MILWAUKEE, Wisconsin — According to 2015 data, in Australia, roughly 1 million people are living “with an eating disorder at any given time.” Many people with eating disorders or disordered eating seek professional help, including inpatient hospital treatment or traditional therapy. However, stigmas surrounding eating disorders stand as barriers to seeking help, especially among marginalized communities such as Australia’s Aboriginal and Torres Strait Islander people. Furthermore, the economic impacts of eating disorders among Aboriginal people show that the consequences of eating disorders are far-reaching.
The Butterfly Foundation
Results of a 2006 U.S. study show that practitioners are “less likely to diagnose a person of color with an eating disorder even if the symptoms were exactly the same as those presented by a White patient.” The consequence of the bias that eating disorders only affect affluent White females often means that people of color and marginalized groups with eating disorders go undiagnosed.
A 2020 study found that “up to 27%” of Aboriginal and Torres Strait Islander people had eating disorders compared to 9% of the entire Australian population. This preliminary data has garnered the attention of the Butterfly Foundation, an Australian charity working to prevent eating disorders and provide equitable access to treatment for all. The organization has established a national eating disorder helpline and runs several body image and eating disorder campaigns.
The Borgen Project spoke with Camilla Becket and Dr. Liz Dale from the EveryBODY is Deadly Campaign, a Butterfly Foundation initiative started in 2021, which aims to raise awareness of eating disorders among Aboriginal and Torres Strait Islander people. Becket, the marketing lead at the Butterfly Foundation, and Dr. Dale, an eating disorder researcher and counselor, told The Borgen Project that the project not only helps to identify how eating disorders affect Indigenous people but is also “essential” to developing “culturally safe and appropriate diagnosis and care.”
What Causes an Eating Disorder?
The Butterfly Foundation recognizes that anybody, including Indigenous people, can suffer from an eating disorder. Eating disorders develop due to “a combination of biological, psychological and sociocultural factors,” and for Indigenous people in Australia, one of these sociocultural factors may be poverty.
According to the Poverty in Australia Report, in 2018, 31% of Aboriginal and Torres Islander people were living in poverty, a rate even higher in very rural areas at 54%. Financial poverty contributes to food insecurity and unmet social and emotional needs, which are two well-known risk factors for binge eating disorders.
When people lack adequate access to food, they are more likely to horde or hide food when it becomes readily available, which can trigger binge eating. The two studies Dr. Dale has worked on found that binge eating disorders are more common than restrictive eating disorders in Aboriginal people, likely due to food insecurity that is a large part of the Indigenous existence and “creates a difficult relationship with food.” In remote areas, Aboriginal people rarely have “access to the traditional means of acquiring food or access to traditional food.” In 2019, 43% of Indigenous people in remote areas reported running out of food “in the previous 12 months” due to the unaffordable costs of food.
Trauma, Poverty and Well-being
Another risk factor for eating disorders among Aboriginal people is intergenerational trauma, a result of colonization and forced separations of the 20th century. During the 1900s and 1970s, the Australian government removed about “one in three Aboriginal and Torres Strait Islander children” from their families and forced them to assimilate into White culture. Descendants of these “Stolen Generations” are more likely to be socioeconomically disadvantaged and suffer from poor mental health.
These “high rates of financial insecurity, poverty [and]lack of housing” put Indigenous people at high risk of eating disorders, said Dr. Dale. Dr. Dale explains that trauma can contribute to an eating disorder because of the related “inability to fulfill some emotional gap or the desire to have control in one’s life.” People may use the false control of an eating disorder to fill the unmet needs that stem from intergenerational trauma.
How Eating Disorders Worsen Poverty
Poverty is not only a factor in the prevalence of eating disorders among Aboriginal people but it can also exacerbate the effects of these disorders. According to Beckett and Dr. Dale, Indigenous people seeking treatment for eating disorders meet many barriers, among them “cost, lower health literacy and a geographic disparity of available services.” Data from 2016 indicates that almost two-thirds of Indigenous Australians live in rural areas. Specialized health services in remote areas are scarce and travel costs to reach these services in urban areas are unaffordable for Indigenous families struggling to put food on the table.
Studies among many populations show that, in general, eating disorders have a detrimental effect on economic well-being. A study published in 2015 analyzing five years of data from the U.S. Medical Expenditures Panel Survey finds that eating disorders link to greater individual health care costs and lower employment and earnings. People with eating disorders paid almost $2,000 USD more annually for health care and were 33% less likely to be working than individuals without eating disorders.
A 2012 Australia-specific study by the Butterfly Foundation itself found that the total financial cost of eating disorders in Australia was more than $17 billion and the majority of this financial loss stems from a loss of individual earnings due to the inability to work as a result of an eating disorder. The high costs of eating disorder treatment only exacerbate poverty and discourage those with lower incomes from seeking out treatment.
The Future of Eating Disorders Among Aboriginal people
As an Aboriginal woman working as a counselor and researcher in Indigenous communities, Dr. Dale has seen first-hand the difficulties of “bridging the gap” between Western science and the Aboriginal experience. She says that “Indigenous research should be led by Indigenous people” because this is how health professionals can work most effectively to treat eating disorders among Aboriginal people. The EveryBODY is Deadly campaign is also trying to “break down negative stereotypes, foster compassion and facilitate conversation” about eating disorders among Aboriginal people.
The campaign is unique because it relies on input directly from Indigenous people — health professionals and researchers like Dr. Dale, educators and those with first-hand experiences of eating disorders. The faces of the campaign, Garigarra Mundine and Felicia Foxx, are both Aboriginal people who have dealt with eating disorders and barriers to treatment. The campaign shares these stories in hopes that increased awareness about eating disorders among Aboriginal people will dissolve barriers and stigmas and increase access to treatment.
– Emma Tkacz