Disordered Eating in Asian American Women: Sociocultural and Culture-Specific Predictors

Protective role of family mealtime frequency against disordered eating behaviors: Racial and ethnic differences

Family mealtimes have been recognized for their positive effect on child and adolescent health outcomes. Frequent family meals have been shown to have protective effects in reducing disordered eating behaviors, but the variability of these effects across different racial and ethnic backgrounds has been less explored. To address the gap, the current study utilizes a sample of 33,417 families with children (ages 6-17) in the United States who participated in the 2022 National Surveys of Children's Health (NSCH). Logistic regressions were conducted to examine the association between family mealtime frequency and the manifestation of disordered eating across youth from diverse racial/ethnic backgrounds. Our findings revealed that frequent family mealtimes are associated with a lower risk of engaging in disordered eating behaviors in youth. However, there were disparities in the associations between family mealtime frequency and the prevalence of disordered eating behaviors among children from different racial/ethnic backgrounds. Youth who never participated in family mealtimes were at a greater risk of engaging in disordered eating behaviors among those identifying as non-Hispanic Black or of 'other' racial groups. In youth identifying with multiple races, the frequency of family was not associated with the odds of disordered eating behaviors. The results provide insights into the nuanced influence of family mealtime frequency on disordered eating based on diverse racial/ethnic groups. This highlights the need for future studies to identify factors associated with racial/ethnic identities that may contribute to disordered eating behaviors in youth to identify the unique needs and challenges faced by families in leveraging the protective effect of family mealtimes.

An examination of individual, relational, and cultural risk for disordered eating in Asian American college students

Objective: This study examined how individual (satisfaction of basic psychological needs), relational (perceived achievement- and dependency-oriented parental psychological control), and cultural (ethnic identity) factors may contribute to Asian American college students' (18 - 25 years of age) disordered eating. Participants: Asian American college students (N = 118) participated in the study. Methods: Participants completed a cross-sectional survey study. Moderated mediation models were used to analyze the data. Results: Analyses showed that perceived achievement-oriented, but not dependency-oriented, parental psychological control was more strongly associated with psychological needs satisfaction at higher, compared to lower, levels of ethnic identity. Conclusions: Findings highlighted the importance of both parenting and ethnic identity among Asian American college students' psychological needs and risk for disordered eating. The complex relations among achievement expectations, ethnic identity and wellbeing in Asian Americans are discussed. The results can inform intervention and prevention programs attending to the needs of this population.

Acculturation and eating disorders: a systematic review

PURPOSE

Acculturation, or the dual process of cultural change that takes place due to the interaction between two or more cultural identities, may contribute to the susceptibility of developing an eating disorder (ED). We conducted a systematic review exploring the relationship between acculturation-related constructs and ED pathology.

METHODS

We searched the PsychINFO and Pubmed/Medline databases up to December 2022. Inclusion criteria were: (1) having a measure of acculturation or related constructs; (2) having a measure of ED symptoms; and (3) experiencing cultural change to a different culture with Western ideals. 22 articles were included in the review. Outcome data were synthesized by narrative synthesis.

RESULTS

There was variability in the definition and measure of acculturation in the literature. Overall, acculturation, culture change, acculturative stress, and intergenerational conflict were associated with ED behavioral and/or cognitive symptoms. However, the nature of the specific associations differed depending on the specific acculturation constructs and ED cognitions and behaviors measured. Furthermore, cultural factors (e.g., in-group vs. out-group preferences, generational status, ethnic group, gender) impacted the relationship between acculturation and ED pathology.

DISCUSSION

Overall, this review highlights the need for more precise definitions of the different domains of acculturation and a more nuanced understanding of the specific relationship between various acculturation domains and specific ED cognitions and behaviors. Most of the studies were conducted in undergraduate women and in Hispanic/Latino samples, limiting generalizability of results.

LEVEL OF EVIDENCE

Level V, Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Differential pathways to disordered eating for immigrant and native adolescents in Taiwan

BACKGROUND

Few studies have investigated disparities in disordered eating between new immigrant and native adolescents in Taiwan. This study examines the differential pathways to disordered eating in these two populations.

METHODS

This cross-sectional study analyzed data collected from March to June 2019. In total, 729 adolescents aged between 13 and 16 years recruited from 37 classes in 3 middle schools in New Taipei City were included in the final analysis. Standardized assessment tools measured disordered eating (EAT-26) and psychological distress (BSRS-5). Generalized structural equation modeling was used to conduct the path analysis.

RESULTS

The prevalence of disordered eating was significantly higher in immigrant adolescents than in their native counterparts. Multipath models indicated that weight-teasing driven by overweight and obese status and weight overestimation could lead to disordered eating through psychological distress; however, the pathways differed for the two groups studied. Family weigh-teasing indirectly leads to disordered eating through psychological distress for native adolescents; by contrast, for immigrant adolescents, friend weigh-teasing indirectly leads to disordered eating through psychological distress. Additionally, weight overestimation directly leads to disordered eating and indirectly through psychological distress to disordered eating for immigrant adolescents.

CONCLUSION

This study offers a plausible explanation of the differences in the paths to disordered eating between immigrant and native adolescents in Taiwan, which was not reported previously. The study urges the need for school-based prevention programs to improve immigrant students' mental health.

Asian students in the anglosphere - unravelling the unique familial pressures contributing to eating pathology: a systematic review

BACKGROUND

There is no clear consensus on the specific familial pressures affecting Asian students in the Anglosphere, despite the validation of the Tripartite Influence model of eating disturbances in this group. However, traditional familial risk factors for disordered eating can be elevated for immigrant Asians with collectivistic-oriented familial dynamics, necessitating an examination of the culture-specific risk profile for eating pathology in student-aged Asians. This systematic review aims to consolidate and critically examine the literature on the most widely studied familial pressures related to disordered eating in Asian students in the Anglosphere.

METHODS

A systematic search was conducted in five databases for peer-reviewed articles measuring familial pressures and eating pathology in Asian students > 10 years old from an Anglosphere country. Following PRISMA guidelines, papers were screened by title, abstract and full text based on the eligibility criteria. Eligible studies were qualitatively analysed and synthesised narratively to assess the relationship between familial pressures and eating pathology.

RESULTS

In total, 14 papers were eligible for inclusion in the review. Eight topics related to familial stressors were identified (1) intergenerational conflict; (2) lack of familial cohesion; (3) parental overprotection; (4) low parental care; (5) familial achievement orientation; (6) parental expectations; (7) parental criticism; and (8) direct parental influence. In multiple studies, intergenerational conflict, maternal overprotection, and familial achievement orientation were significantly elevated and associated with disordered eating in US and UK Asian students, compared to white students. The studies examining parental criticism and familial cohesion had more heterogeneous findings.

CONCLUSION

The findings demonstrate the perception of Asian parenting styles as overprotective and incompatible with individualist-oriented Western values could increase eating pathology in adolescent and university students living in Anglosphere countries. The synthesised findings of the literature also indicate disordered eating acts as a compensatory mechanism for the ongoing psychological distress generated from intergenerational conflict and familial achievement orientation. Conversely, traditional eating disorder literature on familial cohesion and low parental care may not be applicable to young Asians. Future research should focus on how social appearance anxiety and psychological factors can mediate the link between disordered eating and familial stressors in Asian students.

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

Objective

Studies that examine disordered eating in samples of Asian individuals living in the United States frequently combine all individuals of Asian descent into a single group, which can obscure important differences between groups and their experiences of acculturation. The goal of the present study was to establish the relation of acculturation, internalization of appearance ideals, and religiosity as predicting body dissatisfaction and disordered eating in women of South and Southeast Asian (SSEA) descent.

Method

Women of SSEA descent (N = 112) aged 18-51 years (M = 23.10, SD = 6.4) completed a battery of questionnaires that inquire about these variables. A path analysis was conducted with acculturation serving as the independent (exogenous) variable, religiosity and internalization of the thin ideal as mediators, and body dissatisfaction and disordered eating as dependent (endogenous) variables.

Results

Direct paths from acculturation to both body dissatisfaction and disordered eating were not significant. Thin ideal internalization completely accounted for the path from acculturation to both endogenous variables; whereas, religiosity did not significantly account for any indirect effect.

Discussion

For SSEA women, internalization of appearance ideals is a potentially greater risk factor for disordered eating than acculturation or religiosity. As this was an atemporal mediation analysis, more work needs to be done exploring predictors of internalization in this population and how that may impact the development of disordered eating.

Ethnic/racial and gender differences in disordered eating behavior prevalence trajectories among women and men from adolescence into adulthood

BACKGROUND

Disordered eating behaviors (DEB) are highly prevalent and are associated with negative long-term health outcomes. Extant research on DEB prevalence trajectories has predominantly focused on white women, thereby lacking both gender and ethnic/racial diversity, which may lead to preventive interventions that are not optimally timed for socially minoritized groups. The purpose of this study was to identify patterns in DEB trajectories from adolescence to adulthood across intersecting gender and ethnic/racial identities.

METHODS

Participants (n = 1314) were from Project EAT (Eating and Activity in Teens and Young Adults), a population-based sample in the United States. Unhealthy weight control behaviors and binge eating were assessed across four waves at 5-year intervals. Gender-stratified generalized estimating equations (GEE) analyses were applied to examine ethnic/racial and gender differences in the prevalence trajectories of two forms of DEB (unhealthy weight control behaviors and binge eating).

RESULTS

Hispanic/Latina young women reported heightened prevalence of unhealthy weight control behaviors and binge eating during adolescence (82.4% and 31.1%) relative to women with other ethnic/racial identities (44-70.2% and 8.8-18.2%) at any other developmental time point. Black/African American women reported linear increases in unhealthy weight control behaviors from adolescence (46.6%) to adulthood (65.5%), with nearly 20% greater prevalence relative to white women (44.6%) during adulthood. Among men, prevalence of unhealthy weight control behaviors was higher among Hispanic/Latinos (60.7-68.0%) and Asian Americans (41.9-56.7%) relative to Black/African American (24.6-36.9%) and white men (25.7-34.9%). Similarly, Hispanic/Latino young men reported up to ten or more times higher prevalence of binge eating during adolescence (22.8%) and adulthood (26.8%) relative to men from other ethnic/racial identities at any other time point (1.7-12.3%).

CONCLUSIONS

Ethnic/racial disparities in DEB prevalence vary across development, DEB subtype, and by gender. Targeted preventive interventions, or interventions that address these different trajectories, that are optimally timed may reduce these disparities.

Gender-specific responses to multifaceted factors associated with disordered eating among adolescents of 7th to 9th grade

BACKGROUND

The prevalence of disordered eating is increasing among adolescents in Asia. The prevalence and predictors of disordered eating in boys have often gone unrecognized. This study examined gender-specific responses to multifaceted factors associated with disordered eating, including personal, behavioral, family, and school-related characteristics.

METHODS

After excluding responses with incomplete information, a sample of 729 adolescents (48.97% boys) between the ages of 13 and 16 were surveyed through convenience sampling from 37 classrooms in three junior high schools in New Taipei City of Taiwan were analyzed. The Eating Attitudes Test-26 questionnaire was used to identify disordered eating.

RESULTS

No difference in the prevalence of disordered eating between the genders was found. Adolescent girls exhibit a preoccupation with fatness and a desire to be thinner, whereas boys are more likely to engage in extreme dieting behaviors such as vomiting, keeping the stomach empty, and avoiding sweets. Girls engaging in disordered eating reported relatively high levels of interpersonal stress involving family member weight-teasing, low peer acceptance, and high peer pressure to control weight. High intensity of regular exercise was found in girls with disordered eating. The perception of body weight is a more critical factor of engaging in disordered eating for boys than girls. Adolescents with immigrant parents were associated with disordered eating among both genders.

CONCLUSIONS

Changing gender-specific weight-related norms in schools and families is essential to reduce the prevalence of disordered eating, particularly among girls. Future studies using representative samples to confirm this study's findings are warranted.

Investigating the Linkages between BMI, Body Image, and SATAQ among Young Asian Females

Sociocultural attitudes toward appearance and its linkage to body mass index (BMI) and body image is a relationship worth studying, especially in Asia, where the idealization of thinness can be prominent. The Sociocultural Attitudes Toward Appearance Questionnaire (SATAQ) developed by Heinberg et al. in 1995 was used in this study to examine whether these beliefs have been internalized. Furthermore, the Body Esteem Scale (BES) was used to quantify body image. The formal in-person survey was administered in Taipei, Taiwan. There were 301 valid samples out of 330 surveyed respondents. To enhance the representativeness of the samples, a stratified sampling technique was applied to generate survey data with valid samples following gender and age distributions of the population between the ages of 14 and 28. The internalization dimension represented how strongly the respondents considered the importance of the socially accepted concept of appearance based on personal perceived social norms. The other dimension, awareness, represented the sociocultural pressures from the outside world, such as from the image of slimness illustrated in the media or group, in comparison to personal beliefs. Our results demonstrated that respondents with above-normal BMIs internalized the socially preferred standards of thinness more than respondents with normal or under-normal BMIs. Furthermore, results also revealed, overall, a negative relationship between SATAQ and body image and between body image and BMI. The study highlights the need to emphasize “fitness over thinness” to help improve negative body image among young Asian females.

Eating disorder symptoms in Asian American college students

Inconsistent information on levels of eating pathology in Asian Americans exist. We investigated whether there were differences in mean scores for eating disorder (ED) symptoms among Whites, Asian Americans, and individuals identifying as another race (i.e., non-Asian people of color [NAPOC]). Participants included 716 college students (M age = 19.23; SD = 1.65) from a southeastern university. ED symptoms were assessed with the Eating Pathology Symptom Inventory (EPSI). Internalizing symptoms were evaluated via the Depression Anxiety and Stress Scale (DASS). One-way ANOVAs investigated mean differences in symptoms between racial groups, with and without adjusting for sex, BMI, and internalizing symptoms. Overall, 16% (n = 114) of the sample identified as Asian American, 67% (n = 477) as White, and 17% (n = 125) as NAPOC. After correcting for multiple testing and adjusting for covariates, Asian Americans reported higher mean scores of purging, muscle building, and cognitive restraint (qs < 0.05) than Whites and NAPOC. Asian Americans also scored higher on restriction compared with Whites (qs < 0.05), as well as body dissatisfaction and negative attitudes toward obesity compared with NAPOC (qs < 0.05). These findings demonstrate the existence of racial differences among specific ED symptoms, highlighting the importance of considering these distinctions when diagnosing and treating EDs among diverse communities.

Prevalence of eating disorder is lower in migrants than in the Australian-born population

OBJECTIVES

There are limited data on the epidemiology of eating disorders (ED) in migrants. Recent Scandinavian research suggests that migrants are at lower risk of eating disorders, however, to our knowledge there have not been comparable studies exploring eating disorders in Australian adult populations. We sought to explore the prevalence of EDs in first-generation migrants to Australia in comparison with the Australian-born population. A secondary aim was to explore ED prevalence across first-generation migrants from different regions of birth (Europe, Asia, Africa, and Other).

METHODS

We conducted sequential cross-sectional population surveys in South Australian individuals aged over 15 years in 2015 and 2016 (n = 6052). Demographic data were collected and migration status was inferred based on a country of birth outside Australia. Questions asked regarding disordered eating were based on the Eating Disorders Examination.

FINDINGS

The 3-month prevalence of any ED was found to be significantly lower in first-generation migrants born outside Australia (4.5%, 95% CI 3.6-5.6) in comparison to the Australian-born population (6.4%, 95% CI 5.7-7.2). People born in countries in Africa (11.0% 95% CI 6.1-19.1) had a significantly higher prevalence of EDs than those born in Asia (4.0% 95% CI 2.7-5.8).

CONCLUSIONS

First-generation migrants to Australia may be at lower risk of eating disorders compared to their Australia-born peers, suggesting support for a 'healthy immigrant effect'.