By Frieda Millhouse-Jones, M.D.
I’m a physician, but my internalized belief that eating disorders are a disease of affluent white women blinded me from recognizing disordered eating in my own household. In retrospect, the clues were all there.
A few months back, I received the email, “Eating Disorder Panel Q & A.” My physician colleague had become very experienced at caring for eating disorder patients. I arrived and took a seat in the second row. I looked at the panel—all white except for one African American therapist. They began the discussion with overviews of the various types of eating disorders and introduced useful screening tools. I quietly thought, this is interesting, but I’ll never see this in my primarily African American patient base.
Eating Disorder Myths: It Doesn’t Happen in Black Families
As long as I could remember, there was this widespread belief that eating disorders, in particular restrictive eating disorders, just didn’t happen to Black folks. The only people I had ever seen publicly with eating disorders were very thin affluent white women like Karen Carpenter and Princess Diana. They were the complete opposite of the body types I had seen in the Black women I called family. Culturally, we revered “thick women” with our naturally curvy hips and voluptuous rear ends. There was no need to be thin. Why would anyone starve themselves?? Weird, I thought.
With my implicit bias swirling deep inside my brain, I raised my hand. I directed my question to the lone African American therapist on the panel. “How often do you see this in African American patients? I have a majority African American patient base and honestly, I just don’t see this,” I stated, arrogantly. She replied, “Oh, we definitely see it. I probably see binge eating disorder more often, but we still see the other eating disorders like anorexia and bulimia in African American patients.”
I went back to work as normal. Winter was upon us. My husband mentioned a novel coronavirus abroad, looming over the horizon. He deployed shortly thereafter to assist with containment efforts.
I was on my way home from work when I got the call from my youngest daughter, who was crying. “M passed out and I can’t get her to get up!”
“What do you mean, baby?” I said, trying to remain calm. “Where’s Auntie?” My sister was helping out during my husband’s deployment.
“She had to go, please come. Mommy, hurry. She won’t get up, I keep trying…” L’s voice was trembling.
“I’m on my way, honey. Let me talk to M. Give her the phone.”
“Okay. M, Mommy’s on the phone.”
M managed a faint hello.
“What happened?” I asked.
“I don’t know. I got really dizzy walking home from the bus. I got inside the house and sat down, and then I went to get up and I just blacked out on the floor downstairs. I made it up to my room though. I’m lying down.”
“Okay. I’m on my way. I’ll be there soon. I’m driving as fast as I can. Hand the phone back to L.”
L was in a sheer panic at this point. “Mommy!”
“Go get M something salty like soup and tell her to eat it. Tell her I said she HAS to. I will be there soon. “I’m less than 20 minutes away”.
L called back crying, “She won’t drink it, Mommy!! Hurry!!! I don’t know what to do,” she sobbed.
“I know this is scary, baby. Hang on. I’ll be there before you know it. I’m trying as hard as I can to get there to help you.”
I have NEVER felt so helpless. I was driving over the speed limit. There had been little time during this deployment that an adult had not been around. Why did this have to happen now??? My youngest does not know how to manage medical emergencies.
I got home and bolted up the stairs. She was lying there in bed. The untouched bowl of chicken noodle soup that L had placed on a tray was still on her desk. I jumped into physician mode. Her history suggested volume depletion.
“Have you been having diarrhea, M?”
“No,” she said.
“Have you been vomiting?”
“No,” she said.
I knew she always ate “like a bird.” I said, “You’re not eating enough. You need to eat and drink more.” I walked out of her room. Suddenly, this nagging feeling began in the pit of my stomach. I had just learned about eating disorders from the panel discussion in the fall. Could this be it? Could she have an eating disorder? She’s Black. This can’t be. What is happening here?
I went back into her room later that evening and asked the question that would change everything.
“M, have you been vomiting? “
“Yes,” she admitted. “But just a few times, Mom. I won’t do it again. I’ll stop “.
I called my husband. I told him everything that had transpired. He said nothing. His breathing changed. His silence communicated everything I needed to know. I knew what he was feeling because I felt it too. I had called him at a terrible time. He was out of town and working a new assignment. He was surrounded by complete strangers and could not afford to let them see him lose it. It was not fair to call him, but I was heartbroken and alone. We both did not know how to respond so we left it as something we would deal with further when he returned home.
Unfortunately, this disease wanted to make itself known. Several days later, my husband had a conversation with the parents of M’s friend. They told him that M’s friend wanted us to know something. M was making herself vomit in the bathroom at school. The friend was afraid to tell us but wanted her parents to know. He called me that night with the additional news. It felt like time was standing still. I felt nauseated. I couldn’t breathe. I wanted to throw up myself. The very condition that I said “didn’t really happen to Black girls” was happening right here in my very own home. It had been there all along, hiding in plain sight.
The image of my frail weakened sweet girl lying in bed that fateful evening flashed through my mind. That moment, this discovery, still haunts me today. I felt a bottomlessness that I can only associate with enormous fear and back-breaking shame. I was incredulous that, as a physician, I had not identified this sooner.
Eating disorders are mental health disorders manifested through food. Mental health does not discriminate based on race, gender, or sexual orientation.
It affects everyone. Stigmas and stereotypes are the true barriers that we must overcome to help identify those that need help.
The good news is that M is doing extremely well. She is one solid year into recovery. She has an amazing multidisciplinary team consisting of a FBT (Family Based Therapy trained) therapist, individual therapist, psychiatrist, and dietitian. She’s determined not to fall back into her disordered eating patterns, and she wants to share her story in the hopes that it might help others. We continue to work together as a family to make sure she continues to move forward in her recovery, and she is looking forward to graduation and the college selection process.