FROM THE EMBODY LIB BLOG ARCHIVES:
We know that Eating Disorders (ED) can severely harm physical, mental, and socio-emotional health. But Eating Disorders are not only prevalent in white, thin, heteronormative and affluent communities; they affect people of all races and ethnicities, body sizes, genders, sexual orientation, and socioeconomic statuses. Until recently, ED was considered the most lethal mental illness (now it is second to opioid addiction). Yet, tens of millions of people, especially from Latinx and Black communities, remain undiagnosed. In light of National Eating Disorder Awareness Week, Embody Lib wants to dig deeper into the possible reasons of why that is.
A common misconception is that Latinx and Black communities just don’t experience Eating Disorders at the same rates as their white counterparts. In reality, bulimia nervosa (BN) is found to be more prevalent among Latinx and African Americans than non-Latinx whites. In one study, the prevalence of anorexia nervosa (AN) and binge-eating disorder (BED) were similar across white, black, and Latinx test subjects. The same study found that lifetime prevalence of disordered eating, such as binge eating, was greater among each of the study’s ethnic minority groups in comparison to non-Latino Whites. (Marques, Becker, Chen, et al 2011). If studies show that diagnosis rates are about the same across the board why don’t we hear more about the impact of disordered eating and Eating Disorders in these communities of color?
Bulimia nervosa (BN) is found to be more prevalent among Latinx and African Americans than in non-Latinx white individuals. - Marque, Becker, Chen, et al. (2011)
There is discussion as to why Latinx and BIPOC might be at higher risk of developing eating disorders. Some think that acculturation, adopting the cultural norms of the majority culture as their own as a way to gain acceptance, plays a big part in communities of color developing ED. Due to the intense pressure to conform to White European beauty ideals, women of color often resort to disordered eating and exercise behaviors to obtain it. Studies have shown that higher levels of acculturative stress may result in increased bulimic symptoms and body dissatisfaction.
While acculturation might be a factor in the development of disordered eating which can lead to an Eating Disorder, it must be noted Latinx and African American Beauty ideals put just as much pressure on women to achieve and sustain a certain body shape and size. While this shape can be misconstrued as more corpulent than the White European beauty ideal, it still values slimness as the most desirable trait in a woman. This ideal of a slim waist, wide hips, and full breasts and buttocks still confine women to one certain body type and many go to great lengths (usually through disordered and dangerous means) to achieve it.
Aside from acculturation, BIPOC and many Latinx women in the US typically experience substantially more stress and trauma from embodying intersecting identities. Being exposed to other factors that stem from systemic oppression (such as racism, abuse, and poverty) in addition to discrimination based on their gender, can make Latinx and Black women more vulnerable to Eating Disorders.
Cultural and interpersonal barriers such as feelings of shame, fear of stigma, a belief that one should be able to help oneself, inadequate insurance coverage or financial resources, lack of awareness that a formal disorder exists and that treatments are available, and lack of confidence in healthcare providers also hinder these populations in seeking diagnosis and treatment (Cachelin & Striegel, 2006).
However, we must also examine the systemic challenges that keep healthcare providers from taking Eating Disorders symptoms in Latinx and Black individuals seriously enough to provide a diagnosis and access to treatment. In one study, 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)
According to the National Eating Disorder Association (NEDA) website, when presented with identical case studies demonstrating disordered eating symptoms in white, Hispanic and Black women, clinicians were asked to identify if the woman’s eating behavior was problematic. Results showed that:
44% identified the white woman’s behavior as problematic;
41% identified the Hispanic woman’s behavior as problematic,
and only 17% identified the Black woman’s behavior as problematic.
The clinicians were also less likely to recommend that the Black woman should receive professional help (Gordon, Brattole, Wingate, & Joiner, 2006).
Even if there was a diagnosis, studies show that treatment utilization for respondents with a lifetime history of any eating disorder was higher for non-Latino whites than for Latinx or African American individuals. Findings from community-based research indicate that the small percentage of Latinx women who do seek treatment for Eating Disorders typically visit primary care physicians. Often, the primary care provider will minimize or dismiss the symptoms based on body size and address weight status by prescribing restrictive diets, but completely miss the opportunity to recognize and treat the underlying ED (Cachelin & Striegel, 2006).
If we are going to address the severity of Eating Disorders in Latinx and Black communities, we must recognize the importance of access to quality healthcare, equitable and compassionate health providers, and culturally responsive treatment options. Unfortunately for many individuals in Black and Latinx communities, this is out of reach.
Resources Cited and Further Reading:
Becker, A. E., Franko, D. L., Speck, A., & Herzog, D. B. (2003). Ethnicity and differential access to care for eating disorder symptoms. International Journal of Eating Disorders, 33(2), 205-212. doi:10.1002/eat.10129
Cachelin, F. M., Gil-Rivas, V., & Vela, A. (2014). Understanding eating disorders among Latinas. Advances in Eating Disorders: Theory, Research and Practice, 2(2), 204-208.
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. International Journal of Eating Disorders, 44(5), 412-420.
The Emily Program (2019) How Healthcare Providers can Identify Eating Disorders in Non-White Patients. https://emilyprogram.com/blog/how-healthcare-providers-can-identify-eating-disorders-in-non-white-patients/
Rittenhouse, Margot. (2016) Identifying Eating Disorder Issues in the African American Community. Eating Disorder Hope. https://www.eatingdisorderhope.com/blog/identifying-eating-disorder-issues-in-the-african-american-community
NEDA Links:
https://www.nationaleatingdisorders.org/sites/default/files/marginalized_voices_web_0.pdf
https://www.nationaleatingdisorders.org/people-color-and-eating-disorders