(upbeat music) - Hey y'all.

I'm Kiara Butler and welcome to Generation Rising where we discuss hard-hitting topics that our diverse communities face every day.

And today's topic is about eating disorders.

While almost 30 million Americans will have an eating disorder in their lifetime, reports consistently find that for many people of color these disorders are often overlooked.

I'd like to welcome today's guest, Dr. Amy Egbert.

She is a psychologist here in Rhode Island and an assistant professor of Psychological Sciences at the University of Connecticut.

Hey!

- Hi.

Thank you for having me.

- Yes, thank you for coming.

How are you?

- Doing great.

Excited to talk about this important topic.

- Yes.

Let's jump right in.

So when we hear the term eating disorders, like what do people typically think of?

What do they see?

Tell us more about that.

- Yeah, absolutely.

So something that we use to kind of try to help people remember what the stereotype is, is actually the word SWAG.

Oh, so it stands for skinny white affluent girls.

- [Kiara] Wow.

- And those are generally the people that we think of when we think of eating disorders.

It's somebody who is probably young, somebody who is living in a smaller body, somebody who's wealthy, and then of course somebody who identifies as being female.

For the most part, that's what you see on television.

Those are the people you see in movies who are struggling.

And I think that's really, really transferred a lot to even what the medical community sees and what people identify when they're thinking of themselves and whether or not it could be something that they're struggling with.

- And so, SWAG, skinny, white, affluent, what's the G?

- The G is girl.

- The G is girl.

And so tell me what does that look like for women of color?

'Cause we not in this SWAG right here.

- Absolutely.

And that is the big problem.

What it looks like is that women of color are largely omitted from that conversation.

And the idea is that women of color don't have eating disorders.

Why wouldn't a woman of color just be able to eat?

Why would a woman of color be struggling with it?

The stereotype is that we are not a part of that.

And you know, I think up until very recently, nobody was even really challenging that idea.

That was just what was accepted.

- As if racism doesn't exist.

Discrimination doesn't exist.

Like there are a lot of reasons that could, what does the data say around women of color and eating disorders?

- Yeah, so you know, actually, a lot of the data that we have on that is pretty old.

And so I would say it's about 15 to 20 years old.

But the best data that we have is called the National Survey of American Living.

And what that showed us was that probably in terms of Black individuals specifically about 5% met criteria for an eating disorder.

Those percentages are similar to what at that point we thought it looked like for other people as well.

So even then we weren't really seeing that, that people of color had eating disorders at lower rates.

But now what we know actually is that that's probably an underestimate.

Probably a significant underestimate because that takes into account only very specific problems with eating.

And more recent estimates would suggest that somewhere between 10 and 20% of women by the time they're age 40, would struggle with eating disorder behaviors.

- Okay.

And so there are multiple types of eating disorders and you're kind of getting into that.

Tell our viewers like name, can you go more in detail?

- Sure, yeah.

So I think what people think about probably as the most typical eating disorder would be anorexia nervosa.

So that is someone who is underweight usually to a dangerous degree.

They've lost a large amount of their body weight, but despite that, they are still having that intense fear of gaining weight.

So you see a lot of behaviors around that, restricting what they're eating, maybe exercising a lot regardless of the fact that their health is really, really in a bad place at that point.

So that's what we think of, anorexia nervosa, I think the most stereotypical eating disorder when you say somebody has an eating disorder.

The next one would be bulimia nervosa.

So that would be someone who experiences what we call binge eating episodes.

So eating a large amount in a short period of time and then doing some kind of behavior to try to kind of make up for what they're eating.

So again, the stereotype would be they are making themselves throw up in order to make up for that.

But we also know that some people who have bulimia nervosa engage in fasting.

So they say, "Okay, I had a day of a lot of eating yesterday and so today I'm not gonna eat anything."

So that would be an example.

Excessive exercise is also an example.

So I take in this many calories and I am gonna try to burn off at least this percent of the amount of calories that I took in.

Some people take laxatives or diet pills, whatever it is, we call those compensatory behaviors because they're trying to compensate for whatever it is that they ate.

And then the third one that I'll highlight today is binge eating disorder.

And so what that looks like is similar to bulimia nervosa, they have the binge eating episodes.

So eating a large amount of food, feeling kind of this sense of what we call, as clinicians and researchers, loss of control, essentially feeling like you can't stop eating or like you don't really have control over what you're eating.

You just get into it and you're kind of going and going and going, and before you know it, you've had this really large amount of food.

So they experience that at frequent periods, but there's none of those compensatory behaviors that come after that eating episode.

So those are the three that I think people tend to think about when we think of eating disorders.

- And is there one that's most common, like in the Black community that you've seen?

- So binge eating disorder would be the one that is the most common in the Black community.

Binge eating disorder tends to be something that we see more in individuals who are living in larger bodies versus anorexia where you know, you have to be underweight to have the disorder.

But we also see bulimia nervosa in the Black community as well.

The traditional kind of version of anorexia nervosa where somebody is really underweight is not something that we see as much in the Black community.

But more recently we're starting to see something that we call atypical anorexia nervosa.

And so what that looks like is the person has the same fear of weight gain.

They're doing all the same things to try to make sure that they are losing weight and in fact they do lose a significant amount of weight, but they wouldn't be classified by BMI criteria, as being underweight.

- Okay.

And so we're talking about the eating disorder side.

What does a healthy diet look like?

- Yeah, that's a good question.

I mean I think that's different for everybody.

I think we always talk about variety as being the thing that makes something healthy.

So not trying to cut out certain foods, that doesn't, that's not what you have to do to be healthy.

But trying to do things in moderation, enjoy foods that you like, have a variety of fruits and vegetables and foods from different categories and just really trying to kind of be expansive in what you're eating instead of restrictive.

- And so you're saying that there's not a lot of data around Black people or people of color with eating disorders.

What happens typically when a person goes to seek medical attention?

Are we being turned away?

Are we not being taken seriously?

Like what's happening?

- So what we know is that doctors are not recognizing eating disorders when people of color come into the doctor's office.

So in studies where they've actually given doctors kind of little vignettes and they've said, okay, read about this person, this person is white, this person is Black.

When they read about somebody who's Black, they are much less likely to even consider that that person might have an eating disorder when it's literally the exact same story that they're reading.

You've just changed the race of the person.

So we know that that's a problem and that's the case.

We also know that people of color are half as likely to get diagnosed when they come in with symptoms.

So I think it's really an uphill battle just to even get your provider to see that this might be a problem.

And I think that's because of the stereotypes that we were talking about, you and I think about this SWAG stereotype, but so does a physician.

And that's probably what they've been taught too.

So when you or I come into the doctor, the first thought that they're having is not, "Oh maybe this person has an eating disorder."

You know, if we are living in a larger body, their first thought is probably, "Oh, I need to tell them to lose weight."

Which actually would probably backfire for somebody who's struggling with their eating in the first place.

So we have a lot of underdiagnosis, we have a lot of people who are not being recognized.

And then we have a lot of people who are not able to access treatment.

So let's say your doctor does recognize that you have an eating disorder, they tell you, "Hey, maybe you might wanna try therapy.

Where are you gonna find a therapist?"

Yeah, because there aren't that many.

We know here in Rhode Island there's a major shortage of therapists.

We know that nationally, most therapists who work with people who have eating disorders, you have to pay something out of pocket.

What happens if you can't afford $150 a week?

So you know there's a few steps then, right?

So your doctor has to recognize it or somebody does so that you can try to get the information of what you need to do next.

Once you get that information, you have to find somebody who you might be able to talk to, somebody who might be able to help you.

And then you have to actually be able to kind of fit that into your life in terms of time, in terms of money, not even talking about the fit with the person.

What if you don't even like the person you found?

So it's a challenge for sure.

- The main treatment for binge eating disorder is therapy with or without medication.

The evidence-based treatments for BED are cognitive behavior therapy, interpersonal therapy, cognitive behavior therapy guided self-help, and dialectical behavior therapy for eating disorders.

Cognitive behavior therapy addresses binge eating that results from over-restricting your diet and over-focusing on your body image.

The therapy encourages better eating behaviors and it works on your self-image.

Cognitive behavioral therapy guided self-help is a way to do this kind of therapy on your own without a therapist.

Interpersonal therapy helps you identify the negative emotions that you have.

And then there's dialectical behavioral therapy for binge eating disorder.

- And then I know for me being from Mississippi, it's like, oh, you just pray that away or any taboo subject, we don't talk about it, you don't touch on it.

What do you think could be happening at home, especially in the Black community that makes people shy away from actually saying like, "Hey, I may have a eating disorder," or "Hey, I may need help"?

- Well I am from Louisiana so I know what you're talking about with that.

I think culturally speaking, and people that I've worked with, a lot of people have shared what you're saying, which is that they don't necessarily feel comfortable talking to their families about it because it might be seen almost as a weakness.

And you don't wanna come to people and instead of getting the support and the empathy that you might need, they kind of say like, "What, what's going on?

Why are you dealing with this?"

And again, I don't fault the family members who are saying that, I don't fault the friends who are saying that.

I think it's because our culture has given us this message that you shouldn't be dealing with that.

So we're combining all of these cultural issues here.

We're combining the messages from larger society that you shouldn't be dealing with an eating disorder.

Then we also have the cultural message that you're talking about, which is maybe the way that I deal with something is not going to therapy.

Maybe I should be turning to my faith.

Maybe I should be dealing with it more internally.

And so that makes a lot of people really hesitant, I think to even say that there is a problem, to acknowledge that there might be a problem, and that they are struggling.

- Yeah, and thinking back to the acronym SWAG, like if I'm only seeing white women who are like shown to have eating disorders, I may not feel like I fall in that category at all, so it must be something else.

Or this is just a bad habit that I could have picked up and it's gonna go away.

What have patients told you about what happened when they tried to like get diagnosed or seek medical attention?

- So it's a lot of what you're saying.

I think a lot of people say that the first step is even in themselves kind of thinking, "Okay, could there be something that's going on?

Is this something that I just have to live with and that I have to struggle with?

Or could there be something wrong that I could get help with?"

That's the first step.

But then a lot of people have said, "I went to my doctor and my doctor told me, 'Hey, you are overweight and you need to lose 10 pounds.'"

And they didn't ask any questions about, "Hey, tell me about your eating.

Tell me about how you feel about your body.

Tell me about what your experience is right now in your life."

They just looked at a number on a scale and they said, "Hey, this is what you need to do based on this number, not based on anything else."

We can have a whole conversation about body mass index in the Black community and whether or not that's a good measurement, but they say, "Hey, you need to lose weight."

And so many people then come to see me and they say that really made it worse.

So I thought when my doctor said this, so I must need to double down.

I must need to restrict even more.

And then the next thing you know, something that maybe could have been caught early, has turned into a full blown eating disorder.

- And so it's like the leading cause of over 10,000 deaths a year.

Is that right?

- 10,000.

- Why though?

Like why?

- So we know that eating disorders after opioid use disorder are the most common mental illnesses that people die from.

That could be because of a number of kind of physiological impacts.

So a lot of times, especially people are restricting what they're eating, that could lead to cardiac issues.

And so people actually will have a heart attack from kind of starvation essentially, 'cause that's kind of what you have to think about.

The deadliest of all the eating disorders is our very kind of stereotypical anorexia nervosa.

It's extremely deadly.

It's extremely difficult to treat, especially the longer somebody has it.

So we definitely see people who are kind of dying from those concerns.

We also know that about one in five people who struggle long term with eating disorders actually die by suicide.

And so that's a major factor as well because it's a big struggle that may not feel understood, that may not feel like there's really a way to get over it.

And I think a lot of people feel hopeless.

- Yeah.

And so for our viewers who are like, I need to know more about this, I wanna become more knowledgeable, maybe there's someone in my family experiencing this.

Like what resources could they tap into?

Where could they go to learn more?

- Absolutely.

So the National Eating Disorders Association is a great resource.

One of the reasons that I like NETA, that's what we call the organization, is that they have resources that range kind of across the spectrum of where you are.

So if you are somebody who is not quite sure if maybe what you're dealing with would be considered an eating disorder, they have a great screening resource that you can go on the website, you can answer some questions about what's going on and then they kind of give you some information about how likely it is that what you're dealing with would meet criteria for an eating disorder.

Then from there they have a great list of therapists that you might be able to find in your area.

They give really good information about the types of therapy that exists because once you've decided to find a therapist, right, you have to decide like, so what does that even mean?

Most people don't just know exactly what all the acronyms are for the therapies that we have.

So they have really good resources on that.

And then they have really good resources for families as well.

So if you are living with or loving or friends with somebody who's struggling, they have great resources for how you might want to talk to them.

Or if you are the person struggling, they have great resources that you might be able to share with a family member to give them a little bit of information about eating disorders and to help them to kind of understand what you might be going through.

So that's a really good resource.

They have a wonderful website, you can find that online.

Another one that I wanna highlight is a book and it's called "Overcoming Binge Eating."

So we talked specifically about how binge eating is something that for the Black community specifically can be something that happens more commonly.

And so this book is kind of like if you never even make it to therapy, if you feel like that's not for you, if you're not ready, if for whatever reason you can't access a therapist, but this is something you're struggling with, it's a great evidence-based self-help book that you can read for strategies to try to kind of manage binge eating behaviors.

It's written by the same person who writes the treatment manual that therapists use to actually work with the people that they see.

And so it's a good resource just for learning about binge eating and eating disorders and then also having some steps for something that you could do to try to kind of work toward recovery.

- And you may have mentioned this, but I do wanna bring it back.

Do you think eating disorders are more prevalent in the younger generations?

Middle age?

Older age?

What are you seeing?

- So that's also something that as time goes on, we're seeing that what we think about that changes.

Eating disorders do tend to occur the first time in adolescence, young adulthood.

We see most people being diagnosed then, or at least when they are reflecting, kind of saying like, yeah, these behaviors really did start around that time.

But for a lot of people, especially people who aren't able to access treatment, that continues on throughout their lives.

And so it's not like you age out of an eating disorder.

We really have no reason to think that.

So you could be 15 listening to this and you could be struggling, you could be 50 listening to this and you could be struggling.

We know that binge eating disorders specifically, people tend to be older when they're diagnosed.

And still tend to be struggling.

And so it doesn't matter how old you are, an eating disorder is something that you could be dealing with and something that you could get help with if you want it.

- You're struggling to lose weight and you have compulsions to eat, persistent cravings, and feeling like you can't stop?

You might have binge eating disorder.

Binge eating disorder is unfortunately massively underdiagnosed, but makes up almost half of eating disorders.

But there's tons of medication options that are available.

- For me, I was diagnosed with ADHD at the age of 30, but when I thought about the symptoms and the signs, they were always there like since elementary, but no one caught it.

And so are there any signs, like I don't want people just walking around looking for signs of someone in an eating disorder, but are there any signs that parents could be looking for, that teachers could be looking for, just in case they need to help or seek help?

- So I think the biggest one would be if you notice a major change in the way somebody is eating.

So I know that that's broad, but I want to start with something broad because I think that that looks different in every person.

And if I say to you, "Oh, if somebody starts restricting, that's something you notice."

Well for some people maybe it's not restriction.

So you notice a change, that's the first thing.

A lot of times trying to cut out whole food groups can be a sign.

So somebody says, "Well I am not eating any fried foods anymore.

I am not eating any junk food anymore."

That could be because they have had a revelation and they've decided that they are living their best life and that's a part of that.

But it could also be that they are kind of going into this pattern of restriction.

And especially when you start noticing, well first it was just fried foods and they were having baked chicken, but now they're saying, "I can't eat anything sweet."

And now they're saying, "Oh, two out of my three meals need to be a salad."

That's kind of something that you can take a look at.

And I think the other thing would be kind of shame or secretive eating.

So people who you might find, bags and bags of food in the car, for example, that's something that a lot of people who struggle with binge eating talk about that they have a spot where usually it happens.

And many times people don't want other people to know that that's what's going on.

And so parents even will say, "Oh, I noticed that my child had 10 wrappers of candy or whatever in their room."

And it's because there's shame that's associated with it.

There shouldn't be because we know that everybody struggles.

You struggle, I struggle with something.

But there does tend to be shame that's associated with it.

So that's something.

And then I would say the final thing could just be in how the person is talking about their body.

If they're saying really negative things about their body, if you notice that they seem to be really down on themselves looking in the mirror saying, "Oh, I just never look right."

Or "Oh, none of my clothes fit me."

Those kinds of things.

That could be benign because we all feel like that sometimes.

But that also could be a symptom of something larger that's brewing.

So any of these things in isolation might not be anything to worry about, but especially when you start seeing them in combination, it's something that you can can really think about and think about whether or not it might make sense just to talk to them and ask them, "How are you doing?

How are you feeling?"

Because that could really make a difference for somebody.

- Something so simple is just "How are you doing?"

Is there a particular season or time of year that you see some numbers increase, like seasonal depression is a thing, but also at the start of the year, people have those goals where they're trying to lose weight.

Do you see the numbers differ based on the time of the year?

Or is it pretty consistent?

- It's interesting because we do have this kind of conflation of our diet culture and disordered eating.

And we know that if we think of them on a spectrum, our diet culture is certainly something that feeds into that.

But our diet culture in and of itself is not necessarily disordered eating.

So because somebody in January says, "Hey, I'm gonna lose 20 pounds," that doesn't mean that they have an eating disorder.

In terms of when I tend to see people come in.

So I tend to work with a younger population, younger clientele.

So a lot of times it'll be around the beginning of the school year, kind of more pressures there.

Maybe wanting to look a certain way as they're going back to school.

I also think summertime and preparing for summertime can be something that kind of sends people off into a slippery slope especially if they feel like I'm taking this trip, I have to fit into whatever this is.

And so they might be doing things to try to make that happen.

But overall, I think an eating disorder can happen at any time.

So it's always something that somebody could be struggling with.

- Doc, you have a wealth of knowledge and this is a topic that everyone should know about and stay informed.

So how can we stay in touch?

- You can find me on Twitter.

That's probably the place that I am most reliably sharing about research on eating disorders and just that general topic.

And I'm @AmyHEgbert, so my name.

- Yes, and make sure you follow Amy on Twitter.

But you can catch all of our episodes anytime at watch.ripbs.org.

And be sure to follow us on Facebook and Twitter for the latest updates.

Finally, I would like to thank our guest Dr. Amy Egbert, for her time and wonderful work.

And we've started a tradition.

So I'm gonna have you grab some chalk, head on over to the board and leave your mark.

Let people know you were here for times to come.

Thank you so much.

- I'd love to.

Thank you.

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