<p>Emphasizing the “Cultural” in Sociocultural: A Systematic Review of Research on Thin-Ideal Internalization, Acculturation, and Eating Pathology in US Ethnic Minorities</p>

Abstract

A large body of research suggests that thin-ideal internalization is a robust predictor of eating pathology in women and, to some degree, in men. Recent research is exploring the relationships between thin-ideal internalization and culture-specific factors that may be salient to women and men who live in the US but are marginalized based on racial or ethnic background, such as acculturation. This systematic review summarizes published articles examining the relationships among thin-ideal internalization, acculturation-related constructs (including assimilation, marginalization, biculturalism, and acculturative stress), and eating pathology in US adults. Following the PRISMA method, 15 empirical studies met inclusion criteria. Although existing literature was sparse and conflicting in large part due to heterogeneity in acculturation measures, results yielded some support for positive correlational relationships between acculturative stress, thin-ideal internalization, and eating pathology for both men and women (in 4 out of 5 relevant studies). Research on other aspects of acculturation (eg, integration, assimilation) is mixed, with some existing research suggesting a positive relationship and other research finding no statistically significant relationship. Future research would particularly benefit from a gold-standard, multidimensional transcultural measure of acculturation to examine how the acculturation process relates to thin-ideal internalization and eating pathology in ethnic and racial minorities in the US.

Internalization of Appearance Ideals and Not Religiosity Indirectly Impacts the Relationship Between Acculturation and Disordered Eating Risk in South and Southeast Asian Women Living in the United States

“…These results suggest that thin ideal internalization is a risk factor for body dissatisfaction and disordered eating for SSEA women, whereas acculturation and religiosity may not convey similar levels of risk. These findings are consistent with some past research on thin ideal internalization in SSEA women in high income countries (e.g., Mussap, 2009 ; Akoury et al, 2019 ; Goel et al, 2021 ), indicating that desiring the thin ideal increases the risk of body dissatisfaction and eating disorders regardless of ethnicity or culture of origin ( Nouri et al, 2011 ; Doris et al, 2015 ; Warren and Akoury, 2020 ).…”

“…A more nuanced measure may have captured important elements of acculturative stress that are directly related to eating disorder risk and/or the SSEA experience. For example, individual experiences of acculturation (e.g., acculturative stress, discrimination, bullying, and harassment) may also be important to examine in future research ( Warren and Akoury, 2020 ).…”

“…For White and East Asian women, a desire to be thin for aesthetic purposes is predominant whereas SSEA women tend to cite health motives ( Lee et al, 2001 ; Rieger et al, 2001 ; Talukdar, 2012 ; Vaidyanathan et al, 2019 ; Ando et al, 2021 ). It is certainly possible that these motives persist even after relocating or immigrating ( Warren and Akoury, 2020 ), or through intergenerational messaging if born in a predominantly White culture ( Rhodes et al, 2016 ). These distinctions again highlight the importance of cultural sensitivity in eating disorder research, including underlying etiology of body image dissatisfaction.…”

“…Cultural history and practices continue to shape eating behavior when individuals relocate to a new culture ( Reddy and Crowther, 2007 ; Doris et al, 2015 ; Swami, 2015 , 2016 ; Warren and Akoury, 2020 ). Women of SSEA descent living in predominantly White cultures report greater prevalence of eating disorder symptoms than their White counterparts ( Cummins et al, 2005 ; Doris et al, 2015 ; Monterubio et al, 2020 ).…”

Cultural Considerations in the Treatment of Eating Disorders among Racial/Ethnic Minorities: A Systematic Review

“…That is, exploration of ethnic identity, acculturation, and acculturative stress (theme 9) is essential to understanding ED presentation and case conceptualization. It has been recommended that patients with ED complete measures of acculturation, particularly related to acculturative stress given a positive correlational relationship with thin-ideal internalization and eating pathology for both men and women (Warren & Akoury, 2020). Results from these assessments may also provide a framework for eliciting dialogue about the meaning of one’s ED and addressing cognitive distortions that maintain ED symptoms.…”