Abstract
Background
There is debate as to whether the development of an eating disorder (ED) may be triggered by acculturation to Western culture. While there is evidence to suggest that acculturation to Western culture is associated with risk of having an ED, these findings are limited, vary significantly, and are sometimes conflicting.
Aims
To review the literature and empirical data on the association between ED symptoms and acculturation in the context of Western culture.
Methods
A systematic search of peer-reviewed publications using a combination of the keywords “Culture”, “Acculturation” and “Eating disorders” was first performed in August 2014 and updated in February 2015 with the following databases: PubMed and SCOPUS. Reference lists were also hand searched. In total, the search provided more than 50 studies. Following screening (as stated in the PRISMA guidelines) of the titles and abstracts by inclusion and exclusion criteria and quality assessment of the full text, 25 studies were identified to be appropriate for the review. Articles were examined in relation to the findings, as well as the ED and acculturation measures used.
Results
Eleven studies suggested considerable association between ED and culture change/acculturation. Six studies suggested little or no association between ED and culture change/acculturation. Eight studies did not primarily examine association, yet generated valuable insight. While there was relative consistency across studies in terms of the ED measures selected, measures of acculturation varied significantly.
Conclusions
The majority of the evidence reviewed here suggests that there is a substantial association between culture change and ED psychopathology. However, both greater and lesser acculturation have been identified as risk factors for the development of an ED, and this varies depending on the group studied as well as how acculturation and culture change are conceptualized and measured. Further research is warranted to form cross-culturally acceptable definitions and measures of problematic eating, and healthy and high acculturation, to study the relationship between EDs and the process of acculturation to Western culture.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40519-015-0189-9/MediaObjects/40519_2015_189_Fig1_HTML.gif)
Similar content being viewed by others
References
Abdollahi P, Mann T (2001) Eating disorder symptoms and body image concerns in Iran: comparisons between Iranian women in Iran and in America. Int J Eat Disord 30:238–259. doi:10.1002/eat.1083
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders: DSM-5. American Psychiatric Association, Washington, D.C
Ball K, Kenardy J (2002) Body weight, body image, and eating behaviours: relationships with ethnicity and acculturation in a community sample of young Australian women. Eat Behav 3:205–216. doi:10.1016/S1471-0153(02)00062-4
Berry JW (2005) Acculturation: living successfully in two cultures. Int J Intercult Relat 29:679–712. doi:10.1016/j.i**trel.2005.07.013
Barry DT, Garner DM (2001) Eating concerns in East Asian immigrants: relationships between acculturation, self-construal, ethnic identity, gender, psychological functioning and eating concerns. Eat Weight Disord 6:90–96. doi:10.1007/BF03339757
Bruch H (1973) Eating disorders: obesity, anorexia and the person within. Basic Books, New York
Cachelin FM, Veisel C, Barzegarnazari E, Striegel-Moore RH (2000) Disordered eating, acculturation and treatment-seeking in a community sample of hispanic, asian, black, and white women. Psychol Women Q 24(3):244–253. doi:10.1111/j.1471-6402.2000.tb00206.x
Cachelin FM, Phinney JS, Schug RA, Striegel-Moore RH (2006) Acculturation and eating disorders in a Mexican American community sample. Psychol Women Q 30:340–347. doi:10.1111/j.1471-6402.2006.00309.x
Celenk O, Van de Vijver F (2011). Assessment of acculturation: issues and overview of measures. Online Read Psychol Cult 8(1). doi:10.9707/2307-0919.1105
Chamorro R, Flores-Ortiz I (2000) Acculturation and disordered eating patterns among Mexican American women. Int J Eat Disord 28:125–129. doi:10.1002/(SICI)1098-108X(200007)28:1<125::AID-EAT16>3.0.CO;2-9
Chan CKY, Glynn Owens R (2006) Perfectionism and eating disorder symptomatology in Chinese immigrants: mediating and moderating effects of ethnic identity and acculturation. Psychol Health 21(1):49–63. doi:10.1080/14768320500105312
Davis C, Katzman MA (1999) Perfection as acculturation: a study of the psychological correlates of eating problems in Chinese male and female students living in the United States. Int J Eat Disord 25:65–70. doi:10.1002/(SICI)1098-108X(199901)25:1<65::AID-EAT8>3.0.CO;2-W
Di Nicola V (1990) Anorexia multiform: self-starvation in historical and cultural context: anorexia nervosa as a culture-reactive syndrome. Transcult Psychiatr Res Rev 27:245–286. doi:10.1177/136346159002700401
Esteban-Gonzalo L, Veiga OL, Gomez-Martinez S, Veses AM, Regidor E, Martinez D, Calle MA (2014) Length of residence and risk of eating disorders in immigrant adolescents living in Madrid; the AFINOS study. Nutricion Hospitaliaria 29:1047–1053. doi:10.3305/nh.2014.29.5.7387
Fitcher MM, Quadflieg N, Georgopoulou E, Xepapadakos F, Fthenakis EW (2005) Time trends in eating disturbances in young Greek migrants. Int J Eat Disord 38(4):310–322. doi:10.1002/eat.20187
Geller G, Thomas CD (1999) A review of eating disorders in immigrant women: possible evidence for a culture-change model. Eat Disord 7:279–297. doi:10.1080/10640269908251200
Gordon RA (2000) Eating disorders: anatomy of a social epidemic, 2nd edn. Blackwell, Oxford
Gordon KH, Castro Y, Sitnikov L, Holm-Denoma JM (2010) Cultural body shape ideals and eating disorder symptoms among white, latina, and black college women. Cult Divers Ethnic Minor Psychol 16:135–143. doi:10.1037/a0018671
Greenberg L, Cwikel J, Mirsky J (2007) Cultural correlates of eating attitudes: a comparison between native-born and immigrant university students in Israel. Int J Eat Disord 40:51–58. doi:10.1002/eat.20313
Humphry T, Ricciardelli L (2004) The development of eating pathology in Chinese–Australian women: acculturation versus culture crash. In: Proceedings of the 38th APS annual conference: development through diversity. Melbourne Australian Psychological Society, Melbourne, Victoria, pp 93–97. doi:10.1002/eat.10269
Iyer DS, Haslam N (2003) Body image and eating disturbance among south asian-american women: the role of racial teasing. Int J Eat Disord 34(1):142–147. doi:10.1002/eat.10170
Jackson SC, Keel PK, Lee YH (2006) Trans-cultural comparison of disordered eating in Korean women. Int J Eat Disord 29:498–502. doi:10.1002/eat.20270
Jennings PS, Forbes D, McDermott B, Juniper S, Hulse G (2005) Acculturation and eating disorders in Asian and Caucasian Australian adolescent girls. Psychiatry Clin Neurosci 59:56–61. doi:10.1111/j.1440-1819.2005.01332.x
Jennings PS, Forbes D, McDermott B, Hulse G (2006) Acculturation and eating disorders in Asian and Caucasian Australian university students. Eat Behav 7:214–219. doi:10.1016/j.eatbeh.2005.08.006
Kang SM (2006) Measurement of acculturation, scale formats, and language competence; their implication for adjustment. J Cross Cult Psychol 37:669–693. doi:10.1177/0022022106292077
Katzman MA, Hermans KME, van Hoeken D, Hoek HW (2004) Not your “typical island woman”: anorexia nervosa is reported only in subcultures in Curacao. Cult Med Psychiatry 28:463–492. doi:10.1007/s11013-004-1065-7
Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151:65–94. doi:10.7326/0003-4819-151-4-200908180-00136
Lake AJ, Staiger PK, Glowinski H (2000) Effect of Western culture on women’s attitudes to eating and perceptions of body shape. Int J Eat Disord 27(1):83–89. doi:10.1002/(SICI)1098-108X(200001)27:1<83::AID-EAT9>3.0.CO;2-J
Miller M, Pumariega AJ (2001) Eating disorders: a historical and cross-cultural review. Psychiatry 64:93–110. doi:10.1521/psyc.64.2.93.18621
Mussap AJ (2009) Acculturation, body image and eating behaviours in Muslim-Australian women. Health Place 15(2):532–539. doi:10.1016/j.healthplace.2008.08.008
Pavlova B, Uher R, Papezova H (2008) It would not have happened to me at home: qualitative exploration of sojourns abroad and eating disorders in young Czech women. Eur Eat Disord Rev 16:207–214. doi:10.1002/erv.819
Perez M, Voelz ZR, Pettit JM, Joiner Jr TE (2002) The role of acculturative stress and body dissatisfaction in predicting bulimic symptomatology across ethnic groups. Int J Eat Disord 31(4):442–454. doi:10.1002/eat.10006
Sánchez-Johnsen LAP, Hogan K, Wilkens LR, Fitzgibbon ML (2008) Correlates of problematic eating behaviours in less acculturated Latins. Eat Behav 9:181–189. doi:10.1016/j.eatbeh.2007.07.008
Soh NL, Touyz S, Dobbins T, Surgenor LJ, Clarke S, Cohn MR, Walter G (2007) Restraint and eating concern in North European and East Asian women with and without eating disorders in Australia and Singapore. Aust N Z J Psychiatry 41:536. doi:10.1080/00048670701332318
Sussman M, Truong N, Lim J (2007) Who experiences “America the beautiful”?: ethnicity moderating the effect of acculturation on body image and risks for eating disorders among immigrant women. Int J Intercult Relat 31:29–49. doi:10.1016/j.i**trel.2006.03.003
Tsai G, Curbow B, Heinberg L (2003) Sociocultural and developmental influences on body dissatisfaction and disordered eating attitudes and behaviours of asian women. J Nerv Ment Dis 191(5):309–318
Wildes JE, Emery RE (2001) The roles of ethnicity and culture in the development of eating disturbance and body dissatisfaction: a meta-analytic review. Clin Psychol Rev 21:521–551. doi:10.1016/S0272-7358(99)00071-9
Yamamiya Y, Shroff H, Thompson JK (2008) The tripartite influence model of body image and eating disturbance: a replication with a Japanese sample. Int J Eat Disord 41:88–91. doi:10.1002/eat.20444
Acknowledgments
KT would like to thank the Swiss Anorexia foundation and Maudsley Charity ‘Health in Mind’ for their financial assistance.
Conflict of interest
None.
Ethical approval
This article does not contain any studies with human participants performed by any of the authors.
Author information
Authors and Affiliations
Corresponding author
Additional information
E. Doris and I. Shekriladze contributed equally.
Rights and permissions
About this article
Cite this article
Doris, E., Shekriladze, I., Javakhishvili, N. et al. Is cultural change associated with eating disorders? A systematic review of the literature. Eat Weight Disord 20, 149–160 (2015). https://doi.org/10.1007/s40519-015-0189-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40519-015-0189-9