Eating disorders affect people of all races and ethnicities. However, barriers to healthcare may prevent some racial and ethnic groups from receiving accurate diagnoses and treatment.
Eating disorders are conditions characterized by unusual eating behaviors that may involve a preoccupation with food and weight issues.
Researchers have found that eating disorders occur at similar rates across various racial and ethnic groups in the United States. However, structural and systemic barriers can result in healthcare disparities for people of color.
Eating disorders affect at least 30 million people over their lifetime in the U.S. They occur in people of all genders, ages, economic groups, and races and ethnicities.
Research suggests that eating disorders are
However, doctors in the U.S. are about half as likely to diagnose eating disorders in people of color compared to white individuals. Health professionals are also less likely to ask about or recognize symptoms of the disorders in people of color.
What are eating disorders?
Eating disorders are a group of serious and sometimes life threatening conditions that affect a person’s eating behaviors. They
Common eating disorders include:
- Binge eating disorder: This eating disorder involves episodes of excessive overeating that cause a person to feel distress and a lack of control over these behaviors. People with binge eating disorder may have overweight or obesity.
- Bulimia nervosa: A person with bulimia nervosa binge eats over short periods, then compensates with behaviors like purging, fasting, or exercising excessively. Purging behaviors include vomiting and overusing laxatives. The disorder can lead to serious health complications and is life threatening.
- Anorexia nervosa: Intentional food intake restriction and excessive exercise are common symptoms of anorexia nervosa. It can lead to severe health complications that can be life threatening.
Various studies suggest that the prevalence of eating disorders is
African Americans
In a review of studies, researchers reported that binge eating disorder may affect almost 5% of Black women, compared to 2.5% of white women.
Despite similar and sometimes higher rates of eating disorders,
Latin@/Latinx Americans
A 2024 study found that Hispanic females were more likely to experience bulimia nervosa than those who are not Hispanic. Avoidant/restrictive food intake disorder (ARFID) was also found to be more prevalent in Hispanic patients, as well.
The same study also found that those who are Hispanic have a lower likelihood of receiving a diagnosis of anorexia nervosa.
Overall, the two-decade research on eating disorders concluded that Hispanic respondents made up about 10% of the samples.
Asian Americans
In a
- body dissatisfaction
- negative attitudes about obesity
- food restriction
- purging behaviors
- cognitive restraint, which refers to worrying about and making a mental effort to restrict food intake
Another 2024 study found that Asian American women may be more likely to develop an eating disorder due to the conflicting body ideals of American vs. Asian culture.
Makailah’s story: Race and eating disorders
“My eating disorder wasn’t about body image, diet culture, or a fear of taking up space, though that would’ve been enough to spark a loud, angry illness. And it did contribute to the 10+ years I spent fighting for my life. But for me, the roots ran deeper, into things far outside my control.
My grandma raised me as a single parent. She didn’t expect to raise a child at 40, and as a result, we were houseless and food insecure for almost a decade. When I finally had consistent access to food, bulimia nervosa showed up.
I battled my eating disorder for years before I told my primary care doctor. And when I finally did, I was told that people like me don’t get eating disorders. Someone like me was a person of color, in a larger body, and low-income.
My dentist is the one who diagnosed me. He noticed the damage to my teeth and named what was happening, without questioning my body, my background, or my worth. He knew I needed help.”
Barriers to eating disorder treatment
- Financial costs: A person is
more likely to receive the recommended treatment for an eating disorder if a health professional admits them to a hospital. People of color are disproportionately affected by poverty and are less likely to have private medical insurance. This means they may be unable to afford treatment, which costs about $20,817 on average per inpatient stay. - Geographic location: Historically marginalized groups, including people of color, are more likely to live in underresourced and rural locations, which may prevent them from easily accessing effective care.
- Lack of specialty training: Only 20% of people with eating disorders receive an accurate diagnosis from outpatient health professionals who lack specialty care training. Many people in historically marginalized groups, including people of color, may lack access to specialty care, resulting in lower rates of diagnosis and treatment.
- Sociocultural factors: Cultural stigma and personal factors contribute to harmful biases and misconceptions about eating disorders. This can prevent some people of color from seeking treatment, and healthcare professionals from providing appropriate, culturally-sensitive care.
Research suggests that health professionals are less likely to ask about or recognize symptoms of eating disorders in people of color, despite similar rates of the disorders across races. This may be due to several factors, which include:
- Mixed research findings: Early evidence from older studies with small samples suggests that white women tend to have higher body dissatisfaction and be more likely to develop eating disorders than women of other races. However, more recent, large-scale studies suggest that this may be a misconception, and the prevalence of eating disorders is similar across different races and ethnicities.
- Underrepresentation in clinical trials: Many studies on eating disorders focus on white women. Many studies do not include adequate samples of varied populations, and do not provide enough data about how eating disorders affect people other than white women.
- Cultural attitudes: A person’s culture may shape how they experience and seek treatment for an eating disorder. It may contribute to attitudes and beliefs that prevent someone from seeking care, such as feelings of shame.
- Bias in healthcare: Racism and bias in healthcare can result in a lack of appropriate and accessible care.
Makailah’s story: Race and eating disorders
“Attitudes vary across communities of color. For me, the main feelings throughout the process were exhaustion, invalidation, and loneliness. But there were also moments of empowerment that I didn’t expect.
Even after getting diagnosed, it was difficult to access treatment. I was on public assistance in northern Idaho, where most providers had never been trained to recognize or treat eating disorders, especially in people who looked like me.
What I did have was my grandmother and her love. She committed to learning, growing, and adapting the household to my recovery needs. We would eat meals together as a form of accountability, she kept the bathroom door open at all times, and we had ongoing discussions of where I was in recovery. She made her support unconditional; without that, my “treatment” wouldn’t have been complete at all.
My recovery became an extension of her love and support: resilient, unconditional, and unwavering. I thank her for guiding me to that place. I learned to accept the losses and not completely cave to my eating disorder. I learned about harm reduction and how to stop the pendulum of swinging thoughts from dictating my existence. My recovery holds strong today because I learned what sustainable recovery was for my body.
As a society, regardless of our identities or what we have done in this life, we deserve to heal and grow from pain. From whatever is a barrier to our life worth living.”
Experiencing racism and trauma may increase an individual’s risk of developing an eating disorder.
Various studies suggest that experiencing discrimination can impact a person’s self-esteem and increase their risk of depression. Researchers associate both of these factors with increased rates of binge eating disorder.
Research also suggests that racism leads to increased stress and changes in cortisol levels, which can make a person more likely to use harmful coping mechanisms, such as disordered eating.
The prevalence of eating disorders is similar across races.
Despite the similar occurrence rates of these disorders in different groups, people of color tend to receive fewer diagnoses and face more access barriers to appropriate care than white people.
Barriers to healthcare access include financial costs and sociocultural factors.