Eating Disorders Don't Discriminate

Dr. Jennifer Moran is an outpatient psychologist at The Center for Eating Disorders at Sheppard Pratt (CED), a program that has been a national leader for close to 30 years. We sat down with her to discuss how eating disorders impact minority populations.

Tell us a bit about the work you do at the Center for Eating Disorders.

I’m a psychologist and have been a member of the team at CED since 2005. I’m an outpatient therapist for individuals and families, and I work with children, adolescents, and adults. I also consult and do outreach with colleges in the area, and help them brainstorm solutions for any problems they may be experiencing on campus.

In addition to that, I run collaborative care workshops. These workshops are focused on caregivers, such as parents, spouses, and siblings. I educate them about the eating disorder recovery process, and provide them with tools for working through that process with their loved one.

July is Minority Mental Health Awareness Month. Tell us a bit about how eating disorders impact minority populations.

We know that marginalized groups have increased vulnerability to developing eating disorders. Eating disorders can serve as a type of coping strategy (albeit, one that’s ultimately harmful) for someone facing oppression, discrimination, or vulnerability. And when those factors occur in conjunction with genetic predisposition to developing an eating disorder, that vulnerability can be compounded. For someone facing oppression and discrimination, especially teens who are exploring racial or sexual identity, adolescence is such a psychologically intense time that it can also increase one’s vulnerability to developing an eating disorder.

In addition, minority women are less likely to seek treatment for eating disorders. There’s still stigma about seeking mental health treatment in different ethnic groups. There is also a stereotype within the medical profession that eating disorders primarily impact affluent white girls. This is an inaccurate bias that can prevent primary care doctors and other professionals from screening for eating disorders or recognizing the red flags in their minority patients, especially among males. And, there’s been an inconsistency in terms of labelling eating disorders as what they are versus labelling adverse behaviors as simply dieting and/or overeating.

What is the biggest misconception you’ve heard about how eating disorders impact minority populations? Let’s do some myth busting.

The biggest myth is that eating disorders don’t exist in minority populations. I definitely hear people talk about it [eating disorders] as if developing one is based solely on an individual’s race, ethnicity, gender, or even socioeconomic status, and that’s just not the reality. Here at CED, we see people from all different backgrounds.

Are there any differences you see in how eating disorders impact certain ethnic groups? Are there any trends you’ve seen that loved ones should be aware of?

Within African American populations, I’ve seen a tendency towards binge eating disorder or bulimia. We’re less likely to see anorexia nervosa, but those that do develop it [anorexia] tend to have a harder time healing. Part of this stems from lack of recognition of the eating disorder, as well as lack of ready access to mental health services.

Within Asian American populations, there tends to be more perfectionism inherent to the culture, so we see more preoccupation with thinness. Part of that is Asian culture; their ideal body type is likely thinner than the American ideal, so there’s an increased risk of there being more pressure to look thinner. Because of that, we tend to see more restrictive behaviors.

Latino populations tend to have similar rates of eating disorders as white populations; right now, we’re not really sure why that is. But, rates of body image dissatisfaction also seem to be pretty consistent between Latina and white females.

What warning signs should loved ones be on the lookout for?

Any changes with eating at all, whether it’s eating much more or not eating as much as they used to, should be a warning sign. Changes in mood, along with any increase in stressors that are also happening simultaneously (such as a major life transition happening at the same time as an upsetting situation) is another warning sign. If eating or exercise behaviors are changing in response to stressors and thoughts of food or weight start to dominate a person’s thinking or interfere with daily life, that should be concerning.

How do you recommend starting a conversation with your loved one if you suspect they may have an eating disorder?

I always recommend setting aside a separate time to talk, and being very concrete in observations. Saying something along the lines of, “I’ve noticed every time we eat, you say you’ve already eaten; I wanted to see if everything’s OK.” Putting the concrete observations out there and checking in to see if everything’s OK, if they need help with anything, that’s key. It’s also a good idea to give a specific brochure or reading material so the person you’re talking with can follow up and learn more if they want to. CED recently developed the Let’s Check In campaign to help guide friends and loved ones through this very process. 

What tips do you have for minority groups helping a loved one through the healing process?

Getting education is imperative. I would definitely recommend attending collaborative care workshops and support groups to see what the treatment process looks like. In my anecdotal experience, families who are less experienced and educated on eating disorders tend to drop out of treatment earlier because the treatment process seems so long. The average course of treatment is five years.

I would also say that I know it can be hard but to push past the belief that you are alone or that eating disorders don’t occur among minority populations. A lot of our patients say they put off coming to a support group for a long time or wouldn’t consider seeking treatment because they didn’t want to walk through the door and be the only person of color in the room. When they do come for treatment, individuals and families are often surprised by the great diversity of people who are actually impacted by these illnesses.

Dr. Moran, thank you so much for your time! Stay tuned to the blog the rest of the month to learn more about minority mental health.