Eating Disorders (outside the perspective of thin, young, affluent, white girls)
Jessica Chang, MHC-LP
The stereotypical association of eating disorders and thin, young, affluent white girls has long been recognized. But if one struggles with disordered eating habits and identifies outside of those categories, the associated journey can feel utterly isolating - which is astounding, alarming, and heart-wrenching given the facts…
Facts on Eating Disorders
Eating disorders have the highest mortality rate of all mental illnesses, second only to deaths from opiate overdose (Bulik, 2022). Prevalence of global eating disorders increased from 3.4% to 7.8% solely in the year of 2022 (Salazar, 2023). According to the National Eating Disorder Association (NEDA), around 24 million people in the United States suffer from an eating disorder, which is a serious number and most likely a ridiculous underestimation considering underdiagnosing and underreporting. In 2020, the first year of COVID-19, the number of people seeking treatment for eating disorders in the U.S. spiked; rates continued to rise until April 2021 and have not returned to baseline since then (Holcombe, 2022).
Outside the “General Population”
Epidemiological data shows those who suffer from eating disorders include individuals of all genders, sexual orientations, ages, ethnicities, and socio-economic status (Qian et al., 2021). In fact, in recent years, the occurrence of eating disorders has been increasing amongst men, older adults, gender and sexual minority individuals, ethnic minority groups, and adults with disabilities (Halbeisen et al., 2022). In comparison to White, cis-gender women, higher frequency of eating disorders have been found among Asian American men, Black women, transgender, and other sexual minority folk (Halbeisen et al., 2022). In addition to being disproportionately at risk for eating disorders, minority populations are more likely to be uninsured or have public health insurance, greatly limiting access to care in the increasingly privatized sector of eating disorder treatment (Goetz, 2022). The National Association of Anorexia Nervosa and Associated Disorders (ANAD) lists more encompassing statistics pertaining to eating disorders amongst the general US population as well as health disparities which exist amongst BIPOC, LGBTQ+, people in larger bodies, athletes, veterans, and children and young adults (2023). Although current research is scarce pertaining to those with multiple intersecting marginalized identities, preliminary findings suggest that those with intersecting identities (e.g. ethnic and gender minority status) are at greater risk for eating disorders than the risk of each feature separately (Halbeisen et al., 2022).
Stigma and Biases
So how is it that the avatar of eating disorders is so homogeneous? What is keeping the spotlight away from minority communities who are disproportionately suffering when compared to thin, young, affluent, white women? In large part, stigma related to eating disorders and mental health is still pervasive, and these biases are perpetuated at times by societal messages, medical professionals, as well as what is communicated within one’s own community. The next section of this article will focus specifically on BIPOC, LGBTQ+, and QTBIPOC communities.
BIPOC communities
BIPOC are significantly less likely to be asked by a doctor about eating disorder symptoms, and additionally, those with eating disorders are less likely to be diagnosed or to receive treatment (ANAD, 2023). They are also less likely to be offered help and to seek help for their eating disorder (Goetz, 2022).
Within their own communities, BIPOC may be discouraged from speaking about or acknowledging their eating disorders, seen as a weakness or embarrassment, or an invalid experience. As food and the ritual of eating holds cultural value for many BIPOC communities and may serve as a type of love language, conflict may arise between family members and within one’s internal schema. One may feel shame, embarrassment, stupidity, and/or confusion, to name a few possibilities. As people are made to feel like there is no space for their mental health struggles, the silence within communities may continue.
LGBTQ+ communities
Gender and sexual minorities may experience various social pressures such that they feel the need to fit into cis-gendered, straight society while simultaneously trying to fit into queer spaces. Nonbinary representation accepted by society almost always looks thin, white, and Eurocentric, and eating disorders may develop in attempts to be accepted by one’s own community. Conformity may be an act of survival for trans and other queer folk. Disordered eating is such a pervasive experience within queer spaces that having an eating disorder may be seen as a rite of passage in one’s LGBTQ+ community. Acknowledging one’s eating disorder may bring up distress surrounding one’s identity. Further, disordered eating may feel like one’s last option for attaining a body that aligns more with one’s gender identity or perception of self.
Intersectional identities
QTPOC may feel as though they need to look a certain way to be accepted in both their racial/ethnic communities and in queer spaces. They may face double beauty standards imposed by various communities. CBC News released an article on how beauty standards for LGBTQ people impact body image and mental health which highlights the voices of queer folk and specifically queer folk of color (Dayal, 2022). A theme of the article articulates how one’s body is a form of currency in the queer community, especially for BIPOC. A quote from the article states: “Fatphobia is worse in the queer community than a lot of intersectional layers of racism and oppression because if you're a good looking fit ethnic person, you'll be tokenized but at least accepted.”
Final thoughts
In all, there is much work to be done in the field of eating disorders and in society when it comes to mental illnesses. However, this is not an isolated journey. Disordered eating is not confined to one’s own kitchen. It impacts interpersonal relationships, family dynamics, romantic connections, ability to function, both physically (e.g., driving a car) and mentally, body cycles (e.g., menstrual cycles and body temperature regulation), skin and hair health, travel plans, social plans, the mental health of loved ones, and the reach is infinite.
To be clear, if you are a person of color who is currently struggling with an eating disorder, you are not alone. If you are a person of color who looks back at the younger version of yourself who had a tumultuous relationship with food within a family who loves through food, you are not alone. It is okay to seek out and ask for help from a professional. You are not alone.
Sources:
ANAD (2023).
Bulik, C. (2022). Eating Disorders Don’t Discriminate on the Basis of Age or Gender. National Council on Aging.
Dayal, P. (2022). How beauty standards for LGBTQ people impact body image, mental health. CBC News.
Goetz, J. (2022). Eating Disorders in Minority and Marginalized Populations. Psychiatric Times.
Halbeisen, G. Brandt, G., Paslakis, G. A Plea for Diversity in Eating Disorders Research. Frontiers in Psychiatry, (2022) 13. https://doi.org/10.3390/ijerph9020531
Holcombe, M. (2022). Hospitalizations for eating disorders grew in the pandemic. The problem isn’t over, experts say. CNN Health.
Qian J, Wu Y, Liu F, Zhu Y, Jin H, Zhang H, et al. An update on the prevalence of eating disorders in the general population: a systematic review and meta-analysis. Eat Weight Disord. (2021) 1–14. doi: 10.1007/s40519-021-01162-z
Salazar, G. (2023). Eating Disorder Awareness and Research Has Neglected Minority Communities. Exploring Health.