Barriers to Eating Disorder Treatment and Care
Happy Eating Disorder Awareness Week 2024! In our last blog post, Brenna shared the different levels of care available for eating disorder treatment. While we are thankful there are a variety of levels of care to tend to each individual’s needs, there are quite a few barriers to eating disorder treatment and care. This is not an exhaustive list, but we hope it can increase your awareness and propel you to learn more.
Barriers to Eating Disorder Care
Awareness and Education
One of the most significant barriers to eating disorder care and treatment is awareness and education. In our culture, eating disorders are often portrayed as disorders only affecting cisgender (meaning your gender identity corresponds to the gender you were assigned at birth), heterosexual, affluent, thin, young white women.
In reality, this is far from the truth as eating disorders can impact people across the race, ethnicity, gender, sexuality, and ability spectrum. However, those with marginalized and intersecting identities are often misdiagnosed, underdiagnosed, overlooked, and face more barriers to receiving care.
BBIPOC (Black, Brown, Indigenous, People of Color) are about half as likely to be diagnosed with eating disorders as their white counterparts [1,2].
LGBTQIA+ youth are 3x more likely to have an eating disorder [3] and transgender college students are diagnosed with eating disorders at 4x the rate of their cisgender peers [4].
Those meeting diagnostic criteria for anorexia were 14x more likely to receive recommended treatment than those with atypical anorexia [5]. If you remember from our post on Anorexia Nervosa (AN) and Atypical Anorexia Nervosa (AAN), the only difference between the two is that individuals with AAN can have a weight that is within the ‘normal’ range. This statistic is a great example of weight bias and stigma in action.
Women are 5x more likely to be diagnosed with eating disorders compared to males, though men represent 25% of people with eating disorders [2,6].
If you’ve frequented our blog, you know most of our posts talk about diet culture. We encourage you to give that post a read, but the TL;DR version is:
diet culture is a system of beliefs - rooted in and upheld by white supremacy, anti-Blackness, ableism, capitalism, misogyny, and the patriarchy - that values thinness, promotes weight loss, demonizes certain ways of eating and bodies that do not fit unattainable standards deemed ‘healthy’.
These systems of oppression create barriers to education, treatment, and recovery for many individuals. In diet culture, eating disorder behaviors are praised and encouraged, meaning someone can be struggling and go without care. Weight stigma and size bias influence the way medical professionals treat folks in larger bodies and eating disorders will often go unnoticed, again, preventing care. Systemic racism and discrimination increase the rate of BBIPOC folks developing eating disorders, especially Binge Eating Disorder (BED) and Bulimia Nervosa (BN) [7].
Location & Cost
The cost of medical care, including eating disorder treatment at all levels of care, is outrageous. Paying for eating disorder care out of pocket is significant, costing hundreds to thousands of dollars per week, depending on the level of care. While insurance can help ease the financial burden, it’s never guaranteed that an insurance company will pay for the level of treatment an individual needs, for the length of time they need it, or at a location close to their home.
Some insurance companies also use BMI as part of their criteria for assessing the level of care a client needs. Remember that only 6-8% of people diagnosed with an eating disorder fall in the ‘underweight’ category [8]. Using BMI as a criterion for access to care is harmful and can further play into the individual belief of not being ‘sick enough’. Additionally, when receiving eating disorder care, especially care outside of outpatient treatment, individuals must also consider things like childcare, time off of work, distance from their support system, provider-to-client ratios at facilities, provider cultural humility, provider level of eating disorder education, and more.
Personal Factors
We’ve talked before about how eating disorders are emotional management systems. Because of this, eating disorders tend to serve a purpose for individuals. Whether it be a form of protection, a way to assimilate or fit into diet culture, the most supportive tool to help manage systemic oppression, or a device to ease the effects of trauma, it can be difficult to consider a life without your eating disorder and move toward recovery.
The guilt and shame associated with eating disorders are real and significant and can prevent a person from asking for help or even believing they are worth recovering. Not feeling ‘sick enough’ is a belief that many with eating disorders have, in part due to our cultural messaging around what ‘qualifies’ as an eating disorder and what counts as being ‘sick enough’ to receive treatment. If family members or others in your support system also hold these same beliefs, it can make getting help even more difficult.
Moving Forward
To learn more about the plethora of barriers to eating disorder treatment and care, check out Project Heal’s comprehensive overview. Project Heal is an amazing organization working to break down systemic, financial, and healthcare barriers to eating disorder treatment! We encourage you to learn more about eating disorders this week via social media and other outlets. For some of our favorite educators, activists, and content creators, check out our resource guide. If you or someone you know is struggling with an eating disorder and needs help, please fill out our contact form.
Resources Used:
[1] Cheng, Z. H., Perko, V. L., Fuller-Marashi, L., Gau, J. M., & Stice, E. (2019). Ethnic differences in eating disorder prevalence, risk factors, and predictive effects of risk factors among young women. Eating Behaviors, 32, 23–30. https://doi.org/10.1016/j.eatbeh.2018.11.004
[2] Sonneville, K. R., & Lipson, S. K. (2018). Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. International Journal of Eating Disorders, 51(6), 518–526. https://doi.org/10.1002/eat.22846
[3] Milsom, R. (2021). Growing up LGBT+: The impact of school, home, and coronavirus on LGBT+ young people. Just Like Us. https://www.justlikeus.org/wp-content/uploads/2021/11/Just-Like-Us-2021-report-Growing-Up-LGBT.pdf
[4] Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender Identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health, 57(2), 144–149. https://doi.org/10.1016/j.jadohealth.2015.03.003
[5] Moreno, R., Buckelew, S. M., Accurso, E. C., & Raymond-Flesch, M. (2023). Disparities in access to eating disorders treatment for publicly-insured youth and youth of color: a retrospective cohort study. Journal of Eating Disorders, 11(1). https://doi.org/10.1186/s40337-022-00730-7
[6] Sweeting, H., Walker, L., MacLean, A., Patterson, C., Räisänen, U., & Hunt, K. (2015). Prevalence of eating disorders in males: a review of rates reported in academic research and UK mass media. International Journal of Men’s Health, 14(2). https://doi.org/https://doi.org/10.3149%2Fjmh.1402.86
[7] Raney, J.H., Al-Shoaibi, A.A., Shao, I.Y. et al. Racial discrimination is associated with binge-eating disorder in early adolescents: a cross-sectional analysis. J Eat Disord 11, 139 (2023). https://doi.org/10.1186/s40337-023-00866-0
[8] Harrop, E.N., Mensinger, J.L., Moore, M. & Lindhorst, T. (2021). Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature. International Journal of Eating Disorders: 54(8); 1328-1357
Collaborative Counseling & Nutrition is an outpatient nutrition and body image counseling center, with locations in Indianapolis and Carmel, that provides compassionate, holistic eating disorder treatment. Through practicing mindfulness, intuition, and Health At Every Size, we are on a mission to help you find a true state of well-being! We take an anti-diet, weight-inclusive approach with all our clients and work to help guide you towards a way of healthy living designed by you, just for you! This post is for education purposes only and should not be used as a substitute for treatment for an eating disorder. If you are looking for a registered dietitian or therapist to assist you on your recovery journey, please reach out today!
