Thursday, June 2, 2016

Eating Disorders and Underrepresented Communities

Today is World Eating Disorders Day, a day to help raise awareness for eating disorders of all kinds, throughout the world. Unfortunately, there are a lot of people who will be ignored on this day. The typical face of eating disorders will be a young, white, very thin, girl, likely with anorexia or possibly bulimia. And yes, these people exist. This post is not meant to deny or invalidate those experiences because they are very real and very deadly. But while people are offering support and resources to these young women and girls, people of color, fat people, men, trans, and nonbinary people fly under most people's radars.

Let's start with the fact that studies show in 6th and 7th grade girls, Hispanics and Asians showed significantly more body dissatisfaction  more, than white girls. Similarly, Native American girls were attempting weight at a greater rate than white girls. Despite the fact that eating disorders are seen as a white person's issue, ED's affect all races in the US at about equal rates.

Another group that's rarely, if ever, talked about, is older people. Yep, you read that right. Eating disorders among older people are on the rise. There's been a steep rise in the increase in body disatisfaction in people past midlife- a 31% rise in the past few decades and we don't even have statistics on this past 1997 (almost a decade ago!). We do know that over a third of outpatient treatment for eating disorders was for people over the age of 30. And, even though weight loss can be harmful, especially as you age, 20% of women who were 70 years or older were actively trying to lose weight.

Boys and men are not only often ignored when it comes to the ED community, but face added stigma in that eating disorders are seen as a feminine quality. There aren't really many statistics on men and eating disorders and more research needs to be done, but we do know that, though eating disorders affect women and girls more often, cases for boys and men are catching up. And there aren't even statistics on boys and men with muscle dysmorphia or "bigorexia", a condition in which someone is obsessed with the idea of getting bigger with muscle.

Sexuality plays a role in this too. For boys and men who were queer, they were significantly more likely to have starved themselves (fasted), used laxatives or diet pills, or vomited to try to lose weight.  Queer teens were also twice as likely to report incidences of binge eating with queer girls and women being twice as likely to binge. (Binge Eating Disorders is another under the radar, stigmatized, ED that we'll talk about later) Keep in mind that we don't even have a vague idea about eating disorders in the trans community. Among trans and non binary people, eating disorders exist, but we don't know how common they are or how their identities play into their eating disorders. We do know that fat is often associated with femininity, especially when it appears in certain spots in the body (such as the hips or chest). Here's a story about a trans man with an eating disorder where his curves made him feel fat and, ultimately, lead to anorexia nervosa.

And, speaking of fat.. let's get onto eating disorders in fat people. We know that being "overweight" or perceived as "overweight" puts you more at risk for an eating disorder. That's right folks, fat people are at a greater risk for eating disorders than thin people. And fatphobia- convincing thin people that they're fat or need to lose weight- puts them at greater risk too. I don't think we can pretend that fatphobia has nothing to do with eating disorders when thinness is often the goal. Wanting to be thin and body dissatisfaction are the most well known risks for eating disorders, and yet, we like to think that fat shaming not only is good for fat people, but doesn't affect thin people. In reality, fatphobia is deadly. Eating disorders are the deadliest mental illness with people with anorexia nervosa having a mortality rate six times higher than the general population which includes suicide. Bulimia also has a high suicide rate and mortality risks for Bulimia and EDNOS (eating disorder not otherwise specified) were similar to those with anorexia.

We should not that fat people are most often diagnosed with EDNOS and that EDNOS is the most common eating disorder. (Though people with EDNOS can fall anywhere in the weight range from average to fat, they just don't meet the low weight requirements of AN or BN)

Unfortunately, we don't know the suicide rate among those with BED (Binge Eating Disorder) because, let's face it, no one cares. People with BED tend to be fat (Though not all are. You can have BED and be thin) and we don't really care about fat people. Or BED. Binge Eating Disorder is highly stigmatized. If you're thin then the general thought is that eating a lot is cute, adorable. Despite the fact that BED sufferers face extreme emotional distress including guilt, feeling of internalized fatphobia, and self hate. Fat people with BED are thought to just be overeaters who brought their fate on themselves and they could "simply stop eating so much" and they'd be cured.

And please, let's not forget that none of the statistics in this blog cover disordered eating (such as dieting or other methods of weight loss that do not fit the criteria for an eating disorder). When we factor in the percentage of people who are dieting to lose weight, it's clear that eating disorders and disordered eating affect a massive number of people. In adult women, over half say that eating holds no pleasure and they often feel guilty- think about that. Guilt for doing something you have to do to survive, something we've evolved to take pleasure from. Only 20% of women are instinctive (intuitive) eaters, meaning 80% had some kind of disordered eating.

This is a serious public health concern. I know people like to spout off that "obesity is an epidemic!" but this? This is the real epidemic: fatphobia.

So, today as we look at all of the personal stories of people who have struggled with eating disorders or who still struggle, let's remember the marginalized and underrepresented people who struggle as well. Challenge the stereotype and educate people, because ignorance is killing the most vulnerable among us.

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