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.
