Immigration, acculturation and

disordered eating: a study of Georgian

immigrants

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
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 Questions

What are the links between

Immigration to West
Eating patterns

Acculturation Strategy
 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
Hypotheses

Sample and
Procedure
Total 506
Electronic survey was distributed
among Georgians living in the US
and UK through corresponding
communities, groups, individuals,
and electronic venues. .
combination of convenience and snowball sampling
Immigrant group: 253 Georgian women, residing in UK (105) &
USA (148); Participation criteria: Aged 18-55, ethnically Georgian,
born & raised in Georgia, first language is Georgian, 6+ months in
USA/UK
Nonimmigrant group: 253 Georgian women of the same age and
demographic data that live in Georgia and have never lived abroad
(short stay excluded)
Data was first collected from immigrant group and then from
nonimmigrant group. Composition of the latter, as a matched group, was
tailored to the age distribution of the former. Out of 345 nonimmigrant
entries, 253 remained with matched age group distribution, education
and marital status.
 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)
Table 1. Descriptive data of participant demographics

Group Mean Highest education obtained Marital status Mean Group

Age BMI Weight by
BMI
higher incmpl uni high school single married divorced widow
vocational or less /other
Immigrant 41 224 23 6 47 159 36 11 24.12 3.6%<18.5
(N=253) 61%-norm
23.1%-
overweight
11.9%-obese
Nonimmig 41 234 15 3 51 158 33 11 24.94 6.8%<18.5
rant 48%-norm
27.6%-
(N=253) overweight
16.4%-obese

Note. Total number of participants is 506

 Results
Immigration
and eating
patterns
Table 1. EDEQ scores of immigrant and nonimmigrant groups

EDEQ scores Group ID M SD N MANCOVA Partial η2

F
EDEQ Immigrant 1.89 1.59 253
7.53** 0.02
Restriction score Nonimmigrant 1.55 1.50 253

One out of five EDEQ

Eating concern score
Immigrant
Nonimmigrant
0.78
0.97
1.06
1.10
253
253
2.45 0.01

outcomes – food EDEQ

Shape concern score
Immigrant
Nonimmigrant
2.40
2.50
1.68
1.61
253
253
0.43 0.00
restriction EDEQ
Weight concern score
Immigrant
Nonimmigrant
2.08
2.03
1.61
1.56
253
253
0.15 0.00
EDEQ Global score Immigrant 1.79 1.27 253
0.06 0.00
Nonimmigrant 1.76 1.19 253
Note. ** p < 0.01.
 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
Immigration, Acculturation Strategies and Eating Patterns
EDEQ outcomes

EDEQ
Restriction
of Food
Intake
Acculturation Acculturation
EDEQ
Eating
Separation Concern
Integration

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

 Conclusions
Immigration to West
•Moving to West linked with slight increase in food restriction (not sure about pathology
though)

Acculturation Strategies
•Separation and marginalization significantly linked with higher EDEQ scores with separation
being the strongest predictor.
• Integration mildly 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.
• Context is important! In our sample (80% abroad for 6+ ys), high host culture orientation
appeared critical for healthy eating. Careful about generalizations!
 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 Immigrant 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

relocation, cultural distance,
Marginalization Context and 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 0.0

Weight concern 1.72 1.43 2.21 1.65 2.31 0.0

Global score 1.49 1.11 1.89 1.3 2.23 0.0

Assimilation 3.48 1.22 2.86 1.26 -3.5 0.0

Separation 2.56 0.88 3.38 1.24 5.78 0.0

integration 5.68 0.97 5.26 1.19 -2.89 0.0

Table 3. Links between the history of marriage with British/American, acculturation, and
EDEQ outcomes

Married to local Not married to local

M SD M SD F (215) η²
Food restriction 1.57 1.55 2.00 1.58 3.61 † 0.01
Eating concern 0.55 0.90 0.85 1.10 3.84 † 0.01
Shape concern 2.12 1.48 2.50 1.73 2.57 0.01
Weight concern 1.72 1.43 2.21 1.65 4.70* 0.01
Global score 1.49 1.11 1.89 1.30 4.97* 0.01
Assimilation 3.48 1.22 2.86 1.26 12.25*** 0.04
Separation 2.56 0.88 3.38 1.24 24.36*** 0.08
Integration 5.68 0.97 5.26 1.19 6.89** 0.02
Marginalization 2.22 1.08 2.38 1.18 0.953 0.00
Note. *** p < 0.001, ** p < 0.01, * p < 0.05, †p < 0.06
Table 2. Demographics of immigrant group

Variables M Mdn SD Minimum Maximum N

Age of Relocation 29.43 29 7.47 10 54

Length of Residence 11.56 12 6.30 0.6 25
Body Mass Index 24.12 23.24 4.71
Resides in UK 105
Resides in USA 148
Married to 67 (26.5%)
British/American
Undocumented 50 (20%)
Note. Total number of participants is 253
Table 6. Regression models of stepwise regression for eating concern, shape concern, weight
concern, and global EDEQ scores

Model Eating Concern β T

1 BMI .37 6.34***

2 BMI .35 6.32***

Separation .22 3.46**
Marginalization .15 2.38*
Model Shape Concern β T
1 BMI .55 10.64***

2 BMI .53 10.67***

Separation .16 2.84**
Marginalization .14 2.39*
Model Weight Concern β T
1 BMI .49 8.89***

2 BMI .46 8.79***

Separation .21 3.58***
Marginalization .13 2.08*
Model Global EDEQ Score β T
1 BMI .49 8.87***

2 BMI .46 8.83***

Separation .20 3.35**
Marginalization .15 2.46*
Note. *** p < 0.001, ** p < 0.01, * p < 0.05