By Dr. Colleen Reichmann

Who do you think of when you here the term, “eating disorder.” Go on. Think about it. What image comes to mind?

If you are like the majority of people in our culture, you picture the image of an extremely thin, white, able-bodied, cis woman who is conventionally attractive. And why would you not imagine that? After all, this is the image promoted in the media and most advertising. But the 2019 eating disorders awareness week earlier this year marked an important shift.

This year’s eating disorder’s awareness week was decidedly different than those in years past.  There was more of a push for inclusion than I’ve seen before. NEDA (the National Eating Disorders Awareness Association) is a big player when it comes to the field of eating disorders. A giant. And each year, NEDA publicizes a theme for eating disorders awareness week. In year’s past, themes have included “Let’s get real,” “Everybody knows somebody,” and “It’s time to talk about it.” The gist of most of the awareness raising had to do with de-stigmatizing eating disorders—starting the conversation, and encouraging folks to let go of shame when it comes to struggling with an eating disorder.

Let’s End the Stereotype of the Thin White Woman

While valid in their own right, these themes had the unintended effect of upholding the popular fallacy that only one type of person can have an eating disorder. The majority of the images shared on social media were of thin, white, cis, attractive females. The speakers, the story shares, the before-and-after pictures, the awareness-raising images—all tended to center that singular narrative.

This year, NEDA’s theme for the week was “come as you are.” The theme represented a much needed shift: a movement towards inclusivity when it comes to eating disorder awareness and representation. NEDA featured stories from a number of multiply marginalized people, and appeared to put a huge effort into spreading the word that eating disorders happen to all folks. There is no “look” to an eating disorder. This is important for, as I said, NEDA is a giant of sorts when it comes to the eating disorder community. They have a huge platform. This year, I want to commend them for using their platform to elevate people who have historically been silenced.

However, many other eating disorder organizations, treatment centers, and individual activists chugged along throughout the week per usual. A quick scroll through the instagram hashtags #NEDAweek, #NEDAW, #eatingdisorderawareness, and even #comeasyouare revealed image after image of thin white women. Before-and-after posts abounded.

This narrow focus does not do the eating disorders conversation justice.  The posts put a face to eating disorders (white, emaciated). They encourage folks to continue focusing on someone’s appearance as a gauge to estimate how sick they are or once were. That is problematic because the vast majority of individuals suffering from eating disorders are not underweight—including individuals with anorexia.

Yes, people can have restrictive eating disorders while existing in larger bodies. No, most people are not aware of this. Yes, many doctors, clinicians, and managed care companies still tend to use weight as a main decider in whether or not to diagnose someone with an eating disorder. Yes, this means that thousands and thousands of people with eating disorders are misdiagnosed, ignored, or invalidated.

Eating Disorders Affect All People

This type of awareness raising also perpetuates the stereotype that eating disorders are a “white people illness.” This stereotype is powerful—it is engrained in our minds through movies, magazine articles, and even eating disorder research itself. Almost all of the research that exists on eating disorders has been done exclusively on samples of white females.

This is because most of the research has been done on samples from inpatient eating disorder treatment centers. And the majority of inpatient eating disorder treatment center patients are—you guessed it-white, underweight females.

This is not because these individuals have eating disorders at higher rates. It is because these are the folks with more access to care. The same who are centered in the eating disorder conversation, which means that they receive support—doctors who notice them, teachers who push them to get help, and peers who express concern.

So consequentially, white sufferers tend to be the sole samples to inform the research, which informs the medical industry, which informs society—and the cycle continues.*

I want to say this loud and clear: Eating disorders affect people of all different ethnicities, races, genders, sexual orientations, ages, and body types. They Do. Not. Discriminate. But most of the awareness-raising efforts have failed to address this in any large scale way.

So I ask: fellow smaller-bodied, cis, white women: do any of us really want to contribute to the dangerous myth that eating disorders only happen to thin white people? Do we really want to be accidentally perpetuating the discrimination and biases? Is the blog post detailing our own journey worth the harm that it will inevitably cause? Is the before-and-after image important enough to post, knowing that it will lead to ongoing invisibility of those who have already historically been silenced?

If we really want to move forward in eating disorder awareness raising, we must start from the ground up. The system has not been created to welcome POC, larger-bodied folks, queer folks, gender-diverse folks, or neurodivergent people. The research hasn’t been inclusive. The treatment centers are often fat-phobic (many still name obesity as a disease to be treated). The clinicians have unaddressed biases. Of course the faces of campaigns are still so exclusive? Is it any wonder that the individuals who feel empowered enough to post before and after pictures are still thin, white, and female?

It is our duty, as clinicians, researchers, and activists, to dismantle the system. We must work to address our own biases, and constantly uplift those who have been silenced. This does not mean shaming folks who fit the current narrative—it simply means expanding efforts to prioritize and elevate those who have been left out. It is these types of campaigns, and this research, that will lead to the true eradication of eating disorders, and to true body autonomy and food freedom for all.

*Please note: I am in no way invalidating the struggle of underweight, white, cis females who have been to treatment for eating disorders (I am, after all, one of these very individuals.) I am simply attempting to explain the cycle that has contributed to inequality when it comes to diagnostic care and treatment

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