Exploring the Relationship Between Hinduism, Body Image, and Maladaptive Eating Behaviors among South Asian Individuals: A Qualitative Study

Posted on by BUJPH
South Asia

Author: Sammy Plezia

ABSTRACT

Objective: Although eating disorders (EDs) impact individuals from all racial and ethnic groups, the existing literature on EDs focuses disproportionately on the experiences of individuals who are white, female, and living in high-income countries. To better understand potential risk factors  for and protective factors against ED development among culturally diverse groups, this study aims to explore factors associated with Hinduism, maladaptive eating behaviors, and body dissatisfaction among South Asian individuals.

Methods: Three experts (n=3) on eating disorders and mental health among South Asian populations completed virtual qualitative interviews. The author coded each transcript before identifying patterns of relevance through the process of thematic analysis.

Results: Three main themes were identified, with subthemes under each: a) beauty ideals (e.g., the thin ideal, the healthy ideal, colorism), b) social norms (e.g., marriage expectations, food preparation, food consumption), and c) religion (e.g., fasting).

Discussion: The data from this study illustrates the complex relationship between Hinduism, gender roles, and broader sociocultural values. ED interventions for South Asian individuals must account for risk factors, such as globalization and changing beauty ideals, as well as understand the role that families have in regulating and maintaining eating habits.

INTRODUCTION

Existing literature on eating disorders (EDs) focuses disproportionately on the experiences of individuals who are white, female, and living in high-income countries. Researchers in the field have recently begun to examine EDs across more diverse populations, studying the prevalence of these health conditions among Latina women,1 Black women,2 Asian American women,3 and men.4 Despite clinical psychologists improving their efforts in recent years, current literature still fails to represent the experiences of individuals from systemically overlooked groups. EDs impact individuals from all racial and ethnic backgrounds,5 yet researchers have historically overlooked culturally diverse participants.

The urgency to study EDs continues to grow: EDs affect at least 9% of the global population and are the second deadliest mental illness after opioid use disorder.6 Nonetheless, investigators in the field continue to uphold the false narrative that EDs primarily affect white women by prioritizing research on that population. A preliminary literature review to identify articles on Hinduism and EDs among South Asians was conducted, although findings were extremely limited. Current research on EDs and body dissatisfaction among South Asian individuals addresses various themes such as colorism,7 body ideals,8 and unique barriers to help-seeking for EDs.9 However, the inclusion of Hinduism in the search on EDs and religion produced zero results. To better understand potential risk factors  for and protective factors against ED development, this study aims to employ interdisciplinary methods to explore factors associated with religion, maladaptive eating behaviors, and body dissatisfaction among South Asian individuals.

METHODS

The current study utilized anthropological and psychological methods, blending qualitative research from participants and experts to explore religion and EDs among South Asian communities. Nine participants were initially interviewed, although the project was undertaken for academic purposes so the findings from six participants cannot be disseminated. Thus, only three interviews from three health experts who identify as South Asian will be included in the final analysis (n=3). Two experts were ED researchers: Ms. Neha Goel, a counseling psychology doctoral candidate at Virginia Commonwealth University, and Ms. Shruti Shankar Ram, a clinical psychology doctoral candidate at Miami University. The third expert was Dr. Juhee Jhalani, a clinical psychologist working in private practice in New York. Experts were contacted via email. All interviews took place on Zoom in October and November of 2020 and were transcribed by the author. The author created a codebook to detect recurring ideas across interviews. Codes were viewed holistically to identify patterns of relevance, which then became more official interview themes later in the data analysis process.

RESULTS

Beauty Standards

Thin ideal. The thin ideal, or the equation of attractiveness with being thin, is a socio-cultural risk factor for ED development, particularly among women:

“Femininity is associated with a thin, slender body type, [which] can be a really strong predictor of eating disorder behaviors in Western communities … There was some mixed research about whether this would be true for South Asians and it looks like this ideal … is relevant for South Asian women living in the [United States]” [Goel].

While the thin ideal is prevalent, it is not the only expectation that South Asian individuals are expected to meet. The pressure to not be too thin is explored in the following subtheme.

Healthy ideal. In addition to being thin, women are also supposed to maintain a “healthy” body size. The expectation has since been operationalized as the “healthy ideal”:

“The healthy ideal is this idea that in order to convey that you take care of your health, you want to have a more plump body type … more voluptuous, more filled out … so women who sometimes are considered too thin are actually expected to adhere closer to this healthy ideal, whereas women who are considered too healthy or quote-unquote “larger” than that are then shamed to try to adhere more to the thin ideal” [Goel].

Despite the existence of sociocultural messaging that promotes the thin ideal, there is a consensus that being too thin is unhealthy. Consequently, women are placed in a difficult situation of being expected to obtain seemingly contradictory body types.

Colorism. Another beauty ideal is related to skin color, especially the pursuit of a lighter complexion. Some South Asian individuals go to great lengths to obtain a lighter skin tone:

“[There is] pressure of wanting to possess a lighter skin tone, either through natural means or industrial means – meaning skin lightening products. I’m sure you’ve heard Fair & Lovely [a skin lightening cosmetic product that is now called Glow & Lovely]. If you’re working with [the] South Asian community, that kind of captures it all. The name itself tells you what you’re trying to achieve. Some of these products can be extremely harmful and damaging. I mean, you’re bleaching your skin essentially” [Goel].

Another expert also discussed colorism, sharing how beauty ideals appear in Hinduism:

“[Hinduism does] have female goddesses as well and a lot of them honestly look the same … they’re very slender. They always seem to fit with the body type that’s in vogue at the time … They’re white and thin and so it’s sort of like this is what we’re aspiring to be” [Ram].

In totality, all three beauty ideals seem to  disproportionately impact women. Other gender expectations are explored in the following theme.

Social Norms

Marriage expectations. Most of the pressure to look a certain way appears to be associated with the marital expectations placed on women:

“We are expected to aspire to marriage and that means fitting that look: being tall, thin, um, being pale” [Ram].

Another expert elaborated on some of the psychological traits that women are supposed to have as wives:

“So [women] have to present [themselves] a certain way, which will also include some physical traits along with … some psychological traits of empathy. Is she motherly? Is she giving? Is she too professional or is she too smart?” [Jhalani].

While it was noted that men do face pressures related to marriage, women appear to be the most impacted by the physical and psychological expectations surrounding marriage.

Food preparation. Women are also expected to cook for their families. Despite being the ones to prepare the food, women often are unable to enjoy the meal until after their family members are served:

“[Women are] the ones serving the food and making the food. My grandfathers and my dad would always eat first … So when we’d go to India, my aunts and my grandma would slave over this amazing meal and they wouldn’t even get to eat it. They just kind of had to watch while they … they usually [were] with the kids … so before you become a woman, you get to enjoy all these fun perks of not being a woman, like getting to eat first. And then it’s like, ‘All right, well, you get to join us in the kitchen. It’s so fun.’ But like, ‘Oh, but now I don’t get to eat at first.’ So, it’s sort of like, again, the implicit messaging of putting others first” [Ram].

The current practices of food preparation concerned one of the experts as women may potentially internalize that they should put themselves last. There are other gender expectations related to the consumption of food, which are discussed in the following subtheme.

Food consumption. There appears to be a widespread social norm that it is disrespectful to not finish food or refuse additional servings. Goel has labeled this as “clean plate club mentality,” signifying that everyone eats the food on their plates regardless of their hunger levels. Mental anguish can arise because of this expectation:

“You might be put in this position where you’re fat shamed, but you’re also expected to eat more. And so you’re stuck in this double bind where you’re like, ‘Well, what do I do? Because I don’t win either way.’ A lot of these women in my focus groups were talking about this, whether they were in thinner bodies or larger bodies … Regardless of what your weight looks like, you are expected to eat more … ‘Do I reject it and face scrutiny and social shame and disrespecting people or do I just take it and then I’m overly full and have to find a way to like squirrel this food away or hide it or just eat it?’” [Goel].

This phenomenon was identified in an expert’s master’s thesis research:

“When boys are eating, it’s kind of like a game or a food competition … [Unlike women,] they can eat as much as they want” [Goel].

The complex interplay between gender and body size was prevalent in the context of food consumption. Specific trends related to gender, religion, and eating are discussed in the following theme.

Religion

Fasting. The gendered dynamics related to eating were salient in the context of fasting for religious purposes:

“In my household, my mom and my aunts are the ones who are doing the fasting and doing the sacrificial behaviors, usually for their husbands and for their children” [Goel].

Another expert shared a similar occurrence in their family:

“A lot of the time, there are festivals that are just about women and women fasting and praying for like, it’s sort of their role in the household to pray for the good of the family. So maybe it’s the whole fast and [they] pray for their son to find a wife or things like that. And so that’s something that I kind of like grew up with, um, a little bit. We had days where, you know, like on Tuesdays, my mom would – that was her day – she would go to the temple and she wouldn’t eat from like 8 [AM] to 8 [PM] for like 12 hours” [Ram].

Similar to the theme of food preparation, women were expected to engage in behaviors with the intent of helping others. The implications of these gender roles are explored in the Discussion.

DISCUSSION

In totality, broader cultural factors seem to be associated with maladaptive eating behaviors more so than religious ones. Themes related to expectations placed on women in patriarchal societies arose most frequently. While general beauty standards, such as valuing fair skin and thinness, applied to both men and women, women appear to be disproportionately impacted by society’s ideals. One area in which this disparity is especially salient is marriage, since South Asian women are expected to be thin, tall, and fair-skinned to become eligible brides. Gender also influences food preparation and consumption patterns, which contributes to the larger idea that women should consistently put others before themselves. At the same time, women are expected to care for themselves by maintaining thin yet healthy body types. Even if these ideals are not internalized, they are constantly presented to women through social monitoring. Women are met with unsolicited comments about their eating behaviors, body types, health statuses, and skin tones, among many other characteristics.

The question then arises: To what extent do religious ideals contribute to more universal societal beliefs? Ultimately, disentangling religion from culture is a challenging task. Various themes that experts highlighted, such as beauty standards and gender expectations, appear throughout religious texts and practices. In Hinduism, marriage is framed in a way in which the bride is serving the groom. The literary works of Nammalvar present the narrative of a “lovesick” woman affected by the male-female power structure.10 Women were also responsible for preserving their husbands’ lives, often through fasting; Savitri depicts this ideology.11 Lastly, a woman’s primary duty during the Epic period (400 CE) was to obey her husband (pativrata), which further supports the idea of gendered social roles.12

Further, colorism and thinness are both prevalent in Hindu texts. A famous Hindu myth recounts Siva teasing his wife, Kali, about her dark skin tone. Kali then goes to a “cosmic beauty parlor” to lighten her complexion and please her husband.11 The myth closely aligns with the sentiments that Ram discussed during the interview. Nonetheless, further analyzing the complex interplay between religion and culture is undeniably outside the scope of this exploratory study. This point, which is based on others’ interpretations of religious texts and not necessarily representative of everyone’s interpretations, merely displays that some themes addressed by the experts have representation in Hinduism.

Additionally, conversations on colorism and the thin ideal are incomplete without discussing the impact of colonization and globalization on South Asian communities. The experts noted that colonial legacies exist today in South Asia, as well as that Western media influences the spread of beliefs rooted in diet culture. Jayati Ghosh, a professor at Jawaharlal Nehru University who specializes in gender, believes that colorism predates colonialism. However, Ghosh posits that colonialism unquestionably perpetuated colorism. Colonial governments used their members’ skin colors as a means of legitimizing their power and traditionally hired lighter-skinned Indians.13 Diet culture and the thin ideal are believed to have their roots in Western ideals as well.14-16 References to the thin ideal appear to align more so with modern presentations of women in media opposed to the traditional ascetic practices rooted in religion. Internalizing the thin ideal is considered a risk factor for developing body dissatisfaction and disordered eating behaviors,15,17 so determining how it is spread across South Asian communities is crucial for prevention efforts. Overall, women are presented with not only expectations related to the ‘ideal woman’ from their families and communities, but also from the broader capitalistic, increasingly globalized societies surrounding them. Solely attributing patriarchal values to religion fails to account for the devastating harms of colonialism and the more recent spread of Western values through globalization.

Evidently, future research is needed to address the Judeo-Christian bias apparent in existing studies on EDs and religion.18-21 The field of clinical psychology would benefit from diversifying its researchers, research participants, and research questions. It is necessary to better understand the relationship between religion and EDs among South Asian communities, as well as the specific preventive and treatment interventions that would serve the population in a culturally responsive way. A unique area of further research is the role of religion in ED recovery. Existing research on Hinduism’s impact on maladaptive eating behaviors has presented the religion as a potential risk factor for ED development.22 However, studying faith-based recoveries among South Asian communities went unmentioned. Even if some individuals do not identify strongly with a religion, the underlying mechanisms of finding recovery motivation could potentially be utilized to support secular people.

Lastly, this exploratory study did find other promising methods of treating EDs outside of exclusively religious contexts. The results suggest that families play important roles in the regulation and maintenance of South Asian individuals’ eating patterns. Accordingly, future studies could explore adapting the dominant family-based treatment programs used in Western cultures to meet the needs of South Asian populations. Further research ultimately must account for a variety of topics relevant to EDs among South Asian communities, including culturally relevant risk and protective factors, as well as  facilitators in and barriers to recovery.

Limitations

The current study’s primary limitations include the small, homogenous sample, as well as the researcher’s positionality as a white woman living in the United States. While the initial sample had participants from various geographic and religious backgrounds, the three experts all were Indian or Indian American, living in the United States, and most familiar with Hinduism. The experiences of South Asian individuals living in South Asia opposed to those in the diaspora may differ. Interviewing experts based in South Asia would likely have provided better discussion on the unique challenges faced by those living in South Asia. Further, the current sample of experts does not accurately reflect the diversity found within the South Asian community. Only Hinduism was discussed among the experts, which is  not the only religion practiced among South Asian individuals. Future research would benefit from recruiting a larger sample size and initially focusing on either one religion or geographic location to improve generalizability.

Additionally, the researcher’s cultural and racial identities likely impacted the results. Being a white woman with limited familiarity with South Asian cultural norms, the researcher easily could have misidentified or overlooked themes in the analysis, as well as created an environment in which the experts did not feel comfortable disclosing information. In studies with more resources, it would be ideal for the researcher to work collaboratively with individuals who hold the same identities as the participants. The study also applied Western classifications and conceptualizations of EDs to South Asian communities, which presents the risk of pathologizing behaviors that are cultural norms. A future exploratory study could use more culturally relevant methods to determine which eating behaviors are viewed as distressing among South Asian individuals. The current study failed to account for this as it assumed how EDs might present themselves in South Asian cultures according to Western classifications.

References

  1. Rodrigues M. (2017). Do Hispanic girls develop eating disorders? A critical review of the literature. Hispanic Health Care International: The Official Journal of the National Association of Hispanic Nurses, 15(4), 189–196. https://doi.org/10.1177/1540415317744500
  2. Taylor, J. Y., Caldwell, C. H., Baser, R. E., Matusko, N., Faison, N., & Jackson, J. S. (2013). Classification and correlates of eating disorders among Blacks: Findings from the National Survey of American Life. Journal of Health Care for the Poor and Underserved, 24(1), 289–310. https://doi.org/10.1353/hpu.2013.0027
  3. Javier, S. J., & Belgrave, F. Z. (2019). “I’m not white, I have to be pretty and skinny”: A qualitative exploration of body image and eating disorders among Asian American women. Asian American Journal of Psychology, 10(2), 141–153. https://doi.org/10.1037/aap0000133
  4. Murray, S. B., Nagata, J. M., Griffiths, S., Calzo, J. P., Brown, T. A., Mitchison, D., Blashill, A. J., & Mond, J. M. (2017). The enigma of male eating disorders: A critical review and synthesis. Clinical Psychology Review, 57, 1–11. https://doi.org/10.1016/j.cpr.2017.08.001
  5. 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
  6. Lyster-Mensh, L. C. (2020, August 25). Eating Disorders: By The Numbers. F.E.A.S.T. https://www.feast-ed.org/eating-disorders-by-the-numbers/.
  7. Goel, N. (2019). Conceptualization of body image and eating disorders among South Asian American women: A qualitative investigation [thesis]. Virginia Commonwealth University.
  8. Talukdar, J. (2012). Thin but not skinny: Women negotiating the “never too thin” body ideal in urban India. Women’s Studies International Forum, 35(2), 109–118. https://doi.org/https://doi.org/10.1016/j.wsif.2012.03.002
  9. Wales, J., Brewin, N., Raghavan, R., & Arcelus, J. (2017). Exploring barriers to South Asian help-seeking for eating disorders. Mental Health Review Journal, 22. https://doi.org/10.1108/mhrj-09-2016-0017
  10. Narayanan, V. (2003). Gender in a devotional universe. In G. Flood (Ed.), The Blackwell Companion to Hinduism (pp. 569–587). essay, Blackwell Publishing.
  11. Harlan, L., & Courtright, P. B. (1995). From the margins of Hindu marriage: essays on gender, religion, and culture. Oxford University Press.
  12. Khanna, M. (2006). A conversation on two faces of Hinduism and their implication for gender discourse. In H. Haker, S. Ross, & M.-T. Wacker (Eds.), Women’s voices in world religions (pp. 81–89). SCM Press.
  13. Noman, N. (2020, July 12). Skin lightening in South Asia is why we have an anti-Blackness problem. NBCNews.com. https://www.nbcnews.com/think/opinion/skin-lightening-south-asia-why-we-have-anti-blackness-problem-ncna1233549.
  14. 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(4), 245–286. https://doi.org/10.1177/136346159002700401
  15. Moreno-Domínguez, S., Rutsztein, G., Geist, T. A., Pomichter, E. E., & Cepeda-Benito, A. (2019). Body mass index and nationality (Argentine vs. Spanish) moderate the relationship between internalization of the thin ideal and body dissatisfaction: A conditional mediation model. Frontiers in Psychology, 10. https://doi.org/https://doi.org/10.3389/fpsyg.2019.00582
  16. Syurina, E. V., Bood, Z. M., Ryman, F., & Muftugil-Yalcin, S. (2018). Cultural phenomena believed to be associated with orthorexia nervosa – opinion study in Dutch health professionals. Frontiers in Psychology, 9, 1419. https://doi.org/10.3389/fpsyg.2018.01419
  17. 17. Hawkins, N., Richards, P. S., Granley, H. M., & Stein, D. M. (2004). The impact of exposure to the thin-ideal media image on women. Eating Disorders, 12(1), 35–50. https://doi.org/10.1080/10640260490267751
  18. 18. Castellini, G., Zagaglioni, A., Godini, L., Monami, F., Dini, C., Faravelli, C., & Ricca, V. (2014). Religion orientations and eating disorders. Rivista di Psichiatria, 49(3), 140–144. https://doi.org/10.1708/1551.16911
  19. Gates, K., & Pritchard, M. (2009). The relationships among religious affiliation, religious angst, and disordered eating. Eating and Weight Disorders: EWD, 14(1), e11–e15. https://doi.org/10.1007/BF03354622
  20. Gluck, M. E., & Geliebter, A. (2002). Body image and eating behaviors in Orthodox and Secular Jewish women. The Journal of Gender-Specific Medicine: JGSM: The Official Journal of the Partnership for Women’s Health at Columbia, 5(1), 19–24.
  21. Latzer, Y., Orna, T., & Gefen, S. (2007). Level of religiosity and disordered eating psychopathology among modern-orthodox Jewish adolescent girls in Israel. International Journal of Adolescent Medicine and Health, 19(4), 511–521. https://doi.org/10.1515/ijamh.2007.19.4.511
  22. Dell, M. L., & Josephson, A. M. (2007). Religious and spiritual factors in childhood and adolescent eating disorders and obesity. Southern Medical Journal, 100(6), 628–632. https://doi.org/10.1097/SMJ.0b013e31805fe689