Treatment Bias in the Eating Disorder Community: Race, Gender and Age

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:

https://www.nationaleatingdisorders.org/people-color-and-eating-disorders

https://www.npr.org/sections/health-shots/2019/03/03/699410379/when-it-comes-to-race-eating-disorders-dont-discriminate

https://centerfordiscovery.com/blog/overcoming-an-eating-disorder-minorities/

Recovery in these Challenging Times

In the midst of the pandemic, the protests and the violence, everyone is reeling as they try to figure out how to manage. Most people are overwhelmed with their own emotions while also making sense of how to respond to the randomness of nature, the destruction wrought by humanity and the injustice and inequality around us.

How can someone caught in their own recovery from an eating disorder stay present for what is happening in the world and not lose sight of their own personal health?

It’s too easy to say this is not the time to fight for recovery. Instead just focus on surviving now and deal with the eating disorder later.

The problem is that eating disorders don’t stay stagnant while someone deals with the state of our world. It digs in deeper, becomes more powerful and sinks that person further into illness.

The only other choice is to both face the reality in front of all of us and stay present in recovery. Doing both things means staying true to who you are. Each of us needs to manage our own personal lives and find our own way to look at the current events unfolding around us.

It is crucial not to let these events distract from the goal of eating disorder recovery. Food logs, meal plans and journals to log emotions and personal responses remain as important as ever. These cornerstones of recovery serve as the way to stay connected with yourself and not pretend the eating disorder is the true core of one’s identity.

Continuing to attend all appointments for recovery provides opportunities to clarify thoughts and feelings and decrease the likelihood of leaning on eating disorder behaviors to cope.

Last, the more one uses the eating disorder to manage, the less true one’s voice becomes in the world right now. Thoughts and feelings need to stem from each of our own true and genuine selves and need to reflect the most honest place we can find in ourselves to see our world when it faces such an important crisis. The eating disorder will only cloud the truth behind the inanity of obsessing about food and weight.

Now is the time to focus on connecting with ourselves, our community and the people around us, not with a destructive illness.