By Evelyn Mason and Maggie Piper, The Seattle Medium
All women and girls are susceptible to eating disorders and poor body image, but because of misleading medical terminology, popular-media images, and a lack of overall awareness and training, the issue and remedies are framed almost exclusively around white women.
But individuals and organizations are working to shift the discussion and unveil the true complexities of eating disorders, particularly in relation to minoritized communities.
They are producing research, providing resources to increase access and developing proper training practices for the medical community. These groups aim to open up the narrative surrounding eating disorders to include everyone impacted by them.
Black feminist media studies scholar Timeka Tounsel, an assistant professor at the University of Washington, and the author of the book “Branding Black Womanhood”, believes white women are the face of body image and eating disorders because of medical language that is based on white people.
“A lot of medical terminology is based on a prototype that is never going to be a Black person,” Tounsel said. “For something like eating disorders, that’s going to be based on white girls, white women. The idea of thinking about an eating disorder as something that someone suffers from because of an attempt to become ultra thin — as opposed to other kinds of disordered eating — I think that’s one of the reasons why there’s been a focus on white girls.”
White girls are more likely to be exposed to representations of “white femininity,” where a thin ideal reigns supreme.
Black girls, on the other hand, more often see themselves represented with a broader range of body types — and, in many cases, the ideal body type is not ultra thin, but rather a more curvy figure.
Black girls and women have also been found to be somewhat “overexposed” to the media — in other words, they are encountering many more types of images than their white counterparts.
“That’s because they’re watching the ‘Black’ stuff, and they’re watching the stuff that’s considered mainstream and not necessarily geared toward people of their race,” Tounsel said. “So, that ideal isn’t as rigid in their minds, because they’re seeing lots of different glamorized bodies. It doesn’t mean that there isn’t an ideal; it’s just different, and I guess more expansive.”
But, she said, Black women still suffer from damaging body dysmorphia and related eating disorders due to the pressure of attaining an “ideal” body, whether or not it’s the ultra thin white prototype.
Project Heal is a non-profit organization working to address inequitable access to treatment for eating disorders, particularly people of color.
Kelli Rugless, a licensed clinical psychologist and the chief clinical officer of Project Heal, said she came to the organization because of its commitment to social justice and equity in the eating disorder community.
“Our mission at Project Heal is to break down systematic, healthcare, and financial barriers to eating disorder healing,” she said. “Oftentimes, these systemic issues end up affecting different ethnic groups differently because, obviously, they’re systemic. The focus here is really to ensure that everybody has access to eating disorder treatment.”
Anyone in the United States can apply to Project Heal’s services; they cover clinical assessment, insurance navigation, treatment placement and cash assistance.
According to Rugless, providers have to seek additional training to learn how to treat and diagnose eating disorders, which means that a vast majority of professionals, physicians, dieticians and therapists do not have the training to properly identify them.
“I would say, honestly, the biggest barrier at the moment is the lack of education and awareness amongst providers about how eating disorders can look a bit differently in women of color,” Rugless said.
“A big part of eating disorder diagnosis is cultural standards of beauty, cultural ideals. And, because women of color often have different ideals than mainstream European American ideals, it often goes missed by professionals. There’s a huge vacuum of knowledge about what eating disorders are, and they really are a problem in communities of color.”
In order to address these inequities, Rugless emphasized her personal commitment to educating providers on how to understand the warning signs, such as food rituals, withdrawing from friends and family, and sleep problems. She especially encourages providers of color to learn and understand the complexities of eating disorders.
“My goal is to not just address it from the tail-end, but to make sure there are more providers who have the training and are from diverse backgrounds so folks can get seen and these issues can get flagged, even before it reaches the level of treatment center care.”
Rugless said Project Heal has partnered with different organizations to generate empirical data on the effects of eating disorders and, in particular, how peer support impacts the process of recovery.
In one collaboration, Project Heal and the F.E.A.S.T Report, a group that supports and educates caregivers, sought to understand how peer support impacts the ability of primary caregivers to support people in their lives who are battling an eating disorder. Their findings reinforced the importance of peer, familial and outside support for caregivers and allowed researchers to gain a better understanding of how to craft support centers for this group.
In another collaboration, between Columbia University and Project Heal, participants addressed how peer support impacts the successful recovery of those who are healing from an eating disorder. They found that peer mentorship was a much more effective tool than social-support mentorship, noting that participants were far more likely to continue with a peer mentorship program as it helped provide a sense of community.
“The biggest misconception around eating disorders is that you can look at a person and know that they have one,” Rugless said. “You simply can’t and that goes from looking at a person’s race, sexuality, cultural ideals, all of those stereotypes make people think there is only a certain type of group that has eating disorders.
“Project Heal is really working hard to educate people on that. There is not one group that is spared, everyone experiences eating disorders. They might just look a little different in each group.”
Sara Gonzalez, the marketing, publicity, and social media chair for the Seattle National Eating Disorder Association (NEDA) Walk, was diagnosed with an eating disorder at age 12 and received treatment for it throughout her teenage years.
“I am a person of color — I come from a Latinx background, and mental health is a tricky subject in our communities,” Gonzalez said.
“I am a first-generation American and my parents didn’t have the same resources that I have here in the United States. I remember how difficult it was for them, because they couldn’t comprehend the concept of an eating disorder. Like most people, they would tend to say, ‘Why don’t you just eat more?’”
She decided to get involved with NEDA as a way to help bring awareness to the stigmas and lack of conversation around disordered eating, and she saw the Seattle walk as the perfect chance to begin that work.
“When I went to residential treatment, only two people knew about it. It was something I wasn’t comfortable sharing, and I am trying to break out of that and be more vocal about it, because it is something that thrives in silence.”
The NEDA Walk is an annual event that takes place in many cities across the country. The Seattle NEDA Walk will take place in September. The event includes speakers, face painting, a silent auction, and more activities. The event is designed to raise awareness but also to raise funds for NEDA’s community resources, such as financial support for treatment, education campaigns and the NEDA helpline.
Judy Krasna is the Executive Director of F.E.A.S.T. (Families Empowered And Supporting Treatment for Eating Disorders), a global nonprofit that connects parents whose children suffer from eating disorders. She stresses that one of the most important, yet relatively unknown, realities of eating disorders is that they can in fact be genetic.
“If someone in your family has an eating disorder, you’re at a much higher risk for developing it,” Krasna said. “So, one of the things that you can really do to avoid getting an eating disorder is not to restrict food, not to go on a diet.”
Another crucial component to understand is that eating disorders are not a choice. For example, a person could start restricting their intake simply because of a stomach virus — and things might just escalate from there, especially if someone is already predisposed, and particularly if they are dieting unsupervised.
“They’re something that happens to someone, a health crisis that happens to someone,” Krasna stressed.
And it’s not only people’s families and friends who fail to notice eating disorders. It’s commonplace for doctors and pediatricians to miss the signs if a patient doesn’t “look” or “seem” like they’d have a disorder.
“Eating disorders don’t discriminate — they attack people of all races, creeds, colors [and] ages,” Krasna said.
That also includes women who participate in athletics, though you would think they have a stronger understanding of the importance of proper nourishment.
“Athlete-specific behaviors such as excessive exercise, injuries, sports regulations and coaches’ behavior can all contribute to disordered eating,” feminist media scholar Jennifer McClearen said in an email. She is an assistant professor at the University of Texas at Austin, specializing in sports and media industries. “Athletes’ body image is influenced by coaches, and societal pressure to be thin for better performances also has an impact.”
The Eating Recovery Center (ERC) is a national for-profit organization that specializes in the treatment of eating disorders. They have 35 different centers across the country, including one in Bellevue. ERC offers inpatient, residential, partial hospitalization, intensive outpatient and virtual intensive outpatient treatments across their many locations.
Megan Riddle serves as a psychiatrist and the medical director for the Bellevue location.
“Seattle is very rich in eating disorder programs and very strong eating disorder programs, too. But if you head out beyond the Seattle area, there are fewer programs,” she said. “If you are not in driving distance of that, it can be difficult. So, it has been nice to be able to offer online treatment and assistance,” which they started doing during the pandemic.
Riddle has been working with eating disorders since she was in graduate school and has helped develop a curriculum for primary-care physicians, psychiatrists, therapists and others to better establish how to recognize and treat eating disorders.
“People have a very strong preconceived notion of what an eating disorder looks like, so then if someone is a person of color, or trans, or gender diverse, or living in a larger body, they fly under the radar of providers, family members, and more,” she said. “Sometimes they get encouraged to engage in their eating disorders, and their well-intentioned PCP sends them down a restrictive path. It affects everyone, all genders, ethnicities, ages.”
There is hope. According to Rugless of Project Heal:
“I think the pandemic and, you know, what happened with George Floyd gave more space for us to talk about eating disorders in the Black and the Indigenous communities. People of color, in general, we had more of an opportunity to talk through the differences in our communities and what we were noticing, how we could make treatment centers more inclusive.”
She said Project Heal is working to make sure everyone has access to eating-disorder care, and to help create a fuller understanding of different cultures’ relationship to the issues.
“We are moving from just the financial barriers to the healthcare barriers, the systemic barriers to eating disorder healing.”
