Disordered Eating Among Asian/Asian American Women

Abstract

Sociocultural models of eating disorders emphasize the role of internalization of media standards of beauty in eating pathology but rarely examine (a) how racial and cultural factors may be related to women of color’s tendency to endorse Western media beauty ideals or (b) these women’s risk of developing body dissatisfaction and disordered eating issues. This study of Asian/Asian American women (N = 587) investigated the roles of perceived racial discrimination, ethnic identity, and racial/ethnic teasing in relation to self-esteem, internalization of Western standards of beauty, and body dissatisfaction as predictors of disordered eating in a structural model. Results indicated that, when controlling for body mass, perceived racial discrimination, ethnic identity, and racial/ethnic teasing significantly predicted disordered eating and its correlate variables through direct and indirect links. The findings suggest racial and cultural factors may complement sociocultural models in understanding disordered eating issues among Asian/Asian American women.

Keywords

Asian/Asian American eating disorders ethnic teasing racial discrimination ethnic identity

Disordered eating problems, once thought to only afflict young upper-middle-class White women, have also been documented to affect women of color. Recent studies suggest that the prevalence of eating disorder symptoms in U.S. racial and ethnic minority women is similar to those in European American women (Franko, Becker, Thomas, & Herzog, 2007; Shaw, Ramirez, Trost, Randall, & Stice, 2004). Women and girls from various backgrounds are exposed to a preponderance of media and sociocultural messages that idealize thinness as a key to feminine beauty and personal success (Striegel-Moore & Bulik, 2007). Sociocultural models of eating disorders (e.g., Stice, 2001) maintain that when women and girls internalize the media standards of beauty as their own guide to beauty and attractiveness, they are likely to experience body dissatisfaction and engage in disordered eating to control their weight as they recognize the discrepancy between their body size and the body ideal they strive for. Internalization of the standards of beauty portrayed in the media has been shown to predict body image and disordered eating concerns in numerous empirical studies (for reviews, see Grabe, Ward, & Hyde, 2008; Stice, 2002). For reasons of brevity, the term media internalization is used in the remainder of this article to refer to the internalization of media standards of beauty.

Critiques of this literature point to the fact that the majority of the extant research is derived from European American samples. The unique sociocultural contexts that racial and ethnic minority women face in their development of self-construal, body image, and eating practices are rarely accounted for in the existing sociocultural models of disordered eating (Brown, Cachelin, & Dohm, 2009; Talleyrand, 2012). Racial and ethnic minority women are not only exposed to the mainstream media’s propagated beauty ideals, which often portray slender European American women as the norm of beauty, but they also live in sociocultural contexts that may subject them to minority status–related oppression (Smart, Tsong, Mejía, Hayashino, & Braaten, 2011), including societal denigration of their racial and/or ethnic physical characteristics (Kawamura, 2011).

An important gap in the literature is the paucity of empirically supported models delineating how racial and cultural factors that may be significant in the lives of minority individuals (e.g., racial discrimination) are related to Western-based sociocultural risk factors (e.g., internalization of the beauty ideals portrayed in the media) in understanding the unique socialization process of racial and ethnic minority women and their disordered eating concerns (Brown et al., 2009; Dohm, Brown, Cachelin, & Striegel-Moore, 2010; Talleyrand, 2012). As such, the primary purpose of this study is to empirically examine the roles of perceived racial discrimination, racial/ethnic teasing, and ethnic identity in relation to media internalization in a model of disordered eating among Asian and Asian American women (see Figure 1).

Figure 1.

Conceptual model.

Racial and Cultural Factors as Correlates of Disordered Eating in Asian and Asian American Women

Asian/Asian American women in the present study refer to women of Asian descent residing in the United States. The literature often uses Asian women and Asian American women interchangeably (e.g., Brown et al., 2009; Dohm et al., 2010; Hall, 1995), unless specific group information is available (e.g., Korean American). The present study focused on Asian/Asian American women because recent reviews (Chao et al., 2008; Talleyrand, 2012) have noted that they are among the least investigated populations in the eating issues literature. This dearth of research may be related to (a) the assumption that Asian/Asian American women are protected from body dissatisfaction and disordered eating concerns because of their relatively petite stature and smaller body size, as well as (b) the assumption that because “Asian Americans are often characterized as the ‘model minority group’ that suffers from few psychological problems” (Kawamura, 2011, p. 234), disordered eating concerns are irrelevant for this group. This disparity in research could lead to insufficient recognition, treatment, and prevention of problematic eating behaviors and attitudes in Asian/Asian American women (Cummins, Simmons, & Zane, 2005). For example, in an investigation of college students across the United States, Franko et al. (2007) found that Asian/Asian American students who reported laxative use were less likely to be recommended for further evaluation compared with students from other racial/ethnic groups.

Another reason for focusing on Asian/Asian American women pertains to the potential unique salience of racial and cultural factors in this group’s body image and disordered eating concerns. Exoticization of the Asian female image, particularly the racialized objectification of women of Asian descent (e.g., portrayed as submissive, exotic sexual objects), is often present in women’s sociocultural context (Kawamura, 2011; Sue, Bucceri, Lin, Nadal, & Torino, 2007). Women may internalize these racially and sexually objectified views toward their body, which may decrease their positive body image and increase their risk for body modifying strategies such as disordered eating. Moreover, racial microaggressions and discrimination directed at Asians/Asian Americans often involve marginalization and denigration of Asian racial physical attributes (Nadal, 2011; Yoo, Steger, & Lee, 2010), and Asians/Asian Americans are frequently perceived as foreigners regardless of their citizenship or generation status in the United States (e.g., “perpetual foreigners”; Sue et al., 2007). Therefore, for Asian/Asian American women, the pressure to adhere to the Western beauty standards may be intensified to gain recognition, success, and inclusion in the predominant society.

Interviews with therapists treating Asian/Asian American clients for eating issues (Smart et al., 2011) indicated that both the clients and their parents regarded having a slender body and Western facial characteristics as keys to success in the U.S. society. Smart et al. additionally argued that disordered eating may be especially relevant for Asian/Asian American women in the face of stresses because these behaviors provide “culturally congruent coping strategies” (p. 308) for dealing with the distress covertly (e.g., suppressing emotions through disordered eating) and are consistent with Asian values of emotional restraint. Thus, disordered eating among Asian/Asian American women needs to be understood beyond a Western value–based framework to include cultural and racial factors as potential contextual influences.

Perceived Racial Discrimination

Perceived racial discrimination has been theorized as a contextual risk for disordered eating among racial and ethnic minority women (e.g., Kempa & Thomas, 2000; Striegel-Moore & Smolak, 2000), but few writings have delineated systematic models to explain its role in disordered eating. Striegel-Moore and Smolak (2000) proposed a risk factor model that integrates racial and ethnic contextual variables such as discrimination and racial prejudice with Western value–based factors (e.g., thin-body ideal, physical attractiveness as key to success) to explain disordered eating in racial and ethnic minority women. Specifically, experiences of racially oppressive and discriminatory treatment contribute to deficits in the self, including low self-esteem (path a₄ in Figure 1). Low self-esteem, defined as individuals’ negative cognitive and emotional appraisal of their personal worth (Rosenberg, 1965), can then directly lead to disordered eating (path b₃), or indirectly contribute to disordered eating through increasing susceptibility to media internalization, body dissatisfaction, and maladaptive weight control behavior, according to Striegel-Moore and Smolak’s model.

In addition to the indirect links suggested by Striegel-Moore and Smolak (2000), some scholars (Kempa & Thomas, 2000; Root, 1990; B. Thompson, 1994, 1996) have contended that disordered eating is developed in response to stressful life events, including racial and ethnically based slights, denigration, and oppression. Disordered eating behaviors may serve as a way to divert attention from a stressful event (e.g., discriminatory treatment), avoid thinking about the stressor, or reduce tension (Heatherton & Baumeister, 1991; Kempa & Thomas, 2000). Thus, discrimination may have a direct link with disordered eating (i.e., path a₁ in Figure 1). Furthermore, some theorists (Cummins & Lehman, 2007; Kawamura, 2011) have posited that experiencing discriminatory treatment may heighten Asian/Asian American women’s awareness of their minority status, potentially leading to a redoubled desire to match the dominant culture’s ideal of beauty (path a₃) or result in internalized racism and self-denigration, including developing body dissatisfaction (path a₂). However, these theoretical postulations have not been empirically tested. Based on this theoretical literature, the first hypothesis of the present study posited that perceived racial discrimination would be negatively associated with self-esteem, but positively associated with media internalization, body dissatisfaction, and disordered eating.

Few empirical studies have investigated racial discrimination and disordered eating. B. Thompson (1994, 1996) conducted qualitative interviews with racial/ethnic minority women (not including Asians/Asian Americans) with disordered eating concerns and found that many women linked the onset of their eating issues to trauma and stressful events, including racial oppression. Harrington, Crowther, Payne-Henrickson, and Mickelson (2006) investigated racial discrimination and disordered eating in a sample primarily consisting of African American and European American women, and found that perceived racial discrimination had a significant bivariate correlation with binge eating for African American but not European American women. However, the number of African American women in Harrington et al.’s study was relatively small and perceived discrimination was not tested in relation to other variables indicated in Figure 1.

Racial and/or Ethnic Teasing

Racial/ethnic teasing is a form of ridicule focused on those physical characteristics that depart from the predominant group, such as facial features, skin color, and cultural dress (Iyer & Haslam, 2003; Reddy & Crowther, 2007). Racial/ethnic teasing may be seen as a specific form of racial and/or ethnic discrimination, but discrimination involves many other forms of unfair treatment beyond teasing (e.g., racially hateful assault; Yoo et al., 2010). In a recent review of cultural influences on body image and disordered eating, Levine and Smolak (2010) called for the examination of racial/ethnic teasing as a culturally relevant risk factor. Therefore, in addition to investigating the role of racial discrimination based on Striegel-Moore and Smolak’s (2000) framework, racial/ethnic teasing is included as another correlate in Figure 1. To date, only two studies based on small samples of South Asian women in the United States have examined the role of racial/ethnic teasing in disordered eating (Iyer & Haslam, 2003; Reddy & Crowther, 2007). Specifically, Reddy and Crowther found that a history of racial/ethnic teasing was associated with lower self-esteem and higher levels of media internalization. Being teased about racial and ethnic physical features may lead ethnic minority women to feel insecure about their self-worth and attractiveness, question their cultural norms of beauty, and adopt Western standards of appearance ideals to gain a sense of approval by the mainstream society (Reddy & Crowther, 2007). Relatedly, Iyer and Haslam found that experiences of racial/ethnic teasing predicted body dissatisfaction and disordered eating even after controlling for psychological distress, body mass, and self-esteem. Therefore, the second hypothesis of the present study postulated that racial/ethnic teasing would negatively predict self-esteem (path a₉ in Figure 1) but positively predict media internalization (path a₁₀), body dissatisfaction (path a₁₁), and disordered eating (path a₁₂).

Ethnic Identity

Ethnic identity refers to the extent individuals integrate their ethnic group’s values, attitudes, and cultural practices into their own belief system; individuals also often develop a sense of pride and emotional attachment toward the ethnic group with which they identify (Phinney, 1992). Identification with one’s ethnic group has been found to be associated with positive self-esteem in Asian/Asian American college women (Phan & Tylka, 2006). Striegel-Moore and Smolak (2000) explained that a strong ethnic identity may decrease the risk for disordered eating indirectly by contributing to a positive self-esteem (path a₆), in which positive cognitive and emotional appraisal of self protects individuals from maladaptive eating patterns. As a result of the identity search and consolidation processes of ethnic identity development, the individual may become more aware of salient group accomplishments, which facilitates a positive personal identification with and internalization of the group’s resilience. Furthermore, some theorists (Croll, Neumark-Sztainer, Story, & Ireland, 2002; Root, 1990) have contended that because traditional non-Western cultures usually emphasize thinness and attractiveness to a lesser extent than Western cultures, identification with one’s ethnic group may protect racial/ethnic minority women from adopting the mainstream culture’s beauty ideals (path a₇), which may decrease their risk for developing body dissatisfaction (path a₈) and disordered eating attitudes and behavior (path a₅). Others, however, have argued that the protective feature of ethnic identity may be eroding. Due to rapid globalization and societal change, Western beauty ideals have permeated many cultures including Asian communities in the United States and countries in Asia, thus resulting in increasingly westernized norms of beauty in these cultures (Forbes & Jung, 2008; Jung & Lee, 2006).

Consistent with these competing viewpoints, empirical findings have been mixed. In a sample of Taiwanese American women, Tsai, Curbow, and Heinberg (2003) found that a stronger ethnic identity was associated with lower levels of disordered eating, but Sabik, Cole, and Ward (2010), using the same measure of ethnic identity, found that a stronger ethnic identity predicted a greater drive for thinness in a diverse sample of Asian/Asian American women. Other studies found ethnic identity had no associations with body dissatisfaction, disordered eating (Iyer & Haslam, 2003; Phan & Tylka, 2006), or media internalization (Phan & Tylka, 2006). Because of the inconsistent findings from previous research, the third hypothesis of the present study posited that ethnic identity would be positively associated with self-esteem, but the links between ethnic identity and other criterion variables were explored without specification.

The Proposed Structural Model

Of all the paths in Figure 1, perhaps the links among media internalization, body dissatisfaction, and disordered eating have been the most widely examined and established. Precursors associated with vulnerability to these psychological concerns, however, are much less known. The present study sought to examine racial and cultural factors as precursors associated with risk of disordered eating, and furthermore, potential mediational mechanisms involved in transmitting the effects of racial and cultural factors to disordered eating. If mediational pathways are established by research, these findings could provide some direction for effective prevention and intervention foci. Therefore, in addition to the three hypotheses indicated previously, the fourth hypothesis of the present study posited that the relations between the proposed racial and cultural factors (i.e., perceived racial discrimination, ethnic identity, racial/ethnic teasing) and disordered eating would be mediated by self-esteem, media internalization, and body dissatisfaction through mediation systems shown in Figure 1.

Covariate

To allow for more stringent statistical examination of the relations among variables, the present study employed structural equation modeling (SEM) to account for measurement errors and included body mass index (BMI) as a covariate in testing the model presented in Figure 1. BMI has been found to correlate with several body image and eating-related variables, such as weight teasing and pressure to be thin (e.g., Cattarin & Thompson, 1994), body dissatisfaction (e.g., Calzo et al., 2012), and restrained eating (e.g., Snoek, van Strien, Janssens, & Engels, 2008). Thus, when examining racial and cultural predictors of disordered eating in Asian/Asian American women, it is important to control for BMI to avoid its possible confounding of the associations among the predictors and the criterion variables (e.g., the association between racial/ethnic teasing and disordered eating). Existing models of disordered eating among Asian/Asian American women (e.g., Phan & Tylka, 2006) have not utilized SEM and have not controlled for BMI. The present study sought to extend the empirical literature by employing more rigorous analyses.

Plausible Alternative Model

To further examine the relevance of the proposed racial and cultural factors (i.e., perceived racial discrimination, ethnic identity, racial/ethnic teasing), a plausible alternative model was tested in which these variables were hypothesized to have no associations with the criterion variables in the model. If results indicated a better fit of the plausible alternative model to the data than the proposed model, it would indicate that the racial and cultural factors did not explain disordered eating among Asian/Asian American women.

Method

Participants

Participants were 587 self-identified Asian/Asian American women at a large Midwestern U.S. university. Participants ranged in age from 18 to 49 years (M = 22.75, SD = 4.34). In terms of ethnicity, 207 (35.3%) were Chinese, 104 (17.7%) Asian Indian, 100 (17.0%) Korean, 71 (12.1%) Taiwanese, 26 (4.4%) Filipino, 17 (2.9%) Japanese, 16 (2.7%) Vietnamese, 9 (1.5%) Thai, 15 (2.6%) of more than one Asian ethnicity, and 22 (3.7%) “other.” Of these, 325 (55.4%) participants were U.S.-born, 246 (41.9%) were foreign-born, and 16 (2.7%) did not report their country of origin. Among the foreign-born participants, 25% reported their length of residence in the United States to be 5 years or less, 17% between 6 and 10 years, 21% between 11 and 15 years, 22% between 16 and 20 years, 7% between 21 and 25 years, 4% between 26 and 30 years, and 2% between 31 and 35 years. (Because of rounding, some of the percentages in this paragraph do not add up to 100%.)

In terms of college status, 74 (12.6%) were first-year students, 89 (15.2%) sophomores, 80 (13.6%) juniors, 94 (16.0%) seniors, 244 (41.6%) graduate or professional students, and 6 (1.0%) “other.” Participants’ self-reports of weight and height were used to calculate BMI, using the formula BMI = (weight in kg.) / (height in meters)². Mean BMI for this sample was 21.41 (SD = 2.82, range = 16.07-33.67). According to the U.S. guidelines (Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, 1998), a BMI of 30 or more is considered obese, between 25 and 29.9 overweight, from 18.5 to 24.9 normal weight, and 18.5 or less underweight.

Measures

Ethnic identity

The Multigroup Ethnic Identity Measure (MEIM; Phinney, 1992) has 14 items that measure an individual’s ethnic identity exploration, sense of ethnic belonging and affirmation, and involvement in ethnic behaviors. A sample item is “I have spent time trying to find out more about my own ethnic group, such as its history, traditions, and customs.” The MEIM is rated on a 4-point response scale, ranging from 1 (strongly disagree) to 4 (strongly agree), with higher scores indicating higher ethnic identity. Phinney (1992) reported .90 for the internal consistency reliability (i.e., Cronbach’s α) of the MEIM in a diverse college student sample. Among Asian Americans, the MEIM has been found to demonstrate concurrent validity through correlations with measures of social connectedness and self-esteem (R. M. Lee, 2003) and an internal consistency reliability of .89 (Phan & Tylka, 2006). In the present study, item responses were averaged to yield a scale score. Cronbach’s alphas for the present sample are reported in Table 1.

Table 1.

Means, Standard Deviations, Alphas, Value Ranges, and Zero-Order Correlations Among Research Variables.

Variables	1	2	3	4	5	6	7	8
1. Perceived racial discrimination	—
2. Ethnic identity	.14*	—
3. Racial/ethnic teasing	.32*	−.05	—
4. Self-esteem	−.24*	.22*	−.12*	—
5. Media internalization	.12*	−.08	.20*	−.22*	—
6. Body dissatisfaction	.20*	−.14*	.13*	−.46*	.38*	—
7. Disordered eating	.24*	−.05	.21*	−.37*	.52*	.40*	—
8. BMI	.00	.03	.03	.00	.08	.25*	.13*	—
Possible range	1-5	1-4	1-5	1-4	1-5	1-6	1-6	—
Sample range	1.00-4.67	1.14-4.00	1.00-4.43	1.20-4.00	1.00-5.00	1.00-5.67	1.00-5.46	16.07-33.67
M	2.17	2.97	1.93	3.00	3.15	3.15	2.47	21.41
SD	.72	.60	.77	.58	1.10	.82	.74	2.82
α	.76	.92	.85	.92	.95	.88	.91	—

Note. BMI = body mass index.

p < .05.

Perceived racial discrimination

The Subtle and Blatant Racism Scale for Asian American college students (SABR-AA; Yoo et al., 2010) was used to measure perceived racial discrimination. The SABR-AA consists of eight items that are rated on a 5-point scale (1 = almost never to 5 = almost always). Higher scores indicate higher levels of perceived racial discrimination. A sample item is “In America, I am faced with barriers in society because I’m Asian.” Yoo et al. reported Cronbach’s alpha of .88 and 2-week test–retest reliability of .71 for the SABR-AA. Convergent validity was established through this measure’s association with depression, anxiety, stress, and another measure of racial discrimination (r = .32-.73). In terms of discriminant validity, Yoo et al. reported no significant association between SABR-AA and color-blind racial attitudes. In the current study, two items (i.e., “In America, I am called names such as, ‘chink, gook, etc.’ because I’m Asian,” and “In America, I am made fun of because I’m Asian”) were not included in the data analyses because of potential item overlap with the racial/ethnic teasing measure. Ratings of the remaining six items were averaged for analyses.

Racial/ethnic teasing

The Measure of Ethnic Teasing (MET; Reddy & Crowther, 2007) was initially developed to measure teasing related to racial/ethnic physical attributes (e.g., facial features, hair, cultural dress, skin color) among South Asian women in the United States. The original MET contains a total of 26 items that measure the frequency of teasing events, distress at the time when teasing occurred, and current level of distress related to teasing. Because the purpose of the current study was to investigate the association of lifetime teasing experience with body image and disordered eating, only the 7 items that measure the frequency of lifetime teasing events were used in the current study. A sample item is “When you were a child, how often did people make fun of the size or shape of your eyes, nose, mouth, or lips because of your race or ethnicity?” Items were rated on a 5-point scale ranging from 1 (never) to 5 (frequently), with higher scores representing more experience with the specified type of racial/ethnic teasing. Reddy and Crowther reported strong internal consistency reliability (α = .91) and moderate convergent validity between the MET and a measure of self-esteem (r = −.40). Item ratings were averaged for analyses.

Self-esteem

The Rosenberg Self-Esteem Inventory (RSE; Rosenberg, 1965) is a 10-item measure of general self-esteem (e.g., “I feel that I have a number of good qualities”). The RSE uses a 4-point scale, ranging from 1 (strongly disagree) to 4 (strongly agree), with higher scores indicating higher self-esteem. Item responses were averaged for analyses. Silber and Tippett (1965) reported the RSE has a 2-week test–retest reliability of .85 and that it converges well with other measures of self-esteem and clinical assessments. Among Asian Americans, R. M. Lee (2003) reported an internal consistency reliability of .88 for the RSE.

Media internalization

The Internalization-General (nine items) subscale of the Sociocultural Attitudes Towards Appearance Scale–3 (SATAQ-3; J. K. Thompson, Van den Berg, Roehrig, Guarda, & Heinberg, 2004) was used to assess a tendency to internalize body ideals portrayed in the media (e.g., “I would like my body to look like the models who appear in magazines”). The Internalization-General subscale of the SATAQ-3 uses a 5-point response scale, ranging from 1 (definitely disagree) to 5 (definitely agree), with higher scores indicating higher levels of media internalization. Items were averaged for analyses. J. K. Thompson et al. reported evidence of convergent validity through correlations between the Internalization-General subscale and measures of body image concerns and eating dysfunction in two samples of college women (r = .40-.57). Strong internal consistency (α = .92) was reported for the Internalization-General subscale. The SATAQ-3 has been used in prior research with Asian/Asian American women (e.g., Nouri, Hill, & Orrell-Valente, 2011), but internal consistency reliability information was not provided in prior studies.

Body dissatisfaction

The Body Parts Satisfaction Scale (BPSS; Bohrnstedt, 1977) is a 24-item measure that assesses people’s feelings toward their body parts, such as arms, abdomen, and overall face. The BPSS is rated on a 6-point scale ranging from 1 (extremely dissatisfied) to 6 (extremely satisfied). Mintz and Kashubeck (1999) used 12 items (i.e., abdomen, weight, buttocks, hips/upper thighs, nose, eyes, overall face, shoulders, arms, breasts, general muscle tone, and height) of the BPSS in a study with Asians/Asian Americans. Specifically, Mintz and Kashubeck indicated that the 12 items were selected because they (a) are body areas most often associated with body dissatisfaction and eating concerns (e.g., abdomen, buttocks), (b) have potential relevance for defining racial/ethnic characteristics (e.g., nose, eyes), or (c) tend to be deemed important by women or men (e.g., breasts/chest). Following Mintz and Kashubeck’s study, those 12 items were also used in the present study. Item responses were averaged for analyses. The BPSS is typically scored so that higher scores indicate more body satisfaction, but for consistency with the conceptual model in the current study, the BPSS was reverse scored so that higher scores indicated more body dissatisfaction. Noles, Cash, and Winstead (1985) reported adequate internal consistency (α = .89) for the BPSS scores. Convergent validity of the BPSS was demonstrated through its correlation with a single-item measure of body satisfaction (r = .70; Bohrnstedt, 1977). Although the BPSS has been used with Asian Americans (e.g., Mintz & Kashubeck, 1999), no reliability information could be located.

Eating disorder symptomatology

The Eating Attitudes Test–26 (EAT-26; Garner, Olmsted, Bohr, & Garfinkel, 1982) consists of 26 items that assess disordered eating attitudes and behaviors (e.g., “I avoid eating when I am hungry”). The EAT-26 is scored on a 6-point scale (1 = never to 6 = always), with higher scores indicating higher levels of disordered eating. Researchers have suggested scoring the EAT-26 continuously to avoid skewness and kurtosis problems as well as to more fully reflect the spectrum of disordered eating issues in both clinical and nonclinical samples (Kashubeck-West, Mintz, & Saunders, 2001; Mazzeo, 1999). Mazzeo reported good internal consistency (α = .91) and 3-week test–retest reliability (r = .91) for the EAT-26 scores. In a review eating disorders’ assessments, Kashubeck-West et al. concluded the EAT-26 was effective in differentiating between clinical and nonclinical groups and demonstrated high correlation with other eating disorder measures. In a sample of Asian/Asian American women, Phan and Tylka (2006) reported a Cronbach’s alpha of .87 for the EAT-26. Average scores of the 26 items were used for analyses in the present study.

Procedure

Participants were recruited for this study via an online survey with an e-mail sent by the registrar’s office to 4,502 Asian/Asian American students (2,211 women, 2,291 men). A response rate was not able to be determined because it is unknown how many of the e-mails sent were actually received or opened. Two US$50 and 10 US$15 cash prizes were offered as an incentive. Only responses from women were used for this study.

Initially, 590 women completed the survey with usable data. Outliers and data normality were examined. One univariate outlier with an extremely high BMI (48.84) was identified and excluded. Next, significance tests of skewness and kurtosis were performed for each measure, and results indicated no significant departure from normality. Finally, the multivariate statistic Mahalanobis distance procedure was performed to check for multivariate outliers (Tabachnick & Fidell, 2007). Two significant multivariate outliers (p < .001) were identified and excluded. Therefore, the final sample consisted of 587 Asian/Asian American women.

Missing data were examined at the item level for the final sample. Little’s missing completely at random (MCAR) test was not significant (p > .05), indicating data were missing completely at random (Schlomer, Bauman, & Card, 2010). Three hundred ninety-five (67.3%) participants did not have any missing data, 130 (22.1%) were missing less than 1% of items, 57 (9.7%) were missing 1% to 5% of items, 4 (0.7%) were missing 6% to 10% of items, and 1 (0.2%) was missing 20% of items. Because missing data were found to occur at the item level, multiple imputation (five imputed data sets) was conducted with SPSS before computing scale and subscale scores.

Results

Preliminary Analyses

Table 1 presents the scale means, standard deviations, alpha levels, and value ranges of research variables. Table 1 also summarizes bivariate correlations among all research variables to determine the relevance of the hypothesized predictors to the criterion variables in the proposed structural model. Perceived racial discrimination and racial/ethnic teasing, respectively, had significant associations with self-esteem, media internalization, body dissatisfaction, and disordered eating in expected directions. Ethnic identity, however, was only significantly associated with self-esteem and body dissatisfaction but not with media internalization or disordered eating. The bivariate correlations among self-esteem, media internalization, body dissatisfaction, and disordered eating were all statistically significant in expected directions.

Measurement Model

As a first step of SEM, analysis of the proposed measurement model was conducted with Mplus Version 7 (Muthén & Muthén, 2012). Three item parcels (i.e., observed indicators) were created for each of the latent variables shown in Figure 1, following Russell, Kahn, Spoth, and Altmaier’s (1998) recommended procedures. Exploratory factor analyses were conducted for each scale and a forced one-factor solution was employed. Items were assigned to parcels based on item loadings in such a way that each parcel’s loading on its corresponding latent construct was as equal as possible (Russell et al., 1998). Item parceling allows for the formation of latent variables and thus for modeling measurement error to more stringently test the hypothesized associations. An alternative to item parceling would be to use the subscale or scale scores as manifest variables alone, which would not fulfill the purpose of SEM in terms of accounting for measurement error in the model.

After latent variables were created, a confirmatory factor analysis was then performed to examine the fit of the measurement model. The maximum likelihood estimation with robust standard errors (MLR) method in Mplus was used for estimation of the model because this estimator is robust to data nonnormality when missing data are present in the data set (Muthén & Muthén, 2012). For comparison between nested models, the robust chi-square statistics generated by the MLR method were used to perform a chi-square difference test using procedures indicated on the Mplus website (http://www.statmodel.com/chidiff.shtml). Model fit was evaluated based on the suggestions of Hu and Bentler (1999): the comparative fit index (CFI; .95 or greater), the Tucker–Lewis index (TLI; .95 or greater), the standardized root mean square residual (SRMR; .08 or less), and the root mean square error of approximation (RMSEA; .06 or less). Results of the confirmatory factor analyses suggested a good fit: CFI = .96, TLI = .95, SRMR = .04, RMSEA = .05, and χ²(182) = 475.44, p < .001. All factor loadings of the item parcels to their respective latent constructs were significant (p < .001), indicating the latent variables were well represented by their observed indicators.

Table 2 shows associations among the latent constructs in the measurement model with BMI controlled as a covariate. Consistent with the first and second hypotheses, higher levels of perceived racial discrimination and racial/ethnic teasing, respectively, were significantly associated with lower levels of self-esteem and higher levels of media internalization, body dissatisfaction, and disordered eating. Regarding the third hypothesis, Table 2 shows that ethnic identity was positively associated with self-esteem and negatively associated with media internalization and body dissatisfaction, but was not significantly associated with disordered eating. Results pertaining to the fourth hypothesis about indirect effects are presented in the following section in connection with the structural model and mediated effects.

Table 2.

Correlations Among Latent Variables for the Measurement Model Controlling for BMI.

Variables	1	2	3	4	5	6
1. Perceived racial discrimination	—
2. Ethnic identity	.11*	—
3. Racial/ethnic teasing	.41*	−.05	—
4. Self-esteem	−.23*	.29*	−.09*	—
5. Media internalization	.13*	−.09*	.23*	−.24*	—
6. Body dissatisfaction	.23*	−.17*	.14*	−.54*	.41*	—
7. Disordered eating	.25*	−.09	.22*	−.37*	.53*	.40*

p < .05.

Structural Model

A test of the structural model indicated an adequate fit of the model to the data: CFI = .96; TLI = .95; SRMR = .04; RMSEA = .05; χ²(182) = 475.44, p < .001. Figure 2 summarizes the path coefficients of the structural model, with BMI controlled as a covariate. Higher levels of perceived racial discrimination and lower levels of ethnic identity, respectively, were linked to lower self-esteem. Lower self-esteem, in turn, was directly linked to higher levels of body dissatisfaction and disordered eating. In addition, lower self-esteem was linked to higher levels of media internalization, which, in turn, was associated with increased levels of body dissatisfaction and disordered eating. Figure 2 indicates that after accounting for these multistage indirect paths and the variances in the criterion variables due to BMI, perceived racial discrimination still had a significant direct effect on disordered eating (β = .11), whereas racial/ethnic teasing still had a significant direct link to media internalization (β = .21).

Figure 2.

Structural model.

However, other direct paths involving racial and cultural factors as predictors were not significant in the structural model (Figure 2) despite significant associations indicated in the measurement model (Table 2). For instance, the significant associations of perceived racial discrimination, ethnic identity, and racial/ethnic teasing, respectively, with body dissatisfaction indicated in Table 2, were no longer significant in the structural model (Figure 2) when other predictors and mediators were considered. These results suggested that mediational pathways were involved in transmitting the effects of perceived racial discrimination, ethnic identity, and racial/ethnic teasing to the criterion variables in the structural model in Figure 2.

Plausible Alternative Model

Before further examining the mediated effects, a plausible alternative model was tested relative to the proposed model (Figure 1) to examine whether it provided a better or equivalent fit to the data. Specifically, the plausible alternative model hypothesized that perceived racial discrimination, ethnic identity, and racial/ethnic teasing would not be associated with any of the criterion variables in Figure 1. Results of the goodness-of-fit indices for the plausible alternative model were CFI = .95; TLI = .94; SRMR = .10; RMSEA = .06; χ²(194) = 586.55, p < .001. A robust chi-square difference test comparing the plausible model with the proposed model was significant, Δχ²(12) = 108.01, p < .001. Thus, the plausible alternative model did not provide a better fit to the data and could not be regarded as a viable alternative to the proposed model. Therefore, the proposed model (Figure 1) was retained for examination of model parsimony.

Model Parsimony

To arrive at a more parsimonious but equally appropriate model, the nonsignificant direct paths in the proposed structural model (i.e., Figure 2) were eliminated. Because the current study focused on prediction paths, nonsignificant correlations between the three independent racial and cultural variables were not eliminated. Test of model results for the trimmed model yielded CFI = .96, TLI = .96, SRMR = .04, RMSEA = .05, and χ²(196) = 491.15, p < .001. A robust chi-square difference test comparing this trimmed model and the initially proposed model was not significant, Δχ²(14) = 15.50, p > .05, suggesting the trimmed model is equally appropriate as the initially proposed model, but more parsimonious. Therefore, this trimmed model was employed as the final model for the present study, and the path coefficients are presented in Figure 3. The final model accounted for variances of 16% in self-esteem, 10% in media internalization, 43% in body dissatisfaction, and 38% in disordered eating.

Figure 3.

Parsimonious model.

Bootstrap Procedure to Test Indirect Effects

A bootstrap procedure (Shrout & Bolger, 2002) was conducted to examine the mediated relations. Specifically, 1,000 bootstrap samples were generated from the original data, and 1,000 estimates of the path coefficients were saved. The indirect effects were then calculated by multiplying the coefficients of the direct paths. A 95% confidence interval for the mean indirect effect calculated based on the 1,000 bootstrap samples that excludes 0 indicates that the indirect effect is significant at p < .05. Results presented in Table 3 from the bootstrap procedure indicate that all indirect effects in the final model (Figure 3) had confidence intervals that exclude 0 (p < .05), supporting the fourth hypothesis about the mediational pathways transmitting the effects of racial and cultural factors to the criterion variables.

Table 3.

Bootstrap Analysis of Structural Model, Magnitude, and Statistical Significance of Indirect Effects.

Independent variable	Mediator variable(s)	Dependent variable	β (standardized path coefficient and product)	Mean indirect effect (b)^a	SE of mean^a	95% confidence interval for mean indirect effect^a (lower and upper)
PD →	Esteem →	Disordered eating	−.27 × −.23 = .062	.067	.019	[.033, .107]
PD →	Esteem → Internalization →	Disordered eating	−.27 × −.21 × .45 = .026	.028	.008	[.015, .045]
EI →	Esteem →	Disordered eating	.32 × −.23 = −.074	−.076	.019	[−.118, −.042]
EI →	Esteem → Internalization →	Disordered eating	.32 × −.21 × .45= −.030	−.032	.008	[−.050, −.018]
Tease →	Internalization →	Disordered eating	.21 × .45 = .095	.100	.025	[.061, .156]
Tease →	Internalization →	BDS	.21 × .29 = .061	.082	.022	[.046, .133]
PD →	Esteem →	BDS	−.27 × −.46 = .124	.167	.035	[.101, .237]
PD →	Esteem → Internalization →	BDS	−.27 × −.21 × .29 = .016	.022	.007	[.012, .040]
EI →	Esteem →	BDS	.32 × −.46 = −.147	−.192	.035	[−.265, −.132]
EI →	Esteem → Internalization →	BDS	.32 × −.21 × .29 = −.019	−.026	.007	[−.045, −.015]
PD →	Esteem →	Internalization	−.27 × −.21 = .057	.110	.030	[.062, .187]
EI →	Esteem →	Internalization	.32 × −.21 = −.067	−.127	.030	[−.194, −.075]

Note. PD = perceived racial discrimination; Esteem = self-esteem; Internalization = media internalization; EI = ethnic identity; Tease = racial/ethnic teasing; BDS = body dissatisfaction.

These values are based on unstandardized path coefficients.

Discussion

The present study fills an important gap in disordered eating research by testing a theoretical model that integrates racial and cultural factors (i.e., perceived racial discrimination, racial/ethnic teasing, and ethnic identity) with Western sociocultural influence (i.e., media internalization) into the conceptualization of disordered eating with a sample of Asian/Asian American women. Results indicated the hypothesized model provided a good fit to the data, and the proposed racial and cultural factors were associated with disordered eating and other criterion variables through direct and indirect links.

Consistent with a considerable body of research documenting media internalization as a risk factor for body image concerns (Grabe et al., 2008) and disordered eating (Stice, 2002), the present study found that Asian/Asian American women who adhered to the Western media standards of beauty were more likely to experience dissatisfaction with their body image and present disordered eating problems. Interestingly, although body dissatisfaction had a significant bivariate correlation with disordered eating, the path from body dissatisfaction to disordered eating was not statistically significant in the structural model. The only available study examining a model of disordered eating among Asian/Asian American women (Phan & Tylka, 2006) found a direct path between body preoccupation and disordered eating, but BMI was not examined as a covariate in this model. Post hoc analysis of the present study indicated that when BMI was not included in Figure 2, the path from body dissatisfaction to disordered eating was significant (β = .14, p < .05). This pattern suggests that the association between body dissatisfaction and disordered eating among Asian/Asian American women is likely due to a shared source of variation—that is, BMI—such that when BMI was included in the model, the relation between body dissatisfaction and disordered eating disappeared. In predominantly White female samples, body dissatisfaction has been identified as a robust predictor of disordered eating (for a review, see Stice, 2002) even after BMI was controlled (e.g., Stice, 2001), but in the present sample it did not explain the additional variance in disordered eating when BMI was considered. Thus, for Asian/Asian American women it appears that there is significantly more overlap between BMI and body dissatisfaction in predicting disordered eating as compared with White women. Given that most Asian/Asian American women tend to have relatively smaller body size (Kawamura, 2011), perhaps having a larger body size, which would be further from one’s cultural norm, is relatively more influential on Asian/Asian American women’s disordered eating than subjective feelings of body dissatisfaction. Relatedly, some cross-cultural research indicates that many Asian girls and women with eating disorders did not report body image concerns or body dissatisfaction, which are crucial aspects of eating pathology in Western populations (Cummins et al., 2005; S. Lee, 2001). The present study suggests BMI should not be overlooked in empirical models of disordered eating with Asian/Asian American women. Future studies may further examine whether the current model demonstrates equivalent utility for explaining body image and disordered eating issues among different weight status cohorts (e.g., normal range of BMI, overweight range of BMI) of Asian/Asian American women.

Nonetheless, because the primary purpose of the current study was to examine racial and cultural factors as correlates of susceptibility to Western societal influence on appearance ideals, body image, and disordered eating concerns, the present discussion focuses on the direct links and multiple mediational pathways that involve perceived racial discrimination, ethnic identity, and racial/ethnic teasing as precursor correlates of criterion variables in Figure 1. Investigating these direct and indirect links is a unique contribution of the present study to the literature.

The present study found that perceived racial discrimination had significant correlations with self-esteem, media internalization, body dissatisfaction, and disordered eating in expected directions, thus supporting the first hypothesis of the present study. However, when mediator variables were taken into account, only the direct paths from perceived discrimination to self-esteem and disordered eating, respectively, remained significant. This finding shifts attention to the mediational pathways posited in the fourth hypothesis of the present study regarding indirect effects. Consistent with Striegel-Moore and Smolak’s (2000) risk factor framework, the present model indicates that perceived racial discrimination, through the mechanism of promoting negative self-concept and low self-esteem, was a precursor correlate of Asian/Asian American women’s vulnerability to internalizing the pernicious Western media ideals of beauty, experiencing body dissatisfaction, and engaging in disordered eating behaviors. As indicated in Table 3, all the mediational pathways involved self-esteem as a sole or initial mediator for the indirect paths involving perceived discrimination as a predictor. This finding appears to align with previous assertions (Kawamura, 2011; Kempa & Thomas, 2000) that body image and eating issues in minority women are, in part, manifestations of internalized racism and discrimination that foster negative evaluations of self-worth.

In addition to indirect links, higher levels of perceived discrimination directly predicted disordered eating in the structural model. This finding appears to concur with speculations that disordered eating in minority women may be a response to stressful events such as racially motivated discrimination (Kempa & Thomas, 2000; B. Thompson, 1994, 1996). Such behavior may serve the purpose of disconnecting from emotions or diverting attention away from the stressor (Heatherton & Baumeister, 1991; Kempa & Thomas, 2000). Smart et al. (2011) contended that disordered eating may provide coping behaviors that are congruent with Asian cultural norms of concealment of emotions and distress. However, the meaning of the present findings should not be overly interpreted before future studies replicate these results. Nevertheless, as a first investigation of perceived racial discrimination in eating pathology among Asian/Asian American women, the present findings suggest this variable is an important but previously understudied variable in disordered eating research.

With regard to racial/ethnic teasing, consistent with previous research (Iyer & Haslam, 2003; Reddy & Crowther, 2007), a history of racial/ethnic teasing was associated with lower self-esteem, greater endorsement of media beauty ideals, more body dissatisfaction, and higher levels of disordered eating. However, when mediators were considered, the structural model indicated racial/ethnic teasing only had significant direct effects on media internalization. Women who had experienced more teasing about their racial and ethnic physical features reported a stronger desire to attain the Western beauty ideals. Furthermore, the tendency to identify with Western norms of beauty mediated the relations of racial/ethnic teasing with body dissatisfaction and disordered eating. Previous studies have not tested media internalization as a mediator for these links. Nevertheless, a related study (Smart et al., 2011) found that many Asian/Asian American women (whether foreign- or U.S.-born) struggling with body image and eating issues reported considerable pressure to assimilate and “fit in” to the dominant culture, and viewed having a more Western look and slender body as an avenue to blend in and avoid being singled out. Perhaps racial/ethnic teasing represents a source of assimilation pressure that fosters an idealization and internalization of Western beauty norms. Striving to meet such norms, in turn, would increase vulnerability to body dissatisfaction and disordered eating.

The present findings underscore the importance of examining a history of being teased about racial/ethnic physical features in disordered eating research with Asian/Asian American women. The role of racial/ethnic teasing may be particularly important because other separate lines of research have found a pattern of discontent with racial features among Asian/Asian American individuals. Specifically, Mintz and Kashubeck (1999) found that Asian/Asian American women reported lower satisfaction with their overall body image and racially defined characteristics (e.g., eyes, nose) than European American women. Asian/Asian American youth reported more dissatisfaction with their physical appearance than other racial/ethnic minority youth and indicated more desire to have European American features if granted the opportunity (Phinney, 1989). Statistics show that the most frequently requested cosmetic surgeries among Asian/Asian American women were double-eyelid surgeries, nasal bridge implants, and breast augmentation (American Society of Plastic Surgeons, 2010). It is important that future studies examine whether a history of racial/ethnic teasing contributes to these heightened concerns related to racial features.

Regarding ethnic identity, the present study found it was positively associated with self-esteem but unrelated to disordered eating, a pattern also found by Phan and Tylka (2006). Other studies (Sabik et al., 2010; Tsai et al., 2003) using the same ethnic identity measure, however, found ethnic identity had a significant link with disordered eating (but in opposite directions in these studies). In addition, a higher ethnic identity was found to be associated with lower body dissatisfaction. This pattern is consistent with theoretical views about the protective nature of ethnic identity (Croll et al., 2002), but not consistent with studies that did not find such a link (Iyer & Haslam, 2003; Phan & Tylka, 2006). However, different body image measures were used across studies. Future research needs to further clarify the nature of these links.

With regard to the mediated paths posited in the proposed model, a stronger identification with one’s ethnic group was found to predict more positive views of oneself. Positive self-regard was then linked to lower endorsement of the predominant culture’s beauty ideals, which, in turn, predicted lower levels of body dissatisfaction and disordered eating. This multistaged mediation is consistent with Phan and Tylka’s (2006) findings. Thus, rather than having direct effects, ethnic identity, through the process of fostering positive self-esteem, may serve as a source of resilience against disordered eating and other issues frequently associated with eating pathology (e.g., media internalization).

Limitations

Several limitations must be addressed when interpreting the present findings. First, the percentage of graduate and professional students in the sample (41.6%) was slightly higher than that of the institution from which participants were recruited (37.1%), a fact that limits the generalizability of the findings. In addition, the sample is predominantly composed of young women. The mean and standard deviation of the participants’ age indicated more than 90% were younger than 30 years old. To examine the possible confound of age on the study findings, a post hoc analysis was performed and the results indicated that including age as a covariate in the model did not change the significance patterns of the path coefficients reported in Figures 2 and 3. In terms of psychopathology, the sample’s levels of disordered eating (M = 2.47, SD = .74), based on averaged item ratings (range = 1-6), were comparable with those reported in typical (i.e., predominantly White) college women samples (e.g., M = 2.45, SD = .76; Moradi, Dirks, & Matteson, 2005). However, the relatively low levels of psychopathology indicate that the present findings cannot be generalized to populations with higher or clinical levels of eating pathology. Second, a majority of the sample identified as upper-middle class (45.2%) and middle class (37.2%) in terms of family socioeconomic status (SES), which further limits generalizability. Nonetheless, reviews of research generally have not found an association between SES and disordered eating (e.g., Gard & Freeman, 1996).

Third, acculturation was not measured in the present study but could have influenced the present findings. Given that about 42% of participants were foreign-born and ranged widely in years of residence in the United States, they might have varied greatly in levels of acculturation, which could have influenced their identification with their culture of origin (i.e., ethnic identity) and their experience with racial discrimination, teasing, and media messages. For example, participants who recently immigrated may not perceive racist treatment as discriminatory because of limited awareness of racism in the U.S. culture (Viruell-Fuentes, 2007). Other participants may encounter more discrimination than those who immigrated to the United States earlier due to societal intolerance and hostility directed at recent immigrants’ low acculturation and acclimatization to the mainstream culture (Yoo et al., 2010). Related to this limitation is the possible confounding of participants’ varied English abilities in comprehending the survey measures. Only English versions of the measures were used and it is likely that some items may have been difficult for some recent immigrants to understand. This may have also resulted in a selection bias such that only individuals who were more comfortable or proficient with English were drawn to participate in the survey.

Fourth, the relatively low mean of reported racial/ethnic teasing in the current sample, although slightly higher than that in Reddy and Crowther’s (2007) study based on a small sample (n = 74), could weaken the observed relations involving racial/ethnic teasing and other variables. In addition, because the racial/ethnic teasing items assess experiences during formative years, they may not be relevant for some foreign-born Asian/Asian American women who did not become a racial minority until moving to the United States at an older age. However, as double eyelids, pronounced nose, and lighter skin color have been favored in many Asian countries (Forbes & Jung, 2008; Jung & Lee, 2006), it is not unlikely that incidents of being teased about having “too many” Asian features (e.g., slanted eyes, flat nose) might have occurred to individuals during their early years in their country of origin. These early teasing incidents may be connected to future use of double-eyelid surgery, frequently sought in South Korea and China, as a way to increase opportunities for interpersonal and career success (Lah, 2011).

Another limitation is that all data were collected at one time point using self-report measures. Participants’ reports on such measures (e.g., racial discrimination, racial/ethnic teasing) might be affected by social desirability and retroactive perceptions (Heppner, Wampold, & Kivlighan, 2008). Finally, the cross-sectional nature of this study precludes inferences about causality. An alternate model with all paths reversed in prediction may also be plausible (e.g., disordered eating predicted lower self-esteem such that self-esteem was damaged by disordered eating). Longitudinal studies are required to establish the temporal and causal relations of racial and cultural factors with disordered eating and its correlate variables.

Implications

Despite these limitations, the present findings have implications for practice and research. Therapists working with Asian/Asian American women presenting with disordered eating problems may benefit from exploring the client’s experiences with racial discrimination, history of racial/ethnic teasing, identification with own ethnic group, and definitions of beauty and attractiveness. As suggested by the direct link in Figure 3, therapists might be able to reduce disordered eating directly by helping Asian/Asian American women confront racial discrimination and process any racism-related distress and thoughts. Helping women confront discrimination and examine related cognitions and attributions may also prevent the discriminatory treatment being internalized to women’s self-appraisal. Similarly, exploring the quality of clients’ ethnic identification and facilitating consolidation in ethnic identity may result in affirmation of self-esteem, which may then increase resilience against internalization of Western media beauty norms and further protect women from developing body image and eating concerns. Finally, assessing a history of racial/ethnic teasing may help women gain awareness of potential reasons for their identification with Western ideals of beauty and scrutinize their reasons for consuming mainstream media prescriptions of beauty and possibly reducing their tendency to internalize them.

Additional avenues for intervention may be suggested by the mediating roles of self-esteem and media internalization. Therapists could utilize esteem-building approaches and cognitive strategies, with due regard for cultural appropriateness (Cummins & Lehman, 2007), to enhance the client’s self-acceptance and ability to challenge predominant standards of beauty. Outreach programs that promote multicultural campus climates and ethnic identity affirmation, as well as workshops that increase awareness of the racialized definitions of beauty and the domination of Western media in setting beauty norms, may reduce potential contextual risks and increase resilience for positive development in self-esteem, body image, and eating practices in Asian/Asian American women. To prevent racial/ethnic teasing, it might be important to start in schools by educating youth of all groups to appreciate racial and ethnic diversity, and encouraging Asian/Asian American youth to appreciate their racial physical distinctiveness and develop ethnic identity and cultural pride.

Overall, the present study represents an incremental step in understanding racial and cultural factors in disordered eating among Asian/Asian American women. The final model explained 43% of variance in body dissatisfaction and 38% in disordered eating, thus demonstrating effect sizes that are considered large according to Cohen (1992). Future studies may replicate and expand this model to incorporate other factors of potential unique relevance for Asian/Asian American women. For example, the perpetual foreigner stereotype that sees Asian/Asian American individuals as not “real” Americans (Sue et al., 2007) may be especially relevant for this group’s body image and eating concerns. Inclusion of acculturation in the model may deepen our understanding of how racial and cultural factors relate to body image and disordered eating concerns. Another area for further investigation is the operationalization and measurement of the construct of racial/ethnic teasing. Reddy and Crowther’s (2007) measure was developed based on a small sample and has not been evaluated for validity properties through rigorous procedures.

As Asians/Asian Americans tend to report high levels of stigma toward seeking mental health services (Cheng, Kwan, & Sevig, 2013), it is perhaps not surprising that few Asian/Asian American women seek needed treatment for disordered eating issues (Franko et al., 2007). When they do seek treatment, it is important that potential cultural and contextual influences be considered for treatment planning and prevention of early dropout (Cummins & Lehman, 2007). The racial and cultural factors indicated in the present model provide initial directions for conceptualization and planning for disordered eating work with Asian/Asian American women.

Footnotes

Acknowledgements

I would like to thank Eve Adams, Jonathan Schwartz, and Brent Mallinckrdot for their helpful feedback on an earlier draft of this article. I would also like to thank Todd Sevig and Christine Asidao for their support during the data collection process.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biography

Hsiu-Lan Cheng is currently an assistant professor in the Department of Counseling and Educational Psychology at New Mexico State Univeristy. Her primary research interests include multicultural issues in mental health (e.g., body image concerns, eating disorders, depression), racial/ethnic disparities in psychological help-seeking, and attachment theory and affect regulation.

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