Life as a South Asian immigrant with an eating disorder

It’s a gloomy Sunday afternoon as we walk into a Caribou coffee shop in Al Garhoud, Dubai. Apart from the occasional whirring of the A/C, the place is quiet. We quickly find a table in the corner; I order an iced latte while she gets a cookie and cream shake.

Mekha* briefly picks up her cup and looks at it. 

“You know, right now, as I’m drinking this, I’m thinking: should I go throw up? And I tell myself, no, ingest it. I’m trying not to think like that, but it’s just happening.” 

Over the past three years, Mekha has gone days without eating. If she eats out, there’s a high chance she will throw her meal up before leaving the restaurant or later when she gets home. Things kicked off, as they do, with her mother’s focus on her weight – and her insults about it. 

Now, it only takes one comment for her to purge. 

“I don’t usually care about what other people say, but it comes from her,” she says. “And my habits spiral once again.” 

Battling the unknown

Mekha’s mother has known about her eating disorder (ED) for months now, but she doesn’t know how serious it is. 

Being brought up in an Indian family of conventionally attractive and petite people, Mekha thinks her mother is pressured to carry on this burden of beauty and supposed perfection by keeping her husband and kids healthy. And for her, that means being thin.

The first time Mekha threw up was unintentional.

“I remember that day so well. I was home alone – this was in June 2020, sometime after my 18th birthday. I ordered two burgers for dinner. They tasted bad, so I went and threw them up. That’s when I first induced throwing up. When my parents came home, my mum asked me what I had eaten, and when I told her I ordered burgers, she told me I’d get fat eating junk food.” 

But all Mekha could think about was that she wouldn’t.

“That’s when it hit me; wait, I can do this with all my meals. That’s how it started. It took me a while to understand that what I was doing was bad, maybe two, three months into it, but it was too late.”

Whenever Mekha tries to talk to her mom about her ED, her mom takes it personally. So Mekha resorts to lying about her eating habits or how she feels because it’s the easier way out of confrontation. Even though her mother understands what bulimia is, now, she still doesn’t seem to accept it’s a real issue. 

“I’m 53 kilos now, and my best friend tells me my ribs are visible through my clothes. When I stand in front of the mirror, I don’t see someone thin – I see someone fat.”

This is a common scenario for many South Asian (SA) immigrants who suffer from body image issues and EDs. 

A study from January 2022, published in the Asian American Journal of Psychology, was conducted to identify the culturally specific barriers to seeking ED treatment among SA American women. It found that mental health concerns are rarely discussed within families, which has led to a “culture of silence”. The research involved 54 subjects over the age of 18 who were recruited via flyers and email listings from a large public southeastern university. The participants were then divided into groups, and semi-structured interviews were conducted.

“Mental health stigma is pervasive, and many SAs [especially younger generations] are fearful that they won’t be believed if they confide in family members or friends; health providers are not trained in culturally sensitive assessment and treatment for EDs, and the list goes on,” says Neha Goel, a mental health researcher at Virginia Commonwealth University, Richmond, Virginia, and co-author of the study, via email. 

Neha, who grew up an Indian immigrant in America, says that attitudes surrounding mental health and body image issues in SA communities, combined with SAs being a historically underrepresented group in clinical literature, inspired her to pursue research into this topic. 

‘‘I wanted to see myself in the research I conduct, and I think this is an important disparity that needs to be addressed,” she wrote. “I also think there is much silence, confusion, and shame surrounding eating and body image within our communities, so I wanted to give women a platform to speak about what is important for them.’’

My body, their choice

It’s normal in the SA community to comment on someone’s physical appearance. Uncles and aunties, as we call them, friends of friends or extended relatives that maybe saw you as a baby, think it their responsibility to point out that you look “fatter” or “thinner” than when they last saw you. Yes, you might have been in a cradle then, but it’s still a necessary topic of conversation to them many years later.

Jesna*, a 20-year-old design student born who was brought up in the UAE, knows what those unsolicited comments feel like too well. Growing up, she’s consistently been told she was a huge baby. It hurts worse when your parents bear the brunt of your apparent fatness because strangers think it’s all right to counsel them about how much their child should be fed. 

“There have been instances where people at church have come up to my mom to tell her that I look fatter than before,” she says. “I always feel like a letdown. The one thing I can’t control is my body, which people judge me for. It hurts me that my parents get shamed like this in public.”

Much stress and anxiety surrounding food – and later, body image issues – have come from these comments. At her lowest, Jesna had tendencies to starve herself. In 2018, she first lost weight by channelling her passion for dancing to help her overcome her insecurities. And even after working to feel better about herself, the comments and scrutiny don’t stop.

‘‘That’s when I realized: do people’s comments even matter? But the stress of school and everything else made me go back to food.’’

“I hate the control food has on me.”

Even though she feels she’s doing better, there are instances where she binges to distract herself. It’s not something she can always discuss with her mum because she too doesn’t see mental health issues for how serious they can be. 

“It’s always ‘you don’t do this; this is unhealthy; please focus on important things in life’. It’s not about my mental health. And we also talk about something concerning food daily. It’s always we ate too much today, or we need to lose weight.”

The immigrant experience, family, and food 

According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD) in the US, EDs affect at least nine per cent of the population worldwide. Statistics on BIPOC (Black, Indigenous and People Of Colour) with EDs state that they are half as likely to be diagnosed or receive treatment at the right time. 

Sara* is a 19-year-old resident of Switzerland, of Indian descent, who fell into disordered eating and later anorexia after losing her appetite due to an appendectomy in 2019. Her past struggles with diet culture and exposure to social media depictions of thinness manifested into body image issues and extreme fear of carbs and, later, any form of food.

‘‘At some point, I was only eating one yoghurt a day.’’

“Before my appendicitis, I’d like to think I had a normal relationship with food. But I feel it was always skewed because of the whole Tumblr ‘skinny girl’ and having a thigh gap. I was never skinny and always compared myself to the other girls. It wasn’t super-intense, but I might have been predisposed and vulnerable to developing such tendencies.”

Although body positivity and healthier representations of bodies are becoming more visible in the media, studies suggest that women think about their bodies more than before. While social media may not directly cause eating disorders and body dissatisfaction, pre-existing mental health conditions can be exacerbated. 

Eating disorders in men

National EDs Association in America statistics indicate that one in three people who suffer from an ED are male, despite the stereotype that EDs mainly affect women. 

Around four years ago, Shaun* started restricting himself and sometimes even skipping his meals entirely. He didn’t start with a normal relationship with food, either. 

“It was pretty much the all-or-nothing mindset. And I’ve been overweight since a young age,” he says. “Constant bullying and mocking from peers and my family triggered me into these restrictive habits, but I think it got worse after seeing my progress from a week of abstaining from my meals.”

He talks about being perpetually short on energy, with blackout episodes. During one, he was taken to the hospital to be put on IV fluids. When he finally told his parents what had been going on, he was met with reprimands.

“They didn’t want to take me to therapy because they didn’t believe what I was saying,” he said. “And they thought prayers and the like would help.”

Risk factors for men and women differ when it comes to EDs, and there is a shortage of research on South Asian populations, particularly immigrants and those living in their own countries. So far, only one research paper that investigated body image and ED concerns among SA immigrant men. It was conducted in 2017 and examined the effects of immigration and media influence on body image among Pakistani men in the UAE. 

Farheen Hasan, a research associate at the Centre of Appearance Research at the University of the West of England, who came across this paper during her research, shared this detail with me during our interview and confirms that men are drastically underrepresented in the research. 

‘‘There’s a significant amount of research on EDs among men in the West, but it’s still limited for SA immigrants and anything concerning our cultural factors that predispose us are different.’’

Due to cultural bias, men tend not to seek treatment, and the factors for being undiagnosed vary culturally. “There is relatively little research on mental health prevalence and outcomes amongst SAs broadly, and EDs/body image more specifically,’’ adds Neha. ‘‘It’s also much less for men and other groups.” 

The road to recovery is not linear 

The prevalence of EDs among minority communities is no different from that in the West, says Farheen. 

“There is enough data that there are tendencies to develop EDs in SA, and we’ve seen specific concerns among countries in SA. But there isn’t enough research on the risk factors in our populations, and so far, there haven’t been active interventions.”

Farheen further adds that apart from mental health support being expensive and out-of-reach, SA immigrants also struggle to find the right therapist who can understand and accommodate their specific needs. 

But in this community, stigma is the most significant underlying factor of resistance to asking for help.

For M and Jesna, treatment is nowhere in sight. They are aware of their conditions and the difficulty it imposes, but the first step to seeking therapy, which requires talking to their parents, proves a significant barrier.

‘‘I don’t know what will make me happy because I am so afraid of gaining weight,’’ M tells me. ‘‘So, I try to distract myself by spending a lot of money on makeup or something else that will let me focus beyond food.’’

Jesna, who previously had an unhelpful experience with a psychologist, is trying to help herself.

‘‘I’d watched a video about anorexia a while back, and it shook me. I decided that day I wouldn’t let things get bad, but sometimes I fall back into old habits.’’

Shaun is on the path to healing too, and although some residual thoughts affect him, occasionally, he’s learning to walk away – and how to embrace himself wholly. 

Sara, who has been in therapy for over a year, says that guidance and support are helping reshape her relationship with food.

‘‘If I want a doughnut now, I have a doughnut,” she says. “My therapist tells me this is the first step to food freedom- giving my body what it’s been deprived of for so long.’’

*Names have been changed due to the sensitive nature of the topic. Interviews for this piece were conducted between December 2021 and March 2022. The story was completed in April 2022. 

Livehealthymag.com is for every body and mind in the UAE. This magazine is all about moderation, making small changes, little additions and the odd subtraction.

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