Black, Indigenous and People of Colour, Larger Bodies and Eating Disorder Recovery 4
I came across an article where the following graphic was supplied to plain language a study using the Healthy Bodies survey:
Descriptive Text: Eating Disorders by the Numbers
Females were almost five times more likely to be diagnosed with an eating disorder than males.
White students were nearly two times more likely to be diagnosed with eating disorders than students of color.
Females were almost 1.5 times more likely to get treatment compared with males.
Affluent students were nearly two times more likely to get treatment compared to nonaffluent students.
—1
The above conclusions are translating statistical odds ratios and much is lost in that translation. Almost 80% of the data set was white and almost 85% was female. 10% had received a diagnosis of an eating disorder. The entire data set of 1,747 students qualified for an eating disorder diagnosis based on applying the EDE-Q (cut off score of >2) to the comprehensive survey results, yet only174 people had actually received prior screening and a diagnosis.
People with an eating disorder are diagnosed an estimated 30% of the time and the above more time limited year-long analysis suggested 10%.[2] The fundamental problem with the above translation is that the more abysmal chance of a correct diagnosis for men, larger bodied and BiPOC ends up as a subsection of a subsection of tiny real number because white women are very unlikely to be correctly diagnosed as it is.
Here are my frustrations with this current state of affairs:
As I’ve already made obvious throughout the material on this site and in the above sections as well, the classification system for the eating disorders is monstrously responsible for the 70-90% of missed diagnoses.
An eating disorder is neither a weight disorder nor a loss of control disorder but it’s treated as such by laypeople and professionals alike, and that means everyone focuses on treating the eating rather than the eating avoidance. So even when you are in that tiny subsection who receives a diagnosis, your treatment commonly assures you only continued symptoms and ongoing quality-of-life miseries (recover but not too much).
Diagnosis is nonetheless the only gating system through which any patient receives the possibility of useful treatment, however small that possibility might be.
Decades-long awareness campaigns are not resolving the diagnosis chasm because no awareness campaign is educating the public on the fact that eating disorders are eating avoidance disorders and that weight and/or “loss of control” are irrelevant.
While larger bodied and BIPoC are less likely to be screened and diagnosed with an eating disorder, perhaps these facts are missing the forest for the trees. On the one side, diagnosis is the gate anyone must pass through to get access to treatment, and on the other side, the diagnosis may result in treatment that further entrenches the avoidance of food that ruins quality of life in the first place.
I believe that the observation made by Nylah Burton regarding the pursuit, in black communities, of women becoming tradwives is applicable to the world of eating disorder diagnosis and treatment:
“The idea that Black women should aspire to traditional marriage as a way out of capitalist exhaustion is a deeply flawed one, as these are the same systems that excluded us, and now this feels like another means to control us. Our inclusion is also a tool of control, as traditional marriages are also dependent on capitalism and are institutions that can harm Black women.”
Aspiring to the current state of diagnosis and treatment for eating disorders is not aspirational. BIPoC struggle to have proper screening for everything from asthma to heart disease to cancers, wherein the treatment on offer is not just life-saving but also quality-of-life improving. But not everything within the medical and mental health purview is automatically good and helpful.
The Screening and Assessment Tools and Discrimination
Questionnaires. That’s it for tools for screening and assessment of eating disorders. Of course, practitioners regularly use their culturally-driven determination of weight to trigger any decision to apply these questionnaires in the first place.
Only 30% of patients, who meet the criteria of an eating disorder, seek treatment.[4] If patients are not seeking treatment, then it falls to the practitioner to suspect, and then to screen and assess, so as to provide a diagnosis that was not sought but is required for the application of interventions designed to improve morbidity and mortality outcomes.
More on this in the next installment June 27.
Image in Synopsis: DeviantArt.com: Wolfepaw
Sonneville KR, Lipson SK. Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. International Journal of Eating Disorders. 2018 Jun;51(6):518-26.
ibid.
https://www.refinery29.com/en-us/2022/12/11161942/tiktok-black-tradwives-burnout-marriage-capitalism
ibid.
