Eating disorders can happen to anyone

Eating disorders can happen to anyone

Ashley Andreu

“I still don’t trust my parents to feed me,” Sophia, a psychiatry resident who I worked with in an inpatient eating disorder unit for two months, confessed when I asked her what she was most worried about as she neared discharge. The 14-year-old girl was brought to the pediatrician by her parents, concerned about her diet, who discovered that Sophia (not her real name to protect her privacy) had lost 30 pounds in three months. In the weeks prior to her hospitalization, she had only eaten one fruit a day. She could barely walk home from school, her period had stopped, her hair was falling out in clumps, and her heart rate had slowed to a dangerous level.

But Sofia wasn’t your typical eating disorder patient — her family spoke Spanish and had immigrated from Peru — and her confession contained both fears of losing control of her eating and real anxieties about life after she left the hospital.

Her deeply caring family struggled to meet with their loved one during their inpatient treatment, a situation complicated by the need for an interpreter, a prescription for a hospitalized diet that differed from the food they would normally eat at home, and a reluctance to ask questions of the medical team.. Although Sofia recovered to a healthy weight upon discharge, finding appropriate outpatient treatment presented another challenge. Family-based treatment is a standardized outpatient treatment that aims to return adolescent patients to a healthy weight with the support of their parents. The treatment consists of three phases, in which parents initially assume most of the responsibility for food and patients gradually become more independent as their nutrition is restored. This is the gold standard for adolescent outpatient treatment. However, Medicaid does not fully cover most of these programs, and finding a program with a Spanish-speaking therapist was even rarer. Despite the social worker’s efforts, Sofia was placed on a waiting list for a family treatment program with a Spanish-speaking provider that offered sliding-scale payment.

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Sophia’s case highlights the disconnect between those who develop eating disorders and the stereotypes portrayed in popular TV shows and films. 13 Reasons and Black SwanThe media’s misconception that eating disorders occur primarily in affluent, white, young women leads to disparities in underdiagnosis, lack of access to treatment, and lack of understanding of eating disorders, which ultimately leads to poor outcomes.

Eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder. These disorders are associated with serious physical effects such as irregular heartbeats, and mental effects such as depression and suicidal tendencies. The number of people with eating disorders is also increasing, linked to social isolation and increased social media use due to the COVID-19 pandemic. With a 5% mortality rate, eating disorders are one of the deadliest mental illnesses in the world. From Taylor Swift to Princess Diana to Jane Fonda, eating disorders are not a new phenomenon.

Despite what people may think, eating disorders are equally prevalent across socioeconomic status, race, and ethnicity, affecting approximately 9 percent of women and 4 percent of men. Emerging data suggests that individuals with multiple marginalized identities may even be at higher risk: One study of more than 120,000 people found that low-income people were 27 percent more likely to have an eating disorder than those with higher incomes. The study also found that 52 percent of bisexual men and 52 percent of lesbian women of low socioeconomic status who are Latinx tested positive for an eating disorder.

Our relationship with food is complex, as are factors such as ethnicity, the stress of cultural assimilation, Western beauty standards, racism, and trauma, all of which influence the prevalence of eating disorders.

Low-income patients and patients of color are also more likely to be overlooked and undertreated. A statewide survey of Medicaid-insured youth in California found an annual prevalence rate of eating disorders of 0.2 percent, compared with a national prevalence estimate of 5 percent. This highlights the underdiagnosis of eating disorders and limited public funding for treatment. Furthermore, compared with the national prevalence rate of eating disorders, health professionals miss approximately 50 percent of diagnoses in black adolescents in the United States. This underdiagnosis is likely due to diagnostic bias. Clinicians are more likely to diagnose white patients than black patients when they have identical eating disorder symptoms. Diagnosis and treatment are closely related, and correctly identifying patients is the first step to effective treatment. Additionally, training non-mental health care providers in eating disorders is crucial. If pediatricians and social workers don’t know the warning signs, they won’t notice them.

Like an accurate diagnosis, access to care determines treatment. In the United States, access to treatment is closely linked to money, place of residence, political status, prejudice, and blatant discrimination. A study published in 2018 found that Latino youth with eating disorders were less likely to use mental health services compared to non-Latino youth. Wealth was directly correlated to understanding the need for treatment (52% more likely) and receiving treatment (89% more likely) compared to low-income students who participated in the study. Overall, specialized services appear to be less accessible to low-income patients. For example, specialized services for eating disorders are concentrated in more affluent areas, and many only serve those with private health care. Outpatient behavioral health services often refuse Medicaid patients, as seen by Sophia’s inability to receive family-based treatment. Given these diagnostic and treatment inequities, disparities in disease outcomes are inevitable. Early diagnosis and treatment are the best indicators of recovery and reduced illness and death.

So how can we change these disparities? Essentially, we don’t know anything if we don’t study it. The lack of comprehensive studies perpetuates stereotypes and reinforces diagnostic bias. The majority of eating disorder studies have inconsistent information on socioeconomic status and lack sexual orientation. While more studies are reporting data on race and ethnicity, funding and recruitment are often limiting factors. There is a big difference between collecting data and finding ways to actively recruit diverse and representative participants. Most subjects in eating disorder research are still white women. Men, people of color, and gender diverse individuals have rarely been studied.

Ultimately, more diversity in research will allow for better treatment. In medicine, increasing evidence justifies increased investment – a bootstrap effect that explains why eating disorder treatment remains severely underfunded. Patients with multiple minority identities are at increased risk, so research is needed, including how the intersectional experiences of having multiple identities and facing discrimination impact illness.

I am grateful that my facility provides weight restoration treatment completely free of charge and does not require us to rely on insurance companies, which would have resulted in Sophia being discharged from the hospital at a significantly lower weight and receiving outpatient treatment. However, free specialty care is rare in the United States. Even with the quality inpatient treatment available, I wish we could have offered Sophia more outpatient options. I can’t help but feel like the system, and by extension, us, are letting her down when she leaves the hospital. Eating disorders are… Anyone, Changing the narrative is key to pushing for fairer treatment. To ensure people like Sophia are treated equally, we must raise awareness about the different people who suffer from eating disorders and address these biases in research, funding and patient care.

This is an opinion and analysis article and the views of the author are not necessarily those of Scientific American.