Body Image and Eating Disorders Among South Asian American Women: What Are We Missing?

Abstract

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.

Keywords

body image eating disorders South Asians qualitative methods thematic analysis multiculturalism qualitative focus group United States

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References

Ambwani

Gleaves

D. H.

Perez

(2015). Fearing fatness: A cross-national comparison of Indian and European American university students. International Journal of Culture and Mental Health, 8(1), 46–59. https://doi.org/10.1080/17542863.2014.892520

Ata

R. N.

Schaefer

L. M.

Thompson

K. T.

(2015). Sociocultural theories of eating disorders. In Smolak

Levine

M. P.

(Eds.), The Wiley handbook of eating disorders (1st ed., pp. 269–282). Wiley.

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. https://doi.org/10.1191/1478088706qp063oa

Cameron

N. O.

Muldrow

A. F.

Stefani

(2018). The weight of things: Understanding African American women’s perceptions of health, body image, and attractiveness. Qualitative Health Research, 28(8), 1242–1254. https://doi.org/10.1177/1049732317753588

Castleberry

Nolen

(2018). Thematic analysis of qualitative research data: Is it as easy as it sounds? Currents in Pharmacy Teaching and Learning, 10, 807–815. https://doi.org/10.1016/j.cptl.2018.03.019

Chang

E. C.

Perera

M. J.

Kupfermann

(2014). Predictors of eating disturbances in South Asian American females and males: A look at negative affectivity and contingencies of self–worth. Asian American Journal of Psychology, 5(3), 172–180. https://doi.org/10.1037/a0031627

Chen

E. Y.

Segal

Weissman

Zeffiro

T. A.

Gallop

Linehan

M. M.

Bohus

Lynch

T. R.

(2014). Adapting dialectical behavior therapy for outpatient adult anorexia nervosa—A pilot study. International Journal of Eating Disorders, 48(1), 123–132. https://doi.org/10.1002/eat.22360

Cheney

A. M.

(2011). “Most girls want to be skinny”: Body (dis)satisfaction among ethnically diverse women. Qualitative Health Research, 21(10), 1347–1359. https://doi.org/10.1177/1049732310392592

Cheney

A. M.

(2012). Emotional distress and disordered eating practices among southern Italian women. Qualitative Health Research, 22(9), 1247–1259. https://doi.org/10.1177/1049732312449214

10.

Creswell

Poth

C. N.

(2018). Qualitative inquiry and research design: Choosing among five approaches (4th ed.). SAGE.

11.

Cummins

L. H.

Simmons

A. M.

Zane

N. W.

(2005). Eating disorders in Asian populations: A critique of current approaches to the study of culture, ethnicity, and eating disorders. American Journal of Orthopsychiatry, 75(4), 553–574. https://doi.org/10.1037/0002-9432.75.4.553

12.

Fitzsimmons-Craft

E. E.

(2011). Social psychological theories of disordered eating in college women: Review and integration. Clinical Psychology Review, 31, 1224–1237. https://doi.org/10.1016/j.cpr.2011.07.011

13.

Fredrickson

B. L.

Roberts

T.-A.

(1997). Objectification theory: Toward understanding women’s lived experiences and mental health risks. Psychology of Women Quarterly, 21, 173–206.

14.

Goel

N. J.

Burnette

C. B.

Mazzeo

S. E.

(2020). Racial and ethnic differences in the association between parent-oriented perfectionism and disordered eating in college women. International Journal of Eating Disorders, 53, 191–200. https://doi.org/10.1002/eat.23179

15.

Goel

N. J.

Thomas

Boutté

R. L.

Kaur

Mazzeo

S. E.

(2021). “What will people say?”: Mental health stigmatization as a barrier to eating disorders treatment-seeking for South Asian American women [Manuscript submitted for publication]. Department of Psychology, Virginia Commonwealth University.

16.

Goodell

L. S.

Stage

V. C.

Cooke

N. K.

(2016). Practical qualitative research strategies: Training interviewers and coders. Journal of Nutrition Education and Behavior, 48(8), 578–585. https://doi.org/10.1016/j.jneb.2016.06.001

17.

Gupta

Szymanski

D. M.

Leong

F. T. L.

(2011). The “model minority myth”: Internalized racialism of positive stereotypes as correlates of psychological distress, and attitudes toward help-seeking. Asian American Journal of Psychology, 2(2), 101–114. https://doi.org/10.1037/a0024183

18.

Hockin-Boyers

Warin

(2021). Women, exercise, and eating disorder recovery: The normal and the pathological. Qualitative Health Research, 31(6), 1029–1042. https://doi.org/10.1177/1049732321992042

19.

Hoeffel

E. M.

Rastogi

Kim

M. O.

Shahid

(2010). The Asian population: 2010 (Issue Brief No. C2010BR-11). https://www.census.gov/prod/cen2010/briefs/c2010br-11.pdf

20.

Iyer

D. S.

Haslam

(2003). Body image and eating disturbance among South Asian-American women: The role of racial teasing. International Journal of Eating Disorders, 34, 142–147. https://doi.org/10.1002/eat.10170

21.

Kawamura

K. Y.

(2015). Cross-cultural and ethnicity issues in diagnosis. In Smolak

Levine

M. P.

(Eds.), The Wiley handbook of eating disorders (pp. 197–208). Wiley.

22.

Kersbergen

Robinson

(2019). Blatant dehumanization of people with obesity. Obesity, 27(6), 1005–1012. https://doi.org/10.1002/oby.22460

23.

Krueger

R. A.

(1988). Focus groups: A practical guide for applied research. SAGE.

24.

Levinson

C. A.

Brosof

L. C.

(2016). Cultural and ethnic differences in eating disorders and disordered eating behaviors. Current Psychiatry Reviews, 12, 163–174. https://doi.org/10.2174/1573400512666160216234238

25.

Lincoln

Y. S.

Guba

E. G.

(1985). Naturalistic inquiry. SAGE.

26.

Littlewood

(1995). Psychopathology and personal agency: Modernity, culture change and eating disorders in South Asian societies. British Journal of Medical Psychology, 68, 45–63.

27.

Markus

H. R.

Kitayama

(2010). Cultures and selves: A cycle of mutual constitution. Perspectives on Psychological Science, 5, 420–430. https://doi.org/10.1177/1745691610375557

28.

Mensinger

J. L.

Bonifazi

D. Z.

LaRosa

(2007). Perceived gender role prescriptions in schools, the Superwoman ideal, and disordered eating among adolescent girls. Sex Roles, 57(7–8), 557–568. https://doi.org/10.1007/s11199-007-9281-6

29.

Miville

M. L.

Ferguson

A. D.

(2014). Handbook of race-ethnicity and gender in psychology. Springer.

30.

Moradi

(2010). Addressing gender and cultural diversity in body image: Objectification theory as a framework for integrating theories and grounding research. Sex Roles, 63, 138–148. https://doi.org/10.1007/s11199-010-9824-0

31.

Mumford

D. B.

(1993). Eating disorders in different cultures. International Review of Psychiatry, 5, 109–114.

32.

Mumford

D. B.

Whitehouse

A. M.

Platts

(1991). Sociocultural correlates of eating disorders among Asian schoolgirls in Bradford. British Journal of Psychiatry, 158, 222–228. https://doi.org/10.1192/bjp.158.2.222

33.

Mustafa

Zaidi

A. U.

Weaver

R. R.

(2017). Conspiracy of silence: Cultural conflict as a risk factor for the development of eating disorders among second-generation Canadian South Asian women. South Asian Diaspora, 9(1), 33–49.

34.

Nakai

Nin

Goel

N. J.

(2021). The changing profile of eating disorders and related sociocultural factors in Japan between 1700 and 2020: A systematic scoping review. International Journal of Eating Disorders, 54(1), 40–53. https://doi.org/10.1002/eat.23439

35.

Nasser

(1998). The EAT speaks many languages: Review of the use of the EAT in eating disorders research. Eating and Weight Disorders, 2, 174–181. https://doi.org/10.1007/BF03339972

36.

Liu

Gaither

Marsan

Zucker

(2021). The clash of culture and cuisine: A qualitative exploration of cultural tensions and attitudes toward food and body in Chinese young adult women. International Journal of Eating Disorders, 54(2), 174–183. https://doi.org/10.1002/eat.23459

37.

Patton

M. Q.

(1990). Qualitative evaluation and research methods (2nd ed.). SAGE.

38.

Patton

T. O.

(2006). Hey girl, am I more than my hair? African American women and their struggles with beauty, body image, and hair. NWSA Journal, 18(2), 24–51.

39.

Perera

Wickramasinghe

Wanigasinghe

Perera

(2002). Anorexia nervosa in early adolescence in Sri Lanka. Annals of Tropical Pediatrics, 22, 173–177. https://doi.org/10.1179/027249302125000904

40.

Pike

K. M.

Dunne

P. E.

(2015). The rise of eating disorders in Asia: A review. Journal of Eating Disorders, 3(33), 1–14. https://doi.org/10.1186/s40337-015-0070-2

41.

Reddy

S. D.

Crowther

J. H.

(2007). Teasing, acculturation, and cultural conflict: Psychosocial correlates of body image and eating attitudes among South Asian women. Cultural Diversity and Ethnic Minority Psychology, 13(1), 45–53. https://doi.org/10.1037/1099-9809.13.1.45

42.

Rodgers

R. R.

Berry

Franko

D. L.

(2018). Eating disorders in ethnic minorities: An update. Current Psychiatry Reports, 20, 90–101. https://doi.org/10.1007/s11920-018-0938-3

43.

Rodgers

R. R.

Paxton

S. J.

Chabrol

(2009). Effects of parental comments on body dissatisfaction and eating disturbance in young adults: A sociocultural model. Body Image, 6, 171–177. https://doi.org/10.1016/j.bodyim.2009.04.004

44.

Russell-Cole

Wilson

Hall

R. E.

(2013). The color complex: The politics of skin color in a new millennium. Random House, Inc.

45.

Sahay

Piran

(1997). Skin-color preferences and body satisfaction among South Asian-Canadian and European-Canadian female university students. The Journal of Social Psychology, 137(2), 161–171. https://doi.org/10.1080/0022459709595427

46.

Sandelowski

(2000). Whatever happened to qualitative description? Research in Nursing & Health, 23, 334–340.

47.

Shankar

(2008). Desi land: Teen culture, class, and success in Silicon Valley. Duke University Press.

48.

Srinivas

Ravi

M. R.

Prashantha

Prakash

(2017). Prevalence of overweight and obesity, body image perception and weight control practices among college going adolescent girls in Mysore District, Karnataka. International Journal of Community Medicine and Public Health, 4(4), 954–958. https://doi.org/10.18203/2394-6040.ijcmph20170950

49.

Striegel-Moore

R. H.

Bulik

C. M.

(2007). Risk factors for eating disorders. American Psychologist, 62(3), 181–198. https://doi.org/10.1037/0003-066X.62.3.181

50.

Suhail

Nisa

(2002). Prevalence of eating disorders in Pakistan: Relationship with depression and body shape. Eating and Weight Disorders, 7, 131–138.

51.

Tareen

Hodes

Rangel

(2005). Non-fat-phobic anorexia nervosa in British South Asian adolescents. International Journal of Eating Disorders, 37(2), 161–165. https://doi.org/10.1002/eat.20080

52.

Telch

C. F.

Agras

W. S.

Linehan

M. M.

(2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69(6), 1061–1065.

53.

Tsai

J. H.-C.

Choe

J. H.

Lim

J. M. C.

Acorda

Chan

N. L.

Taylor

S.-P.

(2004). Developing culturally competent health knowledge: Issues of data analysis of cross-cultural, cross-language qualitative research. International Journal of Qualitative Methods, 3(4), 16–27.

54.

Tummala-Narra

(2013). Psychotherapy with South Asian women: Dilemmas of the immigrant and first generations. Women & Therapy, 36(3–4), 176–197. https://doi.org/10.1080/02703149.2013.797853

55.

Vaidyanathan

Kuppili

P. P.

Menon

(2019). Eating disorders: An overview of Indian research. Indian Journal of Psychological Medicine, 41(4), 311–317. https://doi.org/10.4103/IJPSYM.IJPSYM_461_18

56.

Wallerstein

Duran

Oetzel

Minkler

(2017). Community-based participatory research for health: Advancing social and health equity (3rd ed.). Wiley.

57.

Woods-Giscombé

C. L.

(2010). Superwoman schema: African American women’s views on stress, strength, and health. Qualitative Health Research, 20(5), 668–683. https://doi.org/10.1177/1049732310361892

58.

World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th Revision.). https://icd.who.int/browse11/l-m/en

59.

Pope

S. C.

Perez

(2019). Clinical treatment and practice recommendations for disordered eating in Asian Americans. Professional Psychology: Research and Practice, 50(5), 279–287. https://doi.org/10.1037/pro0000244

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