Eating disorders have stereotypically been associated with slim, white, young, heterosexual, cisgender women. In reality, eating disorders can affect anyone, regardless of how they look or identify. Eating disorders are brain-based biological illnesses that have complex causes and require specialized care. However, the stereotypical idea of someone with an eating disorder has serious ramifications on who is diagnosed and who then receives proper treatment.
Historically, there has been a misconception that eating disorders affect only thin, young, white females. Early research was conducted on only white women, which led people to believe eating disorders were only a white woman’s disease. Despite most providers now knowing that this is false, the initial belief had serious implications for eating disorder treatment today.
This initial stereotype became ingrained in the larger society, with both patients and healthcare providers working under the assumption that eating disorders only happened in certain individuals. Not only did this lead to providers missing eating disorder diagnoses in people of color, but it also caused people of color to question if they really had disordered eating that was worthy of treatment.
While medical education has improved and the larger cultural dialogue is starting to shift toward the understanding that eating disorders can affect all individuals, traces of the initial bias remain. The National Eating Disorders Association (NEDA) states, “People of color—especially African Americans—are significantly less likely to receive help for their eating issues.” Despite the underdiagnosis and undertreatment, people of color are as much at risk for developing an eating disorder as their white peers—or even more. NEDA provides the following facts:
Despite the facts above, it is clear that individuals of color are diagnosed significantly less than their white peers. One study revealed the discrepancy between diagnosis rates, shedding light on the finding that people of color are significantly less likely to receive care because their symptoms are overlooked or misunderstood.
The study presented clinicians with identical case studies demonstrating disordered eating symptoms in white, Hispanic, and Black women and asked them to identify whether the eating behavior was problematic. Of the clinicians, 44% identified the white woman’s eating behavior as problematic, 41% identified the Hispanic woman’s behavior as problematic, and only 17% of clinicians identified the Black woman’s behavior as problematic.
As these results show, the misconception that only young, thin, white women experience eating disorders appears to have had a tangible effect on the clinicians. Though these clinicians were most likely well-meaning, implicit bias and popular stereotypes could have led them to miss the signs of an eating disorder in the Black women in the study. This shows the real-life impact that misconceptions about eating disorders can have on the lives of people of color.
People of color may find themselves more vulnerable to the development of an eating disorder due to the complex stressors placed on them. People in marginalized communities often experience multiple traumas and microaggressions due to their race, including discrimination, increased sexism, abuse, poverty, body shaming, and more. In addition, people of color experience body shame that is different than their white peers and may pressure them to white “ideals” of a certain body shape or hair type. Eating disorders, in turn, may be a response to this accumulation of stress, or they may be due to a variety of other factors including genetics, biology, psychology, and environment.
It is true that eating disorders can affect anyone and we know that they affect different races relatively equally. It is also true that providers are struggling to shift to this understanding, as we can see in studies like the one where only 17% of clinicians were able to identify an eating disorder in a Black woman. In addition to a lack of provider understanding, people of color often experience additional barriers to seeking treatment, such as a lack of information, a lack of accessible treatment centers, and a lack of representation in the recovery world.
Eating disorders in people of color often have similar warning signs and symptoms as they do in white patients, including increased body talk, concerns about appearance, weight fluctuations, body dysmorphia, and strange food behaviors. In addition to this, people of color may have eating disorders that have nothing to do with weight specifically. Psychologist Marcella Raimondo says she hears common complaints from her eating disorder patients, including, “I didn’t like my eyes. I didn’t like my hair texture. I didn’t like the size of my butt. I didn’t like my nose. My skin color is too dark.” Raimondo states that one warning sign is if individuals are unhappy with their daily existence—that can also mean they are unhappy with their body and that an eating disorder screening is especially vital.
Raimondo states that it is important for providers to ask all patients questions about their daily life. These questions can include:
These questions can alert you to the signs of an eating disorder. Additionally, our Eating Disorder Assessment Quiz is a very simple and straightforward questionnaire that addresses people across eating disorder diagnoses. If you suspect an eating disorder in one of your patients, refer them to a specialty provider like The Emily Program for a full assessment.
If you are a medical professional and wondering how you can better serve people of color with eating disorders, you can…
Keep growing. These are just some ways to become stronger allies to people of color and we hope everyone will keep pushing themselves to learn more and to become more accepting. Everyone, no matter their identity, deserves to have their eating disorder properly recognized and treated. Together we can challenge harmful eating disorder stereotypes so that each patient gets the help they need.
Think one of your patients may be struggling with an eating disorder? Learn the warning signs and symptoms of eating disorders on our website.
Call 888-364-5977 for help now.
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