Update On Black Americans and Eating Disorders

young African American woman sitting alone

Awareness of these conditions in communities of color has come a long way—and frankly there’s a long way still to go to achieve health equity. Here’s the latest.

To get a sense of how uninformed the medical establishment can be about the prevalence of eating disorders among Black patients, here’s the first line of a study published in the Journal of the National Medical Association in 1987: “Eating disorders are rare in the Black population, particularly Black men.” 

Granted, that was 1987, but the statement wasn’t true then, and it isn’t true now. The main problem then was there was hardly any research done on Black patients with eating disorders (EDs), so no one really knew about prevalence rates. We have some data now, but research on eating disorders in people of color is still lagging far behind the studies comprised of predominantly white participants.  As for now, in some age groups for certain eating disorders, prevalence is actually higher for Black people than for Whites. 

Long-standing misperceptions about EDs such as bulimia, anorexia, and binge-eating disorder among Black patients have been held by clinicians (the overwhelming majority of whom are white in the eating disorder field) and also by members of the Black community as well. There’s still a lot of stigma around mental health and eating disorders in the Black community. Those who are living with an ED worry it’ll be seen as a weakness or a moral failing if they come forward with it. But it isn’t either of those things. It’s a diagnosable medical condition you can recover from.

Getting past the treatment barriers

Before Black people get to the point of seeking and receiving treatment for their EDs, they often need to push through personal and community barriers. Shame. Embarrassment. Fear of being ridiculed or shunned. Reactions of anger or disbelief from people you thought you knew and could depend on. 

Stephanie Covington Armstrong describes these barriers well. An ED awareness advocate and author of “Not All Black Girls Know How to Eat: A Story of Bulimia,” Armstrong says this about the struggles many Blacks have: 

“In many ethnic communities, it is not acceptable to have issues with food. This translates into fewer people coming forward and being counted and included in eating disorder studies. I had an extremely difficult time seeking help because all my life I had been told I needed to fit into the strong Black woman archetype. I felt like a failure and had a lot of shame because of my bulimia and anorexia… Although eating disorders are a huge problem in the Black community, we are taught that we must deal with our problems ourselves.”

Problem is, the DIY approach usually doesn’t work. EDs are powerful conditions driven by complex factors, so you’ll want to consider confiding in someone you trust, and asking for their help and support. Or making an appointment with your family doctor, and giving that person an honest account of what’s going on. Or finding an online support group (we list several later in this article) and getting their input and advice. Eventually, if not right away, it’s best to meet with a doctor or therapist who specializes in EDs.

Other barriers include systemic barriers to accessing culturally attuned care. One systemic barrier is the history of egregious abuses of Black patients at the hand of the predominantly white medical establishment. From unethical and harmful research studies on Black patients, to microaggressions, inadequate screening, unequal treatment and even misdiagnosis, the lack of trust in the medical establishment by Black folks is understandable and warranted. 

Including more Black students in medical and clinical training may help to bridge this gap. The degree of underrepresentation of clinicians of color in both the medical community and the eating disorder professional community is astounding. Often, Black people feel more able to trust a clinician who looks like them, especially if they are seeking care at an eating disorder treatment center where Black patients are extremely underrepresented as well. One of the ways to increase representation in the eating disorder professional field is to center the needs and experiences of Black trainees and Black folks with eating disorders. Progress on that front has been slow in the eating disorder world. Those reading this blog in positions of power in eating disorder academic centers and clinical settings should hear this as a call to intentional and conscious action. 

EDs among Black community members is an urgent issue

The prevalence data—when it exists, which thankfully is happening more and more—paints a grim picture. Witness several studies on Black women and girls from the early 2000s, which showed these results:

  • Black girls are about twice as likely as White girls to engage in bulimic behavior.
  • Black patients have a younger age of onset for anorexia than the general population.
  • Black girls tend to have significantly more severe bulimia symptoms than White girls. 
  • Recurrent binge eating is more common among Black women than among White women.

Despite these statistics, many Black people still believe: “I can’t possibly have an eating disorder. Number one, I’m not thin, and number two, I’m not white!” This thinking is also sadly pervasive among medical professionals. “This patient can’t have an eating disorder…they are not thin and they are Black.” This thinking reflects the enduring and inaccurate perception that EDs only occur in the so-called “SWAGs”: skinny, white, affluent girls. Not true!

How and where to get help

First, it’s important to recognize when you need help. Signs that you may be dealing with an eating disorder include:

  • Obsessing about dieting and counting calories
  • Rapid weight decline or weight gain
  • Not wanting to eat in front of others
  • Missing meals and trying to deny hunger
  • Extreme or constant exercising to lose weight
  • Vomiting after meals
  • Increased mood swings 
  • Periods of consuming large amounts of food and feeling out of control during these episodes
  • obsession and dissatisfaction with body image 

If any of these feel familiar, you likely need to seek help. For guidance with next steps, consider the following organizations:

Final thoughts

An eating disorder is not something that’s “just in your head.” EDs are real, they are clinically diagnosable, they can wreak havoc on your life for years, and they can be deadly. But most importantly, they are treatable. 

So take the steps you need to take to get better. When you or a loved one starts the journey to recovery, be prepared to push through your fears, external stigma and self-imposed stigma, as well as the uninformed thinking that still exists in the community at large—including the medical and eating disorder community. 

With proper care, you can stay alive, develop a healthy relationship with food, and build a meaningful and fulfilling life free of eating disorder symptoms.