Eating disorders have been associated with young white women in a high socioeconomic bracket since the inception of these illnesses in the 1970’s and 1980’s. As the incidence of eating disorders has grown significantly in recent decades, research has proven that the power of the diet culture, obsession with thinness and inexorable pull towards weight loss by any means has not discriminated by race, age or gender.
But eating disorder treatment remains very much focused on the original population who first became sick. Therapy, treatment philosophies and residential programs are all geared to young white women of means. The eating disorder treatment world does not make room for other people suffering with these illnesses. African Americans are much less likely to receive eating disorder referrals from their doctor. Men struggle to find any treatment open to them. Older patients are marginalized by a clinical culture that stigmatizes them as untreatable.
Much of this stigma stems from the cultural lie about eating disorders: a person cannot be sick unless they look very underweight. This misunderstanding of eating disorders remains the central diagnostic criterion to doctors, clinicians, families and lay people. Time and again, people say someone cannot be really sick unless they look emaciated.
Meanwhile, all eating disorders, including anorexia, can be serious and severe when people have many different shapes and sizes. Weight and shape are not a good indicator of severe illness. A full assessment of the patient is the only way to understand how sick they are.
Basing someone’s illness on body shape immediately discriminates. On the whole, marginalized people in the eating disorder world are the ones who are unlikely to fit the socially acceptable code for an eating disorder. Only young white women are likely to become emaciated enough to receive attention and a referral.
Facing diet culture and fat phobia also means seeing the inherent racism and bias associated with how clinicians diagnose people with eating disorders. We clinicians need to understand that our own internal racist, sexist and ageist beliefs cannot cloud our clinical judgment. Size, age and gender are not ways to understand someone’s eating disorder. Only a full examination and use of unbiased clinical judgment will allow for fair and equal treatment for all people who need it.
Please find a few resources below to explain more about the bias in eating disorder diagnosis and treatment: