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When Black Women ‘Weigh Too Much’ To Have An Eating Disorder

I was put on medication that would exacerbate my symptom use, and give me the energy to push through my destructiveness.

June 12, 2020

Tonya Russell
Jessica Felicio

y struggles with body image and food began before I even could conceptualize what it meant to be healthy.

I can distinctly remember being eleven years old and wondering why all of a sudden I wasn’t in the right body for my age. That summer, my grandma took me and my cousin shopping at the mall. My cousin would walk out of Macy’s that day with a bag of shorts and tank tops; I would end up with one pair of capri pants and two t-shirts.

My grandmother let me know I couldn’t have shorts because I was starting to get a “shape.”

This was the summer before sixth grade, and I spent quite a bit of time at my aunt’s house. I’d watch as my cousin gallivanted around town, her scrawny legs and knobby knees sticking out of her cute shorts. I started to scrutinize myself, wondering what was wrong with my body. It was changing, and at first I was intrigued with the changes, but that quickly turned to embarrassment. When others noted the changes, I wanted to hide. My older cousins nicknamed me Big Booty Judy, and I would be catcalled for the first time.

My story isn’t unusual. Research shows that Black girls are often viewed as much older than they are, and this perception can fundamentally affect their self-esteem and confidence. Dr. Nekeshia Hammond writes that “early sexualization can lead to depression, anxiety, low-self esteem, and academic problems, due to the added stress and expectations.”

Once I became a teenager, everyone else’s bodies caught up to mine, and I was able to blend in. My high school was diverse, with every culture and body type represented. While I still had curves, I was thin and fast enough to earn a spot on the varsity track team. The only time I worried about my body was when I had to put on the skimpy uniform that consisted of a tank top and bright red bikini bottoms.

It wouldn’t be until college, when I had to navigate eating disorder recovery, that my body truly felt inferior.

In my years of treatment and support groups, I have only come across one woman—out of all the staff and patients—who looked like me. Many women in these groups bore the cultural pressures to be thin at all costs, but my culture glorifies curves and confidence.

I could never reconcile my desire to shrink myself to the point of nothingness with women like Beyonce and Angela Bassett being praised for their bodies.

That desire was met with criticism from others, who said that Black men like meat on their bones. I never wanted to be a certain way for the male gaze, instead my goals were for me. Instead, I viewed the white women in my yoga classes and on TV as “body goals.”

Eating disorders aren’t actually about the food or physical appearance, but focusing on appearance is a way to cope.

“The majority of the clients I have seen over the last two decades have shared experiences where they received feedback about their bodies or weight, often from even well-intentioned individuals, that contributed to the connection of appearance to either shame or approval,” explains eating disorder specialist Ginean Crawford.

“I often hear, ‘The first time I was noticed was when I lost weight. It was the first time I felt seen and then it spiraled from there.’”

Anti-diet dietitian Shana Spence says there are stigmas and values in the Black community that conflict with mainstream culture.

“A large part of the community views eating disorders as a ‘white person problem’. ‘We like to eat’, ‘we like women curvy,’ or ‘we have so many other issues to deal with.’ These are all sayings that I have heard from the community. Even if they are restricting their food or showing signs of being food obsessed, they would not necessarily think to seek treatment because they don’t fit the bill of a typical ED patient.”

And this is evident in Spence’s own practice; she has never treated a Black woman for a diagnosed eating disorder.

And battling food issues in a culture that wraps love around cookouts and Sunday dinners at Grandma’s is tough. Psychologist Nekeshia Hammond says our history of food insecurity — dating back to slavery — can lead to unhealthy patterns and Binge Eating Disorder.

“The societal stress for many Black people — racism, poverty, discrimination — may lead to eating for stress reduction. Also, the history of food culture stems from times when slaves were given less healthy foods to consume, which were higher in fats and sugar and lacked nutrients. Those food customs have continued to this day. In some parts of the Black community, there is also food insecurity, where there is less access to fresh fruits and vegetables and healthy foods in general, which may also lead to more cravings for sugar, carbohydrates, and higher calorie food items.”

Spence explains that food insecurity can also lead to bingeing. “In certain neighborhoods, there are a ton of fast food joints and bodegas, but not enough supermarkets or places to purchase produce. Aside from influencing eating habits, it can make someone food obsessed. This is especially stressful for someone already battling with an ED and reducing their intake as a whole.”

And the stigma surrounding mental health treatment prevents Black people from seeking help even if they’re able to acknowledge it. In a paper written by Dr. Carolyn Coker Ross, she writes:

“Women who embraced this Strong Black Women archetype said they maintained a strong sense of self in spite of the issues they faced…they did not know how to accept help or they felt their vulnerability or dependence on others might lead to getting hurt. Another key characteristic of the SBW is the role of nurturer. Women who take on this role not only feel responsible for the family, but for the black community at large…Black women also reported feeling a responsibility to meet everyone else’s needs before their own, and often took on multiple roles and responsibilities and had difficulty saying no even if they knew that they were overcommitting.”

Hammond’s own studies reflect this. She tells me that “stereotypes like ‘Black people don’t have eating disorders’ or ‘Black people don’t go to therapy’ prevent Black people from seeking treatment. There is also a fear that the provider may not be able to understand the plight of Black people and may not be culturally competent, as well as barriers due to disparities in education, SES, and the healthcare system. Thankfully there are more resources now with competent mental health providers.”

I had always been aware of the benefits of therapy. My mom had me see a therapist as a teen, and I’d attended a family therapy session with my father, his wife, and my siblings. However, when I was 19, I wasn’t initially set on finding someone who looked like me who treated eating disorders, especially considering that eating disorder specialists were already rare in my area.

But when I relapsed after years of recovery, despite my comfort with my therapists, I had trouble admitting that I had anorexia, or being honest about my symptoms.

How could someone curvy like me sit in front of a thin white woman and declare that I don’t eat? How could she take me seriously?

And that is what happened when I sought help from an advanced program.. This happened to me twice and could have cost me my life, as it does for many others. It’s the mental illness with the highest mortality rate; Every 62 minutes at least one person dies as a direct result from an eating disorder.

I was once told I weighed too much to be considered anorexic, and the second time, I was essentially told I wasn’t sick enough. That could have also been because the diagnostic criteria, years, included a certain BMI.

Spence says that anorexia diagnosis is about “optics,” and many clinics have BMI requirements for treatment. She believes that the BMI model is deeply problematic.

“The BMI calculation was based on a population of White men who were considered ‘ideal’ in size, and it was formulated by a mathematician, not even a physician. Wanting to be small and trim was always based on the fragility of white women. Not all white women look the same, but the thin ideal is based off of a racist ideal. Most physicians unfortunately will use this as an argument to someone being unhealthy. Even when the rest of the lab work is fine and the person feels great. Someone is stigmatized based off of BMI.”

Despite my dramatic weight loss in a short amount of time, my BMI was higher than white or Asian women with my disorder. Could I not have been seeing other Black people because of the stigma around mental health in the Black community, or could it have been that our BMI’s are often higher?

And when I was denied for inpatient treatment, my therapist recommended I go on medication — hearing that I wasn’t sick enough would push me to get there. Crawford, says this too is common behavior.

“Often people who struggle with eating disorders find themselves being ‘told’ by their almost personified struggle that they need to be in competition with themselves and with the eating disorder in others. It is a cage that leaves the sufferer trapped in shame and not feeling good enough at even being sick.”

But the doctor I sought for a prescription didn’t take me seriously either. Prior to my appointment, I had previously researched a few options. I was drawn to one — well, at least my eating disorder was drawn to — one that would kill my appetite, of course. I saw some reviews that mentioned weight loss, and I took note of medications that cause weight gain.

When I went to see this new doctor, a fit white woman who gave off Greta Gerwig vibes, I found myself embattled in an inner dialogue between the healthy side of myself and the disordered part. But when describing my symptoms, the healthy voice stepped forward and admitted to having an eating disorder.

Despite that, the doctor told me that she prescribed one of two drugs for women in my age group, since they were either weight neutral or led to weight loss. She prescribed me the one known for weight loss.

Without probing into what I meant by an eating disorder or what disordered behaviors I exhibited, I was put on medication that would exacerbate my symptom use, and give me the energy to push through my destructiveness.

Once my health started to decline, I reconnected with my Black primary care doctor, who I previously stopped seeing because of insurance. She took me off of my legal speed. I took comfort in knowing that my Black doctor saw me, and while she was inexperienced with eating disorders, she knew how to counteract the eroding effects of my starvation.

While I am recovered now, my already arduous path could’ve been a lot different. I could’ve started bingeing after an extensive time of restriction, or I could’ve began using drugs or sex as a means to cope. I’ve developed a healthy passion for movement that requires proper fueling to keep me going. My weight always stayed just at or right above normal for my height, so I haven’t felt overly inferior sitting across from a thin white therapist.

I am glad that the DSM-V has taken out the weight requirement for anorexia diagnosis. Hopefully it’ll save women of color, and larger women, from striving to be sick enough.

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