.