You Don’t Need to have Bulimia or Anorexia to Have an Eating Disorder
You may be thinking, I don’t have an eating disorder. I don’t keep myself from eating food. I don’t throw up any of my food. So I’m okay.
But are you really ok? I recently spoke with a friend of mine who knows I work in the eating disorder space. She shared, “Marcella I just had an epiphany. I have an eating disorder. While I’m not throwing up my food nor am I avoiding eating food, I am struggling.”
“I find myself obsessing about working out. I hate the number on the scale even when I feel good. I struggle to eat certain foods because they have sugar in them. I find myself working out even when I’m exhausted because I’m afraid of weight gain. I am constantly aware of how I look.”
“I find myself comparing myself to others all the time. It’s exhausting. I don’t want to feel this way anymore. And I know it’s hurting my health. I’m getting injured all the time. I’m not eating enough to sustain my workouts. I need to figure this out.”
Perhaps you can see a bit of yourself in my friends' very vulnerable share.
This is why I want to bring more awareness to eating disorders. Because I believe that more people in our country and around the world are suffering and not realizing they have an eating disorder.
We live in a toxic diet culture. Diet culture attaches our worth and value to thinness. Diet culture actively encourages eating disorders by prescribing and praising restriction, excessive exercise, calorie tracking, food labeling, weight monitoring and just being hyper-vigilant about everything we eat and how much we weigh. Diet culture blames, criticizes and shames bodies that are different in any way.
Diet culture abusively demands that we work towards a privileged body by any means. If we do not work towards a privileged body and/or do not achieve it, diet culture says we deserve any negative outcome, including any harm that comes to our bodies. Diet culture is so thoroughly manipulative that it has become interwoven into mainstream living and is embedded in our vocabulary and ultimately our way of living.
Do You Find Yourself?
- Obsessing over your diet
- Judging how many pounds you see on the scale
- Being hyper-critical of what you see in the mirror
- Working out even when you’re exhausted
- Avoiding certain foods even when your body craves them
- Feeling bad about eating certain foods or missing an exercise day
- Controlling what you eat to an obsessive degree
- Using diuretics to control your weight
The reality is that eating disorders are complex and intersected with demographics and numerous oppressions in our society. People with eating disorders experience severe disturbances in their eating behaviors and related thoughts and emotions. People with eating disorders struggle with their relationship to their body. There are many different types of eating disorders:
- Anorexia Nervosa
- Bulimia Nervosa
- Binge Eating Disorder (BED)
- Body Dysmorphic Disorder (BDD)
- Avoidant/Restrictive Food Intake Disorder (ARFID)
- Pica
- Rumination Disorder
- Other Specified Feeding or Eating Disorder (OSFED)
It’s important that we understand eating disorders more fully as sadly, there are many stereotypes and misconceptions about eating disorders. In doing so, we can help loved ones, colleagues and communities get the support they need. We especially need to help marginalized communities who are struggling with eating disorders.
Eating disorders can be deadly.
Let’s raise our understanding around eating disorders to address this as a community.
Understanding Eating Disorders
I’m going to share three t common eating disorders. And how to identify if you or a loved one is suffering from this condition.
Anorexia Nervosa
The most commonly known disorder is anorexia nervosa.
They avoid certain types of food and severely restrict their calorie intake.
They also have an extreme fear of gaining weight. They struggle with their relationship with their body.
Bulimia Nervosa
Individuals with this eating disorder will typically binge eat foods. During a binge, they feel they can’t control eating.
After their binge, they use laxatives, enemas, vomiting or excessive exercise to compensate.
Similar to anorexia, these individuals have an extreme fear of gaining weight.
Binge Eating Disorder
Binge eating is the most prevalent and common type of eating disorder. It’s also one of the most common chronic disorders among adolescents.
People with binge eating disorder do not restrict calories or use purging behaviors, such as vomiting or excessive exercise, to compensate for their binges.
People with binge eating disorder often consume excessive amounts of food and are consumed with guilt, shame and /or negative feelings after a binge.
If you or someone you know is suffering from an eating disorder, please share this article with them. Offer to listen and support them.
I am happy to connect them with the resources and support they need.
It’s important that we help each other given the amount of suffering eating disorders are causing.
The Rise in Eating Disorders
Eating disorders are on the rise. Due to westernization, social media, and the pandemic, we are seeing surges in eating disorders.
Some Concerning Statistics:
- Up to 70 million people suffer from eating disorders
- Severity and prevalence of eating disorders may be spiking even more due to the anxiety and stress unleashed by the COVID-19 pandemic
- Eating disorders prevalence has “increased over the study period from 3.5% for the 2000–2006 period to 7.8% for the 2013–2018 period”
We know we have a problem. The best way we can address eating disorders is by collectively building awareness. Educating ourselves about these challenges.
Need Help?
Navigating the world of eating disorders is not easy. It’s complex and nuanced.
That’s why I’m here to help.
If your team, company, school, community or organization is struggling with eating disorders, I’m would like to help.
No matter what specific challenge you are facing, I provide customized training around eating disorders.
Let’s connect and see what we can build to get you and your team back on track.
Speak soon.
Why is Eating Disorder Training Being Left out of Medical Schools?
Eating disorders affect at least 9% of the population worldwide.1 That means 28.8 million Americans, will have an eating disorder in their lifetime.2 This poses as a significant financial burden as the economic cost of eating disorders is $64.7 billion every year.2
Of all mental illnesses, eating disorders have the highest mortality rate.
And yet, studies show that medical students receive less than two hours of training on eating disorders. They study for 4 to 6 years and spend less than two hours on an illness with a high mortality rate.
Individuals suffering from eating disorders have shared that doctors’ knowledge around eating disorders, or lack of it, can be the difference to continuing to suffer and recovery.
According to a study done in the UK, only 42% felt that their general practitioner (doctor) understood eating disorders. Only 34% believed their doctor knew how to help them with their illness.
To Recap….
- Eating disorders impact millions of people
- They have a high mortality rate
- General practitioners are the frontline workers about individuals’ health
- Medical schools provide medical students with less than two hours of education on eating disorders
What gives?
It seems to me that there is a clear gap. And it doesn’t appear to be that difficult to solve.
Closing the Gap: Training for Medical Practices
I am passionate about closing this gap. This is why I have put together training to support practitioners.
If you haven’t worked directly with eating disorders, addressing and treating them can be stressful. They can also become more complicated. Sometimes you know an eating disorder is present but your client/patient refuses treatment.
In my training, How to Treat Eating Disorders in Your Practice, you will learn how to navigate the complexity of eating disorders. You will discover tools and treatment ideas to help you support your patients.
Who this training is for:
- Therapists, psychologists, social workers, psychiatrists
- Mental health interns
- Post doc residents
- Physicians
- Nurses and dieticians
Over the years, I have discovered that we have many frontline workers. So I have built two additional training sessions to help us get ahead of this eating disorder epidemic.
Eating Disorders in the Classroom
Eating disorders are on the rise, and many teachers are not sure of how to approach it. There is all kinds of information about eating disorders.
Teachers wonder what to do with that information. It can feel overwhelming. Especially with everything else a teacher must watch for among their students.
In my Eating Disorders in the Classroom training, you will learn about eating disorders and treatment options. You will discover how to handle circumstances with students. You will learn what questions to ask your students.
Together, we explore your own fears, concerns and biases around eating disorders in a safe place. You will walk away confident and prepared to support your students.
Who this training is for:
- Elementary School to High School Teachers
- Teachers’ Assistants
- School Administrators
The classroom training helps address eating disorders from Kindergarten to High School. But this still leaves a big gap.
That’s why I built my Workplace Food and Body Liberation training. To tackle eating disorders with adults, through their companies. After all, we spend 40+ hours a week at work. It has a huge impact on our day-to-day lives.
Workplace Food and Body Liberation
We are at work for such a large proportion of our waking hours. Our work demands continue to increase. Yet the pressures of work demands make it difficult to eat away from our desks.
Many workplaces are adopting work programs that focus on food and physical activity. Many “healthy work programs “ take a restrictive approach to food. And a focus on weight loss with physical activity.
We want a work environment where we celebrate food, movement, and each other.
We are already pressured by work demands, we do not need to add the pressures of diet culture to our work.
In my Workplace Food and Body Liberation Training, you will learn about diet culture. How diet culture impacts your workplace. We will explore your own weight stigma biases in a safe space. And you will discover how to build a workplace culture that’s empowered to make changes for food and body liberation.
Who this training is for:
- Companies
- Nonprofits
- Small Business Owners
- Communities
- Organizations
Change begins when we can individually and collectively embrace nourishment, our bodies and each other.
We all deserve to experience food and body liberation.
We all deserve that freedom. It is vital.
Need Help?
I also provide customized training around specific topics or needs.
Let’s connect and see what we can build to get you and your team back on track.
Speak soon.
1Arcelus, Jon et al. “Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.” Archives of general psychiatry 68,7 (2011): 724-31. https://doi.org/10.1001/archgenpsychiatry.2011.74
2Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.
Examining Dated Eating Disorder Views With Dr. Marcella Raimondo
I very much appreciated being interviewed by Erin Skinner on the Empowered Nutrition podcast to explore how to address eating disorders in nutritional settings. I appreciated how open Erin was in hearing how so many food plans, diets, mainstream eating approaches that involve eliminating foods are actually restrictive, depriving, and can cause all kinds of disordered eating. It felt great to have us hold a vision of body and food liberation/justice.
Check it out - https://lnkd.in/gBDZj5Ht
Do you see patients in your practice that struggle with disordered eating and eating disorders?
In this episode, Dr. Marcella Raimondo discusses outdated perceptions of eating disorders and how we, as nutritional professionals, can best aid our mental health counterparts in treating clients with disordered eating.
I find, in my practice, that I encounter clients with eating disorders or disordered eating regularly. As nutrition professionals, it is important for us to be able to work cohesively with the mental health professionals that are treating these clients and stay updated on current treatment plans.
Are you a nutritionist that sees these types of patients? Do you want to know more about what mental health professionals want from us to best aid their patients' recoveries?
Marcella Raimondo, PhD, MPH is a passionate and spirited clinical trainer speaking from her heart on social justice and eating disorders since 1995. Marcella received her B.A. from UC Berkeley and a Master's Degree in Public Health from the University of Michigan. Marcella's desire to address eating disorders drove her to pursue her doctorate in clinical psychology, receiving her PhD in 2012.
She completed her post-doc internships at an eating disorder outpatient program and an eating disorder residential program for adolescents. Marcella currently serves as a Licensed Clinical Psychologist (PSY # 27037) in Kaiser Permanente's eating disorder clinic in Oakland and runs a private practice. Marcella herself recovered from anorexia nervosa over 20 years ago.
In this episode we talk about:
- Marcella's journey to becoming a specialist in eating disorders
- How to strike a balance between eating disorders and therapeutic medical diets
- Whether and how modern foods and diet culture perpetuate eating disorders
- How nutrition professionals can support mental health professionals with meal plans, liberating from restrictive food mentality, support with health needs such as IBS and diabetes, education on metabolic processes, explanation of the physiology of dieting and its effects on metabolism and how it leads to malnutrition
- Marcella's process with eating disorder patients dealing with their behaviors, exercise, body image, diet recall, goals, mental health and family history, risk, and their personal stories and how the disorders may serve to fill a need, and address those needs in a healthy manner
- How she helps practitioners improve their expertise with eating disorders
Connect with Dr. Raimondo at marcella@marcellaedtraining.
Visit Dr. Raimondo's Training Website: https://marcellaedtraining.
Facebook and Instagram: Dr. Marcella Raimondo
Check out the full episode at:
Why it's So Hard to Treat Eating Disorders in an Oppressive Diet Culture World
As an eating disorder psychologist, I love my work. Sure, it can be hard, but it's not exhausting. I do believe that people can recover from eating disorders. I want to learn about my clients and hear how their eating disorders have served as their survival and protection and helped them make sense of their world. So, I lean in to hear folks' stories. By holding their story and honoring it, we can understand it so that healing can happen.
The biggest struggle and frustration of my work is not that it is difficult to treat eating disorders. The biggest challenge is always how toxic diet culture obstructs recovery.
What is Diet Culture?
Diet culture is everywhere. From intermittent fasting to no sugar or no-carb diets, to detoxes and cleanses, to "being bad " if we eat particular foods, or needing to "earn " our meals we are inundated with the belief and mentality that we must continuously strive to be thin. We are conditioned not to trust our relationship with food. We see it in so many aspects of our lives: thinness, weight bias, and privileged body types are glorified, while marginalized bodies are targeted.
Diet culture runs so deep that when we sit with it, we realize how completely entrenched and pervasive it is in our society and in ourselves. I call it "white supremacy in a pretty pink bow. "
Diet culture attaches our worth and value to thinness.
Diet culture actively encourages eating disorders by prescribing and praising restriction, excessive exercise, calorie tracking, food labeling, weight monitoring and just being hyper-vigilant about everything we eat and how much we weigh.
Diet culture blames, criticizes, and shames bodies that are different in any way.
Diet culture abusively demands that we work towards a privileged body by any means. If we do not work towards a privileged body and/or do not achieve it, diet culture says we deserve any negative outcome, including any harm that comes to our bodies.
Diet culture is so thoroughly manipulative that it has become interwoven into mainstream living and is embedded in our vocabulary and ultimately our way of living.
Diet culture also aligns with white supremacy because it specifically targets marginalized bodies.
My clients who are marginalized tell me about their daily experiences of being targeted. They also tell me how thinness can make up for it. It's the one place where I can have some control over my body, and thus how people see me. If I have to lose thinness, I lose the one privilege that I have. If I recover and my body changes, then society will see me for who I am and that's scary, if not dangerous, for me.
It Takes Courage
When folks tell me they are scared to recover because it means they will gain weight and they are fearful of the backlash that will come to them I wish I could say that's not true. But it is true.
My clients tell me all the time the ways that recovery is difficult:
- I'm getting compliments now that I have lost weight.
- If my body changes, my dating pool decreases.
- If I gain weight, I don't get love from my family.
- I'm assigned the boring or less visible jobs at work.
- People make negative comments to me about my body and express concern about my weight.
- I can't eat in public as I get negative looks and/or comments.
- People laugh at me when I exercise, even though I am told I should exercise.
When someone is making the decision to recover from an eating disorder and they seek treatment, they are being very courageous. Folks are terrified to give up an eating disorder. It may be the hardest thing that somebody has ever done. In addition to learning to have a new relationship with food and with their body, they have to struggle with all of the stigmas and biases attached to their recovery within our diet culture. Everyone who suffers from an eating disorder deserves to recover. They also deserve support for their recovery.
Weight is NOT the Problem
One of the greatest dangers of diet culture is that it presents itself as "healthy. " Our medical establishments regard thinness as health. There is a firm and commonly accepted belief that being in a large body is unhealthy, yet the studies that support this idea are inconclusive. BMI (body mass index) the standard by which doctors have measured whether a person is underweight or overweight for over 100 years is a haphazardly invented and flawed mathematical calculation. There is no actual science behind it.
- https://www.medicalnewstoday.com/articles/255712#Is-it-too-simple?
- https://www.livescience.com/39097-bmi-not-accurate-health-measure.html
- https://www.npr.org/templates/story/story.php?storyId=106268439
Weight stigma repeatedly comes up during eating disorders treatment. My clients in larger bodies always tell me:
- People are surprised when I tell them I have an eating disorder.
- People tell me that I don't look like I have an eating disorder.
- My doctor expresses concern about my weight and/or weight gain.
- My doctor encourages food restriction.
It is hard enough to recover from an eating disorder, and now folks have to endure weight bias as their body restores weight. I have had a number of clients tell me that they can't handle the weight gain and weight bias so they leave treatment. This breaks my heart and enrages me. It is unethical for healthcare to encourage people to control their weight through eating disorder behaviors that are medically dangerous. It is also unkind, given the internal suffering and shame that people hold in their bodies. Instead, we need to meet people with compassion and understanding.
I work with a "health at every size " approach and professionals in healthcare tell me repeatedly that this approach is not common. Restriction, losing weight, and food labeling is a chronic focus in the world of healthcare. Anti-fatness is the norm.
Our medical establishments need to go beyond weight in their assessments and prescriptions for health. Weight is not the problem. If our focus for physical health primarily involves making changes through weight loss that's a failure. We're missing a whole spectrum of experiences and understanding, as well as the underlying sociological and emotional issues that contribute to health. We really have to be willing to challenge, and challenge with compassion, how we are all so wired to be anti-fat.
If healthcare does not examine and address its anti-fat and weight biases, we are saying that only thin people with eating disorders deserve to recover. It's the same as saying that people in larger bodies deserve their eating disorder since it will manage their weight.
Everyone who suffers from an eating disorder deserves to recover.
Creating Change, Embracing Nourishment
I remember one woman who called her obsession with food, her body, and weight a "mental prison. " She finally said I can't live like this anymore. When she gave herself permission to eat what she wanted, she felt liberation. My head isn't so preoccupied. It's becoming more and more a journey to embrace my body, and let go of having a smaller body. I can't live in all this excessive hatred.
Despite what society says you have a right to be nourished. You have a right to have food liberation and to have a relationship with your body that works for you. You don't deserve to have an eating disorder. You deserve a life that is more than your eating disorder.
We connect with others through food and through our body.
Change begins when we can individually and collectively embrace nourishment, our bodies and each other. We all deserve to experience food and body liberation. We all deserve that freedom. It is vital.
The thoughts I conveyed here in this blog have been expressed by many activists. I have been in conversations and shared space with so many HAES (health at every size) and eating disorders social justice activists who raise how diet culture impede eating disorder recovery. There is a potent and collective advocacy to challenge diet culture. I encourage you to check out the work of many activists https://marcellaedtraining.com/resources/ I have learned so much from these incredible folks. I also encourage you to look at how diet culture has influenced you, and spend time challenging your own weight bias with compassion.
Marcella M Raimondo, PhD, MPH (PSY#27037)
Psychologist, Consultant and Trainer
Pronouns: She/her
Check out my site - http://www.marcellaedtraining.com/
working with folks with eating problems, eating disorders and body image issues
Expanding our Potential for Healing from Eating Disorders through Diversity of Perspectives and Lived Experiences
"A Hunger So Wide and So Deep, by Becky W. Thompson. To say that this book resonated with me doesn't even capture what happened. It did more. Reading those stories, I felt seen, validated and soothed... and it was everything to me. "
The first time I read about queer women and women of color with eating disorders was in 1995. I was in grad school, interning at an eating disorder clinic, and a friend of mine who knew I was a biracial queer woman who had battled anorexia recommended the book A Hunger So Wide and So Deep, by Becky W. Thompson. To say that this book resonated with me doesn't even capture what happened. It did more. Reading those stories, I felt seen, validated and soothed... and it was everything to me.
The book is centered around the testimonials of queer women and women of color and their personal experiences with eating disorders. Their stories describe how parents and families who immigrate are responding to racism through anti-fatness. They identify the same confusion and mixed-messaging that I had received as a young person growing up in a biracial household. This book goes beyond the mainstream idea that eating disorders mostly happen to white, hetero, affluent, cisgender, able-bodied, neurotypical girls and integrates the impact of racism and oppression on eating disorders.
Until that point, I truly felt that there was something wrong with me and that my eating disorder made no sense. All of the biographies and textbooks that I had read about eating disorders had not in any way mirrored my own experience. As I read the stories in Thompson's book, it made me see that my story was true and valid. I realized that peoplecould understand, and peopledo understand because they were saying my story! And that was incredibly liberating. I felt seen for the first time.
Growing up, food was a huge part of how my family honored our culture. My parents celebrated food and believed in enjoying all foods. I never saw my mom restrict her diet or only eat salads. At the same time, there was so much mixed messaging. I was encouraged to participate to enjoy the food and family traditions that centered around food and at the same time I was constantly being told not to gain weight. There was this sense of showing loyalty to my culture don't abandon us but, in equal measure don't gain weight.
Thompson's book explained the damaging confusion of these mixed messages and why it was so upsetting to me. It also gave me more understanding of my parents, and particularly my mother who was an immigrant and had experienced oppression and the anxiety of assimilation in this country.
When my mom came to the US from Peru, she was learning English, looking for a job, and trying to assimilate. What she encountered as a brown woman with an accent, and all of the ways that our western culture regarded her, shaped in her the idea that in order to be successful and included she had to be thin. Even though roundness was celebrated in her culture, she saw that thinness was, and is, valued. Her thinking was: Of all the things that I am, if I'm thin, that can make up for it. It can be one less strike against me.
So, when I started to go through puberty, and gained puberty weight which is a natural, common, physical response to hormonal changes my mom began expressing her concern. I did not know how to make sense of these mixed messages around aspects of myself that were so personal, nuanced and vulnerable. I felt pressure and confusion around food and my changing body. Overwhelmed and angry, I began restricting my food to numb my pain and confusion. So that was how my eating disorder began.
Thompson's book sparked my life's calling my commitment to bring awareness and change to the huge gap that exists in treatment servicesfor underrepresented and underserved folks with eating disorders. Through this work, I have seen the vital role that diversity plays in the treatment of eating disorders. By bringing in different perspectives and expansive thinking to the field, we create greater possibilities for treatment and recovery for everyone.
Historically, the field of eating disorder recovery and treatment has taken a harmful and exclusive cookie cutter approach to address these issues. The myth that eating disorders only occur in affluent Caucasian girls is damaging to marginalized communities that suffer from eating disorders. This narrow viewpoint continues to reinforce an invisibility that is experienced by marginalized communities. It also limits our ability to understand the underlying problems that cause eating disorders and diminishes the deep complexities and layers that need to be revealed for true healing to occur.
If we think that there is only one perspective, and only one solution, we lock ourselves into one way of thinking for healing and recovery and that is limiting to everyone.
Healing and recovery is personal, individual, and complex. It means different things for different people. And each person's relationship with food is also complex. By bringing in diversity, both in thinking and experience, it allows us to find new, innovative ways to approach treatment. Where in our system and society do we need to change so that recovery is more possible for more people?
Eating problems are very pervasive. They are not confined to specific populations or groups of people. With this greater understanding, we can tap into different people's viewpoints and learn how they use treatment, which grows and strengthens our understanding of what treatment is. We can say, "Let's hear your stories. Let's hear what works for you. " We can hold healing and recovery as an evolving, expansive process. The more expansive we are the more we take on different angles of healing the more we will be able to think of inclusive and inventive ways to approach treatment and recovery. As we open and expand our approach and ideas around treatment, we create a whole new wave and energy that provides more hope and holds healing from eating disorders as absolutely possible.
The invisibility of marginalized folks who suffer from eating disorders
Eating disorders are often viewed as occurring in Caucasian, thin, affluent, cisgender adolescent girls. The way our current media portrays those suffering from eating disorders reinforces this myth.
How current treatment systems continue to be inaccessible for marginalized communities
I am a queer cisgender,
Eating disorders are often viewed as occurring in Caucasian, thin, affluent, cisgender adolescent girls. The way our current media portrays those suffering from eating disorders reinforces this myth. In 2017, Netflix released the movie "˜To the Bone " whose main character fits this exact stereotype from her appearance, narrative and even the way her family easily accessed treatment. It is also important to point out that the actress who portrayed the lead character with an eating disorder suffered from eating disorder years ago. She reported that she worked with a nutritionist to lose a drastic amount of weight in a "healthy " way so that she could have the emaciated body needed for this movie role. Newsflash: you can't lose a drastic amount of weight in a "healthy " way after suffering from an eating disorder. Would you ever ask a person who recovered from substance abuse to do a significant amount of substances and risk an overdose for a part in a movie or play?
Let's focus on the stereotype of an individual with an eating disorder. Here are some statistics from the Marginalized Voices project. The National Eating Disorders Association's Marginalized Voices campaign, supported by Reasons Eating Disorder Center, is confronting the prevailing myths about who struggles with eating disorders, underscoring that everyone's experience is equally as valid and deserving of care and recovery.
- Black teenagers are 50% more likely than white teenagers to exhibit bulimic behaviors, such as bingeing and purging.
- A 2014 study found that rates of disordered eating have increased across all demographic sectors, but at a faster rate in male, lower socioeconomic and older folks
- Transgender college students were significantly more likely than members of any other group of college students to report an eating disorder diagnosis in the past year- 2015 study.
- Teenage girls from low income families are 153% more likely to struggle with bulimia than girls from wealthy families.
- Only 20% of those with eating disorders fit the "emaciated body " stereotype.
The myth that eating disorders only occur in affluent Caucasian girls is damaging to the many people across all races, genders and sexual orientations in all age groups that suffer from eating disorders. This narrow viewpoint continues to reinforce an invisibility that is often felt by marginalized communities. The narrow viewpoint of who gets an eating disorder continues to limit our understanding of eating disorders and not appreciate the deep complexities and layers of eating disorders that need to be revealed for true healing to occur.
As a psychologist who specializes in eating disorders, I continue to be dismayed by how inaccessible treatment is for eating disorders. I recently participated in a retreat for women of color with disorder eating. It was held in Southern California and it was indeed an effort that involved a coming together of many people like myself to create space for women of color with disordered eating. The women described waiting for over a year for a retreat of this nature, these women also reported driving from 20 minutes to 3 hours to get to the retreat site. The question that came up for me is then what? What will these women do after the retreat. There are some incredible community efforts like the work of Gloria Lucas in Nalgona Positivity Pride, who runs an online disordered eating support group for people of color- Sage and Spoon. Yet we need more of these spaces.
Now, let's take a look at trans folks with eating disorders. In a large population study of college students, trans students reported significantly higher eating disorder diagnosis rates, including use of diet pills, vomiting, and laxatives use when compared to all other groups (Diemer, 2015). Yet trans folks struggle with accessing treatment and when they access treatment for their eating disorder, their interactions with treatment was alarming. In a study of 84 trans folks with eating disorders and treatment, not one reported a positive experience, most regretted treatment even after knowing how life threatening eating disorders are. (Duffy, 2016).
Like many mental health illnesses, eating disorders treatment programs, advocates and clinicians must work together to change the current treatment landscape. All individuals affected by eating disorders need to be afforded the means, opportunities and intersectional treatment options needed for recovery.
What can you do as a clinician who does not specialize in eating disorders but sees clients with eating disorders?
- Learn about eating disorders from a wide varied source of information available. My website has some great resources: https://marcellaedtraining.com/resources/
- Assess for eating disorders in all your intakes, continue to assess for eating disorders. Some clients come to see you for substance use or other self harm behaviors. Some come to see you for trauma and the various ways they are disconnected from the world. Assess for an eating disorder.
- Ask people to tell you their experience in their bodies. Ask them what is it like to navigate in the world with the body they are living in. Most body image and eating disorders screening focus on weight and size. It is important to expand our lens on why people may engage in an eating disorder.
- Attend local conferences. Eating Disorders Recovery and Support (EDRS) and International Association of Eating Disorders Professionals (IAEDP) host local educational events in the San Francisco Bay Area.
- Apply for scholarships for your clients with eating disorders: https://marcellaedtraining.com/treatment-scholarships/
*This article was first published in Gaylesta's newsletter.- Summer 2018
Marcella M Raimondo,
Psychologist, Consultant
Pronouns: She/her
Check out my site - https://marcellaedtraining.com/
working with folks with eating problems, eating disorders and body image issues
Our world is diversifying and healthcare needs to respond
Our world is diversifying and will continue to do so. The growth of multicultural communities from sexual orientation, race, ethnicity, age, gender, etc., each with its own cultural traits and health profiles, present a complex challenge to health care providers and policy makers in providing equitable access. Access to healthcare, or mainly a lack of access, for marginalized populations, is one of the reasons for existing health disparities.These realities are present in our eating disorders field on many levels. It was hypothesized that eating disorders exist in solely in heterosexual Caucasian cisgender adolescent girls. However, more recent studies are showing that marginalized populations groups are reaching parity with heterosexual Caucasian cisgender adolescent girls in body image and eating disturbances suggesting that one's identity does not appear to protect against the broader sociocultural factors that foster body dissatisfaction and eating disturbances among adolescent females (Shaw,et.al., 2004; French, et.al. 1997.)Not only is treatment access an issue but eating disorders screening is another complication to be addressed (Becker,et.al., 2003). Multicultural eating disorders studies demonstrate that contributing eating disorder factors for multicultural populations may be unique to their race/ethnicity/sexual orientation/gender/age/disability,etc. (Harris and Kuba, 1997; Harris ,Kuba & O'Toole, 2012) . Often these contributing factors involve cultural dynamics, racism, and oppression, assimilation to dominant culture standards and identity confusion (Harris and Kuba, 1997; Harris ,Kuba & O'Toole, 2012).An even bigger question is are multicultural populations being diagnosed with eating disorders? Studies show that multicultural populations were significantly less likely than Caucasians to receive a recommendation or referral for further evaluation or care (Becker,A; et.al. (2003). Multicultural populations were also significantly less likely than Caucasians to have been asked by a doctor about eating disorder symptoms (Becker,A; et.al. 2003). These outcomes suggest a potential lack of reporting and diagnosis for multicultural populations that is a serious flaw in our health care system.The levels of impairment reported by marginalized populations with eating disorders coupled with their low levels of treatment utilization have serious consequences (Marques, et.al., 2010; Alegria,et.al. ,2007). These populations with eating disorders often remain undetected and this needs to be addressed. The levels of impairment reported by those with eating disorders coupled with the low levels of service use suggest serious consequences for marginalized populations suffering from these disorders, which can no longer be overlooked or remain undetected (Alegria,et.al. (2007).
- Alegria, M; Woo, M.; Zhun,C.; Torres, M.; Meng, X.; Striegel-Moore, R. (2007) "Prevalence and correlates of eating disorders in Latinos in the United States " International Journal of Eating Disorders; Special Issue: International Journal of Eating Disorders Special Supplement on Diagnosis and Classification, 40,S3, pg. S15 "“S21.
- Becker, A. et.al. (2003) Ethnicity and Differential Access to Care for Eating Disorder Symptoms " International Journal of Eating Disorders33, 205-212.
- 3French, S. et.al (1997) "Ethnic Differences in Psychosocial and Health Behavior Correlates of Dieting, Purging, and Binge Eating in a Population-Based sample of Adolescent Females " International Journal of Eating Disorders, 22, pg. 315-322.
- Harris, D. & Kuba, S. (1997) "Ethnocultural Identity and Eating Disorders in Women of Color " Professional Psychology: Research and Practice, 28(4), pg. 341-347. 5. Shaw,H, Ramirez,L., Trost,A., Randall,P., Stice,E. (2004) "Body Image and Eating Disturbances Across Ethnic Groups: More Similarities than Differences " Psychology of Addictive Behaviors, 18(1), pg. 12-18.
Why Addressing social justice in eating disorders in important to me
I will start with some personal thoughts about why this work is so important to me.Our bodies are our home. Yet our bodies take in our experiences and pain. As marginalized folx, our bodies take in the experience of being marginalized in society. Eating disorders are rampant in marginalized communities and yet current eating disorders treatment models are not geared for marginalized folx suffering from eating disorders. So the unhealing continues for marginalized folx. As a cisgender able-bodied queer woman of color whose 10 year battle with anorexia nervosa was shaped by cultural and societal factors, I found it so hard to make meaning of my disorder because I did not have the vocabulary to bring in my culture. Perhaps because I did not value myself as a queer woman of color, I did not give myself permission to bring in my culture. Also my story did not mirror those I read in eating disorder textbooks and biographies when I began my recovery journey. After reading Becky Thompson's "A Hunger so Wide and so Deep ", I began to read testimonials of diverse and queer women with eating disorders and could relate so deeply to how cultural and oppressive factors were so embedded in their experiences. These stories provided me the comfort and validation I needed to recover. I am also very privileged and was able to access eating disorders treatment for my recovery. And due to my proximity of whiteness, I was able to heal in the current eating disorders treatment model. This is not the case for too many marginalized folx who suffer needlessly from eating disorders. And this massive injustice in this field needs to be dismantled. Anybody suffering from an eating disorder deserves healing and we need to especially focus on our marginalized communities who continue to suffer from eating disorders.