I was 12 when I saw my first made-for-TV movie about eating disorders. The year was 1997, and Amy Jo Johnson, the actress famous for playing the pink Power Ranger, starred as a gymnast-turned-bulimic in Perfect Body.* The ’90s was a big decade for eating disorder melodramas. Tracey Gold battled her own disorder and starred in For the Love of Nancy in 1994. A few years earlier there was Kate’s Secret, then A Secret Between Friends, and later Sharing the Secret. Lots of secrets. But the women keeping them were mostly young, thin, popular, and white.
For all the information and raised awareness, the stereotype won’t die—eating disorders are a white-woman problem. And it’s not just a false image set forth by Lifetime movies and the author pics of eating disorder memoirists. Communities of color buy into it, too. “There’s this mentality that this is a white chick illness,” says nutritionist Michele Vivas, who specializes in eating disorder treatment and works with teenagers in Oakland, Calif. “An African-American girl came in and her mom suggested to the school principal that they start a program to increase eating disorder awareness. The principal looked at her and said, ‘Why would we have that? Black folks don’t get eating disorders.’ ”
Doctors have this misconception, too. A 2006 study found that clinicians were less likely to assign an eating disorder diagnosis to a fictional character based on her case history if her race was represented as African-American rather than Caucasian or Hispanic. And although statistics do show that eating disorders predominantly occur in white women, many eating disorder professionals believe those numbers are skewed, as women of color have been alienated from a support network that for too long has bought into the myth.
“When eating disorders were first being recognized, people seeking treatment were young, white girls, so the belief developed early that nobody else suffers from them,” says Gayle Brooks, vice president and chief clinical officer of the Renfrew Center, the country’s first residential treatment facility for eating disorders. “When that became the core of our understanding, we stopped looking at diversity being an issue. We missed a lot.”
According to the National Eating Disorders Association (NEDA), “exact statistics on the prevalence of eating disorders among women of color are unavailable” because, “due to our historically biased view that eating disorders only affect white women, relatively little research has been conducted utilizing participants from racial and ethnic minority groups.” And as Carrie Arnold detailed in a piece for Slate, eating disorder research is “dramatically underfunded.” Still, we know these women exist. Here are a few.
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I met Anahi Ortega at the NEDA conference in 2012, where the topic was “What About Us? Diversity and Complexity in Eating Disorders,” and Ortega was a featured speaker.
Born in Mexico, Ortega moved to California with her family as a baby and spent much of her childhood performing Mexican folkloric dance. She quit dancing at age 12, around the time that her father, who had been sober for many years, resumed drinking and began commenting on her developing curves. Ortega started dieting. Then cutting meals. Soon, she fell into anorexia. “It was so easy to hide at first,” she remembers. “I was very good at it.”
One reason it was so simple to get away with not eating has to do with the traditional Mexican meal structure. “A lot of [Latino] families have a two-meal-per-day pattern,” Vivas says. “It’s easier to get out of eating when you have to get out of two meals a day.” Ioana Boie, assistant professor in the department of counseling at Marymount University in Arlington, Va., agrees. “In California, you see people still adhering to traditional meal times you see in Mexico,” she says. “Eating dinner at 3 or 4 p.m.” This is “exactly how I stayed under the radar,” Ortega told me, explaining how easy it was to tell her parents she was eating all her meals at school when she wasn’t eating a thing. It wasn’t until Ortega’s anorexia escalated into cutting and bulimia at 15 that anyone really took notice—she was hospitalized after accidentally overdosing on diet pills and nearly suffered a stroke.
Doctors diagnosed Ortega with bulimia, and she began group therapy. But cultural differences overshadowed any benefits she may have gotten from shared struggles. “The only thing we had in common was the eating disorder,” she says. “I felt so different in a room full of white girls. When we talked about eating disorders, I could relate. When we talked about home, I couldn’t.”
Ortega eventually enrolled at California State University–Monterey Bay. Her disordered eating ceased, but she continued cutting and began abusing drugs and alcohol. She eventually withdrew from school and attended a codependency program. Her drug use stopped, but the eating disorder kicked back up. “If it wasn’t one, it was the other,” she says.
Ortega’s new doctors in Monterey gave her a different diagnosis: EDNOS—eating disorder not otherwise specified, a catchall definition for anyone who doesn’t fit the strict standards for anorexia, bulimia, or binge eating disorder. “That made it hard to find treatment,” she says. “I didn’t fit the criteria for anorexia or bulimia.”
EDNOS is the most common diagnosis in Latina women. Boie says that’s due in part to anorexia’s diagnostic requirement of a “preoccupation with thinness.” Like Ortega, many Latina women aren’t focused on being stick skinny; the “guitar shape” is considered superior. According to Ortega, “It’s the perfect thing—curvy, but not too much.”
Ortega got back to a stable weight but relapsed immediately. Finally fed up with her interchanging issues, she checked herself into intensive inpatient treatment at the Center for Anorexia and Bulimia at Herrick in Berkeley, Calif. Her three-week stay at Herrick marked the first time Ortega felt entirely comfortable in a treatment setting. She’d been in plenty of support groups and outpatient programs over the years, but she’d always felt like an outsider because of her heritage. “Most of the girls were there because their parents were forcing them to go,” the 25-year-old says of the other patients she encountered before Herrick. “Their parents were involved with the medical treatment, while mine complained about having to drive me to appointments—treatment talk was nonexistent.” Just as eating disorder outreach needs to better target young women of color, “you have to target the [minority] parents and have them involved” as well, Ortega says.
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Ortega didn’t think recovery was possible until she attended her first NEDA conference in 2011 and met Stephanie Covington Armstrong, the author of Not All Black Girls Know How to Eat. There she was: another woman of color who’d grappled with the disease.
Armstrong’s early memories around eating aren’t particularly out of the ordinary, but her life changed dramatically at age 12, when she says she was molested by a relative and had “the need to squash down feelings that are never resolved.” She did this through food, kicking off years to come of disordered eating. “I thought I was the only black person who didn’t know how to eat,” she told me.
The abuse kicked off a string of troubled relationships and a teenage suicide attempt. She left her Brooklyn, N.Y., home and relocated to Los Angeles to pursue acting. “Each day, I trekked 5 to 10 miles searching for work, and before long, I had whittled myself down to a magical size 2,” she writes in her memoir. “For the first time in my life, I didn’t care if I ate or not; in fact I had no desire for food at all (read: depression). I felt phenomenal.” When she came across an article titled, “Bulimia, the New Diet,” a switch flipped. Armstrong didn’t read it as a warning, but as an “educational how-to.”
Armstrong didn’t know black women could be bulimic. No one around her suspected it either. “When I was in the midst of my eating disorder, it let me hide in plain sight,” she says of her race. “When I was throwing up 20 times a day, no one would have looked at my brown skin and been like, ‘That poor thing has a problem.’ It protected me in a way.”
Do many black women suffer from eating disorders? According to research, it depends on the type of disorder. In a 2000 study, researcher Ruth Striegel found that anorexia and bulimia were in fact more common in white women in a community sample, but that young black women were as likely as their white counterparts to report binge eating or vomiting and even more likely to report fasting and laxative and diuretic abuse. “I think there may be certain cultural factors that make individuals more vulnerable to a particular type of eating disorder,” the Renfrew Center’s Brooks says. “Within the African-American culture, they may be more vulnerable to bulimia and binge eating because there may still be some protective measures around the beauty ideal not being so pencil thin. However, conflicts around body image and using food to manage emotions—you’re going to see that in women of color. It just may manifest itself in a different way.”
For Armstrong, it manifested in bulimia. “There’s so much shame in eating disorders, and in the black community, you’re not supposed to talk about things like sexual abuse or too much drinking,” Armstrong says. She also says that her pride—an adherence to what she calls “the strong black woman archetype”—stood in the way of seeking help. “It is so difficult for black women in this country. We’re not going to let you see one more thing you can judge about us,” she says. “We don’t want you to know how we feel about ourselves—it’s not the same way you feel about yourself.”
Armstrong’s pride finally crumbled when she moved back to New York and noticed an ad in the Village Voice for a bulimia research study. She thought it might be her only hope for recovery. But when she showed up at the researcher’s office, the doctors looked confused. When one researcher told her that she was the first African-American applicant in the program, she lost her cool. “It really just pissed me off,” she says. “I felt like the purple giraffe in the room—people aren’t used to women of color coming forward with problems or issues.”
Brooks says practitioners need to catch up to the reality that eating disorders do not discriminate. “A lot of times there can be discomfort talking about race—it’s such a charged issue in our culture and the feeling that if we talk about it, I may offend you or give you the message that your race is the only thing that is really important to me,” she says. “Clinicians need to be trained on how to deal with cross-cultural issues and feel comfortable with that themselves so they can bring that into the therapy room. I also think we need to get more people of color in the field of eating disorders, treating them.” There are even smaller things eating disorder professionals can do, like diversify the public face of eating disorders. Scan the websites and brochures of many treatment facilities and you’ll see mostly white women staring back at you.
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Armstrong’s race may have kept her bulimia under wraps, but Sophie Lee says that being Asian put the spotlight on her body consciousness. “We don’t have a sense of privacy,” the 25-year-old Korean-born college student says of her culture. “We feel it’s OK to comment on people’s appearance because our parents and relatives make a lot of comments. We’re [raised] to think that’s OK.”
Lee’s family relocated from Korea to Singapore when she was 4, and growing up there impacted her body image early on. “Southeast Asians are freakin’ skinny, like emaciated skinny, but that’s their natural weight,” she says. “The bone structure is very different than in East Asians.” Lee was always the tallest in her class, and she felt bigger than the other girls. But at 14, she moved again with her family, this time to Virginia, and suddenly felt a different kind of body consciousness. “I remember feeling like I was surrounded by fat people,” she says. “People who’d also immigrated kept telling me they’d gained like 30 pounds when they moved to America because of the food. That terrified me.”
Fellow immigrants warned her that American food would lead to unwanted pounds, and the continuing open dialogue around weight got to her. “It’s not thought of as being rude,” says New Jersey psychologist and NEDA conference presenter Hue-Sun Ahn, who specializes in eating disorders, racial identity, and acculturation. “People think they’re being caring and doing it for the benefit of whoever’s hearing it. Unfortunately, it can be very triggering to somebody that has an eating disorder.”
Just as Ortega was influenced by the guitar-shaped women of the telenovelas she saw on TV at home, Lee says she strove for Korean pop culture perfection. “My parents watched a lot of Korean shows, and the actresses looked so skinny,” she says. “That was my ideal body image. The Caucasian body is impossible for me to achieve. Our model is the K-pop people,” idolized as much for their bodies, Lee says, as for their talent.
Ahn says it’s almost impossible to know how cultural factors influence the development of eating disorders. “It’s hard to tease out because the world is becoming so globalized,” she says. “I know other immigrants who have visited their country of origin and [eating disorders are] very prevalent there or maybe even more so. A lot of Asian students I work with have had a healthy body image in the U.S. but then gone back to their country of origin and they’re thought of as being overweight. I think there’s even a thinner ideal in many Asian cultures.” Lee says Asian cultures value a completely different feminine ideal. “American women want to be toned, they want to look fit,” she says. “Asian girls don’t want muscles. They want to be as skinny and pale as possible.”
And so did Lee. She got her hands on her cousin’s diet books, which served as calorie restriction guidebooks, and restricted food through high school until she was hospitalized for five days, where she says her parents’ poor English left them vulnerable to prejudiced assumptions. “It wasn’t overt racism, but I think the doctors thought they were ignorant,” she says. “Like they were ‘typical Korean immigrants.’ ”
Having just turned 18, Lee checked herself out of the hospital and soon suffered a hairline fracture on her ankle due to excessive walking. Forced to restrict her exercise, she limited her food intake again. She graduated high school and was accepted to her first-choice college, but school officials forced her to withdraw and seek treatment when a student reported her for looking too frail. “I think if I’d stayed in college, I would’ve died in my sleep,” she says. “That saved my life.”
The school recommended a six-week inpatient treatment program, but instead Lee moved into an apartment with a friend and transitioned from anorexia to bulimia. “Every single day, I was planning from 7 a.m. to 4 p.m. how to eat, puke, eat, puke, eat, puke,” she says. The roommate eventually moved out, and Lee returned home. She credits her family’s connection to Christianity with her recovery. The turning point came in 2008, when she returned to Singapore at 21. “I remembered myself as a cheerful girl,” she says. “In Virginia, I didn’t know who I was. I thought my identity there was the anorexic girl. I could envision a happier version of myself in Singapore.” She stayed for five months and started gaining weight—which she’s kept on.
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In 2011, the New York Times published an article on the alarming increase of eating disorders in the Orthodox Jewish community, and a landmark study that same year called attention to the prevalence of binging and purging in Native American populations. An earlier study found greater body dissatisfaction among Hispanic and Asian girls than white girls.
The overall picture is clear: Eating disorders don’t care about the color of your skin or the socioeconomic status of your family. It’s not just media images that are to blame, or various cultures’ expectations of women, or genetics. It’s not just about stress, or trauma, or power and control. It’s all of it, and everyone is at risk. It’s time for treatment, research, and funding to catch up accordingly.
Correction, March 20, 2014: This article originally misstated the title of the movie Perfect Body.