Eating disorders

Unpacking Eating Disorders among Montreal’s Black Community

Desirée Zagbai

Eating disorders within the Black community in Canada have been bubbling under for decades. Spoken about in hushed tones, it has been found that factors such as trauma, mistrust in health care, and stereotypes have contributed to the ongoing cycle.

According to the National Eating Disorder Information Centre (NEDIC), the lack of representation and research has left many Black people uncertain about how to get help or unsafe on how to acknowledge their eating difficulties.

Montrealer, Catherine Ndiaye, 21, a law student at McGill University, battled with anorexia for two years. Her healing journey was difficult, and she had no support from the Canadian healthcare system.

Ndiaye was hospitalized and was diagnosed with anemia, however, the medics didn’t bother investigating what caused the anemia. For her, this lack of thoroughness served as a wakeup call.

“Doctors couldn’t even identify the cause. If I continued down that path, I could’ve died, and nobody would’ve understood,” Ndiaye said.

Ndiaye had to do her research and found out that she had anorexia. She started working on her relationship with food, went to the gym and found immense support from her parents through it.

She expressed that the current cultural beauty standards also impacted how people viewed her drastic weight loss. She would get compliments instead of concerns regarding her physical change.

Today, when she looks at her pictures during that time, she realizes how dire her situation was.

After the hardship she went through, Ndiaye emphasizes the importance of taking care of one’s health.

“What you see on TV isn’t reality, and you shouldn’t stress yourself out by looking a certain way,” Ndiaye said. “It’s better to be in the shape you’re supposed to be and healthy instead of forcing yourself to conform to a certain standard while being unhappy and unwell.”

Ary Maharaj has worked at NEDIC as an outreach and education coordinator for six years. He expressed that there is no proper race-based data on how eating disorders affect communities of colour, Including Black people, Indigenous communities and other racialized communities.

Maharaj expressed that based on the data NEDIC has so far, Black people experience eating disorders at similar rates to white folks. However, the difference is that Black communities and many other people of colour are less likely to reach out for support.

He mentioned that the experiences of racism, trauma and cultural mistrust of healthcare systems are some of the problems that can hinder Black people from prioritizing getting help for their eating disorder.

“They’re having to separate themselves when they’re accessing help. So, they might not be able to feel like they can get help as a whole person. Because the help that they’re getting isn’t adaptable to their pertinent needs. Common eating disorder treatments are tailor-made for white women, which doesn’t represent other races,” Maharaj said.

Maharaj expressed that at the NEDIC, they often hear that many communities of colour, including Black people, feel the need to self-advocate. This can be hard since it takes a lot of literacy, resourcefulness, strength, and bravery to do your own research and express your grievances to healthcare providers with lots of power. It creates an additional barrier and can make their journey a bit more complicated, especially in the beginning when they try to access care.

He emphasized that the expectation should be that healthcare providers make sure that care is available for the whole person bearing in mind that race and culture are a big part of who a human is.

Maharaj mentioned that the fact that there is an underrepresentation of Black healthcare providers creates an additional barrier. The waiting lists can get long for Black therapists and healthcare workers who want to help Black communities, this creates another problem where the Black experts feel that they are the only ones who can help them.

“To be better at this, we need healthcare providers of all races and identities to feel more comfortable taking a stance of cultural humility about eating disorders,” Maharaj explained. “By changing that system, I think it will make it easier for Black people and families to feel like they can trust the healthcare provider they’re seeing to provide holistic care for their well-being.”

Maharaj expressed that seeking help is essential and members of the Black community should seek help on their terms, whether it be a family doctor in their community or using the NEDIC resource called “Let’s Talk About Disordered Eating and Eating Disorders in the Black Communities.” They can print it and show it to the healthcare provider to better understand their need for help.

In any case, where someone would rather be anonymous, NEDIC operates a national toll-free helpline and live chat that does not require personal information. Maharaj emphasized that there are different ways to get help and depending on one’s concern they can choose what works for them.

“Some help is from the hospital, but people can also find help in community or peer support,” Maharaj underscored. “I imagine that for many folks of colour and including the Black folks that we’ve talked to, it’s sometimes being the unconventional treatment approaches that have been helpful.”

Dr. Natasha Johnson has been a pediatrician and adolescent medicine specialist at McMaster Children’s Hospital for 18 years. From 2015 to 2022, she was the co-medical director of McMaster’s pediatric eating disorder program.

Johnson explained that the standard of care for people who have eating disorders is the same for every person once they identify it. For the most part, the recommendation is the family-based treatment. It is a highly effective method to help young people recover from eating disorders.

She added that ultimately, in Canada, about five per cent of teenagers can have eating disorders. However, eating disorders often go unrecognized or have a delayed diagnosis, especially if someone is racialized, gender diverse, of a higher weight, or a boy.

“So it’s not a difference that’s written into policy, but it’s a difference in the way that doctors, clinicians, other healthcare providers, even community members, may appreciate or not appreciate an eating disorder based on what kind of biases they have in their heads about what an eating disorder should look like,” Johnson highlighted.

Johnson mentioned that throughout her 18 years at McMaster, she was usually the only Black doctor. In the past two to three years, she has seen one or two Black nurses in their inpatient eating disorder unit.

“In my EDI (equity, diversity, and inclusion) work, it is known that outcomes for Black communities for a lot of different health conditions are worse than they are in others in the white community, for example, and that’s where data is collected,” Johnson said. “So, for example, the mortality of Black infants is higher than the mortality of white infants.”

Johnson expressed that one thing that can be an antidote to that mortality rate is having concordance between the health care provider and the patient. If the provider and baby are Black, then the mortality rate is different.

She said that if there were more representation in health care in general, outcomes would be better, not only for eating disorders.

Johnson believes things are improving. The death of George Floyd in 2020 was a catalyst for many organizations, including healthcare organizations, to recognize the existence of anti-Black racism and the need to address it as a priority. It is because where there is data, the outcomes of Indigenous and Black people across several sectors, including healthcare, were significantly worse than many other communities.

She said that proper attention and effort have been made, in some cases, to try to communicate the correct cultural information to communities in their language and have healthcare providers who look like those community members to share that information.

“So, I am blessed to be part of a group called Our Kids Health, and specifically, there’s a chapter of Our Kids Health called Black Kids Health. That chapter has a number of Black healthcare providers, including me, who will make Instagram reels, TikTok reels, and Twitter posts about health-related information specifically geared towards the Black community,” Johnson emphasized.

Johnson underscored that it is important for the Black community to improve its health literacy. While health care providers and institutions work on communicating in an inclusive way, Black people could find the different names of diagnoses and take notes of that, write down the medicines they are taking so they are better prepared when they enter health care spaces, and talk about mental health with their families and children.

 These efforts would be useful in reducing the stigma within Black communities regarding mental health.

Johnson emphasized that better results will result from more representation in more sections, including health care.

“There are a number of medical schools, including McMaster, that have facilitated streams for Black students. So, I assume we will see more Black doctors on the front lines and other Black healthcare providers because of the simultaneous growth. I think of welcoming Black students to the various campuses across Canada,” Johnson said.

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Understanding eating disorders in BIPOC communities

BIPOC individuals with eating disorders are likely to have their condition overlooked. Graphic Myriam Ouazzani

Cole Cooper,
Local Journalism Initiative

Dieticians say people of colour with eating disorders are half as likely to be diagnosed or receive treatment

At one point during her anorexia recovery, Stephanie Ng texted her nutritionist to ask how a specific dim sum fit into her meal plan. Her nutritionist didn’t have an exact answer and told her to eat the dim sum regardless, to lean on the side of abundance to help her recovery.  

“That was like, a nightmare for me to hear because I’m like, ‘I need to know how that fits into  the prescribed meal plan that you’ve made.’” Ng says.

Although BIPOC people develop eating disorders at nearly the same rate as white people, they are half as likely to be diagnosed and significantly less likely to be screened for symptoms. Eating disorders are extremely dangerous psychological and physical afflictions — anorexia nervosa is, after all, the most deadly mental illness — but stigma often prevents BIPOC people from receiving the treatment they urgently need. Those who can access treatment often find it lacks cultural competency.

“Personally, I’ve tried to look for a therapist for myself who is of Asian descent and I could count the number of people I’ve found in Quebec on my hands,” says Jamie Lee, a registered dietitian at the Sööma clinic in Montreal.

“There are a lot of people who come see me. Specifically because I might know their food more,” Lee says.

Sööma is one of Montreal’s two dietary clinics specializing in eating recovery. Lee has been with Sööma since the clininc’s opening four years ago. 

“I was the first one hired. It was just me and my boss,” Lee says. “Now we’re a group of  seven dietitians. So it really grew a lot over the last three, four years.” 

In retrospect, Sööma’s growth is predictable —opening a dietary clinic in 2019 is akin to opening an engineering firm the day before an earthquake. Between March 2020 and December 2022 there were more than double the predicted ER visits for eating disorders, per a 2023 Canadian Medical Association Journal report. In-patient Canadian hospital stays for eating disorders increased by nearly 60 per cent among adolescent girls over the same period, according to the Canadian Institute for Health Information. Those patients needed dietary plans, and to be guided through the refeeding process. 

“A lot of people think directly to a psychologist to help with eating disorders,” Lee says. However, renourishing the brain is often a precursor to genuine psychological progress.  

Eating disorder recovery is often difficult and sometimes life-threatening. According to data from the South Carolina Department of Mental Health, approximately five per cent of patients with anorexia will die within four years of their diagnosis. That rate increases to about ten per cent after ten years and about 20 per cent after 20 years, according to the organization Eating Disorder Hope

Lee compares the recovery process to climbing a mountain, with the dietitian acting as a guide. 

“I can see your mountain, so I know, like, ‘Oh, put your left foot here and put your right there,’”  she says. “We work at the pace that the client works at.” 

Lee and her colleagues repeatedly reinforce that, as emotionally and physically difficult as treatment can be, patients who don’t fit the stereotypical image of an eating disorder are often overlooked. 

Elsa Chu is another dietitian at Sööma. Chu began her career working with athletes and competed  on the winning team at the Canadian Ultimate Frisbee Championships in 2018. 

“BIPOC people in general are a lot less likely to be asked about eating disorder symptoms. The  big stereotype with eating disorders is that we think of a thin white woman,” Chu says. She warns that anyone who doesn’t fit the stereotype has a good chance of being overlooked. 

“BIPOC people with eating disorders are half as likely to be diagnosed or to receive treatment,”  Chu says. 

According to Eating Disorder Hope, 20 per cent of untreated eating disorders result in death. 

This is an issue with a lot at stake. 

For BIPOC people who are able to seek treatment, there is yet another obstacle: the unlikelihood of finding treatment that sees and suits them. 

Ng recalls telling her college therapist that she didn’t know how to say no to her mom when they had disagreements over food. 

“My therapist was like, ‘Just tell her,’ and I was like ‘I can’t.’” Ng says. “It doesn’t work that way, you can’t say that stuff to your mom.” 

Chu also says that eating disorder symptoms can be misdiagnosed and misunderstood based on a patient’s cultural background. 

“So, for example, Hispanics and Asians are more predisposed to diabetes and insulin resistance,” Chu says. “It may not be necessarily right off the bat an eating disorder thing, it might be a predisposition just because of where they’re from.” 

“All the training that we’ve done (for nutrition interventions), it’s based off of studies that were done on white people,” Lee says. 

For example: “In East Asian cultures, dairy and wheat are much less of a thing than they are here, and those tend to be foods we recommend a lot in Eurocentric approaches,” Chu says.

Ng experienced that exact challenge firsthand when she began anorexia treatment as a preteen in Hong Kong. Her recovery was centered around Eurocentric foods, and that lack of cultural sensitivity just made the process harder. 

When Ng was studying in America, she founded the organization Body Banter as a platform for youth to have difficult conversations about body image and mental health. When she returned to Hong  Kong, she realized Body Banter’s efforts were even more necessary there.  

“What happens in public hospitals in Hong Kong is that there is minimal to no psychological  support. Your physical body is seen as the main problem,” Ng describes. “And that’s all that gets  addressed.” 

For those who couldn’t afford professional psychological help, or who weren’t ready for it, Body Banter became a solution.  

Ng says one of Body Banter’s biggest powers is giving people the language to understand their  feelings and talk them through. She describes being unable to explain her emotions to a therapist, 

simply because she didn’t have the words. Her world opened up when psychology classes gave  her the language to make sense of it. She finds youth with more nuanced language to discuss body image allows them to have more informed conversations and to develop more comprehensive understandings of their experiences.  

“Helping our profession become more culturally competent is just having more access to this  information, more awareness,” Chu says. “We can’t fault people for not knowing a culture that is  not their own.”

Having an open-minded approach is what Chu classifies as the key to recovery. “Collaborating and gently modifying through cooperation,” Chu adds.

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