Opinion: Obesity is commonly believed to be primarily associated with a person's individual characteristics.
Evidence: Apart from personal traits, weight can be affected by cultural factors such as collectivism or individualism, as well as self-discipline and adaptability.
Researchers of the HSE Laboratory for Comparative Social Research (LCSR), jointly with colleagues from research centres in Germany, Australia and China, examined the relationship between national variations in obesity rates and cultural dimensions. The associations they found were tested empirically through analyses conducted across 51 countries worldwide. Individualism appears to be associated with a higher prevalence of obesity, but only in the male population. Furthermore, the study examined, for the first time ever, the relationship between obesity and variables such as flexibility (being able to adjust to different situations and embrace change) and self-stability/monumentalism (feeling good about oneself and being unwilling to change). The study confirms that flexibility, which is more prevalent in Confucian cultures such as Japan and China, contributes to maintaining a healthy weight. The study findings have been published in Social Science & Medicine.
Numerous studies have addressed the issue of obesity globally. Over the past half century since 1975, the global prevalence of obesity has almost tripled and now affects 650 million people (13% of the world's population) according to the study authors Plamen Akaliyski, Mikhael Minkov, Jianghong Li, Michael Harris Bond, and Stefan Gehrig.
The researchers explain that the obesity pandemic is often attributed to the unprecedented economic growth experienced by several countries over the past few decades and to trade liberalisation, which have led to an increase in the consumption of widely advertised and affordable products such as fast food and sweets, resulting in obesity and related health issues such as diabetes, cardiovascular diseases, and premature mortality.
However, economic growth alone does not fully account for the prevalence of obesity. For instance, much like Western states, East Asian countries are experiencing economic growth, but the prevalence of obesity there is low: 4.3% in Japan, 4.7% in South Korea, and 6.1% in Singapore (according to WHO). In contrast, the impact of obesity is particularly severe in the less economically developed countries of Latin America and the Middle East, affecting 35% of adults in Jordan, 32% in Egypt, and 29% in Mexico.
Contemporary research aims to comprehend the relationship between culture and obesity across countries. However, according to the study authors, the present body of literature regarding sociocultural contributors to obesity relies, with some rare exceptions, on data from a limited number of countries or comparisons made between different ethnic groups within a single country, primarily the United States.
Additionally, the authors highlight the absence in the available literature of a theoretical framework that would connect culture and obesity. 'Current efforts towards theoretical reasoning primarily rely on the notion that the United States, with its high obesity level, and Japan, with its low obesity level, represent opposite ends of the collectivism vs individualism spectrum. Therefore, data from these two countries is believed to confirm the impact of individualism vs collectivism on the prevalence of obesity,' the researchers comment.
Nonetheless, the presumption that East Asian countries are the most collectivist is not corroborated by recent empirical evidence, say the study authors. This is particularly true of Japan, where the level of individualism is approximately equivalent to that of the United States.
To address the current gaps in knowledge, the authors conducted their own research, which provides comprehensive theoretical explanations concerning certain aspects of the impact of individualism, collectivism, and economic development levels on obesity rates across countries. For instance, individualism is linked to personal choice, which can be exercised in favour of overeating or, alternatively, in support of a healthy lifestyle and maintaining a lean physique. Individualism is also associated with the rejection of weight stigma and with the practice of hedonism, which may involve indulging in tasty but not necessarily healthy foods.
In collectivist cultures, people are expected to follow traditions rather than scientific or medical advice. Some extreme examples include the fattening tradition in certain parts of Nigeria where adolescent girls, after reaching puberty, are restricted to 'fattening rooms' and made to consume large amounts of fatty foods for a period ranging from six months to two years.
The level of economic prosperity can also have an ambivalent effect on the risk of obesity. Individuals in more prosperous countries do not need to demonstrate their wealth through a well-nourished physique, as is customary in certain cultures where excess weight can be regarded as a sign of social status.
Apart from individualism and collectivism, the researchers explore the cultural dichotomy of flexibility vs monumentalism. Flexibility is a cultural trait that emphases humility, self-control, restraint of desires, and self-improvement. People in such cultures tend to have lower self-esteem, which encourages them to work harder on enhancing their image. A survey of weight perceptions conducted in 22 countries grouped into five geographical regions found that despite a low prevalence of obesity in East Asia, respondents in Japan were more likely than residents of any other country in the survey sample to perceive themselves as overweight and in need of losing weight.
The authors note that although women in East Asia are known to have the slimmest physique in the world, they are more likely than others to be dissatisfied with their bodies. At the same time, East Asian countries are heavily influenced by Confucian traditions that promote moderation in all aspects of life and uphold the value of a flexible and lean body.
In contrast, individuals in monumentalist cultures typically have a more optimistic self-image and embrace the philosophy of 'feeling good about oneself', rather than attempting to imitate others who are more knowledgeable or successful. As a result, they may not even be aware of being overweight.
The authors used national statistics and international survey data to study the relationship between culture and obesity across countries. Their final sample includes 51 countries representing a total population of more than five billion people (about 65% of the world's population). The sample comprises countries from all geographical regions across the globe.
To prevent any potential distortions, an additional analysis was conducted, with the results verified using expanded data from 155 countries for which reliable national statistics are available.
The authors utilised a revised Hofstede model to test the association between cultural dimensions and the prevalence of obesity. Hofstede's cultural dimensions theory is a framework that makes it possible to explore the impact of a society's culture on the values of its members.
Individualism was found to be associated with a higher obesity prevalence. During the initial stage of the analysis, this held true for both men and women at the national level. However, after adjusting for undernourishment in certain countries, the impact of individualism was deemed insignificant for women. 'We did not find a net effect of individualism on the prevalence of obesity in women after controlling for potential confounding variables,' the researchers explain. Thus, it appears that individualism is a significant predictor of obesity in men, a result that aligns with prior research.
The authors attribute the gender difference in findings to the unequal impact of culture on men and women. Women are more likely to strive for certain standards of physical appearance, such as body weight. Scientific evidence also suggests that women are typically less satisfied with their physical appearance and invest more energy into managing their weight.
As for the flexibility vs monumentalism dichotomy, flexibility was found to be a strong negative predictor of obesity in both genders. These observations confirm that cultural tendencies towards self-control, self-discipline, and personal development may assist in the prevention of obesity.
The authors report unexpected findings for some countries. For example, the prevalence of obesity among women in Egypt and Turkey was significantly higher than anticipated. Possible reasons, according to the researchers, may include lower rates of employment among women in these countries, greater cultural acceptance of excess weight gain, and barriers to women's participation in physical activity in public places.
First, certain findings—in particular, the finding that individualism is not associated with higher obesity prevalence in women—challenge prior research and may thus encourage further discussion on the subject. 'Our conclusions support a more cautious assessment of the individualistic culture, which is usually portrayed as detrimental to health,' say the authors. In reality, individualism can both protect against obesity and contribute to its development.
Moreover, this is the first time that the association between the cultural dimension of flexibility vs monumentalism and obesity has been examined. The findings provide an insight into why, for instance, citizens of Japan, where individualism is prevalent, maintain a slimmer physique than those residing in many Western countries.
The study authors suggest that their results could help in designing obesity prevention programmes which consider the cultural dimension.
IQ.HSE thanks Boris Sokolov, Senior Research Fellow, Head of LCSR, for his kind help in preparing the text.
Plamen Akaliyski, Associate Researcher, HSE Ronald F. Inglehart Laboratory for Comparative Social Research
Mikhael Minkov, Academic Supervisor, HSE Ronald F. Inglehart Laboratory for Comparative Social Research
Jianghong Li, WZB Berlin Social Science Centre, Germany; Curtin University, Australia
Michael Harris Bond, Hong Kong Polytechnic University, Hong Kong SAR, China
Stefan Gehrig, independent researcher, Berlin, Germany