Navigating Eating Disorder Care: Unique Challenges for AAPI Individuals

By: Members of LEAP for AAPI (Leading Eating Disorder Awareness Project)

The journey of recovering from an eating disorder is deeply personal and complex. For Asian American and Pacific Islander (AAPI) individuals, this path comes with unique challenges that stem from cultural nuances, intergenerational differences in understanding of the topic, and a lack of linguistic resources. In this article, we explore the ways AAPI culture intersects with the treatment of eating disorders, shedding light on the barriers and strengths encountered along the way.

What are the cultural nuances in AAPI culture? How do they impact recovery from eating disorders and disordered eating?

1. Role of Community and Collectivistic Values: 

In AAPI culture, community values play a significant role and can be both a barrier and a source of strength in eating disorders and disordered eating recovery. The strong emphasis on collectivism over individualism means that the well-being of the group often takes precedence over personal needs. This can lead to challenges when an individual needs to prioritize their recovery, which might be seen as selfish or disruptive to family harmony.

2. Body Ideals and Immigrant Identity 

AAPI individuals often navigate multiple body ideals and standards of beauty, which can be confusing and stressful. Immigrants and their descendants might feel the pressure to adhere to both traditional cultural values and those of their new country. For example, setting boundaries with family members around body criticism can be seen as disrespectful, especially when addressing elders, who typically raise these criticisms as an expression of concern and love. This cultural expectation can make it difficult for someone with an eating disorder to voice their needs as well as get those needs met.

Furthermore, AAPI individuals may also be subjected to microaggression and sexual objectification, which exacerbates the pressure to conform to certain body ideals. These experiences can lead to increased self-monitoring and heightened awareness of one’s body, further complicating the path to recovery. 

3. Multifaceted Role of Food

Food plays numerous roles in AAPI cultures, complicating the relationship with food for those suffering from disordered eating. It is often a primary way parents show love. Gathering over meals are also often central to family tradition and holiday celebrations. Food also serves as a connection to one’s culture of origin, preserving stories and memories from previous generations. How one eats can signal personal and family values to others; a hearty appetite, not being picky, and not wasting food are praised, sometimes at the expense of listening intuitively to one’s hunger and fullness cues. Furthermore, deviations in body size (e.g., gaining/losing weight since the last family gathering) can attract criticism and unwarranted advice about how much and what to eat. 

4. Cultural Food Differences

Food also plays a role in traditional medicinal practices in the East. For example, in traditional Chinese medicine, foods are categorized as “hot-natured / warming (yang)” or “cold-natured / cooling (yin)” with a strong emphasis on balance and moderation. This intertwining of food and health adds another layer of complexity for those with eating disorders, as it can be difficult to navigate these beliefs while trying to adhere to recovery guidelines.

Additionally, the food culture in many Eastern countries differs greatly from the culture in the United States, from the ingredients used to the flavors and textures featured, as well as the overall eating culture. This can be challenging during the recovery process, especially if treatment providers lack cultural competency and do not fully appreciate these complexities. Understanding these cultural nuances is crucial for providing effective support to AAPI individuals in eating disorder recovery.

How does the lack of language impact eating disorder recovery?

Language serves as a crucial bridge between inner struggles and external support when navigating mental health struggles. However, for many AAPI individuals, the vocabulary to articulate experiences with disordered eating and body image is scarce. Unlike Western languages, Asian languages often lack specific terms to discuss eating disorders, contributing to a profound difficulty in expressing one’s internal battles.

Moreover, discussing mental illness openly remains highly taboo within AAPI communities. There is a pervasive stigma surrounding psychological disorders, and they are often associated with feelings of shame and familial dishonor. The mere mention of seeking help for mental health issues can evoke fears of institutionalization and ostracization from one’s family and community.

Adding to the complexity, eating disorders are viewed through a cultural lens as a product of Westernization, distancing them from the traditional narratives of AAPI experiences. As a result, individuals grappling with these conditions may struggle to find validation and understanding within their cultural framework.

Intergenerational disparities further complicate the dialogue around body image and food relationships. While younger generations may embrace Western ideals of body positivity, older generations often adhere to traditional standards, creating a rift in communication and comprehension within families.

Navigating Treatment:

In the landscape of eating disorder care, cultural competency is essential for effective treatment. However, many providers lack the cultural awareness necessary to address the multifaceted needs of Asian American and Pacific Islander individuals.

To bridge this gap, it is crucial to develop culturally sensitive approaches that honor the diverse backgrounds and experiences of AAPI patients. This includes integrating cultural perspectives into treatment modalities, fostering open conversation about the intersection of culture and mental health, and engaging community resources to provide holistic support.

Furthermore, AAPI individuals must be empowered to reclaim their narratives and advocate for their needs within the healthcare system. This includes challenging stigmas surrounding mental health, amplifying diverse voices within the AAPI community, and fostering inclusive spaces for healing and growth.

An individual’s journey to eating disorder and disordered eating recovery is shaped by a myriad of influences, including but not limited to culture, familial dynamics, personal experiences, and socioeconomic privileges that impact one’s access to resources and support. We encourage clinicians in the eating disorder field to consider these various layers that impact their AAPI clients’ relationship with food and their bodies. In our opinion, culturally competent care requires a continual commitment to leading with collaborative curiosity, acknowledging your personal gaps in understanding, and asking for permission from your clients and patients to help aid your understanding of cultural nuances that impact their care. Ultimately, embracing cultural diversity and promoting cultural competence within the entire healthcare system improves care and wellbeing for all.

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Yvonne Kong (BSc) serves as a Mental Health Provider at the Eating Recovery Center/Pathlight Mood and Anxiety Center in Seattle, WA. She is the passionate founder of the Leading Eating Disorder Awareness Project (LEAP) for AAPI, an initiative dedicated to supporting AAPI individuals and families affected by eating disorders through culturally-targeted resources.

Ivory Loh (MPH, RDN, CD, cPT) is a Health-at-Every-Size Registered Dietitian and Nutrition Therapist, specializing in eating disorders and disordered eating recovery and weight-inclusive medical nutrition therapy. She provides virtual, outpatient nutrition therapy in her private practice in Seattle, WA. Ivory especially loves working with API folks, teens/young adults, and athletes.