Exploring the Link Between Racism, Diet Culture & Health Care

Author: Emma Leister, RD

Diet culture is infuriating for many reasons. It deprives us of nourishment, teaches us that our bodies are not to be trusted, makes money off of our insecurities, and promotes the harmful practice of under-eating and over-exercising.

When we solely focus on diet culture’s impact on an individual’s relationship with food and their body, we miss a fundamental piece of the story: the racist roots of diet culture. This month, we are going to dive deeper into how diet culture stems from racism and how racism impacts health care, and, more specifically, eating disorder treatment. Just like we all carry anti-fat bias within us, we also all carry racism that must be recognized, confronted, and unlearned. Please join us in unlearning together as an eating disorder community. This is an expansive topic that cannot fully be addressed in a single post, but if you are new to the topic, we hope this gets you started on a more thorough learning experience!

Disclaimer: Beyond’s clinicians are not Black, and this newsletter is written through the lens of a white woman who carries biases and has deficiencies in her understanding that a person with lived experience would not. Please consider supporting the work of Black people who understand this concept through their own experiences, listed throughout.

1. Anti-Fat Bias is Racist

This concept dates back to the transatlantic slave trade, where Europeans used body size as a way to differentiate from Africans. They used their body sizes as evidence that they have “self-control” and are more “rational,” and, therefore, they were the premiere race of the world. Thinness became a way for Europeans to differentiate themselves from Africans. It was also later used as a way to separate European colonizers from indigenous people.

As much as we can talk about that as a concept far in our past, this concept is still very much present today. Think about today’s “clean eating” movement. Who do you picture when you think about “clean eaters” and “whole, natural foods”? Who do you picture when you think about “non-clean” eaters? (We know that “clean eating” is a made-up, nonsense term, but for the purpose of this exercise, we hope that you recognize that diet culture upholds this idea of superiority around certain food and bodies.)

For more information, check out the work of Dr. Sabrina Strings, author of Fearing the Black Body and Da’Shaun Harrison, the author of Belly of the Beast: The Politics of Anti Fatness as Anti Blackness

2. The BMI is Racist

The BMI was created by a mathematician in the 1800s who compared a population of European men to determine the qualities of the “fittest man.” It was later adopted by health care providers to put individuals into categories to determine their health status. Not only was this problematic equation used to study populations (not individuals), but it was never even tested for implementation on people who were not white, European men. The BMI is not only “inaccurate” in terms of telling us how a person’s health is, but the use of the BMI in health care also serves as a tool for health care providers to stigmatize and pathologize a person’s body.

https://elemental.medium.com/the-bizarre-and-racist-history-of-the-bmi-7d8dc2aa33bb

3. Eating Disorder Treatment and Racism

Picture a person with an eating disorder in your mind. What is the person’s body size? What is their skin color?

If you pictured a thin, white woman, you are unfortunately not alone. Research suggests that BIPOC patients are 50% less likely to be diagnosed or treated for an eating disorder. BIPOC children and teens are less than two-thirds as likely to receive ED treatment compared to white children. This has life threatening impacts on BIPOC individuals with eating disorders.

Sonneville, KR, Lipson, SK. (2018). Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. Int J Eat Disord, 51, 518– 526. https://doi.org/10.1002/eat.22846
Moreno, R., Buckelew, S. M., Accurso, E. C., & Raymond-Flesch, M. (2023). Disparities in access to eating disorders treatment for publicly-insured youth and youth of color: A retrospective cohort study. Journal of Eating Disorders, 11(1). https://doi.org/10.1186/s40337-022-00730-7

Want to be part of the solution? Follow the work of Whitney Trotter https://www.instagram.com/whitneytrotter.rd/?hl=en and Rooted Nutrition Services https://www.instagram.com/rootednutritionservices/?hl=en, the co-creators of the BIPOC ED Conference.

4. Mental Health and Racism

We can’t talk about mental health struggles without considering the impact of systemic racism and everything that stems from racism. Poverty, food insecurity, unemployment, low wages, lack of generational wealth, lack of access to housing, lack of safety simply walking down the street, high rates of incarceration and the resulting separation of families. Mental health care is also inaccessible, with mostly white providers who hold a lot of power in the therapy room who have not done their own anti-racism work and who often cause harm. Many of our clients have experienced racism in eating disorder treatment centers and other mental health care settings, which has been deeply traumatic, worsening their mental health.

Check out some eating disorder-specific resources for various marginalized groups here: https://fedupcollective.org/resources

I also recommend the work of Jennie Wang-Hall. She provides education around the overlap between carceral systems and mental health treatment from an abolitionist lens.

5. Physical Health and Racism

Diet culture, wellness culture, and public health professionals love to blame individuals for what they eat as the cause of health problems. We hear the term “diet-related diseases” all the time, assuming that our food choices are causing us to develop diabetes, heart disease, and fatness. Not only is this a false assumption, but it is also missing a huge part of “health” – social determinants of health. These include a person’s environment, income level, access to food and health care, to name a few.

Another factor to consider around a person’s physical health is “allostatic load,” which measures the damage on the body from chronic stress. This impacts the immune, endocrine, and circulatory systems. If a person experiences racism, this in itself can put them at risk for heart disease and diabetes. So let’s stop policing people’s eating and instead put our efforts towards understanding and disrupting systemic racism.

Miller HN, LaFave S, Marineau L, Stephens J, Thorpe RJ Jr. The impact of discrimination on allostatic load in adults: An integrative review of literature. J Psychosom Res. 2021 Jul;146:110434. doi: 10.1016/j.jpsychores.2021.

We hope this intro to racism and diet culture/ED treatment sparks further learning around this topic. Please consider supporting the work of the Black educators and ED providers tagged throughout this post. We are looking forward to continuing this conversation throughout the year!