Eating disorders are overlooked among people of color
Eating disorders affect nearly 10% of the population, and over 30 million Americans will experience an eating disorder at some point in their lives. They are one of the deadliest mental illnesses; about 26% of people diagnosed with a suicide attempt.
But these statistics can be grossly underestimated.
The lack of proactive detection and treatment has left many struggling behind closed doors — largely due to harmful stereotypes about what it’s like to struggle with an eating disorder.
“It’s always a thin, middle-class, upper-class white woman,” says Gloria Lucas, who runs a support group for people of color fighting eating disorders, in a PBS article, outlining the commonly accepted rhetoric.
Research shows that BIPOC people are less likely to be asked about eating disorder symptoms.
“The stereotypes have perpetuated and will continue to perpetuate this inequality, and also the under-detection and treatment of eating disorders, in the BIPOC communities for so long,” said Dr. Toya Roberson-Moore, psychiatrist and associate medical director of the Eating Recovery Center, narrates wealth.
Eating disorders in the BIPOC community
Black people tend to experience anorexia at a younger age than white people and may endure the disorder longer before recovering. Black teens are 50% more likely to have symptoms related to bulimia compared to white teens; Hispanic people are more likely to suffer from bulimia nervosa than non-Hispanic people. Despite the need for intervention in these communities, BIPOC individuals are less likely to be diagnosed and treated for an eating disorder. However, research in this area is sparse.
During routine doctor visits, BIPOC individuals exhibiting symptoms of an eating disorder can feel ignored, Roberson-Moore says.
“When you come through the door, the inequality starts because they don’t even get checked.
Roberson-Moore explains the problem in two ways.
While screening may be denied in some cases, others may need screening that lack cultural sensitivity. Roberson-Moore works closely with BIPOC youth and says the measures used to assess eating disorders do not take into account their specific experiences.
“These rating scales have not been standardized or even validated with marginalized groups,” she says. “As a result, they are essentially unreliable when it comes to risk assessment.”
The experience of racism as a trigger for eating disorders
Roberson-Moore says experiencing racist events are psychological stressors that can push BIPOC youth and adults alike to control their surroundings in ways that feel more approachable. This mindset can lead to the development of an eating disorder, food control, and body image struggles. If these stressors aren’t represented in medical studies, a whole subset of people can be neglected, she explains.
“We have higher rates of eating disorders because [it’s] the way the body copes with the trauma,” she says. “If you can’t control the things that happen to you, they control what you eat.”
It starts with the pediatrician and more research
Research on eating disorders to date has largely focused on those in college settings who are not racially and ethnically diverse, according to Equip, an eating disorder treatment and awareness platform.
“There is much room for research into minority stress and the onset of eating disorders, minority stress related to the treatment environment, the effects of media, and the medical interactions individuals encounter in the process of diagnosis,” says Dr Christyna Johnson, a non-dietitian nutritionist and consultant at Equip, in a blog post.
In her work, Roberson-Moore hopes to draw more attention to debunking the stereotypes that persist around eating disorders in order to develop more integrative treatments, particularly because previous research has shown that race-based stereotypes limit clinicians’ ability to diagnose eating disorders in black people to recognize individuals have changed.
“Eating disorders are not racist, but the institutional exclusion and lack of resources related to eating disorders among BIPOC people certainly are,” says Benjamin O’Keefe, an Equip consultant, in the post. “Only by expanding our understanding of who is affected by eating disorders and mental health issues can we begin to design treatment and advocacy programs that reach those who need them.”
Research differences aside, the way eating disorders are described and discussed on popular teen platforms like TikTok has also led to misunderstandings about diagnosis and treatment. CNN reported that black TikTok creators who have expertise in mental health have raised awareness about changing the narrative of eating disorders and fighting misconceptions.
These platforms can encourage assumptions that people with eating disorders need to look frail and underweight. But less than 6% of those diagnosed with an eating disorder are medically classified as “underweight.” Some people don’t seem to eat very little, either, says Roberson-Moore. However, their relationship with food and/or their bodies is harmful.
“There are many misconceptions that we need to push back that have been perpetuated in the literature and in the scientific community with a lack of awareness of how eating disorders present themselves in the BIPOC community,” she says.
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