Myth: You Can’t Recover Until Society Changes

By B, AKA The No Nonsense Guide guy

Study Finds TV Alters Fiji Girls' View of Body. This was the headline for a 1999 New York Times article. Although it was only a short write-up of a not-yet published study, its conclusion has become common wisdom: Western media promotes anorexia.

The study’s lead author was Anne E Becker, a decorated researcher at Harvard Medical School. It looked at the 1995 introduction of Western programming to television in Fiji. An article about the study was eventually published in the British Journal of Psychiatry in 2002. That article has since been cited hundreds of times, and has inspired other researchers to look at the introduction of television in other countries (such as Ukraine) and at other vectors of Western culture (like social media).

Becker et al discuss various limitations of their research in the published article. However, the published article makes no mention of confounding factors. Might there have been other things going on in the mid 1990s besides television?

The introduction of television to Fiji was just one of many changes affecting the country in the 1990s. Don’t take it from me — take it from Becker herself. This passage appears in another article she wrote about the effects of Western media:

The partial electrification of rural Fiji that began in the mid-1980s has been accompanied by relatively rapid economic, political, and social changes… With increasing opportunities for wage-earning and the stimulation of consumerism by advertising and other exposure to Western lifestyles through television, the acquisition of prestige consumer goods (mostly electric appliances such as refrigerators, television sets, and radios) is now becoming more possible and common in Fiji.

Did you catch the bit about refrigerators? I think this is important, because it means that dietary habits in Fiji were changing in this period prior to television being introduced. Indeed, in the same article Becker mentions a shift to processed foods and a rise in the numbers of people considered obese occurring around the same time. Now, let’s ignore the limitations of BMI for now. On the following chart, we can see the mean BMI for women in Fiji increasing year by year (source). Notice that it’s well above the threshold considered ‘overweight’ in 1995 and continuing to climb.

Perhaps this should have been mentioned as a potential reason why dieting became more prevalent in Fiji?

Here is an alternative story: as Fiji developed, new types of food became available and convenient to consume. This caused some people to weigh more than they were accustomed to. Some of them started diets as a result, and some fraction of them developed eating disorders.

Perhaps Western TV shows played a role in bringing diet culture to Fiji, but I think this unnecessarily discounts biological factors. We don’t understand why, but some people are vulnerable to falling into a self-starvation cycle when they go into energy deficit. Diets are one cause of energy deficits, but they’re not the only one.

We know that the expression of anorexia is shaped by cultural context: Some sufferers attribute their self-starvation to religious ecstasy. Others will blame it on unspecified digestion issues. Many say they’re imitating actors and models. However, I think we should be cautious about saying this or that cultural practice ‘causes’ anorexia.

Thankfully, I’m not the only one who has raised an eyebrow at the 2002 study. Benjamin Radford helpfully pointed out various issues with the study (including its small sample size) in a 2014 article for Skeptical Inqurier. Levine and Murnen 2009 at least note that some biopsychiatric researchers think blaming media for eating disorders is irritating. Nonetheless, it would be good if more researchers focused critical attention on the assumption that anorexia is downstream of culture.

Why does this matter? I think that when we say ‘We have to change Western culture to combat anorexia,’ people with anorexia hear ‘I can’t expect to succeed at recovery until the culture around me changes.’ And that’s not true — recovery is possible even though there are skinny actors on TV.