Rage of the Random Actor Live Addendum
Chapter 11  
The Bunker Syndrome and the African American and Female Factors

DK (10-4-05): Blacks Join the Eating-Disorder Mainstream  My African American colleagues have noted that as their families have become more affluent, they are experiencing new at-risk behaviors. This may be one of them.


Blacks Join the Eating-Disorder Mainstream
September 20, 2005 - New York Times - Denise Brodey

As a teenager, Nickona Knuckles regularly binged on food and then vomited to keep her weight down.

Ms. Knuckles, who is African-American, recalled that at the time she had no idea of the devastating health effects of bulimia, nor did she care. She was one of nine black students in a high school of 3,000 and was struggling simply to be accepted.

"When it came to body image, my perception of beauty was based on my white peers and images of white celebrities in the media," Ms. Knuckles, now 34, said in an interview at her home in Phoenix. "I didn't want to be white but it was very difficult to be comfortable with who I was."

Her parents, concerned about her eating problem, took her to an outpatient treatment program in Mesa, Ariz.

But, Ms. Knuckles said, the program did not help her.

"The place was filled with white people and, to be honest, there was nobody who looked like me or could relate to me," she said. Eating disorders like bulimia and anorexia conjure images of affluent white teenage girls. And most studies of these disorders have focused on white patients.

In recent years, however, more blacks and other minorities have been seeking help from eating disorder clinics.

"We're noticing a trend of more severe eating disorders among African-American girls," said Dr. Gayle Brooks, an African-American psychologist and vice president of clinical services at the Renfrew Center in Coconut Creek, Fla., an eating disorders treatment center.

Dr. Brooks said experts traditionally had thought that "anorexia and bulimia didn't happen to black, Asian or Hispanic women, that they were somehow immune."

In fact, she said, African-American women had in the past been less likely than white women to feel the same pressures to be thin.

"Curvy African-American women were celebrated," Dr. Brooks said. "These girls didn't experience anxiety and shame about their bodies. Being curvy or large was a source of pride within the African-American community."

Up to 4.2 percent of American women at some point in their lives suffer from bulimia, according to the National Institute of Mental Health. The disorder is characterized by binge eating and purging by vomiting, excessive exercise or laxative abuse. Anorexia nervosa, in which people starve themselves to extremely low weight, afflicts up to 3.7 percent of American women over their lifetimes.

No reliable numbers exist for how many minority women suffer from eating problems, but experts suspect that cases are increasing.

In a 2003 study, for example, published in The American Journal of Psychiatry, Dr. Ruth Striegel-Moore, professor and chairwoman of psychology at Wesleyan University, found that young black women were as likely as white women to report binge eating. In an earlier study, published in 2000 in Archives of Family Medicine, she found that black women were as likely as white women to report binge eating or vomiting and were more likely to report fasting and the abuse of laxatives or diuretics than their white peers.

One reason experts do not know how many minorities suffer from the disorders, Dr. Striegel-Moore said, is that minority women are less likely to seek treatment.

In her research, she found that of the 76 women who ever had an eating disorder, 16, or 28 percent, of the white women and 1, or 5 percent, of the black women reported having received treatment for an eating disorder.

"Minority women are not getting treated," Dr. Striegel-Moore said. "It's very clear from my studies that black American women do experience eating disorders, but doctors and therapists still operate under the assumption that they don't; therefore they aren't prepared to deal with them clinically."

News coverage of eating disorders is almost always focused on white patients, she said. Doctors may not be alert for the symptoms of eating disorders in minority women, and therefore may not ask the right questions or refer them for specialized treatment.

A Florida State University study lends support to this observation. The researchers showed fictional diaries of a 16-year-old girl to 150 people. When the diarist was identified as white, most people said the subject, called Mary, had an eating disorder. When she was identified as black, far fewer people identified her as having an eating disorder.

Minority women face other barriers to getting care, as well, Dr. Striegel-Moore said, including "lack of resources and insurance and not knowing who to contact."

Compounding the problem said Dr. Kevin Thompson, a professor of psychology at the University of South Florida, is that body dissatisfaction among African-American, Hispanic and Asian-American women "is catching up rapidly to that of white women."

In some cases, minority women believe that being thin will help them fit into mainstream white culture. "In the past 10 years, there has been a tremendous cultural shift: The image of the ideal body image is narrower," said Dr. Ira Sacker, an expert in eating disorders and founder of the Helping End Eating Disorders Foundation in New York. "Black women, Latina women, they all feel the need to be thin to fit in."

But Dr. Sacker said he now saw more minority women in his practice.

Dr. Stefanie Gilbert, assistant professor of psychology at Howard University in Washington, said black women pictured in magazines often had body types similar to those of white models.

"These types also seem to be the ones who get the top jobs," Dr. Gilbert said.

Paradoxically, said Dr. Striegel-Moore, the increased pressure on minority women to be thin has stemmed in part from companies' efforts to increase diversity in their advertising, with images of thin, beautiful Asian-, Hispanic- and African-Americans joining those of whites.

But media images are not the only factors in the development of eating disorders. Studies show that being overstressed and overweight also puts women at risk, Dr. Striegel-Moore said. Eating disorders often begin in the early teenage years and carry into the 20's, although researchers have recently begun to document cases of middle-aged women developing the disorders.

Gradually, experts say, medical organizations and treatment programs are becoming more aware of eating disorders among minorities. The Renfrew Center, for example, has held lunches and special informational workshops for minority therapists.

Dr. Elena Rios, president and chief executive officer of the National Hispanic Medical Association, said, "Nutrition is on our radar, obesity is on our radar and now eating disorders are, too."

But experts say that African-American psychotherapists and other doctors who treat minorities need to be educated about the problem and they, in turn, need to reach out to their communities, Dr. Brooks said.

"An eating disorder is an illness," Dr. Brooks said. "There are treatments for it, but unless the medical community is trained to identify the illness in women of color, a lot of women suffering will not get treatment."

Ms. Knuckles, who began bingeing and purging when she was 12, might have benefited from such awareness and received effective treatment earlier.

"If I had been helped sooner I would have done a lot less damage to my body," she said.