Eating disorders are often framed as a problem that primarily affects white, affluent women. But research—and lived experience—tell a very different story. Black individuals experience eating disorders and disordered eating at significant rates, yet are far less likely to be diagnosed or receive treatment.

At Equip, our mission is to make effective eating disorder treatment accessible to everyone who needs it. That starts with recognizing how culture, identity, and lived experience shape both risk and access to care. To help close long-standing gaps in research, we conducted a nationwide survey of 858 Black-identifying individuals to better understand eating disorder prevalence, body image, cultural influences, and barriers to treatment within the Black community.

Our findings point to a clear truth: when clinical models fail to reflect cultural realities, people fall through the cracks.

Why we conducted this research

Existing research already shows troubling disparities. Black teenagers are 50% more likely than white teenagers to engage in bulimic behaviors like binge eating and purging, yet Black, Indigenous, and People of Color (BIPOC) are half as likely to be diagnosed or receive treatment. Binge eating disorder is the most prevalent eating disorder among Black adolescents, followed by bulimia nervosa and anorexia nervosa.

Implicit bias plays a major role. In one study, clinicians reviewing identical case studies identified eating problems as concerning in 44% of white women and 41% of Hispanic women—but only 17% of Black women. This means Black patients are less likely to be asked about symptoms, referred for treatment, or diagnosed early.

What’s often missing from the data, however, is how cultural norms around food, family, and body shape create unique pathways to disordered eating that don’t always fit white-centric diagnostic frameworks. Our goal was to document those experiences directly and use them to inform more equitable, culturally responsive care.

Who we surveyed (and what we asked)

We gathered responses from 858 Black-identifying individuals across the United States. Here’s a snapshot of key demographic details:

• Age: Millennials (41%) and Gen Z (39%) made up the majority of respondents
• Gender: 62% identified as female and 35% as male
• Sexual orientation: 26% identified as LGBTQIA+
• Cultural identity: 76% said celebrating their Black heritage is very important to them

Seventeen percent reported having been diagnosed with an eating disorder. Another 26% suspected they had an eating disorder but had never been formally diagnosed—highlighting a significant gap between lived experience and clinical recognition.

To better understand what contributes to that gap, we asked questions about provider representation, cultural identity, body image, and the role food played in respondents’ families and communities.

Key findings

The survey results revealed a lot of eye-opening truths, but three central themes emerged.

Caught between “clean your plate” and disordered eating

Food often holds deep cultural meaning in Black communities: 76% of respondents said food brings people together, 66% connect it to tradition or celebration, and 64% associate it with love and care.

At the same time, many described how these cultural norms can collide with disordered eating patterns. Despite 65% never being diagnosed with an eating disorder, 41% reported restricting or skipping meals and 35% reported binge eating.

“Cooking is and always has been a huge part of my family's cultural identity. And not eating a cooked meal is seen as a sign of disrespect… I have always been expected to finish my whole meal.” — survey respondent

“Growing up, food in my family and culture was tied to love, celebration, and comfort, but it was usually really rich, heavy stuff like fried foods, mac and cheese, and desserts, and I felt pressured to eat it even when it wasn't good for me. Over time that turned into a real compulsion and messed with my mental health and relationship with food.” - survey respondent

Younger generations appear especially affected. Among Gen Z respondents, one in two reported skipping meals, and one in three said adults commented on their weight growing up—often delivering conflicting messages about food and body size.

“My mother constantly commented on my weight if I gained even five pounds. She would also then say that I shouldn't worry because I would lose it eventually. My cousins constantly commented on how small I was.” - survey respondent

Navigating impossible beauty standards

Black women, in particular, face an increasingly narrow and contradictory body ideal: a tiny waist paired with exaggerated curves. Social media trends, including the normalization of cosmetic procedures like Brazilian Butt Lifts, have intensified pressure to conform, sometimes at the expense of health.

Seventy-seven percent of respondents said mainstream beauty ideals negatively influenced their body image, and 53% reported being dissatisfied with their bodies. More than half (56%) said dieting was driven by dissatisfaction with their body shape or weight.

“This idea that the ideal image for black women is the hourglass figure has led people to turn to plastic surgery or extreme dieting to get a tiny waist and thick thighs.” — survey respondent

Others described how these pressures were reinforced at home from an early age.

“My dad would always instill how small a woman should be… ‘Nobody wants a fat girl,’ he says. Some of the things I've heard growing up.” — survey respondent

Gen Z women reported the worst mental health outcomes overall, suggesting that rapidly shifting and hyper-visible body standards may be compounding risk.

The treatment gap remains wide

While 21% of respondents rated their mental health negatively and 17% had eating disorder diagnoses, 39% had never seen a therapist. The most commonly cited barriers to care were cost (47%) and limited provider access (23%).

Representation also matters. One in three respondents said they want a Black provider, yet many reported that difficulty finding culturally competent care discouraged them from seeking treatment at all.

Gen Z respondents reported the greatest need for mental health support, along with the greatest structural barriers—pointing to a system that is struggling to meet rising demand.

How these findings can shape care going forward

This research reinforces what many in the Black community already know: eating disorders don’t look the same across cultures, and neither should treatment.

To create more equitable, effective care, we must:

• Improve cultural competence and representation among providers
• Rethink screening and diagnostic criteria to capture culturally specific experiences
• Address structural barriers like cost, access, and provider shortages

Cultural differences are often framed as obstacles to care. Our findings suggest something more hopeful: when understood and respected, culture can become a pathway to more responsive, effective treatment.

At Equip, we’re committed to continuing this work—and using these insights to help ensure that everyone with an eating disorder can access care that truly meets them where they are.

Explore more of Equip’s research advancing equity and access in eating disorder care.