The Spread of Eating Disorders – A flip side of globalisation?

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Anorexia nervosa (AN) and bulimia nervosa (BN) have long been believed to be disorders specific for industrialised countries, and only occurring in the western world. In the DSM-IV, anorexia nervosa was even classified as a culture-bound disorder, in other words a disorder with a locality-specific pattern of behaviour. However, in recent years, researchers recognized that the disorders are spreading among non-industrialized cultures.

The question we ask ourselves is whether in an increasingly globalised and westernised world, can these eating disorders still be considered as western disorders? And what is the current hypothesis for this change?  

A study from Cambridge, which used representative data from all around the world, compared rates of anorexia nervosa and bulimia nervosa for 27 years. The study identified cases in every part of the world and found a global increase of both eating disorders. As expected, western countries including Australia, Western Europe and North America had the highest prevalence with relatively stable rates. However, more shockingly, the researchers noted that South Asia followed by East Asia had the strongest increase in prevalence in recent years (Wu et al. 2020). Additionally, two other studies evidenced that also the Middle East and Eastern Europe had a spike in prevalence of anorexia nervosa and bulimia nervosa. (Pike at al. 2014) (Túry et al. 2020)

But what is the reason for this change? An older study by Becker et al. (2002) analysed the isolated islands of Fiji during the introduction of television during the 1990s. Fiji had previously had little exposure to western culture, a heavier and more robust beauty ideal, and only one detected case of eating disorder before the 1990s. Becker discovered that an increase of eating disorders and interest to lose weight among Fijian highschoolers was highly dependent on the introduction to TV. Additionally, another study in rural areas of Burkina Faso, where media exposure is low, highlighted the same trend. Here, Terhoeven et al. (2020) evidenced an association between media exposure, body dissatisfaction and eating pathology. These are two examples, among many articles, supporting a link between AN, BN and the exposure of western culture through media. 

Although, when looking at Asia, researchers noticed contradicting results: the diseases developed independently from western countries, allegedly unrelated to the exposure to western influence. For instance, Jackson et al. (2006) compared women in Korea, to Korean women who moved to the US in the past 7 years, and to second generation Korean American women. The study highlighted that women in Korea had higher scores in eating pathology (EAT-26) and a lower body mass index (BMI) than Korean American Women. Korean women who recently moved to the United States, however, did not differ from women in Korea on the EAT-26 scale but had a higher BMI. This article is not alone with its findings. There are also other researchers that supported a similar hypothesis, as they also highlighted a similar connection between the spread of eating disorders and cultural factors. Cultural norms, such as a thin body, perfectionism, and social pressure to conform are widespread in certain Asian cultures, which might promote eating disorders, regardless of the influence of western culture.

It is believed that this independent development is connected to an increase in welfare and industrialization. Wu et al. (2020) noted a positive correlation of the increase of AN, and BN alongside improvements of the human development index (HDI). However, when an HDI exceeds 0.6, the amplitude in variations stabilises, possibly due to better healthcare resources and improved lifestyle choices. Pike at al. (2014) hypothesised that the surge of AN and BN in Asia is in concert with increasing industrialization, and globalisation.

In conclusion, the spread of eating disorders all around the world is a fact. The underlying reasons for this are however more complicated. Even though some research proves a development connected to increased exposure of western media, other research is contradicting. Especially in East Asia, an independent development of the eating disorders is discovered, stronger connected to industrialization, increased welfare, and cultural norms. The reason for the globalisation of eating disorders is most likely an intertwined mixture of cultural factors, industrialization and westernisation.

By

Vita Jamila Keil

Keil.jamila@gmail.com

Bibliography

Becker, A. E., Burwell, R. A., Gilman, S. E., Herzog, D. B., Hamburg, P. (2002). Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls, The British Journal of Psychiatry, 180, 509-514.

Jackson, S. C., Keel, P. K., Lee, Y. H. (2006). Trans-cultural Comparison of Disordered Eating in Korean Women, International Journal of Eating Disorders, 39(6), 498-502.

Pike, K. M., Hoek, H. W., Dunne, P. E. (2014). Cultural trends and eating disorders, Current Opinion in Psychiatry, 27(6), 436-442.

Terhoeven, V., Nikendei, C., Bärninghausen, T., Bountogo, M., Fredrich, H., Ouermi, L., Sié, A., Harling, G. (2020). Eating disorders, body image and media exposure among adolescent girls in rural Burkina Faso, Tropical Medicine and International Health, 25(1), 132-142.

Túry, F., Szabó, P., Dukay-Szabó, S., Szumska, I., Simon, D., Rathner, G. (2020). Eating disorder characteristics among Hungarian medical students: Changes between 1989 and 2011, Journal of Behavioural Addictions, 9(4), 1079-1087.

Wu, J., Liu, J., Li, S., Ma, H., Wang, Y. (2020). Trends in the prevalence and disability-adjusted life years of eating disorders from 1990 to 2017: results from the Global Burden of Disease Study 2017, Epidemiology and Psychiatric Sciences 29, e191.