Eating Disorders in Minoritized Communities
Today, we are sharing an introduction post to eating disorders in marginalized, minoritized, and underrepresented communities. We will cover statistics, stereotypes, and barriers to diagnosis and treatment. Keep an eye out for upcoming posts covering eating disorders in these groups (ie. EDs in the Black Community; EDs in the LGBTQIA2+ Community, etc.).
EDs in Minoritized Communities
When you think of someone with an eating disorder, who do you envision? You might picture a thin or emaciated white woman. She’s likely affluent and young, probably cisgender (meaning your gender identity corresponds to the gender you were assigned at birth). In our culture, many people believe eating disorders only affect those who fall into the SWAG (skinny, white, affluent, girl) stereotype. This not only impacts the cultural perception of who can be affected by an eating disorder but can make it difficult for those outside of the SWAG stereotype to be assessed or screened for an ED and even receive treatment.
If you remember from previous posts, 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.
Intersectionality
Intersectionality is a term first coined by Dr. Kimberle Crenshaw, Civil Rights Advocate and Critical Race Theory Scholar, in 1989. It’s the study of how intersecting social identities are impacted by systemic oppression. We see the impact of intersectionality in eating disorder diagnosis and treatment. Check out the stats below.
Eating Disorders in Minoritized Communities Statistics
BBIPOC (Black, Brown, Indigenous, People of Color) are about half as likely to be diagnosed with eating disorders as their white counterparts [1].
Less than 8% of people struggling with eating disorders are classified as ‘underweight’ [1].
LGBTQIA+ youth are 3x more likely to have an eating disorder and transgender college students are diagnosed with eating disorders at 4x the rate of their cisgender peers [1].
Women are 5x more likely to be diagnosed with eating disorders compared to males, though men represent 25% of people with eating disorders [1].
Higher levels of body dissatisfaction and negative attitudes toward ob*sity were reported in Asian American college students than their non-Asian BIPOC peers [1].
In women over 50, 41% have current or previous core eating disorder symptoms, divided into 13.3% who have current and 27.7% with past symptoms [1].
Men with eating disorders tend not to recognize their symptoms as problematic, in part due to the stereotype of eating disorders as being a “woman’s problem [1]”.
In reports from transgender folks, 32% report using their eating disorder to modify their body without hormones, such as to reduce curves or halt menstruation. Even so, 56% of transgender people with eating disorders believe their disorder is not related to their physical body [1].
Of those who have experienced weight stigma, two-thirds were stigmatized by doctors, leading many to avoid seeking healthcare [1].
People who experience weight discrimination are 60% more likely to die [1].
Black and Latinx lesbian, gay, and bisexual folks have at least as high a prevalence of eating disorders as white lesbian, gay, and bisexual folks [2].
Among males who have eating disorders, 42% identify as gay [2].
One study found Hispanics were significantly more likely to suffer from bulimia nervosa than their non-Hispanic peers.
Minority groups tend toward a higher prevalence of binge eating disorder in all minority groups [2].
Gay males were 7x more likely to report binging and 12x more likely to report purging than heterosexual males [2].
These statistics are SIGNIFICANT and truly underscore the need for accurate screenings and assessments, increased education on how eating disorders manifest in marginalized communities, easier access to treatment, and increased awareness and support.
Barriers to treatment
Eurocentric Beauty Standards + Fatphobia + Systemic Oppression
We know diet culture is rooted in anti-Blackness and anti-fatness. Eurocentric beauty standards of being thin or smaller and having lighter or white skin are seen as more desirable and acceptable. When you take into consideration that one of the tools used to categorize body size, the BMI, and its racist roots, you can more clearly see how those living at the intersection of different identities (Black, fat, or living in a larger body, disabled, etc.) face discrimination.
Cost of + Access to Treatment
We can write another blog post on the cost of eating disorder treatment in the United States and how capitalism’s profit-over-people model impacts access to quality care and treatment. The average cost of eating disorder treatment can cost upwards of $30,000 - $60,000 [3,4]. The University of San Diego estimates that an average eating disorder episode can cost up to $80,000 [3]. Insurance coverage also plays a significant role, with some insurance companies only covering certain levels of care or not covering treatment due to prior treatment history or leaving treatment early.
One study found that of adolescents aged 11-25 who were malnourished due to an eating disorder, only 40% received the recommended treatment. For those adolescents who used public insurance, only 1/3 received the recommended treatment compared to those with private insurance [5].
Childcare, time off of work, distance from a support system, provider-to-client ratios at facilities, provider cultural humility, provider level of eating disorder education, and more all impact access to care.
Cultural barriers
It’s significant to note, in one study, when clinicians were presented with identical case information that demonstrated disordered eating among Black, white, and Hispanic women, the clinicians were more than 50% less likely to identify the Black woman’s behavior and problematic and recommend that she receive professional treatment and care [5].
Clinicians must explore their implicit bias and take the time to better understand those from different cultural backgrounds. Food insecurity, poverty, cultural norms around food and bodies, cultural norms regarding the discussion and care of mental health issues, cultural norms around families, and more can all impact access to quality treatment [7].
Moving Forward
There is a lot of work to be done in the field when it comes to education and access to treatment, especially for those with minoritized identities. We have upcoming blog posts focused on each underrepresented group highlighting how eating disorders manifest, what to look out for, barriers to care, and ways to find support. If you or someone you know is struggling with their relationship to food or body, the dietitians and therapists at Collaborative Counseling & Nutrition are here to help!
Resources Used:
[1] G, A. (2024, April 3). Eating Disorder Statistics | ANAD - National Association of Anorexia Nervosa and Associated Disorders. National Association of Anorexia Nervosa and Associated Disorders. https://anad.org/eating-disorder-statistic/
[2] NEDA: https://www.nationaleatingdisorders.org/statistics/
[3] Cost of Treatment - Project HEAL. (n.d.). Project HEAL. https://www.theprojectheal.org/cost-of-treatment
[4]Strickland, K., & Walden. (2022, September 28). I don’t have insurance: How can I get eating disorder treatment? Walden Eating Disorders. https://www.waldeneatingdisorders.com/blog/i-dont-have-insurance-how-can-i-get-eating-disorder-treatment/#:~:text=If insurance is not an,the National Eating Disorder Association.
[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] Gordon KH, Brattole MM, Wingate LR, Joiner TE Jr. The impact of client race on clinician detection of eating disorders. Behav Ther. 2006;37(4):319-325.
[7] Contributor, D. (2022, December 21). Eating Disorders in Minorities: Part 2. Center for Discovery. https://centerfordiscovery.com/blog/causes-for-eating-disorder-minorities/
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!
