Eating Disorders

Eating Disorder Treatment May Be Failing Black Women

New research sheds light on bias in research and treatment.

Posted Sep 23, 2020

We think we know what someone with an eating disorder looks like—a young, cis, underweight, White woman. Unfortunately, this stereotype is completely inaccurate. Research shows that people who are at higher weights are at increased risk for eating disorders but are less likely to be diagnosed and to receive treatment. A recent research review suggests this is also the case for Black women.

Published earlier this year in International Journal of Eating Disorders, Goode et al conducted a review of the literature on Black women and binge eating disorder (BED). Let’s start with the fact that, out of the extensive body of literature on binge eating disorder, only 38 studies included Black participants and analyses by race. This highlights one of the most important findings of the review: Black women have been largely left out of eating disorder research. The field of eating disorders is centered on the White experience. Research is designed, by predominately White researchers, to study the issues that White women with eating disorders struggle with and treatments, administered by predominately White providers, are developed to best treat White women with eating disorders.

In reviewing the limited research that does include Black participants, researchers found that Black women report similar or higher prevalence of binge eating disorder compared with White women. However, Black women were less likely to access treatment. Studies suggest that less than 8% of Black women with BED sought treatment, compared with 22% of White women. Another study found that White women were more than 5 times more likely than Black women to receive treatment for an eating disorder. The belief that eating disorders only affect White women means that fewer Black women are assessed for eating disorders and referred for treatment.

When Black women do access treatment, they are more than twice as likely to drop out. Previous research identified the quality of the therapeutic alliance (ie. how well the client feels heard or understood by their therapist) as a key factor for treatment completion for Black participants. Is this another area in which predominately White eating-disorder therapists are failing Black clients? In many ways it isn’t surprising that Black clients would be more likely to drop out of eating disorder treatment: The treatment wasn’t designed for them; they are expected to fit into the White mold. If that doesn’t work, the blame is often placed on the client, who is labeled as “treatment resistant” or “noncompliant.”

Research suggests that trauma exposure and distress increase the severity of binge eating. Trauma, including racial trauma (defined as race-based stress that Black, Indigenous, People of Color (BIPOC) experience in reaction to dangerous events and racial discrimination) should be taken into account in eating disorder treatment. Multiple marginalized identities intersect to create layers of oppression. It is likely that the most marginalized people—those most often left out of eating disorder treatment—are those who will suffer the most.

The Goode et al. study emphasizes the ways that eating disorder treatment and research is failing Black women. I see this as a call to action to reevaluate our treatment paradigms. Clearly, there is a lot more research that needs to be done on how to best assess eating disorders in Black women and how to make treatment accessible, effective, and engaging.

References

Goode RW, Cowell MM, Mazzeo SE, et al. Binge eating and binge-eating disorder in Black women: A systematic review. Int J Eat Disord. 2020;53:491–507. https://doi.org/10.1002/eat.23217