Race and Identity Race and Mental Health The Impact of Race and Racism on Eating Disorders By Lauren Muhlheim, PsyD, CEDS Lauren Muhlheim, PsyD, CEDS Facebook LinkedIn Twitter Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy. Learn about our editorial process Updated on May 09, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Ivy Kwong, LMFT Medically reviewed by Ivy Kwong, LMFT LinkedIn Twitter Ivy Kwong, LMFT, is a psychotherapist specializing in relationships, love and intimacy, trauma and codependency, and AAPI mental health. Learn about our Medical Review Board Print Verywell / Laura Porter Table of Contents View All Table of Contents Society's Body Standards Fatphobia Racism and Disordered Eating Disparities in Treatment Resources While there's a general understanding that all bodies are naturally diverse—there's a wide range of sizes, shapes, and colors—we do live in a culture that values certain bodies more than others. Research has shown that systems of power (that disproportionately affect BIPOC and other marginalized groups) may contribute to eating disorders and affect individuals of minority ethnic backgrounds—dealing with disordered eating—differently than their white counterparts. Society's Body Standards In our society, thin bodies are highly idealized. Although eating disorders are serious mental illnesses that often stem from the complex interplay of predisposing and precipitating factors, the thin ideal—our cultural assignment of superiority to thin bodies—seems to contribute to these illnesses. History Thin bodies, however, have not always been deemed more worthy. Throughout earlier periods of human history, fuller bodies were aspirational and represented wealth and wellness. The paintings of Peter Paul Rubens, who lived from 1577 until 1640, depict full, sensuous female bodies. It was not until the end of the 18th century that we started to see an emerging preference for a thin ideal standard of beauty. Some Bodies Have More or Less Value In her book, The Body is Not an Apology: The Power of Radical Self-Love, Sonya Renee Taylor states that societies determine which bodies have the most value and reinforces this through the development of institutions and the enactment of laws that reinforce the privileges of some bodies over others. For example, white men have held many privileges throughout the history of the United States. People who happened to be born into Black and female bodies did not historically have rights. Sonya Renee Taylor, Author From LGBTQIA bodies, to fat bodies, to women’s bodies, we live under systems that force us to judge, devalue, and discriminate against the bodies of others. — Sonya Renee Taylor, Author Because this kind of judgment is commonplace, people in societies will, by default, rank their bodies against the bodies of others. As people evaluate their own bodies against others, people also try to jockey for higher places in the social hierarchy. Thus women, BIPOC, and other marginalized groups might try a myriad of diets, attach themselves to men with privilege or try to lighten their skin in the attempt to be seen as more valuable. As Christy Harrison, dietitian and author, wrote in her book Anti-Diet: Reclaim Your Time, Money, Well-Being, and Happiness Through Intuitive Eating, “These days, diet culture pushes the narrative that the reason we stigmatize larger bodies is because higher weight ‘causes’ poor health. In reality, though, fat bodies were deemed ‘uncivilized’ and therefore undesirable long before the medical and scientific communities began to label them a health risk around the turn of the 20th century." That said, there is evidence that being overweight or having obesity can increase one's risk of developing many potentially serious health conditions, including T2D, hypertension, and high cholesterol. What Is Weight Stigma? Fatphobia In the 19th century, white male scientists of Northern European descent developed theories about race and evolution that categorized people hierarchically. Black Women's Bodies They determined that heavier bodies were more frequently observed in people of color and fatness was, therefore, deemed an inferior trait. Black women tend to be heavier than white women and also to be healthier at heavier weights. During the period of the slave trade, colonists and race scientists asserted that Black people had greater appetites for food and sex. They were described as “gluttonous” and therefore less virtuous in a culture in which the Protestant value of moderation predominated. Over time, as more mixed-race people came into being, the dominant white group used thinness as well as whiteness in order to continue to assert their dominance. Thus, Sabrina Strings—sociologist and the author of Fearing the Black Body: The Racial Origins of Fat Phobia—argues that fatphobia originated as anti-Blackness. Racism and Disordered Eating As a result of systemic racism, BIPOC and marginalized groups who have an eating disorder are less likely to be diagnosed with one, are often hesitant to seek treatment. Furthermore, racism influences the way Black women and BIPOC experience eating disorders: As a marginalized racial group, Black women experience stigma. This stigma in turn increases the risk for all kinds of mental health problems, including eating disorders.As a consequence of institutionalized racism, Black women also experience greater poverty and have less access to health care than white women. They may be more likely to experience food insecurity which can be a risk factor for an eating disorder. BIPOC Often Go Undiagnosed The findings that Black women are on average slightly bigger—and the assumptions that they, therefore, prefer being bigger and also experience less cultural pressure than white women to conform to the thin ideal—creates the mistaken impression that they do not develop eating disorders. Black women may also adopt the belief that they are unlikely to get an eating disorder. This makes it even harder for them to realize they might have a problem and to seek help when they do. Consequently, when their relationship with food causes problems, medical professionals may not take them seriously and may fail to diagnose an eating disorder when one is present. A 2006 study asked clinicians to read passages about Mary, a fictional character with disturbed eating patterns. The ethnicity of the character was manipulated to be African-American, Caucasian, or Latina in different parts of the study. Participants were asked whether they believed Mary had a problem based upon the passage. The results showed that clinicians were less likely to diagnose a person of color with an eating disorder even if the symptoms were exactly the same as those presented by a white patient. The consequence of this bias is significant. It can be difficult to get a timely eating disorder diagnosis even if one fits neatly into the young, affluent, thin white female teen stereotype and has access to good healthcare. For those who don’t, a delay in diagnosis can mean the disorder becomes entrenched and harder to treat. Early intervention is a predictor of long-term recovery without lifelong health consequences. Non-female individuals and those from non-white backgrounds, who are usually diagnosed later in the course of the illness and don’t have timely treatment may have worse prognoses when it comes to recovery. Stephanie Covington Armstrong, the author of Not All Black Girls Know How to Eat, wrote the first memoir of a Black person with an eating disorder. Stephanie Covington Armstrong, Author Because I was a Black girl with natural hair who had grown up below the poverty line, no one ever suspected I could be bulimic. Only I seemed aware that melanin content did not guarantee me an eating-disorder free life. My color became the perfect shield against suspicion. — Stephanie Covington Armstrong, Author BIPOC Groups Face Treatment Barriers Furthermore, treatment may not be culturally sensitive. Black people may not feel comfortable in traditionally white treatment programs. Armstrong describes how she didn’t feel comfortable with a white therapist, but couldn’t find a Black therapist who treated eating disorders. The images used to market treatment centers almost always depict thin white females, further reinforcing the stereotype and subtly communicating to people of color, non-females, and people in larger bodies that they are not welcome or don’t belong there. With this stereotype comes the assumption that anyone with an eating disorder has access to private insurance and can afford expensive treatment—public health programs and public insurance plans commonly do not address eating disorders. This puts even greater limitations on the availability of affordable treatment options for individuals from marginalized groups who may lack funds and insurance. Finally, because eating disorders are commonly seen as a vanity affliction for affluent teenage white girls, there is less funding for treatment or research of eating disorders than other similar illnesses. It can continue to be difficult to get eating disorders on the national agenda when they are widely assumed to affect only a select and well-resourced group. Disparities in Treatment In the larger eating disorder community—including clinicians, treatment centers, and advocates—there are ways in which the destructive status quo is maintained. Thin white women and girls fill the visuals and stories on eating disorder websites, articles, blog posts, and awareness pieces. Eating disorder conference lineups and events continue to center white speakers and do not actively push back against the white affluent female stereotype. Additionally, research often neglects more diverse subjects and fails to acknowledge the narratives of marginalized individuals and their diverse paths to recovery. Popular media depictions of people with eating disorders also overwhelmingly focus on thin white females. The way to achieve the field-wide common goals of early diagnosis, access to treatment, and research funding parity is to ensure that all are aware that eating disorders affect people of all genders, ages, races, ethnicities, body shapes, and weights, sexual orientations, and socioeconomic statuses. They are present in, and a risk to, all families and communities. We need to support emerging BIPOC professionals who are interested in becoming eating disorder specialists. We need to create programs that encourage people of color to work in the eating disorder field. It is only through united, concerted, and continuing efforts that we can change the face of eating disorders and right the current wrongs. Resources If you are BIPOC, part of a marginalized group dealing with disordered eating, or a clinician specializing in the treatment of eating disorders, below is a list of resources that can be helpful: Not All Black Girls Know How to Eat: A Story of Bulimia by Stephanie Covington Armstrong Marginalized Voices Project (NEDA) Nalgona Positivity Pride Encouraging Dietitian Treating Black Women with Eating Disorders: A Clinician's Guide by Charlynn Small, Mazella Fuller Myths and Truths About Eating Disorders 7 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Hollander A.When Fat Was in Fashion. The New York Times. Taylor, S.R., 2018. The Body Is Not An Apology: The Power of Radical Self-Love, Berrett-Koehler Publishers, Inc., Oakland. Harrison C. Anti-Diet: Reclaim Your Time, Money, Well-Being, and Happiness Through Intuitive Eating. New York, NY: Little, Brown Spark; 2019. Katzmarzyk PT, Bray GA, Greenway FL, Johnson WD, Newton RL, Ravussin E, Ryan DH, Bouchard C. Ethnic-Specific BMI and Waist Circumference Thresholds. Obesity. 2011;19(6):1272–78. doi: 10.1038/oby.2010.319 Strings, S. Fearing the Black Body: The Racial Origins of Fat Phobia, New York University Press, New York, NY: New York University Press; 2019. Gordon KH, Brattole MM, Wingate LR, Joiner TE Jr. The impact of client race on clinician detection of eating disorders. Behav Ther. 2006;37(4):319-325. doi:10.1016/j.beth.2005.12.002 Armstrong, SC. Not All Black Girls Know How to Eat: A Story of Bulimia. Chicago Review Press; 2009. Additional Reading Sim L. Our Eating Disorders Blind Spot: Sex and Ethnic/Racial Disparities in Help-Seeking for Eating Disorders. Mayo Clinic Proceedings. 2019 Aug;94(8):1398-1400. DOI: 10.1016/j.mayocp.2019.06.006. By Lauren Muhlheim, PsyD, CEDS Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist Online Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.