Sharp Rise in Eating Disorders in Fiji follows arrival of TV

Sharp Rise in Eating Disorders in Fiji Follows Arrival of TVAfter Three Years of Western Programming, Five Times as Many Teenage Girls Report Vomiting to Control WeightBOSTON--May 17, 1999--A dramatic increase in disordered eating among teenage girls in the Pacific island nation of Fiji may be linked to the recent introduction of TV, Harvard Medical School researchers report.

The sudden infusion of Western cultural images and values through TV appears to be changing the way Fijian girls view themselves and their bodies, says Anne Becker, director of research at the Harvard Eating Disorders Center, assistant professor of medical anthropology at HMS, and assistant professor of psychiatry at Massachusetts General Hospital. The result is a sharp rise in indicators of disordered eating, such as induced vomiting. Becker, who has studied eating habits in Fiji since 1988, conducted the study with research assistant Rebecca Burwell and presents preliminary findings May 19 at the American Psychiatric Association annual meeting in Washington, D.C.

Eating disorders, including anorexia and bulimia, are most common in industrialized Western countries, and epidemiologic data suggest that culture plays a central role. But Becker says she knows of no published studies that have used ethnographic and survey data collected over time to document the onset of disordered eating amid cultural change.

In her 1998 survey, taken 38 months after TV came to Nadroga, Fiji, 15 percent of girls, aged 17 on average, reported that they had vomited to control weight. By contrast, only 3 percent reported this behavior in 1995, just after TV was introduced. In addition, the proportion of schoolgirls who scored high on a test indicating risk for disordered eating was 29 percent in 1998 and 13 percent in 1995.

In 1998, 74 percent of the Fijian girls reported feeling "too big or fat" at least sometimes. Those who watched TV at least 3 nights per week were 50 percent more likely than others to see themselves as too fat, and 30 percent more likely to diet, although the more frequent TV watchers were not more overweight. And 62 percent of Fijian high school girls in 1998 reported dieting in the past month, a proportion comparable to or even higher than reported in American samples.

Fiji has only one TV channel, which broadcasts mostly American, Australian, and British programs. Favorites include Seinfeld, ER, Melrose Place, and Xena, Warrior Princess.

Traditionally, Fijians have preferred robust body shapes for both men and women, reflecting the importance placed on generous feeding and voracious eating.

"Your social position is based on how well you can feed other people," Becker says. "At any meal, especially when you're a guest, you're supposed to eat as much as you can--often beyond satiety." Fijian society has historically been "hypervigilant" about people viewed as undereating, identifying a culture-specific illness called macake--essentially an appetite disorder--and employing herbal medicines to stimulate appetite.

"They also have a culture-specific condition called 'going thin,' meaning losing noticeable weight," she adds. "If somebody 'goes thin,' you go and find out why--you assume there's some kind of social problem" that has left the person ill-fed. Only in very recent years, likely reflecting the encroachment of Western beauty ideals and values, have Fijians begun to focus on heaviness rather than just thinness as a concern. And the custom of caring for people who appear unhealthily thin has carried over so that others are now told frankly that they look too fat. The Fijian diet, in fact, is extremely high in fat, and Becker and her colleagues found that 84 percent of village women in their sample were overweight or obese.

Fiji is developing from a traditional, kinship-based society, where cash was once rarely used and possessions were widely shared, into one that participates in the global economy, where salaried employment and private property are becoming increasingly common and the older generation's values are questioned by the younger.

"It is essentially going from a subsistence agricultural society straight into the information age," Becker says. She sees the girls' desire to be slim as one sign that young Fijians are striving to conform to Western cultural standards. They also show a keen interest in the careers and workplaces depicted on TV, looking to the characters as role models who can provide clues about their own prospects in a fast-changing world. Fijians often find it difficult to accept that TV does not depict real life in America, Becker notes.

As one girl in the study said, "We can see [teenagers] on TV.... They are the same ages, but they are working, they are slim and very tall, and they are cute, nice. ...We want our bodies to become like that ... so we try to lose a lot of weight." Another noted that "since the characters [on Beverly Hills 90210] are slim-built, [my friends] come and tell me that they would also like to look like that. They change their mood, their hairstyles, so that they can be like those characters ... so in order to be like them, I have to work on myself, exercising, and my eating habits should change."

Advising these girls on diet is tricky, Becker says. Their health might benefit if they chose lower-fat foods than the traditional Fijian diet offers. But an overemphasis on avoiding fat and keeping trim--besides defying cultural norms--might encourage vomiting and other unhealthy behaviors.

Becker and colleagues continue to analyze the Fijian data, and plan to examine questions such as generational differences in eating behavior. Preliminary results show, for example, that schoolgirls are 14 times more likely than older women to have ever dieted for weight control.