Doctors, researchers, patients call for equal representation when addressing eating disorders

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KANSAS CITY, Mo. — Eating disorders don’t just affect adolescent or young adult women. People of all ages, races, genders, and sizes can suffer from an eating disorder.  

The kinds of disorders and causes are just as varied as the people they affect. But scientific research traditionally hasn’t represented everyone.

Hollywood would make you believe that every person with an eating disorder is a blonde, very thin, white female.

“For years the standard assumption was that white, affluent females were sort of the face of eating disorders. What we know is that eating disorders exist in every ethnicity, every age group, male vs. female, gay vs. straight, etc,” Children’s Mercy Hospital Dr. Kathryn Pieper said.

Dr. Pieper and experts at Children’s Mercy say that misunderstanding is a systemic issue.

“For a long time, people of color and males have been underrepresented because researchers don’t see them as being as at that risk. So, they haven’t sought them out, and there’s a lot of disparity, too, in terms of accessing health and being able to participate in studies, so I think the science has to get better,” she said.

“Stereotypes. It’s bias. It is that racism where it’s just thought of that eating disorders are for white or Caucasian individuals,” pediatric psychologist Dr. Amy Beck said.

“And so, when a patient comes in with symptoms that are eating disorder-like, but if they’re a person of color, it’s more likely that they’re going to be overlooked. If it’s overlooked and not treated, it’s at risk of worsening.”

For years, Salome Wilfred has studied disparity of research on body image and eating disorders between Black women and white women.

“If we’re not being represented in having body image concerns, there isn’t going to be as much reaching out when it comes to eating disorders,” the third-year University of Missouri-Kansas City doctoral student said.

She says when she first started, she was hard pressed to find any research regarding women of color and body issues. In her research, she’s found white culture has a big impact on the expected beauty ideals for Black women.

“It’s two-fold. I think living in a white-dominant culture, there’s still that pressure to align with the thin ideal, but on top of that we are looking at cultural aspects, there’s a different body type that’s often referred to  as a slim-thick body type,” Wilfred said.

“So, historically it’s been seen as the hourglass figure, thin waist, big breast, big butt, hips.”

Wilfred says body type expectation can be just as damaging for women of color, if they don’t fit this so-called acceptable image for their ethnicity.

She says in her research, women of color had a hard time talking about body image, largely because they’ve been so under-represented.

“A lot of raw conversations that I don’t think a lot of Black women have had the avenue to discuss because it’s been historically such a white woman experience,” Wilfred said.

Mimi Cole didn’t realize how under-represented Black women are in this field until she found out what she believed was anxiety was also an eating disorder combined with other mental health issues.

“There’s definitely a really small number of Black therapists and bipoc therapists in general. I was just researching this – about 4% of the field of psychologists identifies as Black or African-American, and then you have to narrow it down to those who specialize in eating disorders,” Cole said.

“We are really not represented, and representation is really important to make sure people see themselves in the people who are providing care for them,” she said.

Cole says she was lucky to find a therapist who listened and took her needs seriously, regardless of the color of her skin or the size of her body. She was diagnosed with orthorexia – an unhealthy obsession with healthy eating, and immediately put on a path to healing.

It was an experience that changed her life, and her career goals. Instead of being a nutritionist, she’s studying to become a therapist.

As she studies, she has become a voice for other women of color on social media under the name “The Lovely Becoming,” to share her experience and the struggle of a changing body, while healing into a healthier mental state.

“I think everyone has to get to their own point where they say dieting and eating disorders is not better than trusting someone for a different approach,” she said.

“It’s really hard work to recover into a body that society doesn’t celebrate or accept, and it’s really hard to go against the grain and the culture.”

But it’s essential for survival.

“And eating disorders, specifically anorexia and also bulimia, are some of the most dangerous mental health conditions because of the quick and immediate impact on your physiological health and cardiac function,” Dr. Beck said.

“You can actually die from an untreated eating disorder. So, if we’re ignoring segments of the population then we’re putting them at an increased risk.”

So how do we change the conversation about body size? Some doctors say it’s time we start to understand what factors contribute to a person’s size, and those factors stretch far beyond diet and exercise.

Once again- race, stereotypes, hormones, and socio-economic status are all contributors to how a person’s body grows and changes.

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