Explaining Underweight BMI and Body Dissatisfaction among Young Korean Women

Spring 2011 Conant Prize in General Education

Flip open any mainstream fashion magazine, and the discrepancy with real life is striking: Rail-thin models stare out from the pages, a marked contrast from the obesity epidemic that is sweeping through modern society. These glossy images obscure the reality that obesity rates have doubled worldwide since 1980 — indeed, in 2008, the World Health Organization reported that nearly 25% of the global population was “overweight.” The trend toward unhealthily high body weight has become a truly international phenomenon, rising consistently in developed and highly-developing countries on every continent. Amidst such overwhelming numbers, the anomaly of Korea is significant. According to a 2009 poll by the

Organization for Economic Cooperation and Development (OECD), among the thirty-four nations claiming OECD membership, South Korea has the lowest obesity rate: 3.5%, as opposed to the 34.3% rate attributed to the United States. At the same time, despite their comparatively low level, Korean rates of overweight have been slowly but steadily rising in recent years, reflecting the direction of global trends [Fig. 1].

In the context of this societal rise in overweight and obesity, the demographic of young women presents a distinct contrast. A 2010 study by Y.H. Khang and S.C. Yun revealed a definite rise in “underweight” BMI among young Korean women. Based on findings from four Korean National Health and Nutrition Examination Surveys, which encompassed data from 22,995 men and women aged 20 and over, Khang et al. noted a statistically significant rise in underweight rates among women aged 20–39, from 8.2% in 1998 to 13.2% in 2007 [Fig. 2]. Even considered within Korea’s generally low rates of obesity and overweight, the direction of this trend toward underweight uniquely among the demographic of women aged 20–39 is an important finding that demands greater study. Given trends toward greater obesity, both internationally and within Korean society, what factor(s) contribute to this rise in underweight?

In this paper, I examine recent cross-cultural research and sociocultural theories in order to offer potential explanations for the increase of underweight among young Korean women. After contextualizing Korea’s generally low BMI in the country’s

unique “nutrition transition,” I present the findings of several cross-cultural studies that reveal high levels of body dissatisfaction among Korean women. I then attempt to explain these research findings through multiple sociocultural lenses, considering how the influence of media portrayal, Westernization, gender ideals, and norms of collective identity may contribute to female body image and subsequently low BMI. My paper concludes by recognizing limitations of existing research, suggesting important areas for further inquiry.

South Korea’s overall low BMI may be partially explained by the active societal emphasis on a “traditional” Korean diet. Following the country’s increasing globalization after the Korean War, particularly following the influx of international influences surrounding the 1988 Seoul Olympics, there was growing concern that Western eating patterns would infiltrate Korean dietary norms. In response, concerted efforts by government initiatives, public education campaigns, nutrition specialists, and private organizations emphasized the important value of traditional Korean cuisine, typically low in fat and high in vegetables. Today, Korean society has one of the highest per capita vegetable intakes throughout Asia. Accordingly, a 2002 study by Lee et al. writes that “the most noticeable feature of the South Korean nutrition transition is that the dietary shift has not been linked with a level of fat intake commensurate with its income level.” The overall healthfulness of typical Korean

nutrition, despite increasing Western influence on global dietary patterns, is certainly a contributing factor in the country’s comparatively low BMI.

While these nutrition norms must be considered as one influence on young women’s below-average BMI, the trend toward increased underweight among women 20–39 remains a particularity that demands greater exploration. One significant, potentially explanatory correlation is found in the high levels of body dissatisfaction among Korean women. According to a 2006 International Health and Behaviors Study of 18,512 university students across 22 countries, the dieting rate of Korean women was the highest rate of males or females in any country — 77% of Korean women reported dieting, as compared to overall rates of 51% of women and 25% of men. In a similar way, a 2010 study by Kim et al. identifies a trend toward high levels of body dissatisfaction among Korean female undergraduates. In their survey of 532 university women across four Korean provinces, Kim et al. found that 64.1% of women overestimated their own weight. Although the study encompassed women from a range of BMIs (from “severely underweight” to “obese”), Kim et al. found that the overestimation group consisted of only “normal weight” and “underweight” women, revealing an association between lower BMI and weight overestimation. This study also showed a correlation between weight overestimation and low self-esteem, body dissatisfaction, and dieting behaviors.

The work of Kim et al, which establishes a positive association between normal/underweight Korean women, weight overestimation, and body dissatisfaction, requires cross-cultural contextualization in order to determine the uniqueness of the Korean case. In the last few years, multiple studies by Jung et al. compare Korean and American women, using survey data to show the particularly high occurrence of body dissatisfaction among young Korean women. In a comparative study of 139 Korean and 102 American college women by Jung et al., survey data revealed that Korean women demonstrated consistently higher levels of body dissatisfaction, particularly as measured by discrepancy between reported and ideal body weight. A similar study by Jung et al. in 2006, surveying 201 Korean and 205 American undergraduate women, revealed that Korean women were comparatively more critical of their own appearances, although American women unexpectedly displayed slightly greater weight dissatisfaction (perhaps linked to the confounding factor of participants’ average weight, which was generally higher and presumably less satisfactory for Americans). A 2009 study by Jung et al. also suggests that body dissatisfaction is established at an early stage: In a survey of 12- to 15-year-old adolescents from Korea (272 girls and 276 boys) and the United States (251 girls and 220 boys), Korean girls demonstrated the strongest level of body dissatisfaction of any gender-nationality combination. These studies consistently support the presence of particularly high rates of body

dissatisfaction among Korean women — attitudes that seem to be instilled from a relatively early age.

When considered in tandem with these studies, the increase in Korean women’s rate of underweight BMI correlates with especially heightened rates of body dissatisfaction among the young female Korean demographic. Establishing causal explanations for this trend, however, is more challenging. While a significant tradition of scholarship has focused on female body image and disordered eating in Western society, this research has only begun to be extended to women’s body attitudes in other cultures. Over the past decade, the specificities of the Korean case have begun to be examined in an attempt to determine the role of gender and culture in the unique Korean context. Unpacking possible factors requires a consideration of Western influence on Korean media, changing representation of gender ideals, and the role of cultural norms surrounding “collective” rather than “individual” identity.

The impact of media norms on female self-perception has been repeatedly demonstrated in existent scholarship. In the Korean case, this factor is specifically shaped by the influence of Western standards of beauty. In conjunction with Korea’s growing globalization in recent decades, Western physical norms have exerted an increasing impact on the physical self-perception of Korean women — as evidenced by the booming culture of plastic surgery that has swept South Korea. According

to TIME Asia in 2002, at least 10% of Korean adults have received surgical enhancement. Common procedures range from muu-dari, a surgery molding the shape of calf muscles, to the incredibly widespread blepharoplasty, the “double eyelid” surgery that aims to make eyes appear larger and more rounded. These procedures produce more stereotypically Western (Caucasian) features that have become prized by Koreans for their aesthetic beauty. Added to the prevalence of incredibly thin women celebrated in mainstream Korean pop culture, such as the incredibly well-known girl bands of the K-Pop musical genre [Fig. 3], this emphasis on Westernized form and figure is one potentially formative factor contributing to high rates of body dissatisfaction that may be linked to Korean women’s rise in underweight status.

At the same time, recent gendered shifts in Korean society offer another potent explanation for the trend in female body image. In the past thirty years, Korean society has undergone significant political and economic transformations, democratizing and industrializing at an incredible pace — and offering an extreme expansion of societal opportunities for women. Specifically since the 1980s, Korean women have seen an important increase in university attendance; today, 72% of South Korean women attend college, the highest rate of any country. According to feminist theory, this recent upsurge in female societal empowerment may be associated with an oppressive backlash in media portrayals of gender ideals. As

explained in the work of Jaehee Jung and Gordon Forbes, historical data suggest that societal shifts toward gender equality are often accompanied by increased media portrayal of unrealistic gender norms as a reactive “tool of oppression” by mainstream society. Jung and Forbes cite the examples of both Europe and the United States: In the 1870s, it was during Europe’s industrialization and nascent women’s movement that accounts of anorexia nervosa first appeared, and the thinnest women in American fashion magazines appeared at the same time as momentum built for women’s rights in the 1920s and the 1970s. According to these scholars, the case of Korea is particularly striking due to the restrictive patriarchal nature of the country’s traditional Confucian culture, in which women’s familial and societal subordination is rigidly emphasized. Linking media portrayals to South Korea’s recent expansion of overall female opportunities, this feminist argument offers another potential explanation for the rise in body dissatisfaction and low BMI among Korean women in recent years.

In tandem with media portrayal of gender ideals — shaped by both Western influence and backlash to female societal empowerment — Korea’s central culture of collective identity is a final factor that potentially affects the body awareness of Korean women. While American culture emphasizes the importance of individual identity, Korean culture is significantly tied to expectations of group solidarity and communal norms. As Jung

et al. summarize in their 2006 study of Korean and American body image, Korea’s “collectivist” mindset divides society into “ingroup” and “outgroup” factions. Cultural influences, such as the increasing relevance of Western beauty standards, shape the formation and delineation of these groups, exerting powerful social pressures that are without parallel in individualist societies. This discrepancy in societal mindset offers another potentially compelling explanation for the heightened impact of media portrayals of gender in Korea. By communicating communal norms for female body shape and size, media representations exert an even greater influence on young Korean women by establishing group pressure for adherence to a certain body type, potentially producing the high rates of body dissatisfaction that seem to accompany the rise in young women’s underweight BMI.

While recent research has made great strides toward understanding the unique cultural and gender norms impacting body weight and self-image among Korean women, existent studies are limited in number and comprehensive content. A greater focus on cross-cultural studies should be furthered in order to effectively isolate which variables are uniquely active in shaping Korean ideas of body image and female ideals. At the same time, standards of comparative measurement must be chosen with utmost care. Use of WHO-defined BMI as a foundational standard of analysis may be

problematic for interethnic analysis: In their 2005 study on Japanese and Korean students, for example, Sakamaki et al. use BMI measurements from the Japan Society for the Study of Obesity, explaining concerns that WHO classifications are based on Caucasian norms and may not be immediately accurate when applied to interethnic groups. While more recent scholarship is moving to address these limitations by explicitly “controlling for body size,” greater standardization of measurement should be established to effectively compare cross-cultural data. This is true not only for physical measurements but also survey form. As Jung et al. recognize, accurate measurements of self-perception and body attitudes may require different survey formats for different cultural groups, making effective comparison a challenging task.

The potential presence of confounding or other relevant interactive factors should also be more thoroughly examined. The influences of socioeconomic status, rural vs. urban context, and education level have been inadequately examined in the Korean case. Lack of analysis into educational impact is a particularly major omission because the majority of existent research relies upon survey groups taken from university students, representing a significant selection bias. This is especially relevant in the Korean context: According to the OECD, “[Korean] women with poor education are 5 times more likely than more educated women to be overweight,” while no comparably significant disparity exists for Korean men [Fig. 4].

Future scholarship on women’s body image and BMI trends should focus on more rigorous multivariate analysis in an attempt to distinguish the relative impact of these additional contextual factors. Finally, as evidenced by my own research, current scholarship on the Korean case is dominated by the interest of a few scholars; a greater diversity of research backgrounds in this topic would provide a valuable range of perspectives.

In addressing the rise of underweight BMI among young Korean women, more comprehensive scholarship is the first important step in guiding effective policy recommendations. Studies that offer potential explanations are necessarily challenged by the multifaceted nature of body self-assessment and the difficulty determining the tangible impact of media-induced gender norms. Establishing concrete causal mechanisms between high body dissatisfaction and rising rates of underweight may be virtually impossible; however, the strong correlation between these trends in modern Korean society strongly suggest a relationship that warrants further investigation. Although South Korea’s unique nutrition transition has positively contributed to overall low rates of societal obesity, the rise of underweight BMI among young women is a potentially troubling development associated with its own negative health consequences. Unpacking the influences — both individual and interactive — of media portrayals, Western aesthetic standards, gender ideals, and collective pressures is

critical to identifying relevant societal factors that shape Korean women’s self-perception and dietary behaviors. Further cross-cultural research and multivariate analysis are also crucial to furthering this effort. While young Korean women may celebrate their lack of obesity, their trend toward the other weight extreme is a development that deserves greater attention if the unrealistic norms of media representation are to be healthily countered.

Works Cited

  1. Cullen, Lisa Takeuchi. “Changing Faces.” TIME Asia. 5 August 2002. Accessed 28 April 2011. <http://www.time.com/time/ asia/covers/1101020805/story.html>.
  2. “Global Database on Body Mass Index: BMI Classification.” World Health Organization. 5 February 2011. Accessed 1 May 2011. <http://apps.who.int/bmi/index.jsp?introPage=intro_3. html>.
  3. Jung, Jaehee, and Gordon Forbes. “Body Dissatisfaction and Disordered Eating Among College Women in China, South Korea, and the United States: Contrasting Predictions from Sociocultural and Feminist Theories.” Psychology of Women Quarterly 31 (2007): 381–393.
  4. Jung, Jaehee, and Gordon Forbes. “Multidimensional Assessment of Body Dissatisfaction and Disordered Eating in Korean and US College Women: A Comparative Study.” Sex Roles 55 (2006): 39–50.
  5. Jung, Jaehee, Gordon Forbes, and Yoon-jung Lee. “Body Dissatisfaction and Disordered Eating Among Early Adolescents From Korea and the US.” Sex Roles 61 (2009): 42–54.
  6. Jung, Jaehee, and Seung-Hee Lee. “Cross-Cultural Comparisons of Appearance Self-Schema, Body Image, Self-Esteem, and Dieting Behavior Between Korean and U.S. Women.” Family and Consumer Sciences Research Journal 34.4 (June 2006): 350–365.
  7. Khang, Y.H. and S.C. Yun. “Trends in general and abdominal obesity among Korean adults: findings from 1998, 2001, 2005, and 2007.” J Korean Med Sci 25.11 (2010): 1582–8.
  8. Kim, M. and H. Lee. “Overestimation of own body weights in female university students: associations with lifestyles, weight control behaviors and depression.” Nutrition Research and Practice 4.6 (December 2010): 499–506.
  9. Lee, Min-June, Barry M Popkin and Soowon Kim. “The unique aspects of the nutrition transition in South Korea: the retention of healthful elements in their traditional diet.” Public Health Nutrition 5 (2002): 197–203.
  10. “Obesity and the Economics of Prevention: Fit not Fat - Korea Key Facts.” Organization for Economic Cooperation and Development. Accessed 28 April 2011. <http://www.oecd.org/ document/20/0,3746,en_2649_33715_46038740_1_1_1_1,00.html>.
  11. “Obesity and Overweight.” World Health Organization. Fact Sheet No. 311. March 2011. Accessed 28 April 2011. <http:// www.who.int/mediacentre/factsheets/fs311/en/index.html>.
  12. “S. Korea’s Obesity Rate Lowest in OECD.” The Korea Times. 12 April 2009. Accessed 27 May 2011. <http://www.koreatimes. co.kr/www/news/nation/2009/05/113_42993.html>.
  13. Sakamaki, R., R. Amamoto, Y. Mochida, N. Shinfuku, and K. Toyama. “A comparative study of food habits and body shape perception of university students in Japan and Korea.” Nutrition Journal 31.4 (2005).
  14. Wang, Youfa, Carlos Monteiro and Barry M Popkin. “Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China, and Russia.” American Journal of Clinical Nutrition, 75.6 (June 2002): 971–977.
  15. “Wonder Girls break into Billboard Hot 100.” Yeinjee’s Asian Journal. 24 October 2009. Accessed 28 April 2011. <http://yeinjee.com/2009/wonder-girls-break-into-billboard-hot-100/>.

Endnotes

  1. “Obesity and Overweight.” World Health Organization. Fact Sheet No. 311. March 2011. Accessed 28 April 2011. <http://www.who.int/mediacentre/factsheets/fs311/en/index.html>.
  2. “Global Database on Body Mass Index: BMI Classification.” World Health Organization. 5 February 2011. Accessed 1 May 2011. <http://apps.who.int/bmi/index.jsp?introPage=intro_3. html>.
  3. Note: Throughout this paper, BMI refers to the anthropometric measurement of body mass index, determined by the World Health Organization as BMI = weight (kg) / height2 (m2). Similarly, WHO definitions are referenced in my usage of the terms “obese” (BMI ≥ 30 kg/m2), “overweight” (BMI ≥ 25 kg/m2) “underweight” (BMI < 18.5 kg/m2).
  4. Wang, Youfa, Carlos Monteiro and Barry M Popkin. “Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China, and Russia.” American Journal of Clinical Nutrition, 75.6 (June 2002): 971–977.
  5. “S. Korea’s Obesity Rate Lowest in OECD.” The Korea Times. 12 April 2009. Accessed 27 May 2011. <http://www.koreatimes. co.kr/www/news/nation/2009/05/113_42993.html>.
  6. “Obesity and the Economics of Prevention: Fit not Fat - Korea Key Facts.” Organization for Economic Cooperation and Development. Accessed 28 April 2011. <http://www.oecd.org/ document/20/0,3746,en_2649_33715_46038740_1_1_1_1,00.html>.
  7. Khang, Y.H. and S.C. Yun. “Trends in general and abdominal obesity among Korean adults: findings from 1998, 2001, 2005, and 2007.” J Korean Med Sci 25.11 (2010): 1582–8.
  8. Lee, Min-June, Barry M Popkin and Soowon Kim. “The unique aspects of the nutrition transition in South Korea: the retention of healthful elements in their traditional diet.” Public Health Nutrition 5 (2002): 200.
  9. Lee et al. “The unique aspects of the nutrition transition in South Korea.” 198.
  10. Lee et al. Ibid. 200.
  11. Kim, M. and H. Lee. “Overestimation of own body weights in female university students: associations with lifestyles, weight control behaviors and depression.” Nutrition Research and Practice 4.6 (December 2010): 499.
  12. Kim et al. “Overestimation of own body weights in female university students.”
  13. Jung, Jaehee, and Gordon Forbes. “Multidimensional Assessment of Body Dissatisfaction and Disordered Eating in Korean and US College Women: A Comparative Study.” Sex Roles 55 (2006): 39–50.
  14. Jung, Jaehee, and Seung-Hee Lee. “Cross-Cultural Comparisons of Appearance Self-Schema, Body Image, Self-Esteem, and Dieting Behavior Between Korean and U.S. Women.” Family and Consumer Sciences Research Journal 34.4 (June 2006): 350–365.
  15. Jung, Jaehee, Gordon Forbes, and Yoon-jung Lee. “Body Dissatisfaction and Disordered Eating Among Early Adolescents From Korea and the US.” Sex Roles 61 (2009): 42– 54.
  16. Jung, Jaehee, and Gordon Forbes. “Body Dissatisfaction and Disordered Eating Among College Women in China, South Korea, and the United States: Contrasting Prediction s from Sociocultural and Feminist Theories.” Psychology of Women Quarterly 31 (2007): 381.
  17. Jung et al. “Body Dissatisfaction and Disordered Eating Among College Women in China, South Korea, and the United States.” 381.
  18. Cullen, Lisa Takeuchi. “Changing Faces.” TIME Asia. 5 August 2002. Accessed 28 April 2011. <http://www.time.com/time/ asia/covers/1101020805/story.html>.
  19. Image source: “Wonder Girls break into Billboard Hot 100.” Yeinjee’s Asian Journal. 24 October 2009. Accessed 28 April 2011. <http://yeinjee.com/2009/wonder-girls-break-into-billboard-hot-100/>.
  20. Jung et al. “Body Dissatisfaction and Disordered Eating Among College Women in China, South Korea, and the United States.” 383.
  21. Jung et al. “Body Dissatisfaction and Disordered Eating Among College Women in China, South Korea, and the United States.” 383.
  22. Ibid. 382.
  23. Ibid.
  24. Ibid. 383.
  25. Jung et al. “Cross-Cultural Comparisons of Appearance Self-Schema, Body Image, Self-Esteem, and Dieting Behavior Between Korean and U.S. Women.” 353.
  26. Jung et al. “Cross-Cultural Comparisons of Appearance Self-Schema, Body Image, Self-Esteem, and Dieting Behavior Between Korean and U.S. Women.” 353.
  27. Sakamaki, R., R. Amamoto, Y. Mochida, N. Shinfuku, and K. Toyama. “A comparative study of food habits and body shape perception of university students in Japan and Korea.” Nutrition Journal 31.4 (2005).
  28. Jung et al. “Body Dissatisfaction and Disordered Eating Among Early Adolescents From Korea and the US.”
  29. Ibid.
  30. Of the studies cited in this paper, the majority exclusively examine university populations: Kim et al. 2010, Sakamaki et al. 2005, Jung et al. 2006 (“Cross-Cultural Comparisons”), Jung et al. 2006 (“Multidimensional Assessment”), and Jung et al. 2007.
  31. “Obesity and the Economics of Prevention: Fit not Fat - Korea Key Facts.” OECD.

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Established in the mid-1950s, the Conant Prize is “awarded annually … to students who, as part of their regularly assigned work in elementary General Education and Core Program courses in any of the natural sciences, submit the best essays on the subject of scientific interest.”

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