When many people think of individuals with eating disorders (EDs), they usually picture a White, cisgender, young, affluent, thin female in their mind. However, the idea that eating disorders only present in this stereotypical manner is an unfortunate and dangerous myth. Eating disorders largely exist outside of White females. Researchers (e.g., Cheng et al., 2019; Sonneville & Lipson, 2018) pointed out that the prevalence of eating disorders among people of color is similar to their White peers, but people of color are often less likely to receive the diagnosis of eating disorders. More specifically, Asian American young adults are at a higher risk of having disordered eating symptoms and body image concerns than White people (Akoury et al., 2019; Zhou et al., 2022). As a Chinese female clinician in the U.S., I would like to share my perspectives on eating disorders among Chinese females and possible obstacles in their recovery journeys.

In 2023, Holmes and Ma shared their views about the development of gender and beauty ideology for young Chinese females. Specifically, young Chinese women are expected to have white skin, thin bodies, and a youthful appearance. For example, many young Chinese women use various diet methods to lose weight and purchase beauty products that lighten their skin. Many of my Chinese female friends talk about their body dissatisfaction and ways they have been considering losing weight. Our lunch or dinner gatherings usually end with statements such as: “I want to eat more, but I am going to stop because I don’t want to gain weight” or “I have been lazy lately not controlling my weight, so I am not going to eat more.” These statements reveal how weight has been associated with discipline, control, and character (i.e., hard-working vs. lazy).

Many Asian women in the U.S. face the stress of wanting to fit into the dominant culture while maintaining or connecting with their native culture (Akoury et al., 2019; Zhou et al., 2022). However, skinny, fragile, and pale are the prevailing beauty standards in Asian culture, contributing to developing and maintaining disordered eating among Asian women. My mother has repeatedly told me that I need to lose weight to improve myself; otherwise, my fatness is going to scare away my husband and bring negative health outcomes. Prior to learning about eating disorder treatment, I, too, was bought into the idea that weight was a reflection of physical health and personal strength/weakness. Every time I wanted to enjoy food, my mother’s judgmental voice appeared in my mind. However, my wise mind informed me that I should be able to enjoy food and respect my body. Recognizing this conflict led me to pursue my curiosity about eating disorders and become a clinician in training at the Eating Disorder Institute Las Vegas (EDI). I am fortunate and privileged to learn about the concepts of intuitive eating, felt safety, and radical acceptance.

I began to explore my connection with food by tracing back to my earlier memories of food with my Chinese family. When I was in kindergarten, my grandfather usually picked me up from school and bought me snacks on our way home. After we got home from school, my grandparents began preparing dinner for the larger family with my uncles, aunts, cousins, and parents. At dinner time, we enjoyed our time together by discussing our school days and sharing food. Food used to represent love and care in my family. But as I transitioned into adulthood, food started to be framed as an enemy. Where food used to symbolize love and connection, now my parents cautioned me from eating too much and pushed me to exercise when I went back home for a vacation. Sadly, even when I have tried to educate them on the harm of diet culture and myths about weight gain, they continued to impose their ideology upon me. Fortunately, I have supportive friends and colleagues who build a safety network for me. I believe this has prevented me from developing disordered eating or negative self-talk around my body.

In a 2023 TED talk with over 2000 views, Jiang shared her story as a Chinese woman living with an eating disorder. Similar to my experience, she also pointed out how Chinese culture connects weight, food intake, and success. She also spoke about mental health stigma being a main barrier when it comes to seeking professional support. I related to her when she talked about mental health literacy among Chinese individuals and the lack of information about eating disorders or any mental health disorders in Chinese language/writing. When I shared my knowledge about mental wellness and mental disorders with my parents, they quickly switched topics; when they shared stories about relatives having mental health concerns, my parents usually made comments about how my relatives could not “just get over it.” I tried to make culturally appropriate recommendations about enhancing mental wellness, but my parents often disputed my sharing by saying that I was only “textbook smart.”

ne of the many barriers. Jiang also talked about the lack of culturally relevant practices and representation for Chinese women with eating disorders. In my career journey of becoming a health service psychologist, I am either the only one or one of the two Asian females in the classrooms or training sites. Many of the evidence-based treatments available for treating various mental health disorders are based on research studies on White individuals. Despite the development and promotion of culturally relevant, evidence-based practices in the field, the access to and quality of care for Chinese individuals is concerning. Jiang shared an example of how the meal plan provided by her treatment team was hard for her to follow because Chinese food could not be easily examined in terms of its fat, carbohydrate, and protein.

In sum, Chinese females must face many obstacles along their path of identification, assessment, and recovery from an eating disorder and/or other mental health disorders. Therefore, here are my recommendations for mental health providers working with people of color with an eating disorder:

• Spend time exploring and understanding our clients’ cultural identities and social positions (e.g., gender identity, sexual orientation, class, nationality)
• Explore existing research and literature on eating disorders and mental health disorders among marginalized individuals and communities
• Engage in self-reflection about our privileges, biases, and prejudices about food, weight, and mental health
• Participate in continuing education to learn about up-to-date information about eating disorders and culturally relevant, evidence-based treatment
• Conduct research to understand the experiences of Asian individuals with diverse gender identities, which will inform clinical practices centered on healing and empowerment.

References

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. https://doi.org/10.3389/fpsyg.2019.01950

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. https://doi.org/10.1016/j.eatbeh.2018.11.004

Holmes, S., & Ma, H. (2023). A feminist approach to eating disorders in China: a qualitative study. Journal of Eating Disorders, 11(1), 157-173. https://doi.org/10.1186/s40337-023-00883-z

Jiang, A. (2023, February). Fat, Asian and living with an eating disorder [Video]. TED Conferences. https://www.ted.com/talks/anne_jiang_fat_asian_and_living_with_an_eating_disorder?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare

Sonneville, K. R., & Lipson, S. K. (2018). Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. International Journal of Eating Disorders, 51(6), 518–526. https://doi.org/10.1002/eat.22846

Zhou, Z., Liew, J., & Luo, W. (2022). Acculturation and disordered eating among Asian American College students: the role of objectification through a sociocultural lens. International Journal of Environmental Research and Public Health, 19(21), 13967. https://doi.org/10.3390/ijerph192113967

Written by Yin Cai, MS, M. Ed

EDI practicum student