Alliances and healing

How do the stresses of daily life impact the eating habits in people of color?
Appetite loss or binge-eating is not uncommon in response to daily tensions and stressors. 

The daily lived experiences of many Black, Indigenous, and other people of color often include anxiety from invalidating, intimidating, and subtle microaggressions. BIPOC are also impacted by the daily effects of macroagggressions such as housing discrimination, police misconduct, and other systematic social injustices.

Patterns of emotional eating to cope with the effects of these events can result in eating disorders.

How else can race contribute to disordered eating?
Identity is at the heart of eating disorders. Issues of colorism — prejudice or discrimination against persons with dark skin by persons with fair skin, a remnant of the institution of slavery — are points of contention among Black women. Colorism’s destructive effects contribute significantly to body image issues and are associated with elevated risk for developing eating disorders.

Your new book focuses on Black women. What unique concerns arise for this population when it comes to eating disorders?
For Black women in particular, eating problems evolved as ways to cope with traumas like racism.

Often, Black women in larger bodies are told — based on one-size-fits-all growth charts — to lose weight. We’re warned about heart disease and diabetes — issues we should consider. However, there usually isn’t any query about why we’re overweight.

Black women are not monolithic. They have some unique issues and challenges that are often directly related to their eating patterns. In addition to colorism, our children are disproportionately affected by adverse childhood experiences. For instance, Black children are more than twice as likely as white children to be sexually abused, and research shows an association between early childhood sexual abuse and eating disorders.

Why is it important to develop a guide for clinicians specifically around these issues?
Many practitioners take a colorblind approach to treatment, perhaps out of concern for being called racist, but assessments must be thorough and culturally sensitive. If practitioners aren’t aware of correlations between Black women’s unique issues and the increased risk of eating disorders, then these potentially deadly disorders won’t be recognized in these groups, which decreases the chances of referral and treatment.

Additionally, most eating disorder assessment measures were developed and validated in samples that did not include Black women. The result is that we don’t always meet criteria for eating disorders based on these measures when we should.

Because of the coronavirus, racism has become more widely discussed as a public health crisis. What are your thoughts on this?
Black communities are being disproportionately affected by the pandemic in many ways. We’re dying at rates much greater than most other groups for numerous and varied reasons. The emotional response can trigger or increase unhealthy eating patterns.

For some Black women with eating disorders, perceptions of a scarcity of food and the fear of rationing are real. By contrast, some of those who restrict food intake restrict even more during quarantine. A common distorted thought for some is that because they have been less active during quarantine, they don’t deserve to eat.

More than ever before, we as practitioners must be prepared to cultivate the therapeutic alliances essential for healing. By engaging, listening, and asking hard questions, we can learn about patients’ lived experiences. This will lead to opportunities to educate and foster the sense of empowerment necessary to commit to recovery.