Eating disorders have long been stereotyped as only affecting white/Caucasian female teenagers. However, recently there have been many studies that have revealed the prevalence of eating disorders among ethnic minorities in Western countries (1). Eating disorders affect folks of all different races.
Risk Factors for Eating Disorders
Eating disorders are mental illnesses that can affect individuals of any gender, age, racial and ethnic identity, sexual orientation, or socioeconomic background (2).
Some of the main risk factors for developing an eating disorder are (3):
- Biological: Having a close relative with an eating disorder/mental health condition
- Psychological: Anxiety, body image issues, perfectionism
- Experiences of weight stigma, acculturation, limited social networks, and trauma (3)
It is important to note that eating disorders are more complex than the desire to be thin, and they are often a coping mechanism, though maladaptive, for difficult life events.
Canada as a Multicultural Country
Approximately 1 million Canadians (around 2.7%) meet the criteria for an eating disorder diagnosis (2). Early detection and intervention are key predictors of eating disorder recovery. The longer someone lives with an eating disorder, the harder it is for them to recover. Many Canadians suffering from eating disorders do not have access to the specialized care they need (2), and as a result, they may live undiagnosed and untreated. Therefore, the number of Canadians living with eating disorders may actually be higher.
The multiculturality and ethnic diversity in Canada, as well as the increase in immigration and refugee programs, means that the number of Canadians living with an eating disorder likely includes people from various and diverse ethnic backgrounds.
According to the 2021 Canadian census (4), over 450 ethnic/cultural origins were self-reported by Canadians, with about 11.2 million (31.3%) people belonging to an ethnic minority group:
The main cultural groups in Canada are First Nations/Indigenous (6.1%), South and Southeast Asians (8.2%), East Asians (5.6%), West Asians and Arabs (2.9%), Black Canadians (4.3%), Filipinos (2.6%) and Latinos (1.6%) (4).
As a result, it is possible that eating disorders are prevalent among Canadians from diverse ethnocultural backgrounds.
Immigration to Canada
Many ethnic minorities that make up the Canadian population are descendants of immigrants or are immigrants themselves. Immigration is a process where individuals move from one cultural setting to another to settle down either permanently or for long periods of time. Therefore, this definition includes permanent immigrants, international students, and refugees.
People who migrate to a new country often experience loss, stress, and trauma after leaving their native country (5). Language barriers and unfamiliarity with cultural norms may contribute to isolation. Folks may have negative thoughts due to isolation and stress, including stress related to racial stereotyping, weight stigma, and discrimination (6). This, coupled with the pressures of acculturation and the thin ideal in western countries, may lead women from different ethnic groups to engage in disordered eating behaviours. These disordered eating behaviours may be used as maladaptive coping mechanisms to achieve Western beauty ideals (5).
Barriers to Eating Disorder Treatment
Ethnically diverse individuals face additional barriers to accessing eating disorder care that is culturally appropriate (7). In a series of semi-structured interviews conducted among eating disorder patients from diverse ethnic groups, the main barriers to treatment were mental health stigma and shame related to talking about food and weight from the affected individual’s family or social support systems (7). The stigma surrounding mental health treatment and stereotypes about eating disorders not being serious mental illnesses, or being a private issue that individuals shouldn’t disclose, were present among Latino and Asian participants (7). Weight being a “touchy” subject was a recurrent topic among African American participants (7).
Some of these patients also identified difficulty seeking help due to barriers (perceived or real) related to racial stereotyping in the healthcare system (7). As one participant noted, her psychologist didn’t believe she had an eating disorder because she “didn’t fit the stereotype” since she was African-American (7). Harmful stereotypes like this one could be very dangerous to individuals suffering from an eating disorder. Thus, providing flexible and inclusive care is essential to treat eating disorders among patients from diverse ethnic backgrounds.
Eating Disorder Treatment Recommendations
A systematic review conducted in 2021 by Ashley Acle and colleagues (8), identified some core recommendations to address cultural differences in eating disorder treatment. Among these recommendations were:
- Providing individualized, flexible care (client-centered approach coordinating with community leaders or alternative medicine).
- Understanding patients within their cultural context by asking them about their worldview, the reasons behind their behaviours, and their cultural norms.
- Understanding the nuance behind the clinical presentations of eating disorders in different ethnic groups (varying levels of symptoms and weight/body image concerns).
- Applying critical thinking when using diagnostic criteria that focuses on specific weight criterion and specific symptoms and/or frequency, and providing affirming care and support to all who struggle with their relationship with food.
- Educating ourselves by acknowledging diversity between and within groups, developing awareness of the values and beliefs within cultures, and not perpetuating harmful stereotypes.
- Exploring family/social supports, including family dynamics and cultural expectations.
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