The Cloak of Invisibility: Why Eating Disorders Are Being Missed in Black Communities
Blog Post By Kristyn Soto and Jenifer Smith
2020 was a defining year for the mental health field. Even in 2023, we are still navigating the mental and emotional toll that COVID-19 took on us. In the midst of the mental health crisis, eating disorders were thrust into the spotlight as one of the top issues that people were struggling with (often co-occurring with depression and anxiety). Yet even as we learn more about the impact and treatment of eating disorders, there are still many communities whose voices and experiences seem to be covered by a cloak of invisibility - one being the Black community. This Eating Disorders Awareness Week, we want to raise awareness about this important issue and how it affects these communities so that more people reach out to access the care that they deserve.
The Problem
Studies show that more than 28.8 million people in the U.S alone are diagnosed with an eating disorder at some point in their lifetime, while millions more suffer from chronic dieting, compensatory exercise, body dysmorphia and disordered behaviors. In spite of these alarming statistics and the fact that eating disorders are the second deadliest mental health disorder (recently surpassed by opioid use), this issue is still widely misunderstood and under diagnosed - especially in Black and Brown communities.
The Warning Signs
In the process of identifying an eating disorder, common warning signs include restricting meals, eating food well past the comfort of fullness (binging), purging after meals, laxative abuse, compulsive dieting, counting calories, overexercise or loss of interest in food. When these behaviors start it is also common to see weight loss, depression symptoms and irritability. When warning signs like this occur it is important to see a medical or mental health professional for evaluation.
Historically, Black individuals have a hard time reporting eating disorder behaviors and being properly diagnosed because of the lack of representation in the field and the common stereotype that eating disorders primarily impact White women. Television and the media often portray young, thin, affluent White women attending treatment or therapy and do not reflect people of color, men or children who can also have eating disorders. Most individuals would find it difficult to seek care or support for any health issue, if they do not see themselves represented in the struggle.
So if eating disorder behaviors are being reported at similar rates in both White and Black communities, where is this gap in care coming from?
The Gaps (just to name a few)
Stigma: The stereotype of the young, thin, affluent White woman who struggles with anorexia or bulimia (often reinforced through television and movies) has reinforced the idea that this issue affects only one community. This leaves the “others” (fat, BIPOC, queer, men, geriatric, etc.) to fall through the cracks of the treatment landscape.
Access and equity: Healthcare in Black communities is less accessible than in White communities due to funding and resources, making it difficult for people to be diagnosed and treated. In low-income Black communities, people may not have access to health care due to low wage jobs, homelessness and/or knowledge about resources. This makes it difficult for people to reach medical professionals who can make an appropriate diagnosis.
Lack of representation in the field: Eating disorders are a very isolating disorder, leaving many to feel like they are the only ones who struggle. But for Black individuals who struggle with eating disorders, this feeling is reinforced by the fact that they often don’t see themselves represented in the community. For any client there is comfort in working with a provider who shares a similar cultural background, connects with the client’s lived experiences and, for Black individuals in particular, can relate to and understand the racial trauma that comes with a person’s lived experience (even beyond allyship). A lack of representation across the eating disorder provider field can prohibit individuals from both being properly diagnosed and seeking care.
So what do you do if you are a Black person who struggles with this issue? How do you get connected to the care you need? Is there even hope for recovery?
The simple answer - absolutely!
The Next Steps (there’s hope for healing)
Recovery is possible for everyone! We are in a time of evolution where there is more awareness of people of color with eating disorders. If you or someone you know is showing warning signs/symptoms of an eating disorder, the best thing you can do to support your recovery journey is to get yourself or your loved one connected to treatment. Eating disorder care can range from working with an outpatient team (a therapist, a dietitian, a primary care provider) to getting medical care and mental health support at a higher level of care facility (learn more about eating disorder levels of care here). It’s important to receive a referral from a professional who can recommend the appropriate care plan. There’s no shame in asking for help or needing treatment, and it’s important to find the right provider(s) and facility for your needs.
Here are some questions you can ask providers to make sure you receive specialized, affirming care:
Do you specialize in treating eating disorders? What training have you done in this area?
Have you worked with clients of color before?
Have you done any learning around racism’s role in weight stigma and disordered eating in Black and Brown communities?
Are you Health at Every Size (HAES) aligned? How does that inform your work with clients? (Pro tip: If they do any weight loss work, they are not a HAES provider)
Do you have recommendations for HAES-aligned primary care providers?
Do you offer a sliding scale payment plan (even with insurance) or know of any scholarship support that is available to help with the cost of my treatment? (For more on treatment scholarships, check out our friends at Project HEAL)
Even when working with an outpatient team of providers, it’s always a good idea to consider plugging into a group for connection and support. We recommend seeking out a Black, Indigenous, and People of Color (BIPOC) support group. These groups are designed to provide support for clients who want to be with others who they identify with and relate to.
Through it all, don’t forget to give yourself grace along the way. Recovery is a journey, one that requires patience with yourself and for your loved ones who may not fully understand what you are going through. But one day at a time you’ll begin to heal, and your story will give light to the truth about Black communities and the impact of disordered eating - tearing down that cloak of invisibility one layer at a time.
Additional resources:
Choosing Therapy Therapist Directory
Arise: Virtual eating disorder support for BIPOC individuals
Therapy for Black Men from African American Psychologist, therapists and coaches
Podcast: Be Well Sis (See Episode 4 - Yes, Black Women Get Eating Disorders Too)
Book: The Care and Feeding of Ravenously Hungry Girls (Anissa Gray)
About Kristyn Soto: Kristyn became Rock Recovery’s Director of Community Partnerships in October of 2017. She was drawn to Rock Recovery’s powerful, Christ-centered mission to serve those struggling to find recovery and freedom from eating disorders. Kristyn has an educational background in Developmental Psychology, having obtained her BA from Messiah University and her MS from the University of Pittsburgh.
About Jenifer Smith: Jenifer is a Resident in Counseling in Virginia, focusing on disordered eating, health at every size (HAES), ARFID, anorexia, bulimia, self-esteem, body image, relapse prevention, and family dynamics. Jenifer has experience working at a variety of levels of eating disorder care. She is passionate about helping clients become the best version of themselves. Jenifer enjoys working with teens, adults, and families, integrating evidence-based approaches, including IFS and solution-focused therapies. Jenifer has two Master's Degrees from Barry University in Marriage and Family Therapist and Mental Health. Jenifer joined Rock Recovery in November 2022.