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:
- Why is there such a discrepancy between the prevalence of eating disorders among women of color and the number of women of color who receive treatment for eating disorders?
- How is the experience of an eating disorder tied to one’s racial or ethnic identity?
- How can clinicians specializing in the treatment of eating disorders better serve minority populations?
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.
- The diagnostic criteria used to diagnose eating disorders does not adequately represent how women of color experience eating disorders. Many people who suffer from eating disorders go unnoticed because they do not present in a way that makes their eating disorder obvious.
- Conversations about eating disorders must be more intersectional, meaning that they need to acknowledge that marginalized folks, such as women of color, experience forms of oppression based on factors outside of the mental health issues that led to their eating disorder. These factors include oppression based on race, ethnicity, culture, immigration status, gender identity, sexual orientation, education, socioeconomic status, or religion. Until all of these identities are understood as existing together and in relationship to one another, women of color will continue to be misunderstood and mistreated.
- Many Latina and Black women agree that there need to be more clinicians of color who specialize in eating disorders. Although it is not always the case that a woman of color seeking out care will choose to work with a clinician of color, having the option to work with someone who looks like you and who may be able to mirror your experiences in a more nuanced way, may make women of color feel safer and more willing to ask for help.
- There is a real need within Latina and Black communities for education about eating disorders. Mental health issues are highly stigmatized in many communities of color, which makes seeking out professional care as well as family or community support even more difficult. If communities of color can become educated about eating disorders, it will make it easier for them to successfully support those in their community that are suffering.
- Clinicians must continue to respect and acknowledge that clients are the experts of their own experiences, especially when it comes to their race and ethnicity. Since many clinicians feel as though they may not have received enough education on how eating disorders may present differently in individuals with marginalized identities, clinicians must continue to seek out resources that can help clients with marginalized identities feel more understood and comfortable within treatment settings.
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:
- Report Reveals Surprising Data on Bulimia by Suzanne Wu
- Prevalence and Correlates of Eating Disorders in Latinos in the U.S. by Alegría et al., 2009.
- America is Utterly Failing People of Color with Eating Disorders by Angela Garbes
- The Impact of Client Race on Clinician Detection of Eating Disorders by Gordon et al., 2006
- Our World is Diversifying and Healthcare Needs to Respond by Marcella Raimondo
- Why We Need More ‘Hunger’ and Less ‘To the Bone’ by Melissa Fabello
- Eating Disorders Do Not Discriminate by Michelle Konstantinovsky
- ‘Eat Up’: How Cultural Messages Can Lead to Eating Disorders by Carmen Cusido
- Factors Associated with Self-Identification of an Eating Disorder History Among Latinas Meeting Criteria for Past or Current Eating Disorders by K. Higgins et al., 2016.
- Barriers to Treatment for Eating Disorders Among Ethnically Diverse Women by Fary M. Cachelin et al., 2000.
- Eating Disorders: A Sane Response to Systematic Oppression by Ophira Edut
- The Changing Demographic Profile of Eating Disorder Behaviors in the Community by Deborah Mitchison et al., 2014.
- Eating Disorders Quietly Plague Black Communities by Ashley Michelle Williams
- A Hunger So Wide and So Deep: A Multiracial View of Women’s Eating Problems by Becky W. Thompson
- Hunger: A Memoir of (My) Body by Roxane Gay
- Behind the Mask of the Strong Black Woman: Voice and the Embodiment of a Costly Performance by Tamara Beauboef- Lafontant
- How American Diet Culture Negatively Affects Latinas by Viviana Rose
- Not All Black Girls Know How to Eat: A Story of Bulimia by Stephanie Covington Armstrong
- Hijas Americanas: Beauty, Body Image, and Growing Up Latina by Rosie Molinary
 Marginalized individuals are members of groups excluded due to race, religion, political or cultural group, age, gender, or financial status.