Black, Indigenous and People of Colour, Larger Bodies and Eating Disorder Recovery
These are very important topics to me and incredibly daunting ones to tackle. I am not the one who should be tackling them and I hope to have a more appropriate voice join in on this site in some guest posts this coming summer.
As a white woman with no history of an eating disorder, I am comfortable wading around in all the published research and providing my own synopses of those materials. The studies are disproportionately about white women with eating disorders. So, while I offer no representation on the lived experience of having, or having had, an eating disorder myself, I do offer representation as a white woman navigating the world of sexism in the medical and research industrial complex. I am even able to fairly competently speak of internalized fattism, as that is an almost ubiquitous implicit bias for most of us today.
And I can also speak to racism, but not on the receiving end. Too many white folk fail to recognize that soaking in 500-odd years of colonialism and European domination doesn’t get purged from our implicit biases simply because we utter the odd land acknowledgement or profess ourselves to be allies. Do I mean, or have I ever meant, to be a racist? Well of course not, but my intentions don’t wipe away ignorance, lack of education and the negative outcomes for BIPoC simply because “I meant no harm in assuming my culture didn’t need any critical assessment.” I don’t think that “I couldn’t be bothered to question much of anything,” stands up in the court of empathy or human rights.
I also have a particular bias wherein I don’t find the current state of diagnosis and treatment of eating disorders suitable for any human being. As such, it’s possible that this multi-part piece will give the impression that I am simply waving away very real discrimination for BIPoC when it comes to eating disorder diagnosis and treatment. Therefore, to clarify upfront here, BIPoC face life-limiting and life-denying levels of discrimination throughout the mental health and medical industrial complex. It is also true that the current state of diagnosis and treatment for eating disorders is not particularly life-extending or life-affirming for anyone.
What I will attempt to do in this piece:
Eating disorder symptom overlap and transitions are the norm. There are problematic moral judgments associated with culturally-dominated checklists masquerading as scientific and clinical classification.
Eating disorder diagnostic failure for BIPoC and those with both average and larger bodies.
Metabolic disrupting chemicals and their role in shifting the body’s energy management system.
Spaces and places where you might find community and treatment support.
Diagnosing Eating Disorders
Finally, as of 2024 we have a peer reviewed published paper that states exactly what I’ve been saying for well over a decade:
“All eating disorders were characterized by a mixture of binge eating and compensatory weight control behaviors”
As time goes on, I become increasingly frustrated with the arbitrary checklists that define one eating disorder as distinct from another and that these false delineations drive the entire treatment industry.
Restriction is a time-limited effort. If a patient with an eating disorder does not start eating, they die. The vast majority of patients with eating disorders beyond year two of the activation of the condition (and commonly only a few months in), will experience a mixture of ‘binge’ eating combined with whatever control cycles take root: exercise, clean eating, purging, misuse of prescriptions or substances to delay or suppress food intake…Binge eating itself is a ridiculous term as it’s just eating to restore energy—as there’s an energy deficit the food intake level is not excessive but rather rectifying.
Although the DSM 5 removed the checklist item for anorexia nervosa (AN) that specified a weight demarcation (below average), if a patient is of average or above average weight, then they would be diagnosed today with “atypical” anorexia. The weight bias is still very much built into the checklists of the DSM as atypicality should, by its very definition, refer to eating disorder patients with below average weight.
Show me a patient diagnosed with anorexia nervosa who has survived two years, and almost without exception, they will have experienced “binges.” By that I mean that they have been driven to eat more than what they accept as reasonable because the energy deficit becomes deadly if maintained any further without food intake. The drive to survive overtakes the avoidance of food.
The threat identification system in the brain triggers agitation and anxiety when a threat is detected in the environment. That state is physically very uncomfortable because it’s designed to get a human being to avoid the identified threat. The chemicals coursing throughout the body in an agitated and anxious state positively prepare and compel us to move.
When the brain has mistyped something as a threat, the person generates a post-hoc rationalization for being compelled to get away from something that is clearly not a threat and yet physiologically has been defined as one.
Eating more than is bearable results in extreme distress for the patient. It compels the patient to renew efforts to avoid food (the threat) and enact compensatory behaviours to try to minimize the food’s negative impact (as they conceive of it).
If you manage to escape from a lion attack unscathed, you will absolutely commit to avoiding any more lions at any cost. You will up your vigilance and likely overcompensate—doing even more than is necessary to avoid lions and perhaps never setting foot on any open plain even when you know that no lions live on the continent you now live on. But if in some alternate universe your very survival depended upon you being near lions, then that is a close approximation to the long-term experience of those with eating disorders.
Restriction (food avoidance) is a time-limited effort.
“In this sense, it is the distinct combination of symptoms or behaviours that determines the diagnosis, and acquiring or losing one symptom can result in transition to a new diagnostic category, a process known as diagnostic crossover.”
Right out of the shoot, no matter whether you are BIPoC or white, average or above-average weight, it’s important to externalize the entire diagnostic slots and silos of eating disorder categories. You may have to engage in all of it to receive professional treatment, but internalize only the fact that an eating disorder is the misidentification of food as a threat.
Next segment coming June 6.
Image in synposis: DeviantArt.com/ReactoCore3
Stice E, Desjardins C, Shaw H, Siegel S, Gee K, Rohde P. Prevalence, incidence, impairment, course, and diagnostic progression and transition of eating disorders, overweight, and obesity in a large prospective study of high-risk young women. Journal of Psychopathology and Clinical Science. 2024 Nov 7.
Mortimer R. Pride before a fall: Shame, diagnostic crossover, and eating disorders. Journal of bioethical inquiry. 2019 Sep;16(3):365-74.
