If someone brought up the subject of eating disorders, it wouldn’t be surprising if the first thing that came to mind was an image of a slim caucasian woman. This stereotype can make it easy for Black people to overlook eating disorders, a reality that plagues our communities too.
“It’s been labeled as such a white woman’s disease that a lot of times when I see adolescents, their parents don’t pick up on the symptoms of the eating disorder until their teen or young adult is really sick,” says Whitney Trotter, a registered dietician who specializes in eating disorders. By the time families realize something is wrong, she says the illness may be so far gone the affected person ends up hospitalized or needing a higher level of care.
Eating disorders are a mental illness that 28.8 million Americans will struggle with during their lifetime according to the National Association of Anorexia Nervosa and Associated Disorders. They can affect people of all ages, be it a 5-year-old, teens, young adults, and even older adults. Because people of color are still unlearning stereotypes around mental health, this may be another reason eating disorders are overlooked.
There are multiple types that exist. While they differ, at the core, all of them comprise eating habits that negatively impact one’s health. One that is common in the Black community according to Trotter is bulimia.
“It’s the binging that is accompanied by a compulsive symptom, whether that’s purging, laxative use, excessive exercise,” she explains. “I see that pretty heavily in the Black community [with] males and females and those who are non-binary.”
Other types of eating disorders that exist include anorexia nervosa, which is characterized by a distorted body image and obsession with weight loss and calorie counting. There’s also binge-eating disorder—when individuals eat large quantities of food at once and experience shame or depression after.
Disparities in Diagnosis and Treatment
It is easy for healthcare providers to overlook eating disorders among Black individuals, especially when it comes to conditions like anorexia and binge eating, says Trotter.
“For Black people, what I see clinically is we don’t get the diagnosis of anorexia or binge purge subtype because we go through puberty differently compared to a lot of our peers, specifically our white peers. And so with anorexia, a lot of providers won’t even diagnose you unless your BMI is under a certain threshold,” she says.
People who suffer from anorexia have a tendency to binge and purge–when you restrict or limit food intake. Some other symptoms of anorexia beyond being underweight include insomnia, dizziness or fainting, dry and yellowish skin, thinning hair, dehydration and eroded teeth. Behaviors associated with the condition may include a preoccupation with weight, shuffling food around one’s plate or excessively cutting food.
Aside from being underdiagnosed, Black people are also less likely to receive the medical help they need, according to ANAD. It can get tricky when treating eating disorders as an individual may need a combination of services simultaneously.
“If I have somebody who is excessively purging, I need them to see a dentist. They also need to see a GI doctor for the possible esophageal erosion. So it’s hard kind of coordinating those services sometimes too, because we have often in the black community, particularly in the south, a mistrust of medical providers and rightfully so,” Trotter says.
Common treatments for eating disorders include psychotherapy, education and meal planning with a dietician, as well as medical services to address any physical damage caused by the condition. Not only do Black people struggle with trusting healthcare providers, but the high cost of treatment can also make getting help inaccessible. “I’ve had families that have had to take out second mortgages on their house to pay for treatment,” she says.
Working Towards a Positive Body Image
We know pop culture and the media heavily influences how we see our bodies. Within the Black community, curvy and “thick” bodies are often praised as the prototype. This can put pressure on women who don’t fit that description and create unhealthy behaviors. While men struggle with anorexia, bulimia and bingeing too, women are two times more likely to deal with such conditions according to a 2018 report on the economic cost of eating disorders.
“There can be this negative association or negative perception if one’s body doesn’t kind of fit the Black stereotype or the Black mold and it’ll drive or kind of reinforce some of those eating disorder behaviors to be a particular shape and size.”
It’s also important to not assume that women who do fit the mold and have that idealized body in our community don’t also struggle with eating disorders. Remember, not everyone who has an eating disorder is visibly sick or underweight.
“I think there’s a misconception that particularly those who are assigned female at birth or identify as a female, we all love our body and we all love our curves,” says Trotter.
While eating disorders can’t always be prevented and for the most part, the causes are unknown, we can do our part as a society to be mindful about what we say about other people’s bodies. That means keeping comments about how thin or round someone has become to yourself.
To create a better culture around body image, it’s imperative we embrace all body types, remembering that there is beauty in range and diversity. All bodies cannot and don’t need to look the same. Trotter also advises communities of color to begin having open and honest conversations about body image, self-esteem as it relates to our bodies, and food as a preventive measure.
Getting Help
Eating disorders are one of the deadliest illnesses, with an estimated 10,200 people dying annually from them. If affected individuals get help quickly, they don’t have to result in death.
As mentioned earlier, getting treatment for an eating disorder can be expensive, but there are alternatives. Some providers do sliding scale rates, which is when they work with your income or budget. Some other resources include the following:
- Project Heal, a national non-profit working towards increasing access to treatment for eating disorders through scholarships of financial assistance.
- National Eating Disorder Association’s website offers a list of virtual or in-person support groups. They also have a hotline, online chat, and text service.
- The Loveland Foundation can help with free therapy, which is usually one treatment option for people with eating disorders.