This study used focus group methodology to examine South Asian (SA) American women’s conceptualizations of eating disorders (EDs) and body dissatisfaction, and their perspectives regarding cultural influences on these conditions. Using a qualitative descriptive approach, seven focus groups were conducted ( N = 54, mean age = 20.11 years, SD = 2.52). Themes ( n = 15) were organized according to the amended objectification theory framework. Women described experiences of cultural stressors specifically related to living in the United States, and weight stigma from multiple sources, especially older women (e.g., mothers, relatives, and aunties). Participants also experienced pressures to achieve competing body and appearance ideals (“thin” and “healthy”). In addition, they reported pressures to possess light skin, dark black hair, minimal body hair, and marry young, and noted these pressures negatively impacted their body esteem. Findings indicate that a combination of “traditional” and culturally-influenced factors are important to consider when conceptualizing eating pathology and body image in young SA American women.

Objective: Eating disorders (EDs) were once conceptualized as primarily affecting affluent, White women, a misconception that informed research and practice for many years. Abundant evidence now discredits this stereotype, but it is unclear if prevailing "evidence-based" treatments have been evaluated in samples representative of the diversity of individuals affected by EDs. Our goal was to evaluate the reporting, inclusion, and analysis of sociodemographic variables in ED psychotherapeutic treatment randomized controlled trials (RCTs) in the US through 2020.Methods: We conducted a systematic review of ED psychotherapeutic treatment RCTs in the US and examined the reporting and inclusion of gender identity, age, race/ethnicity, sexual orientation, and socioeconomic status (SES) of enrolled participants, as well as recruitment methods, power analyses, and discussion of limitations and generalizability.Results: Our search yielded 58 studies meeting inclusion criteria dating back to 1985.Reporting was at times incomplete, absent, or centered on the racial/gender majority group. No studies reported gender diverse participants, and men and people of color were underrepresented generally, with differences noted across diagnoses. A minority of papers considered sociodemographic variables in analyses or acknowledged limitations related to sample characteristics. Some progress was made across the decades, with studies increasingly providing full racial and ethnic data, and more men included over time. Although racial and ethnic diversity improved somewhat, progress appeared to stall in the last decade.Discussion: We summarize findings, consider context and challenges for RCT researchers, and offer suggestions for researchers, journal editors, and reviewers on improving representation, reporting, and analytic practices.Public Significance: Randomized controlled trials of eating disorder psychotherapeutic treatment in the US are increasingly reporting full race/ethnicity data, but information on SES is inconsistent and sexual orientation absent. White women still

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This study used focus group methodology to identify culturally specific barriers to, and facilitators of, eating disorder (ED) treatment-seeking for South Asian (SA) American women. Seven focus groups were conducted with 54 participants (M age = 20.11 years, SD = 2.52), all of whom had lived in the United States (U.S.) for at least 3 years (63.0% of the sample was born in the U.S.). Transcripts were independently coded by a team of researchers (n = 4) and the final codebook included codes present in at least half of the transcripts. Thematic analysis identified salient themes (barriers, n = 6; facilitators, n = 3) for SA American women. Barriers to ED treatment-seeking were inextricable from barriers to mental health treatment, more broadly. In addition to generalized mental health stigma, participants cited social stigma (i.e., a pervasive fear of social ostracization), as a significant treatment-seeking barrier. Additional barriers were as follows: cultural influences on the etiology and treatment of mental illness, parents' unresolved mental health concerns (usually tied to immigration), health care providers' biases, general lack of knowledge about EDs, and minimal SA representation within ED research/clinical care. To address these obstacles, participants recommended that clinicians facilitate intergenerational conversations about mental health and EDs, partner with SA communities to create targeted ED psychoeducational health campaigns, and train providers in culturally sensitive practices for detecting and treating EDs. SA American women face multiple family, community, and institutional barriers to accessing mental health treatment generally, which limits their ability to access ED-specific care. Recommendations to improve ED treatment access include (a) campaigns to destigmatize mental health more systematically, (b) collaboration with SA communities, and (c) training providers in culturally sensitive care. What is the public significance of this article?In this qualitative study, South Asian (SA) American women were asked to discuss their perceptions of barriers to and facilitators of eating disorders (EDs) treatment-seeking for their group. Findings indicate that SA women living in the United States face multiple family, community, and institutional barriers to treatment-seeking for all mental health issues, including EDs, which intersect to perpetuate treatment disparities.