For years, most Americans believed that eating disorders only targeted The Gossip Girl-type crowd: upper-class white girls. People felt that women of color, especially black women and girls, were immune to these types of disorders, characterized by obsessive negative thoughts and feelings about body weight and food, refusal to eat, binging and purging (bulimia) and excessive exercise.

Over the years, cultural myths perpetuated false beliefs, such as black women cannot be victims, they never suffer from low self-esteem and they love their figures because African Americans in general appreciate a more voluptuous body. Unfortunately, these biases affect how some scientific work is conducted—who is included and who is overlooked when researchers investigate how eating disorders affect all people.

During the past decade, however, researchers have done more studies to discover if there is a link between eating disorders and women of color. The new information counters what we once thought—black women do suffer from eating disorders at higher rates than past studies showed, but not as high as white women. Nevertheless, it is a growing problem.

This past March, University of Southern California economics professor Michelle Goeree released the results to her study about bulimia; they were shocking. By analyzing data from a 10-year survey of more than 2,300 girls from schools in California, Ohio and Washington, DC, Goeree and fellow economists John Ham of the University of Maryland and Daniela Iorio of Universitat de Autònoma Barcelona found that black girls are 50 percent more likely to develop bulimia than their white counterparts. They also found that black girls in low-income brackets are 153 times more likely to develop bulimia than African-American girls who live in the highest-income bracket.

RH spoke to Goeree to get to the bottom of her groundbreaking report.

What was your team originally researching?
We were interested in looking at whether bulimia was habit-forming and were there any addictive elements to the behavior. This is important because, right now, eating disorders are labeled as mental disorders—they are really expensive to treat. From a policy standpoint, if bulimia was perceived an addiction, there’s the possibility of federally funded programs to ensure that more people would get treatment. We found that there are habit-forming aspects of bulimia, indicating that it’s an addiction, but more work needs to be done. In addition, we discovered that black girls were 50 percent more likely to develop eating disorders than [their white counterparts].

I must admit, even as an African-American female health writer who understands that my community is prone to developing eating disorders, I was shocked by your findings.
We were too. We didn’t collect the data ourselves; this particular data set already existed. It was really unique and great because it asked all of the young girls—regardless of race and economic status—questions about their binging and purging activities, excessive exercise and laxative use, all behaviors consistent with bulimia. Normally, it’s really hard to get data sets that ask everyone the same questions. Usually what happens is that you look for people who are already being treated for an eating disorder, to learn about the characteristics of those people. But that approach suffers from a common problem known in economics as “sample selection bias.” Treatment for eating disorders is very expensive and usually not covered by insurance. Therefore, if you cannot afford treatment then you are not part of that data—that leaves out a lot of people, especially African Americans and people who live in a lower economic bracket.

In addition, we are so used to the media discussing white women or white celebrities with anorexia (starving oneself) that bulimia doesn’t get as much attention. So, we are used to seeing very skinny women, when most bulimics in fact are of average weight and unless you were looking for certain signs, you would not know that someone was suffering from it. This [shift in thinking] is starting to change, but we are still trained to think about eating disorders as a white woman’s disease.

What are some other numbers that you thought were important?
We also found that habit-forming behaviors among African Americans tend to be more persistent and tend to last longer as compared with whites. That means that once you start, it’s harder to stop. We also found that even after you controlled for both race and income, being part of a lower-income family and being African American increased the likelihood of having bulimia. When we looked at low-income families from different racial backgrounds, we still found that African Americans are more likely than lower-income whites to have bulimia. If you look at African Americans as a whole, those who are from a lower-income [bracket] are more likely to have bulimia than higher-income African Americans.

Many theories I’ve read say that maybe a reason why eating disorders are increasing is because some middle- and upper-class African Americans searching for jobs are engulfed by white culture and competition with white women. But your findings may suggest something different.

Well, we don’t know what issues are affecting these girls. Unfortunately, the [original researchers] didn’t ask them any questions about it. Moving forward, I hope this work does spark more research to create data sets that are inclusive of everyone and ask questions to indicate why.

In the meantime, what we could learn from this study is that maybe we should use education more effectively to inform people about eating disorders. In particular, we should make sure we also tell African Americans that they might be affected by this and what the dangers of bulimia are.

Are you or someone suffering from an eating disorder? Not sure what the signs are? Here are some resources to access for help:

National Eating Disorders Association

National Institute of Mental Health