Is cultural change associated with eating disorders? A systematic review of the literature.

backgroundThere is debate as to whether the development of an eating disorder (ED) may be triggered by acculturation to Western culture. While there is evidence to suggest that acculturation to Western culture is associated with risk of having an ED, these findings are limited, vary significantly, and are sometimes conflicting.

aimsTo review the literature and empirical data on the association between ED symptoms and acculturation in the context of Western culture.

methodsA systematic search of peer-reviewed publications using a combination of the keywords "Culture", "Acculturation" and "Eating disorders" was first performed in August 2014 and updated in February 2015 with the following databases: PubMed and SCOPUS. Reference lists were also hand searched. In total, the search provided more than 50 studies. Following screening (as stated in the PRISMA guidelines) of the titles and abstracts by inclusion and exclusion criteria and quality assessment of the full text, 25 studies were identified to be appropriate for the review. Articles were examined in relation to the findings, as well as the ED and acculturation measures used.

resultsEleven studies suggested considerable association between ED and culture change/acculturation. Six studies suggested little or no association between ED and culture change/acculturation. Eight studies did not primarily examine association, yet generated valuable insight. While there was relative consistency across studies in terms of the ED measures selected, measures of acculturation varied significantly.

conclusionsThe majority of the evidence reviewed here suggests that there is a substantial association between culture change and ED psychopathology. However, both greater and lesser acculturation have been identified as risk factors for the development of an ED, and this varies depending on the group studied as well as how acculturation and culture change are conceptualized and measured. Further research is warranted to form cross-culturally acceptable definitions and measures of problematic eating, and healthy and high acculturation, to study the relationship between EDs and the process of acculturation to Western culture.