When we think about eating disorders, what comes to mind most often are underweight white females. But this stereotype is causing a great number of males and people of color to miss out on getting proper health care, say researchers at the University of Michigan.
In a survey of college-age students, Kendrin Sonneville and Sarah Lipson of the U-M School of Public Health found great disparities in who was getting both diagnosis and treatment for eating disorders, including anorexia nervosa, bulimia, binge eating disorder and overconsumption.
"While many people assume that eating disorders affect 'skinny, white, affluent girls,' we found that among college students with eating disorders, just 2 percent were underweight, most were not affluent, and a sizeable portion were male and nonwhite," said Sonneville, assistant professor of nutritional sciences.
"We also found that stereotypes about who develops eating disorders could contribute to disparities in diagnosis and treatment, with males, those of higher weight, people of color, and the nonaffluent most likely to be slipping through the cracks."
In their analysis of more than 1,700 young people from 12 colleges and universities across the country that participated in the Healthy Bodies Study, the researchers found that females were almost five times more likely to get diagnosed than males; white students were nearly two times more likely to get diagnosed than students of color; and underweight students were more than six times more likely to get diagnosed than those students with a health body weight. Students with overweight/obesity were about half as likely to get diagnosed.
When it came to treatment, females were almost 1.5 times more likely to get help compared with males, and affluent students were nearly two times more likely to get treatment compared to nonaffluent. Underweight students were almost six times more likely to get treatment compared to students with a healthy body weight.
Estimates are that nearly 5 percent of the population in the United States has an eating disorder at some point in their lives, yet only one third of individuals receive treatment.
Among the college students in the current study with an eating disorder, nearly 31 percent perceived a need for treatment, 10.5 percent had received a diagnosis and nearly 14 percent had received treatment in the past year.
"Most people with an eating disorder never get diagnosed and never get treatment, even though successful treatments that can reduce suffering, health consequences and cost are available," Sonneville said. "Most media coverage about eating disorders has focused on cases of anorexia among thin, white female celebrities. Many individuals with eating disorders do not recognize themselves in these stereotyped portrayals of eating disorders in the media and may not recognize the need for treatment."
In fact, the team found that anorexia was much more likely to get diagnosed (73 percent) compared to individuals with binge eating disorder (7 percent). This disparity could perpetuate stereotypes because anorexia will be the most common diagnosis encountered, even though it is the least common eating disorder.
Sonneville said universal screening and prevention, led by clinicians, could help reduce these disparities.
"In general, more attention needs to be paid to the prevention of eating disorders at the population level," Sonneville said. "Smaller-scale efforts that focus only on those at highest risk (for example, women) may be effective. They may also disadvantaged people who already feel excluded from the prevailing discourse about eating disorders and marginalized within treatment settings."
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K. R. Sonneville et al. Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students, International Journal of Eating Disorders (2018). DOI: 10.1002/eat.22846