Globalization and Eating Disorders
Globalization and Eating Disorders

Newspapers around the world share similar headlines and stories about the increase incidences of eating disorders in their countries. An Israeli newspaper, Haaretz, cites, “Can too much healthy food hurt you?, ” covering a relatively new and controversial eating disorder, orthorexia. The Copenhagen Post online contains a story, “Models are still skinny,” discussing the lack of follow-through of the modeling industry to follow health guidelines. The Jakarta Globe of Indonesia posts an article “More Women Become ‘Fashion Victims’ As Eating Disorders Spread in Indonesia,” highlighting the increased awareness of and incidences of eating disorders in Indonesia.

International studies on eating disorders show that:

  • One percent of college-aged women in the U.S. have anorexia, while four percent of college-age women in the U.S. have bulimia1
  • 2.6 percent of female Norwegian students and 1.3 percent of Italian students have anorexia2
  • 1.2 percent of Cairo school girls and 3.2 percent of Iranian school girls have bulimia nervosa3
  • As few as 30% of people with EDs ever receive treatment for their illness, and in some communities that number is below 10%.”4

How are eating disorders impacted by globalization? Does media coverage increase the number of cases? Is Westernization of beauty ideals the main culprit behind the global spread of eating disorders? What can be done to combat eating disorders and who is responsible for monitoring progress and enforcing regulations?

What are eating disorders and how are they diagnosed

There are four main categories of eating disorders: anorexia nervosa; bulimia nervosa; binge eating disorder; and eating disorder not otherwise specified (EDNOS).

A relatively new eating disorder, coined orthorexia nervosa by Dr. Steven Bratman in 1997, is considered a “fixation on righteous eating.” Orthorexics are concerned not about the amount of food they consume, but about the quality of the food. They often refuse to touch sugar salt, caffeine, alcohol, wheat, gluten, yeast, soya, corn and dairy foods. In addition, they refuse to eat any food with pesticides, herbicides or artificial additives. They are proud of their eating habits and often become socially isolated. Most orthorexics are in the middle class and well educated. Some doctors believe orthorexia should be classified as a separate disorder and not just part of EDNOS.6 Doctors from around the world are starting to recognize the disease, including the U.S, United Kingdom, and Israel.

It is challenging to diagnose disorders across cultures, as rationales vary and do not always fit in with Diagnostic and Statistical Manual of Mental Disorders, one of two main tools (World Health Organization’s International Classification of Mental Health Disorders (ICD) is the other) used to diagnose the disease. For example, fatphobia is commonly cited as a main rationale for those suffering from anorexia; however, a study by the Prince of Wales Hospital (Hong Kong), Harvard Medical School, and Chinese University of Hong Kong found a lack of “fatphobia” amongst female anorexic patients in Hong Kong.7

Different countries and publication use different standards in their studies. Not all studies rely on clinical diagnosis, which further complicates international comparison.8

What causes eating disorders and why are they becoming more popular around the world

Researchers have documented psychological, biological, genetic, familial, and societal-level causes for eating disorders. Common causes include genetic predispositions, food aversions or cravings, “comorbidity” with other mood or personality disorders, abuse by a family member, cultural “fatphobia,” cultural body-type norms, and even state nutrition policies.9

Certainly many blame television and the Internet for the rise of easing disorders. A September 2, 2009 Wall Street Journal article, “Girls and Dieting, Then and Now,” notes, “today’s fourth-grade girls are barraged by media images of thinness. They can cruise the Internet visiting “Pro-Ana” (pro-anorexia) Web sites and can view thousands of “thinspiration” videos on YouTube celebrating emaciated young women.”10 The Wall Street Journal article though does not solely blame the media, “Parental fixations on weight, children’s urges toward perfectionism, family conflicts, and a $40 billion-a-year dieting industry can all lead girls to disorders.”11

A blog posting by Susan Bordo, Professor of Philosophy at the University of Kentucky and author of Unbearable Weight blames the rise of eating disorders around the world on the spread of western cultures and beauty ideals via mass media:

…the Fiji islands did not have access to television until 1995, when a single station was introduced It broadcasts programs from the United States, Great Britain, and Australia. Until that time, Fiji had no reported cases of eating disorders, and a study conducted by anthropologist Anne Becker showed that most Fijian girls and women, no matter how large, were comfortable with their bodies. In 1998, just three years after the station began broadcasting, 11 percent of girls reported vomiting to control weight, and 62 percent of the girls surveyed reported dieting during the previous months.12

Bordo further cites as article by Eunice Park in Asian Week,As many Asian countries become Westernised and infused with the Western aesthetic of a tall, thin, lean body, a virtual tsunami of eating disorders has swamped Asian countries.13 She decisively concludes, “we are dealing here with a cultural problem.”14

An Audrey Magazine (The Asian American Women’s Lifestyle Magazine) article notes that beauty standards in Korea changed after its media was open to foreign programming. Similar trends were found in Hong Kong, as women want “small breasts, small waists and Western facial features.” Often EDs are not discussed in Korea (and possibly other Asian cultures) because of the concept of shame, and the notion that problems should stay within the family.15

Political Scientist Dr. Kristen Edquist of Eastern Washington University describes how the theory of de-territorialization can be used to explain the spread of eating disorders. This method examines both the role of the person with the disorder as well as the diagnostician. Dr. Edquist believes that other theories (such as spread of Western media content) “miss the broader contexts and varied meanings of food refusal.”16

She postulates that the observer affect may account for increased diagnosis of EDs. Increased information about the diseases is easily accessible on the Internet and diagnosticians are increasingly collaborating on studies. She states that better diagnostic tools taking into account different cultures is needed.17

What can be done to combat eating disorders?

The Academy for Eating Disorders, a professional association for eating disorders professionals, has called upon governments and industry to support a ban against severely underweight models on the runway and in magazines. The Academy for Eating Disorders and the Brazilian Fashion Industry both have set similar guidelines for the fashion industry, including:

  • age threshold, physical and mental health parameters (such as BMI limits),
  • health monitoring for models and students who are aspiring models,
  • health promoting educational initiatives,
  • inclusion of models of varying weights and body types,
  • educational campaigns to raise awareness about photographic manipulation and,
  • establishment of collaborative channels with the government, eating disorders and eating disorders related organizations.

Brazil specifically got involved because there was a recent series of tragic deaths of Brazilian fashion models.18

Denmark’s’ Fashion Industry developed similar ethical guidelines in 2007; however, as of 2009, little has changed. A recent study shows that the fashion industry has ignored the guidelines. Denmark’s national society against eating disorders and self-mutilation (LMS) has proposed that models undergo an annual physical examination and that magazines should label all digitally altered photographs. LMS also wants to work with the government and civil society groups to start changing public ideals of body image. An estimated 75,000 Danes suffer from eating disorders.19

In Canada, hospitals and NGOs are pushing for more hospital staff on hand to treat eating disorders, who are multilingual. The Université du Québec en Outaouais in Gatineau and the Hopewell Eating Disorder Support Centre in Ottawa conducted an e-mail survey about eating disorders clinics in Eastern Ontario and West Quebec. The survey found that, “61 per cent of respondents believed a French-language eating disorders clinic was needed” and “41 per cent of those sampled would prefer to use French during treatment.”20 There is an estimated 8,400 people in French-speaking people in Ottawa, Gatineau and Eastern Ontario that have anorexia nervosa and bulimia.21

So far there have been few successful efforts led by national fashion councils to impose health and diet requirements on their models. Britain’s Fashion Council’s requirements for required doctor’s certificate of healthiness failed when other major fashion capitals did not follow their lead.22 Community and religious groups, as well as schools and hospitals are often at the front lines offering counseling and support groups, which provide much needed services for those suffering from EDs, but do not necessarily, stem the tide of new cases.

Conclusion

An 18 year old Irish woman has been lobbying the Irish government and Irish Internet Providers to ban pro-Anxoreia websites. The providers claim they cannot do anything until psychologists and the Irish government provides better guidelines.23

Should pro-eating disorder websites be classified similar to pornographic websites and other sites with harmful content? Where should the responsibility lie? Changing cultural attitudes and perceptions of weight and body image requires international collaboration of governments, industry, and community groups. Until they all work together, societal norms will most likely not change.


1 Edquist, Kristin. “Globalizing Pathologies? Eating Disorders and the Global Deterritorialization of Authority.” Paper presented at the annual meeting of the Western Political Science Association, Marriott Hotel, Portland, Oregon Online. 2009-05-26
2 Makino, Mariko, Koji Tsuboi, and Lorraine Dennerstein. “Prevalence of Eating Disorders: A Comparison of Western and Non-Western Countries.” MedScape Today. September 27, 2004.
3 Edquist, Kristin. “Globalizing Pathologies? Eating Disorders and the Global Deterritorialization of Authority.” Paper presented at the annual meeting of the Western Political Science Association, Marriott Hotel, Portland, Oregon Online. 2009-05-26
4 Sheppird, Sari. “Top 10 Facts You Need to Know About Eating Disorders.” Encyclopedia Brittanica Blog. August 25, 2009.
5 Edquist, Kristin. “Globalizing Pathologies? Eating Disorders and the Global Deterritorialization of Authority.” Paper presented at the annual meeting of the Western Political Science Association, Marriott Hotel, Portland, Oregon Online. 2009-05-26
6 Hill, Amelia. “Healthy food obsession sparks rise in new eating disorder.” The Observer. August 16, 2009.
7 Edquist, Kristin. “Globalizing Pathologies? Eating Disorders and the Global Deterritorialization of Authority.” Paper presented at the annual meeting of the Western Political Science Association, Marriott Hotel, Portland, Oregon Online. 2009-05-26
8 Makino, Mariko, Koji Tsuboi, and Lorraine Dennerstein. “Prevalence of Eating Disorders: A Comparison of Western and Non-Western Countries.” MedScape Today. September 27, 2004.
9 Edquist, Kristin. “Globalizing Pathologies? Eating Disorders and the Global Deterritorialization of Authority.” Paper presented at the annual meeting of the Western Political Science Association, Marriott Hotel, Portland, Oregon Online. 2009-05-26
10 Zaslow, Jeffery. “Girls and Dieting, Then and Now.” Wall Street Journal. September 2, 2009.
11 Ibid.
12 Bordo, Susan. The Globalization of Eating Disorders.
13 Ibid.
14 Ibid.
15 Haynie, Devon. “Feeding on Stereotypes.” Audrey Magazine. June 9, 2007.
16 Edquist, Kristin. “Globalizing Pathologies? Eating Disorders and the Global Deterritorialization of Authority.” Paper presented at the annual meeting of the Western Political Science Association, Marriott Hotel, Portland, Oregon Online. 2009-05-26
17 Ibid.
18 “Recommendations for the Brazilian Fashion Industry.” Academy for Eating Disorders.
19 “Models are still skinny.” The Copenhagen Post Online. September 2, 2009.
20 Rodgers, David. “French facility for eating disorders needed: report.” The Ottawa Citizen. September 2, 2009.
21 Ibid.
22 “Size zero. The debate.”
23 Murphy, Claire. “We can’t ban anorexia sites say web firms.” Herald. September 9, 2009.

* Picture sources: http://www.flickr.com/photos/katietegtmeyer/67863749/ and http://www.flickr.com/photos/quiltingmick/2251908028/

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