Written By Alexa Riobueno-Naylor, MEDA Undergraduate Intern
Over the course of the summer as an undergraduate intern at MEDA, I’ve had the opportunity to conduct preliminary research for my thesis which I will complete during my upcoming senior year at Wellesley College. My research topic focuses on how Latina and Black women experience eating disorders, which is of particular interest to since it allows me to focus on the relationship between social inequality, individual psychology, and culture. My hope is that my research findings will bring much needed attention to the experiences of Black and Latina women who struggle with eating disorders without receiving appropriate treatment. I also hope that this research highlights the need to bring diverse voices into conversations about eating disorders, in order to help challenge stereotypes about what kind of people are affected by eating disorders.
I first became aware of the discussion around the topic of marginalized populations affected by eating disorders through a YouTube video. This spring I stumbled upon a video created by the National Eating Disorders Association (NEDA) titled, “Marginalized Voices and Eating Disorders: It’s Time to Start the Conversation.” It was only after watching this short video that I realized how significantly individuals with marginalized identities continue to be misunderstood, discriminated against, and further marginalized by a society ignorant to their experience. Many people, including some clinicians and doctors, continue to not fully comprehend the truths regarding the experience of an eating disorder in an individual who is not White, a member of a Western culture, cis-gender, straight, socioeconomically privileged, or has access to health insurance. Until these experiences are brought to light, far too many individuals with life-threatening eating disorders will continue to be underserved.
Soon after deciding that I wanted to focus on this topic, I recognized that I would need to focus on one or two specific populations rather than trying to complete a research project on all marginalized populations struggling with eating disorders. For many reasons, including the fact that I personally identify as Latina, my research focuses specifically on cis-gender women with or in recovery from eating disorders who identify as Latina or Black. Unfortunately, I was only able to include cis-gender women in my research since their stories were the ones accessible to me. My inability to find resources on these populations speaks to an even broader issue regarding the marginalization of trans, gender-queer, gender-fluid, and non-binary folks within eating disorder communities, which would (and should) be a whole other research project.
Over the past few decades there has been a slow but steady increase in research dedicated towards understanding eating disorders in marginalized populations. I have provided links to some of these resources including recent research articles at the end of this post. To summarize, what research has revealed is that women of color experience eating disorders at rates comparable to White women. Some groups even experience eating disorders at higher rates than White women, such as Black women (see Suzanne Wu’s article below) and Latina women (see Alegría et al., 2009). Unfortunately, clinicians and doctors are less likely to diagnose women of color (specifically African American women) with eating disorders, creating yet another obstacle for women of color to maneuver if they hope to seek out professional help for their eating disorder (see Gordon et al., 2006).
In response to outcries from marginalized individuals who have demanded that they be better included in eating disorder communities, the eating disorder community is currently challenging how eating disorders are represented and understood by the public. Many individuals have publicly challenged the blatant homogeneity that persists within movies, TV shows, books, and images that depict individuals with eating disorders. These representations include stories and images of white, cis-gendered, able-bodied, thin, and socioeconomically privileged women such as Lilly Collins in the Netflix film To the Bone and Troian Bellisario in Feed— two movies that were released this summer featuring main characters with eating disorders.
Homogeneous representations of eating disorders push marginalized populations further into the margins of society. This results in feelings of exclusion and loneliness, which makes it much harder for people in marginalized communities affected by eating disorders to ask for the help and support that they need. Therefore, it is crucial that we give marginalized voices the opportunity to be heard.
My research brings together stories written by women of color about their own experiences with eating disorders. By putting their voices at the forefront of my research, I hope to create a more accurate and empowering representation of how Black and Latina women experience eating disorders. I will work to honor the reality of their experiences by focusing on the truth of their story as they describe it in their own words. I will also work to honor the women’s individual experiences, since perpetuating a single narrative based on racial or ethnic identity is what I am attempting to challenge through this research. Hopefully, by rooting my research in the direct experiences of women who have told their stories, I will also be able to offer more specific and informed recommendations as to how Black and Latina women can be better supported by healthcare professionals who treat eating disorders.
Finding ways to make Latina and Black women feel more comfortable seeking out professional mental healthcare is a significant motivating factor behind my research. Many marginalized populations continue to be misunderstood and ignored, which negatively impacts their willingness to utilize mental health treatment services, if those services are even available to them. Researchers and activists have begun to uncover some of the difficult truths behind why marginalized populations do not receive proper eating disorder treatment. However, many questions still go unanswered, including:
Since I am only an undergraduate student, I have not had the ability to personally interview those currently struggling with or in recovery from eating disorders to help me answer these questions. Thankfully, many brave individuals have told their own stories through online mediums like blogs, videos, and podcasts. Many women have also turned their stories into memoirs or novels. Included in my research data are seven novels by White, Black, and Latina women, including the first memoir written about anorexia published in 1979 (Aimee Liu’s Solitaire), as well as Roxane Gay’s novel Hunger: A memoir of (my) body, which was published this summer.
In total, I have accumulated sixty-four stories by women who self-identify as White, Black, or Latina. I’ve begun engaging in a narrative analysis to methodologically compare the stories according to major themes that the stories include. This process includes analyzing the stories according to how they reference or discuss topics such as race, ethnicity, culture, family, community, religion, sexuality, socioeconomic status, education, language, healthcare, immigration, and of course, mental health. The process of analyzing and comparing over 64 stories will be a process I will continue into the fall and spring semester of this academic year.
Along with analyzing women’s stories, I have also conducted twelve interviews with clinicians who focus on treating individuals struggling with eating disorders. I have interviewed both therapists and nutritionists, and asked them questions about how they not only treat individuals with eating disorders, but also how they make their treatment more accessible and appropriate for clients who may not be White, able-bodied, economically stable, insured, or have the same kind of support systems available to many “typical” eating disorder clients.
From these interviews, one thing has become particularly clear: many clinicians desperately want to be able to serve a broader, more diverse client population. However, larger factors out of their control such as regulations set by insurance companies, adequate funding to be able to offer sliding scale or pro-bono services, affordable or available office locations, and appropriate training related to how marginalized identities impact clients’ eating disorders are not always available to them.
Clinicians and clients alike are frustrated by the fact that eating disorder treatment continues to be inaccessible to many populations, and more specifically in this case, Latina and Black women. Although clinicians may want to help, and clients may want the help, many suffering with eating disorders continue to go without proper, life-saving care.
From what I’ve learned through my research thus far, both through the stories I have read written by women of color about their own experiences and the interviews I have conducted with clinicians, I’ve come up with a few preliminary findings. This list of findings marks only the beginning of a long list of ways that eating disorder representation, education, diagnosis, and treatment must change in order to better serve the needs of Black and Latina women with eating disorders. I will be adding to this list as my research continues.
Although eating disorders are difficult, destructive, and complicated diseases, full recovery or healing from an eating disorder is possible if individuals who are suffering have access to inclusive, sensitive, and respectful care. I look forward to continuing my research and learning more about how eating disorders impacting Latina and Black women can be more appropriately treated. The eating disorder community is beginning to make great strides in their fight to help individuals with eating disorders get the care they need, regardless of their race, gender, religion, ethnicity, socioeconomic status, body size or background. I look forward to contributing to these conversations by highlighting voices that have been previously silenced.
Additional resources to review related to this topic:
 Marginalized individuals are members of groups excluded due to race, religion, political or cultural group, age, gender, or financial status.
Written by Stacey Koller from New Haven RTC
When an adolescent is struggling with an eating disorder, the effects are not limited to her alone. Eating disorders can have great power in a family system, and every family member will have a unique relationship with the eating disorder.
When a daughter is struggling with an eating disorder, parents experience extreme anxiety. They are fearful for their daughter’s physical health and her emotional well-being. Like all anxiety, this often leads to an attempt to control, so it is common for parents to become obsessive over their daughters eating or exercising habits, and obsessing over her weight. This attempt to control is done in earnest concern but typically leads to power struggles that escalate the behaviors.
At New Haven, we specialize in the family system work that is essential in treating adolescent eating disorders. We understand the power struggles that develop within the bonds of a family when a daughter is struggling with an eating disorder. Because the eating disorder touches each member of the family we make sure to work with each family member as a part of treatment.
Narrative Therapy is utilized with families to help them understand that the problem is the problem-not the person. This gives the family space to address the eating disorder itself, or more importantly the issues that are driving the eating disorder. Moving from an attempt to control into a space where resolution can be found is essential for recovery. Narrative Therapy helps the family unite, then align, against the narrative that is driving the eating disorder.
Of course, this sounds easier on paper than it is in real life. As discussed in our last blog post, New Haven utilizes our Adaptive Family Systems Model to address the roles and narratives that exist in the family. This works takes time, and when it comes to an eating disorder, fear can make it difficult for families to make these shifts. While moms tend to better understand the ideas and narratives that drive the daughter to her eating disorder behavior, dads sometimes have a more difficult time shifting from a place of control and moving to the deeper work at the core. Structural Therapy is used to realign the roles that have developed around the eating disorder, but it is important to recognize that each parent and sibling’s unique relationship with the eating disorder will need to be addressed.
The programming that exists at New Haven already creates an environment where focus on the eating disorder can be minimized so families can also focus on building positive family relationships. As a family becomes closer and connected, the eating disorder loses power in the system. Healing is found over time through dedicated family work.
written by MEDA Undergraduate Intern, Alexa Riobueno-Naylor
Need a break from negativity? Want to jam out to tunes that will make you feel powerful, uplifted, and remind you about how wonderful you are? Listen to the Positivity Playlist!
Recent research out of Durham University and the University of Jyväskylä in Finland revealed that listening to music can impact your mood significantly, both positively and negatively. There is no doubt that music is a powerful force, and can do wonders in changing your mood, energy, and level of confidence.
Thanks to everyone who gave me song recommendations for this playlist!
Click here to listen to the playlist on Spotify, or clink on the links below to listen to each of the songs on YouTube.
I Lived (One Republic)
“I owned every second that this world could give, I saw so many places, the things that I did, with every broken bone, I swear I lived.”
Quit Pulling Me Down (Secret Someones)
“This time, baby, I’m not coming back to you. You won’t break me, it don’t matter what you do. I’d forgotten I was strong since you came around. Quit pulling me down.”
Firework (Katy Perry)
“You don’t have to feel like a waste of space, you’re original, cannot be replaced. If you only knew what the future holds, after a hurricane, comes a rainbow.”
My Skin (Lizzo)
“I woke up in this, I woke up in this, in my skin.”
Brave (Sara Bareilles)
“Maybe there’s a way out of the cage where you live. Maybe one of these days you can let the light in. Show me how big your brave is.”
Fight Song (Rachel Platten)
“My power’s turned on. Starting right now I’ll be strong. I’ll play my fight song. And I don’t really care if nobody else believes. ‘Cause I’ve still got a lot of fight left in me.”
Roar (Katy Perry)
“You held me down but I got up. Already brushing off the dust. You hear my voice, you hear that sound, like thunder gunna shake the ground. You held me down, but I got up. Get ready cause I had enough.”
Marchin On (One Republic)
“There ain’t no other step than one foot right in front of the other”
“I’m so powerful I don’t need batteries to play, I’m so confident, I’m unstoppable today.”
Don’t Be So Hard on Yourself (Jess Glynne)
“Don’t be so hard on yourself, no. Learn to forgive, learn to let go. Everyone trips, everyone falls. So don’t be so hard on yourself, no”
Beautiful Day (U2)
“It’s a beautiful day, don’t let it get away.”
Love Myself (Hailee Steinfeld)
“I’m gunna put my body first and love me so hard ‘til it hurts.”
Beautiful (Christina Aguilera)
“I am beautiful no matter what they say. Words can’t bring me down. I am beautiful in every single way.”
Walking on Sunshine (Katrina & The Waves)
“I’m walking on sunshine, and don’t it feel good?”
Born This Way (Lady Gaga)
“Don’t hide yourself in regret, just love yourself and you’re all set.”
Soy Yo (Bomba Estéro)
“Y no te preocupes si no te aprueban cuando te critiquen tu solo di soy yo” / “and don’t worry if you are judged, when they criticize just say I am me”
Wings (Little Mix)
“And we don’t let nobody bring us down. No matter what you say—it won’t hurt me. Don’t matter if I fall from the sky. These wings are made to fly.”
The Greatest (Sia, Kendrick Lamar)
“I’m free to be the greatest, I’m alive”
Live Your Life (Yuna)
“Find your light, don’t hide from who you are. And rise before you fall in hope for something more.”
Shake It Out (Florence + The Machine)
“Shake it out, shake it out. It’s hard to dance with a devil on your back.”
Be OK (Ingrid Michaelson)
“I just want to be ok. I just want to be ok today.”
Set It All Free (Scarlett Johansson)
“I can finally see, it’s not just a dream when you set it all free.”
Brave Honest Beautiful (Fifth Harmony, Meghan Trainor)
“Don’t criticize yourself no more. You got a smile worth fighting for.”
Express Yourself (Labrinth)
“It’s not what you look like when you’re doing what you’re doing, express yourself.”
written by Shari Rogers, LCSW, Therapist, Timberline Knolls Residential Treatment Center
Change is a part of life. As adults, we know that things rarely remain the same.
Conversely, normal transitions can be perceived of quite differently and far more negatively by young people. This is primarily due to the simple fact that they are young; a girl of 12 or 13, even 17 and 18, just hasn’t lived that long.
Unfortunately, two key transitions—entering high school and entering college can prove dangerous, even highly damaging to certain females.
For most girls, life proves fairly predictable through elementary school; even if a junior high offers a change, it is usually not too dramatic. High school is different for a variety of reasons. Typically, several schools feed into a freshman class; therefore there are whole new groups of kids to adapt to. Keep in mind that this is a key maturational time for girls, in that most of them are rapidly moving into puberty. This means their bodies are changing in unexpected ways. Commensurately, their emotions are thrown into a tailspin due to hormone fluctuations. High drama can be the rule, not the exception.
If a girl has been taught healthy coping skills, she will weather this temporary storm; if not, she easily becomes fertile ground for an eating disorder. Knowing that at the heart of a food-related disorder is the need to control and cope with turbulent feelings, beginning to restrict or binge and purge can mitigate emotional chaos. Especially with the former approach of reducing food intake, there is the added benefit of weight loss, which seemingly many young girls want these days.
With the exception of puberty no longer being relevant, the transition to college can be even more traumatic. This is often the first time a young woman has lived away from home. Everything is new: friends, dorm life, meals, environment, to say nothing of increased academic pressures. Without parental support, she can easily move into bad habits, especially where food is concerned.
No matter the school or region of the country, female students are keenly aware of the feared “freshmen 15”. No one wants to validate that stereotype. It is no wonder that female college students, particularly in sororities, teach each other how to use eating disorder behaviors.
With a new school year just starting, it is important for parents, school counselors, even primary care physicians to be mindful of how transitions are proceeding with girls and young women. If a girl appears to be highly stressed due to peers or life at a new school, this should be addressed. If parents get the sense that a daughter is not adapting well to college life, a visit might be planned.
Two things are true about eating disorders. The first is that they work. This is difficult for many people to understand; nevertheless, it is true. Whether a girl is starving herself or a young woman is bingeing and/or purging, the behavior is serving a purpose: her stress and anxiety are reduced, she is finding it easier to cope. The second thing is that the early an eating disorder is diagnosed and treated, the better the chance of a complete and lasting recovery.
Written by MEDA Undergraduate Intern, Alexa Riobueno-Naylor with fellow Undergraduate Interns, Julia Kassman & Patty Atkinson
It’s been almost three weeks since members the MEDA community came together to watch the Netflix movie To the Bone. Since then, MEDA has been dealing with the aftermath of an office flood, providing us with ample time to reflect, ponder, and reconsider the impact of the movie. Although the intensity of the conversations surrounding the movie’s release may have died down, the movie continues to impact many people’s relationship to and understanding of eating disorders. Some people also may also be viewing the movie for the first time now, and we wanted to ensure that the conversation surrounding the film was continued.
There have been some comparisons between To the Bone to another Netflix series, 13 Reasons Why, due to similarities in their problematic depictions of mental illness. We know that many people struggling with depression have been negatively impacted by 13 Reasons Why, and unfortunately, the impact of To the Bone may be similarly negative. Although movies may not be real, movies impact people’s lives in very real ways.
One of the reasons why we decided to host a viewing of To the Bone was because we wanted to ensure that people had a safe space to watch it, where they could reach out for help if they felt like the movie was especially triggering to them. When it finally came time for us to watch, many of us were anxious and held expectations on what the movie would be like based on the trailer or one of the many articles that had been published prior to the film’s release.
It was amazing to see so many faces of the MEDA community come together to support each other during the movie screening. Throughout the movie, there were various audible reactions. Scoffs, giggles, moans, sniffles, and deep breaths rippled through the crowd at various points. Although no one could hear it, there were also many eye rolls during various scenes.
When the movie finally ended, those of us sitting in the room were left with many emotions: anger, annoyance, anxiety, sadness, confusion, surprise, and for some, not many feelings at all. In fact, if I were to sum up the feeling in the room after the closing credits began, it would be underwhelmed.
The build-up to the viewing of this movie was so big, that when we actually came together to watch it, many of us were left feeling disappointed and confused. The end of the movie felt so unsatisfying, so ambiguous, and so romanticized. It almost felt as though the movie was cut short, and we were left wondering “Is that it? Is that really the end?”
After watching, we came together to debrief as a group. We were led by one of MEDA’s fantastic clinicians, who asked us how we were feeling and what we liked and did not like about the film.
I’ll begin with the good. MEDA Executive Director, Beth Mayer, noted that she was happy that the film included the message that there are a million reasons why people get eating disorders. A few MEDA community members stated that they really loved the character of Eli’s sister, Kelly, who displayed a glimmer of realness in disclosing how her sister’s eating disorder impacted her own life. Beth also noted that we have to applaud the fact that someone took the risk to make this film, and that in the end, we want people to be talking about the issues surrounding eating disorders.
However, this film struggled at times to portray these issues properly. One member of the community beautifully articulated the movie’s main fault— the fact that many of the messages in this film may not make sense to people who have not had or been closely impacted by an eating disorder, thus perpetuating many misunderstandings surrounding eating disorders.
For example, the depiction of eating disorder treatment was described by another community member as “romanticized and inappropriate.” Although the movie’s goal was to educate the public on what eating disorders are really like, the movie failed to depict the difficult reality of eating disorder treatment. Many viewers also felt uncomfortable with the inclusion of romance in the story, noting that Eli’s romantic relationship with Luke was distracting, uncomfortable, and never would have been allowed in a residential treatment facility.
The fact that there was no depiction of the re-feeding process was also especially problematic. For many, re-learning how to eat is a huge part of treatment, and it was never shown in the film. The residents in Eli’s treatment home were given autonomy over what they ate, essentially allowing them to engage in unhealthy behaviors around food without the necessary professional supervision and guidance.
This sense of autonomy made it seem like individuals in treatment for eating disorders have the ability to take control over their own disease, when in actuality, it is not that easy. Although it was communicated that the treatment depicted in this film was referred to as a radical last resort for Eli, the treatment was also referred to as having “great outcomes,” insinuating that it was not only appropriate, but effective.
The other MEDA interns and I all have different histories and backgrounds when it comes to eating disorders. In order to comprehensively assess the film and its impact, we wanted to highlight each of our individual voices. As someone who has never gone to treatment, I can’t speak to what it is like to go through recovery in a residential treatment center. To speak about that, I will hand it over to my fellow undergraduate intern, Julia:
“I spent years of my adolescence fighting to overcome many of the struggles depicted in this film. Today, I can confidently say I am fully recovered and a healthy young adult. Due to my own experiences, I attended MEDA’s viewing of the film so that I could be in a safe place surrounded by clinicians available to offer support. As I watched the film, various images of an emaciated Lily Collins were triggering, but not nearly as much as I expected them to be. However, explicit eating disorder behaviors were depicted, which may have inspired some viewers to engage in specific eating disorder behaviors, instead of educating about the disease itself.
More than anything I was angered and frustrated by the film. To the Bone gave an inaccurate portrayal of recovery, and an even more inaccurate portrayal of recovery in a residential treatment center. For many, recovery is an ongoing and tumultuous process. The film portrays Ellen as having control over her disease while her family voices their lack of understanding as to why she is choosing to do this. Having an eating disorder is not a choice, and is far more complex than simply making a decision to eat.
Modeling current eating disorder treatment practices may have been less ‘entertaining,’ but at least audiences would have gained a real understanding and awareness. The film neglects basic tenants of recovery such as weight restoration, and developing a healthy relationship with food and eating. There are multiple scenes in the film that are centered around meal time, where patients in the residential treatment center have the freedom to choose what and how they eat. Although treatment centers may vary in their techniques and practices, the inclusion of structured, monitored and nutritious meals within treatment is an essential part of the recovery process.
The film fails to give audiences an accurate insight into the loneliness, denial and shame that often come with recovery. Exposing audiences to some of these raw emotions would have been more insightful. In the end we were left with no real representation of successful recovery, only a mere suggestion of it. What message did this send to those possibly battling an eating disorder? That a healthy, stable lifestyle was unattainable? For those watching the film for entertainment or educational purposes (ha) what message were they left with? It would have been empowering for at least one character in the film to serve as a role model and to successfully recover. Recovery is attainable with hard work, determination and support. That, most of all, is something I wish audiences could have been exposed to through the viewing of this film.”
Hearing from recovered individuals such as Julia allows us to better understand how the film impacted individuals who have experienced an eating disorder, and feel unhappy that their experiences were not represented. Patty, another undergraduate intern here at MEDA, who is also recovered from an eating disorder, offers her own reactions on the film:
“Both Lily Collins and director Marti Noxon suffered from an eating disorder. I was initially horrified that Collins had to lose weight for the movie. However, I have yet to think of a better way to go about portraying the character. Losing such a dramatic amount of weight is unhealthy and dangerous both psychologically and physically for anyone. Yet, it may have been inaccurate and less impactful to portray a severe case of anorexia with a person of healthy weight. The reality is that almost anyone who played Collins’ character would have received criticism and concern.
I appreciate that the movie depicts realistic family dynamics and how difficult it can be to maintain close, strong and healthy relationships with parents and family throughout one’s battle with an eating disorder. The movie does well in its portrayal of how difficult it can be for loved ones to support someone with an eating disorder. Eating disorders are hard, complicated and confusing for everyone involved. Many people, including a majority of those who are going to watch To the Bone, don’t understand what it’s really like for those struggling and wonder why the person won’t ‘just eat’. Often times Ellen’s family does not know what to do or say to make things better, making them feel overcome with guilt, anger, sadness, and confusion.
Eating disorders, just as many other mental illnesses, are hard for people on the outside to understand. This movie does not answer all questions about eating disorders, but it does promote awareness and conversation about the illness that affects so many people today. It will hopefully keep people questioning and encourage advocacy and research. I think that it is important to note that although the movie has its flaws it provides us with the opportunity to bring attention to a still severely stigmatized mental illness.”
It’s safe to say that this film does not serve to offer any sort of new perspective on the experience of eating disorders. Because when it comes to eating disorders, white, thin, cis-gendered female bodies have always been the default, and obviously continue to be. The movie is centered around the experience of a well-off white woman, but tries to sprinkle in the stories a of a few people of color, who serve as background characters.
We must critique how these characters were represented in this film. The only Latina woman shown in the film is the heavily-accented housekeeper. When we are first introduced to Kendra, the only black person in the treatment house, she doesn’t even speak for herself. “That’s Kendra,” says house-mate Anna, who identifies herself as having “Bulimia Nervosa, but more just Nervosa now.” In the end we don’t learn anything about Kendra besides the fact that she is a binge eater, and is sassy. Could the writers have gotten just a bit more creative, instead of relying upon the stereotype of a sassy black girl with binge eating disorder?
To be fair, we didn’t learn a ton more about the other supporting characters, such as Tracy and Pearl, but they were featured more prominently in the film. I would have loved to learn more about Kendra, and of course for the movie to have featured more marginalized voices. But that would just be too good to be true.
If you are interested in hearing from more people of color about their experiences with eating disorders, check out Gloria Lucas’ Nalgona Positivity Pride or The Body is not an Apology, which both work to center marginalized bodies. Pick up a copy of Stephanie Covington Armstrong’s book, “Not All Black Girls Know How to Eat,” or watch the trailer for Solace, a short film written and directed by Tchaiko Omalwale about her own struggles with an eating disorder and self-harm. Those are just a few of the marginalized voices out there, ready to challenge the stereotypes about eating disorders perpetuated by this movie.
There’s a lot of work to be done if we hope to really start an inclusive conversation about eating disorders which does not revolve around the stories of white woman with access to expensive eating disorder treatment. Because more often than not, eating disorders do not always look like Lily Collin’s character in To the Bone. Isn’t it time for a fresh and more inclusive perspective?