The Disparate Impact of Eating Disorders

"For there is always light, If only we're brave enough to see it, If only we're brave enough to be it. –Amanda Gorman

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This post was written by Gia Marson, Ed.D.

World Eating Disorders Action Day falls on June 2, 2021. This year’s theme, #Equity4EatingDisorders, urges us to take a hard look at the range of health disparities surrounding eating disorders. Because the truth is that myths, a lack of culturally-relevant assessments and interventions, and systemic racism, among other biases, contribute to unequal access to health care, diagnosis, and treatment. It’s time to change that.

A deadly eating disorder myth

The myth that eating disorders affect mostly “skinny, white, affluent girls” persists, in spite of mounds of data. Regrettably, this SWAG stereotype means that people of higher weights, members of racial and ethnic minority groups, those who are socioeconomically disadvantaged, and males receive disproportionately less care.

This troubling equity issue also stems from internalizing the myth. For example, a 2017 large-scale study asked college students with symptoms of eating disorders about their experiences with issues related to eating and body image. Males were less likely to perceive a need for treatment than females, and participants from affluent backgrounds were more likely to think they needed treatment and to have received treatment than their less-affluent peers.

Eating disorders don’t discriminate, yet studies like this one continue to reveal systemic biases, including biases from within our own minds against our own bodies.

“Eating disorders are invisible in the Black community largely because of misinformation and racial bias in the health care system ... as well as an overall lack of training in how to assess and treat eating disorders, results in Black people being misdiagnosed with obvious symptoms of an eating disorder.” –Kelli Rugless, Psy.D.

"It is no longer appears tenable to assume that EDs are uncommon in males nor that males account for only a negligible proportion of the public health burden of EDs and disordered eating ... efforts to advance research around clinical practice relating to the treatment of males with EDs are now critical." –Stuart Murray, Psy.D.

"As therapists, it is important for us to look deeply at our own biases and the ways they may show up in our work ... Taking steps to identify your own implicit assumptions about body size, eating behaviors, and health will minimize the potential of your beliefs influencing the way you work with those who come to you for help." –Lindo Bacon, Ph.D.

Eating disorders and disparities in the BIPOC community

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In the past two decades, eating disorder research has highlighted the range of unmet needs among Black and indigenous people, and other people of color (BIPOC). Here is a sample of those findings:

• Those in the BIPOC community are less likely to receive a diagnosis or to be referred to treatment for an eating disorder, even when they are equally symptomatic to white counterparts.
• Stress due to discrimination and acculturation worsens body dissatisfaction and ED symptoms in BIPOC individuals.
• Clinicians are less likely to ask people of color about their eating habits, and are less likely to refer them to further evaluation or treatment, even after eating disorder symptoms were indicated on a health screening.
• Those identified as BIPOC are more likely to binge eat than white individuals.
• Compared to people at higher weights, those who are underweight are significantly more likely to receive a diagnosis, to perceive a need for treatment, and to receive treatment.
• People of color are less likely to use mental health services.
• Black women are more likely to drop out of treatment.
• The frequency of loss-of-control eating is associated with perceived discrimination among Black and Latino men.

“For the Black person, negative body image tends to go beyond body shape and size. It also encompasses those physical traits associated with Blackness. For example, skin color, hair texture, nose size and shape, eye color, hair color, etc. A Black person cannot fully accept their body without also accepting their Blackness.” —Kelli Rugless, Psy.D.

Stand for equity in eating disorder treatment

You don’t have to have an eating disorder or know someone who does, and you don’t have to become an expert in eating disorders, to be an agent of change. If you are willing to champion fairness, offer compassion, and speak up against stigma, you can start by taking this oath today.

Eating Disorders Essential Reads

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When an Eating Disorder Isn't Just About Body Image

Oath for equity in eating disorders

To promote equity, I commit to…

1. Advocate for access, because every person deserves an accurate diagnosis.
2. Promote social justice by demanding improved clinician training, inclusive research, culturally-relevant prevention, and evidence-based treatments that better serve BIPOC communities.
3. Support the body-positivity movement because it asserts that everyone should be encouraged to have a positive connection with their own body.
4. Spread awareness, because eating disorders impact all races, genders, sexual orientations, and ages.
5. Reject the concept that there is only one ideal body type.

To increase support, I commit to…

1. Uphold intuitive eating principles by not dieting, fasting, doing cleanses, or participating in unrealistic fitness challenges.
2. Offer compassion, because no one deserves to have an eating disorder.
3. Stay humble, because families are not the cause of eating disorders.
4. Be aware, because intervention can be the difference between life and death.
5. Be present, so that no one has to feel alone.

To decrease stigma, I commit to…

1. Accept that health cannot be measured by BMI or a number on a scale.
2. Embrace diversity by not judging how much other people eat, weigh, or work out.
3. Be honest by checking in with myself about my own biases.
4. Learn about the many factors that influence developing an eating disorder.
5. Be kind, because no one should feel criticized for a health problem.