Culturally appropriate care is a necessary pillar in the treatment of eating disorders, yet often times, the diverse needs of clients are not being met. There is disconnect between the individuals’ eating disorder needs and the treatment they are receiving. This is likely fueled by multiple factors, including a lack of proper training for healthcare providers to provide care that is culturally sensitive and a lack of understanding about how racism influences people’s health outcomes (Majaraj et al., n.d.).
The idea of culturally appropriate care emerged out of the need to address diversity and inequality, with the first definition of cultural competence being offered in 1989 by Cross and colleagues (Georgetown University, n.d.). Although we have recognized the importance of diversity across a multitude of systems, applying this framework in a healthcare setting has been a slow process. To this day there is a gap in care for culturally diverse individuals that needs to be addressed.
When looking at eating disorders out of a cultural lens, we can see that culture plays an important role in shaping one’s experiences of their eating disorder. Ideas around body image and food itself can be rooted in different cultural values, norms, and traditions. For example, in western cultures, thinness has been idealized whereas some studies have shown Black women idealize curvier bodies (Eating Disorder Hope, n.d.; Majaraj et al., n.d.; Mikhail & Klump, 2021).
In a recent study conducted by Li and colleagues (2024), they aimed to understand the body image experiences of BIPOC men and highlighted the multiple factors that intersect and relate to body image concerns. What they found was that BIPOC men’s negative feelings about their height was mostly associated with the people they are close to, however, their dissatisfaction with the size of their muscles is more heavily associated with media. This speaks to the fact that these men are trying to fit in with both cultural/ethnic ideals and ideals portrayed in the media, making it more difficult for them to feel satisfied with their bodies.
Food itself is also very cultural. Our life experiences help us to develop ideas about what foods are healthy or unhealthy (Majaraj et al., n.d.). BIPOC communities are also more likely to experience food scarcity which can impact the types of food they are able to eat. It is important to understand how culture impacts access to food and the types of food individuals consume, to ensure that in eating disorder treatment plans cultural factors are considered. This means looking at things from outside a westernised lens and acknowledging that foods deemed as “healthy” in western society may not be accessible, affordable, or culturally relevant.
As well, it is necessary to understand the barriers individuals face when trying to access care for their eating disorders. Black, Indigenous, people of colour (BIPOC) individuals have been marginalized and oppressed in society, which has influenced their mental health literacy and therefore their knowledge on the available information and resources is lacking (Majaraj et al., n.d.). These structural barriers play a role in why BIPOC individuals have historically been less likely to access care. Furthermore, when BIPOC individuals decide to access care, sometimes they are met with stigma from healthcare professionals. This reduces their likelihood of receiving adequate care and may deter them from accessing care again (Majaraj et al., n.d.).
So, what are ways that healthcare can become more culturally inclusive to ensure everyone’s needs are being met? Healthcare practitioners should practice taking an intersectional approach to care. Intersectionality refers to understanding how race, class, culture, gender, sexuality, health etc. interact to produce’s an individual’s experience in the world. For example, an Indigenous man who has binge-eating disorder will have a very different experience than a Black woman with anorexia nervosa. Taking an intersectional approach will allow practitioners to understand the individual’s experience of their eating disorder and how their identities shape their relationship with food, body image, and access to care. This approach allows for comprehensive care that focuses not only on the eating disorder itself but other factors that may be contributing to it, moving beyond a one-size-fits-all approach and considering the unique social and structural barriers people face.
This also means practicing cultural humility. Cultural humility is about understanding your own views, background, and perceptions and recognizing how this may differ from your clients’ background (Brown-Crosby & Williams, n.d.). It means recognizing that you do not know everything about other cultures and identities and approaching clients with an open mind. Being able to learn from clients rather than treating them with the preconceived notions you have about them is essential in providing care that is relevant and helps the client.
A great resource for practitioners aiming to improve their intersectionality and providing cultural appropriate care is NEDIC’s “Let’s Talk About Culturally-Sensitive Eating Disorder Care: Supporting the Healing of Black, Indigenous, and Racialized Clients”. This this informative document provides many important principles for healthcare practitioners to incorporate in their practice to ensure care is culturally relevant and sensitive to the individual needs and experiences of clients. The link can be found here:
Please use the following link to find out about eating disorder community groups in your area that provide care for diverse groups of individuals: https://nedic.ca/community-groups/
References
Brown-Crosby, M & Williams, L (n.d.). Culturally-sensitive care for patients with eating disorders. Within. https://withinhealth.com/learn/within-summit-series/culturally-sensitive-care
Eating Disorder Hope (n.d.). How cultural traditions can shape body image. https://www.eatingdisorderhope.com/blog/how-cultural-traditions-can-shape-body-image
Li, Z., Talleyrand, R. M., & Sansbury, A. B. (2024). Sociocultural influences on body image concerns in men of color - a structural equation modeling study. Ethnicity & Health, 29(8), 1008–1025. https://doi.org/10.1080/13557858.2024.2396825
Majaraj, A., Tam, E., & Hundal, A (n.d.). Let’s talk about culturally-sensitive eating disorder care: Supporting the healing of Black, Indigenous, and racialized clients. National Eating Disorder Information Centre. https://nedic.ca/media/uploaded/NEDIC_-_Lets_Talk_About_Culturally-Sensitive_ED_Care.pdf
Mikhail, M. E., & Klump, K. L. (2021). A virtual issue highlighting eating disorders in people of black/African and Indigenous heritage. The International journal of eating disorders, 54(3), 459–467. https://doi.org/10.1002/eat.23402
Georgetown University (n.d.). Definitions of cultural competence. https://nccc.georgetown.edu/curricula/culturalcompetence.html#:~:text=The%20seminal%20work%20of%20Cross,during%20the%20past%2015%20years.
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