The Culture of Eating Disorders

Trigger warning: This content includes information about eating disorders.

The term “Westernization” has often been used to indicate the spread of Western influences and practices to other parts of the world. These influences may be observed in aspects such as politics, technology, and industry. A popular example is the rapid expansion of the McDonald’s franchise to nearly all areas of the world. Less commonly known is the mention of “Westernization” in conversations about eating disorders (EDs) in non-Western regions, particularly in Asia. Eating disorders are characterized by unhealthy relationships with food and body image (Pike & Dunne, 2015). Since the 1960s, when cases of EDs rose in the Western world, the widely conceptualized image of an individual suffering from an ED has been a young, wealthy, educated, White woman (Pike & Dunne, 2015). As EDs began to rise in Asia in the 1990s, many researchers assumed Western influences of dieting and exercising to achieve the ideal physical appearance. However, solely attributing the increase of EDs in Asia to Westernization would be inaccurate.

Eating disorders involve persistent concerns with eating behaviors and physical appearance.

Contributing factors to increasing EDs in Asia likely involve economic development and consumer culture, which may or may not be independent of influences from the West (Pike & Dunne, 2015). Transformations of the economic system in many Asian countries propelled the beauty and fashion industries (Pike & Dunne, 2015). With influences also from the media, physical appearance became a sort of measure to achieve one’s ideal self. What begins as an admiration of celebrities and models on social media may slowly lead to an obsession.

Beauty standards may be perpetuated on media.

Two of the most well-known EDs are anorexia nervosa (AN), which involves low caloric intake to promote weight loss, and bulimia nervosa (BN), which involves a pattern of binge eating followed by purging (e.g., self-induced vomiting, misusing laxatives, or excessive exercising) to prevent weight gain (Timko et al., 2019). As deadly as these eating disorders may be, they may manifest structural changes in the brain, which may lead to further alterations in brain function and behavior. Frank et al. (2013) compared individuals with AN, individuals who recovered from AN, individuals with BN, and healthy controls in order to understand how their brain and behavior might differ. The researchers obtained magnetic resonance imaging (MRI) data from all participants. In addition, individuals in the study completed the Revised Sensitivity to Reward and Punishment Questionnaire, which measures how people perceive rewards/punishments, and rated the sweetness and pleasantness of a sucrose solution.

Gyrus rectus in the frontal cortex indicated in purple

The structural brain imaging data demonstrated that compared to healthy controls, individuals who currently suffered from or had a history of EDs have a greater volume of the gyrus rectus, which is part of the orbitofrontal cortex that is responsible for emotional processing and the sensation of taste (Frank et al., 2013). There was actually a positive correlation between the gyrus rectus volume and both sucrose taste sweetness/pleasantness rating and reward/punishment sensitivity (Frank et al., 2013). In other words, people who had EDs may have had greater sensory experiences of taste and may be more sensitive to rewards/punishments. Because the gyrus rectus volume was increased in individuals who had an ED, people who suffer from EDs may experience stronger sensations to food, which may be overwhelming to the point at which food is viewed as a heightened reward or punishment.

Graph (A) suggests the eating disorder groups overall have greater left gyrus rectus gray matter volume than the healthy group. Graph (B) shows the positive correlation between the left gyrus rectus gray matter volume and sucrose pleasantness rating.

Understanding the role of the brain, specifically the gyrus rectus, in EDs can help us figure out why some individuals may be more susceptible to EDs. Although researchers are still learning the reasoning behind the increased gyrus rectus volume, one possibility may be due to different brain development in individuals who suffer from EDs (Frank et al., 2013). Provided that our development is highly dependent on genetics, variations in brain maturation may be related to genetics. In turn, the differences in brain matter that are seen in people with EDs may be caused at least partly by genetics.

In fact, there is an ongoing large-scale study of eating disorders genomics, including thousands of ED cases from 17 European countries and recent additional cases from East Asian countries (Bulik, 2021). Prior studies have found in Asian populations a prevalence of non-fat phobic anorexia nervosa, which involves restricting food intake without the drive to reach thinness and instead due to causes such as lack of hunger/appetite or abdominal pain (Pike & Dunne, 2015). If there are genetic factors in certain populations that naturally lead to lower appetite and/or enhanced development of the gyrus rectus area, as well as environmental factors that greatly emphasize the ideal beauty standard of thinness, some individuals may be especially vulnerable to EDs. Further analysis of eating disorder genomics may uncover the connection between the brain, eating disorders, and culture.

Our world consists of a heterogeneous population, so the description, diagnosis, and treatment of EDs may differ across cultures. Thus, pointing to Westernization as the cause for the surge of EDs in Asia would be inappropriate because a multitude of genetic and environmental factors may be at play. Furthermore, Western and non-Western ideal standards of beauty vary. Pike & Dunne (2015) explain that eating disorders are not specific to any one culture but rather a reaction to a culture. With additional research in diverse psychiatric genomic samples, we may be able to identify these harmful reactions early and provide culturally specific interventions before permanent damage is done.

Eating disorders can become dangerous, leading to serious health detriments.

References

Bulik, C. M. (2021). Eating disorders genetics in Asia. International Journal of Eating Disorders, 54(2), 184-186. https://doi.org/10.1002/eat.23445

Frank, G. K., Shott, M. E., Hagman, J. O., & Mittal, V. A. (2013). Alterations in brain structures related to taste reward circuitry in ill and recovered anorexia nervosa and in bulimia nervosa. American Journal of Psychiatry, 170(10), 1152-1160. https://doi.org/10.1176/appi.ajp.2013.12101294

Pike, K. M., & Dunne, P. E. (2015). The rise of eating disorders in Asia: a review. Journal of Eating Disorders, 3(1), 1-14. https://doi.org/10.1186/s40337-015-0070-2

Timko, C. A., DeFilipp, L., & Dakanalis, A. (2019). Sex differences in adolescent anorexia and bulimia nervosa: beyond the signs and symptoms. Current Psychiatry Reports, 21(1), 1-8. https://doi.org/10.1007/s11920-019-0988-1

6 thoughts on “The Culture of Eating Disorders

  1. Hello Erica,

    Your post was enlightening. I did not know about the existence of non-fat phobic anorexia nervosa. I had assumed that anorexia nervosa is always motivated by a desire to become thin.

    I was also intrigued by the connection between ED and the gyrus rectus.

    Great Post!
    Sincerely, Bashaina (Shasha)

    Liked by 1 person

  2. My main takeaway from this post is that due to the intricacies and unique nature of each culture, eating disorders can arise in a wide variety of ways. I think you did an outstanding job explaining these concepts through the use of strong, concise language. I would be curious to learn more about how eating disorders vary across gender and across different places. For instance, I think it would be cool to see statistics comparing males’ and females’ levels of left gyrus rectus gray matter volume and sucrose pleasantness ratings. I know these eating disorders are typically more common in women than in men, so I think it would be fascinating to compare the two at a neurological level. Great job on this post!!

    Liked by 1 person

  3. Hi Erica! This was a great read. As someone who’s studied this mental illness extensively and spoken with many college-age sufferers, I really appreciated your inclusion of the role of the brain (i.e. the gyrus rectus) in EDs. This hints at the idea that EDs can be genetically predisposed in some people, and how certain brain structures may lend themselves to a higher likelihood of developing restricting EDs such as anorexia and bulimia, or atypical EDs such as pica and ARFID that may not be driven by weight-related concerns. Research that may help us figure out why some individuals are more susceptible to EDs is vital, since EDs are the most dangerous and fatal mental illness in terms of mortality rates. I do know that EDs can affect brain development in young people as well, and since they’re so widespread among younger populations, it’s critical that we study this further and prioritize a furthering of our understanding. Great post! This is a great jumping-off point in our study of EDs across gender, economical and ethnic populations.

    Liked by 1 person

  4. Hey Erica!

    What a wonderful blog post. I appreciate the brief overview of the role genetics may play in EDs as well as the notion that Westernization is not a throughly applicable reason as to why EDs develop throughout certain parts of the world.

    Liked by 1 person

  5. I thought you did a really good job explaining the cultural misconceptions about eating disorders. Before reading this I didn’t know how the genetic makeup of ones brain could determine how susceptible a person is to having an eating disorder. This was a really helpful contribution because it proves that a persons social environment is not the only thing can determine obtaining an eating disorder. Also, this may also be helpful in providing better support and care fore those dealing with eating disorders, because it shows that developing this disorder is out of an individuals control

    Liked by 1 person

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