Causes of Eating Disorders – Cultural Influences

The impact of culture on health and well-being cannot be understated. Culture encompasses a wide range of behaviors, beliefs, and traditions that influence how individuals within a group act. Often overlooked, these factors can have a powerful impact on how individuals experience disease and the potential barriers to effective treatment.

Disordered eating encompasses a range of medical conditions (such as anorexia nervosa and bulimia nervosa) that involve harmful eating or purging behaviors. These conditions were traditionally thought of as purely ‘reactive’ diseases driven by individual circumstances and societal pressures. However, we now know that eating disorders are complex, involving a mix of biological, psychiatric, family, and cultural factors. ^[1]

Eating disorders can be incredibly harmful and potentially lethal conditions. If you are worried that you or a loved one may have an eating disorder, seek support from your healthcare provider. This information is not intended to replace professional medical advice.

How does culture affect eating disorders?

Traditionally, anorexia and other related conditions were seen as disorders almost exclusively affecting teenage girls from upper socioeconomic, Western backgrounds. However, whilst disordered eating does exist in this group in significant numbers, the notion that it does not affect other groups is outdated. ^[2]

As globalizing culture shifts and evolves, identifying the cultural risk factors behind eating disorders becomes more challenging. In fact, research indicates that cultural change itself is an important driver of disordered eating. These cultural changes may be societal or individual. ^[3]

Understanding the ever-changing cultural influences on eating behavior is vital for addressing how to prevent and treat eating disorders effectively.

Beauty Standards and Body Image

Unrealistic beauty and body standards have long been understood to drive eating disorder behavior. Research has consistently demonstrated a strong link between perceived body image and behaviors associated with eating disorders. ^[4]

Cultural pressures have the potential to drive a wedge between idealized body image and the way individuals perceive their bodies, leading to significant dissatisfaction. Minor lifestyle and diet changes can quickly spiral into harmful restrictions and purging in an effort to seek a more extreme ideal body image. Body image dissatisfaction affects physical and mental health, as well as an individual’s self-esteem. ^[4]

Anorexia isn’t always about body image

When discussing culture and eating disorders, it’s important to note that thinness is not always the driver of anorexia across cultures. According to one 1997 study, anorexia reported in India and Hong Kong was largely motivated by religious or nutritional ideals. However, as the world has become more globalized, ‘fear of fatness’ has, in many cases, taken over as the primary driver of eating disorders. ^[5]

The Influence of Media on Eating Disorders

The number of teenagers affected by eating disorders has risen over the last 50 years. As concerns over body weight and image are becoming more widespread, it is worth considering what is driving this change. Many studies have pointed towards exposure to continuously evolving media. ^[6]

Several changes in media consumption are thought to have increased the risk of developing an eating disorder. ^[6]

• Increased levels of significant thinness amongst models.
• Promotion of thinness as an ideal and healthy body.
• Presence of more extreme diet and exercise information.
• The use of airbrushing and image manipulation.

Alongside traditional media, the rise of social media has contributed to an acceleration in disordered eating. Social media opens the door for ‘social comparison,’ where individuals are able to constantly compare themselves to people they perceive to be skinnier or have a more desirable body type. There has also been a worrying rise in ‘eating disorder culture’ on these platforms that promotes extreme and harmful exercise and diet routines. ^[7]

The impact of media across cultures

Although thinness was typically considered a body image ideal exclusive to Western media, globalization has led to access to these ideals in “media naive” populations. These groups are particularly vulnerable to the impact of how the media portrays the ideal body. ^[6]

The rise of consumerism is also feared to contribute to the development of eating disorders globally. As everything becomes a commodity, individuals feel pressured to achieve an unrealistic body standard that meets society’s perceived expectations or risk falling out of desirability. ^[8]

Gender Roles and Eating Disorders

It is well known that eating disorders occur at a higher rate in women when compared to men. However, this has long led to an underrecognition of eating disorders amongst men and individuals whose gender identity does not align with their sex assigned at birth. In fact, non-cisgendered individuals experience some of the highest levels of eating disorders of any group. This is also true for gay and bisexual men when considering sexual orientation. ^[9]

The promotion of ideal body types that focus on thin female beauty and muscular male physique has contributed to the dissatisfaction that drives disordered eating. Taking this further, stereotypical roles for women in society have idolized sensitivity and social empathy, leading individuals to be vulnerable to making physical changes that conform to society’s expectations. ^[6],^[9]

The impact of alternative gender roles

As society increasingly moves away from reliance on stereotypical gender roles, it might be tempting to think that the cultural pressures that contribute to eating disorders are easing. However, this change in society brings a new set of pressures and challenges.

Many women report cultural demands for thinness are directly linked to career progression despite the same not being expected of men. Similarly, as men increasingly embrace characteristics stereotypically associated with femininity, many report increased levels of eating disorder symptoms. ^[9], ^[10]

Cultural Food Practices and Disordered Eating

It’s important to recognize that eating and food practices differ greatly between cultures. Much research has focussed on the impact of the Western diet on eating disorders. With the rise of readily available processed foods, diet culture can be seen as a reaction to the health concerns associated with these types of foods. However, diet culture itself can lead to harm, with false beliefs about weight being a direct representation of health, opening the door to disordered eating behaviors. ^[11]

Studies have also pointed to an increased risk of eating disorders among people with a Jewish, Catholic, or Italian cultural heritage. This may be, in part, explained by the cultural attitudes of the importance of food held by these groups. ^[2]

When considering the link between culture and eating disorders, it’s important to ask why differing food practices may increase the risk of disordered eating. Ultimately, these reasons are highly individual. For some, food restriction may form part of a religious belief system. For others, control over food intake may be a rebellion against the expected cultural norms of high-consumption diets.

Can acculturation contribute to eating disorders?

Acculturation is the process of psychological and cultural change that occurs as a result of the blending between two or more cultural groups. Often, this refers to the changes that occur when non-Western cultural groups adjust to or integrate with Western culture. ^[12]

When discussing acculturation and eating disorders, we must consider how this risk occurs. With exposure to ‘Western’ ideals of thinness and body image, individuals often feel societal pressure to adapt rapidly. This cultural strain may lead to adopting dysfunctional coping strategies in the form of eating disorder symptoms. ^[12]

Do Socioeconomic Factors Have a Role to Play?

Socioeconomics has long been associated with eating disorders. Traditionally, eating disorders were thought of as a disease exclusively related to upper socioeconomic groups. Previous research has attempted to explain this through harmful, stigmatizing beliefs that eating disorders are a result of attention-seeking or weakness of character. ^[13]

In reality, a 2021 systematic review found no evidence of an association between socioeconomic group and the risk of developing an eating disorder. The review did find that previous research has failed to adequately address the presence of disordered eating in lower socioeconomic groups. ^[13]

Furthermore, there may be different risk factors driving eating disorder symptoms between groups. For example, researchers have pointed to evidence of a link between food insecurity among individuals in a lower socioeconomic group and developing bulimia nervosa. ^[13]

Socioeconomic factors impact beyond food

Research indicates that individuals from lower socioeconomic groups may be more heavily impacted by the effects of eating disorders. People from these cultural groups may see increased barriers to treatment through discrimination and stigmatization. They may also experience difficulties accessing adequate healthcare and lack exposure to education and resources to combat eating disorders. ^[13]

Can Cultural Stigma Prevent Access to Healthcare?

Stigma presents many barriers to accessing appropriate prevention and treatment across a variety of health conditions. As eating disorders have a significant mental health component, stigma is particularly widespread for these conditions. Mental health has long been wrongly associated with poorer social acceptance when compared to ‘physical’ health, even amongst healthcare professionals. ^[14]

A 2021 systematic review found that people with eating disorders face a significant amount of stigma, centrally revolving around a harmful belief that eating disorders are ‘self-imposed’ problems. This, in turn, leads many individuals to self-stigmatize, feeling intense guilt and shame for their conditions. Stigma prevents those affected from seeking help, forcing them to hide and ultimately worsen their condition. ^[15]

For certain cultural groups, this stigma can be even more intense. Individuals from a cultural background with poorer levels of acceptance for mental health conditions can feel unable to access help without fear of ostracization. ^[14]

The stigma associated with men who have eating disorders

Eating disorders have been stereotypically seen as ‘female disorders.’ This incorrect assertion puts up several barriers to men accessing help for fear of stigmatization. Eating disorders have also been significantly under-researched and under-diagnosed in men due to professional stigma. ^[9],^[15]

Cultural Considerations in the Treatment of Eating Disorders

In this article, we’ve explored the cultural risk factors associated with developing an eating disorder and the potential barriers to accessing support. In order to appropriately support those affected by eating disorders, it is important to consider the role of cultural factors in successfully treating these conditions.

Some important cultural considerations for the treatment of eating disorders include:

• Cultural background may influence the type of foods an individual is able to eat. Care must be taken to ensure recovery through adequate nutritional intake is possible whilst still being sensitive to cultural needs.
• Professionals must make an effort to understand cultural influences in the home and family environment, offering appropriate education and support where possible.
• ‘Thinness’ may not be a driving factor behind an eating disorder. Understanding these influences is important for tailoring psychological support to meet an individual’s needs.
• Media and social media can exert immense pressure on people recovering from eating disorders. Education programs and expert support may be needed to help individuals develop a healthier relationship with social media.
• Equitable access to treatment and support must be ensured for people from a wide range of socioeconomic backgrounds.