Is it possible for a Black woman to have an eating disorder?

Dear Curious,

Unfortunately, eating disorders know no boundaries. According to the National Eating Disorders Association, at any point in time, more than 10 million Americans of all races and ethnicities report symptoms of disordered eating. Not long ago, it was thought that eating disorders exclusively affected affluent white women from Westernized countries. Although Black women have always lived with eating disorders, only in the early 2000s did researchers begin to study eating disorders among Black women and other non-white people. These studies have shown little difference in eating disorder prevalence between racial and ethnic groups. Despite these similar rates, the stereotypical view of eating disorder patients has prevented Black women from realizing that they have an eating disorder, seeking help for their illness, and being properly diagnosed and treated. While the number of Black patients in treatment for eating disorders has increased in recent years, many cases remain hidden in Black communities.

Although many communities of color have long held the view that a voluptuous body is attractive and considered an indicator of wealth and fertility, some Black women feel an increasing pressure to conform to society's pursuit of thinness. While many overweight Black women consider themselves to be physically attractive, studies indicate that others (particularly high income Black women) feel pressure to look more “White.” One potential cause is media's celebration of White features as the only standard of beauty, coupled with the consistent underrepresentation of Black people and other people of color.

Acculturation stress, the stress of adapting to another culture, can also increase the risk of developing eating disorders. Examples include the daily stress and trauma of living as a Black person in a White society, interactions with law enforcement, or discrimination at work. Other risk factors for eating disorders, such as anxiety and depression, affect women of all races and ethnicities. There is research that supports a relationship between brain chemistry and poor impulse control, which is a risk factor for bulimia.

The psychological risk factors for developing eating disorders are similar regardless of race, ethnicity, gender, sexual orientation, or class. They can include:

• Relational problems within the family
• Stress
• Anger
• Feelings of inadequacy
• Low self-esteem
• Abuse
• Substance abuse disorder

There is also research that suggests Black women are more susceptible to certain types of non-restrictive eating disorders, such as recurrent binge eating, than more publicized eating disorders such as anorexia and bulimia. It’s worth noting that most research instruments used to measure eating disorder prevalence focus on the psychological internalization of the dominant culture’s idealization of thinness. Because Black people are less likely to be dissatisfied with being overweight or obese, the instruments may not adequately capture eating disorder prevalence in this population; furthermore, it may contribute to their minimal representation in eating disorder research. Having culturally sensitive research instruments will provide accurate prevalence data, which may improve access to resources for Black women with eating disorders. Improving these instruments can also help researchers explain the unique, protective factors against body dissatisfaction. Overall, future research needs focus on how to support Black women through their intersectional experiences of having an eating disorder. 

Many cultures associate the development of eating disorders and other psychological conditions with dysfunction and failure. This stigma may prevent many cases of eating disorders from being treated. Despite having similar rates of eating disorders, the stigma may be more severe in Black culture, as attempts to be thin or “shapeless” may be interpreted as disloyalty to the culture of origin.

Another factor at play is institutional racism, which may lead to missed diagnosis and treatment. Medical facilities and professionals are generally less available in many Black communities, making access to health care more difficult. When there is access, historic mistreatment has led to mistrust of medical institutions, which may make Black women less likely to seek out care even when it’s available. Unfortunately, those who don’t seek help for an eating disorder are more likely to be hospitalized. Because the eating disorder trajectory, onset signs, and self-assessment reports tend to be different among Black individuals there could also be a lot of misdiagnosed eating disorders. Research indicates that self-assessments can be particularly challenging because Black women may internalize the "strong Black woman" stereotype, making them more likely to score their experiences as less severe than they are, especially as they get older. Health care providers may also be more likely to miss or ignore signs of eating disorders in Black women due to racial bias. 

The longer someone lives with an undiagnosed or untreated eating disorder, the more harmful its effects are on the body. One-fifth of eating disorder patients die of the disease, and those with the condition are approximately 56 times more likely to die by suicide than people without eating disorders. Therefore, it’s critical that eating disorders be taken very seriously. It’s best for individuals with signs or symptoms of disordered eating be seen by medical providers as soon as possible, even if it's thought that the unhealthy eating habits are unintentional or harmless. 

If a person feels that they or a friend are suffering, they can contact their health care provider for an assessment. Making an appointment with a mental health professional may also be beneficial. For more information, including referrals to local resources, check out the National Eating Disorders Association.