The Social Network and Anorexia

Could social networks be more important than the media in the spread of eating disorders?

There's a story about eating disorders roughly like this: eating disorders (ED) are about wanting to be thin. The idea that thinness is desireable is something that's spread by Western media, especially visual media i.e. TV and magazines. Therefore, Western media exposure causes eating disorders.

It's a nice simple theory. And it seems to fit with the fact that eating disorders, hitherto very rare, start to appear in a certain country in conjunction with the spread of Westernized media. A number of studies have shown this. However, a new paper suggests that there may be rather more to it: Social network media exposure and adolescent eating pathology in Fiji.

Fiji is a former British colony, a tropical island nation of less than a million. Just over half the population are ethnic native Fijian people. Until recently, these Fijians were relatively untouched by Western culture, but this is starting to change.

The authors of this study surveyed 523 Fijian high school girls. Interviews took place in 2007. They asked them various questions relating to, one the one hand, eating disorder symptoms, and on the other hand, their exposure to various forms of media.

They looked at both individual exposure - hours of TV watched, electronic entertainment in the home - and "indirect" or "social network" exposure, such as TV watched by the parents, and the amount of electronic entertainment their friends owned. On top of this they measured Westernization/"globalization", such as the amount of overseas travel by the girls or their parents.

So what happened? Basically, social network media exposure, urbanization, and Westernization correlated with ED symptoms, but when you controlled for those variables, personal media exposure didn't correlate. Here's the data; the column I've highlighted is the data where each variable is controlled for the others. The correlations are pretty small (0 is none, 1.0 would be perfect) but significant.


They conclude that:

Although consistent with the prevailing sociocultural model for the relation between media exposure and disordered eating... our finding, that indirect exposure to media content may be even more influential than direct exposure in this particular social context, is novel.

The idea that eating disorders are simply a product of a culture which values thinness as attractive has always seemed a bit shaky to me because people with anorexia frequently starve themselves far past the point of being attractive even by the unrealistic standards of magazines and movies.

In fact, if eating disorders were just an attempt to "look good", they wouldn't be nearly so dangerous as they are, because no matter how thin-obsessed our culture may be, no-one thinks this is attractive, or normal, or sane. But this, or worse, is what a lot of anorexics end up as.

On the other hand, eating disorders are associated with modern Western culture. There must be a link, but maybe it's more complicated than just "thin = good" causes anorexia. What if you also need the idea of "eating disorders"?

This was the argument put forward by Ethan Watters in Crazy Like Us (my review)... in his account of the rise of anorexia in Hong Kong. Essentially, he said, anorexia was vanishingly rare in Hong Kong until after the much-publicized death of a 14 year old girl, Charlene Chi-Ying, in the street. As he put it:

In trying to explain what happened to Charlene, local reporters often simply copied out of American diagnostic manuals. The mental-health experts quoted in the Hong Kong papers and magazines confidently reported that anorexia in Hong Kong was the same disorder that appeared in the United States and Europe...

As the general public and the region's mental-health professionals came to understand the American diagnosis of anorexia, the presentation of the illness in [Hong Kong psychiatrist] Lee's patient population appeared to transform into the more virulent American standard. Lee once saw two or three anorexic patients a year; by the end of the 1990s he was seeing that many new cases each month.

Now it's important not to see this as trivializing the condition or as a way of blaming the victim; "they're just following a trend!". You only have to look at someone with anorexia to see that there is nothing trivial about it. However, that doesn't mean it's not a social phenomenon.

It's a long way from the data in this study to Watters' conclusions, but maybe not an impossible leap. Part of Westernization, after all, is exposure to Western ideas about what is healthy eating and what's an eating disorder...

Becker, A., Fay, K., Agnew-Blais, J., Khan, A., Striegel-Moore, R., & Gilman, S. (2011). Social network media exposure and adolescent eating pathology in Fiji The British Journal of Psychiatry, 198 (1), 43-50 DOI: 10.1192/bjp.bp.110.078675