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June 11, 2020

Beyond “Eating Disorders Don’t Discriminate”

Beyond “Eating Disorders Don’t Discriminate”

When those of us in the field say “eating disorders don’t discriminate,” we’re trying to express that eating disorders affect everyone. The intention is to challenge the stereotype of the thin, white woman and recognize a diversity of experiences and identities.

And while it’s true that eating disorders affect all social groups, this statement is inadequate. Much like “eating disorders see no color,” it lacks nuance and complexity. Taken alone, it doesn’t advance meaningful conversation about race-related body, food, and illness experiences. 

The conversation about eating disorders in the Black community cannot stop here. 

As our field commits to racial diversity and inclusion, we must do more than name as myth the idea that only white women have eating disorders. It is not enough to nod to the few statistics and studies about these disorders in marginalized communities, suggesting representation is inclusivity. Doing so in the context of our white-oriented field implies that the prototypical eating disorder experience is the Black experience as well. It applies our understanding of eating disorders in white women to Black people and other people of color and upholds the dominant white framework. 

We must truly see and center eating disorders in communities of color to challenge the systemic inequality perpetuated by and within our field. We must understand how race is tied to experiences of body and food, and how unique cultural forces contribute to the development of eating disorders in Black communities. Only then will our research and care be culturally informed and responsive.

Eating disorders can affect anyone, yes. But eating disorders affect people differently based on race, and understanding and accounting for the unique experiences of people of color is our field’s necessary, overdue work. 

The History of the Eating Disorder Stereotype

The eating disorder field is rooted in white-dominated medical, psychological, and psychiatric systems. Our knowledge is based largely on the experiences of a small, homogenous population: thin, white, privileged women. It is these women who had access to care when eating disorders were first identified and diagnosed in the late 1800s. It is these stories that were told, albeit from the perspective of the white men who treated them.

Psychiatrist Hilde Bruch advanced the field’s knowledge with the 1978 publication of The Golden Cage. The book allowed for illness descriptions from patients themselves, but still the patients were exclusively thin, white women. Media further centered this demographic in the public’s mind when singer Karen Carpenter died from anorexia in 1983, and when Princess Diana spoke out about her bulimia in the 1990s. In research, in clinics, and in popular culture, it seemed all who suffered from eating disorders were white women.

Eating Disorders in the Black Community 

Though our understanding is based on the experiences of white women, eating disorders and disordered eating do affect people of color at significant rates. The limited research involving Black participants offers the following statistics:

It is important to note that even this research is based on frameworks and diagnostic tools developed with white women in mind. Accurate estimation of prevalence is difficult, and it is believed that a large percentage of eating disorders in Black Americans are unreported and untreated.

Cultural Context 

We understand eating disorders as complex biopsychosocial disorders impacted by a range of biological, psychological, and sociocultural factors. There is no single cause. Instead, a genetic predisposition or particular temperament, for example, interacts with cultural factors to increase one’s susceptibility to developing the illness.

The Thin Ideal 

In discussions of cultural causes of eating disorders, we often mention society’s obsession with weight. We name the obsession as it’s reflected in body and diet commentary, weight-based bullying and bias, and idealized media imagery. Linking eating disorders to the internalization of the thin ideal, we promote positive body image as a protective measure. 

While a cultural value of thinness may indeed contribute to body dissatisfaction and eating disorder development, emphasizing body ideals as the only cultural factor has likely impeded the detection of eating disorders in Black populations. As Becky Thompson writes in A Hunger So Wide and So Deep, “The culture-of-thinness model has been used, erroneously, to dismiss eating problems among women of color based on the notion that they are not interested in or affected by a culture that demands thinness” (1994, p. 9). Extrapolating from a cultural appreciation for size diversity, the assumption has been that Black women are immune to eating disorders. Such race-based stereotypes have impacted clinicians’ ability to detect the illnesses in African-Americans (Gordon, Brattole, Wingate, & Joiner, 2006).

Contrary to these stereotypes, research shows that Black women are not protected from cultural standards of thinness and beauty. In studies on body dissatisfaction, Black participants experienced similar (Pumariega, Gustavson, Gustavson, Motes, & Ayers, 1994) or higher (Fernandes, Crow, Thures, & Peterson, 2010) rates of dissatisfaction than white participants. The internalization of a thin ideal seems to be more common in Black women who are highly acculturated to white culture. However, we still cannot assume that a drive for thinness is the primary factor underlying eating disorders in Black women. 

Racism and Other Contextual Factors

Often focused on the thin ideal and body dissatisfaction, our field largely overlooks the impact of other contextual factors on eating disorders in Black and other people of color. Experiences of racism, acculturative stress, and other race-related trauma influence how people of color exist in their bodies. These experiences negatively impact both physical and psychological health, but little research explores the effect of these stressors on the development of eating disorders specifically. As a means to cope with stress, eating disorders likely function as a response to these significant stressors. Our field must examine the link between eating disorders and racial discrimination, acculturation, and associated feelings of anxiety, lack of control, and lack of safety. 

Prioritizing Diverse Voices

Because our field still centers the stereotypical eating disorder experience in research, treatment, and popular culture, marginalized voices are the only experts of their experiences. As we push for inclusivity, we must make space for this expertise and these voices to be heard.

The following list includes books and articles about Black women’s lived experiences with eating disorders:   

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