​Upon hearing about the experiences my lab had at the 2018 International Conference on Eating Disorders in Chicago, Illinois, we discussed the controversial nature that exists when researchers use “triggering,” terminology. Audience members became upset with certain researchers who used words such as “overweight,” and “obese,” which were used to describe study participants. These words have been part of the terminology present in fat-shaming, fat discrimination, and micro aggression towards a population that society has deemed to have above average weight. Furthermore, these words become associated with individuals that society has frequently labeled as “lazy” or “incapable” as dictated by their portrayals in films, television, and other media outlets. However, this begs the question: Should researchers use these words if they are so triggering in the public domain? The answer is complicated.
 
“Obese,” comes from the latin “obesus,” which means “fat, stout, plump.” It was believed that Hippocrates recognized obesity as a medical condition as it gave rise to the onset of other diseases (Christopoulou-Aletra & Papavramidou, 2004). The modern term “obesity,” one that became stigmatized by society today, took shape in 1942, when The Metropolitan Life Insurance Company began to determine mortality rates based off of age and weight. For the first time, individuals were standardized and the notion of what an individual “should” weigh was popularized (Statistical bulletin of the Metropolitan Life Insurance Company). While initially designed to determine “desirable weight” dependent on age, height and mortality values, the insurance company changed the medical term into one that society was able to pass medical judgment on, completely discounting the innate nature in which all bodies are different.
 
Researchers Meadows and Danielsdottir (2016) said it best, “Part of the problem is that the very act of labeling is a process of othering, one that creates a distinction between us and them; which raises the question: who is entitled to do the labeling and why, and in what conditions is such a distinction needed?” Within research, othering is needed in order to determine differences between two groups of individuals. However, when presenting research, the two groups must be labeled in order for other researchers to understand what populations the research is being done on. The questions Meadows and Danielsdottir (2016) raise are both legitimate and further contemplation could give rise to an ethics paper worth developing.
 
However, I argue, researchers ought to be allowed to use the triggering word, upon critical consideration, as long as its intent is to use the word as it originally appeared in the dictionary and not one that was shaped from societal norms. I recognize this statement contains many caveats, like “what if the word in the dictionary was created offensively in the first place?” It is the responsibility of researchers to develop a common word that can be used for research purposes.
 
Let’s say for instance, researchers were to change the word of a specific demographic every time social norms dictate it as “triggering.” Not only would this be a disservice to the population in which the research was presented on, but also could have a negative impact on the research itself. For example, if researchers cannot come up with a common language for the subject in which they are communicating, then the ability to share research will be dependent on how long the terminology within that research is deemed “acceptable.” For this reason, when reporting on demographics, researchers ought to be careful in the first place of the terms they do use.
 
In the end, I believe that “obese” as a research term ought to continue to be used, reporting results unbiased without regard to social norms. Further, if new information comes to light, for example if it was discovered that Hippocrates used “obese” as a derogatory term, then it is the ethical responsibility of researchers to utilize different terminology for this demographic.

​While the culture in the United States has come a long way in terms of normalizing and destigmatizing mental illness, particularly with respect to depression and anxiety, there are still a lot of misconceptions and stereotypes surrounding other mental illnesses, such as eating disorders and obsessive-compulsive disorder. Eating disorders, and mental illness in general, is still a taboo topic in a lot of communities, specifically among people of color.
 
As an Indian-American, I have witnessed the culture surrounding mental illness within my community. Rather than being seen as a real illness that warrants the same attention and level of care as a physical ailment, mental illness is often dismissed and not legitimized. Even when one’s mental illness is acknowledged, their family might try to explain it by giving it a biological cause, such as rationalizing it as a thyroid dysfunction. Due to a myriad of sociocultural factors, South-Asians face unique barriers to seeking treatment for eating disorders.    
 
One issue is that eating disorders are still stereotyped as an issue that only affects young, affluent, White women. In reality, eating disorders affect people of all genders, ethnic groups and ages (Marques et al., 2011).
 
While extensive research on eating disorders has been conducted in European-American populations, and some research has been conducted in African, Latin-American, and Hispanic populations, eating disorder research has been historically sparse in Asian populations (Soh & Walter, 2013). Research has suggested that referrals to eating disorder services from South-Asian populations are under-represented (Abbas et al., 2010), despite evidence suggesting that rates of disordered-eating behaviors are similar to the rest of the population (Wales et al., 2017). Studies have also shown that there is a high prevalence of disordered eating behaviors in minority populations in general (Solmi et al., 2014), and research in South-Asian populations have suggested that the incidence of certain eating disorders, specifically bulimia nervosa, is higher in South-Asian populations than White populations (Mumford et al., 1991).
 
Eating disorders are particularly relevant in the South-Asian community due to role that food plays in the culture. Any large gathering of family or friends usually involves a lot of sugary, fatty food, and people are encouraged to socialize and eat, and those that do not partake are seen as asocial. However, it is also a common occurrence in the South-Asian community to have various relatives or family friends comment on various aspects of one’s life, including one’s physical appearance. In the Indian community, being light-skinned and thin are seen as not just sufficient, but necessary to be considered attractive, if you are a woman. Societal pressure in the form of comments or suggestions are often made if a woman does not match this ideal body type, conditioning individuals to go to extremes pursuing this ideal. Research has found that this is a common theme in the South-Asian community that can prime individuals to develop disordered eating habits and behaviors (Wales et al., 2017). Much of this pressure is faced by young women and adolescent girls, as patriarchal norms dictate that they are expected to look attractive to find an ideal husband. Men in the South-Asian community also face the same societal pressures, but generally to a lesser extent. Older women often note that they do not face the same pressures after marriage, though some pressures still exist. This dual pressure to eat in social settings and yet maintain a thin figure may be one reason why there is a higher than average prevalence of bulimia nervosa in South-Asian women, and why anorexia nervosa might not be as common (Mumford et al., 1991; Abbas et al., 2010). Klump and Keel (2003) also provide other explanations on cultural differences in eating disorders, and their research has found that bulimia nervosa has greater variability cross-culturally than other eating disorders, such as anorexia nervosa.
 
Additionally, women who are part of the South-Asian diaspora, but who live in the Western world face experience many conflicting messages about food and weight, as they are exposed to more traditional South-Asian influences from their family, as well as being exposed to various Western disordered eating triggers such as peer pressure, pictures of thin celebrities and pro-anorexia websites.
 
Not only do South-Asians face unique sociocultural pressures that may contribute towards disordered eating, but they also face barriers to seeking treatment. One of the biggest barriers to accessing services is lack of knowledge – while younger South-Asians tend to be more aware and exposed to ideas about mental illness, they may be dismissed by elder family members or friends. The lack of communication and understanding of the seriousness of eating disorders can keep younger South-Asians from accessing care, particularly if they are dependent on family members to assist with paying for treatment (Wales et al., 2017). This goes along with the general stigma surrounding mental illness in the South-Asian community – seeking treatment involves acknowledging the mental illness, and many South-Asians do not want to admit that there is a “problem” in their family or community.
 
While South Asian populations face these unique barriers to accessing care for eating disorders, progress is still being made. Mental health is being discussed in a serious way in South-Asian media, such as in Bollywood movies, reshaping the way it is viewed by the general population. However, increasing eating disorder research on this understudied population is important, as it could contribute towards reducing barriers to treatment and improving quality of care to the South-Asian population. Moreover, eating disorders may present differently in Eastern populations versus Western populations, so more research needs to be done to parse out if such differences exist. Additionally, normalizing topics within these communities is essential, as stigma can keep South-Asians from accessing mental health services, even when readily available.
 
References
 
Abbas, S., Damani, S., Malik, I., Button, E., Aldridge, S., & Palmer, R. L. (2010). A comparative study of South Asian and non‐Asian referrals to an eating disorders service in Leicester, UK. European Eating Disorders Review, 18(5), 404-409.
 
Keel, P. K., & Klump, K. L. (2003). Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology. Psychological bulletin, 129(5), 747.
 
Marques, L., Alegria, M., Becker, A. E., Chen, C. N., Fang, A., Chosak, A., & Diniz, J. B. (2011). Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders. International Journal of Eating Disorders, 44(5), 412-420.
 
Mumford, D.B., Whitehouse, A.M., & Platts, M. (1991), Sociocultural correlates of eating disorders among Asian schoolgirls in Bradford. The British Journal of Psychiatry, 158(2), 222-228.
 
Soh, N.L. & Walter, G. (2013), Publications on cross-cultural aspects of eating disorders. Journal of Eating Disorders, 1(1), 1-4.
 
Solmi, F., Hatch, S.L., Hotopf, M., Treasure, J. and Micali, N. (2014), Prevalence and correlates of disordered eating in a general population sample: the South East London community (SELCoH) study. Social Psychiatry and Psychiatric Epidemiology, 49(8), 1335-1346.
 
Wales, J., Brewin, N., Raghavan, R., & Arcelus, J. (2017). Exploring barriers to South Asian help-seeking for eating disorders. Mental Health Review Journal, 22(1), 40-50. doi:10.1108/MHRJ-09-2016-001