diversity culture (1)

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Running head: EATING DISORDER AND DIVERSITY Eating Disorder and Diversity Name Institution Affiliation

EATING DISORDER AND DIVERSITY 2 Eating Disorder and Diversity Eating disorders affect individuals of all races and ethnic backgrounds, body types, sexual orientations, and gender identities. It does not discriminate against any person. With the existing widespread effects of eating disorders representation, individuals ought to take a close look at diversity's absence in eating disorder spaces and strive to alter the face of eating disorders. There have been several stereotypes that eating disorders only affect a particular type of individual. These cultural and societal influences are a big misconception about eating disorders. People need to understand the diversity in the realm of eating disorders (Rodgers et al., 2019). There has been an increasing number of disordered eating among the ethnic and racial minorities in America for the past few years. Contrary to the belief that eating disorders occurred in young white women. Dieting is associated with perceived overweight, dissatisfaction with weight, and lack or low body pride among the ethnic groups. There has been a rise in reports about eating disorders among women of color. However, the rise of these cases may be resulting from the reporting of eating disorder problems as opposed to the actual increase of the disorder. Various reasons may be affecting the degree of reporting among minority women. These factors include; misdiagnosis or under- diagnosis on the treatment provider, underreporting of these disorders by the people, and the Diagnostic cultural bias and Statistical Manual-IV for eating disorders. Sociocultural factors may also be a contributing factor to the disorder. Compelling media images may give a particular defined conception of beauty. They may not go well with some women. With this ideal conception of beauty, some women, mostly of color, may suffer the effects of low self-esteem, eating disorders, and poor body image (Rodgers et al., 2019). African-American and Native- American women who embraced the white American culture indicated more symptoms of

EATING DISORDER AND DIVERSITY 3 bulimia and anorexia compared to those who were less accepted to be acculturated. Prevalence of binge eating disorder (BED) is high in Latina/Hispanic women, while that of (BN) bulimia nervosa and (AN) anorexia nervosa is low. African Americans indicate few eating disturbances and are more contented with their appearance compared to white women. It is challenging to diagnose African Americans of both genders with anorexia nervosa than the whites. However, they may exhibit the condition for a prolonged period. There have been lower rates of treatment for people with eating disorders among significant diverse populations. This may be attributed to numerous factors, which include; the difference in clinical presentations that cannot be captured by the use of traditional instruments developed primarily for the whites, variations in treatment rates may occur due to differences in help-seeking patterns, and both the clinical officer and the individual may not recognize the eating disorder. For instance, the clinician and the individual may believe that ethnic minorities do not undergo eating disorders. Thus, there may be bias or clinician error in referring and diagnosing eating disorders, leading to a lower disease treatment rate. Clinicians are most likely to insinuate that there is no need for an individual with AN to seek help when portrayed as African American than when portrayed as a white or Latina. Currently, with the awareness created, clinicians attend to all eating disorder patients regardless of race. There is a need to create awareness of the stereotypes associated with eating disorders to peers because peers are necessary for referral and recognition. Many people with these disorders do not initiate treatment. Prolonged illness leads to poor outcomes for BN and AN, and delay in detecting it can result in longer illness duration. Eating Disorder and Black Indigenous Person of Color (BIPOC) Populations

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EATING DISORDER AND DIVERSITY 4 Despite the misconception that eating disorder affects individuals from all ethnicities and demographics at similar rates, individuals identifying as Black, Indigenous, or Person of Color (BIPOC) have been getting treatment at a low rate. Doctors are less likely to ask those who identify as BIPOC about their eating disorder symptoms than the whites. They are also to be less likely to be diagnosed with an eating disorder or receiving treatment. This makes access to treatment difficult, as well as for deciding to get treatment uncomfortable. Although the symptoms are the same, BIPOC people are underrepresented in treating eating disorders that may incorrectly insinuate the population does not require treatment. Routine care, lack of access to the care, and the existing stereotypes about eating disorders significantly contribute to the gap in receiving the care (Mikhail et al., 2020). There is a need for clinicians to communicate to the public concerning eating disorders. This will help society, parents, friends, and families easily detect the symptoms. Family members and BIPOC caregivers struggle to access support in their society for eating disorders. When society is knowledgeable, it will, in turn, give help to these families. BIPOC people often differ in presentation and symptoms. The most common eating disorder is BED (Binge Eating Disorder), with Bulimia Nervosa being second across the BIPOC groups. They can be with Anorexia Nervosa but is less common. Asian American women, Hispanic/Latina, and Black African Americans incur higher vomiting rates than non-Hispanic white women with, Asian American women reporting higher laxative misuse than all groups. Asian American women, Hispanic/Latina, and Black African Americans report less compulsive excessive exercising than non-Hispanic white women. People with African or Black American identities often report weight concerns and not body shape concerns. Likewise, they report less ambition for thinness. Hispanic/Latina women often report the ambition for a curvy body shape but slender and not ultra-thin ideal. Asian American women

EATING DISORDER AND DIVERSITY 5 present high-level social appearance anxiety that influences their eating disorder symptoms. These differences in symptoms between the groups are significant because BIPOC people present differently, and treatments might also work differently. An understanding of how the symptoms vary will aid in improving assessment and capture variations better across individuals. The majority of individuals with eating disorders are living in denial. Eating disorders are trauma-based among black women, resulting from discrimination, marginalization, and racism. There is a need for the treatment of this trauma to resolve eating disorders. Additionally, black women are less screened for eating disorders. They are often dismissed and instructed to lose weight instead of being accessed for concerns such as binge eating disorder (BED) or bulimia by medical doctors (Mikhail et al., 2020). Many specialists for an eating disorder are self-pay only, and most BIPOC individuals are underinsured or uninsured. This makes access to these services difficult, posing a challenge to Women of Color. Besides the economic barriers, women of color often have limited supports that are competent culturally. Some therapists are WOC, with most specialists for the eating disorder being white. This may make some people feel uncomfortable. It would have been beneficial if Women of Color had more therapists sharing such ethnic factors. To improve BIPOC access to eating disorder treatment and recovery, education and efforts to prevent WOC's aim should be prioritized. It is necessary to create awareness among all black women to be aware that they are not alone. Schools, nurses, educating counselors, and coaches should be familiar with eating disorders among black teens. All people should strive to access help when diagnosed as eating disorders are harmful to the mind and body. Eating Disorder and LGBT Populations

EATING DISORDER AND DIVERSITY 6 Lesbians, gays, bisexuals, and transgender people experience various challenges that lead to eating disorders. Some of the factors that can significantly lead to eating disorders include; receiving damaging information about gender identity, violence, bullying, failure to meet the ideal body image, failure to be accepted by peers and family, and the fear and anxiety about coming out gay. This results in a psychological toll among them. Body dissatisfaction and gender dysphoria in the population of transgender are the main contributors to eating disorders. They may restrict their eating habits to appear thin, a popular stereotype among the populations' culture. LGBT adolescents and adults are most likely to experience mental illness resulting from stress brought by prejudice and stigma (Contributer, 2021). They are also most likely to have disordered eating behaviors and eating disorders. Disordered eating behaviors and eating disorders affect people with different identities. However, there are disparities in some marginalized groups like sexual and gender minorities. The MSM (minority stress model) is commonly used to elaborate on mental health disparities in gender and sexual minority groups. MSM suggests that people from the LGBT community experience particular distal stressors like discrimination, stigma, and proximal stressors like transphobia or internalized homophobia and concealment of gender and sexual identity, leading to higher risks of physical and mental health issues. Sexual minority youths have increased sexual minority-specific victimization, suicidality, and depressive symptoms than their heterosexual peers. People from sexual and gender minority groups report symptoms of eating disorders and shame. Acceptance of one's sexual identity and discrimination enhances eating disorders in sexual minority women and men (Contributer, 2021). Also, minority stress is connected to bisexual women and lesbians' binge-eating and body dissatisfaction in male gays. Eating gender behaviors and eating disorders frequently occurs in LGBT people instead of their

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EATING DISORDER AND DIVERSITY 7 cisgender and femininity level. This behavior is higher than the cisgender and heterosexual male population but is not significantly different from cisgender and heterosexual females. Disordered eating behaviors such as dieting to reduce weight, fasting, and using diet pills among LGBT youths are high compared to heterosexual youths. This poses the risk of an eating disorder. The appearance ideal of young adults and adolescents is brought by social media, dating apps, LGBT- specific media, and family. Appearance ideals and LGBT stereotypes are intertwined with individuals expecting them to have a particular appearance based on the stereotype of their gender identity. For example, stereotypically, gay men have a muscular and lean body. Likewise, sexual orientation, gender identity, and ethnicity contribute to an individual's pressure to appear a certain way (Contributer, 2021). Some protective factors have been put in place to protect the LGBT population against disordered eating behaviors. They include; LGBT engaging in a stable relationship, social support, self-compassion, and masculinity regardless of biological sex. The LGBT population is at a higher risk for clinical disordered behaviors and eating disorders, with all minority groups being affected differently. Adults' lesbians' diets frequently and exercises more compared to other groups. There has been an increased incidence of disordered eating behaviors in adult and adolescent lesbians than heterosexual women and men. Adult and adolescent sexual minority women are more likely to be involved in restrictive dieting than heterosexual women. Incidents of women dieting to lose weight have been increasing for women with same-sex partners compared to those with opposite-sex partners. However, there is no significant difference between heterosexual women and lesbians regarding disordered eating behaviors and dieting. There are more similarities instead of differences between the two concerning disordered eating behavior. Compared to bisexual and heterosexual women, adult lesbians highly engage in physical activity and healthy

EATING DISORDER AND DIVERSITY 8 eating behaviors. Adult lesbians face lower self-esteem and higher feelings of ineffectiveness, have difficulties identifying emotions, and duffer interpersonal distrust compared to heterosexual women. Lesbians' self-esteem majorly depends on BMI and body-esteem. Thus, they are more vulnerable to the societal pressure of thin-ideal (Contributer, 2021). Most lesbians feel unprotected from societal pressures because of their association with the lesbian subculture. Adolescent and adult lesbians mostly report higher BMIs, which enhances their risk for disordered eating behaviors. The increased rates were due to education level, identifying self as a lesbian, age, depression, increased use of alcohol, and the idea of using eating as a coping mechanism to concur stress. There are distal risk factors associated with disordered eating behavior in adolescent and adult lesbians. Risk factors associated with sexual orientation in adult lesbians include; concealing sexual orientation, discrimination, internalized homophobia, lower sense of belonging to organizations, lesbian community, and stigma consciousness. Risk factors concerning relationship dynamics include; pressure to be thin from family, LGB friends, female partners, and less support from family, friends, isolation, and sexuality. Risk factors concerning mental health include; depression, anxiety, and eating as the negative regulation effect, while risk factors associated with gender attitudes include; low women endorsement movements, negative femininity, a realization of sexism, and not being identified as a feminist. Adolescent and adult gay males are more likely to encounter eating disorders or disordered eating behaviors than heterosexual males. They tend to diet and have less control over their eating behavior and are more involved in exercising. Adolescent and gay young adult males primarily engage in exercises to lose weight, restrict eating, fast, uses diet pills. Thus, they risk having eating disorders (Contributer, 2021). They are less likely to add weight, experience a

EATING DISORDER AND DIVERSITY 9 decrease in BMI, and are less involved in physical activity. Adolescent's sexual minority males are most likely to improve their disordered eating behaviors with time. Bisexual adults experience high purging, binge eating, and related disordered eating behaviors compared to their heterosexual counterparts. Bisexual men are at a higher risk for eating disorders as opposed to heterosexual men. Consequently, adolescents and adult bisexual females have high frequencies of diet pills, weight cycling, skipping meals, fasting, and smoking to reduce weight, body dissatisfaction, and overall eating disorders (Parker et al., 2020). They are also less involved in healthy eating behaviors and physical activity compared to heterosexual females. Bisexual females encounter an increased rate of eating pathology as opposed to gay and lesbian individuals. Adolescent bisexual males are likely to use diet pills, experience shape, weight concerns, fast, and involve themselves in poor physical activity patterns. Additionally, bisexual and majorly heterosexual men principally engaged in unhealthy weight control behaviors compared to heterosexual and gay men. Transgender adolescents and adults have higher fasting incidents, diet pills, dietary restraint, purging, bingeing, and overall disordered eating behavior compared to cisgender peers. Gender non-conforming and transgender adolescents are more likely to be bullied for their size and weight, and they are less physically active than transgender youth. Most transgender experience body dissatisfaction, leading to disordered eating behaviors and eating disorders (Contributer, 2021). Transgender women (the ones assigned male sex at birth but with female gender identity) may involve themselves in dietary restrictions to suppress features related to their birth sex. Alternatively, they may struggle to be thin to fit well with their desired gender. Transgender men appear to be at a higher risk for increased BMIs, which increases disordered eating behaviors.

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EATING DISORDER AND DIVERSITY 10 Eating Disorder and Body Type Primarily, eating disorders are perceived to occur in people who are extremely thin and underweight. However, eating disorders affects all types of bodies, and by looking at an individual, you cannot tell whether they have it. Individuals' weight cannot determine eating disorders. Thus, many individuals are hesitant in acknowledging that they are suffering from eating disorders since they are not underweight or thin and do not feel sick (Body Image & Eating Disorders, 2021). This false assumption prevents several individuals from seeking help and treatment. Individuals who experience advanced body dissatisfaction may suffer from isolation, depression, eating disorders, and low self-esteem. Body types start at a young age and may continue throughout the life of an individual. It affects all people regardless of gender and age. Girls in Western culture suffer from the societal pressure to appear thin as it is depicted as a beauty ideal whereas, boys suffer from societal pressure to be muscular and lean. There is a need to embrace body diversity by acknowledging all bodies as good (Carey et al., 2019). There is also a need to overpower negative thoughts days we feel our bodies are not appealing. Individuals should respect and recognize their natural shape. Men suffering from disordered eating behavior and eating disorders have been left out in treatment and diagnosis due to stigma. Based on NEDA (National Eating Disorder Association) reports, many men (around 10 million) are likely to suffer from eating disorders in the United States. Men sometimes face double stigma for having a disorder characterized as gay or feminine and trying to get psychological help (Eating Disorders in Men & Boys, 2012). The risk of mortality is higher in men suffering from eating disorders than females, so it is necessary for early intervention. Disordered eating behaviors such as laxative abuse, binge eating, purging, and fasting to lose weight are common in men as they appear in women. Nearly in three individuals

EATING DISORDER AND DIVERSITY 11 struggling with eating disorders, one is a male. Some factors contribute to boys and men being under or undiagnosed for these eating disorders. One of the significant factors is; cultural and societal bias, which lowers men's likeliness to seek treatment. Assessment tests are geared to girls and women, leading to misconceptions about men's disordered eating. There is a need for a gender-sensitive approach to recognize various dynamics and needs for males in the treatment (MacNeil et al., 2019). Boys and men can feel uncomfortable while receiving treatment surrounded by men. There should be all-male treatment centers if possible. This will encourage more men to seek treatment. Conclusion All individuals must understand that eating disorders affect all people regardless of race, appearance, gender, and identity. Therefore, it is a collective responsibility of all individuals to strive to stop inaccurate stereotypes and stigmas existing for a long time. Increased awareness about the diversity of impacted individuals by eating disorders will help encourage those struggling to get the help they deserve. Researchers and treatment organizations are adopting to increase inclusivity in the care of eating disorders. Developments are being made regarding how treatment can be welcoming and affirming to all individuals without exception. Most treatment centers have utilized individualized treatment plans for eating disorders to cater to their patients' diverse nature. Improvements are also being made in recovery by ensuring the needs of every individual. Recovery can be attained on all individuals regardless of their background or identity.

EATING DISORDER AND DIVERSITY 12 References Body Image & Eating Disorders. (2021). Retrieved 5 April 2021, from https://www.nationaleatingdisorders.org/body-image-eating-disorders Carey, M., & Preston, C. (2019). Investigating the components of body image disturbance within eating disorders. Frontiers in psychiatry , 10 , 635. Contributer, D. (2021). Eating Disorders in the LGBTQ Community - Center For Discovery. Retrieved 5 April 2021, from https://centerfordiscovery.com/blog/eating-disorder- discrimination-lgbt-community/ Eating Disorders in Men & Boys. (2021). Retrieved 5 April 2021, from https://www.nationaleatingdisorders.org/learn/general-information/research-on-males MacNeil, B. A., Hudson, C. C., & Leung, P. (2018). It's raining men: descriptive results for engaging men with eating disorders in a specialized male assessment and treatment track (MATT). Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity , 23 (6), 817-824. Mikhail, M. E., & Klump, K. L. (2020). A virtual issue highlighting eating disorders in people of black/African and Indigenous heritage. Parker, L. L., & Harriger, J. A. (2020). Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature. Journal of Eating Disorders , 8 (1), 1-20. Rodgers, R. F., Donovan, E., Cousineau, T. M., McGowan, K., Yates, K., Cook, E., ... & Franko, D. L. (2019). Ethnic and racial diversity in eating disorder prevention trials. Eating disorders , 27 (2), 168-182.

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