To the Editor: In the article by Chi-Fu Jeffrey Yang et al. (1), the authors found that heterosexual Taiwanese men exhibited significantly less body dissatisfaction than their Western counterparts. They concluded that the Western tradition of muscularity and more muscular male bodies in the Western media might be responsible for the differential attitudes about body image. Although they did not interview Caucasian men in Western societies directly in this study (they used results from an earlier study conducted by one of their coauthors [2]), their cross-comparison was supposed to be valid. However, I think another important comparison group is clearly missing: the group of Asian men raised and living in the Western societies, such as Asian Americans.

One recent study by Tsai et al. (3) did compare self-reported body dissatisfaction and eating disorders between Taiwanese women and Taiwanese American women. Although they originally hypothesized that Taiwanese American women would have higher body dissatisfaction than Taiwanese women because of their increased levels of acculturation to Western ideals, their results turned out to be in the opposite direction: Taiwanese women reported higher scores for body dissatisfaction than Taiwanese American women. Tsai et al. speculated that, based on "social comparison theory," since most Taiwanese American women are in the minority in the environment in which they grow up, they tend to be smaller and skinnier than their Caucasian peers. In turn, they do not compare their body shape regularly with their Caucasian counterparts. Body dysmorphia may manifest in a nontraditional way and be less overt. Contrarily, Taiwanese women’s day-to-day interactions are usually with other Taiwanese women with much more similar physical characteristics; there may be more comparison in body shape that results in body dissatisfaction (3).

It would be interesting to examine if such a difference between Asian and Asian women in the West also appears in men. Since Asian men are usually of smaller build and are less muscular than Caucasian men, Asian men in the West might be influenced by multiple factors that exacerbate body dissatisfaction. We hope that the authors will recruit Asian American men as a comparison group and extend their examination of this intriguing phenomenon in the future. In addition, the authors should also examine body image among Asian men and Asian men in the West with homosexual orientation. Body dysmorphia in men having sex with men may increase the frequency of unsafe behaviors that put this group at higher risk for HIV infection. However, few studies have been done on the association between body dysmorphia and HIV risk in Asian men having sex with men.