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Eating disorders: Challenging the stereotypes

By Haddi Brown

Our knowledge of eating disorders is based on the experiences of one group: thin, White, privileged women. Since these are the women who had access to treatment when eating disorders were first identified in the late 1800s, these are the stories that formed the basis for medical and psychiatric treatments. To this day, eating disorders are associated with White women. Research and psychiatric/psychological services do not reflect or account for the unique experiences of ethnic minority groups. This means that eating disorders in Black populations tend to go unreported and untreated.

People with eating disorders display severe disturbances in eating behaviours and a preoccupation with food and body weight. Anorexia sufferers feel fat even when they’re skeletal and they have an abnormal fear of weight gain with a determined pursuit of thinness; Bulimia sufferers also feel larger than they really are and engage in recurrent binge eating accompanied by purging and/or fasting.

Not just an illness for White women

Surprise, surprise - Black people are underrepresented in eating disorder research. And the studies that do exist involving Black participants have mostly been done in America. The limited evidence shows that:

  • Binge eating is more common among Black women than White women

  • Black girls are 50% more likely than White girls to engage in bulimic behaviour

  • Black Americans are less likely than White Americans to develop Anorexia. But those who develop it do so at a younger age and struggle with it for a longer time

Even this research is based on theories and diagnostic tools developed around the experiences of White women. This makes it difficult to accurately estimate levels of eating disorders in Black groups.

Anorexia and Bulimia are not the only eating disorders

In the Black community, the ideal body type tends to be fuller and curvier. So many Black women suffer from Binge Eating Disorder (BED), putting them at risk for physical health issues. Compulsively overeating can be a way to cope with negative emotions or life struggles. But overeating is not uncommon in Black population, so it doesn’t get recognised as a life-threatening eating disorder.

Here are some other examples of eating disorders and their symptoms:

Muscle dysmorphia - Hench gym-obsessed Black men can have eating disorders too

  • Excessive time and over-exertion in weightlifting to increase muscle mass

  • Preoccupation and panicking over workout if unable to attend

  • Overtraining or training when injured

  • Disordered eating, using special diets or excessive protein supplements

  • Steroid abuse and often other substance misuse

  • Distress if exposed leading to camouflaging the body

  • Compulsive comparing and checking of one’s physique

  • Prioritizing one’s schedule over all else or interference in relationships and ability to work

Anorexia AthleticaWhen exercise becomes unhealthy

  • Excessive exercise

  • Obsessive thoughts and behaviours with calories, fat, body image, and weight

  • Self-worth is based on physical performance

  • Enjoyment of sports and activity is diminished or non-existent

  • Denying that excessive exercise is a problem

Food addictionSimilar to binge eating

  • Gorging in more food than one can physically tolerate

  • Eating to the point of feeling ill

  • Going out of your way to obtain certain foods

  • Continuing to eat certain foods even if no longer hungry

  • Eating in secret, isolation

  • Avoiding social interactions, relationships, or functions to spend time eating certain foods

OrthorexiaAn obsession with healthy eating isn’t always healthy

  • Cutting out particular foods and food groups from your diet in an attempt to make their diet healthier. More and more foods may be cut out over time

  • Taking an existing theory about healthy eating and adapting it with additional beliefs of your own

  • Judgment about the eating habits of others

  • Obsession with healthy or supposedly healthy diet

  • Increased focus on what you’re eating may interfere with other areas of your life (e.g. relationships or work)

Myth: Black people are immune to eating disorders

Doctors and Psychologists are so focused on body dissatisfaction and ideals of thinness that they overlook other factors that may promote eating disorders in Black people. The levels of eating disorders in Black groups are underestimated because health professionals frequently fail to identify eating disorders in these populations.

Research proves that experiences of racism, acculturative stress (mental and emotional challenges of adapting to a new culture), and other race-related trauma make Black people more vulnerable to mental illnesses like psychosis. However, little research explores the effect of these stressors on the development of eating disorders. Research is needed to investigate the link between eating disorders and racial discrimination, acculturation (assimilation to a different culture, typically the dominant one), and the feelings that come with these experiences: anxiety, lack of control, lack of safety.

Eating problems among Black women are dismissed based on the assumption that they are immune to eating disorders due to being uninterested in or unaffected by a culture obsessed with thinness. People assume that Black women are immune to getting eating disorders because they traditionally do not highly value thinness and instead value plumpness. Such race-based stereotypes affects doctors’ ability to detect eating disorders in Black people.

In fact, research has found that Black women displayed similar or higher levels of body dissatisfaction than White women, showing that they are not protected from western standards of thinness and beauty. Black women who are highly acculturated to White culture are more likely to internalise a thin ideal. However, we still cannot assume that a pursuit of thinness is the only factor affecting eating disorders in Black women.

Is the ‘thin ideal’ to blame?

Eating disorders are likely to look different in non-Western patients when compared to patients of North-European backgrounds, due to differing cultural values. People assume that eating disorders are ‘Western culture-bound syndromes’. They became more common among young females during the latter half of the twentieth century, when beauty icons became thinner and articles on weight loss were increasingly published in women’s magazines.

However, variants of Anorexia have existed in every non-Western region of the world for centuries - before modern ideals of thinness and many sufferers did not have weight concerns. Cases of self-starvation that cannot be attributed to the influence of current Western ideals have been reported throughout numerous historical periods. For example, Anorexia was documented in Japan in 1941 and referred to as a psychological “non-eating” illness dating back to the 17th-18th century. The growing idealisation of thinness may cause someone to develop eating problems but it’s not enough on its own to cause Anorexia and keep it going.

However, Bulimia appeared to emerge as a new illness in the 1970s. There was a large increase in prevalence from 1970 to 1990, following an increase in societal pressure to be slim. So, Bulimia is influenced by cultural values (specifically weight concerns). Weight concerns are observed in all cases of Bulimia, but such concerns are not required for a diagnosis of Anorexia.

The bottom line is that Anorexia is universal and can affect anyone, even if you're not concerned about your weight.

There needs to be more awareness within the Black community about the signs of different eating disorders. More research is needed to understand how unique cultural influences contribute to the development of eating disorders in Black people.



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