The Disparate Impact of Eating Disorders
Shedding light on inequities in access, treatment, and recovery.
Posted June 1, 2021 | Reviewed by Jessica Schrader
"For there is always light, If only we're brave enough to see it, If only we're brave enough to be it. –Amanda Gorman
This post was written by Gia Marson, Ed.D.
World Eating Disorders Action Day falls on June 2, 2021. This year’s theme, #Equity4EatingDisorders, urges us to take a hard look at the range of health disparities surrounding eating disorders. Because the truth is that myths, a lack of culturally-relevant assessments and interventions, and systemic racism, among other biases, contribute to unequal access to health care, diagnosis, and treatment. It’s time to change that.
A deadly eating disorder myth
The myth that eating disorders affect mostly “skinny, white, affluent girls” persists, in spite of mounds of data. Regrettably, this SWAG stereotype means that people of higher weights, members of racial and ethnic minority groups, those who are socioeconomically disadvantaged, and males receive disproportionately less care.
This troubling equity issue also stems from internalizing the myth. For example, a 2017 large-scale study asked college students with symptoms of eating disorders about their experiences with issues related to eating and body image . Males were less likely to perceive a need for treatment than females, and participants from affluent backgrounds were more likely to think they needed treatment and to have received treatment than their less-affluent peers.
Eating disorders don’t discriminate, yet studies like this one continue to reveal systemic biases, including biases from within our own minds against our own bodies.
“Eating disorders are invisible in the Black community largely because of misinformation and racial bias in the health care system ... as well as an overall lack of training in how to assess and treat eating disorders, results in Black people being misdiagnosed with obvious symptoms of an eating disorder.” –Kelli Rugless, Psy.D.
"It is no longer appears tenable to assume that EDs are uncommon in males nor that males account for only a negligible proportion of the public health burden of EDs and disordered eating ... efforts to advance research around clinical practice relating to the treatment of males with EDs are now critical." –Stuart Murray, Psy.D.
"As therapists, it is important for us to look deeply at our own biases and the ways they may show up in our work ... Taking steps to identify your own implicit assumptions about body size, eating behaviors, and health will minimize the potential of your beliefs influencing the way you work with those who come to you for help." –Lindo Bacon, Ph.D.
Eating disorders and disparities in the BIPOC community
In the past two decades, eating disorder research has highlighted the range of unmet needs among Black and indigenous people, and other people of color (BIPOC). Here is a sample of those findings:
“For the Black person, negative body image tends to go beyond body shape and size. It also encompasses those physical traits associated with Blackness. For example, skin color, hair texture, nose size and shape, eye color, hair color, etc. A Black person cannot fully accept their body without also accepting their Blackness.” —Kelli Rugless, Psy.D.
Stand for equity in eating disorder treatment
You don’t have to have an eating disorder or know someone who does, and you don’t have to become an expert in eating disorders, to be an agent of change. If you are willing to champion fairness, offer compassion, and speak up against stigma , you can start by taking this oath today.
Oath for equity in eating disorders
To promote equity, I commit to…
To increase support, I commit to…
To decrease stigma, I commit to…
Academy for Eating Disorders. (2021). https://www.aedweb.org/resources/about-eating-disorders/fast-facts
Becker, A. E., Franko, D. L., Speck, A., & Herzog, D. B. (2003). Ethnicity and differential access to care for eating disorder symptoms. International Journal of Eating Disorders , 33(2), 205–212. https://doi.org/10.1002/eat.10129
Eating Recovery Center. (2021). https://www.eatingrecoverycenter.com/conditions/eating-disorders/facts-…
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Perez, M., Voelz, Z. R., Pettit, J. W., & Joiner, T. E., Jr. (2002). The role of acculturative stress and body dissatisfaction in predicting bulimic symptomatology across ethnic groups. International Journal of Eating Disorders , 31(4), 442–454.
Sonneville K. R., & Lipson, S. K. (2018). Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. International Journal of Eating Disorders. https://doi.org/10.1002/eat.22846
Gorman, Amanda. 2021. The Hill We Climb. Penguin Random House. New York, New York.
J.M. Nagata et al. (eds),. 2021. Eating Disorders in Boys and Men. Springer Nature, Switzerland AG, Switzerland.
Bacon, Linda, PhD. 2010. Health at Every Size: the surprising truth about your weight. BenBella Books. Dallas, Texas.
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Gia Marson, Ed.D. , and Danielle Keenan-Miller, Ph.D ., are co-authors of The Binge Eating Prevention Workbook .
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