two BIPOC trans people sit outside in a park. trees full of leaves fill the background. they look at each other and smile lovingly
(via The Gender Spectrum Collection)

Thanks to Project HEAL, an organization that addresses systemic health care and financial barriers to eating disorder treatment, Da’Shaun Harrison was finally diagnosed with an eating disorder last year. But they have long struggled with disordered eating. As a Black trans person, Harrison lives with the impacts of oppression.   

“Growing up as someone who was socialized as a Black boy, who was always fat, doctors never even considered [an eating disorder],” said Harrison, a theorist and author of the award-winning book, “Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness.” “Doctors told my mom that wasn’t a thing for me. And instead, I started to be punished by way of exercise, by way of working out, by way of diet culture, by way of gym culture for my size, as opposed to finding ways to care for my eating disorder.”

Eating disorders are often only conceptualized as impacting rich, thin white young women, contributing to gaps in care like Harrison experienced. In part, this is why researchers are pleading for diversity in eating disorders research.

In their book, Harrison deconstructs how anti-fatness continues to operate as anti-Blackness and how medical racism and eugenics (and a health care system rooted in both) affect all Black people, but especially fat Black people

“Black folks are positioned outside the realm of possibility for an eating disorder because Black folks are positioned outside of the realm of possibility for care,” Harrison said. “The term ‘care’ functions as anti-Black, [as in] ‘care’ is reserved for folks who are not understood to be what I call ‘the underbelly of humanity,’ who are understood to be people and therefore deserving of care.”

Harrison’s experience of navigating disordered eating without access to care largely informs their work, which draws on the writing of Dr. Sabrina Strings, a Black researcher and the author of the book, “Fearing the Black Body: The Racial Origins of Fat Phobia.” Analyzing art, media, medical journals, and other texts, Strings outlines how fatness came to represent racial inferiority between the Renaissance and the 19th century. 

“The major intervening variable was race science because the trans-Atlantic slave trade existed for approximately 200 years,” said Strings in an interview with Prism. “The argument was that if you had dark skin, you were a slave; if you had white skin, you were free. But with years and years of race mixing, mostly due to sexual assault in the colonies, skin color was no longer a good determinant of who should be a slave and who should be free, so race science existed to adjudicate whether there were so-called ‘natural slaves.’” 

Strings notes how this conceptualization evolved over time to incorporate the physical embodiment and behaviors of individuals around the globe to identify characteristics of African people that were considered low, coarse, or inferior. 

“They claimed that Africans were wholly taken up with the animal appetites,” said Strings. “They loved sex. They loved food. And those qualities mark them as distinct from Europeans. And significantly to the extent that people who are of African descent supposedly loved food so much, this is why they were purportedly fatter than Europeans. They were clearly, in the middle of the 18th century, trying to make a connection between fatness and Blackness that would degrade both of them and provide an ongoing rationale for enslavement.”

According to Strings, fat stigma negatively impacts individuals. Despite it being a poor measure of health, the medical-industrial complex’s preoccupation with body mass index (BMI) contributes to this stigmatization. Strings explained that health is not solely based on one’s weight. 

“It probably has something to do with myriad other factors from genetics to exposure to environmental toxins … the amount of exercise, family history. There are so many things that go into whether a person is healthy, [but] we’ve been duped into thinking that you can become healthy or unhealthy by gaining or losing a couple of pounds,” Strings said.

Food apartheid and oppression-fueled disorders

When access to nutritious food is mediated by race and class, oppression has impacts on the eating habits of BIPOC LGBTQIA+ communities. This is something Karen Washington understands deeply as the Black activist who coined the term “food apartheid” to highlight how this lack of access is by design. 

“For me, first of all, we don’t live in a [food] desert. And I coined the term [food apartheid] because I wanted [to note] what was missing was the conversation around why there is such a discrepancy and inequity in the food system because no one talks about race,” Washington said. “No one talks about where you live, no one talks about economics, how much money you have. ‘Food apartheid’ would get people to start having those conversations and looking at the food system more closely. Why in the greatest country that we live in do we have hunger and poverty? Just saying ‘food desert’ doesn’t get to the root of what the problem is.”

While eating disorders are often framed around food intake, Washington believes such a conceptualization does a grave disservice to marginalized groups. 

“You have to look at the environment that you live in. Stress can kill you, mental health, so it’s not just food alone … Do you have access to food, decent housing, and clean water? All those things go into any sort of disorder,” Washington explained. “Do you have the right clinician who is able to see what you have and treat you holistically?”

Public health educator, advocate, and activist Patrilie Hernandez navigates oppression daily as a self-described “higher-weight, multiracial, neuroatypical, bisexual, genderfluid femme of the Puerto Rican diaspora.” Hernandez’s identities inform the work of Embody Lib, the business they formed that provides education around the systemic, policy, and environmental factors that contribute to poor health outcomes in historically marginalized communities. Hernandez told Prism that eating disorder organizations tend to focus on anorexia nervosa using images of emaciated cis white women, which informed the narrative and treatment around the disorder for decades. 

“The popular perception that eating disorders are usually only experienced by thin, cis, upper-to-middle-class, white, young women [has] informed eating disorder treatments, and not [just] treatment itself, but funding streams [and] who they advocate for,” Hernandez said.

Without the proper resources available to fat BIPOC, doctors and medical staff misdiagnose them or altogether ignore eating disorders when patients are facing other complex health issues. 

“I know that personally affected me, as somebody that was diagnosed with bipolar disorder at 19, [when I] was also in the middle of a severe eating disorder episode. I was never even asked about my eating habits,” Hernandez said. “The idea that I might have an eating disorder while I was in high-level mental health treatment never crossed the minds of any of the providers.”

Hernandez’s eating disorder is now in recovery, but they remain concerned that they were not even asked about their eating until they were first diagnosed with an eating disorder at the age of 32. 

“Black and brown people of color are generally not associated with any form of disordered eating … On top of that, you have systemic barriers if you are LGBTQIA+. The access to get competent health care that is gender affirming is the biggest barrier, [so] you’re always in survival mode,” Herndandez said.

The inherently white supremacist colonialist cisnormative model of care erases BIPOC LGBTQIA+ individuals from eating disorder narratives and the health care system as a whole.

“It becomes this cycle of harm because you don’t see them represented in eating disorder awareness campaigns, therefore they’re ignored in the clinical settings, therefore they’re not reflected in research that informs the eating disorder campaigns,” Hernandez explained. 

Through the power of social media, Hernandez noted that BIPOC LGBTQIA+ groups have developed peer support community-centered models of care for people with shared identities. However, much of the funding for eating disorder treatment still goes toward organizations that focus on fitness and that are centered on whiteness, they said. 

“We know that current systems and current structures that were not built for us are not going to heal us. What does it mean to come together as a community and develop models of care that are informed by addressing trauma [and] the root causes of eating disorders?” said Hernandez, noting that eating disorders sometimes become a coping mechanism for gender-nonconforming people looking for a sense of control to affirm their gender.

The public health educator further explained that bigger bodies are usually associated with femininity, so nonbinary people sometimes turn to disordered eating—especially when they don’t have access to gender-affirming care. With the recent rise in anti-trans legislation nationwide that makes accessing gender-affirming care even more challenging, Hernandez said they expect to see more trans and nonbinary people engaging in disordered eating as a coping mechanism.  

For BIPOC LGBTQIA+ communities, Hernandez also noted that disordered eating may be a tool to cope with generational trauma as the legacies of white supremacy, colonialism, and slavery persist. They said this is yet another argument why there needs to be multifaceted approaches to care.

Intergenerational food trauma and equitable care 

Tara Maudrie’s work as a nutritionist and public health researcher focuses on the intersection of nutrition and mental health—and it takes colonialism’s impacts very seriously. The enrolled citizen of the Sault Ste Marie Tribe of Chippewa Indians told Prism that Indigenous communities have always lived in reciprocity with the land.

“Then, in 1492, [colonization] changed our food landscape. Not only did it change our ecosystems and our ability to access healthy foods, but with it came European imperialism. There’s early records of Spanish explorers [who] said things like ‘Indigenous peoples are inferior, not for their lack of education, but the quality of their diet.’ This whole idea came early on in the 1400s—people came here with the idea that Indigenous peoples and Indigenous bodies are wrong, and our diets are wrong, and our foods are wrong,” the public health researcher said.

Maudrie noted how this reflects how traditional foods of Indigenous communities were weaponized against them as a tool for subjugation. For example, George Washington burned Iroquois crops so they would starve in the winter of 1779 and be forced to rely on settlers. To this day, Indigenous food systems remain disconnected and disrupted, leading to intergenerational trauma around food knowledge and cultural values, according to the researcher.

“We lived in reciprocity. We knew the seasons, and we knew the foods, and we engaged in what [Indigenous scientist and professor] Robin Wall Kimmerer calls ‘the honorable harvest principles’ … Many of these traumas of the food and waterways being changed, [of] the food system being weaponized against us, the introduction of invasive species and non-indigenous plants and animals—it changed the ability we have to be able to pass on that [food] knowledge that comes from living in reciprocity,” said Maudrie.

Maudrie’s great-grandparents were part of the boarding school generation, whereby children were forcibly taken from their families and put in boarding schools for the goal of assimilation. The motto at the time was “kill the Indian, save the man,” which was used to justify horrific conditions. Maudrie said that among many things, this iteration of colonialism changed the relationship that Indigenous children had to food because they were robbed of learning how to hunt, fish, and forage. Instead of having a relationship with food that was focused on reciprocity, childrens’ relationships to food was based on “Eurocentric imperialist ideas.” 

Indigenous communities are still harmed by intergenerational food trauma, and in medical settings, health care professionals pathologize Indigenous people’s relationship to food. 

“I have diabetes in my family, but they look at that and then they look at your weight, and they tell you to be smaller, to be less, to starve yourself—you need to exercise more because of one indicator that’s poorly associated with health outcomes,” Maudrie explained. “I don’t want to say I’ve ever had an eating disorder, but I think like most of us I’ve had disordered eating behaviors in the past, and a lot of those are driven by Eurocentric or dominant society food and health values that are fear based.” 

According to Maudrie, settler colonialism needs to be taken into consideration for effective eating disorder treatment—especially as it relates to the care received by Indigenous people. These communities were deprived of all their resources and then blamed for negative health outcomes as if these were just lifestyle choices, she said.

As a Black researcher with an eating disorder in recovery, Rachel Goode echoed Maudrie’s insights regarding the ties between historical trauma and food. In an effort to navigate the continued impacts of oppression, Black communities may use food as a coping mechanism or are often forced to rely on food that is easily available rather than nutritious.

“When I think about Black women, eating disorders might show up in emotional eating [and] compulsive overeating to deal with trauma, stress, racism, [and] food insecurity … It’s a way of coping with trauma,” Goode said. “It also can show up when we are in predominantly white spaces … I’ve heard narratives of women who have struggled with restrictive-type eating disorders in those spaces because of those pressures they’re feeling, their response to being othered, all the things they’re carrying. It’s very stressful.” 

If you or someone you know may be in need of support to manage challenges with disordered eating, Project HEAL’s HEALers Circle offers free and sliding-scale treatment to support U.S. residents who are uninsured or underinsured to access the care that they need.

Krystal Kavita Jagoo is a social worker, artist, and educator who prioritizes equity in all her work. Her essay, “Inclusive Reproductive Justice,” was in Vol. 2 of the Reproductive Justice Briefing...