Eating behaviours and attitudes following prolonged exposure to television. PDF

Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls ANNE E. BECKER, REBECCA A. BURWELL, DAVID B. HERZOG, PAUL HAMBURG and STEPHEN E. GILMAN BJP 2002, 180:509-514. Access the most recent version at DOI: 10.1192/bjp.180.6.509 References This article cites 0 articles, 0 of which you can access for free at: http://bjp.rcpsych.org/content/180/6/509#BIBL Reprints/ To obtain reprints or permission to reproduce material from this paper, please permissions write to [email protected] You can respond http://bjp.rcpsych.org/cgi/eletter-submit/180/6/509 to this article at Downloaded http://bjp.rcpsych.org/ on October 7, 2013 from Published by The Royal College of Psychiatrists To subscribe to The British Journal of Psychiatry go to: http://bjp.rcpsych.org/site/subscriptions/ B R I T I S H J O U R N A L O F P S YC H I AT RY ( 2 0 0 2 ) , 1 8 0 , 5 0 9 ^ 5 1 4 Eating behaviours and attitudes following complement quantitative methods. Specific research questions included: whether expo- sure to Western television has stimulated prolonged exposure to television among disordered disordered eating behaviour despite local cultural practices that have traditionally ethnic Fijian adolescent girls{ supported robust appetites and body shapes; whether markers of disordered ANNE E. BECKER, REBECCA A. BURWELL, STEPHEN E. GILMAN, eating in Fiji are associated with body dis- DAVID B. HERZOG and PAUL HAMBURG satisfaction as they are in the West; and whether a shift away from traditional values ± as evidenced by intergenerational disparities in attitudes concerning diet ± Background There are no Epidemiological data showing a greater prev- may be one mechanism mediating between published studies evaluating the impact alence of eating disorders in industrialised television exposure and disordered eating. societies than in developing societies of introduction of television on disordered suggest that the cultural context may be eating in media-na|« media-na|veve populations. Study site one important aetiological component. However, specific cultural mechanisms that Fiji was selected as a study site because of Aims To assess the impact of novel, its extremely low prevalence of eating dis- mediate disordered eating remain poorly prolonged exposure to television on understood. Previous attempts to establish orders, having only one reported case of disordered eatingattitudes andbehaviours and behaviours a relationship between media exposure and anorexia by the mid-1990s. The Nadroga eating disorders have been limited by the province of Fiji was selected for its lack among ethnic Fijian adolescent girls. use of study subjects from environments of exposure to television until mid-1995. Method A prospective, multi-wave in which there is chronic exposure to Similar to other Polynesian groups (Pollock, Western media imagery and disordered 1995), ethnic Fijian traditional aesthetic cross-sectional design was used to eating is already prevalent. The purpose of ideals reflect a preference for a robust body compare two samples of Fijian schoolgirls habitus; thus, the prevailing `pressure to be this study was to evaluate the impact of before and after prolonged regional the recent introduction of Western tele- slim' thought to be associated with dieting television exposure with a modified vision on disordered eating among ethnic and disordered eating in many industrialised (indigenous) Fijian adolescent girls ± a societies was distinctly absent in traditional 26 -item eating attitudes test, relatively media-naõ media-naõve Ève population in which Fiji. In addition, traditional Fijian values supplemented with a semi-structured and practices encourage robust appetites disordered eating previously was thought interview to confirm self-reported and a widespread vigilance for and social to be rare. To our knowledge, this is the symptoms.Narrative data from a subset first study investigating patterns of dis- response to appetite and weight loss. of respondents from the exposed sample ordered eating before and after prolonged Individual efforts to reshape the body by television exposure in a developing society. dieting or exercise thus traditionally have were analysed for content relating Demonstration of a significant impact of been discouraged (Becker, 1995; Becker & television exposure to body image Hamburg, 1996). media exposure would allow insight into concerns. the pathogenesis of eating disorders and Results Key indicators of disordered suggest potential preventive strategies. Study population eating were significantly more prevalent The study population comprised all ethnic Fijian adolescent girls enrolled in Forms following exposure.Narrative data METHOD 5±7 at two secondary schools in Nadroga revealed subjects' interest in weight loss during the respective data collection periods. as a means of modelling themselves The impact of television exposure on indi- Written informed consent was obtained cators of disordered eating was investigated from subjects and a corresponding parent after television characters. via a prospective, multi-wave cross-sectional or guardian. Sixty-three respondents parti- Conclusions This naturalistic design in which two separate samples of cipated in the study in 1995, within a month ethnic Fijian adolescent girls were assessed of television being introduced to the area, experiment suggests a negative in Nadroga, Fiji. The first wave occurred and 65 respondents participated in 1998, impact of television upon disordered in 1995, within a few weeks of the intro- after television had been broadcast to the eating attitudes and behaviours in a duction of television to Nadroga, and area for 3 years. Information about the media-na|« media-na|veve population. the second in 1998, after the area had total number of students meeting inclusion been exposed to television for 3 years. criteria was not available in 1995; in Declaration of interest This study Qualitative methods ± borrowed from the 1998, the response rate was 71%. was supported by funding from the standard toolbox of anthropological methodology and involving a detailed Harvard Medical School. Data collection analysis of narrative data to illuminate how cultural processes affect feelings and Subjects in both samples responded to a { See editorial, pp. 480^482, this issue. behaviours in this context ± were used to modified 26-item eating attitudes test 509 BECKER E T AL (EAT-26; Garner et al, al, 1982) that included you go to a [traditional feast]? What do respective samples appeared relatively questions concerning bingeing and purging you think of American TV? Do you admire homogeneous, with virtually all subjects behaviours. The EAT-26 has been in wide- any characters on TV? Do you ever wish (98% and 97%, respectively) reporting spread use in a variety of cultural settings you could be more like them? Do you think some television viewing at the time of and required no translation for use in this TV has affected cultural traditions in Fiji? the survey. Thus, chronicity of television study population because all subjects were exposure to the community, reflected by fluent in English; however, to enhance Data analysis differences between the 1995 and 1998 comprehensibility, concepts or words that Sample differences in television exposure, samples, was the major variable chosen were thought potentially unfamiliar to sub- age, body mass index, bingeing and for assessment of the effects of television jects were explained orally in both English purging behaviours, and EAT-26 scores viewing on disordered eating attitudes and (the language of instruction) and the local were examined. Student's t-tests were used behaviours. In addition to chronicity of Fijian dialect (Nadroga (Nadroga,, an unwritten to test for differences in means across exposure, the samples differed significantly variant of standard Fijian) at the discretion samples. Differences in proportions were with respect to access to television viewing, of the investigators. An EAT-26 score assessed using w2 tests and corresponding as reflected by between-sample differences greater than 20 was considered to be high exact P values due to small sample sizes. in the prevalence of household ownership (cf. Garner et al, al, 1982). In addition, subjects Finally, adjusted odds ratios were obtained of television: 41.3% of the 1995 sample responded to questions concerning house- from logistic regression models to examine indicated household ownership of a tele- hold ownership of television and frequency the associations among markers of dis- vision, which increased to 70.8% in 1998 of television television viewing. Weight and height ordered eating, body dissatisfaction and (w211.31, 11.31, d.f.1, d.f. 1, P0.001). 0.001). were measured also. Respondents in the intergenerational intergenerational disparity. Narrative data Two significant between-sample differ- two waves who self-reported either binge- from the 1998 sample were audiotaped, ences on indicators of disordered eating ing or purging behaviours were asked to transcribed and analysed for thematic were identified. First, the percentage of respond to a semi-structured interview content and frequency of responses with subjects with EAT-26 scores greater than developed for this study, keyed to clinical the assistance of ATLAS.ti (Muhr, 1997). 20 was 12.7% in 1995, compared with definitions of bingeing and purging to con- 29.2% in 1998 (w (w25.25, 5.25, d.f.1, d.f. 1, P firm the behaviour (e.g. to determine RESULTS 0.030). Within the 1998 sample, EAT-26 whether vomiting was induced and directed scores greater than 20 were significantly towards weight control). Quantitative data associated with dieting (w (w28.20, 8.20, d.f.1, d.f. 1, In 1998, additional survey questions The mean age in years in the 1995 and P0.006) 0.006) and self-induced vomiting (w (w2 elicited data on body image, dieting and 1998 samples was 17.3 (s.d.0.9) (s.d. 0.9) and 16.9 12.10, d.f.1, d.f. 1, P0.002), 0.002), as expected, potential intergenerational disparities (s.d.1.1), (s.d. 1.1), respectively. The mean body indicating its likely value as an indicator between subjects and their parents with mass index (BMI) was 24.5 (s.d.3.4) (s.d. 3.4) and of disordered eating in this population. respect to traditions concerning diet and 24.9 (s.d.2.5), (s.d. 2.5), respectively. Table 1 shows Second, the percentage of subjects reporting weight. For example: How important is it that there were no significant differences self-induced vomiting to control weight to you to weigh what you would like to between the samples in mean age or body was 0% in 1995 but had reached 11.3% weigh? Would it bother you if you were mass index. By study design, the samples by 1998 (w(w26.95, 6.95, d.f.1, d.f. 1, P0.013). 0.013). There too thin? Would it bother you if you were were chosen for their markedly different was no confirmed diuretic or laxative use too heavy? Do you ever think that you look duration of television exposure; television to lose weight nor BMI consistent with too big or too fat? Do you ever think that was introduced to Nadroga just prior to anorexia nervosa (i.e. 417.5) (American you should eat less? Have you ever tried the beginning of the study, so the 1995 Psychiatric Association, 1994) in either to change what you eat in order to change sample had been exposed for less than one sample. Finally, the frequency of self- your weight? Have you ever tried to change month; by contrast, the 1998 sample had reported binge-eating was not significantly how much you eat in order to change your been exposed to television for just over different in the 1995 and 1998 samples: weight? Do your parents or family ever say 3 years. Television exposure within the 7.9% and 4.6%, respectively (Table 1). that you should eat more? In addition, narrative data were collected via open- Table Table 1 Comparison between 1995 and 1998 samples with respect to age, body mass index (BMI), household ended, semi-structured interviews from a ownership of television, bingeing, purging and high EAT-26 scores subset of 30 purposively sampled respondents with a range of disordered eating attitudes and behaviours and tele- 1995 Sample 51 month 1998 Sample 43 years P value vision viewing habits within the original TV exposure (n (n63) 63) TV exposure (n (n65) 65) sample. Questions probed attitudes and practices concerning diet and weight relative Mean age, years (s.d.) 17.3 (0.9) 16.9 (1.1) NS to local cultural traditions and exposure to Mean BMI (s.d.) 24.5 (3.4) 24.9 (2.5) NS television within this peer environment. For Household ownership of a television, n (%) 26 (41.3) 46 (70.8) 0.001 example: How do you feel about your Bingeing, n (%) 5 (7.9) 3 (4.6) NS weight? Have you ever tried to gain or lose EAT-26 420, n (%) 8 (12.7) 19 (29.2) 0.030 weight? Do you want to look different from Some induced-vomiting to control 0 (0) 7 (11.3) 0.013 the way your parents think you should weight, n (%) look? How do you feel about eating when 51 0 T E L E V I S I ON E X P O S U R E A N D E AT IN I N G B E H AV I OU R IIN N F IJIAN GIRL S Variability in daily television viewing the time, in sharp contrast to previous pre- example, 31% of the study population per- was not substantial enough in the 1995 vailing traditional norms supporting a large ceived that parents felt that they should and 1998 samples to allow for meaningful meaningful body size. Feeling `too big or fat' was signifi- eat more than they, themselves, felt was analysis of the association between cantly associated with current dieting (w (w2 sufficient (see Appendix). frequency of viewing and disordered eating 10.04, d.f.1, d.f. 1, P0.003), 0.003), suggesting that attitudes and behaviours. However, we were body dissatisfaction expressed in this way DISCUSSION able to examine the association between has concrete behavioural manifestations in television ownership and disordered eating. this context. This study represents the first known in- Respondents living in households with a vestigation of television's impact upon television set were more than 3 times as disordered eating attitudes and behaviours likely to have an EAT-26 score greater Qualitative data in a traditional society. Survey data demon- than 20 (OR3.47; (OR 3.47; 95% CI 1.21±9.98; Several themes emerged from the open- strate a significant increase in the prev- P0.021). 0.021). This association was somewhat ended interviews in 1998 that suggest alence of two key indicators of disordered attenuated after controlling for sample year television's profound influence on attitudes eating among this study population of (OR2.86; (OR 2.86; 95% CI 0.97±8.44; P0.057). 0.057). and behaviours concerning diet, weight ethnic Fijian adolescent girls ± high EAT- Given the local practice of collective viewing and body shape in this peer environment. 26 scores and self-induced vomiting to lose at one another's homes, we consider house- First, narrative data revealed prevalent weight ± following novel, prolonged tele- hold television ownership to be an indi- admiration for characters seen on tele- vision exposure in their community and a cator of community access to television in vision as well as explicit interest in concomitant increase in the percentage of addition to a marker of individual exposure. emulating them through changing be- households owning television sets. In addi- Next we tested the hypotheses that haviour, clothing or hairstyle or through tion, narrative data explicitly link changing body dissatisfaction (as reflected in the reshaping the body; indeed, all subjects attitudes about diet, weight loss and opinion that one should eat less) and inter- but one (of note, one without a history of aesthetic ideals in the peer environment to generational disparity in values placed on vomiting or a high EAT-26 score) reported Western media imagery. The impact of robust appetites were associated with self- this. Of the subjects interviewed, 83% television appears especially profound, induced vomiting and high EAT-26 scores responded that they felt television had given the longstanding cultural traditions within the 1998 sample. As predicted, a specifically influenced their friends and/or that previously had appeared protective significantly higher proportion of subjects themselves to feel differently about or against dieting, purging and body dissatis- who felt that they should eat less reported change their body shape or weight and faction in Fiji. self-induced vomiting (21.4% v. 2.7%, 77% reported that television had in- w25.82, 5.82, d.f.1, d.f. 1, P0.037). 0.037). Notably, self- fluenced their own body image. Indeed, induced vomiting was not associated with they frequently articulated articulated a desire to lose Relationship among culture, BMI, indicating that the subjects' perceived weight or reshape their body in order to the media and eating disorders rather than actual weight was the salient become more like a Western television char- Current understanding of how cultural con- predictor of purging behaviour. Moreover, acter (see Appendix). Of note, the subjects text promotes risk for eating disorders links high levels of perceived intergenerational with high EAT-26 scores or induced vomit- body dissatisfaction to internalisation of a disparity on the issue of eating less were ing were more likely (85%) than subjects cultural valuation of thinness, thus pre- associated with an increased probability of without high EAT-26 scores or vomiting disposing towards disordered eating self-induced vomiting (26.3% v. 4.4%, w2 (60%) to report television's influence on (Garner et al, al, 1980; Striegel-Moore et al, al, 6.75, d.f.1, d.f. 1, P0.019). 0.019). In a multivariate their own body image. 1986). With the theoretical premise that logistic regression model, the likelihood of Respondents demonstrated a keen exposure to idealised images of beauty in having an EAT-26 score greater than 20 interest interest in enhancing their prospects of the media stimulates social comparison was significantly higher also for those securing a job or in accomplishing work (Festinger, 1954) and potential body image who reported feeling that they should eat at home, with 40% of subjects interviewed disturbance or dissatisfaction (Heinberg & less (OR7.42, (OR 7.42, 95% CI2.12±30.93, CI 2.12±30.93, P rationalising their desire to eat less or lose Thompson, 1992), numerous observational 0.003), independent of subjects' BMI. weight as a means of improving career studies have investigated how media expo- Baseline survey data on dieting were not prospects or becoming more useful at sure (specifically, (specifically, televised and print media collected in 1995 because ethnographic data home. In addition, 30% of those inter- from the women's fashion industry) is had demonstrated previously that dieting viewed indicated that television characters related to disordered eating. Several of for weight reduction was rare in Fijian served as role models concerning work or these studies have demonstrated an associa- traditional culture (Becker, 1995). By 1998, career issues (see Appendix). Finally, all tion between reported media exposure and however, survey data indicated that dieting subjects interviewed identified ways in various indices of disordered eating (e.g. had become extremely prevalent among the which television affected traditional values Stice & Shaw, 1994; Tiggemann & Picker- study population, with 69% reporting that or behaviour. Some subjects also expressed ing, 1996; Field et al, al, 1999). Whereas a they had dieted to lose weight at some their awareness of developing intergenera- causal relationship is difficult to establish previous time and 62% reporting that they tional tensions around the teenagers' in observational studies, an increase in had engaged in dieting behaviour in the 4 adoption of Western customs viewed on indices of disordered eating has been weeks prior to the study. In addition, television and specifically articulated documented following the experimental 74% of the 1998 study population reported conflict concerning expectations about an manipulation of subjects by exposure to that they felt `too big or fat' at least some of appropriate amount of food to eat. For media-generated images (e.g. Irving, 1990; 511 BECKER E T AL Richins, 1991; Stice & Shaw, 1994). How- to the increased prevalence of high EAT-26 extremely low-weight individuals in either ever, a number of studies found that only scores and induced vomiting in the 1998 sample may be explained by the calorific vulnerable subjects (i.e. those with some sample. On the other hand, the narrative density of the traditional Fijian diet. The underlying eating disorder symptomatology data in this study suggest specific ways in lack of increase in bingeing between 1995 or body dissatisfaction) were affected which televised images have been instru- and 1998 merits further exploration. adversely by experimental media exposure mental in stimulating body dissatisfaction Next, the possibility that participants (e.g. Hamilton & Waller, 1993), whereas and a desire to lose weight. As Fijian in successive samples were not fully com- others found no clear impact of media expo- adolescents become increasingly aware that parable cannot be excluded. However, both sure upon indices of disordered eating (e.g. their traditional culture does not equip study populations were drawn from the Cusumano & Thompson, 1997). them to negotiate the novel conflicts posed same grade levels and schools and were With one exception (Richins, 1991), by rapid social change, television provides similar with respect to ethnicity, gender, these studies did not incorporate qualitative the illusion of a template for the successful age and BMI, suggesting a high degree of data; thus, subjects' experience of how media engagement in a Western lifestyle. comparability. We also cannot exclude the consumption may affect body image and Similarly, other studies of the effects possibility that the subjects who reported dissatisfaction or disordered eating is not of television on traditional societies have disordered eating symptoms in 1998 had well understood. Moreover, these studies documented ways in which local cultures experienced them even before television have uniformly examined media exposure incorporate ideas from this medium in exposure in 1995, although we believe this among populations already chronically creative ways, such as in gleaning strategies to be unlikely given that previously there exposed to media, making it difficult to for coping with changes associated with was an extremely low prevalence of eating discern the consequences of novel media modernisation (Varan, 1998) or negotiating disorders in Fiji. The sample sizes in this exposure on eating disorder symptoms. `hybrid identities' in the context of global- study also were unavoidably small because Finally, in contrast to the present study, isation (Barker, 1997). Finally, although of the limited population of ethnic Fijian these other studies have exclusively exam- television is not the only source of idealised adolescent girls attending these secondary ined media impact upon individuals rather images of Western beauty available to Fijian schools. than upon a peer environment. Thus, adolescents ± indeed, print media, movies, Finally, because of the homogeneity of although it is widely believed that media videos and advertising predate television in television viewing within the respective exposure may be an important socio- this area ± it is certainly the most accessible study populations and in contrast to cultural cultural factor contributing to the patho- and most widely consumed medium and the previous studies on media exposure and dis- genesis of eating disorders, previous studies only one introduced during the time frame ordered eating, this study demonstrates the investigating investigating its impact on disordered of this study. effect of a prolonged duration of television eating have been inconclusive. exposure on a peer environment rather than a dose effect of television exposure on Study limitations individuals. None the less, narrative data Social change and Several potential considerations arise in suggest that the effects of television expo- eating disturbances interpreting these data. First, clinical diag- sure indeed may be diffused among the peer A growing literature documents the emer- noses were not sought in this study and group. That is, respondents not only made gence of disordered eating in the setting disordered eating attitudes and behaviours explicit references to how television influ- of cultural transition and globalising cannot necessarily be equated with the enced them, but also to how peer opinion political political and economic forces (Lee, 1998). presence of an eating disorder. Neverthe- of what was admirable in television charac- For instance, intergenerational conflict less, both high EAT-26 scores and induced ters affected them. Indeed, we believe that arising within cultural transition appears vomiting are potentially worrisome clinical the effects of television exposure on adoles- to be associated with eating disturbances signs that often are associated with an eating cent individuals' body and self-image may (Furnham & Husain, 1999). Moreover, disorder. Although the interpretation of a be mediated through the peer environment specific cultural forces, such as exposure symptom such as induced vomiting should by influences on community-wide aesthetic to Western media imagery, may promote be made cautiously in another cultural con- ideals and stimulation of consumerism. transformations transformations in body aesthetic ideals text, its association with body dissatisfaction (Craig et al, al, 1996) that stimulate eating in this study population parallels clinical disordered behaviour and encourage its presentations of disordered eating in Western Implications widespread use as an idiom of distress in settings. Second, not all indicators of dis- Generalisation about the impact of tele- the setting of tensions generated by social ordered eating increased in this study. The vision upon Fijians to other populations change (Katzman & Lee, 1997). absence of purging by induced vomiting or requires caution; indeed, there are several In the past several decades in Fiji, sub- diuretic or laxative abuse in the first sample factors that may render Fijian adolescents sistence agriculture lifeways that prevailed is consistent with the previously extremely especially vulnerable to developing dis- for centuries have yielded to a cash economy, low prevalence of bulimia nervosa among ordered eating in response to television and an increased participation in the global ethnic Fijians; apparently, television expo- exposure. First, there is a pronounced dis- economy has brought a rise in consumerism sure had no effect in stimulating either parity between the narrow range of body and increasing opportunities for and laxative or diuretic abuse among subjects shapes portrayed on television and those pressures to engage in wage-earning among in this study population, possibly due to of ethnic Fijians in a setting in which youth. Thus, television is potentially only lack of spending money to purchase over- traditional culture supports a keen one of several social factors contributing the-counter preparations. The absence of attentiveness for appetite and weight 51 2 T E L E V I S I ON E X P O S U R E A N D E AT IN I N G B E H AV I OU R IIN N F IJIAN GIRL S change. This may engender sensitivity the schools' participation. The authors thank Kesaia know, we can't do what Xena can do... when among Fijian adolescents to the routine Navara and Sr Joana Rokomatu for their facilitation Xena started, from there I started to change Fijian commentary about weight. Second, and assistance with data collection. This study was my,I lose weight. (s-50) supported by: the Irene Pollin Fellowship in Memory television actresses' slender bodies are...Ireally want myselfto be belike like [Xena]. And also, of Cherry Adler; Harvard Medical School; a consistently paired with icons of prestige Dupont ^Warren Fellowship from the Harvard IIlike like the look of her body, the shape of her body. that are appealing yet relatively in- Sometimes I really want myself to be like her, Consolidated Department of Psychiatry; and the accessible to Fijians (e.g. expensive cloth- but then at home they keep on telling me that I Harvard Eating Disorders Center. will never be like her. (s-62) ing and careers), thus associating thinness with glamour. Finally, ethnographic data... the actresses and all those girls, especially suggest that there may be little awareness APPENDIX those European girls,Ijust like,Ijust admire them and I want to be like them. I want their body, I that television images are contrived and Excerpts of narrative want their size. I want myself to be [in] the same heavily edited. Further qualitative research data indicating admiration for position as they are....Because Fijians are, most is warranted on television's impact on of us Fijians are, many of us, most,I can say most, and a desire to emulate television adolescents in other settings to compare we are brought up with those heavy foods, and characters' body shape and size vulnerabilities to media exposure and our bodies are, we are getting fat. And now, we enhance understanding of how media `When I look at the characters on TV, the way are feeling, we feel that it is bad to have this huge they act on TV and I just look at the body, the body. We have to have those thin, slim bodies imagery mediates the risk of disordered figure of that body, so I say,``look at them, they [onTV].' (s-64) eating. are thin and they all have this figure'', so I myself On the other hand, the recent intro- want to become like that, to become thin. (s-22) duction of broadcast television into a Excerpts of narrative... I think all those actors and actresses that relatively media-naõ media-naõveÈve traditional society data indicating how television they show on TV, they have a good figure and with an extremely low prevalence of eating so I, I would like to be like them... since the characters are perceived as role disorders has allowed a naturalistic experi- characters [on Beverly Hills 90210] are slimbuilt, models for entering a job ment evaluating the impact of Western tele- [my friends] come and tell me that they would `... sometimes we can see [teenagers] on TV... vision exposure on disordered eating also like to look like that. So they, they change and they are very slim. They are the same ages, attitudes and behaviours. The addition of their mood, their hairstyles, so that they can be but they are working, they are slim and they are like those characters... so in order to be like qualitative data to a conventional survey very tall and they are cute, nice; so from there them, I have to work on myself, exercising and design provides an essential context for my eating habits should change. (s-46) we want ourselves or we want our bodies to understanding the potential mechanisms become like that. So we try to maintain our... when they see that some of the characters weight, try to lose a lot of weight to become that connect television exposure to symp- are, are very fit in their body and then try to be more like them. (s-24) toms in this population. The dramatic like that, they try to be like that character. (s-30) increase in disordered eating attitudes and... they look good on the television, how they... it's good to watch [TV] because... it's act and also how their body looks like when they behaviours in this peer environment follow- encouraged me that what I'm doing is right;... do some jobs, they are free to move around ing prolonged television exposure exposure represents when I see the sexy ladies on the television, well, and do their jobs... I try to look at them and an extraordinary cultural shift, given the I want to be like them, too. (s-20) change the way, my way, of dressing and also the previously enduring strong cultural ways of looking fit and look to lose weight. (s-44) [TV] usually affects me because I see some of sanctioning of robust appetites and body the, some of the girls, when I see their bodies, size among Fijians. I like Shortland Street [an Australian drama] how they have been built, their weight. I see because of the many young adults involved with The identification of specific Western them, it affects me 'cause, ah, I usually want to it... I want to be like that, I want to imitate cultural values and media imagery associ- become that weight.... Because people them ^ the way they live, the type of food they ated with changing aesthetic ideals and body nowadays watching TV, they copy some of the eat... it itgives gives me ideas of how to solve problems things that [are] there. That's why they are dissatisfaction in Fiji provides novel support when being in this world. (s-64) changing so much. (s-7) for specific culturally based contributions to [TV] teaches me what I should do, and what I the aetiology of disordered eating. More- [TV viewing] affects me because sometimes I feel fat... (s-34) should not do.' (s-26) over, it affords a unique window on the cultural mediation of disordered eating in... most of the time when I watch TV... when I Westernised, industrialised societies and look at [the actresses] they... look... thin, Excerpts of narrative and they do most of the things I can't do, so I just data indicating perceived may suggest preventive strategies in a variety want to lose my weight again. (s-44) intergenerational conflict of social contexts. Further research is required to understand how Western media... I just want to be slim because [the television stimulated by exposure to television characters] are slim. Like it's influencing me so imagery and television viewing may act `... the rules that have been made by the village, much that I have to be slim. (s-45) as catalysts for other social and mental they are not following it, [because] they are health problems among youth in developing I want to be like [Cindy Crawford]... I want to copying Western culture. (s-24) be like that, very tall, [I] want to be taller and societies and elsewhere.... the way of talking to adults has changed; thinner... [TV] always affects me that... I always say how thin I want to become... I before they used to be polite, but now some wanted to become that thin, but I always tried of the Fijian children, they are tending to be to become that thin. (s-48) impolite. (s-46) ACKNOWLEDGEMENTS I like Xena [a female television character] a little Culture in Fiji normally accepts women here as The authors wish to acknowledge the Fijian Ministry bit... 'cause she's just slim and she's... fit, too big, heavy. In the TV, the women are thin... of Education for their assistance in arranging for... before when I was a lot bigger and fat, you (s-58) 513 BECKER E T AL... my parents tell me to eat more, but I don't want to gain more weight. (s-15) CLINICAL IMPLICATIONS... [my family will tell me to eat more], but I will not,I do not wantto eat a lot of food to gain again & Cultural context appears to be relevant to the development of disordered eating some of the weight that I have lost. (s-23) attitudes and behaviours. My mom wants me to look like her, like growing fat like that, but I don't want that.' (s-50) & Western media imagery may have a profoundly negative impact upon body image and disordered eating attitudes and behaviours, even in traditional societies in which REFERENCES eating disorders have been thought to be rare. American Psychiatric Association (1994) Diagnostic & Social change can rapidly alter mental illness idioms. and Statistical Manual of Mental Disorders (4th edn) (DSM ^ IV), p. 540.Washington, DC: APA. LIMITATIONS Barker, C. 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