Correlates and Determinants of Body Image in Korea and Taiwan

Correlates and Determinants of Body Image in Korea and Taiwan

Sang-Wook Kim

(Prof. of Sociology, Director of Survey Research Center, Sungkyunkwan Univ., Korea)

Paper Prepared for the JGSS Symposium

Osaka Univ. of Commerce Osaka, Japan

June 10, 2012

My Own Works Lately

(1) ‘Risk Factor’ Analysis (Korean data) – Published in Survey Research (2011)

(2) “Subjective & Objective Measures of Body Shape: The Compatibility Issue Revisited in Korea”—Osaka, May 2011

(3) “Factors Leading to the Desired Body Weight in Korea and Japan”—Taipei, Nov. 2011 (4) “Correlates and Determinants of Body Image in Korea and Japan”—Osaka, June 2012 (5) --- (Xian, Nov. 2012)

(6) ---

 The Problem

✔ Research Interests in Body Shape and Image -- Epidemiology

-- Medical (body) sociology -- Health management sciences

✔ Why Study Body Shape and Image?

(1) Societal: Overweight and obesity continue to be more and more serious public health problems and concerns in most countries (Eastern, as well as Western, countries)

-- U.S.: One-quarter of adults are classified as obese (BMI ≥ 30), and 50 to 60%

are classified as either overweight or obese (BMI ≥ 25) (Flegal et al., 2002) -- OECD survey (2006-8) indicates that obesity rate (BMI ≥ 30) is highest in the

U.S. (34.3%), followed by Mexico (30%), --, New Zealand (25%), --, Switzerland (7.7%), Japan (3.9%), and Korea (3.5%)

-- What really matters, however, is the speed of increment, especially among the younger generation

☞ “Obesity Crisis” (Brownell, Battle, & Horgen, 2003) // “Global Epidemic”

(WHO, 1998) // “toxic environment” (Brownell and Horgen, 2003)

(2) Psychosocial (Stigmatization): Prejudice, bias, discrimination (interpersonal &

institutional), unpleasant interpersonal treatment (harassment/teasing, treated w/ disrespect, treated as if one has a character flaw), life dissatisfaction,

retreatment from social life, social withdrawal, social exclusion or rejection, maladjustment and strained relationships in family and society, negative stereotypes, “obtrusive” social life, impaired quality of life

(3) Psychological: Depression, distress, discredited self, poor self-esteem, negative affect (affective disorder)

(4) Biological (Physiological): Chronic diseases (ex. coronary heart disease, diabetes, high blood pressure, etc.), mortality, physical functioning, eating disorders

(ex. binge eating)

✔ Stigmatization or ‘Ant-Fat Bias’

-- Obese persons are viewed as physically (also sexually) unattractive, incompetent, and undesirable (Puhl and Brownell, 2001) than their slimmer or slender counterparts -- Obese people are the last group for whom overt bias and discrimination are socially

acceptable (Puhl et al., 2004)

✔ Major Theories Accounting for the Stigmatization or ‘Ant-Fat Bias’ (Anti-Obese Attitude)

(1) Attribution Theory (Crandall, 2000; Crandall et al., 2001; Crandall and Schiffhauer, 1998)

-- When people encounter an individual belonging to a stigmatized group, they search for the cause of the stigma. If the stigmatized trait is thought to be under personal control, blame is assigned, bias seems reasonable, and discrimination is justified. In the case of obesity, individuals have a highly stigmatized condition and are thought to be responsible for it

(2) Personality Explanation

-- Obese people are weak willed, lazy, sloppy, incompetent, emotionally unstable, and even defective as people (Puhl et al., 2004)

-- Obese people are personally responsible for their weight due to some character flaw or “blemish,” such as laziness, gluttony, or a lack of self-control (Harris et al., 1982)

(3) Modified Labeling Theory (Link et al., 1989)

-- Through the process of socialization, individuals develop and internalize

negative beliefs about what it means to belong to a stigmatized group; thus they form beliefs about how others will view them and ultimately will treat members of that stigmatized group

✔ Major Foci on Body Shape and Image

(1) Body image as an independent variable: Leading to several outcomes (psychological, psychosocial, biological, etc.)

(2) Body image as a dependent variable: Resulting from body shape per se, coupled w/ several socio-demographic characteristics

(3) Body image as a mediating variable: Confounding the relationship between body shape and outcomes (psychosocial, psychological, biological, etc.)

✔ Cultural Norms and Variations

-- Prevailing emphasis on thinness, denigration of excess weight, and stigmatization of obese individuals

-- Norms about ideal body weight (“ideal physique”) vary across socioeconomic and cultural contexts (Crandall and Martinez, 1996; Celio et al., 2002)

-- As the social pressure for thinness increases, the discrepancy between desirable body weight and actual body weight increases as well

-- Not all obese persons, however, suffer from the problem or are equally vulnerable, thus introducing the strong need to identify and search for the ‘risk factors’

 Risk Factors (Schwartz and Brownell, 2004) (1) Physical risk factors

-- Current weight status (BMI)

-- Current weight trajectory: Whether the person is gaining, losing, or maintaining (2) Individual & cultural risk factors

-- Gender: Being females (Heavier males tend to see themselves as “big and strong”

rather than “fat”, thus making them complacent about their weight) -- Race: Being white (Black women are the least risky)

-- Sexual orientation: Homosexual men (Lesbian women have lower risk) -- Binge eating disorder (BED)

-- History of weight cycling (experience of losing and regaining weight repeatedly over time): “yo-yo dieter”

-- Phantom fat (residual body image problems following weight loss): People who have been overweight in the past do not ultimately obtain the same positive body image when they lose weight as someone who was never overweight

-- Age of obesity onset and appearance teasing: Risky are childhood onset and being teased about weight or appearance

-- Strong investment in appearance: Risky are those who invest a lot in their appearance (ex. participation in a diet or fitness program) and who strongly internalize the appearance standard prevalent in a society

-- Age: Younger

-- Educational attainment: Higher education -- Occupation: Higher occupational status -- Income: Higher income

☞ People with higher SES are less likely to be overweight or obese, more likely to value thinness, diet, exercise, and more likely to hold negative attitudes toward obesity

☞ What really matters is not so much body shape (BMI) as ‘body image,’ since the latter tends to have more significant and profound impacts on one’s psychosocial

✔ Problems or Limitations in Extant Studies (1) Restricted sample

-- Focus mostly on some specific samples, usually females and/or those who are seeking treatment for obesity (e.g., lean or obese individuals)

-- Sample-specific findings  General population or nationally representative sample, preferably cross-national, is needed

(2) Clinical (experimental) data  Community data is needed

(3) Bivariate (correlational) analysis  Multivariate analysis (ex. ‘risk factors’

analysis) is needed

 Purpose of This Study

Identify the correlates and determinants of body image in Korea and Taiwan by means of analyzing the EASS 2010 (Health) cross-national data

 Methods

 Data: 2010 EASS ‘Health’ module survey in Korea [Part of the 2010 KGSS (Korean General Social Survey)] & Taiwan [Part of the 2011 TSCS (Taiwan Social Change Survey)]

 Sampling: Multi-stage area probability sampling (“No substitution at all”)

 Mode: Structured face-to-face, in-depth interviews (interviewer-administered)

 Sample Cases

✔ Korea: Initial sample = 2,500

 2,461 [39 ineligibles due to the incapacity (e.g., illness, literacy limitation, old age)]

 1,588 [Unit responses] ☞ Valid response rate = 1,588/2,461 (64.5%) 912 [Unit non-responses]

✔ Taiwan: Initial sample = 4,042

 3,891 [151ineligibles due to the incapacity]

 2,005 [Unit responses]  Split the sample for ISSP Health (2011) (N=983) and EASS Health (2012) (N=1,022)

☞ Overall response rate = 2,005/3,891 (51.2%)

 Measurement and Specification of Variables (Table 1)

✔ Body Image: Subjective assessment [Underweight / Normal weight / Overweight]

✔ Correlates (‘risk factors’)

BMI = Weight (kg) / {Height (m)}²: [Underweight (BMI<18.5) / Normal weight (18.5≤BMI<25.0) / Overweight(BMI≥25.0)]

Physical Health Status: Poor / Middle / Good Mental Health Status: Poor / Middle / Good

Chronic Diseases (hypertension, diabetes, heart disease, respiratory problem, etc.):

0 = Nay; 1 = Yea

Smoking: 0 = Nay; 1 = Yea Drinking: 0 = Nay; 1 = Yea

Physical Exercises: 0 = Nay; 1 = Yea Gender: Male = 0, Female =1

Marital Status: Without spouse = 0; With spouse = 1 Age: 20’s / 30’s / 40’s / 50’s / 60’s +

Educational Attainment: Elementary or below / Middle sch. / High sch. / Jr. college / College / Graduate sch.

Occupation: Unemployed / Manual / Service-Sales / Clerical / Semi-professional / Administrative-professional

 Results

 Univariate Analysis (Table 1)

✔ Body Image

[Korea] Underweight = 17.4%; Normal Weight = 46.7%; Overweight = 35.9%

[Taiwan] Underweight = 12.5%; Normal Weight = 36.0%; Overweight = 51.4%

☞ The extent to which one perceives s/he is fat is stronger for Taiwanese than Koreans

✔ Body Shape (BMI)

[Korea] Underweight = 7.2%; Normal Weight = 70.1%; Overweight = 22.7%

[Taiwan] Underweight = 6.2%; Normal = 61.2%; Overweight = 32.6%

☞ Taiwanese are indeed fatter than Koreans

☞ Taiwanese are fatter than Koreans in terms of both subjective and objective criteria

 Bivariate Analysis (Table 2)

✔ Although more people are overestimating, rather than underestimating, their weights inBody Image

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both countries, the extent is somewhat stronger in Taiwan than Korea

✔ Body Image

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Proportion of people who perceive they are fat is particularly higher among those who have poorer health statuses in both countries

✔ Body Image

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People who have chronic diseases think they are fat in Korea (not in Taiwan, though)

✔ Body Image

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Smokers in Korea don’t think they are fat ( gender differentials in smoking)

✔ Body Image

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Those who exercise frequently are more likely to perceive they are fat in Korea (not in Taiwan)

✔ Body ImageInterestingly enough, the extent to which females think they are fat compared to their

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✔ Body Image

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Those who have a spouse in Taiwan are more likely to think they are overweight than underweight

✔ Body ImageOverall, younger people tend to think they are fat in both countries, but the pattern and

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degree is more clear-cut and stronger, respectively, in Taiwan than in Korea

☞ In sum, those who are pretty sensitive to their body weights (i.e., who perceive they are fat) tend to be ones who have higher BMI, poorer heath statuses, chronic diseases, non- smokers, regular exercisers, females, married, and the younger generation. A non-

negligible amount of country-variations is observed, though, thereby calling for a multivariate analysis.

 Multivariate Analysis (Table 3)

✔ Factors leading to ‘Under’-Weight Image

(1) Korea: BMI; Health status (physical + mental); Smoking; Gender

Controlling for the variables in the equation, those who perceive they are thin

(instead of having a normal weight) in Korea are slimmer people (people w/ lower BMI), physically and mentally poorer people, smokers, and males.

(2) Taiwan: BMI; Health status (physical + mental); Gender

Those who perceive they are thin in Taiwan are indeed slimmer people, physically and mentally poorer people, and males.

✔ Factors leading to ‘Over’-Weight Image (1) Korea: BMI; Physical health; Gender; Age

Those who perceive they are fat in Korea are indeed bigger people, physically poorer people, females, and younger people (20’s in particular).

(2) Taiwan: BMI; Physical health; Drinking; Gender; Age; Occupation

Those who perceive they are fat in Taiwan are indeed bigger people, physically poorer people, drinkers, females, younger people (20’s in particular), and

the unemployed (as opposed to manual workers).

 A set of stepwise regressions (Table 3) indicate that: (1) the variables in the equation

 Discussion & Conclusion

(I) Despite the almost lowest level of obesity worldwide in Korea and Taiwan alike, a substantial no. of people in the two countries still perceive they are overweight.

 Individual perception or social pressure?

(II) Overestimation of one’s own body weight—“risky” or “sensitive” guys—is particularly prevalent in both countries among those who are indeed fatter people, who have poorer health, chronic diseases, non-smokers, regular exercises, females, married, and the youngsters.

(III) Overall, factors responsible for the ‘under’-weight image tend to be similar to those responsible for the ‘over’-weight image

‘Under’-weight image is particularly prevalent among those who are indeed slimmer people, physically and mentally poorer people, and males in both countries.

‘Over’-weight image is particularly prevalent among those who are indeed bigger people, physically poorer people, females, and the youngsters (20’s) in both countries.

 Generally consistent w/ the ‘risk factors’ reported in Korea (Kim, 2011) and

(IV) A few differentials in the factors are observed, though, between Korea and Taiwan.

Factors responsible for body image (over- or under-) only in Korea include smoking and educational attainment.

Factors responsible for body image (over- or under-) only in Taiwan include drinking and occupation.

 Socio-cultural uniqueness to Korea and Taiwan, respectively

☞ Sensitivity to body weight tends to be stronger in Taiwan than Korea [Evidence: (1) Higher proportion of people who perceive they are fat in Taiwan; (2) Stronger Phi coefficient from the x-tab between BMI and body image observed in Taiwan (φ = .631) than in Korea (φ = .567)]

☞ Social pressure for thinness, then, is stronger in Taiwan than Korea?

Emphasis on physical appearances (or ‘ideal physique’) is particularly prevalent and pervasive in Korea, though.

 Record-high plastic surgery rates in Korea (1.324 per 100 persons

—ranking no. 1 all over the world) compared to Taiwan (.805 per 100 persons) (Int’l Society of Aesthetic Plastic Surgery, 2010)

(V) What would explain the difference between Korea and Taiwan?

(Conjecture 1) Socio-economic development:

‘Higher calorie & less exercise’  ‘fatter’ populace (Conjecture 2) Social pressure:

‘Physical appearance’ (slimmer body) = one’s own “competitive edge”

(VI) Universality or Uniqueness in terms of explanatory factors in East Asia as compared to the West

 Requires a truly cross-national comparison between Eastern and Western societies (No question on body image in ISSP Health module, unfortunately)

More Information

Available at swkim@skku.edu

or http://www.src.re.kr