Eating Disorder Symptoms in Asian American College Students

By Melissa Munn-Chernoff, Ph.D.

Most research on eating disorders and their symptoms have been conducted in individuals of European ancestry, despite studies demonstrating their presence in individuals of Asian ancestry (for a brief summary, click here). In general, studies have found that the prevalence of eating disorders are comparable to other ethnic/racial groups.^1,2 However, few studies have investigated differences in levels of specific eating disorder symptoms in Asian populations compared with additional ethnic/racial groups. Identifying which specific eating disorder symptoms may be more common in Asian Americans can assist with recognizing, preventing, and treating eating disorders in this understudied population.

In a recent study³ led by one of our CEED postgraduate research trainees, Rachel Uri, we examined similarities and differences in levels of multiple eating disorder symptoms among Asian Americans, Whites, and Non-Asian People of Color. In approximately 700 college students, we assessed eight eating disorder symptoms: restriction (i.e., specific efforts to reduce or avoid eating), body dissatisfaction, purging, binge eating, excessive exercise, muscle building, negative attitudes toward obesity, and cognitive restraint (i.e., cognitive efforts to reduce eating, even if attempts are not successful).⁴ Overall, the majority (61%) of the sample was female; 16% of the sample identified as Asian American, and 67% as White. Individuals who were African American, Pacific Islander, Multiracial, or identifying as another race were included as Non-Asian People of Color, which comprised the remaining 17% of the sample. We found the following results:

• Asian Americans reported increased levels of purging, muscle building, and cognitive restraint compared with Whites and Non-Asian People of Color.
• Asian Americans had higher levels of restriction than Whites.
• Increased mean scores on body dissatisfaction and negative attitudes toward obesity emerged for Asian Americans compared with Non-Asian People of Color.
• All of these aforementioned results were statistically significant after adjusting for internalizing symptoms, including depression, anxiety, and stress.

Our results indicate that Asian American college students have higher levels of certain eating disorder symptoms compared with their peers who identify as White or are Non-Asian People of Color. It is possible that the higher levels of these specific symptoms may reflect an increased representation of, for example, acculturative stress (i.e., stressors associated with adapting to a new culture), Western body ideals, or theories of objectification.^1,5,6 However, additional work is needed to determine the influence of acculturation, immigration/generational status, and ethnic and national identity, within men and women separately. Studies should also differentiate between Asian ethnic subgroups and between Asian immigrants and American-born Asians. Still, these findings highlight the importance of assessing for the presence of eating disorders and their symptoms in Asian Americans in order to improve detection, diagnosis, and treatment.

References

1. Cheng, Z.H., Perko, V.L., Fuller-Marashi, L., Gau, J.M., Stice, E. (2019). Ethnic differences in eating disorder prevalence, risk factors, and predictive effects of risk factors among young women. Eating Behaviors, 32, 23-30.
2. Marques, L., Alegria, M., Becker, A.E., Chen, C.N., Fang, A., Chosak, A., Diniz, J.B. (2011). 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. International Journal of Eating Disorders, 44, 412-420.
3. Uri, R.C., Wu, Y.-K., Baker, J.H., Munn-Chernoff, M.A. (in press). Eating disorder symptoms in Asian American college students. Eating Behaviors. doi: 10.1016/j.eatbeh.2020.101458.
4. Forbush, K.T., Wildes, J.E., Pollack, L.O., Dunbar, D., Luo, J., Patterson, K. … Watson, D. (2013). Development and validation of the Eating Pathology Symptoms Inventory (EPSI). Psychological Assessment, 25, 859-878.
5. Akoury, L.M., Warren, C.S., Culbert, K.M. (2019). Disordered eating in Asian American women: Sociocultural and culture-specific predictors. Frontiers in Psychology, 10, 1950.
6. Masuda, A., Le, J., Cohen, L.L. (2014). The role of disordered-eating cognitions and psychological flexibility on distress in Asian American and European American college females in the United States. International Journal for the Advancement of Counselling, 36, 30-42.