Why So Many Asian American Women Struggle in Silence with Disordered Eating

Author: Ella Ryan

          Asian American women experience unique challenges when it comes to body image, disordered eating, and accessing mental health care. These issues are shaped by a mix of cultural expectations, exposure to Western beauty ideals, and the impact of racism and sexism. Even though disordered eating is a serious issue in this group, it often isn’t fully understood by healthcare providers. The following sections will look into three main areas to better understand the problem: the sociocultural factors that influence disordered eating, the role of trauma and objectification, and the barriers that make it harder to get help, along with ways we can improve support and care moving forward.

1. Sociocultural Roots of Disordered Eating in Asian American Women          
          Eating disorders and body dissatisfaction stem from a combination of colonization, changes in gender roles, urbanization in Asia, and the ideal beauty standard that emphasizes thinness in many Asian cultures (Tsong et al., 2023). Asian Americans have been objectified throughout history through colonization, military policies, and violence. In regions of U.S militarization, Asian women have been sexually exploited. Asian American women have been historically depicted as stereotypes, such as the ‘Dragon Lady’ or ‘Lotus Blossom,’ which portray how they have been reduced—both sexually and racially. While these stereotypes originated in earlier eras, they continue to persist in modern American media and social narratives, in which Asian women are still sometimes viewed as passive or obedient (Cheng et al., 2018).
          In many parts of Asia, the media continues to glorify extremely low body weights. For instance, there is a myth that 110 pounds is the ‘healthy’ standard, and this is often promoted by celebrities. As a result, Asian women, including those in the U.S., may internalize both Asian and Western ideals of beauty. This can be even more present for those feeling lost while navigating between American and Asian cultures. Studies have found patterns of Asian women receiving more criticisms of their bodies compared to other women in the U.S. Existing studies show that it is not Asian culture itself that poses a primary risk for eating disorders but cultural conflict (Tsong et al., 2023).

2. Trauma, Objectification, and Their Psychological Impacts
          Disordered eating and body image problems are affected by trauma resulting from racial and sexual objectification. Many women report that their struggles with body image and disordered eating began after experiences of racial and sexual oppression, reflecting a traumatic stress response. Body image and eating concerns in Asian American women haven’t been widely studied from the perspective of trauma, but early research suggests that the racial and sexual objectification of women can play a role in the development of these issues (Cheng et al., 2018).
          Asian American women’s bodies have been objectified, with certain features like eye shape being mocked. Racial and sexual objectification together contribute to body image concerns and disordered eating. Cheng et al. (2018) found a positive correlation between exposure to sexually objectifying media and eating disorder symptoms. Furthermore, this association was mediated through the internalization of sociocultural beauty ideals alone or through combinations of internalization, body surveillance, face surveillance, and body shame. A study in South Korea had similar findings of a positive correlation between exposure to sexually objectifying media and symptoms of disordered eating. This association was also mediated by the internalization of beauty standards and body-related concerns.
          Research on South Asian American Women, racial discrimination, and teasing about physical appearance was related directly to disordered eating. Therapists interviewed in another study reported that Asian and Asian American women with disordered eating often expressed a desire for more Western features, reflecting the impact of exclusion and marginalization (Cheng et al., 2018).
          Overall, these findings emphasize how racial and sexual objectification, both through personal experiences and media exposure, can have lasting psychological impacts on body image and eating behaviors among Asian American women.

3. Barriers to Care and Culturally Responsive Interventions
          Asian women are significantly less likely than white women to access mental health services. This disparity is partly due to experiences of gender and racial or ethnic discrimination, which contribute to lower satisfaction with the mental healthcare process (Appel et al., 2011).
          Tsong et al. conducted a study surveying Asian American women who were asked the reasons they had or had not sought help for disordered eating or body concerns. Participants reported barriers at three levels: personal, social, and structural. Personal barriers included viewing their concerns as a sign of weakness and feeling ashamed. Social barriers involved a lack of familial support or fear of disapproval. Structural barriers included cost, time constraints, and limited access to mental health services. Participants also noted the limited awareness of symptoms and treatment options, as well as stigma surrounding mental health. Additionally, some described turning to alternatives to therapy, such as self-help strategies or support from non-professionals. From this study, four main factors contribute to low service use: disordered eating literacy, stigma, a preference for self-reliance, and distrust of mental health professionals  (Tsong et al., 2023).
          Another study showed that the use of alternative services played an important role in determining whether individuals with mental health disorders sought professional care. However, the impact of these alternative services differed depending on the person’s proficiency in English. These findings highlight that the broader issue of underutilization of mental health services among Asian Americans is shaped by factors such as access to other health services and immigration-related experiences (Le Meyer et al., 2009).
          Several improvements are needed to better support Asian American women struggling with eating disorders. Screening and assessment should go beyond diagnosable eating disorders to include disordered eating cognitions, such as the fear of weight gain and the importance placed on body shape ideals. Intervention programs are more effective if they address the disordered eating cognitions, teach cognitive monitoring and restructuring, and target negative body language. It is also important to provide culturally informed resources, equip women to speak with their families, and provide information on services like bilingual therapists. Clinicians should be informed of the cultural context, explore the client’s beauty standards and their sources, and provide education about treatment options (Tsong et al., 2023).
          Therapists should recognize that the intersecting impacts of racism, sexism, and objectification shape Asian American women’s mental health. They need to consider the full scope of trauma and how these experiences influence psychological symptoms. Therapists should also develop self-awareness about their own cultural values and assumptions, as these can affect clinical expectations and interactions. Furthermore, therapists should explore clients’ dissatisfaction with their ethnic physical features and investigate the roots of these feelings, including experiences of teasing or exposure to harmful media stereotypes (Cheng et al., 2018).
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Sources
Appel, H. B., Huang, B., Ai, A. L., & Lin, C. J. (2011). Physical, behavioral, and mental health issues in Asian American women: Results from the National Latino Asian American Study. Journal of Women's Health, 20(11), 1703–1711. https://doi.org/10.1089/jwh.2010.2726

Tsong, Y., Ward, M. L., Dilley, A., Wang, S. C., & Smart, R. (2023). To seek help or not: Asian American women mental health services utilization for disordered eating and body image concerns. Asian American Journal of Psychology, 14(2), 155–165. https://doi.org/10.1037/aap0000270

Cheng, H.-L., & Kim, H. Y. (2018). Racial and sexual objectification of Asian American women: Associations with trauma symptomatology, body image concerns, and disordered eating. Women & Therapy, 41(3–4), 237–260. https://doi.org/10.1080/02703149.2018.1425027
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Le Meyer, O., Zane, N., Cho, Y. I., & Takeuchi, D. T. (2009). Use of specialty mental health services by Asian Americans with psychiatric disorders. Journal of Consulting and Clinical Psychology, 77(5), 1000–1005. https://doi.org/10.1037/a0017065