00:00:00

Intro

00:05:00

What is the Fiji study?

00:06:35

Why was Fiji a good place to conduct this study?

00:09:00

What is the Eating Attitudes Test?

00:10:30

What did the study find?

00:16:30

What’s the take home message here?

00:00:00

Intro

Chris Sandel: Welcome to Episode 130 of Real Health Radio. You can find the links talked about as part of this episode at the show notes, which is www.seven-health.com/130.

Welcome to Real Health Radio, health advice that’s more than just about how you look. And here’s your host, Chris Sandel.

Hey, all. Welcome back to another episode of Real Health Radio. It’s been a while since I released a new episode, which wasn’t intentional. Life has been plotting against me and getting in the way of me putting out new episodes. I will save all the details for when I do a life update, but I can give you a bit of a mini update about what’s been keeping me busy.

Over the summer, we had a number of visitors over. First my brother and his girlfriend and their two kids came over; then a couple weeks later, my parents came over. We then went away with my parents. We went to Sitges in Spain. It’s about 40 or 50 minutes from Barcelona, along the same coastline, and it’s lovely. There was loads of nice food and we had lovely weather. Ramsay got to spend time at the beach. He’s definitely inherited my love of the water and sand and being on the beach. Holidays definitely aren’t the same as they used to be prior to having a child, but it was really nice to get away.

Over this time as well, Ali, my fiancée, had two more surgeries, which thankfully should be the end of things on the surgery front.

I also had a number of last-minute guest cancellations for the podcast, so there were episodes that were meant to go out, but then they got cancelled. These have been booked in for later dates, but it just meant that nothing got put out.

Then I was also signing up new clients and starting with new clients over this time, and it really does take a lot of time to do initial chats with people and then go through all the forms for us to get started.

All this is to say I’ve had a busy couple of months where my usual work times have been interrupted. Clients always take priority, but lately once I’d finished up with client work, and because of the increased parenting that needed to happen, there wasn’t much time left over. Hence the podcast going MIA. I’m hoping to get things back on track with the podcast. In the beginning it might be a bit less than weekly, but the goal is still to get back there, so that is the plan.

This week, it is a solo episode. It’s a little shorter than usual, but hopefully it’s still interesting and useful. What I’m going to be covering is a study that is typically referred to as the Fiji study. The actual study name is “Eating behaviour and attitudes to television among ethnic Fijian adolescent girls’. This is a study I’d heard referenced before on podcasts; it’s also talked about in different books. I’ve definitely heard Carolyn Costin talk about it, but there’s definitely others who’ve mentioned it.

So what I decided to do was go and read the full study, which was very interesting, so I decided to do this episode covering what happened as part of the study and what the results were.

I’ve actually done episodes like this before where I go through a study or multiple studies, so if you like this episode, then there’s some others I can suggest checking out. Episode 42 on the Minnesota Starvation Experiment. There’s Episodes 81 and 83 looking at how the environment affects our eating – although these episodes were based on the work of the Cornell Food and Brand Lab and Brian Wansink, and Wansink’s work has now come under question and lots of studies have now been retracted, so I honestly don’t know how much of that research to believe anymore. Episode 85 looks at the ACE study, which is the adverse childhood experiences study, so basically how childhood trauma affects physiology and behaviour. Episode 114 is on weight set point theory and the research surrounding how the body regulates its own weight. Episode 120 is on the replication crisis, so the failure in science for many studies to be replicated and what this means. And then there’s Episodes 102 and 127 looking at how dieting thoughts, known as cognitive dietary restraint, affect various systems within the body.

If you are new to the podcast, or even if you’ve been listening for a while but haven’t gone back through all the older episodes, those are some that are in a similar vein to this one, where I go through research and explain it, hopefully in an easy-to-understand way.

00:05:00

What is the Fiji study?

Let’s get started with the Fiji study. It’s a study that came out in 2002; it appeared in the British Journal of Psychiatry. The study actually included two waves, the first being in 1995 and the second was then in 1998, so three years apart. What the study wanted to look at was how television has an impact on eating behaviour and body image.

The reason why this is such a great study is that for most of the world, television in 1995 had been a constant for decades. We often talk about the impact of television and how this affects our beliefs or our perceptions, but because television has now been a constant throughout our lives, it’s hard to quantify how much of an impact this is having.

But for Fiji, this was different. It wasn’t until 1995 that TV made its way to Fiji. This isn’t technically true; prior to this, in the early 1990s, TV was temporarily introduced to broadcast the rugby and the cricket World Cup, but it wasn’t until June 1994 that the first permanent commercial broadcasting network was founded in Fiji. And for Nadroga, which is the area in which the study was completed, it wasn’t until 1995 that television was introduced.

When they did the first wave of the study in 1995, television had been introduced a couple of weeks prior to that first wave.

00:06:35

Why was Fiji a good place to conduct this study?

Another reason why Fiji is such a great place to do a study like this is because its values of beauty, at least back in 1995, were very different to that of Western culture. In the West, the thin ideal had been something that had been around for a long time. Even if we remove TV, every other piece of advertising and cultural norm really reiterates this belief.

Bu for Fiji, this was different. I’m going to quote the study here in their description. “Similar to other Polynesian groups, ethnic Fijian traditional aesthetics ideals reflect a preference for a robust body habitus. Thus, the prevailing pressure to be slim thought to be associated with dieting and disordered eating in many industrialised societies were distinctly absent in traditional Fiji. In addition, traditional Fijian values and practices encourage robust appetites and a widespread vigilance for and social response to appetite and weight loss. Individual efforts to reshape the body by dieting or exercise thus traditionally have been discouraged.”

I should add that prior to television, there was print media, there was movies, there was videos and advertising that included Western beauty ideals. But once television came in, it was the most accessible, the most widely consumed medium. So it did mark quite a shift, as we’ll see once we get into the results of the studies.

The participants in this study were all Fijian adolescent girls. They were enrolled into secondary schools in Nadroga during the respective time periods. In the first wave in 1995, there were 63 respondents who participated in the study, and in the second wave in 1998, three years after television had been introduced, 65 participants participated in the study.

I should add that the participants that were in Wave 1 were different to the ones that were in Wave 2, so this study wasn’t following the same individuals to see how their beliefs changed over time, but it did pick people from the same age group and the same schools to see how opinions and behaviours have changed over this time.

00:09:00

What is the Eating Attitudes Test?

As part of the study, the subjects in both waves completed an Eating Attitudes Test, known as the EAT 26. There’s 26 questions as part of it, and it includes questions concerning binging and purging behaviours. I’ll link in the show notes to the EAT 26 online, so if you’re interested you can have a look at the questions yourself.

But as an example, some of the questions were “I’m terrified about being overweight,” “I find myself preoccupied with food,” “I feel extremely guilty after I’ve eaten,” “I eat diet foods,” “I vomit after I’ve eaten.” That’s just an example of some of the questions. The questionnaire is then scored. An EAT 26 questionnaire with a score of 20 or above is considered to be high, and this indicates a high level of concern about dieting and body weight or problematic eating behaviours.

As I said, this survey was done in both waves, in 1995 and in 1998. In addition, in 1998, extra survey questions were asked about body image and dieting and possible disparities between the subjects’ and their parents’ views around eating and weight. They also did 30 longer form interviews with subjects from the 1998 group. So in this 1998 section, they had both the quantitative data as part of the EAT 26 and then the qualitative data as part of the interviews.

00:10:30

What did the study find?

What did the study find? In 1995, the percentage of subjects with a high EAT 26 score was 12.7%. By 1998, this had shot up to 29.2% – nearly tripling. But it does show that issues around food and body were already present. Sometimes this study is presented as if there was no eating or dieting issues in Fiji until television turned up, but this is clearly not the case considering that 12.7% of the 1995 group already were scoring high on the EAT 26. But back to the results.

In 1995, the percentage of subjects that reported self-induced vomiting to control their weight was 0%. By 1998, it was 11.3%. Television viewing in Fiji at the time of the study was actually done collectively, so even if you personally didn’t own a television, it was normal to go to someone else’s house and to watch it. It was done as part of the community or people doing it together.

But despite this, for respondents how lived in a household that did have a television, they were three times more likely to have an EAT 26 score greater than 20 than someone whose household didn’t own a television.

Subjects that felt that they should eat less were more likely to report self-induced vomiting. Interestingly with this one, it was not correlated with someone’s actual BMI, but rather how they perceived their weight. So it didn’t matter what they weighed; it matter what they thought of that weight.

In 1995, the researchers didn’t actually collect any data on dieting. Because of the strong cultural tradition against dieting, they felt that it was rare. It’s kind of frustrating that this is the case because, considering that 12.5% were already in the high range, I would imagine that even though traditionally dieting was rare, it was probably still happening. Or at least, it was happening in the teenage demographic who were used as part of this study.

But by 1998, when they did collect data, 69% of the surveyed population said that they had dieted to try to lose weight, and 74% of the surveyed population reported they felt too big or fat at least some of the time. This is a rather stark change in attitudes considering that the cultural norms had always supported a larger body size.

The interviews that were then done with 30 respondents in 1998 also garnered many insights. Of those interviewed, 83% responded that they felt television had influenced them and/or their friends to feel differently about or change their body, and 77% reported television had influenced their own body image.

They actually articulated that they wanted to reshape their body or lose weight to look more like Western television characters. Based on the responses, some of the shows they were watching were things like Beverly Hills 90210 and Xena: Warrior Princess. They also made reference to Cindy Crawford and ‘those European girls’ as an aesthetic to admire.

They also mentioned about the differences in opinions between them and their parents in terms of what was an appropriate weight and an appropriate amount of food to eat. For example, 31% of the study participants felt that their parents felt that they should eat more than what they themselves thought was appropriate.

To quote the study again: “Narrative data explicitly links changing attitudes about diet, weight loss and aesthetic ideals in the peer environment to Western media imagery. The impact of television appears profound given the longstanding cultural traditions that previously appeared protective against dieting, purging and body dissatisfaction.”

I should add that there are likely other changes that occurred between 1995 and 1998 that could account for some of these changes in how the subjects felt about their body or their behaviours. Television feels like it is the obvious reason, but we can’t rule out other things. What other social, cultural, economic, religious, or other factors were changing at the same time that television was introduced?

In the study, they actually make reference to this. Again, to quote: “In the past several decades in Fiji, subsistent agricultural life ways that prevailed for centuries have yielded to a cash economy, and an increased participation in the global economy has brought a rise in consumerism and increasing opportunities for and pressures to engage in wage earning among youth. Thus, television is potentially only one of several social factors contributing to the increased prevalence of the high EAT 26 scores and induced vomiting in the 1998 sample.”

Television may be the big thing that makes these changes, or maybe it’s just more broadly Fiji’s adoption for a more Western way of life and consumerism. My sense is it’s probably a combination of both, although television probably played a large supporting role as part of this.

So that’s the study and its findings.

00:16:30

What’s the take home message here?

What is the take-home message that I have for you based on this study? Disordered eating and eating disorders are multifactorial. Genetic factors definitely make some people more susceptible to getting a full-blown eating disorder while someone with different genetics maybe lingers in a place of on and off restriction and on and off dieting.

But one of the big factors that makes this restriction or this dieting or this purging more likely is the media landscape that we currently live in. We can rather naively feel that this doesn’t impact on us. We know that images are Photoshopped, that actors or actresses on TV aren’t the norm in terms of their body shape and size, that movies and television are contrived using shorthand stereotypes or tropes or motifs that don’t necessarily match up to the real world.

But even if we know this rationally, when this is all that we see, it’s hard for it not to affect our view of the world and how we perceive ourselves. We are such visual creatures; what we see does have an impact on our perception of what is normal or what is beautiful. The Fiji study demonstrated this perfectly. Even against a backdrop of preference for a bigger, more robust body, the Western thin ideal won out in the hearts and minds of those in the study.

While this has an impact on all of us, it is especially true for teenagers. It’s a time in our lives when we are struggling to find our identities. We are breaking away from what our parents believe and trying to determine what is true for us. We’re incredibly body-conscious and insecure, partly due to the huge changes that have occurred in our bodies and in our desires over a short number of years. At this stage, we’re both more vulnerable and more susceptible to having our beliefs shaped about what’s normal and what’s beautiful and what we should be working towards.

But I also think it’s a good reminder that what we take for granted as normal is cultural. What we often think of as universally attractive is rarely universal. It also shows how temporary and changeable this can be. With one set of input, we get one set of beliefs. With another set, you get something different.

I’ve talked about it before on podcasts, and I know it’s probably pretty common advice these days, but it really does help to diversify the images and the media you’re consuming. Instagram, when used correctly, can be an incredible force for good on this front, as there are so many different accounts showing so many different people and bodies and shapes and sizes that you can follow. Never before could you have this kind of diversity at your fingertips.

We can also look up from our phones and see the real people around us. I often suggest to clients to go to public pools or public gyms, and when they’re getting changed to look around – not in a creepy way, but to actually see other real bodies, because it’s so rare to see nudity or scantily clad bodies in real life. It ends up only being the bodies that we see in magazines and television or movies, and these tend to fall into a very narrow and largely unattainable band.

I know this can feel like a drop in the ocean, that we’re still swimming in a sea of shows and images that continue to prop up the thin ideal. But for the clients who have actually done this and made it a regular practice, it is amazing how their perception changed, and that’s perception about others, but importantly, about themselves.

That is it for this week’s show. I’m hoping to be back with another episode next week, but if not, I will catch you the week after. Either way, I look forward to being with you on another episode soon enough.

Thanks for listening to Real Health Radio. If you are interested in more details, you can find them at the Seven Health website. That’s www.seven-health.com.