For National Eating Disorders Awareness Week, Gloria Oladipo explores the difficulties of receiving treatment as a Black woman and the ways in which the treatment can and should improve by tackling colonialism and white supremacy.
By Gloria Oladipo
My experience as a Black woman in eating disorder treatment is a difficult one. At the different levels of treatment I’ve been at, within the various centers I have been to, eating disorder treatment programs continue to be predominantly white spaces. In the United States, at least 30 million people suffer from an eating disorder. Contrasted from the common myths that eating disorders disproportionately impact young, white women, research shows that women of color develop eating disorders at similar rates. However, despite this fact, women of color are often diagnosed less often than their white peers.
According to the National Eating Disorder Association, in a study that presented identical case studies featuring disordered eating, while 44% identified the white women’s eating habits as problematic, only 17% recognized the Black women’s eating habits as disordered. Moreover, while Hispanic women and Black women were identified to suffer from bulimia at significantly higher rates than white women, studies concluded that they were significantly less likely to be asked by a doctor about eating disorder symptoms. Overall, eating disorder treatment and diagnosis continues to be extremely white washed, excluding women of color from the unbiased care they desperately need.
During my participation in different treatment programs, I encountered white therapists, white behavioral counselors, and leagues of other white mental health professionals, many of whom paid lip service to the ways in which anti-Blackness and my eating disorder interacted. Most of the people receiving care alongside me were white, only reifying my anxious, false belief that eating disorders didn’t happen to Black people. My various meal plans and nutrition groups revolved around American food and how incorporating that cuisine was the only way to maintain balanced eating habits. The food of my Nigerian culture never fit into my meal plan, one that was constructed solely around breakfasts of pancakes and sausage with dinners revolving around meat and potatoes.
Most of the time, white people believe that our calls for more diversity are nothing more than complaints about racial aesthetics.
Obviously, the ability to go to treatment in of itself is a huge privilege. Of the 30 million Americans that have an eating disorder, only one out of 10 will receive treatment, with an even smaller percentage being given adequate coverage to receive the full amount of treatment needed. However, when large components of your eating disorder involve feeling devalued because of racial discrimination, a race neutral version of treatment becomes ineffective. I and other people of color deserve eating disorder treatment that recognizes how our racial identities actively shape our lived experiences as well as our interpretation of value and self worth. Therefore, we need and deserve eating disorder treatments that recognize and interact with this truth. So, knowing the various deficiencies that eating disorder specialists have in treating people of color, what changes can be made to force eating disorder treatment to account for our unique needs?
Eating disorder treatment centers need to purposely hire more counselors and mental health professionals of color. Most of the time, white people believe that our calls for more diversity are nothing more than complaints about racial aesthetics. White patients and providers alike ask, “If eating disorders are universal diseases, why does increased representation matter? Isn’t the main qualification finding someone who understands the struggle of the illness?” Of course, genuine experience and knowledge around eating disorders is an essential qualification for providers, but representation is also a critical tool.
White professionals don’t understand that racism, itself, is a trauma that can easily spark an eating disorder.
Lack of representation highlights the difference between feeling comfortable sharing with your therapist that your disordered eating partly comes from a desire to fit in with your smaller, white peers, versus deciding to just remain silent about this factor because a white therapist probably won’t understand. Representation is the difference between being understood and empathized with when you complain about the lack of racial diversity on staff and your peers, compared to being asked to “deal” and to “stop looking for differences.” Representation means a shared frustration and anger between counselor and counselee when another white resident drops the n-word versus being told that you saying “Becky” (in reference to someone’s actual name) is also a hateful slur (it’s not). Sure, a lot of people “understand” eating disorders, but not enough white mental health professionals understand the implicit power relations that are at play during treatment and how those relationships can feel and often are racially driven. White professionals don’t understand that racism, itself, is a trauma that can easily spark an eating disorder. This knowledge and understanding shouldn’t be optional when working with Black and Brown patients, but instead understood as a core part of relating to ours experiences.
Nutritionists employed at treatment centers need to vastly expand their understanding of what can constitute a healthy diet. Often times, nutritionists use government provided resources such as MyPlate, a nutritional guide provided by the USDA Center for Nutrition Policy and Promotion. These resources use almost entirely ostensibly white American food to structure meals, using main entrees such as pizza and hamburgers to teach nutritional value and meal planning. The concept of only using American food to demonstrate nutrition is inaccessible to many patients of color, particularly those with an international background. My family doesn’t eat pork chops with a serving of mashed potatoes; we dine on garri, a dough made of cassava, and a spinach egusi stew. I remember returning home from treatment and approaching these dishes that I once cherished anxiously. I didn’t know how to fit it into my meal plan; I wasn’t sure what nutritional value they could provide me. I even approached my dietician for help on fitting these items into my menu. She was confused about what theses dishes were and suggested I instead go for something more “familiar.”
Often times, the meal plans thrust onto recovering patients are simply not conducive to the eating habits of some people of color. For example, several of the centers I went to listed dairy as an essential component of my meals. However, myself, my family, and many other Africans often do not consume a daily amount of milk as we have genetically adopted a low calcium diet. In fact, according to the National Digestive Diseases Information Clearinghouse, as much as 75% of African Americans and Indigenous Americans and 90% of Asian Americans have some form of lactose intolerance. Trying to force patients of color to participate in a white American form of eating erases our traditional and cultural needs that manifest via food.
For patients of color, providers need to walk a fine line between acknowledging the similarity in the experience of all eating disorder patients while acknowledging the role race, gender, and other identifiers have in creating different experiences.
Eating disorder treatment programs need to find ways to certify that patients of color feel a level of community within the programming. On a basic level, this is achieved by creating expectations that ensure a safe community, a strong emphasis on group therapy and connection, and opportunities for participants to learn from and relate to one another. For patients of color, providers need to walk a fine line between acknowledging the similarity in the experience of all eating disorder patients while acknowledging the role race, gender, and other identifiers have in creating different experiences. Providers need to delete phrases like “look for what you have in common” or “let’s emphasize our similarities” from their vocabulary, allowing for discussions on race, privilege, and other scenarios that impact one’s eating disorder to happen freely.
I am extremely grateful for many of the mentors in my life that have acknowledged my eating disorder and respect my recovery process. I am very thankful for the opportunities to receive significant amounts of treatment at the appropriate level of care, especially considering the high cost of full-time facilities. However, the highlight of every stretch in treatment has been a validation of my experience as a Black woman with disordered eating, the tailored information given to me that specifically applied to my story. I remember the moments when a therapy group discussed the timeline of body image ideals in Black communities, and I am so thankful for the appointments where my dietician would ask what my family would eat instead of handing out a generic meal plan filled with hamburgers and hot dogs. Even more recently, I have never felt more cherished than when a part-time staff member working at my residential center read an article I wrote about the intersections of anti-Blackness and my eating disorder, telling me that it had touched her, and shared it with my peers.
This is what it looks like to use our positionalities as people of color to inform our care. For eating disorder treatment to be truly effective for everyone, instead of shaming people of color for discussing our racial trauma and experiences in a racist society, eating disorder treatment programs must find creative and thoughtful ways to include a perspective of race in their care.
If you or someone you know is struggling with disordered eating, please call the NEDA hotline at 1-800-931-2237 or visit their webpage here.
Gloria Oladipo is a Black woman who is a sophomore at Cornell University and a permanent resident of Chicago, IL. She enjoys reading and writing on all things race, gender, mental health, and more. You can email her at firstname.lastname@example.org or follow her on instagram at @glorels.