Eating disorder science confronts its Eurocentric blind spots across cultures

Eating disorder research and treatment have long been built on a narrow foundation, and a new editorial in Frontiers in Psychiatry argues that the consequences are now impossible to ignore. Jennifer Jordan of the University of Otago and Health New Zealand – Canterbury, Gloria Fraser of Te Herenga Waka – Victoria University of Wellington, and Eva M. Trujillo Chi Vacuán of Comenzar de Nuevo A.C. and Tecnológico de Monterrey write that the dominance of Eurocentric, White, cisgender, heterosexual perspectives has produced limited diversity in research and treatment trials. Compared with majority populations, minoritised groups often experience disparities in eating disorder recognition, access to treatment, and treatment retention. The editorial introduces a special research topic that gathers studies from across the Middle East, Australasia, Latin America, the USA, Italy and China, all asking the same uncomfortable question: do the models and measures that dominate the field actually apply elsewhere?

The editors are careful about what the existing evidence does and does not show. Culturally adapted interventions appear to improve outcomes for psychiatric conditions other than eating disorders when compared with non-adapted interventions, but for eating disorders specifically, the applicability of Eurocentric models for Indigenous and ethnic minoritised cultures across the world cannot be assumed without evidence. They also point to recently highlighted iatrogenic treatment harms in eating disorder treatment as relevant to this gap. Culturally responsive adaptations, they argue, may be important to reduce the risk of perpetuating long-established inequities and potential harms for minoritised groups and for cultures outside dominant Eurocentric eating disorder paradigms. Such adaptations need to align with the cultural values, knowledge and healing traditions of culturally diverse groups, as well as with the lived experience of diverse subcultures within Eurocentric societies.

The special topic invited papers addressing the potential mismatch of Eurocentric assessment, prevention and treatment models for minoritised groups and across different cultures. The thirteen included papers span diverse geographical, cultural and minoritised populations: four from the Middle East, three from Australasia, two from Latin America, two from the USA, one from Italy and one from China. That spread is itself part of the argument, because the historical framing of eating disorders as predominantly Western conditions is increasingly difficult to sustain. The editors note that increasing recognition and reported prevalences of body dissatisfaction and eating disorder symptoms across diverse regions challenge that framing, although important regional evidence gaps remain.

Several papers tackle the question of whether existing measures and models travel well. Acle extended the skin tone trauma model to propose a potential pathway linking colourism to eating disorder risk among Black, Indigenous, and other People of Colour. Mancilla-Díaz and colleagues conducted a systematic review on the influence of beauty ideals for Indigenous communities in Latin America and found what they describe as a complex cultural negotiation between traditional and Western body ideals, noting corresponding limitations of current body image assessment tools. In other words, the instruments used to detect body image distress may themselves carry cultural assumptions that fail to capture how appearance concerns are experienced in communities negotiating multiple, competing ideals.

Three papers examined aspects of body image in Middle Eastern samples. Alwulaii and colleagues examined social beauty norms, body image and self-esteem among men and women in Saudi Arabia, identifying gendered differences in how appearance norms were experienced. Taha and colleagues reported that a substantial proportion of Jordanian medical students screened positive for elevated eating disorder risk, with higher Eating Attitudes Test (EAT-26) scores among women and associations between body mass index and both eating attitudes and body-shape concerns. Given rapid socioeconomic change and greater exposure to Western thin ideals in the Gulf region, Melisse and colleagues conducted a psychometric evaluation of the Body Uneasiness Test in clinical and community samples across Gulf Cooperation Council countries, providing preliminary support for its use in the region while identifying areas requiring further validation.

Biological research also features, with a cautionary lesson about interpretation. Wang and colleagues identified some gut microbiota differences between Chinese women with anorexia nervosa and healthy controls, but found no robust associations with clinical features. The editors present this study as underscoring the value of diverse samples, the need for cautious interpretation and the need for further research. Findings generated in predominantly Western cohorts cannot simply be assumed to replicate elsewhere, and even well-designed studies in new populations may yield results that require replication before firm conclusions can be drawn.

Two papers explored eating disorder risk and related psychosocial processes among transgender and gender-diverse people. Bonato and colleagues examined relationships among beauty standards, eating concerns, resilience and dehumanisation, finding context-dependent associations involving several resilience factors. Ker and colleagues reported elevated eating disorder risk among trans people in a national cross-sectional survey in New Zealand, particularly among younger participants and those who were Māori, neurodivergent, experiencing functional impairment, and/or experiencing material hardship.

Prevention and treatment studies in the collection illustrate different points on what the editors call a cultural continuum. Ciao and colleagues described outcomes of Body Justice, a co-designed universal eating disorder prevention programme for early adolescents in the Pacific Northwest United States. The programme, which incorporated culturally tailored content and media representation, was well liked by students with marginalised identities, although preliminary evidence suggested outcomes varied across identity subgroups. Trujillo Chi Vacuán and colleagues presented the protocol for the first pilot randomised controlled trial of the culturally adapted Body Image Program in Mexico, designed primarily to assess feasibility and acceptability and to inform a definitive trial. As a protocol, it describes planned methods rather than demonstrated efficacy, and the editors present it as an early step in building an evidence base rather than a completed one.

On the treatment side, Clark and colleagues noted that the mismatch between holistic Māori views of wellbeing and Western eating disorder models may insufficiently address cultural and spiritual dimensions, creating a gap in culturally responsive care for Māori in New Zealand. They propose integrating specialist supportive clinical management with Rongoā Māori, traditional Māori healing, to provide a holistic, culturally grounded approach addressing the whole person within their cultural context. El Khazen and colleagues described the rationale and implementation of culturally adapted cognitive behaviour therapy enhanced (CBT-E) within the first specialised eating disorder programme in the United Arab Emirates, established in 2017, with adaptations addressing linguistic, sociocultural and religious considerations including Ramadan fasting, modesty norms and family involvement. Thomas and colleagues explored Christian religion and spirituality among people with lived experience of eating disorders in Australia and New Zealand, finding that religion and spirituality could be sources of struggle as well as support across illness and recovery.

The editorial closes with a distinction that its authors clearly consider crucial. Most of the papers in the special topic drew on Eurocentric assessments, preventative interventions or treatments, but with attention to cultural or community context, which the editors describe as an established approach to cross-cultural research and care. However, they warn, adapted interventions should not be conflated with those grounded in diverse worldviews. Cultural adaptation represents one important approach but does not in itself address the need for interventions developed from diverse cultural knowledges and ways of being. To help characterise and position different approaches, the editorial presents a cultural responsiveness framework distinguishing culturally sensitive application of evidence-based models, adapted evidence-based measures or strategies, and culturally developed treatments that emerge from within the values and worldviews of a specific culture or subgroup. The editors call for continued efforts to amplify diverse voices globally by identifying and addressing the structural barriers that limit research and publication from under-represented regions and subgroups affected by body dissatisfaction and eating disorders, arguing that expanding the evidence base is necessary to realise the health and wellbeing aspirations of underserved groups.

Subject of Research: Cultural adaptation and cross-cultural applicability of eating disorder and body image interventions

Article Title: Editorial: Expanding the evidence base: the cultural continuum of interventions for eating disorders and related body image difficulties

Article References: Jordan, J., Fraser, G., & Trujillo-Chi Vacuán, E. M. (2026). Editorial: Expanding the evidence base: the cultural continuum of interventions for eating disorders and related body image difficulties. Frontiers in Psychiatry, 17, 1980904. https://doi.org/10.3389/fpsyt.2026.1980904

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1980904

Keywords: eating disorders, body image, cultural adaptation, Eurocentric models, health equity, prevention, treatment, transgender health, Indigenous health, psychiatry, Editorial, Expanding