The skinny on eating disorders in Korea

South Korea is a country of tiny women and sometimes, even tinier men. The sight of anyone significantly overweight causes me to do a double take in the subway, and more often than not, it turns out to be a foreigner.

It’s a land of the “free size”, the one and only size available in most Korean-made clothing and probably for good reason: one size does generally fit all. I always thought that Koreans were just naturally small-framed, and to a large extent this is true; genetics combined with a (fairly) healthy lifestyle play a huge role, but what I didn’t realize is that the rates of eating disorders are high…and on the rise.

I guess I really shouldn’t be surprised, considering the tremendous value put on appearance here. Everywhere you turn, there’s a Korean looking in the mirror, glass (anything reflective!) at themselves; examining every bump and imperfection, adjusting their hair, make up, sometimes just unabashedly staring (and in the worst cases, popping their pimples…or even their boyfriends!). In Canada, I would be embarrassed to be caught catching a glimpse of myself while passing a mirror or taking a sultry self-portrait, but here, it’s entirely commonplace.

I’m not saying that appearance isn’t important; some Canadians could certainly take a little more pride in theirs (pajama pants in public…come on!), but when you have to send a photograph in with your resume to apply for a job, it’s not hard to see why Koreans might get hung up on their looks…and their weight.

Mirror, mirror on the wall…

As a result, plastic surgery is popular and widely accepted in Korea. I went with my Korean friend, (we’ll call her D), to get my hair done one Saturday afternoon, and was bombarded with advertisements for plastic surgery of all types as I flipped through a Korean magazine. When D started naming off all the different kinds of surgery that the Korean teachers at our academy had had done, I was exceptionally taken aback: double eyelid surgery, nose jobs, fat from the thigh injected into the forehead and cheeks (to make the face less flat), and even into the back of the head (to make the head rounder)!

Double eyelid surgery seems to be the big seller around here. If you’re wondering what the heck “double eyelids” are, they are the eyelids that non-Asian people have, i.e. not hooded eyelids (see the picture on the left). These surgeries are increasingly common: they’re often given as graduation gifts to girls from their parents after they finish high school.

The before and after pictures in the magazines suggested an interesting, if not disturbing, trend. To me, the before pictures looked very Korean, while the after pictures looked much more Caucasian, as if the person was only half Korean (see picture below). D told me that many Asian models and actresses who we in the West think of as being very beautiful, are seen in Korea as ugly, because they tend to have very “Asian” features, like sharp, defined cheekbones, small noses, and distinct almond-shaped eyes. I myself wouldn’t mind a nice delicate Asian nose, mine being a little above average in size, (maybe a slight understatement), but in Korea, I am often praised for having such a “high” nose, a term I much prefer to the usual ones I hear back home (usually more along the lines of “beakish”), although one little boy did tell me I looked like an elephant the other day (haha).

(*Check out this website for a look at the different types of plastic surgeries in Korea. Make sure not to miss the section titled "Reason why Asian nose is not beautiful"...absolutely disgusting. http://www.vipps-clinic.com/nose/content/c1_0101.php)

My friend D has been pressured many times by her mother to get a number of facial surgeries, but has resisted (rightly so; she’s a beautiful girl)! Not only that, but her mother has suggested she get injections to decrease the size of her fat cells, and even sent her to a “fat camp” when she returned from university in the U.S. to shed the extra pounds she had gained while living there.

These are not the only disturbing stories I’ve heard. A friend told me that a friend of her friend, a Korean girl, found it unbearable to live in Korea as an overweight person. She said that it was difficult to make friends; no one would speak to her, and that sometimes she was even ridiculed in public by strangers. She ended up moving to the United States, where she happily reported back that she finally felt accepted and had made friends.

The Westernization theory: popular but true?

A recent survey of more than 13,000 people worldwide found that Koreans are among the most weight-conscious in the world, with 28% weighing themselves weekly, the largest number next to Americans (1). It’s not alarming then, in a collectivist society where being overweight or obese is rare and where adhering to the norm is imperative, that eating disorder numbers are on the rise.

It was difficult for me to find actual statistics in English on disordered eating in Korea, but what is clear from the few journal articles that I’ve read, is that rates in Korea are now similar to those in the West (2).

The only journal article I found worth mentioning is a trans-cultural comparison of disordered eating in Korean women of various backgrounds: second-generation Korean Americans, Korean immigrants to the U.S., and native Koreans. The study was conducted to examine the theory that Westernization of South Korea is to blame for the increasing levels of eating disorders in Korean women, a position that is popular in recent research.

“According to Westernization, individuals in non-Western cultures are adversely affected by an introduction to Western beliefs and ideals, including the thin ideal. Eating disorders among Koreans may be caused by attempts to emulate the West as it is portrayed through media.” (2)

This particular study, however, disputed this hypothesis as it found that even though Korean Americans had the most exposure of the three groups to Western ideals and norms, they had the lowest rate of disordered eating when compared to women born in Korea (2).

Korea, j’accuse!

The authors of the article suggest that the blame may lie beyond Westernization, and may perhaps be more related to Korean culture than to Western culture.

Although only 0.2% of South Koreans list Confucianism as their religion, Confucian ideology is still largely influential on other religious practices (namely Buddhism and Christianity as the primary religions in South Korea) and on Korean culture as a whole (3). According to traditional Confucian gender roles, a woman serves her family by getting married into a prominent family. While matchmakers rate men primarily by occupation, women are rated mainly by looks, which leads parents to place great value on their daughter’s appearance, often over their abilities. This, coupled with the importance of self-restrictive behaviours in Confucianism, suggests a link between the ever-present Confucian ethical thought in Korean culture and eating disorders (2).

Regardless of the root causes, whether they be of Western or Asian origin, eating disorders in Koreans continue to climb, but hopefully with the right education and the appropriate prevention and treatment programs, the numbers will fall, and “free size” will no longer make the heavy girl feel imprisoned in her own country.

Sources

(1) Lee JY, Asia One Health. Koreans Among Most Weight-Conscious. http://www.asiaone.com/Health/News/Story/A1Story20100903-235376.html. Access date: September 23, 2010.

(2) Jackson SC, Keel PK and Lee HY. 2006. Trans-cultural Comparison of Disordered Eating in Korean Women. Int J Eat Disord 39: 498-502.

(3) Wikimedia Foundation Inc. 2010. Religion in South Korea. http://en.wikipedia.org/wiki/Religion_in_South_Korea. Access date: September 23, 2010.

Like white on rice

Another important staple in the Korean diet, as well as the diet of practically all of Asia, is rice. Every meal you order in Korea is served with some form of rice, be it rice cakes, a thick pasta-like version, coupled with spicy red sauce in dduk bok gi, sticky rice in the Korean version of sushi, gimbap (includes processed cheese slices and ham :S), or in makgeolli, a milky rice wine often drunk alongside greasy potato pancakes.

You have to hand it to the Koreans for being so creative with this one crop, but the question that I have is,

“Why white rice?”

With rice making up a reported 35% of food intake in East Asia, why not go for the original, and much more nutritious, brown rice (1)?

Stripping the rice down

Just to clarify, white rice is rice that is milled in order to remove the husk, the bran layer, and the germ from the original grain. Now, it is absolutely necessary to remove the husk in order to make the rice edible, but the removal of the other layers is purely a matter of taste. Unfortunately, removing these layers means removing most of the rice’s nutrients as well. On the left is a summary of what is lost (2).

I remember learning in a university nutrition class that milling, or polishing, rice began in the 1800s and was a sign of affluence. When this process became mainstream in Asia I’m not sure, but what is certain is that there were some serious problems that appeared, including, most notably, beriberi, a thiamine (vitamin B1) deficiency, which is removed during milling. What is interesting about this situation is that it is a very rare case of the poor having a better diet than the rich.

These days many developed countries enrich their rice, although regulations vary from country to country. How removing the nutrients and then putting them back makes any sense, I have no idea, but this is how it is done in many privileged countries. Although certain vitamins and minerals can be added back to the rice via enrichment, milling strips away the majority of the fiber, and this can have serious consequences for the health of a rice-eating nation (2).

The link to diabetes

One of the major problems, which has been fairly widely discussed in the scientific community as of late, is Type 2 diabetes. White rice has a higher glycemic index than brown rice does, which means it causes sugar levels in the blood to increase faster than brown rice does (3). (The fiber that is removed during the milling process helps slow the rush of sugar into the blood.) (2).
I read a CBC article a couple of months ago about how eating brown rice in lieu of white rice appears to prevent diabetes, and it prompted me to look into diabetes and metabolic syndrome, (a precursor to diabetes), rates in Korea, where so many people eat so much white rice.

It turns out that diabetes in Korea is common. The report, which was based on the 2001 Korean National Health and Nutrition Survey, looked at adults over the age of 20, and found that 7.6% had diabetes. If the results are age-adjusted, this means that a whopping 1.4 million Korean men and 1.3 million Korean women have diabetes, if not more. The study goes on to state that half of the diabetes cases in Korea remain undiagnosed. These figures include both Type 1 and Type 2 diabetes (4).

This statistic is comparable to a 6.0% diabetes rate in Canada (5) (and 7.7% in the U.S. (2)). For a nation that still manages to maintain a fairly consistent traditional diet, this is a large
figure…much too large. Maybe it’s just me, but I tend to associate diabetes (at least Type 2 diabetes, the preventable kind you develop later on in life), with people who have a poor diet, maybe don’t exercise too often…you know, the usual poor lifestyle choices. However, from what I’ve seen, it doesn’t appear that these habits are overly common in Korea, at least not to the extent that we see in the West.

I can’t help but think that this massive consumption of white rice in Korea must play at very least a minor role in the high rates of diabetes.

Ditching the white

The study in the CBC article found that replacing just one-third serving of white rice a day with brown rice could lower the risk of developing Type 2 diabetes by 16%...and that’s just a tiny portion of what Koreans are eating every day (6). Imagine what replacing every serving of white rice with brown rice could do!

The problem is changing people’s attitudes towards white rice. For many, brown rice is associated with backwardness and poverty, not to mention the fact that people have come to acquire a taste for white rice, myself included (7).

Having been raised on white rice, the switch to brown rice is a transition in progress for me. It’s not that the taste of brown rice is bad, but the grains are noticeably grittier than those of soft white rice, with an almost nutty flavor. The fiber superiority of brown rice is, however, almost immediately apparent…if you know what I mean.

In the end, changing the main component of a whole society’s diet is probably a bit ambitious for now, but on an individual level, it is fully achievable, and this shift from white to brown can make a difference to your health. Switch from white to what’s right (tonight)!

Sources

(1) Kiple KF and Kriemhild CO. The Cambridge World History of Food. http://www.cambridge.org/us/books/kiple/rice.htm. Access date: August 10, 2010.
(2) The President and Fellows of Harvard College. 2010. Can brown rice blunt an epidemic? http://www.hsph.harvard.edu/news/hphr/spring-2009/brown-rice.html. Access date: August 10, 2010.
(3) CBC. 2010. Brown rice better at preventing diabetes: study. http://www.cbc.ca/health/story/2010/06/14/brown-rice-diabetes.html. Access date: August 10, 2010.
(4) Kim SM et al. 2006. Prevalence of Diabetes and Impaired Fasting Glucose in Korea. Diabetes Care 29: 226-231.
(5) Diabetes, by age group and sex. 2010. Statistics Canada. http://www40.statcan.ca/l01/cst01/health53b-eng.htm. Access date: August 12, 2010.
(6) Sun Q et al. 2010. White Rice, Brown Rice, and Risk of Type 2 Diabetes in US Men and Women. Arch Intern Med 170 (11): 961-969.
(7) Javier EQ, Asia Rice Foundation. 2004. Let’s promote rice to combat hidden hunger. http://www.asiarice.org/sections/whatsnew/letspromote-Philippines.htm. Access date: August 17, 2010.