BY: Victoria Heath

Sitting on the dorm room floor, its cheap carpeting scratching my knees, I held a cold, aluminum trashcan in between my hands. I asked myself that weighted question, “How did I get here?” My personal lapse into the depths of an eating disorder was gradual, but that particular night sparked over four years of what Sheila M. Reindl coined the “paradox” of bulimia. She called it “both an expression of feelings and a defense against experiencing feelings.”

Unfortunately, my tale is not unique, and according to statistics from the National Association of Anorexia Nervosa and Associated Disorders, over 30 million people across all ages and genders have an eating disorder in the United States. That’s just a few million shy of Canada’s entire population.

Global statistics regarding eating disorders are hard to find, but using statistics from a 2004 World Health Organization report, as well as population statistics from the US Census Bureau, I estimated that in 2015, over 925 million women between 10-25 years old are at risk of, or have already developed, an eating disorder.

Like I said, my tale is not unique.

Fortunately, my recent steps into recovery have encouraged me to confront the root causes of my disorder, including the deep societal issues that contributed to it. Interestingly, this has allowed separate passions and interests of mine to intertwine. As an American expatriate who grew up in the Middle East, I not only have a profound sense of nostalgia for the region, but also a part-time obsession with studying the social changes occurring within its borders.

I realized that eating disorders have crept their way into Middle Eastern societies.

It’s widely assumed that eating disorders, namely bulimia and anorexia, are Western ills– a reaction to changing consumption behaviors and cultural pressures—otherwise known as a “culture bound syndrome.” Eating disorders, particularly anorexia and bulimia nervosa, increased dramatically in the United States, United Kingdom and other Western countries during the second half of the 20^th century due to socio-cultural and economic changes in the region. The rise of a consumer culture, fragmented family life, and changes in “female identity” are partly to blame. With this came increasing rates of obesity in the West, which developed a “weight stigma,” subsequently encouraging dietary regimens that bolstered an unhealthy obsession with weight, a mind-set linked closely to the development of eating disorders.

Recent studies have shown that these ills are becoming increasingly common in developing, non-Western countries, such as the Gulf countries of the Middle East.

While the United Arab Emirates (UAE) is known for its high-rise hotels and dazzling shopping malls that feature everything from Starbucks to indoor roller coasters, the country is increasingly struggling to balance being a modern, tourist destination and a traditional, (Gulf) Islamic-based society. Its profound economic and industrial growth over the past two-decades have introduced social changes at a rate unparalleled in other societies.

While the United Arab Emirates (UAE) is known for its high-rise hotels and dazzling shopping malls, its economic and industrial growth over the past two-decades have introduced social changes at a rate unparalleled in other societies.

Photo by: Sam Valadi

Unfortunately, this has led to increased reports of eating disorders among both men and women. As Dr. Fareeha Sadiq, a psychiatrist in Dubai said to The National in 2015, “pro-anorexia and pro-bulimia material on sites such as Instagram, Tumblr, blogs and Facebook has increased,” particularly among adolescent Emirati girls. Academic researchers within the country have also identified a growing trend in eating disorders among the female Emirati population, potentially caused by the “internalization of the thin ideal,” which can act as a trigger for certain people. Mirey Karavetian, an assistant professor of nutrition at Zayed University found that 30% of adolescent girls observed at a secondary school in Sharjah reported having an eating disorder. Karavetian told The National:

“I believe they might be expressing themselves through controlling their diet. You want to have control of something in your life. Also, here, it is a huge part of the culture to be married and part of that is to have a perfect body so they are chosen.”

The trend can be somewhat explained by the “Culture Change Syndrome” model developed by Richard A. Gordon in his book, Eating Disorders and Cultures in Transition, which claims that certain medical disorders, such as eating disorders, are connected to culture as a cause, trigger or envelope. Often this model is used to explain why immigrants from non-Western countries may develop an eating disorder (specifically anorexia and bulimia nervosa) after moving to the West. However, this model is relevant to the UAE because it has become a highly industrialized, affluent country experiencing immense social and cultural changes in the past few decades.

Let’s take a step back first, and address what causes eating disorders.

You may already be aware of the several common causes and risk factors to eating disorders. These include: 1) stress/anxiety, 2) family dynamics, 3) obsession with weight/dieting, 4) lack of self-confidence, and 5) desire for control/perfectionism. Traumatic life experiences can also lead to the development of eating disorders by inducing extreme stress, anxiety and/or a feeling of uncontrollable circumstances.

The reality is that simply being young and a female is a risk factor, and if your family has a history of eating disorders then you’re at a greater risk to develop it. (So, essentially, I was doomed from the start.) For young women, the cultural obsession (particularly in the West) to obtain the “thin ideal” and embody women in mass media is linked to the development of irregular eating patterns and attitudes towards food and body image, which may lead to eating disorders.

The UAE is now experiencing the “Culture Change Syndrome.”

Some of the trends that the West experienced within the second half of the 20^th century are now being experienced by the UAE.

By examining Dr. Gordon’s “common characteristics” outlined in the “Culture Change Syndrome,” it’s easy to see how the UAE is experiencing each one, and therefore may be increasingly dealing with higher rates of eating disorders.

1) Highly developed economies or rapid market changes:

The UAE has experienced rapid economic development due to the discovery of oil in the 1930s and its export that started in 1962. The country holds 10% of the world’s known oil reserves and had a GDP of $419 billion in 2014, making it one of the wealthiest nations in the region.

2) Global consumer culture and a subsequent emphasis on “slenderness:”

Within the Middle East, and particularly the Gulf region, the UAE is regarded as one of the most “liberal” states, relying heavily on tourism, foreign investment, migration and the arts. Consumerism within the UAE is reflected in per capita spending. According to the Abu Dhabi Department of Economic Development, Emirati nationals recorded the highest level of annual consumption spending, with 16% spent on food and drink. Per capita spending in the UAE is eight times higher than the average in the rest of the Arab world.

For women, the influx of Western goods, culture and fashion has impacted “female identity” and the internalization of the “thin-ideal.” It has generated a discussion in Emirati society that wasn’t necessary only a few decades ago—regarding the impact mass media and the “thin ideal” can have on women’s self-confidence and image.

For women, the influx of Western goods, culture and fashion has impacted “female identity” and the internalization of the “thin-ideal.”

3) Mass access to education and changing roles in public life, which often conflicts with traditional female gender roles, etc.:

In the UAE, education is free for nationals up to the graduate level, and over 95% of women apply for university education after secondary school. In fact, they are more likely to complete post-graduate studies than men. Due to the government’s Emiratization programs, women have also entered the workforce at the highest rates in history, representing approximately 59% of the national UAE labor force in many different fields, such as healthcare, engineering and government. These are immense changes in only a few short decades, and they often contradict the relatively conservative culture of the Emirates.

Women are feeling social pressure to achieve “perfection” in their professional and personal lives, particularly from family members. The National reported in a 2014 editorial, “Women in particular feel this pressure, expected as they are to not only succeed in education and excel in their career, but to marry early, marry well and raise perfect children.” As eating disorders are often related to feelings of control and anxiety, many women turn towards maintaining and controlling their weight and/or diet in order to deal with such stress.

4) Changing patterns of eating that are associated with obesity and Western style of diet/lifestyle:

High-calorie foods and beverages imported from the West have put obesity and diabetes among the biggest health concerns in the UAE. In 2013, obesity rates in the UAE were estimated to be twice that of the global rate, with over 60% of women reported to be overweight or obese. The UAE was also found to have a high rate of diabetes, with over 19% of the population reported diabetic. The rapid increase of urbanization and the design of cities have also impacted health, as many rely on automobiles for transportation and therefore are less likely to walk or run for exercise on a daily basis. For women nationals, social restrictions may also keep them from engaging in physical activity. A study examining physical activity among women in the UAE in 2007 found that, on average, 41% of Emirati women claimed to engage in modest to rigorous levels of physical activity. In, Saudi Arabia, the number was below 65%.

The road to recovery starts with admitting there is a problem.

Unsurprisingly, the UAE suffers from the same problems as Western countries in addressing eating disorders, particularly the negative effects of stigma. Many of my friends and family are still unaware that I’m a recovering bulimic because I’m terrified of what they’ll think, say or do. Like many other women who have suffered from eating disorders, I don’t want to be seen as a victim or a weaker person, and the guilt from lying to them and myself for years is enough punishment. I’m not sure I want to gamble with being a disappointment too.

In the UAE, Dr. Nadia Dabbagh told The National that she rarely sees female patients, even though they are at greater risk for developing eating disorders. Jared Alden, a psychotherapist in Dubai also told the newspaper that this is due in large part because of the stigma around mental health in general, not only within the country but also globally.

Although there is no specific national plan addressing the issues of eating disorders, the UAE Ministry of Health in 2010 did develop a new mental health care plan and has subsequently supported centres with facilities to treat patients with eating disorders. However, treatment at these centres is expensive and out of reach for some Emiratis.

Although this is a step in the right direction, there are deeper societal issues that also need to be addressed in order to combat the prevalence of eating disorders, another measure the West has also failed to take. As I continue my own personal recovery, I can’t help but ask myself that same question: “How did I get here?”

The same “thin ideals” I saw in magazines, on television, and social media are now finding their way across the Middle East and to countries such as the United Arab Emirates. These images, coupled with pressures to be not only physically perfect, but a perfect wife, daughter, sister and general member of society, create a ring of ideals that are impossible to achieve.

For just a moment, allow me to get on my virtual soapbox…

And plead with all societies, including the UAE, to relinquish the historical fixation on perfection, and the modern fixation on consumption. Surely, progress, innovation and growth do not have to bring with it unhealthy obsessions with physical ideals and models of beauty that straddle the boundaries between real and fantasy.

Surely no other young girls should find themselves as I did four years ago, sitting in my dorm room wishing I was anyone but myself.

When discussing this topic, I’m always reminded of the words written by one of the most idealized symbols of beauty in history, Marilyn Monroe. A woman who was both built up and torn down by the society that claimed to adore her.

I’m always reminded of the words written by one of the most idealized symbols of beauty in history, Marilyn Monroe.