Navigating cultural differences when recovering from an Eating Disorder
Have you ever eaten at a restaurant of another culture, and been told off for unintentionally doing something that was considered ‘rude’?
For me, I vividly remember walking into a Chinese dumpling restaurant for a family dinner. As a young child, who did not yet grasp the necessary skills to utilize the commonly used utensil known as chopsticks, I decided to cheat and stick one chopstick into a big juicy dumpling. I will never forget the horror on my parent’s face when they saw what just happened, as they silently but sternly shrieked at me, “Don’t! It’s rude to leave the chopstick like that!” I later on learnt that doing so is frowned upon because it was akin to the Chinese practice of burning incense to the dead.
As I grew older and started travelling around the world, I started to notice these cultural differences a lot more. For example, in Western society, making noises while eating is viewed as ill mannered, while in Japan, slurping noodles loudly is a way to indicate that the dish is delicious.
This goes to show how one’s culture can affect an individual’s whole worldview and perception of food. Our various cultural and societal experiences make and shape us each invaluably into unique, individual human beings.
These cultural experiences are also important factors to consider in eating disorder treatment, as perceptions of body and food can be heavily influenced by culture. Depending on the culture and overall emphasis of traditions involved, one may find their surroundings either favourable or resistant to the building of a healthy body image and relationship with food.
Cultural risk factors for Eating Disorders
Note: There is never one single risk factor for an eating disorder, and is likely due to combination of causes.
Family environment
Family plays a huge role in the development of cultural values, and is also significantly influenced by the culture of society you grew up in. Certain family attitudes or dynamics may contribute to the risk of a child or teenager developing an eating disorder. The risk for eating disorders may be higher in families that:
Focus on high achievement
Emphasize on being perfect
Are concerned about appearance
Struggle with talking about or coping with negative emotions
Worry about being socially accepted
Are overly concerned about weight or physical fitness
This can be seen in some cases of Asian culture/families that have a hyper focus on physical appearance, especially with the notion that being thinner was linked to success or getting married, two key things that are highly regarded in this culture. Food and communal eating is at the heart of Asian culture, but this can be dreadfully confusing when it feels like your body is under constant assessment from immediate or extended family and friends.
It is common especially for families in Asian communities to comment on physical appearance. An example of this could be the same family members who keep trying to feed you, making the comments about your weight. This food-centric nature of Asian cultures has not allowed families to safely and genuinely engage in discussions about having a healthy relationship with food, and what to do if someone is exhibiting unhealthy food patterns.
Discrimination
Being treated unfairly because of your culture/religion, or living life in ways that are not acceptable to your culture of birth can negatively impact on one’s mental health.
As different cultures have different traditions, different rituals around food, and different body ideals, all these pressures can be extremely stressful and increase the risk of developing a body image issue or eating disorder. For individuals predisposed to developing an eating disorder, experiencing discrimination can be an environmental trigger that sets off the progression of this mental illness.
Food may be used as a way to cope with the negative emotions caused by experiences of discrimination and stigma. For example, individuals may engage in binge eating to escape from negative views of their own body, or how others perceive them.
Likewise, those struggling with hidden identities (e.g. sexual or gender minorities) may try to use physical appearance to feel accepted as a member of the majority group (e.g. cisgender and heterosexual), in hopes that this would decrease the chances of future discrimination.
Unfortunately, most treatments at present do not address discrimination or stigma as factors that contribute to eating disorders. It is critical to understand how to address discrimination in eating disorder treatment for all individuals.
Impact of Western Culture and Colonisation
Western culture in general, tends to place a hyper-focus on dieting and physical body appearance, namely thinness for women and muscularity for men, even though realistically it extremely difficult to achieve. People in this culture are bombarded with heavily filtered, photo-shopped, digitally retouched photos through advertising and the increased use of social media. This can project an unrealistic expectation of a certain body aesthetic, which can increase one’s body dissatisfaction.
People of colour often struggle with body image in a Western culture, where prevailing beauty standards primarily value thin, white women. They may feel that if they meet these cultural standards set by Western society through eating disordered behaviours to modify body shape, they will be more likely to ‘fit in’ with society and feel more accepted.
Unfortunately, the misconception that eating disorders affect only Caucasian women is still very common in many communities. It is interesting to note that some research has indicated that clinicians are less likely to diagnose eating disorders in people of colour, further propelling the myth that only Caucasian women suffer from Eating Disorders.
Aboriginal and Torres Strait Islander people experience eating disorders at an increased rate than those who are not. This highlights the impact a clash of cultures can have, considering the oppression and multigenerational trauma experienced by First Nations communities since Western colonisation. These feelings of exclusion and isolation can snowball and lead to poor psychological and social wellbeing, which further increases the risk for developing an eating disorder.
Adapting to new environments
Moving to a new town, city, or country can be exciting, but also comes with some challenges. The stress of migrating and trying to fit in to a brand new cultural environment can contribute to the development of disordered eating.
An example of this is could be when people find themselves turning to food and abnormal eating behaviours in attempt to cope with the adjustment into a new culture.
The clash between a person’s original, traditional culture and their new, adopted culture can increase the risk for body dissatisfaction and body image issues. This is especially true when values about physical aesthetics are involved.
The diversity of cultures in Australia makes it tricky to navigate so many unique traditions. Nearly half of Australians are either born overseas (first generation Australian) or have one or both parents born overseas (second generation Australian). Almost one-third of Australians identify as having culturally and linguistically diverse backgrounds, which highlights the significant variety in social, educational and economic settings that exist within our society.
With so many cultures in one community, individuals from differing cultural backgrounds may find it tricky navigating the large diversity of cultures, and there is an increased risk of clashes in cultural differences or misunderstandings to occur. Hence, it is even more crucial, as individuals or health professionals, to understand the influence of culture in the identification, treatment and prevention of eating disorders.
Things to consider when talking to someone with an Eating Disorder
Do not assume
The crux of eating disorder treatment lies in understanding that each individual is unique, and so will their experience of the world and their eating disorder.
Do not assume to understand why someone feels or behaves the way they do. Each individual is an expert on their own life and perspective. Remain open and let them tell you how their cultural experiences has shaped and impacted them.
Be open and curious
Ask about culture! This is incredibly important as it shows the many ways an individual’s cultural experiences and upbringing can impact their beliefs relating to body, food and self.
Doing your own research about different cultures is a good start to forming a solid foundation for navigating conversations about cultural differences well. Try reading a book or looking up the Internet about various cultures and traditions. You may even start by asking your own friends/family about their own traditions and cultures!
Some questions to consider when striking a conversation about culture and food/body:
What is your relationship to your body? What do you feel your body is intended for?
What is your relationship with body image? How does this relate to the eating disorder?
What is the relationship with your family and does this impact your eating behaviors?
Is religion important to you? What do you believe and does it relate to the way you view your body or eating habits?
Has society impacted your view of body image? Is this different from what you have been taught or believe?
Asking the right questions at the right time may be helpful in revealing some root issues of the eating disorder is, and how that plays into their relationship with the body and food.
Remember, culture is only one part of a bigger picture
While culture alone is not responsible for negative body image or eating disorders, there is no doubt it has substantial influence and potential to impact how someone feels about themselves and their body.
Helping someone recognise how cultural differences can contribute to the understanding of their perception of body image is an important step towards building a positive self-esteem and eating disorder recovery.
More importantly, we need to acknowledge and be aware that eating disorders and body image issues do not discriminate; it can affect anyone at any time, from any culture or background.
Additional resources and support
The Embrace Project: A project run by Mental Health Australia, which provides a focus on mental health for people from culturally and linguistically diverse backgrounds. (https://embracementalhealth.org.au/about-us)
Health Translations: The Centre for Culture, Ethnicity and Health offers free translations of mental health information in more than 100 languages (https://www.ceh.org.au/?s=health+translations)
References:
https://www.sciencedirect.com/science/article/abs/pii/S0005789406000505