Eating Disorders in Latinxs: Lessons Learned From History
The 10th Annual Veritas Collaborative Symposium on Eating Disorders, co-hosted by The Emily Program, will unite healthcare professionals and eating disorder experts around this year’s theme, “Engaging Science, Unifying Voices, and Transforming Access.” In this article, Mae Lynn Reyes-Rodríguez, PhD, FAED, a speaker at this year’s Symposium, discusses the prevalence of eating disorders in the Latino population and underscores the need for culturally competent care.
Eating disorders do not discriminate based on race or ethnicity. Actually, data from different national studies have shown that eating disorders in the Latino population are at similar or higher prevalence when compared with non-Latino Whites (Alegria et al., 2007; Marques et al., 2011; Udo & Grilo, 2018). However, due to the historical emphasis around European White females in the eating disorder field, most of the assessments and treatments have been developed and tested with and for this population. This is problematic because it has contributed to clinician bias and stigma, which are some of the barriers preventing Latinas to seek treatment for eating disorders (Reyes-Rodríguez et al., 2013). Moreover, the research about service utilization among individuals with a history of eating disorders reveals that Latinxs with bulimia nervosa (BN) and binge eating disorder (BED) are less likely to seek treatment when compared with non-Latino Whites (Coffino, Udo, & Grilo, 2019; Marques et al., 2011). This health disparity is concerning because BN and BED are the most prevalent eating disorders in this population (Perez, Ohrt, & Hoek, 2016). Other factors such as lack of health insurance, lack of bilingual services, and lack of information about services can be associated with this underutilization of services (Ali et al., 2017; Reyes-Rodríguez, 2013). The long history of misconception and negligence has negatively affected the early detection, prevention, and treatment for eating disorders in the Latino population.
History does not determine the future but can reshape it
History can be powerful if we choose to learn from it and make changes to construct a better present and future. Fortunately, during the past years, the awareness about how eating disorders are affecting diverse populations has progressively increased. However, much work needs to be done. In the United States, only two main cultural adaptations for evidence-based treatment (EBT) have been conducted in Latinas with binge-eating type eating disorders (Cachelin et al., 2019; Cachelin et al., 2014; Reyes-Rodríguez, Baucom, & Bulik, 2014; Reyes-Rodríguez, Watson, Smith, Baucom, & Bulik, 2021). Using a form of cognitive behavioral therapy (CBT) for binge-eating type eating disorders, these cultural adaptation studies found that CBT was feasible, with good acceptance and effectiveness. Although no major changes were required on the content of the CBT, cultural adaptations in the delivery process are recommended to improve engagement and retention, especially for those less acculturated. The integration of central values in Latino culture such as familism and personalism in addition to bilingual services, treatment at low or no cost, flexibility in order to be responsive to their needs, integrating family or addressing family criticism, and food centrality are some of the cultural adaptations necessary in order to provide a culturally sensitive treatment for Latinas. No cultural adaptations have been published for evidence-based treatment for anorexia nervosa (AN) or for Latino males with any type of eating disorder.
In the direction of continuing to reshape the future, it is essential to focus on early detection, education, and making culturally sensitive treatments more accessible to Latinxs. Considering that Latinxs tend to underutilize specialized treatment, primary care and community settings can be optimal settings for assessment and treatment delivery. Raising awareness and educating primary care physicians about the importance of screening Latinxs for eating disorders on a regular basis ̶ same as it has been established for depression, anxiety, and other mental health disorders ̶ is one of the first steps. Meanwhile, when providers encounter a Latinx patient, the following is recommended:
- Identify any cultural adaptation (clinical trial, case report) that could inform you about potential modifications to treatment.
- In the case that a cultural adaptation has not been published, use the current EBT but with an open mind and flexibility to incorporate modifications based on literature review, treatment progress, and feedback from patient and/or relatives.
- Get well informed about cultural values that are relevant for Latinxs.
- Recognize your own biases that could interfere with the treatment and determine if a referral is the best course of action.
Recent work about cultural adaptations for diverse populations was published with the intention to provide a practical guide for providers and professionals in the eating disorder field (Reyes-Rodríguez & Franko, 2020). We need to continue making efforts in order to reduce health disparities. If providers and professionals in the field are educated and aware of how to change the misconception that has marked our past, we can begin to make the present and future more fair and equitable.
About the Author
Dr. Mae Lynn Reyes-Rodríguez is clinical associate professor at the Psychiatry Department of the University of North Carolina at Chapel Hill. She is fellow of the Academy for Eating Disorders (AED) and Expert of Content for the National Center of Excellence for Eating Disorders (NCEED). As a researcher and clinical psychologist, she has devoted her clinical research career to adapt eating disorders treatments for the Latino population in Puerto Rico during her early career and later with Latinos in the mainland, particularly in Central North Carolina. She has published numerous papers and book chapters on cultural adaptation. She is actively involved in the Latino community as a columnist in one of the main Latino Newspapers in NC, La Noticia, in which she provides psychoeducation on mental health in order to raise the awareness and reduce the health disparities.
Alegria, M., Woo, M., Cao, Z., Torres, M., Meng, X. L., & Striegel-Moore, R. (2007). Prevalence and correlates of eating disorders in Latinos in the United States. Int J Eat Disord, 40 Suppl, S15-21. doi:10.1002/eat.20406
Ali, K., Farrer, L., Fassnacht, D. B., Gulliver, A., Bauer, S., & Griffiths, K. M. (2017). Perceived barriers and facilitators towards help-seeking for eating disorders: A systematic review. Int J Eat Disord, 50(1), 9-21. doi:10.1002/eat.22598
Cachelin, F. M., Gil-Rivas, V., Palmer, B., Vela, A., Phimphasone, P., de Hernandez, B. U., & Tapp, H. (2019). Randomized controlled trial of a culturally-adapted program for Latinas with binge eating. Psychol Serv, 16(3), 504-512. doi:10.1037/ser0000182
Cachelin, F. M., Shea, M., Phimphasone, P., Wilson, G. T., Thompson, D. R., & Striegel, R. H. (2014). Culturally adapted cognitive behavioral guided self-help for binge eating: a feasibility study with Mexican Americans. Cultur Divers Ethnic Minor Psychol, 20(3), 449-457. doi:10.1037/a0035345
Coffino, J. A., Udo, T., & Grilo, C. M. (2019). Rates of Help-Seeking in US Adults With Lifetime DSM-5 Eating Disorders: Prevalence Across Diagnoses and Differences by Sex and Ethnicity/Race. Mayo Clin Proc, 94(8), 1415-1426. doi:10.1016/j.mayocp.2019.02.030
Marques, L., Alegria, M., Becker, A. E., Chen, C. N., Fang, A., Chosak, A., & Diniz, J. B. (2011). Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders. Int J Eat Disord, 44(5), 412-420.
Perez, M., Ohrt, T. K., & Hoek, H. W. (2016). Prevalence and treatment of eating disorders among Hispanics/Latino Americans in the United States. Curr Opin Psychiatry, 29(6), 378-382. doi:10.1097/YCO.0000000000000277
Reyes-Rodríguez, M., Ramírez, J., Patrice K., Rose, K., Bulik, C.M. . (2013). Exploring barriers and facilitators in the eating disorders treatment in Latinas in the United States. Journal of Latina/o Pychology, 1, 112-131.
Reyes-Rodríguez, M. L., Baucom, D.H., Bulik, C.M. (2014). Culturally sensitive intervention for Latina women with eating disorders: A case report. Mexican Journal of Eating Disorders, 5, 135-146.
Reyes-Rodríguez, M. L., Franko, D. L. (2020). Cultural adaptations of evidence-based treatments for eating disorders. In A. B. G. Christina C. Totolaini, & Daniel Le Grange (Ed.), Adapting evidence-based eating disorder treatments for novel populations and settings: A practical guide (pp. 3-30). New York: Routledge.
Reyes-Rodríguez, M. L., Watson, H. J., Smith, T. W., Baucom, D. H., & Bulik, C. M. (2021). Promoviendo una Alimentacion Saludable (PAS) results: Engaging Latino families in eating disorder treatment. Eat Behav, 42, 101534. doi:10.1016/j.eatbeh.2021.101534
Udo, T., & Grilo, C. M. (2018). Prevalence and Correlates of DSM-5-Defined Eating Disorders in a Nationally Representative Sample of U.S. Adults. Biol Psychiatry, 84(5), 345-354. doi:10.1016/j.biopsych.2018.03.014