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Here’s What Happens When “Eating Disorder” = “Rich White Girl with Anorexia”

By Tomi Akanbi, MS, RD

When eating disorders are depicted in movies and TV shows, the story is often this: A middle-class, straight white girl has anorexia, likely (though not always) due to body image issues caused by the media.  This character exists in real life. But so do a million other people with eating disorders—people of all sizes, races, classes, genders, ages and sexual orientations. Eating disorders don’t discriminate.

The lack of representation in eating disorder (ED) narratives has recently gotten more attention with the release of Netflix’s movie To the Bone, starring Lilly Collins as a young woman in recovery for anorexia. I’ve heard that this movie does many things right when it comes to depicting anorexia and recovery (I haven’t seen it, so I can’t comment on this personally). But it still reinforces this one ED narrative.

The absence of stories about people who aren’t white, straight and well-off has serious, concrete consequences for people with eating disorders. Here are 6 of them.

1. EDs are seen as an indulgence instead of a mental illness.

Teen girls from low-income families are over 1.5 times MORE likely to have bulimia than teen girls from higher-income families. Yet EDs are widely seen as an “indulgence” that middle-class and wealthy people can “afford.”

EDs are NOT an indulgence or a choice. They are a serious (but treatable) mental health disorder. In fact, EDs have the highest mortality rate of any mental illness.

Treating an ED as anything less than the serious mental illness it is minimizes the immense pain they cause and the tremendous strength of survivors.

2. People with other EDs don’t get treatment.

Since anorexia is the most commonly portrayed ED, many people don’t think about the wide variety of EDs that exist. This means that people with  binge eating disorder (BED), Avoidant Restrictive Food Intake Disorder (ARFID), Other Specified Eating Disorders (OSFED) and more don’t recognize their own behavior as an ED or mental illness—and neither do their family and friends.

For example: Even though more people have BED than bulimia and anorexia COMBINED, less than half of people with BED receive treatment during their lifetime. This isn’t only because of lack of media representation—but it would definitely help.

3. People of color don’t receive critical care and support.

The rates of EDs are roughly the same across ethnicities in the United States. Yet people of color are significantly less likely to receive treatment. This may be partly because people of color are more likely to have BED, which is less likely to get diagnosed.

But that doesn’t account for all of the difference. Health care providers are susceptible to the same media messages that the general public is—some studies show that their biases contribute to these discrepancies in diagnosis.

In addition, people of color may be less likely to recognize that they have an ED themselves.

This also affects the reaction that their family and friends have to their behavior. Parents of color may be less likely to take their child to a physician because, “that doesn’t happen in our communities.”

4. Men with EDs are stigmatized.

Even though girls are more likely to develop EDs than boys, 10 million men in the United States have an ED. Around 36% of people with BED and 25% of people with bulimia and anorexia are men.

But EDs are still seen as a “women’s issue.” This means that men with EDs may not realize they have a disorder, and may face additional stigma when they seek support.

5. LGBT communities’ needs aren’t addressed.

The prevalence of EDs in LGBT communities is especially high. Transgender college students are five times more likely to have an ED than their cis peers. Gay and bisexual men are 3 times more likely to have an ED than straight men.

To be clear, this increased risk is NOT due to sexual orientation or gender identity, but to stigma and discrimination. Accessing treatment is often more difficult for LGBT individuals, who may not have supportive family or culturally-competent healthcare providers.

6. People assume that individuals are overweight because of personal choices rather than mental health or social reasons.

Weight stigma—judging, shaming, or making assumptions about someone because of their size or shape—is a huge problem in our society. Often, people associate being overweight with being lazy and making bad choices. But being overweight is often an indicator of complex emotional and social issues.

Three out of ten people trying to lose weight show symptoms of BED. But many people with BED have never heard of the disorder, and don’t realize that they have a mental illness. They often blame themselves for their behavior—“If I had more self-control, I’d be able to stop eating.”

It also means people with BED don’t get medical help, don’t get diagnosed, and don’t get treated.

If our media included more diverse stories about EDs—with a diverse range of bodies, backgrounds, identities and ED types—more people may feel less alone, and ultimately get treatment.

If you think you or someone you know have an ED, you can call the National Eating Disorder Association Helpline at 800-931-2237 or learn more on their website. If you live near NYC and you’re 10-22 years old, you can come to the Mount Sinai Adolescent Health Center for completely free, comprehensive, LGBT-inclusive eating disorder treatment.

 

Tomi Akanbi, MS, RD is the Clinical Nutrition Coordinator at the Mount Sinai Adolescent Health Center. She holds a Master’s degree in Nutrition and Public Health from Columbia University, as well as a BA in Comparative Human Development from the University of Chicago. Tomi is passionate about improving our relationship with food and breaking down the barriers that prevent all New Yorkers from having access to affordable, nutritious food. She understands the challenges of maintaining a healthy lifestyle, but believes that balanced eating, exercise, and overall wellness can be enjoyable and attainable for all.

The Mount Sinai Adolescent Health Center is located in New York City. It provides comprehensive, confidential, judgment free health care at no charge to over 10,000 young people every year. This column is not intended to provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, only general information for education purposes only.

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