such as racism, abuse and poverty. african perspective in the majority of many african communities, thinness is generally not seen as an ideal body type and most pressure to attain a slim figure may stem from influence or exposure to western culture and ideology. traditional african cultural ideals are reflected in the practice of some health professionals; in ghana, pharmacists sell appetite stimulants to women who desire to, as ghanaians stated, "grow fat". girls are told that if they wish to find a partner and birth children they must gain weight. on the contrary, there are certain taboos surrounding a slim body image, specifically in west africa. lack of body fat is linked to poverty and hiv/aids. however, the emergence of western and european influence, specifically with the introduction of such fashion and modelling shows and competitions, is changing certain views among body acceptance, and the prevalence of eating disorders has consequently increased. this acculturation is also related to how south africa is concurrently undergoing rapid, intense urbanization. such modern development is leading to cultural changes, and professionals cite rates of eating disorders in this region will increase with urbanization, specifically with changes in identity, body image, and cultural issues. further, exposure to western values through private caucasian schools or caretakers is another possible factor related to acculturation which may be associated with the onset of eating disorders. other factors which are cited to be related to the increasing prevalence of eating disorders in african communities can be related to sexual conflicts, such as psychosexual guilt, first sexual intercourse, and pregnancy. traumatic events which are related to both family (i.e. parental separation) and eating related issues are also cited as possible effectors. religious fasting, particularly around times of stress, and feelings of self-control are also cited as determinants in the onset of eating disorders. asian perspective the west plays a role in asia's economic development via foreign investments, advanced technologies joining financial markets, and the arrival of american and european companies in asia, especially through outsourcing manufacturing operations. this exposure to western culture, especially the media, imparts western body ideals to asian society, termed westernization. in part, westernization fosters eating disorders among asian populations. however, there are also country-specific influences on the occurrence of eating disorders in asia. china in china as well as other asian countries, westernization, migration from rural to urban areas, after-effects of sociocultural events, and disruptions of social and emotional support are implicated in the emergence of eating disorders. in particular, risk factors for eating disorders include higher socioeconomic status, preference for a thin body ideal, history of child abuse, high anxiety levels, hostile parental relationships, jealousy towards media idols, and above-average scores on the body dissatisfaction and interoceptive awareness sections of the eating disorder inventory. similarly to the west, researchers have identified the media as a primary source of pressures relating to physical appearance, which may even predict body change behaviors in males and females. fiji while colonised by the british in 1874, fiji kept a large degree of linguistic and cultural diversity which characterised the ethnic fijian population. though gaining independence in 1970, fiji has rejected western, capitalist values which challenged its mutual trusts, bonds, kinships and identity as a nation. similar to studies conducted on polynesian groups, ethnic fijian traditional aesthetic ideals reflected a preference for a robust body shape; thus, the prevailing 'pressure to be slim,' thought to be associated with diet and disordered eating in many western societies was absent in traditional fiji. additionally, traditional fijian values would encourage a robust appetite and a widespread vigilance for and social response to weight loss. individual efforts to reshape the body by dieting or exercise, thus traditionally was discouraged. however, studies conducted in 1995 and 1998 both demonstrated a link between the introduction of television in the country, and the emergence of eating disorders in young adolescent ethnic fijian girls. through the quantitative data collected in these studies there was found to be a significant increase in the prevalence of two key indicators of disordered eating: self-induced vomiting and high eating attitudes test- 26. these results were recorded following prolonged television exposure in the community, and an associated increase in the percentage of households owning television sets. additionally, qualitative data linked changing attitudes about dieting, weight loss and aesthetic ideas in the peer environment to western media images. the impact of television was especially profound given the longstanding social and cultural traditions that had previously rejected the notions of dieting, purging and body dissatisfaction in fiji. additional studies in 2011 found that social network media exposure, independent of direct media and other cultural exposures, was also associated with eating pathology. hong kong from the early- to-mid- 1990s, a variant form of anorexia nervosa was identified in hong kong. this variant form did not share features of anorexia in the west, notably "fat-phobia" and distorted body image. patients attributed their restrictive food intake to somatic complaints, such as epigastric bloating, abdominal or stomach pain, or a lack of hunger or appetite. compared to western patients, individuals with this variant anorexia demonstrated bulimic symptoms less frequently and tended to have lower pre-morbid body mass index. this form disapproves the assumption that a "fear of fatness or weight gain" is the defining characteristic of individuals with anorexia nervosa. india in the past, the available evidence did not suggest that unhealthy weight loss methods and eating disordered behaviors are common in india as proven by stagnant rates of clinically diagnosed eating disorders. however, it appears that rates of eating disorders in urban areas of india are increasing based on surveys from psychiatrists who were asked whether they perceived eating disorders to be a "serious clinical issue" in india. 23.5% of respondents believed that rates of eating disorders were rising in bangalore, 26.5% claimed that rates were stagnant, and 42%, the largest percentage, expressed uncertainty. it has been suggested that urbanization and socioeconomic status are associated with increased risk for body weight dissatisfaction. however, due to the physical size of and diversity within india, trends may vary throughout the country. black and african american historically, identifying as african american has been considered a protective factor for body dissatisfaction. those identifying as african american have been found to have a greater acceptance of larger body image ideals and less internalization of the thin ideal, and african american women have reported the lowest levels of body dissatisfaction among the five major racial/ethnic groups in the us. however, recent research contradicts these findings, indicating that african american women may exhibit levels of body dissatisfaction comparable to other racial/ethnic minority groups. in this way, just because those who identify as african american may not internalize the thin ideal as strongly as other racial and ethnic groups, it does not mean that they do not hold other appearance ideals that may promote body shape concerns. similarly, recent research shows that african americans exhibit rates of disordered eating that are similar to or even higher than their white counterparts. american indian and alaska native american indian and alaska native women are more likely than white women to both experience a fear of losing control over their eating and to abuse laxatives and diuretics for weight control purposes. they have comparable rates of binge eating and other disordered weight control behaviors in comparison to other racial groups. latinos disproportionately high rates of disordered eating and body dissatisfaction have been found in hispanics in comparison to other racial and ethnic groups. studies have found significantly more laxative use in those identifying as hispanic in comparison to non-hispanic white counterparts. specifically, those identifying as hispanic may be at heightened risk of engaging in binge eating and bingeing/purging behaviors. food insecurity food insecurity is defined as inadequate access to sufficient food, both in terms of quantity and quality, in direct contrast to food security, which is conceptualized as having access to sufficient, safe, and nutritious food to meet dietary needs and preferences. notably, levels of food security exist on a continuum from reliable access to food to disrupted access to food. multiple studies have found food insecurity to be associated with eating pathology. a study conducted on individuals visiting a food bank in texas found higher food insecurity to be correlated with higher levels of binge eating, overall eating disorder pathology, dietary restraint, compensatory behaviors and weight self-stigma. findings of a replication study with a larger, more diverse sample mirrored these results, and a study looking at the relationship between food insecurity and bulimia nervosa similarly found greater food insecurity to be associated with elevated levels of eating pathology. trauma one study has found that binge-eating disorder may stem from trauma, with some female patients engaging in these disorders to numb pain experienced through sexual trauma. heterosexism some eating disorder patients have implied that enforced heterosexuality and heterosexism led many to engage in their condition to align with norms associated with their gender identity. families may restrict women's food intake to keep them thin, thus increasing their ability to attain a male romantic partner. mechanisms biochemical: eating behavior is a complex process controlled by the neuroendocrine system, of which the hypothalamus-pituitary-adrenal-axis (hpa axis) is a major component. dysregulation of the hpa axis has been associated with eating disorders, such as irregularities in the manufacture, amount or transmission of certain neurotransmitters, hormones or neuropeptides and amino acids such as homocysteine, elevated levels of which are found in an and bn as well as depression. serotonin: a neurotransmitter involved in depression also has an inhibitory effect on eating behavior. norepinephrine is both a neurotransmitter and a hormone; abnormalities in either capacity may affect eating behavior. dopamine: which in addition to being a precursor of norepinephrine and epinephrine is also a neurotransmitter which regulates the rewarding property of food. neuropeptide y also known as npy is a hormone that encourages eating and decreases metabolic rate. blood levels of npy are elevated in patients with anorexia nervosa, and studies have shown that injection of this hormone into the brain of rats with restricted food intake increases their time spent running on a wheel. normally the hormone stimulates eating in healthy patients, but under conditions of starvation it increases their activity rate, probably to increase the chance of finding food. the increased levels of npy in the blood of patients with eating disorders can in some ways explain the instances of extreme over-exercising found in most anorexia nervosa patients. leptin and ghrelin: leptin is a hormone produced primarily by the fat cells in the body; it has an inhibitory effect on appetite by inducing a feeling of satiety. ghrelin is an appetite inducing hormone produced in the stomach and the upper portion of the small intestine. circulating levels of both hormones are an important factor in weight control. while often associated with obesity, both hormones and their respective effects have been implicated in the pathophysiology of anorexia nervosa and bulimia nervosa. leptin can also be used to distinguish between constitutional thinness found in a healthy person with a low bmi and an individual with anorexia nervosa. gut bacteria and immune system: studies have shown that a majority of patients with anorexia and bulimia nervosa have elevated levels of autoantibodies that affect hormones and neuropeptides that regulate appetite control and the stress response. there may be a direct correlation between autoantibody levels and associated psychological traits. later study revealed that autoantibodies reactive with alpha-msh are, in fact, generated against clpb, a protein produced by certain gut bacteria e.g. escherichia coli. clpb protein was identified as a conformational antigen-mimetic of alpha-msh. in patients with eating disorders plasma levels of anti-clpb igg and igm correalated with patients' psychological traits infection: pandas is an abbreviation for the controversial pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections hypothesis. children with pandas are postulated to "have obsessive-compulsive disorder (ocd) and/or tic disorders such as tourette syndrome, and in whom symptoms worsen following infections such as strep throat". (nimh) pandas and the broader pans are hypothesized to be a precipitating factor in the development of anorexia nervosa in some cases, (pandas an). lesions: studies have shown that lesions to the right frontal lobe or temporal lobe can cause the pathological symptoms of an eating disorder. tumors: tumors in various regions of the brain have been implicated in the