The bias that exists around eating disorders has proven dangerous for black women, particularly because the conversations are always centred on affluence, whiteness and youth.

Eating disorders are often seen as taboo or an idealisation of skinny image associated with white people. And for black girls and women, stereotypes around eating disorders not only threaten their health but also their access to treatment.

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According to the Daily Beast, activists say teachers, doctors, faith leaders and even therapists don’t always catch an eating disorder when consulting a black woman.

The reason for the stereotypes, taboo, lack of research and subsequent threat to access to treatment has something to do with education and knowledge.

According to the South African Society of Psychiatrists (SASOP), eating disorders include anorexia nervosa, bulimia nervosa and binge eating, where anorexia has the highest death rate of all mental health conditions.

Broadly, it can also be seen as an unhealthy preoccupation with eating, food, weight, exercise or body image – together with behaviours such as the restriction of intake, excessive exercise, binge eating or purging – that impacts on quality of life and the ability to function in daily life.

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Professor Christopher Szabo, head of department of psychiatry at the University of the Witwatersrand, says eating disorders did not feature much in literature in South Africa and a lot of the existing literature is confined to white suburban young women. 

He says the understanding became that modernisation changed the landscape and eating disorders were not recognised and described as something that existed before in South Africa, but he says it doesn’t mean that they didn’t. 

He adds that eating disorders have been described in South Africa since the 1970s but exclusively involved white women and girls, and the first series of cases among black women and girls was described in 1995 but in urban communities and conducted in English.

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In research Prof Christopher co-authored called Application of the Eating Attitudes Test (EAT-26) in a rural, Zulu speaking, adolescent population in South Africa the studies suggest that eating disorders will emerge in the black community to the same extent as within the white community and that while increasing numbers of black patients have presented for treatment, the numbers haven’t reached equivalent levels to the number of those presenting from white patients.

He says even if a person has insight, access to treatment and would like to get better, the severity of eating disorders also often results in resistance to treatment and makes it difficult to change habits. 

And, Prof Christopher says, living with an eating disorder can affect someone at many levels, including the physical, emotional (anxiety), sleep, social life, academics and work (cognitive performance) wellness.

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