RESIDENT: From Taarof to Table: A Scoping Review of Hospitality Norms and Disordered Eating

Learning Objectives

1. Describe how taarof and Persian hospitality norms influence eating behaviors, body image pressures, and patterns of disordered eating in Iranian and Persian-diaspora populations;
2. Identify culturally specific mechanisms-such as collectivist family expectations, shame/modesty norms, and repeated food-offering rituals-that may mask symptoms or delay help-seeking for eating disorders; and
3. Discuss implications for culturally responsive assessment and intervention, including how clinicians can sensitively explore food-offering/declining rituals and family dynamics in clinical encounters.

Abstract

Background: In Iranian and Persian-diaspora contexts, disordered eating may be shaped by collectivist family dynamics, modesty/shame norms, and thin-ideal internalization. Furthermore, the ritual of taarof— polite, repeated offering/refusal around food-likely affects social eating, refusal skills, and help-seeking, yet remains notably under-studied. 

Objective: To map peer-reviewed evidence linking taarof and related hospitality/collectivist norms to eating disorder risk, presentation, disclosure, and care across Iran and Persian-diaspora populations. 

Methods: PRISMA scoping review of MEDLINE, PsycINFO, CINAHL, and Scopus with reference hand- searching; dual independent screening; standardized data charting; narrative synthesis with concept mapping. 

Results (anticipated synthesis): We expect to (1) delineate mechanisms through which hospitality and collectivist norms shape symptoms (e.g., thin-ideal internalization, shame/honor, modesty, family expectations); (2) identify contexts where food-offering/declining rituals intensify risk (e.g., pressure to accept food; avoidance of social meals); and (3) describe barriers to care (low ED literacy, stigma, limited services) alongside culturally responsive strategies (family-inclusive planning; respectful scripts for declining offers; supervision-informed continuity). 

Conclusions/Implications: Hospitality and collectivist norms may heighten social pressure around eating, mask disordered patterns, and channel help-seeking through family hierarchies. Clinically, culturally attuned probes of food-offering/declining and role expectations may be helpful. 

Literature References

1. Ghannadiasl, F. & Mahdavi, R. (2017). Changes in Eating Self-Efficacy During Weight Loss Intervention.... Jundishapur J Health Sci. - Noted that social eating norms like taarof make refusing food socially difficult.

2. Garrusi, B. & Baneshi, M. (2013). Eating Disorders and Associated Risk Factors among Iranian Population - a community study. Glob J Health Sci, 5(1):193-202. - Reported ~11.5% ED prevalence; Western media exposure wasn't a significant predictor, suggesting cultural mediators.

3. Abdollahi, P. & Mann, T. (2001). Eating disorder symptoms and body image in Iran: Women in Iran vs. America. Int J Eat Disord, 30(3):259-68. Found no difference in disordered eating between Iranian women in Tehran and those in Los Angeles; acculturation to Western norms did not explain ED levels. 

4. Sahlan, R.N. et al. (2022). Sociocultural correlates of eating pathology in college women from US and Iran. Front. Psychol. 13:966810. Cross-cultural survey; thin-ideal internalization and pressure for thinness predicted pathology in both groups. Notably, hijab did not reduce body concerns and strict modest dress linked to lower body dissatisfaction in one sample. Highlighted measurement non-equivalence, implying cultural nuance.

5. Kachooei, M.A. et al. (2018). Eating Disorders among Iranian Male Adolescents. Iran J Psychiatry Behav Sci, 12(2):e9357. - 15% prevalence in teen boys (mostly bulimic behaviors); higher social pressure scores in those with ED, but body dissatisfaction and BMI were the key direct risk factors. Suggests social influences act via internalized dissatisfaction. 

6. Seifi, F. et al. (2023). Challenges and Needs of Iranian Parents Seeking Help for Adolescents with Anorexia: An IPA study. Int J Behavioral Sciences, 17(2):82-88. - Qualitative interviews with parents identified low awareness, misdiagnosis, lack of specialist care, and stigma as major barriers to treatment. Parents needed more education, guidance, and support. 

7. Rezazadeh, A. & colleagues (year unavailable). – Negative affect and ED psychopathology in Iranian students (source excerpt) found shame and hostility were central emotions bridging to disordered eating, underscoring the importance of culturally-informed emotional targets in therapy. 

8. Mashhadi, A.G. & Noordenbos, G. (2012). Dieting and the Development of Eating Disorders among Iranian Women: Comparing Tehran and the Netherlands. - (Referenced in secondary sources) Noted that Iran remains a collectivist society despite Westernization, and contextually unique factors may influence ED development, warranting further comparative research.