Editing Eating disorder (section)

=== Environmental influences ===
==== Child maltreatment ====
[[Child abuse]] which encompasses physical, psychological, and sexual abuse, as well as neglect, has been shown to approximately triple the risk of an eating disorder.<ref name=Cas2016 /> Sexual abuse appears to double the risk of bulimia; however, the association is less clear for anorexia. The risk for individuals developing eating disorders increases if the individual grew up in an invalidating environment where displays of emotions were often punished. Abuse that has also occurred in childhood produces intolerable difficult emotions that cannot be expressed in a healthy manner. Eating disorders come in as an escape coping mechanism, as a means to control and avoid overwhelming negative emotions and feelings. Those who report physical or sexual maltreatment as a child are at an increased risk of developing an eating disorder.<ref name="Cas2016">{{cite journal |vauthors=Caslini M, Bartoli F, Crocamo C, Dakanalis A, Clerici M, Carrà G |title=Disentangling the Association Between Child Abuse and Eating Disorders: A Systematic Review and Meta-Analysis |journal=Psychosomatic Medicine |volume=78 |issue=1 |pages=79–90 |date=January 2016 |pmid=26461853 |doi=10.1097/psy.0000000000000233 |s2cid=30370150}}</ref>

==== Social isolation ====
[[Social isolation]] has been shown to have a deleterious effect on an individual's physical and emotional well-being. Those that are socially isolated have a higher mortality rate in general as compared to individuals that have established social relationships. This effect on mortality is markedly increased in those with pre-existing medical or psychiatric conditions, and has been especially noted in cases of [[coronary heart disease]]. "The magnitude of risk associated with social isolation is comparable with that of [[cigarette smoking]] and other major [[biomedical]] and [[psychosocial]] [[risk factors]]." (Brummett ''et al.'')

Social isolation can be inherently stressful, depressing and anxiety-provoking. In an attempt to ameliorate these distressful feelings an individual may engage in emotional eating in which food serves as a source of comfort. The loneliness of social isolation and the inherent stressors thus associated have been implicated as triggering factors in binge eating as well.<ref>{{cite journal |vauthors=Troop NA, Bifulco A |title=Childhood social arena and cognitive sets in eating disorders |journal=British Journal of Clinical Psychology |volume=41 |issue=Pt 2 |pages=205–11 |date=June 2002 |pmid=12034006 |doi=10.1348/014466502163976}}</ref><ref>{{cite journal |vauthors=Nonogaki K, Nozue K, Oka Y |title=Social isolation affects the development of obesity and type 2 diabetes in mice |journal=Endocrinology |volume=148 |issue=10 |pages=4658–66 |date=October 2007 |pmid=17640995 |doi=10.1210/en.2007-0296 |doi-access=free}}</ref><ref>{{cite journal |vauthors=Esplen MJ, Garfinkel P, Gallop R |title=Relationship between self-soothing, aloneness, and evocative memory in bulimia nervosa |journal=The International Journal of Eating Disorders |volume=27 |issue=1 |pages=96–100 |date=January 2000 |pmid=10590454 |doi=10.1002/(SICI)1098-108X(200001)27:1<96::AID-EAT11>3.0.CO;2-S |doi-access=free}}</ref><ref>{{cite journal |vauthors=Larson R, Johnson C |title=Bulimia: disturbed patterns of solitude |journal=Addictive Behaviors |volume=10 |issue=3 |pages=281–90 |year=1985 |pmid=3866486 |doi=10.1016/0306-4603(85)90009-7}}</ref>

Waller, Kennerley and Ohanian (2007) argued that both bingeing–vomiting and restriction are emotion suppression strategies, but they are just utilized at different times. For example, restriction is used to pre-empt any emotion activation, while bingeing–vomiting is used after an emotion has been activated.<ref>{{cite journal |vauthors=Fox JR |title=Eating disorders and emotions |journal=Clinical Psychology & Psychotherapy |volume=16 |issue=4 |pages=237–9 |date=July 2009 |pmid=19639648 |doi=10.1002/cpp.625 |doi-access=free}}</ref>

==== Parental influence ====
Parental influence has been shown to be an intrinsic component in the development of eating behaviors of children.<ref name=":20">{{cite journal | vauthors = Savage JS, Fisher JO, Birch LL | title = Parental influence on eating behavior: conception to adolescence | journal = The Journal of Law, Medicine & Ethics | volume = 35 | issue = 1 | pages = 22–34 | date = 2007 | pmid = 17341215 | pmc = 2531152 | doi = 10.1111/j.1748-720X.2007.00111.x}}</ref> This influence is manifested and shaped by a variety of diverse factors such as familial genetic predisposition, dietary choices as dictated by cultural or ethnic preferences, the parents' own body shape, how they talk about their own body, and eating patterns,<ref>{{cite journal | vauthors = Lydecker JA, Riley KE, Grilo CM | title = Associations of parents' self, child, and other "fat talk" with child eating behaviors and weight | journal = The International Journal of Eating Disorders | volume = 51 | issue = 6 | pages = 527–534 | date = June 2018 | pmid = 29542177 | pmc = 6002914 | doi = 10.1002/eat.22858}}</ref> the degree of involvement and expectations of their children's eating behavior as well as the interpersonal relationship of parent and child.<ref name=":20" /> It is also influenced by the general psychosocial climate of the home and whether a nurturing stable environment is present. It has been shown that maladaptive parental behavior has an important role in the development of eating disorders. As to the more subtle aspects of parental influence, it has been shown that eating patterns are established in early childhood and that children should be allowed to decide when their appetite is satisfied as early as the age of two. A direct link has been shown between obesity and parental pressure to eat more.<ref>{{Cite web |title=Eating disorder {{!}} Health Psychology |url=https://courses.lumenlearning.com/suny-hvcc-healthpsychology/chapter/eating-disorder/#:~:text=Parental%20influence&text=This%20is%20in%20addition%20to,the%20development%20of%20eating%20disorders. |access-date=2023-12-28 |website=courses.lumenlearning.com}}</ref>

Coercive tactics in regard to diet have not been proven to be efficacious in controlling a child's eating behavior. [[Affection]] and [[attention]] have been shown to affect the degree of a child's finickiness and their acceptance of a more varied diet.<ref>{{cite journal |vauthors=Johnson JG, Cohen P, Kasen S, Brook JS |title=Childhood adversities associated with risk for eating disorders or weight problems during adolescence or early adulthood |journal=The American Journal of Psychiatry |volume=159 |issue=3 |pages=394–400 |date=March 2002 |pmid=11870002 |doi=10.1176/appi.ajp.159.3.394}}</ref><ref>{{cite journal |vauthors=Klesges RC, Coates TJ, Brown G, Sturgeon-Tillisch J, Moldenhauer-Klesges LM, Holzer B, Woolfrey J, Vollmer J |title=Parental influences on children's eating behavior and relative weight |journal=Journal of Applied Behavior Analysis |volume=16 |issue=4 |pages=371–8 |year=1983 |pmid=6654769 |pmc=1307898 |doi=10.1901/jaba.1983.16-371}}</ref><ref>{{cite journal |vauthors=Galloway AT, Fiorito L, Lee Y, Birch LL |title=Parental pressure, dietary patterns, and weight status among girls who are "picky eaters" |journal=Journal of the American Dietetic Association |volume=105 |issue=4 |pages=541–8 |date=April 2005 |pmid=15800554 |pmc=2530930 |doi=10.1016/j.jada.2005.01.029}}</ref><ref>{{cite journal |vauthors=Jones C, Harris G, Leung N |title=Parental rearing behaviours and eating disorders: the moderating role of core beliefs |journal=Eating Behaviors |volume=6 |issue=4 |pages=355–64 |date=December 2005 |pmid=16257809 |doi=10.1016/j.eatbeh.2005.05.002}}</ref><ref>{{cite journal |vauthors=Brown R, Ogden J |title=Children's eating attitudes and behaviour: a study of the modelling and control theories of parental influence |journal=Health Education Research |volume=19 |issue=3 |pages=261–71 |date=June 2004 |pmid=15140846 |doi=10.1093/her/cyg040 |doi-access=free}}</ref><ref name=":20" />

Adams and Crane (1980), have shown that parents are influenced by stereotypes that influence their perception of their child's body. The conveyance of these negative stereotypes also affects the child's own body image and satisfaction.<ref>{{Cite journal |vauthors=Adams GR, Crane P |date=1980 |title=An Assessment of Parents' and Teachers' Expectations of Preschool Children's Social Preference for Attractive or Unattractive Children and Adults |journal=Child Development |volume=51 |issue=1 |pages=224–231 |doi=10.2307/1129610|jstor=1129610}}</ref> [[Hilde Bruch]], a pioneer in the field of studying eating disorders, asserts that anorexia nervosa often occurs in girls who are high achievers, obedient, and always trying to please their parents. Their parents have a tendency to be over-controlling and fail to encourage the expression of emotions, inhibiting daughters from accepting their own feelings and desires. Adolescent females in these overbearing families lack the ability to be independent from their families, yet realize the need to, often resulting in rebellion. Controlling their food intake may make them feel better, as it provides them with a sense of control.<ref>Nolen-Hoeksema, Susan. ''Abnormal Psychology, 6e''. McGraw-Hill Education, 2014. p. 359-360.</ref>

Negative parental body-talk, meaning when a parent comments on their own weight, shape or size, is strongly correlated with disordered eating in their children. Children whose parents engage in self-talk about their weight frequently are three times as likely to practice extreme weight control behaviors such as disordered eating, than children who do not overhear negative parental body-talk. Additionally, negative body-talk from mothers is explicitly correlated with disordered eating in adolescent girls.<ref>{{cite journal | vauthors = Neumark-Sztainer D, Bauer KW, Friend S, Hannan PJ, Story M, Berge JM | title = Family weight talk and dieting: how much do they matter for body dissatisfaction and disordered eating behaviors in adolescent girls? | journal = The Journal of Adolescent Health | volume = 47 | issue = 3 | pages = 270–276 | date = September 2010 | pmid = 20708566 | pmc = 2921129 | doi = 10.1016/j.jadohealth.2010.02.001}}</ref><ref>{{cite journal | vauthors = Myntti WW, Parnell L, Valledor V, Chow CM | title = Adolescent-perceived parent-child negative body talk and disordered eating: Evidence for behavior-specific affective mediators | journal = Journal of Adolescence | volume = 96 | issue = 5 | pages = 1126–1136 | date = July 2024 | pmid = 38594877 | doi = 10.1002/jad.12323}}</ref>

==== Peer pressure ====
In various studies such as one conducted by [[William L. McKnight|The McKnight Investigators]], [[peer pressure]] was shown to be a significant contributor to body image concerns and attitudes toward eating among subjects in their teens and early twenties.<ref name = "McKnight_2003">{{Cite journal | vauthors = ((The McKnight Investigators)) |date=2003 |title=Risk Factors for the Onset of Eating Disorders in Adolescent Girls: Results of the McKnight Longitudinal Risk Factor Study |url=https://ajp.psychiatryonline.org/doi/full/10.1176/ajp.160.2.248 |journal=American Journal of Psychiatry |volume=160 |issue=2 |pages=248–254 |doi=10.1176/ajp.160.2.248 |pmid=12562570 |issn=0002-953X}}</ref>

Eleanor Mackey and co-author, Annette M. La Greca of the University of Miami, studied 236 teen girls from public high schools in southeast Florida. "Teen girls' concerns about their own weight, about how they appear to others and their perceptions that their peers want them to be thin are significantly related to weight-control behavior", says psychologist Eleanor Mackey of the Children's National Medical Center in Washington and lead author of the study. "Those are really important."<ref>{{Cite web |title=Study finds teenagers' peers play big role in weight control |url=https://www.heraldtribune.com/story/news/2008/07/30/study-finds-teenagers-peers-play-big-role-in-weight-control/28651148007/ |access-date=2024-03-15 |website=Sarasota Herald-Tribune}}</ref>

According to one study, 40% of 9- and 10-year-old girls are already trying to lose weight.<ref>{{cite journal |vauthors=Schreiber GB, Robins M, Striegel-Moore R, Obarzanek E, Morrison JA, Wright DJ |title=Weight modification efforts reported by black and white preadolescent girls: National Heart, Lung, and Blood Institute Growth and Health Study |journal=Pediatrics |volume=98 |issue=1 |pages=63–70 |date=July 1996 |doi=10.1542/peds.98.1.63 |pmid=8668414 |s2cid=43322352}}</ref> Such dieting is reported to be influenced by peer behavior, with many of those individuals on a diet reporting that their friends also were dieting. The number of friends dieting and the number of friends who pressured them to diet also played a significant role in their own choices.<ref>{{cite journal |vauthors=Page RM, Suwanteerangkul J |title=Dieting among Thai adolescents: having friends who diet and pressure to diet |journal=Eating and Weight Disorders |volume=12 |issue=3 |pages=114–24 |date=September 2007 |pmid=17984635 |doi=10.1007/bf03327638 |s2cid=28567423}}</ref><ref name = "McKnight_2003" /><ref>{{cite journal |vauthors=Paxton SJ, Schutz HK, Wertheim EH, Muir SL |title=Friendship clique and peer influences on body image concerns, dietary restraint, extreme weight-loss behaviors, and binge eating in adolescent girls |journal=Journal of Abnormal Psychology |volume=108 |issue=2 |pages=255–66 |date=May 1999 |pmid=10369035 |doi=10.1037/0021-843X.108.2.255}}</ref><ref>{{cite journal |vauthors=Rukavina T, Pokrajac-Bulian A |title=Thin-ideal internalization, body dissatisfaction and symptoms of eating disorders in Croatian adolescent girls |journal=Eating and Weight Disorders |volume=11 |issue=1 |pages=31–7 |date=March 2006 |pmid=16801743 |doi=10.1007/bf03327741 |s2cid=10497977}}</ref>

Elite athletes have a significantly higher rate in eating disorders. Female athletes in sports such as gymnastics, ballet, diving, etc. are found to be at the highest risk among all athletes. Women are more likely than men to acquire an eating disorder between the ages of 13 and 25. About 0–15% of those with bulimia and anorexia are men.<ref>{{cite book |vauthors=Nolen-Hoeksema S |year=2014 |title=Abnormal Psychology |location=New York |publisher=McGraw-Hill Education |page=323 |isbn=978-0-07-803538-8 |edition=6th}}</ref>

Other psychological problems that could possibly create an eating disorder such as Anorexia Nervosa are depression, and low self-esteem. Depression is a state of mind where emotions are unstable causing a person's eating habits to change due to sadness and no interest of doing anything. According to PSYCOM "Studies show that a high percentage of people with an eating disorder will experience depression."<ref>{{Cite web |title=Anorexia & Depression: When Eating Disorders Co-Exist with Depression |website=Psycom.net |url=https://www.psycom.net/anorexia-and-depression/ |access-date=2020-06-05}}</ref> Depression is a state of mind where people seem to refuge without being able to get out of it. A big factor of this can affect people with their eating and this can mostly affect teenagers. Teenagers are big candidates for Anorexia for the reason that during the teenage years, many things start changing and they start to think certain ways. According to Life Works an article about eating disorders "People of any age can be affected by pressure from their peers, the media and even their families but it is worse when you're a teenager at school."<ref>{{Cite web |title=Peer Pressure 'Big Factor' in Teen Eating Disorders {{!}} Life Works Rehab Surrey |url=https://www.lifeworkscommunity.com/blog/peer-pressure-big-factor-in-teen-eating-disorders |access-date=2020-06-05 |website=www.lifeworkscommunity.com}}</ref>

==== Cultural pressure ====
===== Western perspective =====
There is a cultural emphasis on thinness which is especially pervasive in western society. A child's perception of external pressure to achieve the ideal body that is represented by the media predicts the child's body image dissatisfaction, body dysmorphic disorder and an eating disorder.<ref>{{cite journal |vauthors=Knauss C, Paxton SJ, Alsaker FD |title=Relationships amongst body dissatisfaction, internalisation of the media body ideal and perceived pressure from media in adolescent girls and boys |journal=Body Image |volume=4 |issue=4 |pages=353–60 |date=December 2007 |pmid=18089281 |doi=10.1016/j.bodyim.2007.06.007}}</ref> "The cultural pressure on men and women to be 'perfect' is an important predisposing factor for the development of eating disorders".<ref>{{cite journal |vauthors=Garner DM, Garfinkel PE |s2cid=15755468 |title=Socio-cultural factors in the development of anorexia nervosa |journal=Psychological Medicine |volume=10 |issue=4 |pages=647–56 |date=November 1980 |pmid=7208724 |doi=10.1017/S0033291700054945}}</ref><ref>{{cite journal |vauthors=Eisenberg ME, Neumark-Sztainer D, Story M, Perry C |title=The role of social norms and friends' influences on unhealthy weight-control behaviors among adolescent girls |journal=Social Science & Medicine |volume=60 |issue=6 |pages=1165–73 |date=March 2005 |pmid=15626514 |doi=10.1016/j.socscimed.2004.06.055}}</ref> Further, when women of all races base their evaluation of their self upon what is considered the culturally ideal body, the incidence of eating disorders increases.<ref>{{cite journal |doi=10.1177/1077727X03255900 |title=Body Image, Appearance Self-Schema, and Media Images |year=2003 |vauthors=Jung J, Lennon SJ |journal=Family and Consumer Sciences Research Journal |volume=32 |pages=27–51}}</ref>

Socioeconomic status (SES) has been viewed as a risk factor for eating disorders, presuming that possessing more resources allows for an individual to actively choose to diet and reduce body weight.<ref>{{cite journal |vauthors=Nevonen L, Norring C |title=Socio-economic variables and eating disorders: a comparison between patients and normal controls |journal=Eating and Weight Disorders |volume=9 |issue=4 |pages=279–84 |date=December 2004 |pmid=15844400 |doi=10.1007/BF03325082 |s2cid=13089418}}</ref> Some studies have also shown a relationship between increasing body dissatisfaction with increasing SES.<ref>{{cite journal |vauthors=Polivy J, Herman CP |s2cid=2913370 |title=Causes of eating disorders |journal=Annual Review of Psychology |volume=53 |pages=187–213 |year=2002 |pmid=11752484 |doi=10.1146/annurev.psych.53.100901.135103}}</ref> However, once high socioeconomic status has been achieved, this relationship weakens and, in some cases, no longer exists.<ref name="Sohl, N. L. 2006">{{cite journal |vauthors=Soh NL, Touyz SW, Surgenor LJ |s2cid=178892 |year=2006 |title=Eating and body image disturbances across cultures: A review |journal=European Eating Disorders Review |volume=14 |issue=1 |pages=54–65 |doi=10.1002/erv.678}}</ref>

The media plays a major role in the way in which people view themselves. Countless magazine ads and commercials depict thin celebrities. Society has taught people that being accepted by others is necessary at all costs.<ref>{{cite book |vauthors=Essick E |chapter=Eating Disorders and Sexuality |chapter-url=https://books.google.com/books?id=ZaM04DMwK3gC&pg=PA276 |pages=[https://archive.org/details/contemporaryyout0000unse/page/276 276–80] |year=2006 |veditors=Steinberg SR, Parmar P, Richard B |title=Contemporary Youth Culture: An International Encyclopedia |publisher=Greenwood |isbn=978-0-313-33729-1 |url=https://archive.org/details/contemporaryyout0000unse/page/276}}</ref> This has led to the belief that in order to fit in one must look a certain way. Televised beauty competitions such as the [[Miss America]] Competition contribute to the idea of what it means to be beautiful because competitors are evaluated on the basis of their opinion.<ref>{{cite web |vauthors=DeMonte A |title=Beauty Pageants |url=http://www.credoreference.com/entry/sharpecw/beauty_pageants |publisher=M.E. Sharpe |access-date=24 September 2013}}{{dead link |date=June 2016|bot=medic}}{{cbignore|bot=medic}}</ref>

In addition to socioeconomic status being considered a cultural risk factor so is the world of sports. Athletes and eating disorders tend to go hand in hand, especially the sports where weight is a competitive factor. Gymnastics, horse back riding, wrestling, body building, and dancing are just a few that fall into this category of weight dependent sports. Eating disorders among individuals that participate in competitive activities, especially women, often lead to having physical and biological changes related to their weight that often mimic prepubescent stages. Oftentimes as women's bodies change they lose their competitive edge which leads them to taking extreme measures to maintain their younger body shape. Men often struggle with binge eating followed by excessive exercise while focusing on building muscle rather than losing fat, but this goal of gaining muscle is just as much an eating disorder as obsessing over thinness. The following statistics taken from Susan Nolen-Hoeksema's book, (''ab)normal psychology'', show the estimated percentage of athletes that struggle with eating disorders based on the category of sport.
* Aesthetic sports (dance, figure skating, gymnastics) – 35%
* Weight dependent sports (judo, wrestling) – 29%
* Endurance sports (cycling, swimming, running) – 20%
* Technical sports (golf, high jumping) – 14%
* Ball game sports (volleyball, soccer) – 12%

Although most of these athletes develop eating disorders to keep their competitive edge, others use exercise as a way to maintain their weight and figure. This is just as serious as regulating food intake for competition. Even though there is mixed evidence showing at what point athletes are challenged with eating disorders, studies show that regardless of competition level all athletes are at higher risk for developing eating disorders that non-athletes, especially those that participate in sports where thinness is a factor.<ref>{{cite book |vauthors=Nolen-Hoeksema S |title=Abnormal Psychology |year=2014 |location=New York |publisher=McGraw-Hill Education |isbn=978-0-07-803538-8 |pages=353–354 |edition=6th}}</ref>

Pressure from society is also seen within the homosexual community. [[Gay men]] are at greater risk of eating disorder symptoms than heterosexual men.<ref name="Boisvert, J. A. 2009">{{cite journal |doi=10.3149/jms.1703.210 |title=Homosexuality as a Risk Factor for Eating Disorder Symptomatology in Men |year=2009 |vauthors=Boisvert JA, Harrell WA |journal=The Journal of Men's Studies |volume=17 |issue=3 |pages=210–25 |s2cid=144871695}}</ref> Within the gay culture, muscularity gives the advantages of both social and sexual desirability and also power.<ref name="Siconolfi, D. 2009">{{cite journal |title=Body Dissatisfaction and Eating Disorders in a Sample of Gay and Bisexual Men |year=2009 |vauthors=Siconolfi D, Halkitis PN, Allomong TW, Burton CL |journal=International Journal of Men's Health |volume=8 |issue=3 |pages=254–264 |doi=10.3149/jmh.0803.254|doi-broken-date=1 November 2024}}</ref> These pressures and ideas that another homosexual male may desire a mate who is thinner or muscular can possibly lead to eating disorders. The higher eating disorder symptom score reported, the more concern about how others perceive them and the more frequent and excessive exercise sessions occur.<ref name="Siconolfi, D. 2009"/> High levels of body dissatisfaction are also linked to external motivation to working out and old age; however, having a thin and muscular body occurs within younger homosexual males than older.<ref name="Boisvert, J. A. 2009"/><ref name="Siconolfi, D. 2009"/>

Most of the cross-cultural studies use definitions from the DSM-IV-TR, which has been criticized as reflecting a Western cultural bias. Thus, assessments and questionnaires may not be constructed to detect some of the cultural differences associated with different disorders. Also, when looking at individuals in areas potentially influenced by Western culture, few studies have attempted to measure how much an individual has adopted the mainstream culture or retained the traditional cultural values of the area. Lastly, the majority of the cross-cultural studies on eating disorders and [[body image disturbance]]s occurred in Western nations and not in the countries or regions being examined.<ref name=":14">{{cite book |vauthors=Mash EJ, Wolfe DA |year=2010 |chapter=Eating Disorders and Related Conditions |chapter-url=https://books.google.com/books?id=hhvjIBUVDeYC&pg=PT415 |title=Abnormal Child Psychology |pages=415–26 |location=Belmont, CA: Wadsworth |publisher=Cengage Learning |isbn=978-0-495-50627-0}}</ref>

While there are many influences to how an individual processes their body image, the media does play a major role. Along with the media, parental influence, peer influence, and [[self-efficacy]] beliefs also play a large role in an individual's view of themselves. The way the media presents images can have a lasting effect on an individual's perception of their body image. Eating disorders are a worldwide issue and while women are more likely to be affected by an eating disorder it still affects both genders (Schwitzer 2012). The media influences eating disorders whether shown in a positive or negative light, it then has a responsibility to use caution when promoting images that projects an ideal that many turn to eating disorders to attain.<ref>{{cite journal |vauthors=Schwitzer AM |doi=10.1002/j.1556-6676.2012.00036.x |title=Diagnosing, Conceptualizing, and Treating Eating Disorders Not Otherwise Specified: A Comprehensive Practice Model |year=2012 |journal=Journal of Counseling & Development |volume=90 |issue=3 |pages=281–9}}</ref>

To try to address unhealthy body image in the fashion world, in 2015, [[France]] passed a law requiring models to be declared healthy by a doctor to participate in fashion shows. It also requires re-touched images to be marked as such in magazines.<ref>Kim Willsher, [https://www.theguardian.com/world/2015/dec/18/models-doctors-note-prove-not-too-thin-france Models in France must provide doctor's note to work] {{webarchive |url=https://web.archive.org/web/20161226221553/https://www.theguardian.com/world/2015/dec/18/models-doctors-note-prove-not-too-thin-france |date=2016-12-26}}, The Guardian, 18 December.</ref>

There is a relationship between "thin ideal" social media content and body dissatisfaction and eating disorders among young adult women, especially in the Western hemisphere.<ref name="auto">{{cite journal |vauthors=Ghaznavi J, Taylor LD |title=Bones, body parts, and sex appeal: An analysis of #thinspiration images on popular social media |journal=Body Image |volume=14 |pages=54–61 |date=June 2015 |pmid=25880783 |doi=10.1016/j.bodyim.2015.03.006}}</ref> New research points to an "internalization" of distorted images online, as well as negative comparisons among young adult women.<ref name="auto1">{{Cite journal |vauthors=Perloff RM |date=2014-05-29 |title=Social Media Effects on Young Women's Body Image Concerns: Theoretical Perspectives and an Agenda for Research |journal=Sex Roles |volume=71 |issue=11–12 |pages=363–377 |doi=10.1007/s11199-014-0384-6 |s2cid=28345078 |issn=0360-0025}}</ref> Most studies have been based in the U.S., the U.K, and Australia, these are places where the thin ideal is strong among women, as well as the strive for the "perfect" body.<ref name="auto1" />

In addition to mere media exposure, there is an online "pro-eating disorder" community. Through personal blogs and Twitter, this community promotes eating disorders as a "lifestyle", and continuously posts pictures of emaciated bodies, and tips on how to stay thin. The hashtag "#proana" (pro-anorexia), is a product of this community,<ref>{{cite journal |vauthors=Arseniev-Koehler A, Lee H, McCormick T, Moreno MA |title=#Proana: Pro-Eating Disorder Socialization on Twitter |journal=The Journal of Adolescent Health |volume=58 |issue=6 |pages=659–64 |date=June 2016 |pmid=27080731 |doi=10.1016/j.jadohealth.2016.02.012 |doi-access=free}}</ref> as well as images promoting weight loss, tagged with the term "thinspiration". According to social comparison theory, young women have a tendency to compare their appearance to others, which can result in a negative view of their own bodies and altering of eating behaviors, that in turn can develop disordered eating behaviors.<ref>{{Cite journal |vauthors=Yu UJ |title=Deconstructing College Students' Perceptions of Thin-Idealized Versus Nonidealized Media Images on Body Dissatisfaction and Advertising Effectiveness |journal=Clothing and Textiles Research Journal |volume=32 |issue=3 |pages=153–169 |doi=10.1177/0887302x14525850 |year=2014 |s2cid=145447562}}</ref>

When body parts are isolated and displayed in the media as objects to be looked at, it is called objectification, and women are affected most by this phenomenon. Objectification increases self-objectification, where women judge their own body parts as a mean of praise and pleasure for others. There is a significant link between self-objectification, body dissatisfaction, and disordered eating, as the beauty ideal is altered through social media.<ref name="auto" />

Although eating disorders are typically under diagnosed in people of color, they still experience eating disorders in great numbers. It is thought that the stress that those of color face in the United States from being multiply marginalized may contribute to their rates of eating disorders. Eating disorders, for these women, may be a response to environmental stressors such as racism, abuse and poverty.<ref>{{cite web |title=People of Color and Eating Disorders |url=https://www.nationaleatingdisorders.org/people-color-and-eating-disorders |website=National Eating Disorders Association |date=18 February 2018}}</ref>

===== African perspective =====
In the majority of many African communities, thinness is generally not seen as an ideal body type and most pressure to attain a slim figure may stem from influence or exposure to Western culture and ideology. Traditional African cultural ideals are reflected in the practice of some health professionals; in Ghana, pharmacists sell appetite stimulants to women who desire to, as Ghanaians stated, "grow fat".<ref>{{cite journal |vauthors=Keel PK, Klump KL |s2cid=7683812 |title=Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology |journal=Psychological Bulletin |volume=129 |issue=5 |pages=747–69 |date=September 2003 |pmid=12956542 |doi=10.1037/0033-2909.129.5.747}}</ref> Girls are told that if they wish to find a partner and birth children they must gain weight. On the contrary, there are certain taboos surrounding a slim body image, specifically in West Africa. Lack of body fat is linked to poverty and [[HIV/AIDS]].<ref name=":2">{{cite journal |vauthors=Coetzee V, Faerber SJ, Greeff JM, Lefevre CE, Re DE, Perrett DI |title=African perceptions of female attractiveness |journal=PLOS ONE |volume=7 |issue=10 |page=e48116 |date=2012-10-29 |pmid=23144734 |pmc=3483252 |doi=10.1371/journal.pone.0048116 |bibcode=2012PLoSO...748116C |doi-access=free}}</ref>

However, the emergence of Western and European influence, specifically with the introduction of such fashion and modelling shows and competitions, is changing certain views among body acceptance, and the prevalence of eating disorders has consequently increased.<ref name=":2" /> This acculturation is also related to how South Africa is concurrently undergoing rapid, intense urbanization. Such modern development is leading to cultural changes, and professionals cite rates of eating disorders in this region will increase with urbanization, specifically with changes in identity, body image, and cultural issues.<ref>{{Cite journal |vauthors=Freeman AC, Szabo CP |date=2005 |title=Eating Disorders in South African Males: A Review of the Clinical Presentation of Hospitalised Patients |journal=South African Journal of Psychology |volume=35 |issue=4 |pages=601–622 |doi=10.1177/008124630503500401 |s2cid=144551239}}</ref> Further, exposure to Western values through private Caucasian schools or caretakers is another possible factor related to acculturation which may be associated with the onset of eating disorders.<ref name=":9">{{cite journal |vauthors=Davis C, Yager J |title=Transcultural aspects of eating disorders: a critical literature review |journal=Culture, Medicine and Psychiatry |volume=16 |issue=3 |pages=377–94 |date=September 1992 |pmid=1395702 |doi=10.1007/BF00052156 |s2cid=40864146}}</ref>

Other factors which are cited to be related to the increasing prevalence of eating disorders in African communities can be related to sexual conflicts, such as psychosexual guilt, first sexual intercourse, and pregnancy. Traumatic events which are related to both family (i.e. parental separation) and eating related issues are also cited as possible effectors.<ref name=":9" /> Religious fasting, particularly around times of stress, and feelings of self-control are also cited as determinants in the onset of eating disorders.<ref>{{cite journal |vauthors=Taylor JY, Caldwell CH, Baser RE, Faison N, Jackson JS |title=Prevalence of eating disorders among Blacks in the National Survey of American Life |journal=The International Journal of Eating Disorders |volume=40 |issue=Suppl |pages=S10-4 |date=November 2007 |pmid=17879287 |pmc=2882704 |doi=10.1002/eat.20451}}</ref>

===== Asian perspective =====
The West plays a role in Asia's economic development via foreign investments, advanced technologies joining financial markets, and the arrival of American and European companies in Asia, especially through outsourcing manufacturing operations.<ref name=Pike2015>{{cite journal |vauthors=Pike KM, Dunne PE |title=The rise of eating disorders in Asia: a review |journal=Journal of Eating Disorders |volume=3 |issue=1 |page=33 |date=2015-09-17 |pmid=26388993 |pmc=4574181 |doi=10.1186/s40337-015-0070-2 |doi-access=free}}</ref> This exposure to Western culture, especially the media, imparts Western body ideals to Asian society, termed Westernization.<ref name=Pike2015 /> In part, Westernization fosters eating disorders among Asian populations.<ref name=Pike2015 /> However, there are also country-specific influences on the occurrence of eating disorders in Asia.<ref name=Pike2015 />

====== China ======
In China as well as other Asian countries, Westernization, migration from rural to urban areas, after-effects of sociocultural events, and disruptions of social and emotional support are implicated in the emergence of eating disorders.<ref name=Pike2015 /> In particular, risk factors for eating disorders include higher socioeconomic status, preference for a thin body ideal, history of child abuse, high anxiety levels, hostile parental relationships, jealousy towards media idols, and above-average scores on the body dissatisfaction and interoceptive awareness sections of the Eating Disorder Inventory.<ref>{{cite journal |vauthors=Chen H, Jackson T |title=Prevalence and sociodemographic correlates of eating disorder endorsements among adolescents and young adults from China |journal=European Eating Disorders Review |volume=16 |issue=5 |pages=375–85 |date=September 2008 |pmid=17960779 |doi=10.1002/erv.837}}</ref> Similarly to the West, researchers have identified the media as a primary source of pressures relating to physical appearance, which may even predict body change behaviors in males and females.<ref name=Pike2015 />

====== Fiji ======
While colonised by the British in 1874, Fiji kept a large degree of linguistic and cultural diversity which characterised the ethnic Fijian population. Though gaining independence in 1970, Fiji has rejected Western, capitalist values which challenged its mutual trusts, bonds, kinships and identity as a nation.<ref>{{cite book |vauthors=Becker AE |title=Body, self, and society : the view from Fiji |date=1995 |publisher=University of Pennsylvania Press |isbn=978-0-8122-1397-3 |location=Philadelphia |page=15}}</ref> Similar to studies conducted on Polynesian groups, ethnic Fijian traditional aesthetic ideals reflected a preference for a robust body shape; thus, the prevailing 'pressure to be slim,' thought to be associated with diet and disordered eating in many Western societies was absent in traditional Fiji.<ref>{{cite journal |vauthors=Pollock N |date=1985 |title=The Concept of Food in a Pacific Society: A Fijian Example |journal=Ecology of Food and Nutrition |volume=17 |issue=3 |pages=195–203 |doi=10.1080/03670244.1985.9990896|bibcode=1985EcoFN..17..195P}}</ref> Additionally, traditional Fijian values would encourage a robust appetite and a widespread vigilance for and social response to weight loss. Individual efforts to reshape the body by dieting or exercise, thus traditionally was discouraged.<ref>{{cite journal |vauthors=Becker AE, Hamburg P |title=Culture, the media, and eating disorders |journal=Harvard Review of Psychiatry |volume=4 |issue=3 |pages=163–7 |date=January 1996 |pmid=9384990 |doi=10.3109/10673229609030540 |s2cid=30169613}}</ref>

However, studies conducted in 1995 and 1998 both demonstrated a link between the introduction of television in the country, and the emergence of eating disorders in young adolescent ethnic Fijian girls.<ref>{{cite journal |vauthors=Becker AE, Gilman SE, Burwell RA |title=Changes in prevalence of overweight and in body image among Fijian women between 1989 and 1998 |journal=Obesity Research |volume=13 |issue=1 |pages=110–7 |date=January 2005 |pmid=15761169 |doi=10.1038/oby.2005.14 |doi-access=free}}</ref> Through the quantitative data collected in these studies there was found to be a significant increase in the prevalence of two key indicators of disordered eating: self-induced vomiting and high Eating Attitudes Test- 26.<ref name="Eating behaviours and attitudes fol">{{cite journal |vauthors=Becker AE, Burwell RA, Gilman SE, Herzog DB, Hamburg P |title=Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls |journal=The British Journal of Psychiatry |volume=180 |issue=6 |pages=509–14 |date=June 2002 |pmid=12042229 |doi=10.1192/bjp.180.6.509 |doi-access=free}}</ref> These results were recorded following prolonged television exposure in the community, and an associated increase in the percentage of households owning television sets. Additionally, qualitative data linked changing attitudes about dieting, weight loss and aesthetic ideas in the peer environment to Western media images. The impact of television was especially profound given the longstanding social and cultural traditions that had previously rejected the notions of dieting, purging and body dissatisfaction in Fiji.<ref name="Eating behaviours and attitudes fol"/> Additional studies in 2011 found that social network media exposure, independent of direct media and other cultural exposures, was also associated with eating pathology.<ref>{{cite journal |vauthors=Becker AE, Fay KE, Agnew-Blais J, Khan AN, Striegel-Moore RH, Gilman SE |title=Social network media exposure and adolescent eating pathology in Fiji |journal=The British Journal of Psychiatry |volume=198 |issue=1 |pages=43–50 |date=January 2011 |pmid=21200076 |pmc=3014464 |doi=10.1192/bjp.bp.110.078675 |doi-access=free}}</ref>

====== Hong Kong ======
From the early- to-mid- 1990s, a variant form of anorexia nervosa was identified in Hong Kong.<ref name=":5">{{cite journal |vauthors=Miller MN, Pumariega AJ |title=Culture and eating disorders: a historical and cross-cultural review |journal=Psychiatry |volume=64 |issue=2 |pages=93–110 |date=May 2001 |pmid=11495364 |doi=10.1521/psyc.64.2.93.18621 |s2cid=21186595}}</ref> This variant form did not share features of anorexia in the West, notably "fat-phobia" and distorted body image.<ref name=":5"/> Patients attributed their restrictive food intake to somatic complaints, such as epigastric bloating, abdominal or stomach pain, or a lack of hunger or appetite.<ref name=Pike2015/> Compared to Western patients, individuals with this variant anorexia demonstrated bulimic symptoms less frequently and tended to have lower pre-morbid body mass index.<ref name=Pike2015/> This form disapproves the assumption that a "fear of fatness or weight gain" is the defining characteristic of individuals with anorexia nervosa.<ref name=":5"/>

====== India ======
In the past, the available evidence did not suggest that unhealthy weight loss methods and eating disordered behaviors are common in India as proven by stagnant rates of clinically diagnosed eating disorders.<ref>{{cite journal |vauthors=Mammen P, Russell S, Russell PS |title=Prevalence of eating disorders and psychiatric comorbidity among children and adolescents |journal=Indian Pediatrics |volume=44 |issue=5 |pages=357–9 |date=May 2007 |pmid=17536137}}</ref> However, it appears that rates of eating disorders in urban areas of India are increasing based on surveys from psychiatrists who were asked whether they perceived eating disorders to be a "serious clinical issue" in India.<ref name=Pike2015 /> One notable Indian psychiatrist and eating disorder specialist Dr Udipi Gauthamadas is on record saying, "Disturbed eating attitudes and behaviours affect about 25 to 40 percent of adolescent girls and around 20 percent of adolescent boys.<ref>{{Cite web |title=At war with the Body |url=https://www.newindianexpress.com/lifestyle/health/2019/jul/28/at-war-with-the-body-2009347.html |access-date=2023-08-05 |website=The New Indian Express|date=28 July 2019}}</ref> While on one hand there is increasing recognition of eating disorders in the country, there is also a persisting belief that this illness is alien to India. This prevents many sufferers from seeking professional help.<ref>{{Cite web | vauthors = Chaudhuri ZR |date=2018-01-05 |title=Over 25% of teenage Indian girls suffer from eating disorders. This art project shows how they feel |url=https://scroll.in/magazine/863540/over-25-of-teenage-indian-girls-suffer-from-eating-disorders-this-art-project-shows-how-they-feel |access-date=2023-08-05 |website=Scroll.in}}</ref>"

23.5% of respondents believed that rates of eating disorders were rising in Bangalore, 26.5% claimed that rates were stagnant, and 42%, the largest percentage, expressed uncertainty. It has been suggested that urbanization and socioeconomic status are associated with increased risk for body weight dissatisfaction.<ref name="Pike2015" /> However, due to the physical size of and diversity within India, trends may vary throughout the country.<ref name="Pike2015" />

==== American perspective ====

===== Black and African American =====

Historically, identifying as African American has been considered a protective factor for body dissatisfaction. Those identifying as African American have been found to have a greater acceptance of larger body image ideals and less internalization of the thin ideal,<ref>{{cite journal |vauthors=Miller KJ, Gleaves DH, Hirsch TG, Green BA, Snow AC, Corbett CC |title=Comparisons of body image dimensions by race/ethnicity and gender in a university population |journal=The International Journal of Eating Disorders |volume=27 |issue=3 |pages=310–6 |date=April 2000 |pmid=10694717 |doi=10.1002/(sici)1098-108x(200004)27:3<310::aid-eat8>3.0.co;2-q |doi-access=free}}</ref><ref>{{cite journal |vauthors=Rand CS, Kuldau JM |title=The epidemiology of obesity and self-defined weight problem in the general population: Gender, race, age, and social class |journal=International Journal of Eating Disorders |date=1990 |volume=9 |issue=3 |pages=329–343 |doi=10.1002/1098-108X(199005)9:3<329::AID-EAT2260090311>3.0.CO;2-B}}</ref><ref>{{cite journal |vauthors=Thompson SH, Corwin SJ, Sargent RG |title=Ideal body size beliefs and weight concerns of fourth-grade children |journal=The International Journal of Eating Disorders |volume=21 |issue=3 |pages=279–84 |date=April 1997 |pmid=9097201 |doi=10.1002/(SICI)1098-108X(199704)21:3<279::AID-EAT8>3.0.CO;2-H}}</ref> and African American women have reported the lowest levels of body dissatisfaction among the five major racial/ethnic groups in the US.<ref>{{cite journal |vauthors=Vander Wal JS, Thomas N |title=Predictors of body image dissatisfaction and disturbed eating attitudes and behaviors in African American and Hispanic girls |journal=Eating Behaviors |volume=5 |issue=4 |pages=291–301 |date=November 2004 |pmid=15488444 |doi=10.1016/j.eatbeh.2004.04.001}}</ref>

However, recent research contradicts these findings, indicating that African American women may exhibit levels of body dissatisfaction comparable to other racial/ethnic minority groups.<ref>{{cite journal |vauthors=Olson KL, Lillis J, Panza E, Wing RR, Quinn DM, Puhl RR |title=Body shape concerns across racial and ethnic groups among adults in the United States: More similarities than differences |journal=Body Image |volume=35 |pages=108–113 |date=December 2020 |pmid=32979632 |pmc=7744334 |doi=10.1016/j.bodyim.2020.08.013}}</ref> In this way, just because those who identify as African American may not internalize the thin ideal as strongly as other racial and ethnic groups, it does not mean that they do not hold other appearance ideals that may promote body shape concerns.<ref>{{cite journal |vauthors=Nagata JM, Murray SB, Bibbins-Domingo K, Garber AK, Mitchison D, Griffiths S |title=Predictors of muscularity-oriented disordered eating behaviors in U.S. young adults: A prospective cohort study |journal=The International Journal of Eating Disorders |volume=52 |issue=12 |pages=1380–1388 |date=December 2019 |pmid=31220361 |pmc=6901753 |doi=10.1002/eat.23094}}</ref> Similarly, recent research shows that African Americans exhibit rates of disordered eating that are similar to<ref>{{cite journal |vauthors=Beccia AL, Jesdale WM, Lapane KL |title=Associations between perceived everyday discrimination, discrimination attributions, and binge eating among Latinas: results from the National Latino and Asian American Study |journal=Annals of Epidemiology |volume=45 |pages=32–39 |date=May 2020 |pmid=32340835 |pmc=7329263 |doi=10.1016/j.annepidem.2020.03.012}}</ref><ref>{{cite journal |vauthors=Grabe S, Hyde JS |title=Ethnicity and body dissatisfaction among women in the United States: a meta-analysis |journal=Psychological Bulletin |volume=132 |issue=4 |pages=622–40 |date=July 2006 |pmid=16822170 |doi=10.1037/0033-2909.132.4.622}}</ref> or even higher<ref name=":15">{{cite journal |vauthors=Marques L, Alegria M, Becker AE, Chen CN, Fang A, Chosak A, Diniz JB |title=Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders |journal=The International Journal of Eating Disorders |volume=44 |issue=5 |pages=412–20 |date=July 2011 |pmid=20665700 |pmc=3011052 |doi=10.1002/eat.20787}}</ref> than their white counterparts.

===== Native American =====

[[Native Americans in the United States|Native American]] women are more likely than white women to both experience a fear of losing control over their eating<ref name=":16">{{cite journal |vauthors=Striegel-Moore RH, Rosselli F, Holtzman N, Dierker L, Becker AE, Swaney G |title=Behavioral symptoms of eating disorders in Native Americans: results from the ADD Health Survey Wave III |journal=The International Journal of Eating Disorders |volume=44 |issue=6 |pages=561–6 |date=September 2011 |pmid=21823140 |doi=10.1002/eat.20894 |doi-access=free |pmc=11624507}}</ref> and to abuse laxatives and diuretics for weight control purposes.<ref name=":17">{{cite journal |vauthors=Franko DL, Becker AE, Thomas JJ, Herzog DB |title=Cross-ethnic differences in eating disorder symptoms and related distress |journal=The International Journal of Eating Disorders |volume=40 |issue=2 |pages=156–64 |date=March 2007 |pmid=17080449 |doi=10.1002/eat.20341}}</ref> They have comparable rates of binge eating and other disordered weight control behaviors in comparison to other racial groups.<ref name=":16" /><ref name=":17" />

===== Latinos =====

Disproportionately high rates of disordered eating and body dissatisfaction have been found in [[Hispanic and Latino Americans|Hispanics]] in comparison to other racial and ethnic groups. Studies have found significantly more laxative use<ref>{{cite journal |vauthors=Monterubio GE, Fitzsimmons-Craft EE, Balantekin KN, Sadeh-Sharvit S, Goel NJ, Laing O, Firebaugh ML, Flatt RE, Cavazos-Rehg P, Taylor CB, Wilfley DE |title=Eating disorder symptomatology, clinical impairment, and comorbid psychopathology in racially and ethnically diverse college women with eating disorders |journal=The International Journal of Eating Disorders |volume=53 |issue=11 |pages=1868–1874 |date=November 2020 |pmid=32918315 |pmc=7669650 |doi=10.1002/eat.23380}}</ref><ref name=":17" /> in those identifying as Hispanic in comparison to non-Hispanic white counterparts. Specifically, those identifying as Hispanic may be at heightened risk of engaging in binge eating and bingeing/purging behaviors.<ref name=":15" />