Blacks With Bulimia: A Secret in Plain Sight

Debunking stereotypes, research suggests that black women are actually more likely than whites to be bulimic. So why aren't we talking about it?

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When stress mounts for Stephanie Covington Armstrong, she catches herself before reaching for comfort food. Instead she chews over what's really bothering her. "Once I can identify that, then I'm quickly able to just shift," she told The Root. "I've gone through a lot of therapy, so I'm very aware if I'm on the road to practicing behavior that's unhealthy."

Armstrong's mindfulness is worlds away from the years during which she responded to anxiety by binge eating, followed by hunching over the toilet to vomit, abusing laxatives or taking three consecutive aerobics classes and then doing thousands of sit-ups. Like the estimated 4.2 percent of American women who suffer from bulimia nervosa at some point in their lifetime, Armstrong was gripped by an obsessive cycle of bingeing and purging.

As a black woman, she also reflects growing research that debunks the myth that bulimia is an affluent white girl's disease -- and shows that African Americans are actually more likely to suffer from the disorder.

"Our community doesn't talk about this stuff," says Armstrong, who chronicled her battle in the 2009 memoir Not All Black Girls Know How to Eat: A Story of Bulimia. "I have girlfriends who've been bulimic, who casually mention it without really having any depth of conversation. Because what black woman wants to admit she can't eat? No one's tougher than us. And no one is willing to talk about it."

The Face of a Disorder

A pioneering 2000 study of black women and eating disorders, published in Archives of Family Medicine, found that black women were just as likely as white women to report recurrent binge eating and vomiting. It also concluded that black women are actually more likely to abuse laxatives or diuretics.

"Not much was surprising because we did this study to provide evidence that eating disorders exist in the black community, which until recently was not a widely held belief," Denise Wilfley, a lead researcher, told The Root. As director of the Weight Management and Eating Disorders Program at Washington University in St. Louis, Mo., which treats patients in the largely African-American city, she had long known that this was the case. "But we were surprised to find that black women used more 'nontraditional' purging methods, like laxatives and diuretics." Because the public strongly associates vomiting with bulimia, Wilfley theorizes, black women may use other means without realizing that they are in fact participating in bulimic behaviors.

Subsequent reports have produced even more stereotype-shattering results. A 2009 study (pdf) showed that not only were African-American girls 50 percent more likely than white girls to be bulimic, but girls (black or white) from the lowest income bracket were also significantly more likely -- 153 percent more -- to experience bulimia than their peers in the wealthiest group.

"We had also held the popular conception that bulimia was more common among girls from white, middle- to high-income families, so the results surprised us," Michelle Goeree, a lead researcher in the study, told The Root. It made more sense after the researchers realized that many insurance policies don't cover the doctor's visit where eating disorders are diagnosed, thus throwing off the documented numbers. "If two girls suffer from bulimia nervosa, but one is from a low-income family and the other from a high-income family, which girl is most likely to be diagnosed if it often requires a visit to the expensive psychiatrist?"

A 2011 study published in the Journal of Adolescent Health also confirms that bulimic behavior is more common among African-American youths. In fact, young people from various racial backgrounds, including Asian Americans and Latinos, were found to practice extreme food-related behaviors, such as vomiting and laxative abuse, two to 10 times more often than their white counterparts. 

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