Are Eating Disorders Culture-Bound?

Eating disorders are more frequent in industrialized countries and more common among women than men, mirroring society’s pressure on women to be thin. Two recent studies have added new information on the role culture may or may not play in the development of certain eating disorders.

Culture and genetics

Drs. Pamela K. Keel, of Harvard University, and Kelly L. Klump, of Michigan State University, recently published an extensive search of the medical literature (Psychological Bulletin 2003;129:747) that began by evaluating whether the incidence of anorexia nervosa (AN) and bulimia nervosa (BN) has increased over time. According to the authors, AN has been observed in every non-western region of the world. In addition, epidemiological evidence also suggests that the prevalence may be similar to that reported in Western nations. Thus, AN doesn’t appear to be a culture-bound syndrome, according to the authors. They add that although cultural factors such as the increasing idealization of thinness may influence the rate of AN, such factors don’t seem sufficient or necessary. Also, throughout history, cases of sustained self-starvation, sometimes leading to recovery and sometimes leading to death, have been reported among young adolescent girls.

In contrast, numerous studies suggest that bulimic behaviors are more culture-bound, and these behaviors have been difficult to define. In addition, definitions of bulimic behaviors have varied over time, and cases originally defined as BN have been challenged by later investigators. The case of Ellen West, where some researchers challenge the original diagnosis of BN as representing a case of AN, is one example.

A study in Fiji

Concerns about weight and shape reach far beyond western communities. In what may be the first study of binge eating disorder, or BED, in a small-scale, indigenous or developing society, a Harvard group has evaluated binge eating and BED in a Fijian community.

A. E. Becker and her co-workers at Harvard Medical School investigated the prevalence of binge eating among 50 ethnic Fijian women in a rural community (Int J Eat Disord 2003;34:423). The women completed a self-report measure on dieting and their attitudes toward their body shape and change, a Nadroga language questionnaire on body image, and the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). Height and weight were also measured. Patterns of dieting, high body mass index (BMI), and attitudes toward eating and body image were then compared between women with and without a history of binge eating.

Incidence of binge eating

Ten percent of the participants reported binge eating at least weekly during the past 6 months and 4% reported symptoms consistent with BED. Those who were binge eaters also had a BMI above 35, a history of dieting, and a high concern with body shape. Binge eating was not associated with several markers of acculturation, but it was associated with a key, nontraditional Fijian attitude toward the body. Binge eating occurred in a social context with traditions concerning weight and diet that were quite different from Western populations. The authors also hypothesize that nontraditional Fijian attitudes toward weight and body shape may affect the incidence of binge eating in this population.