Eating Disorders: Shifting the Conversation

By: Katie Abramowitz

In 2017, Netflix released a film titled To the Bone, which told the story of a girl named Ellen, a 20-year-old white American female battling anorexia nervosa disorder. 

The film sits next to countless others – Thin (2006), Girl, Interrupted (1999), Heathers (1989), to name a few – that include main characters with eating disorders. In a large majority of these movies, these characters fit a specific criteria: they are white, cisgender (typically heterosexual) young women. 

These tilted representations are a larger reflection of how we think and talk about eating disorders in America, and who we think of when we talk about those who exhibit disordered eating patterns. Historically, white, cisgender women have been presumed to develop disordered eating patterns as a result of thinness ideals that permeate Western society (Gordon, Perez, & Joiner, 2002). Consequently, women of color, non-binary people, and other groups have been excluded from the conversation, assumed to possess a sort of “immunity” to these beauty standards.

The data on eating disorders in America sharply dispute the misconception that eating disorders only affect white, cis women. According to the National Eating Disorders Association, Asian, Black, Hispanic, and white young people report attempts to shed weight at roughly equal rates. In fact, young Black people are 50% more like to engage in bulimic behaviors than are young white people (NEDA, 2020). In a large-scale study of undergraduate students, Diemer et al. (2014) found that transgender undergraduates were over four times more likely to have been diagnosed with anorexia or bulimia, and were two times more likely to exhibit disordered eating behaviors (e.g., purging) relative to female, cisgender women (Diemer et al., 2015). Further, there may be additional risk factors for eating disorders in non-white and non-binary groups; women of color living in the United States, for instance, face unique environmental stressors (i.e., racism and sexism) resulting from their affiliation with two marginalized groups, making them even more susceptible to disordered eating patterns (NEDA, 2020). This tends to go unrecognized in mainstream media. 

Despite the facts, researchers have found that the association between eating disorders and white, cisgender bodies is imprinted deep in our minds. In a study of undergraduate students, Gordon et al. (2002) distributed to participants three fictional case studies about a young woman who exhibited disordered eating behaviors. The three passages told the same exact story but differed based on the woman’s race (Black, Hispanic, or white). The researchers found that participants were significantly more likely to identify the behaviors as symptoms of an eating disorder when the woman was said to be white (rather than Black or Hispanic). The findings suggest that the notion that eating disorders only affect white women may be more implicit than we realize. 

These implicit biases may be so strong that they have the potential to impact those with medical training. In a later study, Gordon and colleagues (2006) again presented fictional passages describing a woman with an eating disorder, but this time to a sample of physicians. Similar to the previous study, the passage only differed based on race (Black, Hispanic, or white). Alarmingly, 44% of the sample responded that the white woman’s symptoms were problematic, while 41% responded that the Hispanic woman’s symptoms were problematic and only 17% responded that the Black woman’s behavior was problematic. Perhaps most striking was the fact that the physicians were least likely to suggest that the Black woman should be treated for an eating disorder professionally. 

The association between eating disorders and white, cis women can have damaging effects in practice. In a qualitative study of participants in a screening program for eating disorders, Becker et al. (2003) obtained data on the impact of racial minority status on treatment recommendations for eating disorders via self-report. Becker et al. found that non-white participants were less likely to report being questioned about eating disorder symptoms by a doctor than white participants. Latino and Native American participants in the program were significantly less likely to receive a recommendation for treatment or additional care than white participants, even after controlling for the severity of disordered eating patterns (Becker et al., 2003). These findings can have a cascade of detrimental effects for people of color; how are eating-disorders sufferers of color supposed to seek and receive help if they are told that eating disorders don’t apply to them?

We need to shift the dialogue around eating disorders in America. The associations between eating disorders and white, cisgender women are deep and damaging. Not only can they lead to inadequate treatment recommendations for non-white, non-binary individuals; these associations also have the potential to make these groups feel additional shame and insecurity about their eating disorder. It’s important to talk about eating disorders with the full magnitude of all they encompass; eating disorders are a spectrum. There are more than two of them – focusing only on anorexia and bulimia excludes a vast range of disordered eating experiences – and they affect bodies of all shapes, sizes, and identities. Let’s talk about them as such. 

Reference List:

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. 

Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health, 57(2), 144–149. 

Gordon, K. H., Brattole, M. M., Wingate, L. R., & Joiner, T. E., Jr. (2006). The Impact of Client Race on Clinician Detection of Eating Disorders. Behavior Therapy, 37(4), 319–325.

Gordon, K. H., Perez, M., & Joiner, T. E., Jr. (2002). The impact of racial stereotypes on eating disorder recognition. International Journal of Eating Disorders, 32(2), 219–224. 

Greenfield, Lauren, director. Thin. 2006.

Lehmann, Michael, director. Heathers. 1989.

Mangold, James, director. Girl, Interrupted. 1999.

Noxon, Marti, director. To the Bone. 2017.

“People of Color and Eating Disorders.” National Eating Disorders Association, 26 Feb. 2018, www.nationaleatingdisorders.org/people-color-and-eating-disorders.