- Just ahead on ""Black Issues Forum"," misconceptions about who eating disorders affect have real consequences, especially in the Black community.

Leading with the knowledge that eating disorders don't discriminate is critical to making sure that everyone has access to health and support.

Our guests join us to provide insight and solutions right after this.

- [Narrator] "Black Issues Forum" is a production of PBS North Carolina with support from the Z. Smith Reynolds Foundation.

Quality Public Television is made possible through the financial contributions of viewers like you to invite you to join them in supporting PBS NC.

[theme music] ♪ - Welcome to "Black Issues Forum", I'm Kenia Thompson.

Eating disorders are often thought of as diseases that affect only young, white, affluent women, but that couldn't be further from the truth.

Eating disorders affect everyone regardless of gender, age, race, ethnicity, culture, or sexual orientation.

Misconceptions about who eating disorders affect have real consequences leading to fewer diagnoses, treatments, options, and other pathways to help those who just don't fit the stereotype.

When it comes to identity and eating disorders, one's experience should be understood within the broader cultural context of oppression.

And to help us better understand how these disorders impact our Black communities, we invite to the show double board-certified child adolescent and adult psychiatrist, Dr. Erikka Dzirasa, founder of Becoming Counseling PLLC, Cherrelle Davis, and registered dietician, health and Fitness expert, Chasity Newkirk.

Welcome ladies.

- Thank you.

- Hi.

- It is so wonderful to see Black providers in this space.

- Yes.

Absolutely.

- Mm-hmm.

So, great.

- I wanna start by having all of you just share a little bit about what you do as it pertains to eating disorders and why it's important.

Erikka, we'll start with you.

- Absolutely.

Well, first of all, thank you so much for having us, and for highlighting this topic that is often neglected, I think, in the field and especially amongst our community.

So I really am excited that we're talking about this today.

So again, I'm a child adolescent adult psychiatrist, and I currently am the co-owner of Catalyst Therapeutic Services, and we treat lots of different psychiatric conditions, including eating disorders.

I also am the chief medical officer of Arise Health, which is a telehealth platform for individuals with eating disorders.

And we really are designing it to target folks who are typically underserved in the community.

And then lastly, I also serve on Project HEAL's Board as the board chair.

And Project HEAL is a nonprofit organization that really aims to reduce barriers to care for individuals with eating disorders.

So healthcare barriers, systemic barriers, financial barriers to really make sure people get the access and the care that they need and the good care that they need so it really is an honor.

And I kind of fell into this because during my training, I did an elective, and I realized that I actually had my own bias about eating disorders.

And it wasn't until I actually got into the field, I realized, "Oh wow, our communities actually are being impacted by eating disorders and we just don't know it."

There's a lot of shaming, there's a lot of silencing.

And I really wanted to make sure that I got involved so that I could really get the word out and really help people who otherwise can't get resources.

- And this topic came about when we were having a conversation one day.

And when I thought about having this discussion on the show, I asked 'cause I couldn't find any other providers in this space.

- Right.

[laughs] - And so you recommended Cherrelle.

Cherrelle tell us what you do, and a little bit about how you two work together.

- Yeah, so I am a licensed marriage and family therapist, and I'm also a certified eating disorder specialist.

And so Erikka and I met actually at a treatment center, We were both working as providers, treating people of color, and realizing that we really weren't treating that many people of color.

It's very difficult to get access to treatment at a higher level of care.

And so that's how Erikka and I met.

And I also kind of just fell into the work.

I was looking for an internship in graduate school, ended up at a hospital setting that couldn't offer me an internship but offered me a job, and I really just loved the population.

I recognized the gap of not having representation, and so I really, that's just kind of what drew me to it.

- Yeah.

- And now I own a private practice, and so I get to choose and select seeing people of color and making sure that they're served.

- That's beautiful.

And when we talk about eating disorders, obviously, how we have relationships with food is a huge thing, which is where I was again in search of a Black provider and a good friend recommended Chasity Newkirk as a dietician.

So tell us a little bit about what you do in this space.

- Yes, so I work in the clinical setting, so I see especially people of color referred for issues not related to eating disorders or disordered eating.

And sometimes it's a bigger issue than it seems where they push weight loss and chronic disease management when there's disordered eating patterns and habits that we may not know about.

And typically in the clinical setting, there's not a lot of Black providers.

So it's sometimes difficult having those tough conversations when someone doesn't look like you or when someone not like you is telling you about your habits.

There's that defense mechanism, and sometimes that leads to them not coming back and the proper care not being received.

So for me, in the nutrition setting, it's really about being seen and building that trust so that more people are aware of their disordered eating patterns and feel comfortable talking about it and taking that next step for care.

- That's great.

And our history with food goes way back in our culture, and sometimes that can be a good thing and it can be a bad thing.

But Dr. Erikka.

- Yeah.

- When we talk about the Black community's relationship with food, how does that influence some of the behaviors that we've seen in this disordered eating space?

- Wow.

Such a thoughtful question.

our relationship with food, as you said, goes way back, right?

And when I think about the cultural experience of food, I think of connection, right?

There's connection really to our ancestors when you think about it.

It's really interesting going to places like Ghana and seeing women pounding yam to make fufu.

And then you go all the way across the world to Columbia and see women pounding corn in the same manner to make tortilla.

And how some of those things have been preserved over time and over centuries and generations, and we have that connection to our ancestors in that way.

And then I think about the connection to our families, how we connect over celebrations over food, and funerals over food, food becomes comforting, and we are very proud of the food that we serve.

And then there's that internal connection as well.

What brings about that cultural identity, that sense of self when you think about food.

And all the ways our senses are involved when it comes to food, if you smell something, you smell... Like your auntie, for me it's my auntie's mac and cheese, that immediately takes me back to my childhood and really good memories.

- Yeah.

- But for some people, they may have connections to food, even cultural that may bring about negative emotions or feelings or maybe even trauma.

And I think that's really important when you think about food insecurity for instance.

And not necessarily having the right resources or access to food.

Oftentimes there's okay, "You need it, clean up your plate and eat everything, because we don't know where we're gonna be able to eat again."

- Yeah.

- Right?

And that in itself can lead to disordered eating as well.

So there's definitely a connection, and there's so many layers to it from a cultural standpoint.

- Yeah.

Cherrelle what have you seen as far as people using food as distraction?

- Yeah, I think people use food for a distraction all the time.

Like, Erikka was saying, there's so many like emotional responses that we get to food.

It's your auntie's mac and cheese, for me, it's my grandmother's grits.

And that to me has such an emotional aspect to it because I can reflect on her teaching me how to make grits.

I can think about her making me grits when I was happy, when I was sad.

- And so I think the same thing happens where people use food as a way of distracting, or sometimes even as a way of connecting.

But the downside of that is that if we are using food to distract, we're not being mindful.

And then that's what leads to disconnection with hunger and fullness cues, leads to using foods to cope instead of using food as fuel for your body.

And so we really have to pay attention to being mindful about the food that we're taking in.

- Yeah.

Chasity, when we talk about access to food and the impact that it has on local environment, how do you see that being involved in our dietary habits and food choices that we make daily?

- You know, historically, like you mentioned, we used to grow our own foods, and even we were given kind of the leftovers and we made something outta nothing.

And fast forward to now, that culture and that food has been deemed unhealthy in a way.

So we are left thinking, "Okay, well I can't have the grits, I can't have the things that I grew up on and that I know, so what can I have?"

And then tied with that, the food insecurity and other systemic things that are disadvantaged for us, it makes it very difficult.

Not everybody has the access to fresh produce, they don't have the transportation to get to a grocery store.

And when we hear from our doctors, we need to eat this or eat that, we're confused.

So that can lead to us not eating.

It can lead to us feeling that shame or guilt when we do want some of our cultural foods or things that we know, but not all of our foods are unhealthy.

So it's really important from a nutrition standpoint to properly educate on what is and what isn't.

Even in the sense of food insecurity because there's still a way to preserve our culture with what you have, because we've done it before, we can continue to do it.

- So creative.

Yeah.

- When we look at society's perspective of what we're supposed to look like, especially when it comes to a Black woman's body, what are your thoughts on the impact of that on our eating?

- Ooh.

Okay, that's the deep one right there because there's so much to unpack when we think about the Black women in our body and even Black men in their bodies.

And when you think about, again, like pre-slavery, going all the way back to West Africa, before colonialism, right?

Before white people came and kind of determined what the European standard of beauty was.

There were a lot of people who shared that bigger, larger bodies actually was associated with like pride and a sense of like joy and excitement and like wealth.

- Wealth.

- Yeah, that's right, that higher socioeconomic status.

And then when you look at populations, there's research done in Fiji that actually showed as soon as they introduced television, Western television to that area, they started to diet and they started to try to lose weight, even though before that they really were proud of their larger bodies.

- Yeah.

- So it really just goes to show that how we see our bodies, how we see our sense of self, and thinking of even the European standard of beauty, that's all rooted in racism, it's rooted in white supremacy.

And sometimes what we do, I think as women and men, we internalize that, right?

- Yeah.

- And then our doctors internalize it.

So I learned it all throughout my medical training that we have to stay strict to the BMI when the BMI was never created for us, for people who look like us.

It was never validated amongst people who look like us.

And yet now we are actually being told that we have to fit this perception of what healthy is and what beauty is.

So it's a lot of pressure that we then begin to internalize.

And I think just like you said, we internalize it and then live with a lot of shame and a lot of guilt and kind of struggle in silence.

- Well, research shows that eating disorders among minorities has shown that these disorders are not limited to any specific ethnic or racial group, as we've said already.

And certainly they can affect individuals from various backgrounds.

However, the graphic that's shown now, only 17% identified eating behaviors of Black women as problematic.

And this does not account Black men or children of either gender.

The study was done in 2021, which I know obviously that may have skewed since then.

While there are disparities in terms of prevalence, diagnosis, access to treatment and outcomes, we're hopeful that increased diagnosis will lead to increased access to care.

So Erikka, when we talk about the barriers to care, that's big.

- Yeah.

- Already, I think one of the major barriers is recognizing that it affects us, right?

- Uh-huh.

- Absolutely.

- And then finding women or men that look like us, like you guys, to provide that care.

But talk about some of the other barriers as it pertains to disorders.

- Yes, so some much of it includes implicit bias from a clinical standpoint.

So that study that you referenced actually looked at lots of different clinicians who are able to just look at a case study, and so many of them missed it, right?

Because they were looking at it through a lens that was biased.

- Yeah.

- So part of it is educating our other medical providers, dieticians, therapists, getting more people into the field.

We only represent less than 2% of all clinicians in the eating disorder treatment world.

- Wow.

You said less than 2%?

- Less than 2%.

- Wow.

- I could think of about four other psychiatrists besides myself who are doing this work who are people of color.

- And you know, even in looking for panelists, right?

- Yes.

- That it's very difficult to find people who are competent at treating eating disorders.

- That's right.

Right.

- That makes sense.

- And then the other barrier is actually the research, right?

So when we even think about the types of eating disorders that we typically think about, right?

Most of us typically think of an affluent, cisgender, white woman who with anorexia nervosa, who's underweight.

- Yeah.

- Well, that probably only represents less than 6% of all eating disorders.

There are lots of different types of eating disorders, but the challenge is so many of them have been only studied in that white affluent population.

- Yeah.

- Mm-hmm.

- So if we're not bringing people of color and communities to the table, how do we understand how eating disorders may even manifest within different communities?

- I wanna bring Chasity in as a dietician, when a client comes to you, do they realize they have an eating disorder?

And then how do you go about diagnosing them?

- Most of the time, no.

So through the thorough nutrition assessment process, we really take a deep dive into beliefs, attitudes and habits.

And especially in our communities, it is first educating to say, hey, it is not normal to eat once a day, or it is not normal to frequently skip meals or whatever the eating disorder habit may be.

And then from there, working to remedy that.

And if it can't be remedied right away, that's where the care coordination and referral to a more advanced specialist like a therapist is needed.

And a lot of times it goes hand to hand, it's a team effort, because usually it's not always about the food.

The food, kind of like you mentioned, is a result of certain trauma or stress, anxiety that someone has been dealing with for who knows how long.

- That's a great segue 'cause that's what I was gonna ask you Cherrelle.

When we talk about the intersectionality of other traumas such as sexual abuse, child abuse, how does that impact eating disorders even further?

- Yeah, there's a huge intersectionality between trauma and eating disorders or other mental health issues and eating disorders.

And many people- - And sorry.

- Go ahead.

- Are eating disorders considered mental health disorder?

- Yes.

- Okay.

- Eating disorders are in the DSM-5 which is what we as clinicians use to diagnose any mental health illness.

- Okay.

- And so, yeah, there's a huge intersectionality.

A lot of people, unfortunately, have been traumatized around food, whether that is food insecurity like we've discussed, or it's just like perhaps there's a perpetrator who assaults someone and then they're expected to eat a meal afterwards, or they use food as like the only thing that brings them joy or feel soothing.

And so there's a lot of connection unpacking we have to do as clinicians when people have trauma.

So yes, huge, huge overlap.

- Wow.

- And I wanna add, even though they are psychiatric conditions, they're mental health conditions, there's so much overlap with medical conditions.

So a lot of the eating disorders actually have medical consequences as a result of them.

So that's why it's really important to do a thorough assessment because it really does cross the line of both sides of medical and in psychiatry.

It really is a perfect example of how they are so interconnected.

- Yep - Yeah.

- Yeah.

And sometimes the nutritional deficiencies are more telling because that trust in talking to a provider, you may say, "Yeah, I eat three meals a day and that's it."

But what are these meals?

And it may take some time to open up so it really can impact other things internally as well.

- Another barrier I had in putting the show together was that we like to have what we call B-roll, video over what we're talking about, but there was no video or images that I could find that depicted Black women or Black men or Black children with eating disorders.

And that was the most frustrating thing.

And so when I think to myself, if I did have an eating disorder, I was maybe thinking, I may not even think it's possible for me.

- Right.

- Right.

Yeah.

- Because I don't see myself in media represented in that space.

- Absolutely.

- Yep.

- Is there work being done around this?

- Well this is part of it, right?

- Yeah.

- Yes.

- Is bringing awareness to the table, right?

And bringing people of color who have been in this space to the table, right?

Bringing them into leadership positions because we are being left out of the story.

And it's really unfortunate because as you mentioned, if you don't see yourself and you think, "Okay, that I can't possibly be dealing with that," and then you struggle on your own, what then happens is you struggle for a longer period of time.

- Yeah.

- And then by the time you do reach that treatment, things are so bad, you actually end up having poor outcomes than so many others because your treatment has been delayed for so long.

So we tend to have more difficult times navigating our eating disorders when we're struggling because we just don't have the resources, we don't see people, we don't even know where to begin.

- Right.

There's a lot of silence and shame around it too, is that you say?

- Mm-hmm.

- What have you experienced in that difficulty of getting a patient to just even onboard to the idea that this is a thing for me?

- Yeah.

I've had so many patients that are like, "I don't have an eating disorder.

Black people don't have eating disorders."

Or my mom says "It's normal to eat this way" or, you know.

So I think a lot of it is dispelling what people have internalized over time to believe is an issue or not an issue.

But I like to just present people with education and say "Hey look, this is what the DSM suggests, let's talk about your symptoms that you're experiencing."

And I think sometimes providing people more education helps them to realize like, "Oh wow, I do have a lot of anxiety around food."

- Yeah.

- Yeah.

- Or a lot of anxiety about mealtimes with my family.

And so yeah, I think that helps people to shift into like, "Okay, I do need some assistance, I need some help."

Then it becomes where do you get treatment?

Because treatment's very expensive, especially if you need a higher level of care.

It's about $80,000 for treatment, which most of us cannot afford.

And so I think like we were doing here, having more education and more resources so that people can know where to go to seek help.

- Yeah, 'cause there's a lot of misinformation out there, which can be even more harmful as well, so getting that right information is key.

- And thinking about, because clinicians don't recognize it in us as well, sometimes we're even put on diets or weight management or medications to lose weight.

And we can actually be causing so much harm as a profession when we don't take the time to sit and actually explore what that person's relationship is like to their body, to food, to exercise.

- Right.

- Right.

- So, yeah, so important.

- Wow.

Well, ultimately, the key to accurate diagnoses is to approach each individual with empathy, open-mindedness and a willingness to understand their unique experiences within their cultural context.

Cultural competence and sensitivity are crucial components to providing effective care for individuals from minority backgrounds who may be at risk or of struggling with eating disorders.

If you're wondering what some of those signs look like, we'll talk about it more, but here's a graphic that shows a few dramatic changes in weight, wanting to make their own meals, unhappy with their bodies, concerned with weight, always stepping on that scale.

I want this session here to kinda just be an open conversation when we talk about some of those signs.

Are those realistic signs?

'Cause that's what I pulled from research, right?

But does that apply to us?

- Yes.

Yes.

- Yeah, that such a good question, and yes it does.

I mean, there may be some things that are a little different, right?

But I think realizing that, yes, restrictions.

So skipping meals, or eating less than what you should be eating during the day, limiting what you eat, And then maybe engaging and binging behaviors, which is eating excessive amounts of food and feeling really guilty about it.

And then engaging in compensatory behaviors that make up for it, which can include self-induced vomiting or purging, excessive exercise, abusing certain medications, like laxatives or diuretics or even caffeine, so those are very common.

And then also exploring the body checking behaviors that you talked about.

So weighing yourself excessively, looking in the mirror excessively, engaging behaviors where you're measuring yourself.

The beads, body beads, the belly bead that we are seeing.

- Oh yeah, is that what that's for?

- Yes, yes, people do that.

And they measure and see okay, how loose are they over time?

That's a way of body checking.

- So what's a healthy balance, right?

So I think we should know how much we weigh, we should be checking, making sure we're eating right.

But when does it become problematic?

Which you may have already answered that, but what's a healthy balance?

- I really think enough is when you visit your doctor once a year, right.

And I think there are people who would be like "Once a year?"

There's a lot of weight change that can happen, which is true, but I think for most adults, your clothing size doesn't really shift that much if your intake and your exercise are stable.

But I think if you notice like I'm checking frequently or if I am distressed by the number that I'm seeing and it's making me change my behavior.

So let's say I go to the doctor and I get weighed, and I don't like the number, and now I'm like shifting my behaviors drastically.

That would certainly be inappropriate.

But I really think any behavior that makes you get anxiety or that you notice like I am getting worked up about this, I'm perseverating on it, I'm really changing how I approach my life to manage my weight or manage my eating.

Yeah.

- Only a couple minutes in the show.

I always hate this part 'cause it feels like we're getting deep into it.

- [Erikka] Yes.

- Chasity, I wanna bring you in and let's talk about creating new habits 'cause we like to provide solutions as well, right?

Not just talk about the problem.

How do we create new habits around food?

- First, recognizing if there are disordered eating habits and having a individual approach because there's no one size solution with anything.

- [Kenia] Yeah.

- So if say for instance, it is frequent weighing every day, the habit is, "Okay, how can we weigh less first?"

Making small changes really can lead to bigger results.

And just that proper education on "Okay, weight fluctuates throughout the day."

So yes, your weight might be a little bit higher in the evening, but if you look back two or three weeks, you'll see that you have maintained your weight or something like that.

Is it another approach, another way to look at it, instead of "I need to be this every day."

- Cherrelle, last question about a minute left.

If we fear someone we love is dealing with symptoms that looks like an eating disorder, how do we approach that?

- With empathy.

I think notice what you're observing about their behavior and say to them, "I'm concerned about you.

How can I support you?"

If you are fortunate enough to be in touch with resources, connect them.

But I think the biggest thing is to approach without judgment, yeah.

- Thank you so much.

This was such a good conversation.

So much more to talk about and hopefully we can revisit it in a different perspective later on in the season, but thank you so much all of you for being here.

- Yes, thank you.

- Thanks for having us.

- We invite you to engage with us on Instagram using the #blackissuesforum.

You can also find our full episodes on pbsnc.org/blackissuesforum and on the PBS video app.

Thanks for watching.

I'm Kenia Thompson.

I'll see you next time.

[theme music] ♪ ♪ - [Narrator] "Black Issues Forum" is a production of PBS North Carolina with support from the Z. Smith Reynolds Foundation.

Quality Public Television is made possible through the financial contributions of viewers like you, to invite you to join them in supporting PBS NC.