I was 12 when I saw my first made-for-TV movie about eating disorders. The year was 1997, and Amy Jo Johnson, the actress famous for playing the pink Power Ranger, starred as a gymnast-turned-bulimic in Perfect Body.* The ’90s was a big decade for eating disorder melodramas. Tracey Gold battled her own disorder and starred in For the Love of Nancy in 1994. A few years earlier there was Kate’s Secret, then A Secret Between Friends, and later Sharing the Secret. Lots of secrets. But the women keeping them were mostly young, thin, popular, and white.
For all the information and raised awareness, the stereotype won’t die—eating disorders are a white-woman problem. And it’s not just a false image set forth by Lifetime movies and the author pics of eating disorder memoirists. Communities of color buy into it, too. “There’s this mentality that this is a white chick illness,” says nutritionist Michele Vivas, who specializes in eating disorder treatment and works with teenagers in Oakland, Calif. “An African-American girl came in and her mom suggested to the school principal that they start a program to increase eating disorder awareness. The principal looked at her and said, ‘Why would we have that? Black folks don’t get eating disorders.’ ”
Doctors have this misconception, too. A 2006 study found that clinicians were less likely to assign an eating disorder diagnosis to a fictional character based on her case history if her race was represented as African-American rather than Caucasian or Hispanic. And although statistics do show that eating disorders predominantly occur in white women, many eating disorder professionals believe those numbers are skewed, as women of color have been alienated from a support network that for too long has bought into the myth.
“When eating disorders were first being recognized, people seeking treatment were young, white girls, so the belief developed early that nobody else suffers from them,” says Gayle Brooks, vice president and chief clinical officer of the Renfrew Center, the country’s first residential treatment facility for eating disorders. “When that became the core of our understanding, we stopped looking at diversity being an issue. We missed a lot.”
According to the National Eating Disorders Association (NEDA), “exact statistics on the prevalence of eating disorders among women of color are unavailable” because, “due to our historically biased view that eating disorders only affect white women, relatively little research has been conducted utilizing participants from racial and ethnic minority groups.” And as Carrie Arnold detailed in a piece for Slate, eating disorder research is “dramatically underfunded.” Still, we know these women exist. Here are a few.
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I met Anahi Ortega at the NEDA conference in 2012, where the topic was “What About Us? Diversity and Complexity in Eating Disorders,” and Ortega was a featured speaker.
Born in Mexico, Ortega moved to California with her family as a baby and spent much of her childhood performing Mexican folkloric dance. She quit dancing at age 12, around the time that her father, who had been sober for many years, resumed drinking and began commenting on her developing curves. Ortega started dieting. Then cutting meals. Soon, she fell into anorexia. “It was so easy to hide at first,” she remembers. “I was very good at it.”
One reason it was so simple to get away with not eating has to do with the traditional Mexican meal structure. “A lot of [Latino] families have a two-meal-per-day pattern,” Vivas says. “It’s easier to get out of eating when you have to get out of two meals a day.” Ioana Boie, assistant professor in the department of counseling at Marymount University in Arlington, Va., agrees. “In California, you see people still adhering to traditional meal times you see in Mexico,” she says. “Eating dinner at 3 or 4 p.m.” This is “exactly how I stayed under the radar,” Ortega told me, explaining how easy it was to tell her parents she was eating all her meals at school when she wasn’t eating a thing. It wasn’t until Ortega’s anorexia escalated into cutting and bulimia at 15 that anyone really took notice—she was hospitalized after accidentally overdosing on diet pills and nearly suffered a stroke.
Doctors diagnosed Ortega with bulimia, and she began group therapy. But cultural differences overshadowed any benefits she may have gotten from shared struggles. “The only thing we had in common was the eating disorder,” she says. “I felt so different in a room full of white girls. When we talked about eating disorders, I could relate. When we talked about home, I couldn’t.”
Ortega eventually enrolled at California State University–Monterey Bay. Her disordered eating ceased, but she continued cutting and began abusing drugs and alcohol. She eventually withdrew from school and attended a codependency program. Her drug use stopped, but the eating disorder kicked back up. “If it wasn’t one, it was the other,” she says.
Ortega’s new doctors in Monterey gave her a different diagnosis: EDNOS—eating disorder not otherwise specified, a catchall definition for anyone who doesn’t fit the strict standards for anorexia, bulimia, or binge eating disorder. “That made it hard to find treatment,” she says. “I didn’t fit the criteria for anorexia or bulimia.”
EDNOS is the most common diagnosis in Latina women. Boie says that’s due in part to anorexia’s diagnostic requirement of a “preoccupation with thinness.” Like Ortega, many Latina women aren’t focused on being stick skinny; the “guitar shape” is considered superior. According to Ortega, “It’s the perfect thing—curvy, but not too much.”
Ortega got back to a stable weight but relapsed immediately. Finally fed up with her interchanging issues, she checked herself into intensive inpatient treatment at the Center for Anorexia and Bulimia at Herrick in Berkeley, Calif. Her three-week stay at Herrick marked the first time Ortega felt entirely comfortable in a treatment setting. She’d been in plenty of support groups and outpatient programs over the years, but she’d always felt like an outsider because of her heritage. “Most of the girls were there because their parents were forcing them to go,” the 25-year-old says of the other patients she encountered before Herrick. “Their parents were involved with the medical treatment, while mine complained about having to drive me to appointments—treatment talk was nonexistent.” Just as eating disorder outreach needs to better target young women of color, “you have to target the [minority] parents and have them involved” as well, Ortega says.
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Ortega didn’t think recovery was possible until she attended her first NEDA conference in 2011 and met Stephanie Covington Armstrong, the author of Not All Black Girls Know How to Eat. There she was: another woman of color who’d grappled with the disease.
Armstrong’s early memories around eating aren’t particularly out of the ordinary, but her life changed dramatically at age 12, when she says she was molested by a relative and had “the need to squash down feelings that are never resolved.” She did this through food, kicking off years to come of disordered eating. “I thought I was the only black person who didn’t know how to eat,” she told me.
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