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Eating disorders are generally defined in psychiatric terms as a disturbance in the perception of body shape and poor body image, resulting in restrictive or binge eating/purging patterns. Current literature had conceptualized eating disorders as culture-bound syndromes with nearly 7 million Americans and 1.15 million citizens of the UK, predominantly women, suffering from these syndromes. Idealized and normally unattainable body types of extreme thinness appear to be at the core of the syndrome. Although every culture has a normative body type associated with attractiveness, associated eating disorders had been found predominantly in Western countries. As worldwide immigration has reached historical highs with movement patterns from Asian, African, or Latin American countries to Western ones, the question has been raised as to the effects of immigration on women’s body image and risks for eating disorders. This chapter summarizes the extant literature on the effects of immigration and acculturation on body image and eating behavior. The effects are complex with home culture, level of acculturation, and other demographic variables affecting clinical dissatisfaction with one’s body and disordered eating. Methodological problems plague this research area and the inconsistent use of scales and other assessments impede rigorous comparisons or the ability to integrate the literature.
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3241
V.R. Preedy et al. (eds.), Handbook of Behavior, Food and Nutrition,
DOI 10.1007/978-0-387-92271-3_202, © Springer Science+Business Media, LLC 2011
Abbreviations
APA American Psychiatric Association
ED Eating disorders
202.1 Introduction
Eating disorders are generally defined as a disturbance in the perception of body shape resulting in
restrictive or binge eating/purging patterns (Mintz and O’Halloran 2000). Extant literature had con-
ceptualized eating disorders as culture-bound syndromes (Prince 1985), manifested in two disorders
described in the DSM-IV: anorexia nervosa and bulimia. Anorexia is defined as a disorder in which
the individual is resistant to maintaining a minimally normal weight, has an intense fear of gaining
weight, and has infrequent menstrual periods (American Psychiatric Association 1994); bulimia is
defined as a disorder in which the individual has recurrent episodes of excessive binge eating, a
strong sense of lack of control, and recurrent compensatory behaviors (e.g. use of laxatives, enemas,
vomiting, excessive exercise (APA 1994)). In the extreme, both syndromes can lead to death by
starvation. Moreover, these eating disturbances have been understood as specific to Western culture
as, in general, women in cultures removed from Western media exposure (Akiba 1998) or economic
development and modernization (Lee and Lee 2000) had higher body esteem and lower fat concerns.
Significant levels of disordered eating have been found in the USA, Britain, Canada, and Australia
with lower prevalence in Western Europe and rare occurrences in Africa and Latin America.
202.2 Cultural Differences in Body Ideal
Culture, it appears, influences both attitude toward body shape in general, evaluation of one’s own
body, and eating behaviors. While body shape, size, and weight are essential elements of physical
attractiveness for many cultures, each differs in their preferences. Kenyans (Furnham and Alibhai 1983)
Chapter 202
Body Image and Eating Disorders Among Immigrants
Nan M. Sussman and Nhan Truong
N.M. Sussman (*)
Department of Psychology, College of Staten Island, City University of New York,
Staten Island, New York
e-mail: nan.sussman@csi.cuny.edu
3242 N.M. Sussman and N. Truong
and Ugandans (Furnham and Baguma 1994), for example, rated larger female figures more favorably
than did British women, who found female anorexic figures appealing. Similarly, Cogan, Bhalla,
Sefa-Dedeh, and Rothblum (1996) found that women from Ghana were more likely to rate larger
body sizes as ideal compared to US students. Caribbean women of African descent maintained this
preference with studies finding obesity associated with satisfaction, wealth, and happiness (Simeon
et al. 2003). Little normative data exists about Central and South American women in their home
country although there is speculation that the body ideal is shorter and rounder than the US ideal.
Mexican-Americans, for example, are heavier than their White nonHispanic counterparts, and chil-
dren who were overweight had a stronger affiliation to Mexican culture (Ayala et al. 2007).
In traditional Chinese culture, heavy women were evaluated positively (Nasser 1988) and some
contemporary Chinese women view plumpness as a component of the ideal female body shape (Chen
and Swalm 1998). Current studies of Hong Kong Chinese adolescent females find, in comparison with
American adolescents, similar body dissatisfaction but lower drive for thinness, and among college-
aged Chinese women, lower body dissatisfaction and drive for thinness (Leung et al. 2004). Chinese
women also consistently score lower on self-esteem scales which may be attributed in part to the self-
effacing nature of Chinese values (Bond and Cheung 1983). Scant research has investigated normative
body image among Eastern European women. However, in a comparison of the link between slimness
and sexual attractiveness of women rated by Finnish and Russian men, researchers found the slim ideal
was held by the Finnish but not the Russians (Haavio-Mannila and Purhonen 2001).
Some studies have also examined the role of ethnicity within a single country in shaping body
preferences. Results indicate that, within the US, Asians and Whites prefer the thin body ideal and
Hispanics and African-Americans tend to prefer a larger body size (Molloy and Herzberger 1998).
Black women tend to be less preoccupied with dieting and weight loss and less negative about their
body image than White and Latin American women (Cash and Henry 1995; Miller et al. 2000). Also,
African-American women perceived themselves to be more sexually attractive, have higher self-
esteem, and higher body esteem than the other ethnic groups (Miller et al. 2000).
There is support among many studies correlating poor body satisfaction with increased risk or
prevalence of eating disorders. In the USA, thinness is a core body ideal and is highly valued (Garner
et al. 1980). Unfortunately, this ideal is often unattainable and results in negative evaluations of one’s
body. Two concepts which have been developed to assess the subjective self-perception of the body,
commonly referred to as body image, are body esteem, an overall evaluation of one’s body, and sat-
isfaction with individual parts of the body. General self-esteem is also associated with both body
image and eating disorder risks (Mintz and Betz 1988).
202.3 Body Image and Eating Disorders
The majority of American women tend to overestimate their body size, and thus view their bodies in
self-deprecating ways (Lewis and Donaghue 1999) which results in general dissatisfaction with their
bodies (Cash and Henry 1995) and poor self-esteem (Matz et al. 2002). America’s obsession with
thinness combined with body dissatisfaction, which has consistently been demonstrated to be a risk
factor in eating disorders (Altabe and Thompson 1992), has resulted in negative physical health
consequences for an estimated seven million (predominantly white) females in the USA who are
afflicted with eating disorders (EDs) (Eating Disorder Statistics 2003) and many more who are at
risk for disordered eating. Among White US women, EDs were correlated with low body esteem
(Striegel-Moore et al. 1993) and low self-esteem (Joiner and Kashubeck 1996) among other factors.
It is estimated that 1.15 million people in the UK have an eating disorder.
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202 Body Image and Eating Disorders Among Immigrants
This link between body dissatisfaction, low body or self-esteem, and disordered eating is not
found uniformly in other countries or among immigrant samples. Chinese (Pan 2000) and Japanese
(Mukai et al. 1998) women had lower body esteem than US women but not greater rates of eating
disorders and Doan (2001) found that self-esteem and eating disorder symptomology were unrelated
among East Asian-Americans. Among Indian female adolescents, decreased appetite and excessive
weight loss is found but not accompanied by body image disturbances or fear of becoming fat
(Khandelwal and Saxena 1990). Additionally, Afro-Caribbean British women, compared to Caucasian
British, were less likely to have feelings of depression or anxiety related to disordered eating atti-
tudes (Dolan et al. 1990). However, among Chinese-Australian women, eating pathology was associated
with lower levels of satisfaction with the body. In summary, culture shapes its citizens’ preferences
for body shape and size, evaluation of body against a cultural norm (body image), and the association
between body attitudes and eating behaviors. Therefore, in this chapter, the literature will be reviewed
by world region.
202.4 Immigration and Cultural Transitions
Rapid cultural changes in the world, coinciding with the expanded influence of Western culture and
increased immigration, have shifted our current thinking and understanding of eating disorders from
culture-bound to culture-transition syndromes (see Table 202.1). Transitions may take place within
a culture as Western values and attitudes have permeated domestic perspectives of body image. For
example, Khandelwal and Saxena (1990) indicate that India is increasingly influenced by Western
values and may result in anorexia being more prevalent. Transitions also take place within an indi-
vidual’s psychological attitudes, values, and behaviors as one migrates from home country to host
country. Among the new values and norms to which immigrants are exposed are those pertaining to
the culturally ideal body type and standards of physical attractiveness. Thus, one question posed by
researchers is “What is the effect of immigration and its consequences for body image and the risks
for eating disorders?”
Table 202.1 Key facts about immigration
1. In 2005, world immigration totaled 190,633,564
2. Of the top ten countries that were recipients of migrants, eight were Western
economically developed countries (USA, Russia, Germany, France, Canada,
UK, Spain, Australia).
3. Regions of origin of immigrants:
To From
Percent of total immigration
to host country (%)
USA Mexico 30
East and Southeast Asia 18
Central America 8
France North Africa 47
Canada East and South Asia 12
UK South Asia 15
Spain South America 18
Australia Asia 7
Germany Europe 50
This table provides recent demographic statistics on immigrant country of origin
and country of destination
3244 N.M. Sussman and N. Truong
Immigrants undergo a process of cultural transition in which their attitudes, beliefs, values, and
behaviors change as they adapt to their new home country. This adaptation process is referred to as
acculturation (see Table 202.2), although recent conceptualizations suggest a more complex and
nuanced intersection of maintenance of attitudes from the country of origin and adaptation of atti-
tudes from the new home country (Trimble 2003). Growing attention has been paid to the role of
multi-directional acculturation on the mental and physical health of immigrants living in the USA,
Australia, and Britain. A second research question asks “Will the process of immigration uniformly
influence all migrants or will the level of individual acculturation to the host country affect body
attitudes and eating behaviors?” Speculation is that both individual level and cultural level variables
modify the effect of immigration on body image and eating disorders.
Findings from the past literature are equivocal. Immigration to a Western country has been identified
as a possible risk factor in eating disorders (Geller and Thomas 1999) as has been the increased accul-
turation level. The latter has been found among Hispanic-American girls (Gowen et al. 1999) and other
acculturated ethnic minority women (Cachelin et al. 2000; Chamorro and Flores-Ortiz 2000).
Other studies find no link between acculturation and eating disorders among Asian- and Chinese-
American women (Haudek et al. 1999; Pan 2000). Among East Asian immigrants, acculturation did
not predict desire to be thinner, feelings of guilt after eating, or fear of being overweight (Barry and
Garner 2001). Huang (2001) found that only Asian-American women, who more strongly identified
with White American culture, were more likely to engage in compensatory weight loss behavior but
not binge eating. Among African-Americans, evidence demonstrates that they are less likely to inter-
nalize the thin ideal than Asian or White Americans (Shaw et al. 2004).
These inconsistencies may be explained by examining residential patterns of immigrants. Urban
dwellers who are surrounded by ethnic peers and thus less influenced by the dominant culture’s body
standards may be buffered against body dissatisfaction and risks for eating disorders. In two studies,
Caribbean-Americans (Sussman et al. 2007) and Mexican-Americans (Fisher et al. 1994) who lived
in ethnic urban enclaves revealed lower anxiety, higher self-esteem, and a few ED symptoms than
those peers living in suburban or more integrated neighborhoods.
This chapter, in addition to reviewing the literature by world region of the immigrant, will also report
the effects of acculturation. It should be noted that measures of acculturation vary dramatically among
studies: some include a unitary measure while others are multi-dimensional; some use self-report assess-
ments and others are archival. These variations make direct comparisons and syntheses troublesome.
Table 202.2 Definitions and explanations
1. Acculturation: Although the concept is complex, we refer to the adoption of thoughts, attitudes, values, and
behaviors of the host culture. Acculturation has been measured employing single variables such as length of
residence in the host country, and multi-item scales of language use.
2. Body image: Body image refers to an evaluation of one’s body (positive or negative) that involves feelings about
his/her body in relation to the body ideal. Some concepts employed to measure body image include body parts
dissatisfaction/satisfaction, body dissatisfaction/satisfaction and body esteem.
3. Eating disorder: Eating disorder in this chapter has referred to the clinical syndromes anorexia nervosa and
bulimia, as well as risk for the development of eating disorders, maladaptive eating attitudes and behaviors, and
eating pathology.
4. Immigrant: Immigrant refers to individuals who moved from their country of birth and settled in the host
country. We distinguished between individuals who migrated to the host country, referred to as “immigrants” or
“first generation immigrants” and individuals who were born in the host country but had immigrant parents,
referred to as “second generation immigrants”.
5. Host country: The country to which the immigrant migrated and settled. This term is in contrast to the home
country, the country to which the immigrant was born.
This table lists five terms and their definitions that are used often in the chapter. The definitions will improve the
understanding of the research discussed in the text of the chapter
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202 Body Image and Eating Disorders Among Immigrants
202.4.1 Immigrants from Asia
Very few studies have examined body image and eating disordered attitudes and behaviors of non-
clinical Asian sample populations within their own countries. Kayano et al. (2008) examined eating
attitudes and body dissatisfaction among Filipino, Omani, Japanese, Indian, and Euro-American
adolescents. Not surprisingly, both male and female European youth indicated the greatest desire to
be thin compared to the other groups. However, Filipino males and females and Indian females indi-
cated greater maladaptive eating attitudes than their European counterparts. Among Filipinos, non-
hunger related motivational eating patterns have been shown as a result of “demographic changes,
economic development, and nutritional transitions” (p. 23). These motivations include the environ-
ment, such as being surrounded by delicious foods, eating socially, particularly among family and
friends, and emotional eating due to loneliness, depression, and anxiety. Eating disordered behav-
ioral patterns among Indians may be due to belief aspects of their Hindu religion, which include
vegetarianism. Perhaps the greater their beliefs in Hinduism, the more likely they are to follow a
strict vegetarian diet which in turn leads to higher disordered eating attitudes. Among the female
Japanese adolescents, maladaptive dieting and a desire to be thin occurred when there was an increase
in body mass index (BMI). Among the Filipino, Indian, and Japanese Asian groups, the Japanese
adolescents appeared to have the healthiest eating attitudes and behaviors overall. This may be due
to the relatively low BMI in Japanese female adolescents, and therefore they were satisfied with their
bodies and felt no need to diet or be thin.
202.4.1.1 Body Image and Eating Disorders
Studies on Asian immigrants have generally shown that migrating to Western countries such as the
USA and European countries has led to lowered body image and greater risk for eating disorders.
Waller and Matoba (1999) examined the relationship between emotional eating and disordered eating
among Japanese women who were born and currently reside in their home country, Japanese women
who have lived in the UK for at least 9 months and currently reside in the UK, and British women
living in the UK. Japanese women living in the UK showed a relationship between emotional eating
and bulimic attitudes, similar to the patterns found in the British women. However, this association
was not found in the Japanese women in Japan. In another study comparing Chinese women from
Hong Kong and Chinese women from mainland China (Lee and Lee 2000), Chinese women from
Hong Kong adopted the Western beauty ideal, were slimmer, had greater body dissatisfaction, and
greater eating disorder behaviors. In another study by Mujtaba and Furnham (2001), British Asian
immigrant females from Pakistan reported higher levels of risk for developing eating disorders com-
pared to Pakistani females in Pakistan. In Choudry and Mumford’s (1992) study, Pakistani immigrants
living in the UK showed a higher prevalence of bulimia than Pakistanis residing in their home country.
Thus, for Asian women moving to the West, immigration itself appears to be a risk factor for EDs.
202.4.1.2 Acculturation Effects
A closer examination of the process of immigration has shown that more acculturated Chinese
immigrants to Western culture report lower body satisfaction and lower eating disorders. Among
immigrant Chinese-Americans born in Taiwan, China, and Hong Kong, participants who were less
Chinese (more acculturated) on the Chinese Orientation subscale showed lower body satisfaction
3246 N.M. Sussman and N. Truong
(Cheng 2001). In another study of Chinese undergraduate students who were primarily born in
Hong Kong (10% were US born) and lived in the USA, females who were bicultural or mostly
American (high acculturation) on the Suinn-Lew Acculturation Scale reported significantly greater
bodily perfectionism and higher eating disorder scores than females who were very or mostly Asian
(low acculturation) and males (Davis and Katzman 1999).
Some researchers have examined underlying psychological mechanisms through which accultura-
tion plays a role in body image and eating disordered attitudes and behaviors. Humphry and Ricciardelli
(2004) found that in their sample of primarily Asian-Australian immigrants who were born in China,
Hong Kong, Malaysia, and Singapore (7% were Australian-born), women who had a weak Chinese
identity (high acculturation) on the Ethnic Identity Scale did not differ from those with a strong
Chinese identity (low acculturation) on eating disorder attitudes. It was only when high acculturated
Chinese-Australian females perceived more pressure to lose weight from their father or best friends
that they showed greater eating disorder attitudes than their low acculturated counterparts. In the same
study, women who reported a high Chinese identity and higher parental care showed higher levels of
eating disorders. In another study on Chinese immigrants living in New Zealand, two aspects of accul-
turation, values toward other groups and interpersonal distrust, mediated the relationship between
positive or healthy appraisal of perfectionism and eating disorders (Chan and Owens 2006). Here, a
positive appraisal of perfectionism appears to serve as a buffer between adopting the values, attitudes,
and behaviors of the host culture and the development of eating disorders.
Other studies have indicated that acculturation does not play a role in the body image and eating
disorders. In a study on East Asian immigrants by Barry and Garner (2001), acculturation was not
related to wanting to be thin, guilt from eating, afraid of being overweight, and worrying about hav-
ing fat on the body. In another study (Pan 2000), among Chinese-American women acculturation did
not correlate with body image attitudes, eating attitudes, and eating behaviors. In Soh et al.s (2007)
study of Northern European and East Asian women with and without eating disorders, acculturation
was not related to eating concerns among East Asian Australians and Singaporean Chinese women.
Based on the National Latino and Asian American Study, acculturation – defined as US born versus
immigrant, number of parents born in the USA and length of residence in the USA – did not predict
eating disorders within the past 12 months (Nicdao et al. 2007). In two studies employing the Suinn-
Lew Asian Self-Identity Acculturation Scale (SL-ASIA), one on South Asian-American women
who were predominantly Indian (89%) and second generation (79%) (Iyer and Haslam 2003), and
the other on Korean immigrant women to the USA (18%) and second generation Korean-American
women (82%) (Jackson et al. 2006), acculturation was not related to risk for developing eating dis-
orders. Iyer and Haslam (2003) also found that the SL-ASIA was not associated with body image
disturbance in their sample of South Asian-American women.
Researchers have examined other variables that may contribute to body image and eating disor-
ders among this ethnic population. For Asian women, not only do societal pressures to be thin play
a role in eating disordered behaviors, but also intrafamilial relations and conflicts. In Humphry and
Ricciardelli’s (2004) sample of predominantly Asian-Australian immigrants, parental bonding and
physical appearance also predicted eating disorder attitudes, such that Chinese-Australian women
who reported high parental overprotection and less satisfaction with their physical appearance tended
to show higher eating disorder attitudes.
Among British Asian females who were predominantly Muslim second generation immigrants
from India- and Pakistan-born parents (Furnham and Husain 1999), conflicts with parents over social-
izing – going out and choice of friends – correlated with higher risk for eating disorders. Similarly, in
a study of British Asian female immigrants from Pakistan and Pakistani females in Pakistan, greater
conflict with parents and greater overprotection from parents were associated with higher risk for
developing eating disorders (Mujtaba and Furnham 2001). British Asian immigrants had greater
conflict with parents, greater overprotection from parents, and higher risk for developing eating disorders
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202 Body Image and Eating Disorders Among Immigrants
than their Pakistani counterparts. In a study of South Asian US immigrant women (31%) and American
born South Asian women (69%), three aspects of teasing, overall appearance, weight and shape, and
ethnicity were related to body dissatisfaction and eating disorders (Reddy and Crowther 2007).
The current paradigm around eating disordered behavior and attitudes is understood to be culture
transition rather than culture-bound. In many countries, Western cultural values and ideas around the
thin body ideal have influenced their culture’s body image ideal. Interestingly, unique symptoms
associated with eating disorders have been evidenced in India (Khandelwal and Saxena 1990). Here,
anorexia and bulimia are less prevalent than in countries where thinness and body image is empha-
sized. Whereas anorexia is generally found to be correlated with negative body image, this is not the
case among this population. Rather, hysterical symptoms have been found to correlate with anorexia.
This may be a result of poor socioeconomic conditions, where poverty and famine are among the
main concerns in the everyday lives of these people.
202.4.2 Immigrants from Central and South America
The USA is the largest recipient of immigrants from Central and South America and these residents,
collectively referred to as Hispanics, are the largest immigrant group in the USA; Mexican-Americans
form the majority. Attempts to estimate the frequency of ED among this population has resulted in
conflicting figures: One study indicates that 4.3% of Mexican-American women suffer from Bulimia,
similar to Caucasian Americans (Lester and Petrie 1998) while another study concludes that Hispanic
have more severe binge eating compared to White and Black Americans (Fitzgibbon et al. 1998).
Among Mexican-American women, the relationship between body esteem/satisfaction, acculturation,
and eating disorders is also inconsistent. One study found no effect of acculturation on body esteem
(Schwartz et al. 1998); one found no effect of body satisfaction on bulimia symptomology (Lester and
Petrie 1995); and two others found that body dissatisfaction was positively related to anorexia and
bulimia (Joiner and Kashubeck 1996; Straeter 2002). More consistent were the results examining the
association between acculturation to the USA and ED: Three studies found that acculturation did not
predict ED (Joiner and Kashubeck 1996; Kuba and Harris 2001; Lester and Petrie 1995) while
Chamorro and Flores-Ortiz (2000) report that more acculturated women had more disordered eating.
However, each of these studies used different measures of acculturation (one used a US Eurocentric
scale and two others used generation as a proxy for acculturation – second generation women, pre-
sumed to be more acculturated, compared to first generation) which weakens comparisons.
Puerto Rican immigrants in New York and Cuban immigrants in Florida form two other large
groups who have been investigated. In a qualitative study of 12 women from both ethnic groups,
those who immigrated at a young age and were assumed to be more acculturated to US culture were
more dissatisfied with their bodies (Smith 2001). In another study, among Cuban-American women,
body dissatisfaction was linked to ED but acculturation was not (Rodriguez-Hanley 2004).
202.4.3 Immigrants from Russia and Eastern Europe
In Eastern Europe, the thin body ideal is not emphasized as it is in Western countries and thus striving
for extreme thinness and accompanying eating disorders are less frequent. Few studies have examined the
role of acculturation on body image and eating disorders among Eastern European immigrants. Some
studies have found that the more acculturated to Western body ideals Eastern European immigrants
became, the more negative was their body image and the higher their eating disordered attitudes and
3248 N.M. Sussman and N. Truong
behaviors. Greenberg, Cwikel, and Mirsky (2007) examined risk for developing eating disorders in
both male and female native Israeli and immigrant European college students living in Israel. The
majority of the immigrants came from the former Soviet Union (93%), mostly Russia and Ukraine. The
immigrants were separated into two groups, veteran immigrants with a length of residence in Israel of
approximately 9.5–12.5 years, and new immigrants with a length of residence of about 1.5–2.5 years.
In general, the native Israeli and veteran immigrants indicated a higher prevalence for eating disorder
attitudes. Veteran female immigrants showed a higher risk for developing eating disorders than the new
female immigrants. Differences in female immigrant groups were found to be the greatest with bulimia.
This suggests that Russian and Ukrainian female immigrants who live in Israel for a longer length of
time are more likely to adopt the thin ideal and standards of a Westernized culture and are therefore
more at risk for developing eating disorders than those who recently immigrated to Israel. The research-
ers suggest that the lack of prevalence for eating disordered attitudes among the new immigrants may
be because they are less likely to have served in the Israeli Defense Forces, the Israeli army, which
would expose them to maladaptive eating behaviors and attitudes. Also among the veteran immigrants,
prolonged exposure to Western media may have influenced their eating attitudes and behaviors.
Bulik (1987) presented two case studies of Eastern European women who were new immigrants to
the USA with their families. Before both women immigrated to the USA they were not preoccupied with
the desire to be thin. However, within 2 years after living in the USA, they developed eating disorders,
one with bulimia and the other with anorexia nervosa. Both women left their country during their ado-
lescence and adapted to American culture quickly. Adopting a sense of independence from the family
conflicted with the traditional family values of their own culture. This led to feelings of guilt. Also, these
two women played conflicting family roles, the loyal child and the parent. Since their parents decided to
immigrate to the USA, both women had no choice in leaving their home country. As obedient children,
they followed their family’s decisions. When they moved to the USA, they became translators for the
family since they were the most fluent in English. As a result, they felt like they were the parent in the
family as well. Feeling conflicted with their family roles and guilt over wanting independence, both
women felt a sense of emptiness. Moreover, they felt like they did not fit in with American society and
a lack of acceptance when they first moved to the USA. Through the media and interactions with peers,
they learned that being thin was a way to gain social status, approval, and acceptance. They began to base
their self worth on the slenderness of their body and their control of food intake.
Pavlova, Uher, and Papevoza (2008) interviewed six young Czech female sojourners to the USA
and echoed similar experiences of isolation in their host country as one of the trajectories through
which they either developed eating disorders or worsened their eating disorder symptoms.
In contrast to the previous studies described, one study found that acculturation plays a role in
body image among Eastern European immigrants, but less so in eating disordered attitudes. Sussman,
Truong, and Lim (2007) found that Eastern-European immigrant women who identified less with
their birth country (more acculturated) indicated lower body esteem and were less satisfied with their
body parts. US born European women exhibited higher risk for eating disorders than the Eastern-
European immigrant women, but the difference was not significant.
202.4.4 Immigrants from Europe
The flow of immigrants from Europe to other regions of the world is light. During the 1990s, there
was a significant migration from Ireland to UK, Canada, and the USA. However, this group was
not included in any studies of body image and ED. Geller (2005) found that in their sample of
second-generation Greek and Italian women living in Canada, greater internalization of the Western
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202 Body Image and Eating Disorders Among Immigrants
thin ideal was predictive of higher risk for eating disorders. Greater conflicts with their family and
higher levels of perfectionism also led to higher risk for eating disorders. Although not directly related
to eating disorders, higher body mass index was related to more extreme weight loss behaviors.
Since the creation of the European Union and the loosening of immigration policies, there has
been considerable immigration within Europe although few studies have examined these popula-
tions. For example, Germany has been the destination country of more than 7 million immigrants,
about 50% from Europe, but none of these immigrant groups have been investigated regarding eating
disorders. In one of the few studies investigating trans-European movements, Kirchengast and
Schober (2006) found that migrant children from Turkey and the former Yugoslavia to Vienna and
Austria were found to have a higher prevalence of being overweight and obese.
202.4.5 Immigrants from the Middle East
There is little normative information about the body image and ED risks or behaviors among women
in Middle-Eastern countries. In one of the few studies, Abdollahi and Mann (2001) found that in
their sample of Iranian women living in Iran and in the USA, exposure to Western media, length of
residence in the USA, and language use were not associated with disordered eating symptoms and
body image issues. The researchers suggest that the lack of differences in body image and eating
disorder symptoms between the two groups may be due to the high Westernization of Iran prior to
the Islamic revolution in 1978, which is evident in the familiarity with Western culture among the
participants’ parents. Also, the Iranian population in Los Angeles is large, and this may serve as a
buffer against the effects of exposure to Western body image ideals.
Other factors that influence body image and eating disorders among Middle-Eastern immigrants
include independence, control, sexuality, religion, and familial and individual personality factors. Timimi
(1995) describes the process by which adolescent Arab female immigrants develop eating disorders:
their yearning for independence and seeking pleasure in the self conflicts with their family traditions and
expectations, as well as their Muslim religion and identity. These conflicts lead to feelings of guilt and
depression, and therefore they may seek solace in food constraints as a way to purify the Muslim self.
These maladaptive eating behaviors then result in the development of anorexia nervosa.
202.4.6 Immigrants from the Caribbean and Africa
In the Caribbean and Africa, the body ideal tends to deviate substantially from the Western thinness
ideal. One Caribbean woman described the body image ideal in her home country, “A women can
almost never be too fat. Even if I had weighed 80 kg, men would have found me more attractive than
if I were thin.” (Willemsen and Hoek 2006, p. 353). In a study of South Asian, African, and mixed
adolescents living in Trinidad, a greater percentage of overweight African adolescents were satisfied
with their body size than the South Asian and mixed overweight adolescents (Simeon et al. 2003).
Similarly, in a study on cross cultural differences in body image perceptions among Kenyan Asian
immigrant females living in Britain, Kenyan British females, and British females, the Kenyan Asian
immigrant group perceived the larger female body shapes more positively and the thin female body
shape more negatively than the other groups (Furnham and Alibhai 1983). This difference in beauty
ideal may stem from the poor socioeconomic conditions of these developing countries, whereby
overweight and normal body size signify wealth and having a healthy body (Simeon et al. 2003).
3250 N.M. Sussman and N. Truong
Very few studies have investigated the effects of immigration on body image and eating disorders
among this population. Willemsen and Hoek (2006) presented a rare case study of a Caribbean
Antillean woman who immigrated to the Netherlands and subsequently developed anorexia nervosa
through adopting the thin beauty ideal there, primarily through television. Other case studies of
Caribbean and African women with eating disorders describe their struggles with separation from
their parents, as well as family and sexual conflicts (Geller and Thomas 1999).
In general, however, Caribbean and African female immigrants tend to display a lower prevalence
of eating disorders and greater body satisfaction than Westerners. In Sussman, Truong, and Lim’s
study (2007), Caribbean immigrant women were more satisfied with their body parts than Eastern-
European immigrant women (see Fig. 202.1). Moreover, Caribbean immigrant women had the lowest
Self-Esteem
2.7
2.8
2.9
3
3.1
3.2
3.3
3.4
3.5
3.6
First Third +
Generation Status
Mean Scores
Afro-
Caribbean/
African-
American
Eastern-
European/
European-
American
Body-Esteem
0
0.5
1
1.5
2
2.5
3
3.5
4
First Third +
Generation Status
Mean Scores
Afro-
Caribbean/
African-
American
Eastern-
European/
European-
American
Body Parts Satisfaction
0
1
2
3
4
5
6
First Third +
Generation Status
Mean Scores
Afro-
Caribbean/
African-
American
Eastern-
European/
European-
American
Risk for Eating Disorders
0
2
4
6
8
10
12
14
16
First Third +
Generation Status
Mean Scores
Afro-
Caribbean/
African-
American
Eastern-
European/
European-
American
Fig. 202.1 Ethnicity moderating effects of acculturation (Sussman et al. 2007). This figure shows the moderating effects
of country of origin for immigrants to the USA. As Caribbean immigrant women became more acculturated to the USA
(first generation compared to third + generations), they had higher self-esteem, body esteem, and body parts satisfaction,
and lower risk for eating disorders. However, as Russian immigrant women became more acculturated to the USA, they
had lower self-esteem, body esteem, and body parts satisfaction, and were at higher risk for eating disorders
3251
202 Body Image and Eating Disorders Among Immigrants
risk for eating disorders compared to Eastern European and Chinese immigrant women. This may in
part be due to the fact that the Caribbean immigrant women resided in neighborhoods that were
primarily Caribbean immigrants. Therefore isolating themselves away from the Western thinness
ideal may have served as a buffer against developing a negative body image. In another study of first
generation immigrant Jamaican-American women and US born African-American women, both
groups did not differ in body satisfaction and both displayed similar body ideals (Williams 2007).
However, the Jamaican-American immigrant women displayed a higher drive toward thinness. The
higher drive to be thin among the immigrant group may in part have resulted from their experiences
of acculturative stress, which was found to be related to concerns over one’s body image.
202.5 Summary
The effects of immigration to Western countries on body image, risks for ED, or ED symptomology
vary by cultural group. Among Asian immigrants, lower body esteem was often associated with
greater risks for ED while for Central and South American immigrants, the correlation was equivo-
cal. Immigration does not appear to negatively affect the body satisfaction of Caribbean or African
immigrant women (see Table 202.3).
The level of acculturation to the host country was predicted by many researchers to be positively
associated with ED or risks for the syndromes – the higher the acculturation, the higher the risk for
the disease. This variable too was modified by home cultural group. The experience of Asian immi-
grants generally supported the prediction whereby the more acculturated women had disordered
eating or higher risks for ED. The data from Central and South American women were inconsistent
although predominantly demonstrated no relationship between the level of acculturation and ED.
Caribbean immigrants had the lowest incidence of ED in part because they acculturated the least. It
Table 202.3 Key points of eating disorders among immigrants
1. Eating disorders such as anorexia and bulimia had been found primarily among women in Western countries. In
extreme forms, these diseases result in death. These syndromes were based on an idealized body type of extreme
thinness which was perceived as attractive. The majority of the nonwestern world did not hold extreme thinness
as an ideal female form.
2. World wide immigration has grown in the last two decades primarily from the developing countries to the West.
One question posed by mental health and other health professionals was what would be the effect of immigration
to the West on women’s attitudes toward their bodies, risks for and prevalence of eating disorders. In general
terms, research finding indicate that there is not a uniform effect of immigration. Women from Africa and the
Caribbean do not appear to be negatively affected by immigration while Asian immigrants to the West tend to
have lowered body image and greater risks for eating disorders.
3. Immigration’s effect on body dissatisfaction and eating disorders can be modified by the extent to which the
immigrant has acculturated or adapted to the host country. The more they live in integrated neighborhoods,
have adopted attitudes of the host country toward body ideals and the attractiveness of thinness, the more
likely they will be dissatisfied with their bodies and engage in disordered eating. Russian immigrants were
found to be affected by acculturation level to the West either with body dissatisfaction or eating disorders.
However, other studies examining Asian and Central and South American immigrants found that acculturation
levels did not affect disordered eating. So high acculturation to the host country does not necessarily result in
poor mental and physical health. Other factors also shown to affect their mental health include family conflicts
and parental overprotection.
This table explains the general factors that influence the development of body dissatisfaction and eating disorders
among women in Western countries. Since there are hundreds of thousands of women from other regions of the world
immigrating to the West, many studies have examined whether these women are at risk for negative attitudes toward
their bodies and for eating disorders
3252 N.M. Sussman and N. Truong
is speculated that living in separate ethnic enclaves buffered them from the dominant culture’s body
ideal that differed from the normative ones in Africa or the Caribbean (see Table 202.4).
Ironically, for many of the immigrant women, the less acculturated they were, the healthier they
were, at least with regard to body image and eating habits. However, we caution drawing many gen-
eralizations from the data. Lack of standardization of assessment instruments, inconsistent opera-
tional definitions of variables, and methodological weaknesses hamper the ability to integrate the
growing literature on this topic. Increased care must be taken to improve the validity and comparabil-
ity of the research. See Table 202.5 for suggestions for future research directions.
Table 202.4 Summary points
Eating disorder symptoms include dissatisfaction with one’s body which results in near-starvation eating
behaviors or bingeing/purging patterns. Extreme forms can result in death.
Until recently, eating disorders were found almost exclusively in Western countries due primarily to the emphasis
of extreme thinness as a standard of beauty.
Ideal body sizes, features, and standards of beauty vary from culture to culture.
As a culture becomes more exposed to Western media and the thinness ideal, eating disorders begin to appear
primarily among young women.
Much research has focused on how immigration to the West affects women’s body ideals, dissatisfaction with
their bodies, risks for eating disorders and prevalence of the syndrome.
Another research question focused on how the level of adjustment to the host country (acculturation) affects body
dissatisfaction and eating disorders.
Results indicate that the culture of the immigrant influences how the immigrant reacts, Russian and Asian
immigrants are the most dissatisfied with their bodies and the more they have adapted to values and attitudes in
the West, the more likely that they will suffer from eating disorders.
Caribbean and African immigrants, despite having body ideals that are very different from those in the West, are
the most satisfied with their bodies and least likely to suffer from eating disorders.
Health and mental health professionals should be aware of culture and acculturation and their affect on eating
disorders when interviewing or treating an immigrant patient.
This table summarizes each of the major points in the chapter in the order that they are presented. These points also
summarize the major research findings regarding immigration and body image and risk or prevalence of eating
disorders
Table 202.5 Suggestions for future research
1. More studies need to test “pure” first generation immigrant samples on acculturation and other sociocultural
factors that affect body image and eating disorders.
2. Further investigate sociocultural factors that influence body image and eating disorders among immigrants in
countries that have been little researched, such as in Central and South America, the Middle East, and Caribbean
and Africa.
3. More studies need to conduct cross-cultural comparisons on body image and eating disorder pathologies between
individuals of a specific ethnicity residing in their native home country and a second group of individuals of the
same ethnicity who immigrate to a Western host country.
4. Conduct studies on body image and eating disorders among immigrants across several countries employing the
same acculturation measures.
5. Conduct studies that employ more powerful methodologies, such as longitudinal studies that examine
influence of acculturation and other sociocultural factors on body image and eating disorders among
immigrants across different time points.
This table provides suggestion for future research studies by including a larger number of countries and limiting weak-
nesses in current methodologies
3253
202 Body Image and Eating Disorders Among Immigrants
202.6 Applications to Other Areas of Health and Disease
While admitting to the limitations of the research, we suggest that physicians and mental health
specialists pay attention to the cultural background, immigration status, level of acculturation, and
familial relationships when conducting intake interviews. As discussed in this chapter, some coun-
tries such as in Eastern Europe are not as concerned with the slim body ideal as in Western countries,
and in the Caribbean and Africa the body ideal deviates substantially from the Western ideal. Cross
cultural comparison studies between a group of individuals from a specific ethnicity residing in their
native home country and another group of individuals from the same ethnicity who immigrated to a
Western host country have shown significant differences in their body image and eating disordered
pathology. Some studies have shown that the level of acculturation plays a role in body image and
eating disorders, such that the more the immigrant adopts the attitudes, thinking, values, and behav-
iors of the Western host country, the more they will be at risk for developing eating disorders. Finally
family conflicts, specifically with the parents, have been found to contribute to body image concerns
and eating disorders.
Also, we have to be aware that the EDs may be presented differently in different countries and
may be triggered by different variables than those shown in the USA, UK, and other Western coun-
tries where EDs have been prevalent. Case studies in India have shown that eating disorders manifest
in different and unique symptoms from those in Western countries.
Acknowledgments The authors appreciate the assistance of Victoria Salvo and Deanna Quinlan in conducting the
literature review.
References
Abdollahi P, Mann T. Int J Eat Disord. 2001;30:259–68
Akiba D. J Soc Psychol. 1998;138:539–40.
Altabe M, Thompson JK. Int J Eat Disord. 1992;11:397–402.
American Psychiatric Association (APA). DSM-IV. Washington, DC: American Psychiatric Press; 1994.
Ayala GX, Mickens J, Galindo P, Elder J. Ethnic Heal. 2007;12:21–41.
Barry DT, Garner DM. Eat Weight Disord. 2001;6:90–8.
Bond MH, Cheung TS. J Cross-Cult Psychol. 1983;14:153–71.
Bulik CM. Int J Eat Disord. 1987;6:133–41.
Cachelin FM, Veisel C, Barzegarnazari E, Striegel-Moore RH. Psychol Women Quart. 2000;24:244–53.
Cash TF, Henry PE. Sex Roles. 1995;33:19–28.
Chamorro R, Flores-Ortiz Y. Int J Eat Disord. 2000;28:125–9.
Chan CKY, Owens RG. Psychol Heal. 2006;21:49–63.
Chen W, Swalm RL. Percept Motor Skills. 1998;87:395–403.
Cheng C-Y. Dissert Abst Int. 2001;61:7A.
Choudry IY, Mumford DB. Int J Eat Disord. 1992;11:243–51.
Cogan JC, Bhalla SK, Sefa-Dedeh A, Rothblum ED. J Cross-Cult Psychol. 1996;27:98–113.
Davis C, Katzman MA. Int J Eat Disord. 1999;25:65–70.
Doan LM. Dissert Abst Int. 2001;62:544B.
Dolan B, Lacey JH, Evans C. Br J Psychiatry. 1990;157:523–8.
Eating Disorder Statistics. Data File. 2003. http://womensissues.about.com.
Fisher M, Pastors D, Schneider M, Peeler C, Neopolitan B. Int J Eat Disord. 1994;16:67–74.
Fitzgibbon HL, Spring B, Avellone ME, Blackman LR, Pingitore R, Stolley M. Int J Eat Disord. 1998;24:43–52.
Furnham A, Baguma P. Int J Eat Disord. 1994;15:81–9.
Furnham A, Alibhai N. Psychol Med. 1983;13:829–37.
Furnham A, Husain K. Soc Psychiatry Psychiatr Epidemol. 1999;34:498–505.
Garner DM, Garfinkel PE, Schwartz D, Thompson M. Psychol Rep. 1980;47:483–91.
3254 N.M. Sussman and N. Truong
Geller G. Dissert Absts Int. 2005;56:7b.
Geller G, Thomas CD. Eat Disord J Treat Prevent. 1999;7:279–97.
Gowen LK, Hayward C, Killen JD, Robinson TN, Taylor CB. J Res Adolesc. 1999;9:67–83.
Greenberg L, Cwikel J, Mirsky J. Int J Eat Disord. 2007;40:51–8.
Haavio-Mannila E, Purhonen S. J Sex Res. 2001;38:102–11.
Haudek C, Rorty M, Henker B. Int J Eat Disord. 1999;25:425–33.
Huang LL. Dissert Abstr Int. 2001;62:1083B.
Humphry TA, Ricciardelli LA. Int J Eat Disord. 2004;35:579–88.
Iyer DS, Haslam N. Int J Eat Disord. 2003;34:142–7.
Jackson SC, Keel PK, Lee YH. Int J Eat Disord. 2006;39:498–502.
Joiner GW, Kashubeck S. Psychol Women Quart. 1996;20:419–35.
Kayano M, Yoshiuchi K, Al-Adawi S, Viernes N, Dorvlo ASS, Kumano H, Kuboki T, Akabayashi A. Psych Clin
Neurosci. 2008;62:17–25.
Khandelwal SK, Saxena S. Br J Psychiatry. 1990;157:784.
Kirchengast S, Schober E. J Biosoc Sci. 2006;38:695–705
Kuba SA, Harris DJ. Heal Care Women Int. 2001;22:281–98.
Lee S, Lee AM. Int J Eat Disord. 2000;27:317–27.
Lester R, Petrie TA. J Multicult Counsel Develop. 1998;26:157–65.
Lester R, Petrie TA. J Counsel Psychol. 1995;42:199–203.
Lewis V, Donaghue N. Percept Motor Skills. 1999;89:165–71.
Leung F, Wang J, Tang CW-Y. J Psychosom Res. 2004;57:59–66.
Matz PE, Foster GD, Faith MS, Wadden TA. J Consult Clin Psychol. 2002;70:1040–4.
Miller KL, Gleaves DH, Hirsch TG, Green BA, Snow AC, Corbett CC. Int J Eat Disord. 2000;27:310–6.
Mintz LB, Betz NE. J Counsel Psychol. 1988;35:463–71.
Mintz LB, O’Halloran MS. J Pers Assess. 2000;74:489–504.
Molloy BL, Herzberger SD. Sex Roles. 1998;38:631–43.
Mujtaba T, Furnham A. Int J Soc Psychiatry. 2001;47:24–35.
Mukai T, Kambara A, Sasaki Y. Sex Roles. 1998;39:751–63.
Nasser M. J Psychosom Res. 1988;32:573–7.
Nicdao EG, Hong S, Takeuchi DT. Int J Eat Disord. 2007;40:22–6.
Pan AS. Dissert Abstr Int. 2000;61:544B.
Pavlova B, Uher R, Papezova H. Eur Eat Disord Rev. 2008;16:207–14.
Prince R. Soc Sci Med. 1985;21:197–203.
Reddy SD, Crowther JH. Cult Div Ethnic Minor Psychol. 2007;13:45–53.
Rodriguez-Hanley A. Dissert Abstr Int. 2004;65:2110B.
Schwartz MA, Vazquez LA, Vazquez EG, McNeil K. Differences in body image satisfaction: impact of gender and
culture. Poster at the 106th Am. Psychol. Assoc. Conference. 1998, August.
Shaw H, Ramirez L, Trost A, Randall P, Stice E. Psychol Addict Behav. 2004;18:12–8.
Simeon DT, Rattan RD, Panchoo K, Kungeesingh KV, Ali AC, Abdool PS. Eur J Clin Nutr. 2003;57:157–62.
Smith AL. Dissert Abstr Int. 2001;62:1600B.
Soh NL-W, Touyz S, Dobbins TA, Surgenor LJ, Clarke S, Kohn MR, Lee EL, Leow V, Rieger E, Ung KEK, Walter G.
Aust N Z J Psychiatry. 2007;41:536–45.
Straeter SV. Dissert Abstr Int. 2002;63:4388B.
Striegel-Moore RH, Silberstein LR, Rodin J. J Abnorm Psychol. 1993;102:297–303.
Sussman NM, Truong N, Lim J. Int J Intercult Relat. 2007;31:29–49.
Timimi SB. Psychotherapy. 1995;32:141–9.
Trimble JE. In: Chun KM, Organista PB, Marin G, editors. Acculturation: advances in theory, measurement, and
applied research. Washington, DC: American Psychological Association; 2003. p. 3–13.
Waller G, Matoba M. Int J Eat Disord. 1999;26:333–40.
Willemsen EMC, Hoek HW. Int J Eat Disord. 2006;39:353–5.
Williams KN. Dissert Abstr Int. 2007;68:5A.
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In this article the relationship among acculturation, body image, self-esteem, and eating disorder symptomatology in 120 Mexican American adolescent women was investigated. Surprisingly, acculturation levels were not related to anorexic or bulimic symptomatology, self-esteem, body dissatisfaction or thinness of ideal and attractive figures. Lower levels of self-esteem predicted higher levels of anorexic and bulimic symptomatology. Body mass was positively related to bulimic scores. In contrast to Lester and Petrie (1995), body dissatisfaction was significantly related to eating-disorder symptomatology. The high levels of disordered eating attitudes and behaviors found in this study suggest that rather than exclusively being an Anglo, middle-to upper-class phenomenon, eating-disordered behavior also exists within lower socioeconomic status Mexican American adolescent women.
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The purpose of this study was to assess howwomen's perceptions of themselves and their bodies varyby race/ethnicity and class. One hundred and fourteenfemale students (45 African-American, 69 Caucasian) from two Connecticut community colleges weresurveyed. We predicted that African-American women willreport higher levels of self-esteem and a more positivebody image than Caucasian women. These predictions were supported. Also as predicted,African-American women report possessing more masculinetraits and that men of their race tend less to preferthin, small figured women. Controlling for these“protective factors” substantially reduces therelationship between race/ethnicity and self-concept.African-American women's racial identity and exposure tothe dominant culture did not relate to self-conceptmeasures.
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We examine the relation between acculturation and eating disorder symptoms in a normative sample of 920 adolescent girls of high school age. Results indicate that acculturation is positively associated with structured-interview defined partial syndrome eating disorders in Hispanic girls (13.6% vs. 0% prevalence rate in more acculturated vs. less acculturated Hispanic girls), but not Asian or European American girls. There was no relation between acculturation and either weight concerns or body dissatisfaction across the 3 ethnicities. This study demonstrates that level of acculturation, as measured by language spoken at home and time lived in the United States, may influence rates of eating disorders in Hispanic adolescents but not in Asian adolescents.