Beyond the Stereotypes: Creating Safer, More Inclusive Eating Disorder Care

For decades, eating disorders have often been associated with an outdated image of a thin, affluent, White adolescent female. As a result, providers may be quicker to identify restrictive eating than other diagnoses, or they may be less likely to suspect an eating disorder in Black, Indigenous, and people of color (BIPOC) patients whose symptoms do not align with that stereotype.

Research suggests these assumptions can influence clinical decision-making. In a landmark experimental study, clinicians were less likely to recognize eating disorder symptoms as clinically significant when they were attributed to a Black patient rather than a White patient. These findings highlight how unconscious assumptions can affect recognition even when presenting symptoms are the same.¹

Symptoms may be attributed to gastrointestinal (GI) concerns, chronic stress, depression, anxiety, diabetes management, weight concerns, or other medical conditions before an eating disorder is considered. Cultural differences in discussing mental health, food, family dynamics, or body image may also influence how symptoms are described during appointments.

Providers may also associate eating disorders with a desire to lose weight or achieve a particular body type. While body image concerns are common, eating disorders can develop through a complex interaction of biological, psychological, and social factors. Limiting assessments to weight or appearance-related concerns may cause clinicians to overlook patients whose symptoms stem from emotional distress, trauma, perfectionism, anxiety, or other underlying experiences. Recognizing this complexity can help providers ask more comprehensive questions and avoid relying on assumptions about why an eating disorder has developed.

Fortunately, research has helped expand our understanding. In one national study, eating disorders were found across all racial and ethnic groups, with bulimia nervosa reported more frequently among Latino and African American participants than non-Latino White participants. The same study found that minority populations experienced similar or greater levels of impairment, challenging the harmful misconception that eating disorders are less severe in BIPOC populations. Despite these findings, Black, Latino, and Asian individuals were less likely to receive treatment than White individuals.²

How Bias Can Show Up in Everyday Clinical Practice

Given how stereotypes influence recognition, it’s not surprising that racial and ethnic minority patients are screened less often and receive treatment at substantially lower rates. These assumptions can influence clinical decision-making in subtle ways, from screening and assessment to everyday patient conversations. 

Providers may be less likely to screen certain patients if they don’t fit the traditional image of someone with an eating disorder. As a result, opportunities to identify concerning eating behaviors early may be missed. When clinicians settle on an initial explanation too quickly, the possibility of an underlying eating disorder may even go unexplored. This may be especially true for patients with binge eating disorder (BED), Other Specified Feeding or Eating Disorder (OSFED), or atypical anorexia nervosa, whose symptoms don’t align with longstanding stereotypes about eating disorders.

During assessments, behaviors may be attributed to stress, gastrointestinal conditions, anxiety, depression, or weight management efforts without considering the possibility of an underlying eating disorder. Referrals to specialty care, then, may be delayed, allowing symptoms to progress before appropriate treatment begins.

Additionally, in patient communication, providers may unintentionally make assumptions about cultural food practices, hesitate to explore sensitive topics related to food, body image, or cultural experiences, or overlook concerns because the patient’s body size doesn’t fit expectations.

Creating Safer, More Inclusive Care Starts with Curiosity

Creating safer, more inclusive care doesn’t require having all the answers. It begins with asking better questions, acknowledging assumptions, and approaching each individual with curiosity. When providers expand their understanding of who eating disorders affect and how they present, they create more opportunities for earlier intervention, stronger therapeutic relationships, and better outcomes across the communities they serve.

Here are four reminders to help providers offer better care for their minority patients.

1. Screen consistently. 

By practicing universal screening, providers reduce their reliance on patient assumptions.

2. Ask open-ended questions. 

Instead of leading questions, ask questions like:

• How has your relationship with food changed recently?
• Have you experienced changes in eating because of stress or body image?

3. Recognize the power of lived experiences. 

It’s important to keep in mind that your patients may have experienced discrimination, minority stress, food insecurity, acculturation, family expectations, and/or cultural body ideals that impact their relationship with food and body image.

4. Practice cultural humility.

Learn about each patient’s individual experiences instead of relying on stereotypes and assumptions. Stay curious, ask questions, and increase your education around eating disorders in BIPOC communities.³

Every patient deserves the opportunity to be recognized, heard, and connected with appropriate care. By approaching each individual with curiosity rather than assumption, providers can help reduce barriers to diagnosis, strengthen trust, and create more equitable pathways to recovery.

To learn more about EDCare or to speak with a member of our compassionate team, please contact the center near you for a free, confidential assessment.