Challenges in BIPOC eating disorders: Prevalence, bias, and treatment barriers

Eating disorder prevalence in the BIPOC community

Eating disorder cases are generally tracked through self-reported scenarios, such as when patients actively seek treatment or volunteer for studies on the subject. And there is no central agency charged with keeping these statistics, making it difficult to find reliable or consistent numbers.

What studies have been done on the topic have uncovered some revealing trends, including:^1,2,3,4,5

• People of color with self-acknowledged weight and eating issues were less likely than White people to have been questioned by a doctor about disordered eating symptoms.
• Native American and Alaskan Native women are more likely than their White counterparts to experience binge eating.
• The lifetime prevalence of binge eating disorder is greater in Black, African American, Latinx, Asian, and Asian American individuals than in White people.
• People of color are disproportionately affected by binge eating disorder.
• Hispanic adolescents are more likely to have bulimia nervosa than non-Hispanic teens.
• Nearly 50% of Indigenous adolescents report trying to lose weight.
• Black adolescents are 50% more likely than their White peers to exhibit bulimic behavior, such as binging and purging.
• Asian American college students experience higher rates of caloric restriction than White college students.

Barriers for proper diagnosis in the BIPOC community

One of the biggest issues facing BIPOC people with these conditions is when the disordered eating behavior they exhibit goes unrecognized or undiagnosed. This can not only lead to a potentially deadly gap in treatment, but create a dangerous blindspot in research and further understanding of how eating disorders impact people.

Indeed, one analysis on the subject looked back at the abstract of each article published in the International Journal of Eating Disorders from 1981 to 2020 and found that only 2.5% of those studies included Black and Indigenous people. And, even in cases when the BIPOC community was considered, they represented a small portion of the overall group.⁶ 

This lack of clinical representation can lead to real-world bias or oversight. Other studies have shown that those who identify as BIPOC are significantly less likely than White people to be asked by their doctor about their disordered eating behaviors. Furthermore, BIPOC individuals are half as likely to get a diagnosis or treatment for an eating disorder.¹

Medical care and racial bias

Doctors also contribute to the underdiagnosis of BIPOC folks, often subconsciously.

One study, reported by the National Eating Disorders Association (NEDA), looked into treatment providers and implicit bias when it came to diagnosing patients with eating disorders. When treatment providers were presented with identical case studies outlining disordered eating symptoms in White, Hispanic, and Black women: 

• 44% of doctors identified the White woman’s symptoms as problematic
• 41% identified the Hispanic woman’s as problematic
• Only 17% identified the Black woman’s symptoms as problematic

Furthermore, the doctors in the study were far less likely to refer the Black woman to eating disorder care.¹ There is clearly still a need for intersectional care for eating disorders. 

Treatment barriers for Black, Indigenous, and people of color 

Aside from being underdiagnosed, Black, Indigenous, and people of color often face unique barriers that may further reduce their access to high-quality care for eating disorder recovery.

Some issues that have been identified in studies on the subject include:^6,7,8,10

• A predominance of White people being featured in advertisements for eating disorder programs, which could signal a lack of inclusion or give off an unwelcoming feel.
• A lack of culturally-responsive and culture-affirming treatment options, which could be demoralizing during an especially difficult period. 
• Disparities in health insurance coverage and quality between White people and people of color. 
• A lack of diversity among treatment providers themselves. As of 2019, 83% of therapists were White and just 17% were people of color. 
• The vast majority of imagery in medical textbooks, which feature White skin and White eating disorder symptoms, reinforcing any racial bias that may appear in medical research.
• An additional stigma surrounding mental health conditions, such as eating disorders, in certain cultures, which may discourage people from seeking care.

As a result of these cultural and societal barriers, many people of color may not receive timely eating disorder diagnoses. But when it comes to these deadliest mental illnesses, early diagnosis and treatment can improve long-term outcomes and recovery, which means BIPOC individuals may be facing a more challenging recovery journey once they do receive care. 

The importance of culturally-sensitive care for eating disorders

Due to the misconception that the “typical” eating disorder patient is a White female from a specific socioeconomic background, treatment protocols in the past have been developed primarily for this patient. This means that treatment plans may not be inclusive for people in the BIPOC community with eating disorders and associated disorders.

The lack of culturally-sensitive care can work to create a toxic and exclusionary environment, which may result in BIPOC individuals feeling shamed and stigmatized, emotions that likely contributed to the development of disordered eating behaviors in the first place.

One 2021 study looked into the issue further, concluding that treatment providers who were comfortable talking about race and ethnicity with clients ended up with better treatment outcomes.⁹

How to be more inclusive of BIPOC eating disorders as a treatment provider 

For treatment providers, creating a welcoming, inclusive atmosphere for clients of all races is a crucial aspect of extending the best possible care for all people. Some tips for creating this type of environment include:

• Staying up-to-date with research about what’s important in culturally sensitive care.
• Evaluating and challenging any preconceptions and assumptions about race and ethnicity
• Choosing to actively practice anti-racism.
• Educating yourself on the nuances of how different ethnicities and races experience eating disorders, and considering how this affects approaches to treatment.
• Recognizing how privilege, power, and racism can affect the therapist-client relationship.
• Employing a diverse treatment team and working on providing a treatment environment that is welcoming to people in marginalized populations.