We Are Failing at Treating Eating Disorders in Minorities
Why people of color and individuals in the LGTBQ community are not seeking help.
Posted Feb 28, 2019
This week is National Eating Disorder Awareness Week, which is sponsored by NEDA and is promoted throughout the United States for everyone who has been affected by an eating disorder, whether directly or indirectly. This year’s theme Come as You Are, highlights NEDA’s movement towards inclusivity in the greater eating disorder community and their goal of unifying the field of eating disorders. Navigating life after treatment for your eating disorder can be challenging, especially leaving a rigid treatment schedule and venturing out into the world of recovery. Individuals often will feel left out in society, which leaves them longing for inclusivity and the desire to be accepted; which is where eating disorder support groups are extremely beneficial for the individual.
While eating disorder awareness has improved in the United States, there still seems to be many misconceptions regarding the "types of individuals" who have an eating disorder. Many individuals usually think of eating disorders as a “heterosexual Caucasian female” problem, and as a result males, people of color and individuals in the LGBTQ community are less likely to be diagnosed and face greater barriers to treatment. All individuals regardless of their race, gender, age or sexual orientation share the same eating disorder signs and symptoms, even if their risk factors differ. People of color and individuals in the LGBTQ community face unique challenges that may put them at greater risk for developing an eating disorder. According to NEDA, research reveals that beginning as early as 12 years of age, gay, lesbian, and bisexual teenagers may be at higher risk of binge eating and purging compared to their heterosexual peers. Statistics also show that African-American and Hispanic teenagers have a higher prevalence of disordered eating patterns compared to their Caucasian counterparts. Even if the incidence and prevalence of eating disorders were equal across the board for all individuals, regardless of race, gender or sexual orientation, the risk factors, stereotypes and stigma attached to minority populations in regards to weight, body image and diet contribute to these minority individuals experiencing hurdles to access appropriate eating disorder treatment.
Stereotypes are simply cognitive shortcuts
Stereotypes are cognitive shortcuts that allow one’s brains to make a snap judgment based off of immediate visceral feelings associated with physical characteristics, instead of basing judgments off of facts and statistics. Stereotypes regarding eating disorders create an increasing stigma and heighten the barrier to treatment, as many of these marginalized individuals are too scared to speak out because they “may not fit the mold for anorexia or bulimia” and as a result, they feel that others may not take their illness seriously. Research has shown that people of color, the LGBTQ community and men are less likely to seek treatment for an eating disorder due to cultural differences, fear of rejection, and discrimination.
Discrimination among health care providers
Unfortunately, health professionals are also blinded by the stereotypes associated with eating disorders, which can vastly affect the quality of treatment and referrals to eating disorder specialists. People of color with self-acknowledged disordered eating patterns and body weight concerns are significantly less likely than white individuals to have been asked by a doctor about eating disorder symptoms, despite similar rates of eating disorder symptoms across all ethnic groups. Health care providers struggle to adjust to the fact that many minority people of color and individuals in the LGBTQ community still face significant barriers to recovery. According to studies and statistics published on NEDA’s website, there is a large amount of discrimination coming from healthcare providers surrounding the stereotypes associated with eating disorders. “When presented with identical case studies demonstrating disordered eating symptoms in white, Hispanic and Black women, clinicians were asked to identify if the woman’s eating behavior was problematic. 44% 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. The clinicians were also less likely to recommend that the Black woman should receive professional help”. Eating disorders are isolating illnesses masked in shame, and it is extremely challenging for a biracial gay man, a Muslim girl in a hijab, or a trans-Latina woman to find a doctor or therapist who looks like them or is familiar with their culture. Because of the stigma associated with these differences, it is that much harder to establish a trusting, productive relationship in eating disorder treatment.
Eating disorders are not about food or thinness
People of color, queer people, and trans people often suffer from complex issues of shame; this is not about a singular desire to be thin. After all, eating disorders, in general, are not about food or thinness. These marginalized individuals describe not only insecurity about their weight, but a larger struggle for recognition. They feel directionless and isolated in a culture where it seems there are few individuals who look like them and who truly understand their experiences.
- Black teenagers are 50% more likely than white teenagers to exhibit bulimic behavior, such as binging and purging.
- In a study of adolescents, researchers found that Hispanics 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.
- Asian, Black, Hispanic and Caucasian youth all reported attempting to lose weight at similar rates, while among Native American adolescents, 48.1% were attempting weight loss.
- LGBTQ individuals are much more likely to experience eating disorders throughout their lifetime, mainly because of the unique challenges they face
- Gay males are thought to only represent 5% of the total male population but among males who have eating disorders, 42% identify as gay.
- Gay males were seven times more likely to report binging and 12 times more likely to report purging than heterosexual males.
- Compared with heterosexual men, gay and bisexual men had a significantly higher prevalence of lifetime full syndrome bulimia, subclinical bulimia, and any subclinical eating disorder.
- Females identified as lesbian, bisexual, or mostly heterosexual were about twice as likely to report binge eating at least once per month in the last year.
Eating disorders in the Latino culture
In many cultures, specifically the Latino culture, love is often shown through food and women are raised to learn how to cook and take care of their household, which illustrates the importance of gender roles in the Latino community. Women are raised to stay in the home and take care of the family, the house and cook meals whereas men are raised to leave the house and make a living in order to financially support the family. This dichotomy creates isolation for women in the Latino community as they learn to put their own needs last, do not ask others for help, do not speak about their problems outside the home and oftentimes do not change their views. These can create many strong barriers to seeking treatment for eating disorders. Studies have shown that Latinas have eating disorders and body image concerns at rates comparable to or greater than non-Latina whites. Other research has demonstrated that Latina women may struggle with conflicting cultural expectation, where within their own families, larger bodies are generally celebrated. However, this conflicts with a Caucasian culture that promotes a thinner body ideal.
Eating disorders in the Asian culture
Asian Americans and Pacific Islanders (AAPI) live in a close-knit community with their family being at their center. Signs of weakness and negative emotions are generally shunned upon and as a result, any type of disordered eating pattern is usually pushed under the rug due to the stigma of being “weak”. In one study, Asian American participants came from higher income, achievement-orientated families and had extreme concerns about meeting parental expectations. This concern could be correlated with levels of perfectionism, which is an important predictor of anorexia. If an individual in an Asian American family admits that he or she needs help for their eating disorder, their parents and other family members may experience fear and shame. They may assume that their son or daughter’s condition is a result of their poor parenting or a hereditary flaw.
Eating disorders in the LGBTQ community
Stereotypes such as “gay men are all muscle or thin” or “all individuals with anorexia are malnourished” prevent people from seeking help. Other common barriers to treatment in the LGBTQ community include a lack of culturally-competent treatment, which addresses the complexity of unique sexuality and gender identity issues, lack of support from family and friends, and insufficient eating disorders education among LGBTQ+ resource providers who are in a position to detect and intervene. Additionally, individuals in the LGTBQ community experience unique risk factors that can cause them to face challenges when accessing treatment and support. These risk factors include the following:
- Fear of rejection or experience of rejections by friends, family, and co-workers
- Internalized negative messages/beliefs about oneself due to sexual orientation, non-normative gender expressions, or transgender identity
- Experiences of violence and post-traumatic stress disorder (PTSD), which research shows sharply increases vulnerability to an eating disorder
- Discrimination due to one’s sexual orientation and/or gender identity
- Being a victim of bullying due to one’s sexual orientation and/or gender identity
- Discordance between one’s biological sex and gender identity
- Inability to meet body image ideals within some LGBTQ cultural contexts
We as a community (regardless of our gender, social class, race or sexual orientation) must work together to acknowledge the shortcomings of eating disorder treatment in minority communities, treat minorities with more compassion, practice empathy towards anyone struggling with an eating disorder or mental health disorder and work that much harder to break down barriers, eliminate the stigma and substitute facts for untrue stereotypes.
Lee HY and Lock, J: Anorexia nervosa in Asian-American adolescents: do they differ from their non-Asian peers? International Journal of Eating Disorders 2007;40:227-231
National Eating Disorders Association (NEDA)