Can Black People (and other BIPOC) Have Eating Disorders?
By Jessica Jones, MS, RD, CDE
When you think of someone having an eating disorder, what kind of person comes to mind first? There is a significant chance that your initial thought was of a thin, affluent, cis-gendered white woman. Which makes you think, can Black people and other BIPOC have eating disorders?
In this article, we’ll cover:
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What an eating disorder is.
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The most common forms of eating disorders.
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Stats on eating disorder prevalence among Black people and BIPOC.
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Struggles faced as a Black person or BIPOC with an eating disorder.
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How to know if you may have an eating disorder.
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How to seek help for a loved one who you suspect may suffer from an eating disorder.
What Is An Eating Disorder?
Let’s start by defining what an eating disorder is. The National Eating Disorders Association (NEDA) defines an eating disorder as a serious mental and physical illness that can affect people from all walks of life. It transcends race, gender, ethnicities, and body size.
There are multiple eating disorders in existence, and all of them do not involve throwing up your food after a meal or significantly restricting your intake. Here is a list of common types of eating disorders according to NEDA:
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Anorexia Nervosa. Commonly identified by weight loss, have a hard time maintaining appropriate body weight for current life stage, and a distorted body image. People with anorexia nervosa generally restrict caloric intake and types of food consumed.
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Bulimia Nervosa. Categorized by a cycle of bingeing and compensatory behaviors to make up for the binge. These behaviors can include making yourself vomit.
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Binge Eating Disorder. Typically characterized as recurrent episodes of eating large quantities of food, feeling like you've lost control during the binge, experiencing shame, distress, and guilt after binge episodes, NOT using compensatory methods to counter binge eating episodes.
And here is a list of all eating disorders:
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Atypical anorexia. This is a condition where a person exhibits the symptoms of anorexia with a weight that is considered “normal” or above the normal range.
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Pica. It involves eating items that aren’t thought of as food and don’t contain significant nutrients. Some examples include eating hair, dirt, and paint chips.
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Orthorexia. This condition is described as having an obsession with healthy eating.
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Other Specified Feeding or Eating Disorder (OSFED). A category of eating disorders which includes individuals who do not meet strict diagnostic criteria for anorexia nervosa or bulimia nervosa but still have a serious eating disorder.
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Avoidant Restrictive Food Intake Disorder (ARFID). It is very similar to anorexia, but there is an absence of distress about body shape, size, or fear of fatness.
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Laxative Abuse. A person intends to eliminate unwanted calories, lose weight, or feel thin/empty by abusing laxatives.
Eating Disorders vs. Disordered Eating - What’s The Difference?
Disordered eating, which you may also have heard of, is different from having an eating disorder. It is a term that describes irregular eating behaviors that may or may not qualify for a diagnosis of a specific eating disorder. An eating disorder, on the other hand, has criteria defined by the American Psychiatric Association that must be met.
Unlike eating disorders, disordered eating is not a medical diagnosis. But if left unaddressed, the habits and patterns formed with disordered eating may develop into a serious eating disorder.
I Thought Eating Disorders Only Happened In Privileged, Thin, White College Students. Is That Not True?
Eating disorders do not discriminate. They can affect all races, ethnicities, people of any sexual orientation, religious following, and economic standing. In a 2010 study, the prevalence of anorexia nervosa was compared between populations from the Netherlands and Curaçao.
It was found that individuals in Curaçao had a lower incidence of anorexia nervosa when compared with individuals who migrated from Curaçao to the Netherlands. Researchers theorized that being exposed to Western ideals of beauty is a risk factor for developing anorexia nervosa.
Let’s Face the Stats and Facts
Additionally, the statistics on eating disorders shared by NEDA among the Black and BIPOC communities is very telling.
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Black teenagers are 50% more likely than white teenagers to exhibit bulimic behavior (binging, purging, etc.)
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In research comparing identical case studies and reporting of problematic (disordered eating) behaviors, clinicians identified white (44%) and Hispanic women (41%) as needing professional help in comparison to Black women (17%) in the same study.
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74% of Native American girls have reported dieting and purging using diet pills
Do I have to be “underweight” in order to have an eating disorder?
No, you can have an eating disorder with any body size. For example, the DSM-5 indicators for binge-eating disorder do not include being underweight. But anorexia which involves a fear of fatness, does include indicators like “significantly low body weight.” And people with ‘Atypical anorexia’ meet all of the criteria for anorexia except being at a low body weight. Additionally, less than 6% of individuals with an eating disorder are medically underweight, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD).
How do eating disorders in Black people and BIPOC manifest differently?
It is theorized that there is a generally lower treatment rate for eating disorders among certain demographics because there is a difference in the clinical presentation that is not adequately captured by traditional instruments that were initially developed for white populations. Atypical anorexia is a prime example of differences in clinical presentation. Because individuals can have symptoms of anorexia while being in a larger body.
Patterns of seeking help may differ. And there may be a bias held by the individual and the clinician that eating disorders only occur in specific populations. This false belief by a clinician can lead to diagnosis bias and lower treatment rates for certain ethnic groups.
According to NEDA,
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Despite similar rates of eating disorders among non-Hispanic Whites, Black people, and BIPOC in the United States, Black people and BIPOC are significantly less likely to receive help for their eating issues.
And ANAD shared the stats that:
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BIPOC are significantly less likely (than white people) to be questioned by doctors about eating disorder symptoms.
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And Black people are less likely to be diagnosed with anorexia than white people but may experience the condition for a longer time.
In conjunction with this lack of treatment, there is also the issue of racism and limited food access. Here is the breakdown of this complex issue: institutional racism has historically led Black women to have greater rates of poverty when compared to white women.
This poverty makes it harder to access healthcare which can make obtaining an eating disorder diagnosis difficult and costly. And poverty often leads to limited food access, which can be a risk factor for developing an eating disorder.
How do I know if I have an eating disorder?
Common behaviors and symptoms that may point to an eating disorder can include:
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Frequent dieting
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Small portions during meals or skipping meals completely
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Extreme concern with body shape and size
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Displays discomfort when eating in front of others
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Refusal to eat certain foods, restricting entire categories of food
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Fainting
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Poor wound healing and impaired immune function
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Menstrual irregularities
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Noticeable fluctuation in weight (up and down)
The Eating Attitudes Test (EAT-26) can also serve as a screening tool used to determine if medical help is needed for an eating disorder. This survey cannot diagnose an eating disorder or replace speaking with a professional. But, it can serve as a tool to view eating disorder risk based on self-reported data.
I think my loved one has an eating disorder, how can I help?
If you suspect that your loved one may have an eating disorder, it is best to approach them with compassion, care, without blame, nor stigma.
Here are five of the tips NEDA recommends on opening up the discussion with your loved one:
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Sticking to the facts (do not let your emotions overtake the conversation, try to remain calm during the discussion)
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Avoid overly simplistic solutions (treatment of an eating disorder is complex and takes time)
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Become as informed as possible about eating disorders
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Address the issue privately and schedule a time to talk
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Be prepared for unpleasant reactions (anger, hostility)
The Bottom Line
If you believe a loved one or you have an eating disorder, please seek out professional help. Taking the EAT-26 can be a method to come to terms with your behaviors, but having a formal diagnosis can be your first step to getting help. Do not wait until your own life or your loved one’s life is in jeopardy. With the help of a psychiatrist, dietitian, and other medical staff, you can beat your eating disorder and be on the road to a fruitful life.
Want to work with a registered dietitian to help treat your eating disorder?
Jessica Jones Nutrition is accepting new clients. Services include help with a variety of conditions, including:
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Intuitive Eating/Food Peace
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Eating Disorders/Disordered Eating (including anorexia, binge eating disorder, bulimia, and orthorexia)
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Intuitive Eating for Chronic Disease (including diabetes and prediabetes)
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IBS (Irritable Bowel Syndrome)
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Body Acceptance/Health at Every Size (HAES) Informed Care
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Inclusive & Culturally Relevant Wellness
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Non-Restrictive Vegetarian and Vegan Nutrition
If you have diabetes or prediabetes and are interested in working with Diabetes Digital to improve your health and relationship with food, please fill out our brief intake form here to get started!
Further Resources:
National Eating Disorder Association (NEDA)
National Association of Anorexia Nervosa and Associated Disorders (ANAD)
Eating Disorder Foundation