Eating disorders: The cultural dimension

Abstract

"As periods of cultural change inevitably carry with them a greater degree of heterogeneity, in the history of any culture or subculture, periods will be found in which adequate social forms for expression of strain or tension will be lacking and the individual will be forced back upon his own body for symbolic expression."Margaret Mead 1947 Summary. The role of socio-cultural factors in the pathogenesis of eating disorders, anorexia nervosa and bulimia has been the object of recent interest. The phenomena, mainly described in the West, were partly attributed to the idealisation of thinness in Western culture. The paper reviews published epidemiological research from non-western countries in the area of eating disorders to elucidate the difference in prevalence, allowing for the lack of clarity in some of the methodology and the absence of operational criteria to define and diagnose the particular syndromes in these studies. The paper also examines research findings of the effect of cultural change on body weight. There is a strong indication that cultural change, i.e. identification with Western norms in relation to body weight, is consistently followed with an increase in weight consciousness and the risk of developing eating disorders.Preoccupation with body weight and the presentation of the eating disorders, anorexia nervosa and bulimia, for medical attention are commonly regarded as phenomena of the past century, the product of our civilisation and increasing affluence (Bruch 1978). The fact that anorexia nervosa has mainly been described in western literature as affecting young girls from upper and middle class backgrounds (Bruch 1973;Crisp et al. 1976;Morgan and Russell 1975) and characterised by a pursuit of thinness, usually ushered in by a shared dieting experience, suggests that socio-cultural factors may be salient determinants.Epidemiological research shows a recent increase in the incidence of anorexia nervosa over the last two decades (Theander 1970;Duddle 1973;Jones et al. 1980;Szmukler 1983). There is also an indication that bulimia, which shares with anorexia nervosa the basic psychopathology of a morbid fear of becoming fat, and manifests itself in binge eating, deliberate vomiting and purging, is probably more prevalent than was originally thought. Vomiting and purging are easily mimicked, and are viewed as a more successful means of keeping weight under control than dieting (Cooper and Fairburn 1982;Halmi et al. 1981;Chiodo 1983).These epidemiological findings were interpreted in the light of recent changes in the concept of female beauty with an increased emphasis on thinness . Dieting and weight control measures have become common preoccupations, evidenced by the number of low calorie diet foods in the market, the proliferation of commercial establishments for losing weight, and the many articles and advertisements on dieting and slimming in women's magazines and the media."Thinness" came to symbolise "the new woman", who is able to combine qualities of self-discipline, control and sexu...

Anorexia nervosa in an Arab culture

“…Anorexia nervosa outside westernized societies is a rare occurrence. Nasser (1988) reviewed the literature on the prevalence of eating disorders and the role of sociocultural factors in their pathogenesis. In the Sudan, anorexia nervosa is considered a rare symptom of hysteria (El-Sarrag, 1968).…”

“…These pressures may not occur in nonwesternized societies, and cross-cultural variations regarding body weight and feminine beauty have been recognized. In Arab culture, thinness has been regarded as socially undesirable, whereas plumpness is regarded as a symbol of fertility and womanhood (Nasser, 1988). Africans have the custom of sending their young girls to fattening houses to make them ready for marriage (El-Sarrag, 1968).…”

Disordered eating related behaviors among Arab schoolgirls in Israel: An epidemiological study

“…Cultural change in non-Western countries involving identification with Western norms of shape and body weight is consistently correlated with an increase in weight consciousness and the risk of developing eating disorders. [3][4][5][6] As a unique multicultural society encompassing various ethnic and religious groups and immigrants from many different countries, Israel is coping with the same issues. In the last three decades, large numbers of Israeli-Jewish adolescents in nonclinical settings have been found to have abnormal eating attitudes and weight concerns 7-9 (Latzer et al Comparative study of eating related attitudes and psychological traits between Israeli Arab and Jewish schoolgirls.…”

“…15 Thus, it is not surprising that low rates of ED have been reported among Arab populations. 3,4,[16][17][18] A few studies examining the prevalence of eating disorders have been conducted in Arab cultures, including two studies that reported cases of BN in Pakistan. 19,20 In another study on female Arab students in London and Cairo Universities, Nasser 18 found that 12% of the participants in the London group met Russell's 21 criteria for BN, whereas none of the Cairo group reported bulimic symptoms.…”

Ethnic differences in BMI, weight concerns, and eating behaviors: Comparison of Native American, White, and Hispanic adolescents

“…She suggested that rapid acculturation to the thin ideal of beauty in the US or disruption of traditional family roles might be involved. Around this same time, Nasser (1988) argued that anorexia and bulimia should be considered "culture-bound" syndromes because they appeared to be linked to "…a recent change in Western values in relation to female shape with more emphasis on thinness…" (p. 574).…”