The Center for Eating Disorders Blog

Who are we missing? Eating Disorders & Minority Mental Health


Minority Mental Health Awareness Month was designated in 2008 to bring awareness to the unique struggles that underrepresented groups face in regard to mental illness in the United States.


Eating disorders can negatively affect almost every aspect of a person’s day-to-day life. They can also be associated with dangerous medical consequences. Recovery is possible though, and these negative effects can be minimized with early intervention and quality treatment. But treatment can’t happen if the people with eating disorders who need the help aren’t identified or supported in seeking that help.

Why do so many people with eating disorders go undetected?

There are many reasons why red flags and warning signs of an eating disorder (ED) might be overlooked.  A major factor being that our current culture normalizes dangerous weight-loss behaviors and promotes body dissatisfaction across the board. As a result, it can be hard to detect clinically significant behaviors in anyone when “everyone” seems to be caught up in a toxic diet culture. But there are other reasons that continue to have repercussions specifically for people in minority groups.

Researchers believe that only 1/3 of the people that meet criteria for an eating disorder ever actually receive treatment.1 

Most of what we know to be true about EDs (or any illness) is based on the existing  research on that topic. Much of the early research about eating disorders was done within populations of people who had already been diagnosed and had accessed treatment. Historically, the majority of people who sought and received eating disorder treatment were wealthy and white.2  Most were also relatively young and female. More and more research was done within this mostly homogeneous treatment-seeking population, and it reinforced misperceptions about who is impacted by eating disorders.

More recently, researchers are doing a better job of capturing representative samples, and advocates worldwide are doing tremendous amounts of work to educate communities   about diversity in eating disorders. Research on the prevalence of eating disorders in diverse communities has revealed a reality in stark contrast to the old stereotypes. For example:

  • Prevalence rates of bulimia nervosa, anorexia nervosa, and binge eating disorder are equal across ethnicities and socioeconomic levels 2,3
  • Prevalence of bulimia nervosa is significantly higher in Latinos and African Americans in comparison to non-Latino whites and Asians.2
  • Girls from a low-socioeconomic status (SES) household displayed a 32% increase in bulimic symptoms compared to girls in middle class households, and a 40% increase relative to girls in high income households.1

It’s clear that people from a variety of backgrounds and across racial and ethnic categories are impacted by serious eating disorders. And yet, we also know that equal and consistent access to treatment remains a problem for marginalized communities. Consider the following:

  • White, Non-Latino, high-SES girls are almost twice as likely to be diagnosed with an ED.1
  • Even though African American girls are more likely to exhibit bulimic behavior, only 0.7% of African American, low SES girls have been formerly diagnosed with an ED.1
  • College students of color are less likely to be diagnosed with an ED compared to white students.3
  • Lower SES students are less likely to receive treatment than students from more affluent backgrounds.3

These findings indicate that the popular perceptions of who is affected by EDs, specifically bulimia nervosa, are only accurate in terms of who is identified and diagnosed, not who is actually impacted. It also tells us that health and mental health providers are not immune from the stereotypes and may be less likely to recognize symptoms or warning signs in their minority patients. As a result, they may then be less likely to provide resources and make appropriate referrals.

Updated research, more thorough training for medical and mental health professionals and diverse outreach is needed across the board so that early intervention can be provided for all who are suffering from these life-threatening illnesses.

What can be done? 

You can help by getting involved in advocacy efforts to advance research and clinical practices for all people impacted by eating disorders. The National Eating Disorders Association (NEDA) and Eating Disorder Coalition (EDC) are two great places to start. If you work in education or health-focused organizations, you can take action to ensure that you and your colleagues receive regular training to enhance cultural competence within your field.

Individually, we should all evaluate whether we perpetuate myths about eating disorders by only sharing images or reading stories told through the lens of young, thin white women. Going forward, be sure to amplify the voices of people of color, men with eating disorders, LGBTQ communities and people in higher weight bodies who have historically not been included in eating disorder narratives. Even just boosting diverse posts and articles on social media can go a long way in helping to change the public perception of EDs and make it a little easier for those who need treatment to receive it, or at least recognize themselves in the coversation.

Tweeting about eating disorders, recovery, body acceptance or non-diet news? Check out: @MelissaDToler / @NalgonaPride / @FoodPsychPod ‏/ @dumplingskin ‏ / @thirdwheelED ‏ / @ASDAH ‏ / @DianneBondyYoga / @StigmaConf ‏ / @jameelajamil ‏ / @RadicalBodyLove / @NEDAstaff / @TFFED

If you think that you (or someone you know) may be struggling with an ED ask for help today. The sooner you connect to resources the sooner you can begin to feel better.  The Center for Eating Disorders is committed to being a safe, welcoming organization for people of all ages, races, ethnicities and genders. Call 410-938-5252 today.


Contributions by:
Avery Madison, Former CED Research Assistant
Avery graduated from Franklin & Marshall College where she earned her Bachelors of Arts in psychology with a minor in Spanish.  In addition to her RA role at The Center, she worked at a counseling center in Lancaster, PA providing one-on-one support for children and adolescents with emotional and behavioral difficulties.  Previously, she has worked as a medical advocate for the YWCA where she provided support to victims/survivors of sexual trauma.  Her past school research projects include examining the relationship between facial mimicry and empathy and between cell phone access and anxiety.


References:

  1. Ham, J., Iorio, D., & Sovinsky, M. (2012). Race, social class, and bulimia nervosa.Human Capital and Economic Opportunity Working Group Working Papers16.
  2. Marques, L., Alegria, M., Becker, A. E., Chen, C. N., Fang, A., Chosak, A., & Diniz, J. B. (2011). Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders. International Journal of Eating Disorders44(5), 412-420.
  3. 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.