How Healthcare Providers Can Identify Eating Disorders in People of Color

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.

Consequences of the Thin, White Woman Stereotype

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.

People of Color and Eating Disorders

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:

1. Black teenagers are 50% more likely than white teenagers to exhibit bulimic behavior, such as bingeing and purging (Goeree, Ham, & Iorio, 2011).
2. Hispanic individuals are more likely to suffer from bulimia than their non-Hispanic peers (Swanson, 2011).
3. Asian, Black, Hispanic, and Caucasian youth all report attempting to lose weight at similar rates, while 48% of Native American adolescents were attempting weight loss (Kilpatrick, Phannessian, & Bartholomew, 1999).
4. People of color with self-acknowledged eating and weight concerns were significantly less likely than white participants to have been asked by a doctor about eating disorder symptoms, despite similar rates of eating disorder symptoms across ethnic groups (Becker, 2003).

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 Be More Vulnerable to Eating Disorders

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.

How Eating Disorders Present in People of Color

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:

• “How are you taking care of yourself?”
• “Are you skipping breakfast?“
• “How much are you exercising?” 

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.

How to Do Better

If you are a medical professional and wondering how you can better serve people of color with eating disorders, you can…

• Acknowledge your bias. It is important for providers to understand their own inherent biases. By recognizing them, providers are able to get outside of them and treat all individuals equally—or to acknowledge when they lack expertise and make the appropriate referral.
• Ask questions. All medical professionals should be alert for eating disorder signs and symptoms. We know eating disorders do not just have to do with weight, so it is important that providers ask patients questions about their eating habits, body image, and more.
• Make referrals. It is okay not to be an expert on everything. If you feel unsure about a patient or a patient’s care, make a referral to someone who is better equipped to aid them.
• Be an educated advocate. Attend trainings and read research on individuals with identities and experiences different from your own. Become aware of other experiences and manifestations of illnesses. Ask questions of those around you and always strive to learn more and do better.

If You Are a White Individual Wanting to Be an Ally for People of Color, You Can…

• Acknowledge your biases. 
• Once you listen to other’s experiences, try to understand them, and ask how you can help.
• Get educated. Attend trainings, have conversations, and read other people’s stories. If you have questions about someone else’s culture, do your own research first before asking others to educate you. Oftentimes, people of color spend a large amount of time educating those around them on racism and this can become an unnecessary burden. So, before you ask someone else to do the work, try to do it for yourself.
• Do not assume your experience is everyone’s. All people have complex, unique experiences. Approach everyone as if they have their own story that you know nothing about. Be kind and be curious.
• Use your privilege and speak up. If someone is saying something racist, sexist, uneducated, or harmful, speak up. While correcting people or having tough conversations can be challenging, it is important work to do.
• If you make a mistake, do not make it into a bigger mistake. Offer a specific, well-thought-out apology, move on, and do better.

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.