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Although people of all identities can experience barriers to quality eating disorder treatment, marginalized individuals are particularly affected, especially those at the intersection of more than one marginalization. People of color, immigrants, LGBTQ+ people, people living in larger bodies, and disabled individuals are less likely to receive specialized, inclusive care. It’s up to many people in the field—treatment providers, clinics, organizations, and insurance companies—to take steps to make eating disorder treatment access more equitable.
Eating disorders affect people of all sizes, weights, genders, sexualities, races, classes, religions, and ages. However, eating disorders have historically been considered conditions that affect young, white, thin, cisgender, heterosexual, and affluent women. However, that is far from the truth, and this harmful stereotype has contributed to countless people outside of this identity going without diagnosis and treatment.
There is a huge gap between the need for eating disorder treatment and access to high-quality care. Black, Indigenous, and people of color are less likely to receive mental health care than white people, and even when they do receive treatment, it is often lower quality than the care white people receive.1
Here are some statistics that highlight this treatment gap:2
Some common barriers to receiving culturally-responsive, high-quality, affordable, and inclusive care include:3,4
Before we can make eating disorder treatment equitable, we must first define equity. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), treatment equity is “the right to access high-quality and affordable health care services and supports for all populations.”5
Equity is not just about having a fair opportunity for treatment access; it’s also about addressing social determinants, like housing, employment, insurance status, and proximity to services, that can influence physical and mental health, including eating disorder development.5
Further, equity is not a one-time event—it’s a restorative process aimed at a just distribution of resources that acknowledges inherent inequity and provides the most meaningful impact for those the system is most egregiously failing.
Equity is more than simply leveling the playing field—it disproportionately gives treatment access to marginalized people while acknowledging the past inequities of the system.
Organizations, treatment centers, providers, and insurance companies that want to take an equity-focused approach to diagnosis, referral, and care need to go above and beyond to include people who have long felt they weren’t a part of the eating disorder community or weren’t worthy of care.
Treatment centers must intentionally cultivate a safe and inclusive space by centering marginalized people in their branding and advertising, offering trans-inclusive bathrooms, hiring a diverse staff, offering diversity training, creating a fat-inclusive environment (e.g., having larger chairs without arms), and beyond.
Change isn’t going to happen overnight. The eating disorder treatment system has long since excluded people of color, people in higher-weight bodies, disabled individuals, and queer and transgender people; building trust and repairing relationships with people who feel harmed will take a while. As individuals and an organization, it’s safe to assume you have harmed or excluded people who needed treatment. The question is, how are you going to respond and do better?
Privileged people need to understand that change happens at the speed of trust. Equity is a lifelong process of being social justice-minded and inclusive. That means that individuals within these systems must reckon with their own racism, homophobia, transphobia, classism, and fatphobia.
It’s also important to note that equity isn’t a goal so much as a north star that you must constantly reorient yourself toward. It’s an ongoing process that requires humility, compassion, empathy, and a willingness to accept criticism and correction with an open mind and heart.
People in leadership positions must be personally invested in the work related to treatment equity. Their values must be oriented around personal interrogation and growth, and equity can’t be peripheral—it has to be a central part of the organization's vision.
For treatment providers, centers, and organizations, leaders must recognize that equity and inclusion are not trends—they are restorative, necessary, and long overdue. When it comes to building trust, first understand why marginalized people distrust many treatment programs. They may have a bad reputation for focusing on dominant identities and people who can pay cash. So many treatment centers have historically focused on filling beds and profiting instead of centering the vulnerable people who need care.
Some ways to create an inclusive and safe space include:
Treatment providers and organizations pursuing equity must be willing to listen to patients, take feedback, and implement changes. And they must be committed to equity because real change starts small and happens over time.