Invisibility of Eating Disorders in the Black Community: It’s More than the Eating Disorder Stereotype
Written by CCTC Staff Writer
The challenges a Black woman faces in the eating disorder sphere is more complex than: “She isn’t white, so no one notices.”
While this is true, it’s almost too easy to blame the underdiagnosis and undertreatment of Black women with eating disorders on the eating disorder stereotype (i.e. young white woman with anorexia).
This is an important conversation to have, as the racial gap between adequate eating disorder treatment is huge and concerning. So while the eating disorder stereotype as a barrier to treatment will be discussed, this will be an in-depth conversation about:
The unique contributing factors to the development of an eating disorder in Black women
The unique challenges the Black woman faces in receiving a proper eating disorder diagnosis
The unique challenges the Black woman faces in receiving adequate treatment for an eating disorder
Many of these problems really can only be addressed through sweeping policy changes to dismantle systemic racism, mass cultural competency training for medical professionals, and incentives to close the educational and economic racial gaps. At the same time, just educating yourself is helpful.
Because dismantling the belief that eating disorders are “white women’s problems” — thus making all Black women with eating disorders more visible to the general population — that starts within your own mind.
Developing an Eating Disorder as a Black Woman: The Narrative and Cultural Experiences Matter
Personal narratives, which are the accumulation of life experiences, have an extreme amount of impact on mental health.
In this case, Black women experience a disproportionate amount of trauma, violence, and adverse childhood experiences compared to white women. These kinds of personal experiences have been directly linked to the development of eating disorders.
The cultural experiences of a community also have the ability to impact the individual. The Black individual’s personal experiences of racism (for example, in school or on the street) and collective experience of racism (for example, the collective trauma of a young Black person being shot and killed when they didn’t need to be, and a seemingly unflinching nation that doesn’t care about them) can irrevocably damage a person. A person may cope with this with eating disorder behaviors.
In addition to the unique social factors that contribute to eating disorders in Black women, they also have unique social barriers to receiving an eating disorder diagnosis and treatment.
Related: Read more about the link between trauma and eating disorders here.
Why Eating Disorders Go Largely Unnoticed in Black Women
The Eating Disorder Stereotype is a Form of Erasure
It should be common knowledge that the thin, young, white female stereotype of eating disorders is completely false. It should also be common knowledge that anorexia is not the only eating disorder out there. In fact, other types of eating disorders are experienced much more than anorexia — yet, these disorder types are publically depicted and researched the least.
And yet, it’s not.
The invisibility of other types of eating disorders, and the invisibility of mental health issues in the non-white population, combine to make eating disorders in the Black population go completely unnoticed.
Lack of Representation in the Research and Healthcare Sphere
Scientific research influences the beliefs and practices of healthcare providers on the whole, which makes sense. However, the problem in research studies is what studies focus on, as well as who is included in these studies.
Until very recently, the overwhelming majority of studies on eating disorders have focused on anorexia. Eating disorders have mistakenly been seen as having to do with body shape and size, so naturally researchers have focused on the eating disorder that most “dramatically” changes body weight and shape.
However, other disorders, like EDNOS (Eating Disorder Not Otherwise Specified) and binge eating disorder are much more common. Individuals in the Black community are also more likely to suffer with these problems than with anorexia (binge eating disorder is the most commonly experienced eating disorder for Black women).
Related: Read more about binge eating disorder, and how to break free from it, here.
So the eating disorders that Black women most identify with are not studied nearly as much as anorexia. Disregarding other eating disorders in research is carried over to the medical community.
Many in the medical community just don’t have the knowledge it takes to diagnose someone with anything other than anorexia. Black women, who are statistically less likely to have anorexia, have eating disorders that are not recognizable and therefore not diagnosable by medical professionals.
The majority of eating disorder study participants are white women. This is because many studies are taken from eating disorder treatment centers, which are overwhelmingly populated with white women (more on this later). It’s also due to the fact that Black women are far less likely to verbalize their mental health issues, especially to medical professionals (more on this later, as well.)
Many studies do not even differentiate between race and ethnic groups. They do not investigate the unique cultural influences of eating disorder sufferers of non-white backgrounds. This skewed understanding of eating disorders in the non-white population, and of how eating disorders present in general, make it so that medical professionals are incredibly unlikely to diagnose Black individuals with an eating disorder.
Perceptions of the Black Body Ideal (As Drawn Up By White People)
There are two ways to view communities: from the outside, and from within:
Public perception of anything is now highly influenced by the media, as this is where most people get their information. This is also how they form opinions on various topics, people, and populations.
Public perception of Black communities has been created by the majority white media. This means that how the general population views Black people is, for the most part, how white people have wanted them to be seen.
Why is the image of the Black community and experience being constantly created by white people? Because there is an incredible lack of diversity in media spaces. This leads to an inaccurate portrayal of Black people and experiences. In fact, two out of three Black Americans feel that they are not properly represented in the media.
What does this have to do with body image and mental illness? The answer is simple: How the public views a Black woman affects how she is treated, and how she perceives herself.
Overwhelmingly, Black women have been portrayed in the media as “thick,” “curvy,” with a certain bust-to-hip ratio, flat stomach, and protruding posterior. Increasingly, pop culture emphasizes this body shape in music, in TV and film, and in who ends up on-screen.
And while it has been found that Black women do not necessarily compare themselves to prominent white female figures, they are more likely to compare themselves to the media portrayals of prominent Black female figures.
So, while a Black woman may not feel pressure to reach the thin ideal laid out for white women, she is not exempt from cultural expectations of how she “should” look. This influences self perception, which influences behavior — and can lead to disordered eating behaviors.
On the other hand, some Black women, especially those highly acculturated with white culture, do in fact feel they need to also reach the thin ideal. And the overwhelming majority of people view very heavy individuals negatively. Many women across the racial and ethnic sphere will resort to eating disorder behaviors to keep from becoming “too overweight.” Many feel shame if they are or become what society deems “extremely overweight.” Shame can further eating disorder thoughts and behaviors.
Perception of Mental Illness From Within the Black Community
Mental illness is often not spoken about in Black communities. Inwardly, many sufferers in these communities are afraid of stigma they may face from others. While the narrative around mental illness is changing, for some there is still the lingering idea that mental illness is a sign of personal weakness and should not be spoken about.
And Black women in particular are expected to “be strong.” This is because of the “Strong Black Woman” Identity. In essence, the Strong Black Women is composed of five elements:
Feeling an obligation to present an image of strength
Feeling an obligation to suppress emotions
Resistance to vulnerability
A drive to succeed despite limited resources
Feeling an obligation to help others
While this identity can be viewed as a source of strength, it is also restrictive: If a Black woman is expected to be strong, how can she admit to having a problem with food, which is often associated with vanity or weakness?
The idea that Black women are not susceptible to the same illnesses that white women are has even, for some, led to self-stigma. For example, Anissa Gray, author of The Care and Feeding of Ravenously Hungry Girls, wrote in this blog post about her history with overexerise and bulimia, that there was always this little voice in her head whispering: Black girls don’t get eating disorders. She and her family believed eating disorders were “white folks’ problems” for a long time. Even Anissa’s therapist believed that her white wife was the one who came for help with an eating disorder, despite their vastly different body shapes.
(Note: Eating disorders are mental illnesses, and have nothing to do with how you look. But in some cases, there are physical side effects of an eating disorder, and to be so biased as to not notice a potential sign is alarming.)
Related: Have you ever felt invalidated about your eating disorder, because you didn’t “fit the look” of an eating disorder? Click here if you want to know what to do about this feeling.
Implicit Bias and Lack of Trust in the Medical Community
Since many medical professionals mistakenly emphasize weight as an indicator of health, they place special consideration on weight standards. They also, despite having been proven to be an inaccurate representation of an individual’s overall wellness, put a lot of emphasis on BMI.
The bodies of Black women are naturally healthier at a slightly higher weight than other populations. Many Black women have, therefore, experienced weight stigma when walking into their doctor’s office, despite the fact that they are literally supposed to weigh more than what an antiquated measure of health says. Those physicians are biased towards the “white standard” of health, and see anyone who does not fit within that size bracket as having a problem.
This results in some detrimental scenarios for Black women who present with eating disorders. For example, in this blog post Achea Redd had suffered with anorexia for several years before eventually receiving help. Despite being malnourished, her healthcare providers were concerned about her eating too much. They based this worry on her weight, rather than asking what she did eat. Her weight was higher than “average” because that “average” did not account for biological differences across different populations.
Many Black women who meet clinical criteria for binge eating disorder find that their doctors focus more on their body weight, rather than diving into the underlying issues. If medical practitioners asked about their patients’ lived experiences, rather than focusing on weight management, then their patients could receive an accurate diagnosis — and then, hopefully, receive help.
Related: There is a small movement gaining traction in the medical and general population, one that takes a more holistic, and less weight based, approach to health. Read more about it here.
Many Black individuals do not trust doctors on the whole. This is not unreasonable, nor should it be. Historically, the Black population has been abused in the name of medicine, having unethical experiments performed on them. Currently, many Black people do not trust the medical community because of systematic disparities when it comes to access to adequate healthcare and insurance (more on this later). Many report personal experiences of discrimination, such as being accussed of using drugs or lying in order to obtain drugs. They have reported not being taken as seriously, or treated as well, as white people.
So it’s hard to walk into a doctor’s office as a Black person seeking help. To know that you may not be taken seriously, or may face outright discrimination, is enough to keep many away from seeking help.
Barriers to Eating Disorder Treatment for Black Women: Institutional Racism and Marginalization
Besides the fact that you can’t get eating disorder treatment without getting diagnosed, there are several other systemic and cultural factors barring black women from receiving adequate treatment.
Disparities in Economic Status and Insurance Coverage
It has been shown that there is a statistically significant disparity in wealth between white and black households. Of course, the reason behind this is generational and current discriminatory practices.
White families are far more likely to earn and retain wealth. Individuals in the white community have greater access to education, employment opportunities, and statistically earn more per hour worked than black individuals. Black individuals face discrimination in the professional world as well. In fact, black job applicants who “whiten” their resumes have been called back for individuals twice as much as those who do not, indicating deep, systemic bias in the professional world.
White families then pass accumulated wealth to their (predominantly white) children, and the wealth gap continues to widen. There is also a distinct lack of investment in public services that allow for economic mobility for minorities. So while the white population can retain and then increase their wealth, nothing is being done to erase historical wealth gaps.
Many individuals also receive insurance benefits from their employers. But benefits are typically included in more stable, professional jobs, and black people are less likely to be able to obtain jobs like this. This leads to many in the black community not having access to quality health insurance. The financial burden of paying for treatment of any health problem is much more heavy for them. And most insurance companies do not have great policies in terms of mental health benefits right now, so paying for eating disorder treatment is especially difficult.
Higher accumulated wealth also acts as a safety net. White people, especially white women who statistically work less than black women, can feel safe to leave their home and receive time-consuming treatment. Black people, especially black women, are much less able to create a safety net, and are not able to stop contributing to household income.
Both of these factors combine to create a huge financial barrier to treatment, one that many black individuals are not able to climb.
Underrepresentation in Treatment Settings
If you were to peer into any residential, partial hospitalization, or intensive outpatient eating disorder treatment program, you are almost guaranteed to find that the majority of patients are white and female.
Treatment center pamphlets, social media accounts, and blogs almost overwhelmingly feature white faces and voices. While there have, in some spheres, been efforts to diversify the narrative surrounding eating disorders in eating disorder communities and large organizations, there is still, on an individual level, a lack of representation.
While treatment programs cannot necessarily shape their patient populations themselves (they don’t choose who calls them) they can work to create a more culturally diverse and culturally informed staff.
Many Black women seeking help for their eating disorder have difficulty finding a Black therapist. They also do not see staff who look like them in treatment centers. Treatment centers, and the eating disorder recovery community in general, should seek out Black individuals to work with. They can educate the rest of the eating disorder community about Black culture, and can be a source of inspiration and comfort for Black women suffering.
If they see someone “like them” in the eating disorder sphere, whether that’s in the treatment setting or in the media, they may be moved to seek help.
If you or a loved one is suffering from an eating disorder, take the first step today and talk to someone about recovery or simply learn more about the holistic eating disorder recovery programs we offer.