Elsevier

Appetite

Volume 54, Issue 1, February 2010, Pages 5-15
Appetite

Research review
Body image and eating disorders amongst Japanese adolescents. A review of the literature

https://doi.org/10.1016/j.appet.2009.11.008Get rights and content

Abstract

This review describes the prevalence of eating disorders and disordered eating behaviors as well as factors influencing body image disturbance amongst Japanese adolescents and compares the prevalence and trends with those of Westernized countries. Although eating disorders have been previously regarded as peculiar to Western society, they are now a more global issue with reports of non-Western countries including Japan having increasing rates of eating disorders. As the aetiology of eating disorders is related to societal norms, culture and ethnicity, their study requires an understanding of body image disturbance within different cultural contexts. Although considered less prevalent than in the West, Japan has an early history of eating disorder research and trends outlined in this review suggest that, as in Western countries the interest in, and study of eating disorders in Japan has increased during the 1980s. The prevalence of eating disorders in Japan based on available reviews, epidemiological studies and clinical reports ranges from 0.025% to 0.2% for AN and from 1.9% to 2.9% for BN. Studies suggest that the prevalence of eating disorders has increased significantly during the past two decades but the prevalence is still quite low compared to those in Western countries. Strategies for culturally appropriate prevention are discussed.

Introduction

This review will describe the prevalence of body image and eating behaviors amongst Japanese adolescents with a particular focus on prevalence in Japan, public health problems related to body image disturbance and possible factors influencing body image disturbance amongst adolescents living in Japanese society.

Eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and eating disorders otherwise not specified (EDNOS) are major and serious health problems related to body image disturbance amongst adolescents (Thompson & Smolak, 2002). In Western countries, the rates of AN and BN amongst young females are reported to be 0.3% and 1%, respectively, in the general population (Howk & van Hoken, 2003).

Although eating disorders have been previously regarded as peculiar to Western society, they are now considered a more global issue with some researchers recently confirming that non-Western countries including Japan, China, Taiwan, Hong Kong, the Republic of Korea and Singapore (Keel & Klump, 2003) have increasing rates of eating disorders (Mellor et al., 2009). As the aetiology of eating disorders is strongly related to societal norms, culture and ethnicity (Keel & Klump, 2003), their study requires an understanding of the issues around body image disturbance within different cultural contexts.

In the current review, we systematically searched the major databases in all languages to try to identify all articles reporting any relevant Japanese studies. The databases included in our search included psychARTICLES, psychoINFO, EBM Reviews, Medline, Pre Medline, Psych Info, Current Contents, ERIC and Web of Knowledge.

In order to search the Japanese databases we used CiNii (National Institute of Informatics Scholarly and Academic Information Navigator) to search for Japanese journals. Keywords in our searches included eating disorders, body image, body dissatisfaction, Japan or Japanese, and adolescents or children.

Section snippets

Early reports of eating disorders from Japan

Very early reports of eating disorders were clearly described in Japan in the medical literature dating as far back as the late-1600s (Kagawa, cited in Nogami, 1997) and these are nicely summarized in a review by Nogami (1997).

In Nogami's review, Shutoku Kagawa (1683–1755) describes patients with a “psychic illness” who would not eat regular rice, but only small amounts of food such as chestnuts or tofu for several days, months, or sometimes for more than a year. Kagawa wrote that ‘they would

Research in the late 20th century

Although considered less in number then in the West, Japan does have a well documented history of eating disorder research dating back to the 1980s. Following the research trends of Western countries the interest in and study of eating disorders in Japan increased during the 1980s (Nogami, 1997) as shown in Table 1. The prevalence of eating disorders in Japan based on reviews, epidemiological studies and clinical reports is shown in Table 1 with the range of rates for eating disorders ranging

Factors associated with body image disturbance and eating related problems amongst Japanese adolescents

There has been some research looking more closely at body image differences between Japan and other countries and the various factors influencing body image and all studies related to the topic have been summarized in Table 6. Kowner (2002) investigated Japanese body image from a cultural perspective, focusing on body esteem. He found that the Japanese identified similar characteristics of body esteem as these cited by Americans, which mainly consisted of physical and sexual attractiveness (

Implications for school-based education and policy

Following the changes of lifestyles in Japan towards a more Westernized pattern, there has been an increased concern from government about underweight and obesity, and imbalanced nutrient intake. In 1997, the Health and Physical Education Council indicated that instruction related to eating habits should be dealt with as an important part of health education in order to enrich and sustain a fulfilling life (Ministry of Education Science Sports and Culture, 1999). This report also stated that,

References (76)

  • R.M. Bell

    Holy anorexia

    (1985)
  • L.H. Cummins et al.

    Eating disorders in Asian populations: A critique of current approaches to the study of culture, ethnicity, and eating disorders

    American Journal of Orthopsychiatry

    (2005)
  • A. Darby et al.

    Disordered eating behaviours and cognitions in young women with obesity: Relationship with psychological status

    International Journal of Obesity

    (2007)
  • H.K. Dohnt et al.

    Body image concerns in young girls: The role of peers and media prior to adolescence

    Journal of Youth and Adolescence

    (2006)
  • A.E. Field et al.

    Relation of peer and media influences to the development of purging behaviors among preadolescent and adolescent girls

    Archives of Pediatrics & Adolescent Medicine

    (1999)
  • S. Grogan

    Body image: Understanding body dissatisfaction in men, women, and children

    (2008)
  • F. Hayashi et al.

    Perceived body size and desire for thinness of young Japanese women: A population-based survey

    British Journal of Nutrition

    (2006)
  • H.W. Howk et al.

    Review of the prevalence and incidence of eating disorders

    International Journal of Eating Disorders

    (2003)
  • M. Inokuchi et al.

    Official Japanese reports significantly underestimate prevalence of overweight in school children: Inappropriate definition of standard weight and calculation of excess weight

    Annals of Human Biology

    (2009)
  • K. Kaneko et al.

    Weight and shape concerns and dieting behaviours among pre-adolescents and adolescents in Japan

    Psychiatry and Clinical Neurosciences

    (1999)
  • M. Kayano et al.

    Eating attitudes and body dissatisfaction in adolescents: Cross-cultural study

    Psychiatry and Clinical Neurosciences

    (2008)
  • P.K. Keel et al.

    Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology

    Psychological Bulletin

    (2003)
  • N. Kiriike et al.

    Are young women in Japan at high risk for eating disorders?: Decreased BMI in young females from 1960 to 1995

    Psychiatry and Clinical Neurosciences

    (1998)
  • R. Kowner

    Japanese body image: Structure and esteem scores in a cross-cultural perspective

    International Journal of Psychology

    (2002)
  • R. Kowner

    When ideals are too “fat off”: Physical self-ideal discrepancy and body dissatisfaction in Japan

    Genetic, Social, and General Psychology Monographs

    (2004)
  • H.L. Littleton et al.

    Negative body image and disordered eating behavior in children and adolescents: What places youth at risk and how can these problems be prevented?

    Clinical Child and Family Psychology Review

    (2003)
  • M. Makino et al.

    Factors associated with abnormal eating attitudes among female college students in Japan

    Archives of Women's Mental Health

    (2006)
  • Ministry of Health Labour and Welfare

    Annual Report of the National Nutrition Survey in 2002

    (2004)
  • Ministry of Health Labour and Welfare

    Interim Report on Health Family 21 Plan

    (2006)
  • Ministry of Health Labour and Welfare

    Annual Report of the National Nutrision Survey in 2007

    (2008)
  • T. Mukai

    Mothers, peers, and perceived pressure to diet among Japanese adolescent girls

    Journal of Research on Adolescence

    (1996)
  • T. Mukai et al.

    Eating attitudes among Japanese and American elementary schoolgirls

    Journal of Cross-Cultural Psychology

    (1996)
  • T. Mukai et al.

    Eating attitudes and weight preoccupation among female high-school students in Japan

    Journal of Child Psychology and Psychiatry and Allied Disciplines

    (1994)
  • T. Mukai et al.

    Body dissatisfaction, need for social approval, and eating disturbances among Japanese and American college women

    Sex Roles

    (1998)
  • M. Murata

    Secular trends in growth and changes in eating patterns of Japanese children

    American Journal of Clinical Nutrition

    (2000)
  • T. Nagai

    The psychology of fear of people—an analysis of the distress in human relations

    (1994)
  • M. Nagai et al.

    The primary prevention program for eating disorders among high school girls

    Japanese Journal of School Health

    (2007)
  • K. Nakamura

    Eating attitudes in elementary school and junior high school students: Comparison between Gunma and Osaka

    Japanese Society of Psychosomatic Medicine

    (2008)
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