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How abnormal is the desire for slimness? A survey of eating attitudes and behaviour among Chinese undergraduates in Hong Kong

Published online by Cambridge University Press:  09 July 2009

Sing Lee
Sing Lee*
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Shatin, Hong Kong
*
1Address for correspondence: Dr Sing Lee, Department of Psychiatry, 11/F, Prince of Wales Hospital, Shatin, Hong Kong.
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Synopsis

Using the 40-item Eating Attitudes Test and other self-report questions, a two-stage screening survey of 1020 (F 646, M 374) Chinese bilingual university students in Hong Kong showed that although female students were ‘underweight’ by Western standard, the majority of them and nearly all female students above a body mass index of 20·5 kg/m2 were cognitively inclined to diet and weigh less, albeit without being driven to actual weight control behaviour. In contrast, most male students and a minority of constitutionally thin female students clearly wished to gain weight. While a number of items were culturally inappropriate, factor analysis supported the overall cross-cultural conceptual validity of the EAT. The principal factor, reflecting dieting concerns, correlated positively with the current body mass index. Among the high scorers, only three female students with partial syndrome bulimia nervosa were identified, yielding a low prevalence of 0·46% for the spectrum of eating disorders. It is argued that the desire for slimness is widespread but its intensity and pathogenic potentiality vary across cultures. In the relative absence of obesity, it may not lead to more eating disorder.

Type
Original Articles
Information
Psychological Medicine , Volume 23 , Issue 2 , May 1993 , pp. 437 - 451
Copyright
Copyright © Cambridge University Press 1993

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References

American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised)(DSM-III-R). APA: Washington, DC.Google Scholar
Brislin, R. W., Lonner, W. J. & Thorndike, R. M. (1973). Factor analysis. In Cross-cultural Research Methods (ed. Brislin, R. W., Lonner, W. J. and Thorndike, R. M.), ch. 9, pp. 255–288. John Wiley & Sons: New York.Google Scholar
Brown, P. J. & Konner, M. (1987). An anthropological perspective on obesity. Annals of the New York Academy of Sciences 449, 29–46.CrossRefGoogle Scholar
Bruch, H. (1973). Eating Disorders. Basic Books: New York.Google Scholar
Brumberg, J. J. (1988). Fasting Girls – the Emergence of Anorexia Nervosa as a Modern Disease. Harvard University Press: Cambridge, Massachusetts.Google Scholar
Buhrich, N. (1981). Frequency of presentation of anorexia nervosa in Malaysia. Australian and New Zealand Journal of Psychiatry 15, 153–155.CrossRefGoogle ScholarPubMed
Button, E. J. & Whitehouse, A. (1981). Subclinical anorexia nervosa. Psychological Medicine 11, 509–516.CrossRefGoogle ScholarPubMed
Chang, K. S. F., Lee, M. M. C., Low, W. D. & Kvan, E. (1963). Height and weight of Southern Chinese children in Hong Kong. American Journal of Physical Anthropology 21, 497–509.CrossRefGoogle Scholar
Chen, C. N., Wong, J., Lee, N., Chan-Ho, M. W., Lau, J. & Fung, M. (1993). The Shatin community mental health survey in Hong Kong. II. Major findings. Archives of General Psychiatry 50, 125–133.CrossRefGoogle Scholar
Chernin, K. (1983). Womansize: The Tyranny of Slenderness. The Women's Press: London.Google Scholar
Clark, M. G. & Palmer, R. L. (1983). Eating attitudes and neurotic symptoms in university students. British Journal of Psychiatry 142, 299–304.CrossRefGoogle Scholar
Crisp, A. H. (1980). Anorexia Nervosa – Let Me Be. Academic Press: London.Google Scholar
DiNicola, V. F. (1990). Anorexia Multiforme: self-starvation in historical and cultural context. Part II. Anorexia nervosa as a culture-reactive syndrome. Transcultural Psychiatric Research Review 27, 245–286.CrossRefGoogle Scholar
Dolan, B. & Ford, K. (1991). Binge eating and dietary restraint: a cross-cultural analysis. International Journal of Eating Disorders 10, 345–353.3.0.CO;2-9>CrossRefGoogle Scholar
Drewnowski, A. & Yee, D. K. (1987). Men and body image: are males satisfied with their body weight? Psychosomatic Medicine 49, 626–634.CrossRefGoogle ScholarPubMed
Eisler, I. & Szmukler, G. I. (1985). Social class as a confounding variable in the eating attitudes test. Journal of Psychiatric Research 19, 171–176.CrossRefGoogle ScholarPubMed
Ford, K. A., Dolan, B. M. & Evans, C. (1990). Cultural factors in the eating disorders: a study of body shape preferences of Arab students. Journal of Psychosomatic Research 34, 501–507.CrossRefGoogle ScholarPubMed
Garfinkel, P. E. & Garner, D. M. (1982). Anorexia Nervosa: A Multidimensional Perspective. Brunner/Mazel: New York.Google Scholar
Garner, D. M. & Garfinkel, P. E. (1979). The Eating Attitudes Test: an index of the symptoms of anorexia nervosa. Psychological Medicine 9, 273–279.CrossRefGoogle ScholarPubMed
Garner, D. M., Garfinkel, P. E., Schwartz, D. & Thompson, M. (1980). Cultural expectations of thinness in women. Psychological Reports 47, 483–491.CrossRefGoogle ScholarPubMed
Garner, D. M., Olmsted, M. P., Bohr, Y. & Garfinkel, P. E. (1982). The Eating Attitudes Test: psychometric features and clinical correlates. Psychological Medicine 12, 871–878.CrossRefGoogle ScholarPubMed
Gortmaker, S. L., Dietz, W. H. Jr., Sobol, A. M. & Wehler, C. A. (1987). Increasing paediatric obesity in the United States. American Journal of Diseases of Children 141, 535–540.Google ScholarPubMed
Hsu, L. K. G. (1989). The gender gap in the eating disorders: Why are the eating disorders more common among women? Clinical Psychology Review 9, 393–407.CrossRefGoogle Scholar
Hsu, L. K. G. (1990). Eating Disorders. Guilford Press: New York.Google Scholar
Johnson-Sabine, E., Wood, K., Patton, G., Mann, A. & Wakeling, A. (1988). Abnormal eating attitudes in London schoolgirls – a prospective epidemiological study: factors associated with abnormal response on screening questionnaires. Psychological Medicine 18, 615–622.CrossRefGoogle ScholarPubMed
Keys, A., Fidanza, F., Karvonen, M. J., Kimura, N. & Taylor, H. L. (1972). Indices of relative weight and obesity. Journal of Chronic Diseases 25, 329–343.CrossRefGoogle ScholarPubMed
Khandelwal, S. K. & Saxena, S. (1990). Anorexia nervosa in people of Asian extraction. British Journal of Psychiatry 157, 784.Google Scholar
King, M. B. (1989). Eating disorders in a general practice population: prevalence characteristics and follow-up at 12 to 18 months. Psychological Medicine, Suppl 14, 1–34.CrossRefGoogle Scholar
King, M. B. & Bhugra, D. (1989). Eating disorders: lessons from a cross-cultural study. Psychological Medicine 19, 955–958.CrossRefGoogle ScholarPubMed
Kleinman, A. M. (1987). Anthropology and psychiatry: the role of culture in cross-cultural research on illness. British Journal of Psychiatry 151, 447–454.CrossRefGoogle ScholarPubMed
Lee, S. (1991). Anorexia nervosa in Hong Kong – a Chinese perspective. Psychological Medicine 21, 703–711.CrossRefGoogle Scholar
Lee, S., Chiu, H. F. K. & Chen, C. N. (1989). Anorexia nervosa in Hong Kong: why not more in Chinese? British Journal of Psychiatry 154, 683–688.CrossRefGoogle Scholar
Lee, S., Hsu, G. L. K. & Wing, Y. K. (1992). Bulimia nervosa in Hong Kong Chinese patients. British Journal of Psychiatry 161, 545–551.CrossRefGoogle ScholarPubMed
Mann, A. H., Wakeling, A., Wood, K., Monck, E., Dobbs, R. & Szmukler, G. (1983). Screening for abnormal eating attitudes and psychiatric morbidity in an unselected population of 15-year-old schoolgirls. Psychological Medicine 13, 573–580.CrossRefGoogle Scholar
Mari, J. J., Sen, B. & Cheng, T. A. (1989). Case definition and case identification in cross-cultural perspective. In The Scope of Epidemiological Psychiatry (ed. Williams, P., Wilkinson, G. and Rawnsley, K.), pp. 489–506. Routledge: London.Google Scholar
Meadows, G. N., Palmer, R. L., Newball, E. U. M. & Kenrick, J. M. T. (1986). Eating attitudes and disorders in young women: a general practice based survey. Psychological Medicine 16, 351–357.CrossRefGoogle ScholarPubMed
Mezzich, J. E., Fabrega, H. & Kleinman, A. (1992). Cultural validity and DSM-IV. Journal of Nervous and Mental Disease 180, 4.CrossRefGoogle ScholarPubMed
Mumford, D. B., Whitehouse, A. M. & Choudry, I. Y. (1991). Sociocultural correlates of eating disorders among Asian schoolgirls in Bradford. British Journal of Psychiatry 158, 222–228.CrossRefGoogle ScholarPubMed
Nylander, I. (1971). The feeling of being fat and dieting in a school population. Epidemiological interview investigation. Acta Socio-medica Scandinavica 1, 17–26.Google Scholar
Ong, Y. L. & Tsoi, W. F. (1982). A clinical psychosocial study of seven cases of anorexia nervosa in Singapore. Singapore Medical Journal 23, 255–261.Google ScholarPubMed
Patton, G. C., Johnson-Sabine, E., Wood, K., Mann, A. H. & Wakeling, A. (1990). Abnormal eating attitudes in London schoolgirls – a prospective epidemiological study: outcome at twelve-month follow-up. Psychological Medicine 20, 383–394.CrossRefGoogle ScholarPubMed
Pope, H. G., Hudson, J. I., Yurgelun-Todd, D. & Hudson, M. S. (1984). Prevalence of anorexia nervosa and bulimia in three student populations. International Journal of Eating Disorders 3, 45–51.3.0.CO;2-G>CrossRefGoogle Scholar
Russell, G. F. M. (1970). Anorexia nervosa: its identity as an illness and its treatment. In Modern Trends in Psychological Medicine (ed. Price, J. H.), vol. 2, pp. 131–164. Butterworths: London.Google Scholar
Russell, G. F. M. & Treasure, J. (1989). The modern history of anorexia nervosa – an interpretation of why the illness has changed. In The Psychobiology of Human Eating Disorders: Preclinical and Clinical Perspectives (ed. Schneider, L. H., Cooper, S. J. and Halmi, K. A.), pp. 13–30. New York Academy of Sciences: New York.Google Scholar
Schmolling, P. (1988). Eating attitude test scores in relation to weight, socioeconomic status, and family stability. Psychological Reports 63, 295–298.CrossRefGoogle ScholarPubMed
Society of Actuaries and Association of Life Insurance Medical Directors of America (1979). Build and Blood Pressure Study. Author: Chicago, IL.Google Scholar
Song, Y. P. & Fang, Y. K. (1990). A clinical report of 9 cases of anorexia nervosa. Chinese Mental Health Journal 4, 24–25.Google Scholar
Steinhausen, H. C. (1984). Transcultural comparison of eating attitudes in young females and anorectic patients. European Archives of Psychiatry and Clinical Neuroscience 234, 198–201.Google ScholarPubMed
Suematsu, H., Ishikawa, H., Kuboki, T. & Ito, T. (1985). Statistical studies on anorexia nervosa in Japan: detailed clinical data on 1011 patients. Psychotherapy and Psychosomatics 43, 96–103.CrossRefGoogle Scholar
Tseng, M. C., Lee, M. B. & Lee, Y. J. (1989). A clinical study of Chinese patients with eating disorders. Chinese Psychiatry 3, 17–28.Google Scholar
Wells, J. E., Coope, P. A., Gabb, D. C. & Pears, R. K. (1985). The factor structure of the Eating Attitudes Test with adolescent girls. Psychological Medicine 15, 141–146.CrossRefGoogle Scholar
Whitaker, A., Davies, M., Shaffer, D., Johnson, J., Abrams, S., Walsh, B. T. & Kalikow, K. (1989). The struggle to be thin: a survey of anorexic and bulimic symptoms in a non-referred adolescent population. Psychological Medicine 19, 143–163.CrossRefGoogle Scholar
Williams, P., Tarnopolsky, A. & Hand, D. (1980). Case definition and case identification in psychiatric epidemiology: review and assessment. Psychological Medicine 10, 101–114.CrossRefGoogle Scholar
Williams, P., Hand, D. & Tarnopolsky, A. (1982). The problem of screening for uncommon disorders – a comment on the Eating Attitudes Test. Psychological Medicine 12, 431–434.CrossRefGoogle ScholarPubMed
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders – Clinical Descriptions and Diagnostic Guidelines. WHO: Geneva.Google Scholar