Evidence is building that eating disorders, long thought to be mostly a problem for white females, are increasingly crossing cultural lines.
"Blacks and Hispanics all use food as a go-to when there is increased anxiety, but there has never been a label for it. They get treated for diabetes, high blood pressure, high cholesterol. But doctors are not getting to the culprit; it is a mental issue," says Nettie Reeves-Lewis of Charlotte, N.C., who in 2013 completed intensive outpatient treatment for an eating disorder she couldn't believe she had.
"Black women don't get eating disorders," she recalls thinking. "But, my life began swirling out of control. I ate. My body changed. I ate more. I feared losing my business as a fitness instructor if I didn't maintain a muscular physique, so I ate more. I knew something was wrong."
Charlynn Small, of the University of Richmond's Counseling and Psychology Services, has different concerns. As the mother of a black son, she struggles with the desire "to eat a Big Mac, ice cream, and a whole pie" to take her mind off her worries when her teenager is out after dark.
Small and Duke University staff counselor Mazella Fuller are both black therapists at predominantly white, universities. They have been studying the effects of oppression and marginalization of populations and found eating disorders top the list.
Statistics on the prevalence of eating disorders among women of color are hard to come by, because there has been so little research on minorities, Fuller said.
According to the National Eating Disorder Association (NEDA), binge eating is the most common eating disorder in the United States affecting 3.5% of women, 2% of men, and up to 1.6% of adolescents. In 2013, BED was included in a revision of the American Psychiatric Association Diagnostic and Statistical Manual for the first time as a diagnosable eating disorder.
Most people with binge-eating disorder are overweight or obese. But they may be at a normal weight. Behavioral and emotional signs and symptoms include:
But women of color may face unique challenges. Small says the larger body type of many black women, for example, is embraced by the African American culture. However, on many college campuses and in the work place after graduation, women may get the message that their "large, voluptuous figures are unattractive." They experience identity conflicts.
Mexican-American women, those born in the U.S. to Mexican-born parents, face similar conflicts, according to Fuller.
The bias -- intended or not -- that many women of color encounter in daily life also has been shown to have negative health effects. Small and her husband once went into a shop to buy wine, and the sales clerk asked if they were interested in tasting the watermelon vodka. They chose to laugh about it, but she remembers the episode still.
Experts hope that as awareness of the problem grows, physicians and therapists will do more to help people of different races, religions and genders understand how the cultural pressures they feel may affect their health.
Since treatment for her eating disorder, Reeves-Lewis says she is not thinner on the outside, but emotionally, she is definitely feeling lighter: "There is no more swirling!"
Diane Girardot is a psychotherapist in Chadds Ford and Philadelphia.