Sensitive content warning: This article discusses eating disorders like binge eating, anorexia and bulimia.
Katharine Smith’s eating disorder began at seven years old. Her weight fluctuated and her father tried to control it by putting her on her first diet. Meanwhile, her mother, a food hoarder, taught her the opposite: to eat in secrecy. As a result, she often swung between the two extremes of restricting and binging as she got older. While one could say that Smith’s parents played a significant role in jump starting her disordered eating, it was also racial bias and the conditioning around white, European beauty standards of thinness that exacerbated her parents’ notions, and her ideas about what her body should look like.
“Growing up in the '80s and '90s, the only images I saw in the media were of thin white women,” Smith tells Unbothered. “There was no mistaking that this was the standard and the shows I watched — like Saved by the Bell and Baywatch — were reinforcing. These ingrained ideals stuck with me for decades.”
Eating disorders are not unique to Black women, but the causes, disordered behaviors and neglect surrounding treatment are. And whether they’re aware or not, most Black women are susceptible to the European, white supremacist ideals about beauty and health.
Eating disorders are not unique to Black women, but the causes, disordered behaviors and neglect surrounding treatment are.
From famous Black women like Zoe Kravitz speaking out about her anorexia and societal pressures to be thin, to Thandie Newton who started bulimia as a ballet student trying to be perfect and nearly invisible, Black women have been open about feeling forced to conform their bodies to historically socially acceptable standards. Most recently, fashion editor and writer Danielle Prescod shared how growing up in predominantly white spaces shaped her identity and her relationship with food and body. In her memoir Token Black Girl, Danielle says that while her eating disorder started years prior, it continued into her career in the largely white fashion industry where she was rewarded for being thin.
Stereotypes regarding how Black women perceive themselves and their bodies — as strong, confident and proud to be in the skin they're in, no matter the size — perpetuate the stigma that their resilience overpowers their need for help.
Smith was so ashamed and afraid of being open about her eating disorders, she was never formally diagnosed. “It took me until my mid-30s to feel safe enough to discuss my eating disorders and how they impacted me,” she shares. “Until then, I hadn't heard from other Black women that this was something they struggled with. Black women are often not given permission to be less than perfect.”
Unfortunately, many Black women experience feeling alone in their struggles with eating disorders. Non-hispanic white women are more likely to be diagnosed with eating disorders and according to ANAD, BIPOC are less likely than white people to be asked by a doctor about eating disorder symptoms. This was true for Smith, whose doctors never even screened her for an eating disorder. “Because I was an overweight child, doctors sought to diagnose me with a thyroid disorder, but I was tested often and my thyroid functioned within normal levels,” Smith says.
It took me until my mid-30s to feel safe enough to discuss my eating disorders and how they impacted me... Until then, I hadn't heard from other Black women that this was something they struggled with. Black women are often not given permission to be less than perfect.
Black people are also less likely to be diagnosed with anorexia, tend to have eating disorders that are less recognizable — like binge eating and bulimia — and are therefore not diagnosed by medical professionals. People with a larger body size are also often under-recognized and under-treated for eating disorders, which impacts Black women who generally are healthier at a heavier weight than white women. When Black women don’t receive diagnoses for disordered eating, they can’t receive adequate treatment, and racism is a glaring factor.
“Black women are less likely to receive treatment because of racism that’s been baked into our healthcare system,” says Dr. Kelli Rugless, owner of Flourish Psychology in Beverly Hills and chief clinical officer at Project Heal, a nonprofit organization focused on providing equitable treatment access for eating disorders. “Even when clients go in and self-identify as having an eating disorder in a doctor’s visit they are less likely to be asked about their symptoms.”
Racial bias in society and healthcare is just touching the surface of what causes and propels eating disorders among Black women. Food insecurity is another cause of harm. Dr. Rugless says racist practices like redlining that have created food insecurity and contributed to the existence of food deserts, food swamps and unsafe living environments are all risk factors for eating disorders.
In 2021, the USDA stated that nearly 20% of Black individuals lived in a food insecure household. The research also showed that Black people are almost three times as likely to face hunger as white individuals and Black children are more likely to experience hunger than children of other races.
Stephanie Covington Armstrong, author of Not All Black Girls Know How To Eat: A Story of Bulimia suffered from yo-yo dieting, binging and bulimia, and attributes the start of her eating disorder to a lack of consistent access to enough food. “I grew up extremely food insecure, so food took on an entire personality,” she says. “I formed friendships with kids who had full refrigerators in order to get fed. I didn’t always have dinner or food in the cupboards so I wasn’t able to take for granted that I would be fed. That meant food, getting fed, staying fed, and wondering when my next meal would come often took over my thoughts.”
The pretense that all Black women want curvy, voluptuous bodies can also further intensify the severity of an eating disorder and downplay the reality of those who are suffering. “For a long time researchers said that Black beauty standards protected us [Black people] from eating disorders but that’s now been proven completely false," says Dr. Rugless. “This has created a blind spot in healthcare where the image of an eating disorder is a teenage, cisgender affluent female and not a Black person or any other person who doesn’t fit that stereotype.”
Dismantling white supremacy in every form, lifting up and supporting Black people, and other folx from marginalized communities that don’t fit the mold…if we were able to do these things we would make a huge dent in the eating disorder crisis in the Black community.
Dr. Kelli Rugless
Experiences of trauma, substance abuse and other stressors influence how Black women live in their bodies. While Black and white people experience trauma at similar rates, Black people are more likely to have lasting effects with mental health conditions like PTSD. Although there’s little research to drill down on how much trauma impacts eating disorders in Black women, the lived experiences of women like Lacou Flipse tell the story.
Flipse’s binge eating started in college during her freshman year while being away from siblings who were a safety net in a world that felt unsafe. “I grew up with a parent addicted to substances and there was a lot of physical and emotional abuse," says Flipse, a pleasure eating coach and owner of Enlightened Munch. “I needed something to cope with the loss of the physical safety net of my sister's presence in my life so I compulsively turned to food.”
If eating disorders for Black women are rooted in racism, then work must be done to address the harmful impact. And to date, eating disorder solutions have failed Black women, who are less likely to be diagnosed or receive treatment.
A key factor for starting and completing treatment is for Black women to feel heard and understood by their therapist or medical professional. With the world of medicine and mental health being predominantly white — 72% of therapists are white and only 5% of physicians are Black — Black women are receiving treatment not designed for them.
“We need more diverse populations of physicians, dietitians, therapists, and treatment centers that are well-versed in the treatment of eating disorders and how they present in the Black community so that we’re not harmed by the systems that are supposed to heal us,” Dr. Rugless says. “When we discuss prevention, we need to begin focusing on the social justice and cultural issues (such as getting rid of medical tools like the Body Mass Index or BMI that are harmful to Black people) that create a fertile ground for eating disorders and negative body image.”
Until institutional changes are made, Black women are taking charge of their health and recovery.
Covington Armstrong sought help from a free support group and eventually a therapist as well spirituality to guide her in addressing underlying issues that attributed to her disordered eating.
Smith’s anorexia and bulimia stopped after she shared her issues with a trusted member at church, but it took her years to end her binge eating, and the immense shame associated with all of it. “In conjunction with my therapist and energy healer, we worked to undo the years of negative messaging and harm,” she says. “It wasn't until I was able to face the psychological underpinnings of my binge eating disorder that I was able to disrupt it.”
For Flipse, whose work as a pleasure eating coach helps all women to feel safe enough in their bodies to release binge-eating behaviors, she put energy into healing her disordered behaviors and the trauma that triggered them.
Still, Dr. Rugless believes that work can’t solely be placed on Black women and that monumental shifts need to happen to create lasting change. “The most immediate thing we can do is create more awareness and education in the Black community about what eating disorders are, who they affect, and how they can be treated,” she says. “Dismantling white supremacy in every form, lifting up and supporting Black people, and other folx from marginalized communities that don’t fit the mold…if we were able to do these things we would make a huge dent in the eating disorder crisis in the Black community.”
If you are struggling with an eating disorder and are in need of support, please call the National Eating Disorders Association Helpline at 1-800-931-2237. For a 24-hour crisis line, text “NEDA” to 741741. You can find a list of mental health and self-care resources specifically for Black and other communities of color here.