The Privilege of an Eating Disorder Diagnosis
Although all demographics and ethnicities experience eating disorders at similar rates, people of color (especially Black women) are underdiagnosed and receive eating disorder treatment significantly less than white women do.
By: Emma Hart
A common misconception is that eating disorders primarily affect white, upper-to-middle class young women in small bodies. We see this narrative played out in the media and pop culture, such as in Netflix’s To the Bone and young adult novels such as Paperweight and Wintergirls. We know this portrayal is simply inaccurate, as research demonstrates that eating disorders affect people from various backgrounds and ethnicities at similar rates:
Asian, Black, Hispanic, and Caucasian youth all reported losing weight at similar rates (Kilpatrick, Ohannessian, & Bartholomew, 1999).
Black teenagers are 50% more likely than white teenagers to exhibit bulimic behavior, such as binging and purging (Goeree, Sovinsky, & Iorio, 2011).
In a study of adolescents, researchers found that Hispanic individuals were significantly more likely to suffer from bulimia nervosa than their non-Hispanic peers. The researchers also reported a trend towards a higher prevalence of binge eating disorder in all minority groups. (Swanson et al., 2011).
For American Indian/Native Americans, a significantly higher percentage of women reported disordered eating behaviors (Striegel-Moore et al., 2011).
Factors Contributing To The Disparity
The media’s portrayal of eating disorders can have serious consequences when internalized. It is not uncommon for people to be unaware of their disorder, and therefore less likely to seek treatment because they don’t fit the typical eating disorder stereotypes depicted in pop culture.
However, media misrepresentation is one of many factors contributing to the underdiagnosis and marginalization of people of color with eating disorders. Systemic discrimination in our white-dominated healthcare system is also to blame. It is important to remember that the eating disorder field is historically rooted in white-dominated medical and psychiatric systems. Therefore, diagnostic assessments, screening tools, and treatment frameworks are developed with white women in mind.
One study found that ethnic minority participants with self-acknowledged eating and body image concerns were “...significantly less likely than non-minority participants to have been asked by a doctor about eating disorder symptoms”. In addition, despite experiencing the same level of severity of eating disorder symptoms, both Latinx and Native American participants were significantly less likely than white participants to receive a recommendation or referral for further evaluation or care (Becker et al., 2003).
Another study done on the impact of race on clinician detection of eating disorders found that, when presented with identical cases of ED symptomatology, 44% of clinicians identified the white woman’s behavior as problematic; 41% identified the Hispanic woman’s behavior as problematic, and only 17% identified the Black woman’s behavior as problematic. These clinicians were also less likely to refer Black participants to healthcare services to address their disordered eating (Gordon et al., 2006). This research demonstrates that clinicians may have race-based stereotypes regarding eating disorders that affect the detection of eating disorder behaviors and symptoms among minority clients, contributing to the underdiagnosis of ethnic minorities with eating disorders and disparities in treatment utilization.
Why Is Diagnosis Important?
Early identification and intervention are key factors contributing to better outcomes for people with eating disorders. Generally speaking, the earlier the diagnosis is made, the more likely it is that the person will reach full recovery. Early detection has been found to reduce ED symptoms to a greater extent, increase the speed of recovery, and improve the likelihood of preventing long and short-term health complications. In addition, a formal diagnosis is often necessary for insurance companies to cover the cost of eating disorder treatment. Hence, the lack of a proper diagnosis increases barriers to care, as people are less likely to receive treatment due to the financial burden.
At BALANCE eating disorder treatment center™, our compassionate, highly skilled team of clinicians is trained in diagnosing and treating the spectrum of eating disorders, including anorexia, bulimia, binge eating disorder, compulsive overeating, and other disordered eating behaviors and body image issues. In addition to our full-time Day Treatment Program and Weeknight Intensive Outpatient Program, we offer high-quality programming, nutrition counseling with a licensed dietitian, meal support, and various other groups and resources to help those seeking help for food concerns.
Our admissions team would be happy to answer any questions you may have about our programs and services. Book a free consultation call with our admissions team below, or read more about our philosophy here.
This post was written by BALANCE Social Work Intern, Emma Hart (she/her).
Emma is a Therapy Intern and graduate student at New York University, where she is pursuing her Master’s Degree in Social Work. Before beginning her graduate program, Emma worked at a neurofeedback clinic where she provided neurotherapeutic services to children, adolescents, and adults with a wide range of diagnoses. She completed her undergraduate degree at the University of Connecticut, majoring in Psychology. Emma’s clinical experience also includes an internship at an outpatient community mental health clinic as part of her social work education. Emma is deeply passionate about eating disorder awareness and recovery and plans to work as a therapist in the eating disorder field after completing her graduate degree.
References
Becker, A. E., Franko, D. L., Speck, A., & Herzog, D. B. (2003). Ethnicity and differential access to care for eating disorder symptoms. The International journal of eating disorders, 33(2), 205–212. https://doi.org/10.1002/eat.10129
Goeree, M.S., Ham, J., & Iorio, D. (2011). Race, Social Class, and Bulimia Nervosa. Health Economics eJournal. DOI:10.5167/UZH-64072
Gordon, K. H., Brattole, M. M., Wingate, L. R., & Joiner, T. E. (2006). The Impact of Client Race on Clinician Detection of Eating Disorders. Behavior Therapy, 37(4), 319-325. doi:10.1016/j.beth.2005.12.002.
Kilpatrick, M., Ohannessian, C., & Bartholomew, J. B. (1999). Adolescent weight management
and perceptions: an analysis of the National Longitudinal Study of Adolescent Health. The Journal of school health, 69(4), 148–152. https://doi.org/10.1111/j.1746-1561.1999.tb04173.x
Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., & Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Archives of general psychiatry, 68(7), 714–723. https://doi.org/10.1001/archgenpsychiatry.2011.22
Treasure, J., & Russell, G. (2011). The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors. The British journal of psychiatry: the journal of mental science, 199(1), 5–7. https://doi.org/10.1192/bjp.bp.110.087585