WRITING AND RESEARCH CONTRIBUTIONS BY Abigail Galvez
REVIEWED BY ALIDA IACOBELLIS, REGISTERED DIETITIAN (RD), MHSC
Eating disorders are often associated with a narrow population – typically young, White women. But, the truth is that eating disorders can affect anyone, of any age, size, gender, or ethnicity. Even though we know eating disorders do not discriminate, barriers to accessing treatment for those with marginalized identities and a lack of research on eating disorders in non-white populations has led to many people suffering in silence and without access to appropriate support and treatment. In this post, we’ll take a deeper look into what we know about eating disorders in marginalized communities and shed some light on how we can work to overcome challenges in the recovery journey.
Prevalence of Eating Disorders Across Cultures
Research suggests that there are no significant differences in the prevalence of eating disorders across cultures (1). This means that no specific racial or ethnic group has a higher or lower risk for developing an eating disorder. The factors that have been well-established in the research to contribute to eating disorder risk are experienced across many different cultures, including:
- Dieting
- Fasting
- Overeating
- Body dissatisfaction
- Excessive exercise
- Drive for thinness (1)
Differences in Eating Disorder Behaviour Across Cultures
Eating disorders are a unique experience for each individual, and it’s important to know that a number of genetic, psychological, and social factors can influence eating behaviour. That being said, research suggests that Hispanic and Black populations have a higher prevalence of bulimia (2), and Asian populations have a higher prevalence of restrictive eating (3) when compared to other ethnicities.
Research also suggests that Black women and Hispanic and Asian men were the groups that engaged in behaviours like fasting, skipping meals, and restricting most often compared to White individuals (4). Although eating disorders can develop among any racial or ethnic group, ethnic minorities may actually be at a higher risk for certain behaviours. Let’s dive into why this might be the case.
Culture & Eating Disorders
Culture plays a significant role in shaping our identity and how we derive self-worth. As a result, cultural values can have a strong impact on how someone views food, their body, and their appearance. Many cultures idealize a certain appearance and body type specific to their culture. In order to feel safe, comfortable and accepted in their body, people may strive to attain the ideal body type of their own culture or the dominant culture surrounding them. This can contribute to the development of eating disorders.
Western Culture & Individualism
In Western cultures, the ideal appearance for a woman often consists of being thin and tall, with an hourglass figure, long hair, fair skin and Eurocentric facial features (5). This beauty standard is subject to change in subtle ways every few years; however, its preference for “White features” has always been present. In North America, it is common for people to want to improve their appearance in order to feel more confident, gain an advantage over others, be accepted, or to be able to compare to celebrities and media influencers (6). The recent increase in cosmetic surgeries and procedures is thought to be related to the increasing pressure to attain an appearance that only a small percentage of the population naturally have (6).
East and South Asian Culture
The ideal beauty standard in South and East Asia often consists of pale skin and a slim figure (7). Throughout history, being small and dainty has been glorified in East Asian culture as it is seen as feminine and beautiful. In the South Asian population, being dissatisfied with one’s natural skin colour is very common and is often associated with greater body image distress in general (8). Also, in South Asian culture, food is seen as a symbol of love and gratitude, and many women struggle to balance their desire to restrict food and their appreciation of their culture (7).
Hispanic/Latinx Culture
In Hispanic cultures, being curvy with a small waist, rounded hips and long hair is accepted as the ideal body type in the media (9). There have been mixed results in the research when it comes to determining whether Latina women are more satisfied with their bodies compared to cultures with a thinner ideal; however, restriction and bulimia is still very common in their culture (10). One of the major predictors of dieting is having a “dual identity”, which is related to receiving mixed messages about the ideal body shape between their own culture and Western Culture (10).
Black Culture
Popular media will often portray Black bodies as curvaceous with full figures. Many believe that this body ideal protects Black women from having negative feelings towards their body shape; however, Black women are just as susceptible, if not more susceptible, to experiencing body dissatisfaction (11). Black culture still glamorizes an unrealistic beauty standard, even though it is different to Western beauty standards. Within a culture, there will still be a natural diversity of body shapes and sizes that exists. At times, even those who have a curvy body can desire to be thinner in order to protect themselves from objectification and harassment (12). Similar to Latinx culture, people in this community experience confusing and conflicting ideas about what the ideal body looks like, and the desire to be thin can be caused by the desire to feel safe and accepted in more Western cultures (11).
Jewish Culture
In Jewish communities, there are many cultural attitudes about the importance of food. Jewish individuals, especially women, are extremely vulnerable to weight-controlling behaviours, more so than their non-Jewish counterparts (13). Sociocultural factors may play a large role in this, as being a minority can lead to pressure to integrate to the more dominant culture (13). Some Jewish groups, like Haredi women, also place high importance on controlling food and body size due to the expectation to practice modesty and become thin for dating and marriage (14). Jewish people may also be more vulnerable to body image and weight concerns due to generational trauma and certain behaviours around food being passed down to children (13).
Indigenous Culture
There is some variation within what is perceived as the ideal body size and shape among multiple Indigenous communities in Canada (15). While some geographic regions prefer the appearance of larger bodies, some show preference towards smaller bodies. In urban schools, indigenous students preferred to wear more revealing clothing and were more likely to feel like they were too heavy (15). In more isolated Indigenous communities, students enjoyed wearing more conservative clothing and perceived themselves as thinner. Within Indigenous communities, older individuals or those who mainly spoke in their Native language were more likely to see larger bodies as ideal and healthy (15).
Religious Fasting and Eating Disorders
Food restriction and fasting occurs in many religions including Judaism, Catholicism, Hinduism, Buddhism, Taoism, and Jainism. Engaging in these practices can lead to challenges and conflicting feelings about food, body image, and religious values. If someone is at risk of developing an eating disorder, fasting practices may unintentionally promote and normalize restriction. If someone already has an eating disorder, fasting out of religious obligation may trigger a relapse or help to mask disordered behaviours (16). Also, having a celebratory meal during the holidays or Iftar may normalize or trigger binge eating (16). If someone decides to fast for cultural or religious reasons, it’s helpful to reach out for additional support from family, friends, their community and professionals.
Family Pressure and Eating Disorders
Concern with appearances, desire for control, and a focus on independence and achievement can be parts of a family dynamic that can make family members more likely to develop eating disorders (17). For example, in some cultures, such as Asian cultures, it is normal to have achievement-oriented families, and children can often feel pressured to live up to extremely high expectations, from academics to appearances. This can lead to perfectionism and a higher risk of developing anorexia. (17). In immigrant families, many daughters shift into a “caretaker” role, which includes taking care of business matters, earning money rather than focusing on school, and being their parents’ translators. These unique daily stressors can lead to isolation and loss of control, which are known to be risk factors for eating disorders (18).
The Role of Family and Community in Eating Disorder Recovery
Incorporating family and community into the eating disorder recovery process can be a powerful part of healing. For instance, some Indigenous healers practice specific rituals where spiritual guidance is facilitated (19). This provides a holistic approach to healing, where not only is the physical self prioritized in recovery, but also the spiritual and emotional self. Incorporating community and social networks into the healing journey can also make people feel a sense of belonging and understanding.
Participating in culturally relevant activities, support groups, or community events can provide an environment where people can share experiences, receive encouragement, and gain strength from their cultural heritage. The integration of family, culture, and community can offer a powerful foundation for healing and recovery.
Media, Social Media, and Eating Disorders
The media is one of the biggest influences driving young people to desire a change in their body or appearance (20). While more diversity in representation of appearances has started to arise in television, movies, and social media through more variety in skin colours and body shapes, the ideal Western appearance is still glamorized, not only in Western countries, but around the world.
Research suggests that when people in marginalized identities are constantly exposed to images of the ideal Western appearance in magazines, television shows, movies, and social media, they are more likely to be concerned or dissatisfied about their appearance, which can lead to weight-controlling behaviours (21).
Although we cannot control what society and popular media sees as the ideal standard of beauty, we can control the ways we view and use them. It is possible to approach media with a balanced and healthy mindset. Diversifying your social media feed, watching TV shows and movies from diverse perspectives, or gradually limiting your social media usage can help reduce body comparison and your desire to lose weight to be accepted by your external environment (21).
Eating Disorder Treatment Challenges for Marginalized Groups
Desiring the Ideal Western Body
The pursuit of the Western beauty ideal as a marginalized identity can often be unhealthy and unrealistic. People often believe that once they have the ideal body type, they will be accepted because of their closer proximity to Whiteness. However, if someone cannot feel empowered, safe, or accepted within their own cultural identity, the pursuit of weight loss will not address the larger systemic issues at play. Research shows that having a strong sense of cultural identity protects people from developing eating disorders (22). Therefore, although the pursuit of weight loss may not be harmful in every case, it’s important to understand the intentions behind it. Embracing and honouring your own cultural identity can prevent the internalization of external ideals of beauty.
Systemic Racism and Eating Disorder Treatment
Suitable health care is important for people with eating disorders to access in order to improve overall health and reduce complications. People in marginalized groups tend to receive fewer referrals for ED related treatment and receive less effective treatment (23). Youth of colour with mental health concerns are half as likely to receive treatment compared to their white peers (23). It is quite possible that implicit racial bias from health care practitioners contributes to these disparities (24). There is also a lack of research about eating disorders in marginalized communities which is a limitation to developing more effective treatment options for this population (25).
Cultural Stigma
Stigma surrounding eating disorders and other mental health conditions is more common in marginalized groups than in the Caucasian population (26).
Four types of stigma are most commonly associated with mental health and eating disorders among marginalized communities:
- Structural Stigma: Stigma that stems from laws, policies and practices. For example, lack of financial resources, high cost of healthcare, and a lack of diversity in the cultural and ethnic backgrounds of clinicians available to provide treatment are common barriers for those in marginalized communities.
- Affiliative Stigma: This stigma comes from the internalization of other people’s negative view of eating disorders and other mental health conditions. Feeling shameful, angry, or concealing the disorder are common behaviours that result from this (27).
- Public Stigma: This stigma refers to the negative attitudes and beliefs about people who have eating disorders, which causes people to judge, reject or fear those who are experiencing them.
- Self-Stigma: This stigma is shame that someone has about their own eating disorder which leads to negative emotions and coping skills (26)
Food Insecurity
Food insecurity refers to lack of access to sufficient, and culturally appropriate food. It has been shown that marginalized groups face food insecurity at higher rates, and racial minority households are almost twice as likely to experience food insecurity (28).
Food insecurity is a risk factor for eating disorders for several reasons. Experiencing food insecurity often means that there is a lack of access to fresh food, and more access to convenience and fast food retailers. This has been shown to be a significant factor when developing Binge Eating Disorder. Food insecurity also creates scarcity around food as a resource, and may result in restrictive eating behaviours in an effort to ration out food. This causes psychological and physical distress (29).
During periods of time when a person does not have enough food to eat, hunger and food preoccupation often result. When food becomes more abundant, such as after receiving a paycheque or government assistance, it makes sense that food intake increases. This creates a “feast-or-famine” cycle that can contribute to a pattern of binge eating, whether the initial period of food restriction was intentional (ie. to lose weight) or not (30). The combination of holding a marginalized identity, facing food insecurity, and dealing with disordered eating behaviour can be very complex and challenging.
Acculturative Stress
Acculturative stress is the stress that comes from transitioning from a one culture to the more dominant culture. This can look like moving from your home country to another country, where the dominant culture is quite different from your own. Some individuals may decide to embrace their culture, or to try to assimilate with the dominant culture. This creates unique stressors that differ from general life stress, such as discrimination and more family conflicts. Body image concerns can arise during the assimilation process when internalizing the ideal body type and pursuing weight loss in an attempt to feel safer and more included in a marginalized body. This is one of the major causes of disordered eating in the BIPOC community (31).
Overcoming Barriers in Eating Disorder Recovery
Reducing Stigma in Eating Disorder Recovery
Stigma surrounding eating disorders can result from many different beliefs and experiences. Addressing stigma is an important part of recovery because it helps to reduce shame and increase willingness to move forward with taking action to seek support. Educating yourself about eating disorders and the complications you might be experiencing is a great first step. It also helps to recognize that eating disorders are complex conditions that usually require specialized treatment. Practicing self compassion by developing a non-judgemental attitude about mental health is helpful during this journey as you start to challenge your beliefs. Reaching out to trusted individuals which may include friends, family members, coaches, teachers, or mentors about your concerns can help alleviate feelings of isolation.
Building a Support System
Having a support system available during recovery is important for all individuals with an eating disorder because it relieves feelings of isolation and provides an opportunity to gain practical and emotional support. Especially among marginalized communities, connecting with others who can relate to your cultural and life experiences can have a significant impact on your wellbeing. This can be done by identifying trustworthy people, joining support groups, and reaching out to online communities.
Accessing Professional Support
There is no one-size-fits-all approach to healing from an eating disorder, and health practitioners like Registered Dietitians, Psychotherapists, Social Workers and Psychiatrists are trained to understand the complexities of eating disorder treatment. Seeking help from those who have experience working with diverse populations can provide culturally sensitive care and support. These individuals can understand and acknowledge the specific experiences, identities, and realities that may impact your relationship with food, body image, and mental health.
Summary
The journey of recovering from an eating disorder is a complex and personal process, especially for those in marginalized communities. Cultural values, stigma, and barriers to accessing care significantly impact the way an eating disorder manifests.
- Eating disorders can affect anyone, of any age, size, gender, or ethnicity.
- Cultural and religious values can have a strong impact on how someone views food, their body, and their appearance. In order to feel safe, comfortable and accepted in their body, people may strive to attain the ideal body type of their own culture or the dominant culture surrounding them.
- Family, media and social media can play a significant role in eating disorder development and recovery.
- Marginalized groups may face unique eating disorder challenges related to desiring the ideal Western body, systemic racism, cultural stigma, food insecurity, and acculturative stress.
- Individuals in underrepresented communities who are at risk, currently experiencing, or receiving treatment for an eating disorder must be supported through a culturally sensitive lens in order to receive compassionate and inclusive care.
Eating Disorder Support Resources for Underrepresented Groups
Atzmi – organization focused on eating disorder prevention in Jewish girls through mental health support and programs designed to improve self-compassion and body acceptance
Sheena’s Place – free eating disorder support resources, including support groups for various underrepresented identities
Sage and Spoon – free online peer support groups for BIPOC
Asian Mental Health Collective – making mental health easily available, approachable, and accessible to Asian communities worldwide
Project HEAL – creating equitable access to eating disorder treatment for BIPOC
FEDUP Collective – organizing and advocating for more accessible, affordable and culturally competent ED treatment
Books on Race and Eating Disorders
It’s Always Been Ours: Rewriting the Story of Black Women’s Bodies
Not All Black Girls Know How to Eat
References
[1] Cheng, Z. H., Perko, V. L., Fuller-Marashi, L., Gau, J. M., & Stice, E. (2019). Ethnic differences in eating disorder prevalence, risk factors, and predictive effects of risk factors among young women. Eating Behaviors, 32, 23–30. https://doi.org/10.1016/j.eatbeh.2018.11.004
[2] Becker, A. E., Franko, D. L., Speck, A., & Herzog, D. B. (2003). Ethnicity and differential access to care for eating disorder symptoms. International Journal of Eating Disorders, 33(2), 205–212. https://doi.org/10.1002/eat.10129
[3] Uri, R. C., Wu, Y.-K., Baker, J. H., & Munn-Chernoff, M. A. (2021). Eating disorder symptoms in Asian American college students. Eating Behaviors, 40, 101458. https://doi.org/10.1016/j.eatbeh.2020.101458
[4] Simone, M., Telke, S., Anderson, L. M., Eisenberg, M., & Neumark-Sztainer, D. (2022). Ethnic/racial and gender differences in disordered eating behavior prevalence trajectories among women and men from adolescence into adulthood. Social Science & Medicine, 294, 114720. https://doi.org/10.1016/j.socscimed.2022.114720
[5] Calogero, R. M., Boroughs, M., & Thompson, J. K. (2007). The impact of western beauty ideals on the lives of women: A sociocultural perspective. The Body Beautiful, 259–298. https://doi.org/10.1057/9780230596887_13
[6] Foley, B., King, L., Pillai, R., Stickell, M., & Zinanni, L. (2020, June 15). Women’s body standards throughout the world. Humanities LibreTexts. https://human.libretexts.org/Under_Construction/Purgatory/Body_Image/WOMEN%E2%80%99S_BODY_STANDARDS_THROUGHOUT_THE_WORLD
[7] Bhatti, N. (2018, February 13). The Impact of Beauty, Body Image, and Health Discourses on Eating Disorder Risk in South Asian-Canadian Women. Western Graduate and Postdoctoral Studies. https://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=7154&context=etd
[8] Chan, J., & Hurst, M. (2022). South Asian women in the United Kingdom: The role of skin colour dissatisfaction in acculturation experiences and body dissatisfaction. Body Image, 42, 413–418. https://doi.org/10.1016/j.bodyim.2022.07.007
[9] Schooler, D., & Lowry, L. S. (2011). Hispanic/Latino body image. In T. F. Cash & L. M. Smolak (Eds.), Body image: A handbook of science, practice, and prevention (pp. 237–244). New York: Guilford Press.
[10] Winter, V. R., Danforth, L. K., Landor, A., & Pevehouse-Pfeiffer, D. (2019). Toward an understanding of racial and ethnic diversity in body image among women. Social Work Research, 43(2), 69–80. https://doi.org/10.1093/swr/svy033
[11] Hughes, E. (2020). “I’m supposed to be thick”: Managing body image anxieties among black American women. Journal of Black Studies, 52(3), 310–330. https://doi.org/10.1177/0021934720972440
[12] Mitchell, K. S., & Mazzeo, S. E. (2009). Evaluation of a structural model of objectification theory and eating disorder symptomatology among European American and African American undergraduate women. Psychology of Women Quarterly, 33(4), 384–395. https://doi.org/10.1111/j.1471-6402.2009.01516.x
[13] Pinhas, L., Heinmaa, M., Bryden, P., Bradley, S., & Toner, B. (2008). Disordered eating in jewish adolescent girls. The Canadian Journal of Psychiatry, 53(9), 601–608. https://doi.org/10.1177/070674370805300907
[14] Bachner-Melman, R., & Zohar, A. H. (2019). Potential risk and protective factors for eating disorders in Haredi (ultra-orthodox) Jewish women. Journal of Religion and Health, 58(6), 2161–2174. https://doi.org/10.1007/s10943-019-00854-2
[15] Alani-Verjee, T., Braunberger, P., Bobinski, T., & Mushquash, C. (2017, June). First Nations Elders in Northwestern Ontario’s perspectives of health, body image and eating disorders. Journal of Indigenous Wellbeing. https://journalindigenouswellbeing.co.nz/media/2022/01/68.57.First-Nations-Elders-in-Northwestern-Ontarios-perspectives-of-health-body-image-and-eating-disorders.pdf
[16] Jay, F. (2022, April 6). Ramadan and eating disorders. British Dietetic Association (BDA). https://www.bda.uk.com/resource/ramadan-and-eating-disorders.html
[17] Lee, H.-Y., & Lock, J. (2007). Anorexia nervosa in Asian-American adolescents: Do they differ from their non-Asian peers. International Journal of Eating Disorders, 40(3), 227–231. https://doi.org/10.1002/eat.20364
[18] Bushelle, Chantal A., “The Risks for Eating Disorders/Disordered Eating in Refugee & Immigrant Experiences and the Imperative of Culturally Alert Screening” (2021). Graduate School of Professional Psychology: Doctoral Papers and Masters Projects. 414. https://digitalcommons.du.edu/capstone_masters/414
[19] Alani-Verjee, T., Braunberger, P., Bobinski, T., & Mushquash, C. (2017, June). First Nations Elders in Northwestern Ontario’s perspectives of health, body image and eating disorders. Journal of Indigenous Wellbeing. https://journalindigenouswellbeing.co.nz/media/2022/01/68.57.First-Nations-Elders-in-Northwestern-Ontarios-perspectives-of-health-body-image-and-eating-disorders.pdf
[20] You, S., & Shin, K. (2020). Sociocultural influences, drive for thinness, drive for muscularity, and body dissatisfaction among Korean undergraduates. International Journal of Environmental Research and Public Health, 17(14), 5260. https://doi.org/10.3390/ijerph17145260
[21] Morris, A. M., & Katzman, D. K. (2003). The impact of the media on eating disorders in children and adolescents. Paediatrics & Child Health, 8(5), 287–289. https://doi.org/10.1093/pch/8.5.287
[22] Opara, I., & Santos, N. (2019). A conceptual framework exploring social media, eating disorders, and body dissatisfaction among latina adolescents. Hispanic Journal of Behavioral Sciences, 41(3), 363–377. https://doi.org/10.1177/0739986319860844
[23] Moreno, R., Buckelew, S. M., Accurso, E. C., & Raymond-Flesch, M. (2023). Disparities in access to eating disorders treatment for publicly-insured youth and youth of color: A retrospective cohort study. Journal of Eating Disorders, 11(1). https://doi.org/10.1186/s40337-022-00730-7
[24] Gordon, K. H., Perez, M., & Joiner, T. E. (2002). The impact of racial stereotypes on eating disorder recognition. International Journal of Eating Disorders, 32(2), 219–224. https://doi.org/10.1002/eat.10070
[25] Overview of Treatment Barriers. Project HEAL. (n.d.). https://www.theprojectheal.org/overview-of-treatment-barriers
[26] Misra, S., Jackson, V. W., Chong, J., Choe, K., Tay, C., Wong, J., & Yang, L. H. (2021). Systematic review of cultural aspects of stigma and mental illness among racial and ethnic minority groups in the United States: Implications for interventions. American Journal of Community Psychology, 68(3–4), 486–512. https://doi.org/10.1002/ajcp.12516
[27] Zhang, Y., Subramaniam, M., Lee, S. P., Abdin, E., Sagayadevan, V., Jeyagurunathan, A., Chang, S., Shafie, S. B., Abdul Rahman, R. F., Vaingankar, J. A., & Chong, S. A. (2018). Affiliate stigma and its association with quality of life among caregivers of relatives with mental illness in Singapore. Psychiatry Research, 265, 55–61. https://doi.org/10.1016/j.psychres.2018.04.044
[28] Odoms-Young, A., & Bruce, M. A. (2018). Examining the impact of structural racism on food insecurity. Family & Community Health, 41(S2). https://doi.org/10.1097/fch.0000000000000183
[29] Becker, C. B., Middlemass, K. M., Gomez, F., & Martinez-Abrego, A. (2019). Eating disorder pathology among individuals living with food insecurity: A replication study. Clinical Psychological Science, 7(5), 1144–1158. https://doi.org/10.1177/2167702619851811
[30] Hazzard, V. (2022). Link Between Food Insecurity and Binge Eating. Minnesota Family Physician.
[31] Jones, L. A., & Cook-Cottone, C. (2013). Media and cultural influences in African-American girls’ eating disorder risk. ISRN Preventive Medicine, 2013, 1–8. https://doi.org/10.5402/2013/319701