Diversity And Eating Disorders
It is widely believed that eating disorders only affect young, white, straight, cisgender (those that identify with their biological gender; those that don’t consider themselves transgender) and able-bodied middle class women. This is a dangerous misconception; the truth is that eating disorders do not discriminate and affect people of all ages, racial/ethnic backgrounds, abilities socioeconomic status, gender identities and sexual orientations.
Who Gets Eating Disorders?
The misconception that eating disorders do not affect people of color, LGBT (lesbian, gay, bisexual, transgender) communities, men, or older people can be detrimental to diagnosis and treatment. Bringing about the understanding that any person can suffer from this disease is critical to encouraging those struggling with eating disorders to engage in help-seeking behaviors and access professional care. Studies have shown that the earlier an eating disorder is treated, the greater the survivor’s chance of making a full recovery. For this reason alone, healthcare professionals and the general public must understand that eating disorders affect all sorts of people; moreover we must be willing to undermine the perpetuation of stereotypes and dismantle the overarching narrative of ED risk demographics in our practices, research and media.
People of Color
A study conducted in 2006 discovered that doctors were much less likely to diagnose a person of color with an eating disorder, even if the symptoms and behaviors presented were exactly the same as those presented by a white patient. The study confirmed that people of color seeking help for eating disorders are less likely to receive an official diagnosis and consequently less likely to seek or be connected to treatment. This type of medical underreporting further demonstrates why incidence rates for eating disorders in non-white individuals are inaccurate.
Studies also show the prevalence of standards of beauty that emphasize the conventional white woman’s body. In 1996, a study of 7th grade girls found that Asian and Latina girls were more dissatisfied with their bodies than white girls. Another study of more than 6,000 Native American girls found nearly half were working to lose weight.
While white people may be more likely to develop anorexia, research shows people of color are just as likely, or even more likely, than white people to develop other eating disorders. For instance, a 2011 study found people of color were somewhat more likely to develop binge eating disorder and Latino/a youth were much more likely to develop bulimia. A 2000 study published in the Archives of Family Medicine found black women were more likely to fast and to abuse laxatives and diuretics than white women.
Eating disorders seem to be increasing among women of color but that perception might not be accurate. It might just be that more health care providers and mental health care professionals are diagnosing eating disorders in women of color and that more women of color are seeking help for eating disorders.
Orthodox Jews and Muslims
Research shows eating disorders are underreported among Jewish women, especially among Orthodox Jewish women, due to the stigma of mental illness in that community. Orthodox Jewish girls may develop eating disorders as a coping mechanism because in their community, eating disorders are considered more acceptable than some other coping mechanisms, such as substance abuse. In Orthodox communities, being thin is often viewed as important with regard to marriage arrangements, as well.
Eating disorders are also a problem for Muslims, for whom fasting is encouraged for Ramadan. Eating disorders are likely underreported among Muslims as in many other communities. Studies of Muslim women, not only in the U.S. but in Britain and in the Middle East, found they are as likely, or even more like, to suffer from anorexia than their non-Muslim counterparts both in the U.S. and in Britain.
National studies assessing the diversity of eating disorders among the general population have estimated that between one and three percent of women and 0.5 percent of men develop anorexia or bulimia nervosa. However, up to two percent of men struggle with binge eating disorder, which is more prevalent among men than other forms of disordered eating. For more info on eating disorders in men.
Gay, Lesbian, Bisexual, Transgender
Between five and twenty percent of people diagnosed with some form of eating disorder are male. Some earlier studies have reported that the majority of men with eating disorders were gay or bixexual, however, this is stigmatizing to heterosexual men who although they may develop eating disorders at lower rates than gay and bisexual men, still comprise the majority of men with eating disorders. Additionally, more recent research has questioned whether sexual orientation is as significant as whether the individual identifies more with traditional male or female gender roles.
Researchers have also suggested that eating disorders among the LGBT population is potentially a result of the stress of ‘coming out.’ While homosexuality is increasingly accepted and normalized, many people with marginalized sexual and romantic orientations still experience discrimination, violence, family rejection and a loss of support networks. Additionally, (lesbian, gay, bisexual, transgender) youth often experience bullying; another environmental stressor that may contribute to a higher incidence of disordered eating. One study revealed that gay and bisexual boys were seven times more likely to admit to binging and purging than their heterosexual peers. They were also significantly more likely to have dieted, vomited or fasted in an attempt to lose weight. The disproportionately high rate of eating disorders in gay and bisexual men may also speak to gay male culture’s unhealthy obsession with youth and sculpted, muscular beauty, as well as the prevalence of methamphetamine use and addiction.
Further supporting these findings, a study published in the International Journal of Eating Disorders examined the prevalence of eating disorders in bisexual, lesbian and gay communities. Researchers found that out of a sample of over 500 people, there was a significantly high prevalence of eating disorders among gay men. The study investigated the incidence of anorexia nervosa, bulimia nervosa and binge eating disorder. Overall, researchers concluded that homosexual and bisexual males have a higher risk of developing an eating disorder than heterosexual males. The study also showed that the prevalence of eating disorders among lesbians, bisexual and queer women is comparable to rates in heterosexual women.
Transgender and gender-diverse communities also struggle with eating disorders disproportionately to the cisgender population (those that identify with their biological gender. As reported April 28, 2015 in the Journal of Adolescent Health, Transgender students were more than four times as likely to report an eating disorder diagnosis as cisgender heterosexual women. Factors contributing to this high incidence rate include the trauma and violence faced by many trans people (especially trans women of color) that often lead to unhealthy coping mechanisms; structural forces like poverty, racism, ableism, homelessness and under/unemployment; and the difficult ways in which body dysmorphia and gender dysphoria are often inextricably linked.
Transgender and gender diverse populations have historically had limited access (financial and otherwise) to healthcare and little to no representation in research and eating disorder-related media. Speaking to long-standing transphobia and the medical community’s marginalization, misunderstanding and poor treatment of trans identity and gender diversity, many individuals also report problematic interactions with healthcare professionals and institutions, ranging from a lack of competency to harassment and denial of care. Health care providers may assume being transgender is itself a sign of mental illness or other pathology, although the American Psychiatric Association, the American Psychological Association, and many other professional associations all disagree. As more trans people obtain health insurance and have greater opportunities through social reforms, it is imperative that healthcare communities increase knowledge about transgender issues, eliminate bias and discrimination against transgender individuals, and leave ideas about the pathology of people that identify as transgender in the past.
Older adults also develop eating disorders. Despite eating disorders’ stereotypical association with young women, an increasing number of diagnoses are occurring in women over the age of 30. In 2012, Cynthia Bulik lead a study that found 13 percent of women over the age of 50 in America experience some sort of disordered eating behavior. As many as 70 percent of women in this age group were actively trying to lose weight, and 60 percent reported anxiety around body weight, which negatively impacted other areas of their lives.
The Faces of Eating Disorders
According to The Renfrew Center in Radnor, PA, the faces of eating disorder struggle are steadily diversifying, as well as increasing (and decreasing, as eating disorders are sadly being diagnosed in more children than ever before) in age. When it comes to understanding eating disorders, it is imperative to recognize that anybody, of any age, gender or race can suffer.
Written by Dr. Lauren Muhlheim, Tabitha Farrar and Dagan VanDemark – 2014
The Marginalized Voices Project is a collaboration between feminist activist, Melissa Fabello, and the National Eating Disorders Association (NEDA). The project seeks to challenge eating disorder myths/stereotypes and amplify diverse voices and experiences.
Islam and Eating Disorders Facebook Page
TIKVAH V’CHIZUK – ED Support for the Jewish Community Facebook Page
Not all Black Girls Know How to Eat by Stephanie Covington Armstrong
Man Up to Eating Disorders by Andrew Walen
Born Round: A Story of Family, Food and a Ferocious Appetite by Frank Bruni
Shattered Image: My Triumph Over Body Dysmorphic Disorder by Brian Cuban
A Girl Called Tim: Escape From an Eating Disorder Hell by June Alexander
Midlife Eating Disorders: Your Journey to Recovery by Cynthia Bulik
Eating Disorders in Diverse Lesbian, Gay, and Bisexual Populations
The Changing Demographic Profile of Eating Disorders
Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students