Differential pathways to disordered eating for immigrant and native adolescents in Taiwan

Plain English summaryThis study fills the gap in the literature on disparities in disordered eating and factors associated with disordered eating among immigrant adolescents in Taiwan. To our knowledge, this is the first study focusing on disordered eating among immigrant adolescents in Taiwan. The unique contribution of this research is to elucidate the different pathways leading to disordered eating for native and immigrant adolescents. In native adolescents, weight-teasing by family members but not by friends was indirectly related to disordered eating through psychological distress. In adolescents with an immigrant background, weight-teasing by friends was indirectly associated with disordering eating through psychological distress. Additionally, weight overestimation is a unique risk factor directly and indirectly through psychological distress related to disordered eating for immigrant adolescents. As a highly Westernized country, the Taiwanese's mainstream ideal body shape is "thinness." Substantial social discrimination against obese adolescents regarding peer acceptance and sexual attraction may put immigrant adolescents at an increased risk of experiencing body dissatisfaction, psychological stress, and eating disorder symptoms due to their minority status, struggling to adapt to a social environment different from their parents, and wanting peer acceptance. The study urges the need for school-based prevention programs to improve immigrant students' mental health. BackgroundFew studies have investigated disparities in disordered eating between new immigrant and native adolescents in Taiwan. This study examines the differential pathways to disordered eating in these two populations.MethodsThis cross-sectional study analyzed data collected from March to June 2019. In total, 729 adolescents aged between 13 and 16 years recruited from 37 classes in 3 middle schools in New Taipei City were included in the final analysis. Standardized assessment tools measured disordered eating (EAT-26) and psychological distress (BSRS-5). Generalized structural equation modeling was used to conduct the path analysis.ResultsThe prevalence of disordered eating was significantly higher in immigrant adolescents than in their native counterparts. Multipath models indicated that weight-teasing driven by overweight and obese status and weight overestimation could lead to disordered eating through psychological distress; however, the pathways differed for the two groups studied. Family weigh-teasing indirectly leads to disordered eating through psychological distress for native adolescents; by contrast, for immigrant adolescents, friend weigh-teasing indirectly leads to disordered eating through psychological distress. Additionally, weight overestimation directly leads to disordered eating and indirectly through psychological distress to disordered eating for immigrant adolescents.ConclusionThis study offers a plausible explanation of the differences in the paths to disordered eating between immigrant and native adolescents in Taiwan, which was not reported previously. The study urges the need for school-based prevention programs to improve immigrant students' mental health.