The Effects of Race on Eating Disorders

INTRODUCTION:
People with eating disorders often get told eating disorders do not discriminate- and they

do not. Eating disorders can affect anyone, regardless of their socioeconomic status, race, gender, or sexual orientation. However, the road to recovery and getting the appropriate treatment can be influenced by these very same factors. Eating disorders are one of the deadliest mental illnesses, second only to opioid overdose (Boston, 2020). People from different backgrounds may have different access to healthcare resources, varying levels of social support, and unique cultural beliefs that can impact their willingness to seek help. Therefore, it is important to recognize and address these factors when working towards effective treatment and support for individuals struggling with eating disorders.

For years, there was a stereotype that eating disorders only affect young, affluent, cisgender, white women (Schlossberg). Dr. Strober, a doctor at UCLA, said, “But in the last decade, the number of young people admitted to the eating disorders program from underserved populations has skyrocketed.”. This review explores the ways race specifically has an effect on receiving the proper treatment for eating disorders. The purpose of this literature review is to investigate the question, what impact does race have on how eating disorders are treated? Race played a significant role in not only what eating disorder treatment patients receive but whether they would receive eating disorder treatment at all. The research showed that people of color disproportionately were less likely to receive the necessary treatment and were even less likely to be asked about eating disorder symptoms by their doctors than white patients (Becker et al., 2002).

BODY:

Racial disparities in accessing treatment for eating disorders are concerning. Moreno, Buckelew, Accurso, and Raymond-Flesch (2023) argued that race and ethnicity affected the likelihood of patients with eating disorders receiving appropriate treatment. Similarly, Becker, Franko, Speck, and Herzog (2002) focused on the effect of race and its impact on receiving an eating disorder referral by a counselor. In a qualitative study examining the impact of race on eating disorders, Moreno, Buckelew, Accurso, and Raymond-Flesch (2023) claim that race and ethnicity affected the likelihood of patients with eating disorders receiving appropriate treatment. Using a retrospective chart review of 1060 participants aged 11 to 15, the researchers coded the charts to identify whether the participants had received the recommended treatment within six months of evaluation (Moreno et al., p.3).

The findings indicate that race and ethnicity significantly affected whether a patient received the recommended treatment, even when the treatment was deemed necessary (Moreno et al., 2023). The study highlights the need for healthcare providers to be aware of and address implicit biases that may impact the provision of appropriate care to patients with eating disorders.

The results of the study showed that Latinx individuals were less likely to receive proper treatment for eating disorders when compared to white individuals. The study showed that Latinx people had a 21.3% chance of not receiving treatment, whereas white individuals had an 11.4% chance of not receiving treatment (Moreno et al., p.4). This disparity may be due to the fact that Black and Latinx individuals with eating disorders are more likely to rely on public insurance, and patients on public insurance were one-third as likely to get the recommended treatment as patients with private insurance (Moreno et al., p.4). One factor is public insurance has a different criteria when it comes to medical authorizations. This is problematic for people who are in need of specialized treatment at the onset of eating disorders but also in more critical stages of eating disorder diagnosis. Often, public insurance companies will deny approval of eating disorder treatment if one metric is not met, even with clear evidence treatment is deemed necessary (Tamargo & Goodman, n.d.). The study also found no significant differences in treatment rates for Asian, Black/African American, Other, or Unknown individuals. However, the study had limitations, such as the small number of African American participants and the lack of representation, which could suggest structural racism in the diagnosis stage (Moreno et al., p.8).

Similarly, in a study conducted by Becker, Franko, Speck, and Herzog (2002), 9,069 participants submitted self-report questionnaires. Of those, 5,787 met an on-site counselor to receive their test results and recommendations. The participants included people of Asian, African American, Latino, Native American, and Caucasian backgrounds. The study found that African American and Latino participants were less likely to be referred compared to Caucasian participants (Becker and et., p 208). However, when cognitive, behavioral, and distress scores were all factored in, African Americans had a higher chance of being referred. Their study found similar results to Moreno et al. in 2002 because even after comparing differences in symptom severity, Native American and Latino participants were still less likely to be referred for further evaluation (Becker et al., p 208). These results showed the disparity of Latino people receiving the proper treatment that they needed. The earlier study did not talk about how Native Americans were less likely to receive treatment because these categories were put in the “other” category for the Moreno et al. study. Contrary to both studies, Gordon, Brattole, Wingatem Joiner Jr. (2006) found that clinicians were least likely to recommend treatment to African American patients than to Caucasian or Hispanic patients. The way the studies conducted their research could play a significant role in why the results showed differing outcomes.

RACIAL STEREOTYPES:

Racial stereotypes can have a significant impact on the treatment of eating disorders.

When stereotypes about certain races are ingrained in the healthcare system, individuals from those races may be less likely to receive the appropriate treatment for their eating disorders. This can result in delayed diagnosis, incorrect treatment, and ultimately poorer health outcomes. According to a study conducted by Burnette, Luzier, Weisenmuller, and Boutté, individuals of different races and ethnicities may receive different treatment based solely on their race. This disparity in treatment can affect a wide range of health-related issues, including the recognition and referral of eating disorders. This observation is in line with the study by Moreno, Buckelew, Accurso, and Raymond-Flesch (2023) which highlighted the issue of patients with public health insurance having a higher hurdle to reach in terms of what meets the criteria for approval of eating disorder treatment. However, another study by Sala, Reyes-Rodríguez, Bulik, and Bardone-Cone contradicts this finding, suggesting that racial/ethnic stereotyping has no effect on the recognition and referral of eating disorders Gordon, Brattole, Wingatem Joiner Jr. (2006) conducted a study to assess how racial stereotypes affect the diagnosis of eating disorders. The study involved 91 clinicians, and each clinician was given one of three passages to read, where the only difference was the race of the character – White, Hispanic, or African American. The participants were then asked if the character, Mary, had an eating problem. The results showed that Mary’s race significantly influenced the clinician’s response to the question. When Mary was portrayed as Caucasian, 44.4% of the participants recognized the symptoms of an eating disorder. Similarly, when Mary was identified as Hispanic, 40.5% of the participants recognized that she had an eating problem. However, when Mary was portrayed as African American, only 16.7% of the participants stated that she had an eating problem (Gordon et al., 2006). Thus,

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clinicians were significantly less likely to diagnose eating disorders in African American patients than in Caucasian or Hispanic patients. However in a similar study by Sala, Reyes-Rodríguez, Bulik, and Bardone-Cone (2014) the results differ. This study investigated racial and ethnic stereotyping in the identification and referral of individuals with eating disorders. They recruited 663 university students and presented them with a description about a patient of a different race/ethnicity who had an eating disorder. After reading the description, the participants were asked to identify the problem and provide healthcare referrals. The researchers found no significant differences across the four different race and ethnicities and no significant interactions between race/ethnicity and conditions. There were variations in the studies that could have influenced their results, such as the location where they were conducted and the way each study categorized race. For instance, Gordon et al. divided race into three categories: White, Hispanic, and Black. In contrast, Sala et al. had the racial categories of Asian American, African American, Latino/Hispanic, and Caucasian. They also used different systems to track the responses (Gordon et al., 2006 )used a “yes” and “no” system to get responses whereas (Sala et al, 2014) used a five point system. Another reason that there could have been differences in what the studies showed was while Gordon et al. focused on how clinicians would respond to the study, Sala et al. examined how the general population would respond to eating disorders based on race.

Burnette, Luzier, Weisenmuller, and Boutté (2021) found that race is a significant factor in the effects on getting eating disorder treatment; they argue that there is evidence to suggest that different races receive different treatments for eating disorders. Individuals with eating disorders are more likely to receive help when they have a weight problem rather than when they are solely struggling with an eating disorder (Hart et al., 2011). For instance, 56% of studies focused on binge eating disorders included a weight loss component (Burnette et al.,

2021). They argue that individuals belonging to certain racial groups are more likely to receive treatment focused on weight loss, rather than addressing the underlying eating disorder. Body Mass Index tends to be higher in Latinx and Black communities and lower in Asian populations.

Additionally, groups with higher BMIs were more likely to seek treatment for binge and weight reduction, as opposed to Asian populations, who were more likely to be referred to anorexia nervosa treatment. Similarly (Becker et al., 2003) found that BMI played an important factor in the analysis of their test, and they also found that African Americans and Latinos had the highest BMI of any race, but even with BMI scores added, Latinos in the study were least likely to receive further evaluation than white patients. These findings suggest that there may be disparities in the way that eating disorders are diagnosed and treated across different racial groups.

CONCLUSION:
The lack of research on the relationship between race and eating disorder treatments is an

area that requires more examination and exploration. Additional research on the factors that influence eating disorder treatment can raise awareness about race bias, leading to greater awareness and change. While there has been an increase in the reporting of race and ethnicity in eating disorder studies, most of the participants are white, which can lead to a more limited outcome on the case results. This limited patient inclusivity can lead to a skewed study outcome that does little to answer the underlying issues of race and eating disorders and potential diagnosis and treatment, due to the lack of diversity of the study’s participants. But that alone is proof that there is a gap based on race for patients who are seeking help and who actually receive accurate diagnosis and treatment for eating disorders.

Moreno, Buckelew, Accurso, and Raymond-Flesch (2023) found that race and ethnicity influenced the likelihood of patients with eating disorders receiving appropriate treatment. Similarly, Becker, Franko, and Speck Herzog (2002) found that race affected the likelihood of receiving an eating disorder referral from a counselor. Both studies found that Hispanic people were less likely to receive treatment or be referred for the proper treatment they needed. Gordon, Brattole, and Wingatem Joiner Jr. (2006) found that clinicians were less likely to diagnose eating disorders in African American patients. However, a study by Sala, Reyes-Rodríguez, Bulik, and Bardone-Cone (2014) found no difference between races and the treatments. Burnette, Luzier, Weisenmuller, and Boutté (2021) found that certain races are more likely to receive specific treatments due to racial stereotypes in healthcare.

In order to address the racial disparities in eating disorders, there is a need for further research. This will help us to identify the reasons why there is a significant difference in the treatment received by white people compared to people of color. The factors that contribute to this disparity include financial constraints, racial stereotyping, white-centered research, and provider bias. By understanding these factors, we can work towards developing effective interventions and strategies that will help to close the gap and ensure that everyone who needs treatment will be able to receive it.

Racial bias relating to eating disorder diagnosis and treatment for people of color is problematic. Many of these people are seeking a professional diagnosis for their problems relating to eating and weight. If care physicians aren’t considering an eating disorder as a possible diagnosis for these patients, many could potentially think that their problem is not serious, even if they know it is. Eating disorders have the second highest mortality rate; with numbers that high, it is vital that patients do not slip through the cracks because of their race.