LAWRENCE, KANSAS — While culture is intertwined with values surrounding food and body image, cultural differences have historically been overlooked by researchers and clinicians seeking to identify and treat eating disorders.
The lack of culturally relevant approaches has been huge barrier for Hispanic, or Latine, women in accessing care, said Sarah Johnson-Munguia, a sixth-year University of Kansas graduate student working in Center for the Advancement of Research on Eating Behaviors (CARE) Lab at the KU Life Span Institute.
Johnson-Munguia is the lead author of a paper published in the December issue of the journal Body Image that examines "factors that contribute to Latine women's positive and negative body image," a group that faces high rates of body dissatisfaction and increasing risks for eating disorders.
"There's a lot of stereotypes in the eating disorder world around who has eating disorders and what they look like," Johnson-Munguia said. "It's a population that's been historically underrepresented in the field, and because of that, understudied."
The paper is a deep look at the unique challenges Hispanic women face with body image and their relationship with family, culture, food and identity.
Eating disorders are associated with disturbing behavior and persistent thoughts related to food and body image. Affecting as much as 9% of the U.S. population at some point in their lives, according to a report published in 2020, eating disorders are among the most dangerous mental health conditions.
Better understanding of the disorder is necessary to both identification and development of effective treatment.
"I really wanted to address that barrier, and this was a first step in understanding a little bit more about how Hispanic women relate to their body image and what kind of culture adaptations might need to be made for this population," Johnson-Munguia said.
The project began as part of Johnson-Munguia's master's thesis and evaluated responses from 19 Hispanic women who were asked to reflect on influences on their positive and negative body image experiences.
The qualitative nature of the study allowed for detailed descriptions of the mixed messages Hispanic women face related to their body, facing tension at an intersection of identities, with simultaneous experiences of being sexually, ethnically and racially objectified.
These combined to contribute to an increased risk for engaging in self-objectification. At social gatherings they may be encouraged to eat more while being cautioned not to overeat.
The study noted as an example that one respondent reported: "You'll go see your grandma and your grandma is telling you to eat more, eat more, you're so skinny. But then when you're not being prompted by somebody else to eat a lot and you go get a second plate or get a second bowl of something, and they're (saying), 'Oh wow, you're eating a lot.'"
Johnson-Munguia's research also looked at positive impacts on body image and found reframing body ideals and relationships with food were important factors. Participants in the study also identified finding community support, seeking out representation and focusing on the functionality of their body and not just how it looks.
As one respondent reported: "I'm super proud of my heritage and coming from Nicaragua. Like I feel that I'm super connected to my culture … I love to dance, and I feel like dancing and the music is just part of me and I love it. And I think that to dance with the slow, with passion, you need to be comfortable with yourself, and I feel like that really connects me to my culture."
Johnson-Munguia was surprised by how frequently associations with positive body image connected back to participants identity as Hispanic women.
"It connected frequently in some way to their cultural context. I think that was something that I found interesting and important," she said.
Previous studies have found that functionality-focused body image (FFBI) programs, which center on what the body can do rather than what it looks like, have been effective at improving body image.
"The example I always love is, instead of thinking about how your arms are fat, thinking about how your arms allow you to hug like the people around you that you love," Johnson-Munguia said.
Understanding these key factors influencing body image for Latine women is valuable for clinicians working to develop better tools for treating eating disorders. And while FFBI has not been developed or tested for populations with ethnic and racial diversity, these themes can be a valuable source of information for those adapting the programs for Latine individuals.
"If someone doesn't see themselves represented in the program, they're not going to want to do it or get as much out of it," Johnson-Munguia said. "There's also some research to suggest that culturally adapted programs can sometimes be more effective for the populations they're serving."
Johnson-Munguia's research offers a detailed insight into how culture and body image intersect in a way that wouldn't be possible without allowing respondents freedom to construct their own answers to open-ended questions.
While a challenge, she said it was important in developing the depth of results that allowed for a better understanding of the experiences of each participant in a way numbers alone couldn't.
"You got a sense of what each individual person was like. You understand more of the nuances that can sometimes get lost in quantitative data," she said.
