Is lack of integration into mainstream

culture associated with more

disordered eating among
immigrants?
A Study of Georgian Women residing in
Western countries
Ia Shekriladze, Nino Javakhishvili, Kate Tchanturia
Ilia State University, Institute of Psychology, Tbilisi, Georgia;
King’s College London, London, UK
ia.shekriladze@iliauni.edu.ge
I, Ia Shekriladze, have no commercial relationships to
disclose.
Georgia: Country Profile
• Population - 3.7 million
• Capital – Tbilisi (1.5 m)
• Life Expectancy: 70/78 - 74
• GDP per capita: $1012
• Poverty rate – 10%
• 1991 regained independence
• 1 million abroad
• Exquisite national cuisine
• Cradle of wine
 Culture Change and Eating Disorders
Notable association exists between culture change and Eating Disorders (ED)
(Doris et al. 2015)

• Culture bound Culture Change/ More

Acculturation acculturated,
higher risk of
• Culture change ED

• Acculturative
More
Stress acculturated,
Disordered lower risk of
Eating ED
• Westernization
 Study Variables

Eating Patterns
unhealthy eating behaviors that

Disordered
resemble Eating Disorders (ED)
although are exhibited in a smaller
degree (frequency and intensity)

the process of psychosocial change that

Acculturation

occurs when an individual is adopting to

a new culture (values, beliefs, language,
habits, traditions)
 Acculturation and ED Variables
Integration: interest in both cultural
identities

Acculturation strategies
(Berry, 1970, 1990)
Eating patterns measured:
Dietary Restriction, Eating Concern,
Shape Concern, Weight Concern
Assimilation: interest in
mainstream culture only
Separation: interest in original
culture only
Marginalization: little interest in
either cultural identities

integration is associated with the best adjustment outcomes, marginalization – with the poorest
(Berry, 2006; Ward & Kus, 2012; Ward & Geeraert, 2016)
 Our Hypothesis

Healthiest eating
Integration outcomes
Residing in
Assimilation Intermediate
Western
outcomes
Country Separation
Least healthy
Marginalization outcomes
 combination of convenience and snowball sampling

253 Georgian women, residing in UK (105) & USA (148)

Sample and Participation criteria: Aged 18-55, ethnically Georgian, born &
Procedure raised in Georgia, first language is Georgian,
6+ months in USA/UK

Recruitment: Electronic survey was distributed among

Georgians living in the US and UK through corresponding
communities, groups, individuals, and electronic venues.
 Demographic/Acculturation variables:: age of relocation, length of residence,
education, financial status, history of being undocumented, history of marriage
with local, BMI.

EAST ASIAN ACCULTURATION MEASURE (EAAM)

(Barry, 2001, Georgian translation Shekriladze, I., 2015):– fourfold measure of
acculturation (assimilation, separation, integration, marginalization) 29
Measures statements with 7-point Likert scale (e.g: “at home I usually speak English”)
EAAM was validated through Confirmatory Factor Analysis (CFA). Fit indices :
χ2= 690.09, df = 316, p =0.000, RMSEA= 0.07, CFI= 0.81, TLI= 0.79
(Javakhishvili et al., 2016).

Eating Disorder Examination Questionnaire (EDE-Q)

(Fairburn and Beglin, 1994; 2008)
4 subscales (dietary restriction, eating concern, weight concern, shape
concern) and global score (mean of the four subscale scores);
previously used with Georgian population (Genders et al. 2008)
 Results
Integration associated with
Acculturation Strategies and Eating best outcomes
Patterns Separation & Marginalization
Correlation and Regression – predictors of unhealthier
Analyses eating patterns on 4 out of 5
outcomes
 Summary of Findings
Acculturation Strategies and Eating Patterns
EDEQ outcomes

EDEQ
Acculturation Strategies Acculturation Strategies
Restriction
of Food
Intake

EDEQ
Eating
Separation Integration
Concern

EDEQ
Shape
Concern
Marginalization Assimilation

EDEQ
Weight
Concern

EDEQ
Global
 Cultural Orientations, Acculturation Strategies, and ED Outcomes

Home culture orientation

Healthiest Outcomes Healthiest Outcomes

Mainstream Integration
Integration Assimilation
Assimilation
culture
Marginalization
orientation Separation
Separation Marginalization

Least healthy Outcomes Least healthy Outcomes

 Demographics/Acculturation
Conditions and their links with
Acculturation Strategies Eating Patterns
Length of residence: Married to British/American:
• Integration (r = 0.26 p = 0.000) • EDEQ global, weight and restriction
Separation (r =-0.20 p = 0.001) scores
Arrival Age: Length of residence:
• Assimilation (r =-0.20 p=0.002) • BMI (r = 0.17 p = 0.008)
Integration (r =-0.24 p = 0.000) History of being undocumented:
Married to British/American • BMI (M = 25.86, SD = 4.59;
• Integration and Assimilation M = 23.69; SD = 4.87;
t (249) =-2.93, p = 0.01. )
 Conclusions
Acculturation Strategies
• Separation and marginalization significantly linked with higher EDEQ scores with
separation being the strongest predictor.
• Integration associated with healthiest outcomes.
• Low host culture orientation, as a common denominator of separation and
marginalization, predicts poorer eating patterns for Georgian immigrant women
• Professionals/programs targeted at immigrants need to support their integration into
society of settlement.

Acculturation Conditions and Context

• Variety of factors shape acculturation and wellbeing outcomes. Context is important!
• In our sample (80% abroad for 6+ ys), high host culture orientation appeared critical for
healthy eating and history of marriage with the local was linked with better integration and
EDEQ outcomes. Careful about generalizations!
Thank you for your time!
 References:
• Ardens-Thós, J. and Van de Vijver, J. R. (2006). “Assessment of psychological acculturation,” In The Cambridge handbook of acculturation psychology, ed. D.L.
Sam and J. W. Berry (Cambridge: Cambridge University Press), 142-162.
• Barry, D. T. (2001). Development of a new scale for measuring acculturation: the East Asian acculturation measure (EAAM). J. Immig, Health. 3, 193-197. doi:
10.1023/A:1012227611547
• Berry, J. W. (1970). Marginality, stress and ethnic identification in an acculturated Aboriginal community. J. Cross-Cult. Psych. 1, 239-252. doi:
10.1177/135910457000100303
• Berry, J. W. (1990). “Psychology of Acculturation,” in Applied Cross-Cultural Psychology, ed. R. W. Brislin (California: Sage), 232-253.Diagnostic and Statistical
Manual of Mental Disorders – 5th edition; American Psychiatric Association, 2013.
• Berry, J. W. (2006). “Contexts of Acculturation,” in The Cambridge Handbook of Acculturation Psychology, eds. D.L. Sam and J. W. Berry (Cambridge: Cambridge
University Press), 17-42.
• Doris, E., Shekriladze, I., Javakhishvili, N., Johnes, R., Treasure, J., and Tchanturia, K. (2015). Is cultural change associated with eating disorders? A systematic
review of the literature. Eat. and Weight Disord. 20, 149-60. doi: 10.1007/s40519-015-0189-9
• Fairburn, C. G., and Beglin, S. J. (1994). Assessment of eating disorders: interview or self-report questionnaire? Int. J. Eat. Disord. 16, 363-370.
• Shekriladze, I., and Tchanturia, K. (2016). “Acculturation to West in the Context of Eating Disorders,” in Encyclopedia of Feeding and Eating Disorders, ed. T.
Wade (Springer Nature Singapore) 1-4.
• Ward, C. and Kus, L. (2012). Back to and beyond Berry’s basics: the conceptualization, operalization and classification of acculturation. Int. J. Intercult. Relat. 36,
472-485. doi: 10.1016/j.ijintrel.2012.02.002
• Ward, C. and Geeraert, N. (2016). Advancing acculturation theory and research: the acculturation process in its ecological context. Current. Opin. In Psycho, 8,
98-104. doi: 10.1016/j.copsyc.2015.09.021
 Demographics of Sample

Variables M Mdn SD Minimum Maximum N

Age of Relocation 29.43 29 7.47 10 54 253

Length of Residence 11.56 12 6.30 0.6 25 253
Body Mass Index 24.12 23.24 4.71
Married to 67 (26.5%)
British/American
Undocumented 50 (20%)
 Discussion
Acculturation Strategies and Disordered Eating
Lengths of Residence (6+
years -80%; Mean LoR – 11.5
years; mdn – 12 years)

Separation and Other factors (nature of

Marginalization Context and relocation, cultural distance,
etc.)
significantly linked with
least healthy outcomes; Acculturation
Integration linked with strategies Ties with original
the best outcomes. community

Limitations of the
measures (do not capture external
factors, e.g. immigration policies, etc.)
 Demographic Variables
• Age
• Marital status
• Household composition
• Education
• Occupation
• Age of moving to a new country
• Social history of moving to a new
country (alone, with family)
• Living situation upon arrival (alone,
with family, with strangers, etc.)
• Length of residence in a new country
• History of being undocumented
• Plan of returning to home
country
• Current type of residence
(urban/rural)
• Type of residence at home
country (urban/ rural)
• Current financial status
• Weight
• Height
• BMI
 Limitations and Future Directions
 Impossible to do random sampling,
sampling bias
 Few newly relocated, few young
 e-survey related limitations
 Could not examine important
acculturation variables (e.g. command
of language, reason for relocation, etc.)
and potential comorbidities
 More focus on the young and newly
relocated populations
 Examining other internal and
external, country-specific factors (e.g.
motivation, immigration policies, food
industries, etc.)
 Looking at inter-country differences
Links between History of Marriage with Local,
Acculturation, and ED Outcomes
Married to local Not married to local

M SD M SD t (215) p

Eating concern 0.55 0.9 0.85 1.1 2.15 0.03

Weight concern 1.72 1.43 2.21 1.65 2.31 0.02

Global score 1.49 1.11 1.89 1.3 2.23 0.03

Assimilation 3.48 1.22 2.86 1.26 -3.5 0.01

Separation 2.56 0.88 3.38 1.24 5.78 0.00

integration 5.68 0.97 5.26 1.19 -2.89 0.01

 The Present Study
A Study of Georgian Women residing in
Western countries
For the purposes of this study, “Western” implies the USA and the UK only.
Study ethics (03-11563/15) permission was obtained from Ilia State University Ethics
Committee Board.