The cultural faces of Eating Disorders and Disordered Eating

When I was in high school I'd visit Japan once a year or two during the school holidays.

I have always been a smaller size in my year group so it felt funny to be 'medium' in Japan. 
The letters indicating my clothes size would range from various small's and large's and everything in between. 

I didn't think of it much more back then than "oh this is so confusing".
But now as a practitioner working with eating disorders and disordered eating, it really gets me thinking.

What difference would have this made to my body image if I were living in Japan for my entire life?

A 9-hour plane ride away, my view of my body would've been totally different.

Back in this and this article from last month I mentioned the disturbingly high rates of body dissatisfaction among the Japanese population.

Now this week Psychology Today has published the alarming reality of eating disorder rates in Asian countries including Japan.

Japan’s Anorexia Nervosa rate is 10 times higher than it was 30 years ago. There were no reported cases of bulimia 40 years ago. Today, it’s the country’s biggest eating disorder problem... is a large part of relationship dynamics in Asian cultures. Food not only feeds and nourishes but is used to unite, celebrate, and be connected. Greetings that single out one's appearance... is commonplace among traditional Asians. In Chinese culture, a relative can openly say, "Hey, it looks like you gained weight!" or "Hey, it looks like you lost weight!" as a means to start a conversation...

But these observations can also be misinterpreted in a culture that relies heavily on food instead of words to communicate love. "Eat, eat" or the feeling you must eat someone's food to show your appreciation of their love or care can play into one's eating disorder...

...not only do Asians put themselves at risk for an eating disorder due to the exposure of Western standards of beauty but traditional Eastern values of abiding by cultural conformity, honor, and collectivism add a distinct layer of challenge that must also be addressed to help this population.
(Read the full article here)

In Japan there is a culture of 'Kenson' i.e. being humble.
Excessively humble, to be accurate.

It would go like this:

Friend: "You look beautiful"

Self: "Oh no way, I'm not beautiful at all!"


Friend: "You did a great job!"

Self: "No not at all! I need to do better next time!"

So if this style of communication is the norm,  how can one possibly develop positive body image when the expectation of the society is for you to undermine and criticise yourself when talking to others?

It is interesting that this study has found that "fear of fat" is not always present in Anorexia Nervosa cases in groups of Asian girls, "suggesting that for this eating disorder symptom may be different in Asian women than in other ethnic groups".
I wonder whether this cultural communication style is leading to a self destructive characteristic of eating disorder in Asia, rather than just the fear of fat.

Also interesting to read:
Cultural difference in eating disorders (By Caleb Lack on Skepticink)