Exploring anorexia and obesity and the link between economically different parts of the world including (MEDC’s) and (LEDC’s).
Abstract:
The issues of physical health affecting mental health in different parts of the world provided me with interest in researching this broad topic further. The purpose of this topic is to delve into the complexity of how such health issues are spread across countries of different economic stages. I will therefore discuss and evaluate the effects these issues have in different parts of the world amongst different people. According to the National Eating Disorder Association, up to 70 million people (both male and female) suffer from eating disorders .
Introduction:
The aim of my project is to illustrate the impacts of eating disorders and how they vary within different parts of the world; especially focussing on the contrast between where there is a larger Gross Domestic Product (GDP) , compared to a smaller GDP. By investigating this aspect, I will be able to demonstrate reasons why a country may have a greater or a reduced proportion of Obese or Anorexic individuals. My initial resources will contain information from scholars, books, newspapers, and educational websites on the Internet. This will be beneficial to obtain and select information from a varied range of sources by analysing data, applying it relevantly and demonstrating the understanding of any appropriate connections and complexities of the topic. My project will abide by a simple structure of firstly explaining the key terms in this extended project, and then by clarifying the effects and impacts. Furthermore, I will convey how each disorder varies in contrasting countries, as well as applying different strategies to validate factual information. Lastly, I will provide a detailed conclusion of my all findings initiated with this project.
Anorexia
Anorexia is explained to be a medical condition where individuals suffering from it have a lack or loss of appetite for food. It is an emotional disorder characterised by an obsessive desire to lose weight by refusing to eat. People who have anorexia experience ‘dramatic weight loss’ by not eating enough or exercising too much. This can make those individuals very ill as they start to starve themselves. They often have a distorted image of their bodies, thinking that they are much larger, even when they are underweight. Men or women of any age can develop anorexia, but its most common in young women and typically starts in the mid teens. A new study published in the journal Neuropsychopharmacology shows that reward circuits in the brain seem to be different based on a person's approach to food.
Anorexia can be caused through a member of the family having a history of eating disorder, depression, alcohol or drug addiction. Similarly, other individuals may cause anorexia as they criticise others about their eating habits, body shape or weight. Many individuals may also be overly concerned with being slim, particularly if you feel pressured through society or jobs (APA, 2006; World Health Organization [WHO], 1993)
Signs and Symptoms of Anorexia:
• Missing meals, eating very less or avoiding eating any foods that you see as fattening.
• Believing that you are fat when you are a healthy weight or underweight.
• Taking medication to reduce your hunger.
• In women, your periods stopping or not even starting.
• Physical problems such as light headed, dizziness or hair loss
Treatment:
You can recover from anorexia but it may take time and recovery will be different for everybody. Medical professional help is required as a treatment plan which will be tailored to you and should consider any support you may need, such as for depression or anxiety. Over 18’s often receive a type of talking therapy to help you manage feelings about food and eating so that you are able to eat enough to be healthy. Talking Therapies that are commonly used to treat anorexia in adults are :
• Cognitive Behavioural Therapy (CBT)
• Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
• Specialist Supportive Clinical Management (SSCM)
Obesity
On the other hand, Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have a negative effect on health. Obesity is generally caused by consuming more calories than you can burn off in physical activity; particularly those in fatty and sugary food. The excess energy is stored in the body as fat.
Obesity is an increasingly common problem because for many of the people living in modern societies it involves eating excessive amounts of cheap, high calorie food and spending a lot of time sitting down at desks, on sofas or in cars.
The U.K has the third highest rate of excess weight behind Iceland and Malta. 67% of men and 57% of women in the U.K are overweight or obese [The Guardian] .
Signs and Symptoms:
• Excessive eating, inability to cope with sudden physical activity
• Breathlessness
• Increased sweating
• Back and joint pains
• Low confidence and self esteem
Treatment:
Local weight loss groups are recommended by GP’s which can be provided through the NHS, as well as exercise through a local active health team.
‘Childhood obesity has always been a public health problem that affected 30–45 million children worldwide’ (Stettler, 2004) . Concurring to the Household Budget Survey conducted by the Brazilian Institute of Geography and Statistics (IBGE), between 1974 and 2009, overweight adolescents (individuals aged 10–19 years) in Brazil increased from 3.7% to 21.7% for males and from 7.6% to 19.4% for females (IBGE, 2012) .
Analysis
The rising dominance of Obesity and the severity of Anorexia, is supported by a recent study which found that individuals with Anorexia have more dysfunctional eating attitudes than individuals with obesity (Alvarenga, Koritar, Pisciolaro, Mancini, Cordás & Scagliusi, 2014) Furthermore, various authors have cited obesity as a risk factor for eating disorders, although most studies have dealt with anorexia and binge eating disorder (Fairburn, Welch, Doll, Davies & O'Connor, 1997; Fairburn et al., 1998; Field et al., 2012; McCabe & Ricciardelli, 2009; Neumark-Sztainer et al., 2007).
Although eating disorders can increase the risk of obesity and obesity might be a risk factor for eating disorders (one perpetuating the other), eating disorders and obesity are considered distinct diseases and are most often treated independently (Ferrari, 2011; Goldschmidt et al., 2008; Neumark-Sztainer et al., 2007). The scientific community is still attempting to establish the clinical features of eating disorders in youths with a history of obesity, primarily to identify the need for adjustments to the diagnostic and treatment processes .
The Difference in Anorexic and Obese Brains
A study I found included researchers who used functional magnetic resonance imaging to examine brain activity in 63 women. These women were either anorexic or obese. Consequently, it led to a comparing of their brains to those of women considered "normal" weight.
Before the brain scans, participants were visually conditioned to associate certain shapes with either a sweet or a non-sweet solution. Then, they received the taste solutions expectedly or unexpectedly as the researchers monitored their brain activity. This task has been associated with brain dopamine function in the past.
Consequently the study found that these reward circuits are "sensitized" in anorexic women and "desensitized" in obese women. During these sessions, an unexpected sweet-tasting solution resulted in increased neural activation of reward systems in the anorexic patients and diminished activation in obese individuals. This diminished reward could be what drives obese people to eat and eat and eat, trying to satisfy their need to activate that reward circuit in their brains .
The Rise Associated With Eating Disorders Around The World
There is no shock stated at the fact that eating disorders in the last few decades are on a significant rise throughout the world, not only within more economically developed countries (MEDC’s) and High Income Countries (HIC’s). With the increasing rise of westernisation, especially the advancement of technology, there is an increasing rise of perceptions including the idea of an ideal body shape and size. This is affecting women and men of all ages especially as they associate themselves on social media where they are exposed to the ‘perfect’ body shape of being ‘slim, but curvy’. Although body dissatisfaction is becoming scarily common amongst those suffering with eating disorders, there are many scholars who don't abide by this rule. The idea of body dissatisfaction is known to be one of the most common causes of entry into an eating disorder, however it has been noted that early case descriptions of anorexia nervosa and evidence from non-western cultures indicate that some patients voluntarily reach an emaciated weight for a variety of psychological reasons.
Consequently, ‘some of the earlier cases from the 19th Century clinical descriptions of anorexia nervosa do not mention body dissatisfaction as a clinical feature of the disorder . Some critiques argue that cases within China and India don't have that fear of ‘becoming fat’ or the idea of body dissatisfaction that is prominent within western cultures. Even in westernised cultures there is a small minority of patients who engage with a very low weight but deny any explanations or reasons associated with body dissatisfaction, during the development of the disorder. In addition some individuals display reasons of sudden weight loss leading to anorexia due to the fears of choking, food allergies and brief phases of physical illness.
An increasingly high number of young girls especially are reporting that they are dissatisfied with their bodies and they continue to force themselves to lose weight in rather unhealthy ways. These include skipping meals, fasting and using tobacco. A smaller proportion of young girls are also resorting to using methods such as self-induced vomiting, diet pills and laxative use . These attitudes and behaviours are having an extreme affect as they place them into a greater risk of developing eating disorders including obesity, poor nutrition, growth impairments, and emotional problems for example depression and anxiety . Further research supports the fact that overweight girls are more likely to diet than their normal-weight peers.
Bulimia leads to binge eating as it then establishes the purge to vomiting, using laxatives and many other means which result in weight gain. More than one third of obese individuals in weight-loss treatment programmes report difficulties with binge eating. This type of habit can contribute to feelings of shame, loneliness, poor self-esteem and depression. Furthermore, adolescents who are depressed show an increased risk of becoming obese. A study conducted by Goodman states that ‘depressed adolescents were two times more likely to become obese at the one year follow up than teens who did not suffer from depression.’
Therefore, it is the influence of mass media; family and friends that may be sending children mixed messages about food and weight that encourage the development of eating disorders. Especially in today’s society where thinness is idealised compared to fatness being stigmatised. This contrasts with the fact that high-calorie foods are still increasingly, widely available and heavily advertised worldwide. At the same time, low levels of exercise are carried out by the minority of people due to higher availability of televisions, computers and mobile phones which replace active leisure with recreational leisure.
Methods used to help body-image, regarding anorexia
Various methods have been implanted to help correct distorted body size estimations. A particular use has included the providence of corrective feedback to anorexia nervosa patients in order to establish the aim of improving certain accuracy over a period of time. One strategy includes the feedback on standardised measures of size estimation, whilst another involves directing patients to study their own body in a mirror and try to develop a more realistic and objective perspective of their weight and shape.
Studies have further concluded that such exercises that are done repeatedly may provide value in helping patients overcome the severity of their disorder. This would bring in positives that would reflect upon the mood of the certain individual as they come to terms with reality and how life doesn't depend on what you look like and what other people think about you. On the other hand, many clinicians argue that changing this perception of body size has a rather limiting role upon treating the health issue of anorexia nervosa. It comes to no surprise that this certain treatment has a little therapeutic effect since most of the patients have a rather long history of receiving feedback that is undesirable by friends and family who insist that they are too thin and must gain weight or in other words ‘curves’.
Defining Obesity and Eating Disorders in Teenagers
Obesity in children can be described as weighing at least 10% higher than what is recommended for height and body type. Information regarding is based upon the BMI score mentioned earlier on in this report. It can be found within the NHS website where individuals can be classed as underweight, healthy or obese. Often, obesity begins around age 5-6 through adolescence and studies have shown that when a child is obese between the ages of 10-13, there is an 80% chance of them becoming obese as an adult . There are many reasons for obesity, including genetic factors, biological reasons, behavioural and cultural factors.
If one parent is obese, then there is a 50% chance that their child will become obese and if both parents are obese, there is an 80% chance that their child will become obese. Often causal factors of obesity in teens are due to poor eating habits, overeating or binging behaviours, lack of body movement or exercise, and a family history of obesity. Other reasons typically include medical illness such as endocrine or neurological disorders, medications being taken by the child, stress, or family and peer problems. Low self-esteem, depression, and other mental health disorders can also be a reason for the development of obesity and eating disorders.
Global Impact of Westernisation of Culture
The first culture that was associated with the rise of eating disorders was Asia. Research was conducted here to allow various conclusions to be made, as it was a low-income country. Immigrants began coming to Western countries, and studies were conducted on the immigrants and descendants prior to the 1990s. These included a handful of reported cases of eating disorders during this time and it was considered to be rather rare.
A blog that I came across insisted that ‘In Japan however, in the 1970s eating disorders were becoming more prevalent, and by the end of the 20th century disordered eating attitudes and behaviours significantly increased among Asian youth (including Singapore, Hong Kong, Fiji, Pakistan, and Taiwan)’ This concluded that in Asia eating disorders are not culture bound or specific, but more culture-reactive. This research is based on the Westernisation of fashion, beauty ideas, television, social media as well as industrialisation and urbanisation of Asia
The analysis of the substantial and rapid rise of eating disorders in Asia takes into consideration the corresponding of westernisation, cultural shifts, industrialisation and urbanisation This demonstrates the different possibilities of the aspects surrounding it which include shifts in population demographics, food supply, global economies, gender role shifts, and the traditional family structure changes .
The Influence Of Media
Eating disorders have been increasingly common since the 1990s, especially in Singapore, which includes body dissatisfaction, as I previously discussed. In the context of an 8 year study that was carried out in 2003, conducted by Lee, Pathy, and Chan it investigated the development of eating disorders according to ethnicity, and found that 91.3% reported cases were female, and 8.7% were male .
“In Hong Kong eating disorders were also seen from the 1990s onward and showed features commonly associated with Western eating disorders were absent, such as body dissatisfaction. Typically individuals attributed their restrictive food intake to somatic complaints (i.e., bloating, abdominal pain, or just not hungry was termed “Non-Fat Phobic Anorexia Nervosa (NFP-AN)”.
Furthermore, this particular research highlights how these individuals reported less bulimic symptoms and lower BMI. Similarly, since these studies in the 1990s, it has been reported that there has been a decrease in non-fat-phobic Anorexia Nervosa (NFP-AN) and a more Westernized disorder of Anorexia has developed. This conveys the process where sufferers, state a desire for thinness and experience high levels of body dissatisfaction .
It is fair to say that the increasing rate of eating disorders, Japan has the highest rate of prevalence, followed by Hong Kong, Singapore, Taiwan, and South Korea. Then following are the Philippines, Malaysia, Indonesia, Thailand, China and Vietnam . As these countries grow in industrialization and more global, eating disorders have risen with increasing dissatisfaction in body shape and size.
Examining The Rise Of Eating Disorders In Different Cultures
When studying Hispanic, African-American, and Caucasian girls in the American grades of 4 to 12, a study found that 10th grade Hispanic girls displayed eating disorders at the same rate of their peers, but also reported higher rates of weight loss attempts.
Once again the advancement in technology pays a major role where researchers have to point to the media’s obsession with the ‘ideal body’ and ultra-thinness. According to the Anorexia Nervosa and Related Eating Disorders, Inc (ANRED), children in the US watch on average 21 hours of television in one week, not counting other forms of screen time This has a major impact on children especially teenagers as they go through the stage of puberty at different ages compared to their class mates. Subsequently, this can account for changing perceptions of the ideal body image or body shape and change perceptions.
Another country that was majorly studies following the increasing ride of eating disorders after the influence of westernisation includes Fiji. Prior to the 1990s there was only 1 documented case of an eating disorder . In the mid-1990s television was introduced into Fiji society. In addition a researcher called Dr Becker lead various studies on measuring eating psychopathology and beauty ideals both prior to and after the introduction to television. After the introduction of television, the rates of eating disorders escalated among the Fijian women. With the prevalence of television and more westernized ideas; rates of body dissatisfaction, dieting, desire to lose weight and the thin ideal internalization as well as bulimic behaviours became more widespread across the island.
After analysing more of the different areas of the globe a particular region that stood out was Pakistan and the early cases of eating disorders it witnessed in the 1990’s. It also exaggerated the effects of malnutrition in some areas as well as the female idea of being robust, which historically was associated with wealth and authority. Recent studies conducted on females within Universities in Pakistan (aged 16-20 years) claim that there is an elevated risk for eating disorders and that 33% of college aged women have dissatisfaction with their weight, as well as 64% scored a 2 or higher on the SCOFF questionnaire This placed the percentage at a greater risk for an eating disorder. Historically Pakistan has been a conservative closed society with low exposure to Western media, fashion, and advertising. However, he government came to a conclusion that general practitioners and paediatricians need to develop practise guidelines so that they don't fail to miss an opportunity in addressing eating disorders when providing consultations to adolescents, young girls and adult women. Additionally the essential bringing of mental health into the education system of school will help address further establishments within the country as a whole. Finally, researchers have insisted to include the use of nationally representative surveys to determine the help ineffectively addressing morbidity associated with eating disorders.
In the past several decades, Pakistan has been a part of increasing industrialization and urbanization, especially in areas like Islamabad. Studies from 2011 indicate that media exposure correlates with negative body image and dissatisfaction in both males and females, across Pakistan. In 2014 another study by Pike and colleagues, found that in Arab and Asian countries, that eating disorders are increasing with the rise of industrialization and urbanization within those regions .
In the United Kingdom, it is estimated that over 1.6 million people are struggling with an eating disorder. In a study which looked at the effect of social media, such as Facebook, Snapchat, Instagram and the influence for eating disorders, 1960 women were examined and found that even after just a mere 20 minutes of social media use, it significantly increased their risk for eating disorders .
In India, prior to 2000, there was very little publications or reports of eating disorders. In the last 15 years, eating disorders has been on the rise, up to 10 times higher than in previous decades. According to Dr Rajesh Sagar, a psychiatrist in India, states that with the invasion of Western television, and super slim models, young girls begin to idolize that look and it has been changing the culture of expectations of women’s body shape and size. Studies are showing that girls as young as 10 years when shown photos of slim, fit women, report the women in the photos as being overweight .
In Africa, over 600 school aged girls were studied to see about prevalence rates of eating disorders in Ghana . Girls were assessed using a mental and physical health exam and completing the Eating Attitudes Test as well as the Bulimic Investigatory Test, Edinburgh. Of the 668 student’s studies, 10 saw self-starvation as the only cause for low weight and viewed their food restriction positively and in religious terms.
These beliefs included ideas of self-control and denial of hunger, but did not include concerns about body weight or shape . In a more recent study, the South African National Health and Nutrition Examination Survey showed that females aged 10 to 14 years had a negative body image. Up to 68% and 17% of females in that age group believed they were fat and perceived their body mass index to be higher than their ideal .
As a conclusion to different cultures affecting such disorders there are various factors that contribute to the rise of eating disorders around the world. These factors include urbanization, industrialization, media influence, westernization, and socio-cultural and gender role shifts. Globally, countries are becoming more urban, which is driven by industrialization due to increased population growth. With urbanization in non-Western countries, psychopathologies, such as eating disorders, can occur.
Roles of 21st Century Social Media
Today’s children and adolescents grow up in a world flooded with the mass media (television, films, videos, billboards, magazines, movies, music, newspapers, fashion designers and the Internet) . Staggering statistics reveal that, on average, a child or adolescent watches up to 5 hours of television per day and spends an average of 6 to 7 hours viewing the various media combined
Over the past 20 years, several articles have proposed a link between the thin female beauty ideal and the muscular male body ideal portrayed in the media with a range of psychological symptomatology including body dissatisfaction and eating disorders. Studies have reported a significant change in the weight and size of female and male models portrayed throughout the media in western society and the concept of the ‘perfect or ideal body’. Over time the cultural ideal for women’s body size and shape has become considerably thinner and leaner and men’s body size and shape has become stronger and more muscular. This is best illustrated in a study by Katzmarzyk and Davis (8) who examined changes in the body weight and shape of Playboy centrefolds, over two decades (1978–1998). They found that there was a significant decrease in the models’ body weights and measurements, with 70% of the women being underweight and greater than 75% of the women were less than 85% of their ideal body weight.
Personally, a survey that I carried out myself amongst 12-18 year olds suggested an outcome of 80% claiming that they have wanted to lose weight due to the influences of social media and the ‘ideal body image’ This provided me with an insight into the real world applications of how social media can influence lives of people. This has especially come prevalent in recent years due to the fact there wasn't any social media about 20 years ago. Advancements on technology and social platforms display not only positives of increased communication and a better lifestyle but also negatives like bullying and body shaming which can lead to such disorders.
Mortality and Recovery Rates
Without treatment, up to twenty percent of people with serious eating disorders die. With treatment, that number falls to (2-3%).
With treatment, about sixty percent of people with eating disorders recover. They maintain healthy weight. They eat a varied diet of normal foods and do not choose exclusively low-cal and non-fat items. They effectively participate in friendships and romantic relationships as well as creating a future with families and careers. It is said that many feel that they are stronger people and more insightful about life in general and themselves in particular than they would have been without the disorder. In spite of treatment, about twenty percent (20%) of people with eating disorders make only partial recoveries. They remain too much focused on food and weight. They participate only peripherally in friendships and romantic relationships. They may hold jobs but seldom have meaningful careers. Much of each pay check goes to diet books, laxatives, jazz exercise classes, and binge food.
The remaining twenty per cent (20%) do not improve, even with treatment. They are seen repeatedly in emergency rooms, eating disorders programs, and mental health clinics. Their quietly desperate lives revolve around food and weight concerns, spiralling down into depression, loneliness, and feelings of helplessness and hopelessness .
In conclusion, within the investigation leading up to the end of my report regarding the issues of eating disorders, I have examined multiple sources, which have all suggested the uncontrollable rise that is occurring worldwide. In particular the issues of eating disorders are arising mainly within adolescents who are targeted hands on through social media via being encouraged to look a certain way in order to fit into the 21st century social norms . This is being done by following examples within magazines, films, TV shows, social media and fashion shows that display particular body types illustrating major mental and behavioural impacts upon children and adults worldwide.
Obesity tends to display an increasing rise within high income and more developed countries compared to low income and less economically developed countries. This further highlights how the more disposable income you have the more luxurious food items you can buy. An increasing amount of high sugary foods are especially desirable to children of a young age. Alongside reduced physical activity and increased food intake, Obesity begins to display a factor as it starts to affect daily routines and habits. On the other hand it would seem that Anorexia would be common in low income countries and those that are less developed due to lower rates of disposable income and the shortage of food. In addition, this most definitely isn’t the case due to factors like teenagers being prone to looking at these perfect men and women that increases their desire to look like them. Today, society has shown a desire for muscular toned men and slim but curvy women. This particular stigma around how both men and women is wrong. It not only goes against the foundations that every single individual is unique but also elaborates on how apparently every person’s desirable partner should look a certain way. Furthermore, this conveys an added pressure amongst the teenagers especially worldwide due to the aspect of bullying that takes place commonly within schools from a very young age. A common criticism towards fat shaming or being ‘too thin’ displays how the child is weak and vulnerable. This produces the aspect of popularity within schools that carries on into adulthood.
The substantial and rapid rise of eating disorders in different parts of the world takes into consideration the corresponding of westernisation, cultural shifts, industrialisation and urbanisation. This demonstrates the different possibilities of the aspects surrounding it, which include shifts in population demographics, food supply, global economies, gender role shifts, and the traditional family structure change . Anorexia and Obesity as a whole have many contributing factors that are different within men, women, the young, the elderly, the rich and the poor. Across the globe, stresses are made especially within the education system to promote the aspect that everyone is unique and we are not in any way obliged to look a certain way. Learning to be comfortable about your healthy weight is a process. It takes plenty of time to unlearn some behaviours and relearn others. Be patient, you can learn to like your body, understand your eating behaviours, and figure out the relationship between feelings and eating — all the tools you need to feel in control and to like and accept yourself for who you are.