Food serves as nutrition. Meals are a time for replenishing, resting and reconnecting with family and friends. Celebrations are cause for feasting.
But for many American Indians and Alaska Natives, food can also become an instrument of anxiety and isolation. Worse, such disorders are rarely discussed among Natives or the medical community in Indian country.
Aberrant eating patterns barely register as a blip in Indian Health Service (IHS) materials. At the same time, urban Indian clinics are struggling to address such related problems as obesity, diabetes and mental-health issues. When coupled with other criteria—embarrassment, distress, a loss of control, and binge frequency—binge eating becomes a full-blown mental condition. It even has a recognized name: binge-eating disorder (BED).
Part of the problem is that eating disorders are often treated as physical ailments instead of the mental illnesses they are. And in Indian country, a lack of recognition that American Indians are at risk may lead to a lack of proper diagnosis.
“From my clinical experience, it’s treated more as a physical disorder, even though there are elements from a behavioral-health perspective,” says Dr. Jami Bartgis, director of research and technical assistance at the National Council of Urban Indian Health.
Practitioners may see the drawbacks inherent in this system. Last year, for example, the IHS established patient education protocols that recommend treating eating disorders, incorporating emphasis on the mind, body and spirit. But in a health-care system tasked with urgent needs and limited resources, nuances can fall by the wayside.
“We have so many more-pervasive problems that this hasn’t made the radar yet,” says Bartgis. “We’ve got the highest suicide rate of any ethnic group in the country; we’ve got incredible trauma problems. There’s depression. There’s traumatic stress. There’s behavioral-health issues like diabetes and obesity. And of course diabetes and obesity can result from binge eating and can be life-threatening. But I’m guessing the reason we haven’t addressed eating disorders is because we’re trying to put out all these other fires.”
Admittedly, when compared with suicide, binge eating pales in severity. Yet the roots of BED and other eating disorders aren’t far removed from these more-pervasive issues. BED sufferers frequently report stress as a trigger for bingeing.
“Disordered eating isn’t about the food at all,” says Sunny Sea Gold, recovered binge eater and author of Food, The Good Girl’s Drug: How to Stop Using Food to Control Your Feelings. “But our bodies are a very convenient, tangible place to place our angst, our stress, trauma, self-esteem issues, whatever else.”
One reason for the ongoing lack of attention is that eating disorders are widely viewed as a problem affecting white women. Thus, some sufferers might not recognize warning signs in themselves, thereby furthering the shame that lies at the root of their syndrome.
“We paint this picture of eating disorders being linked to rich white women because too often we think that eating disorders are about meeting a glamorized media ideal,” says Rosie Molinary, author of Hijas Americanas: Beauty, Body Image, and Growing Up Latina. “But the reality is that they’re so much more complex than that. No one group has a corner on the market, so to speak.”
“I found only very limited research on this problem,” says Dr. Ruth Striegel, a researcher and professor of psychology and social sciences at Wesleyan University. Earlier this year, she co-published a study showing that American Indian women are actually more likely than white women to experience episodes of disordered eating, specifically binge eating. But they were less likely than white women to have been properly diagnosed.
Indeed, the subject is so rarely mentioned that when Striegel began her investigation, she came to learn about it indirectly, through the study of obesity. “I met Sara Young, member of the Crow tribe, and talked about various health issues confronting tribal communities across Montana, including obesity,” she says. “This prompted me to look for research of binge eating in Native Americans.”
Obesity is indeed a health concern for the Native community: 38 percent of American Indian women are considered obese, according to the study “Obesity and American Indians/Alaska Natives,” released in 2007 and completed by the U.S. Department of Health and Human Services. But not all obese people binge eat, and not all people diagnosed with BED are obese or even overweight. Treating obesity is not the same as treating an eating disorder.
“Asking people to lose weight does not address the source of binge eating,” says Striegel. “For many people, binge eating is the result of feeling stressed.” While the medical community may theoretically make the distinction between obesity and mental health in binge eating, that doesn’t always translate to practice.
In fact, some stresses that are unique to ethnic minorities may play a role in the development of eating disorders beyond binge eating. Perversely, the attention paid to obesity within Indian country could trigger some young women’s nascent eating-disorder tendencies. Dieting is a risk factor for eating disorders like anorexia and bulimia, and the emphasis on maintaining a healthy weight could potentially backfire for some: A 1999 study found that 48 percent of Native American adolescents were trying to lose weight, more than any other ethnic group in the United States.
In addition, Native women who are more acculturated to mainstream white culture are more likely to show symptoms of anorexia and bulimia than Indian women who are less accepting of it, according to a 1993 study through the National Eating Disorders Association, published in the Journal of Multicultural Education.
“A lot of times people think disordered eating comes from a desire for physical change, and that’s not [necessarily] the case,” says Molinary. “It can come just as easily from stressors in the environment, or pressures in school. When things go out of control, it’s not surprising that people look for something they can control, which is food intake. And when you’re an ethnic minority and maybe financially struggling and there are other social and cultural issues you might face, it’s easy for things to feel out of control.”
In fact, women in low-income households are more prone to bingeing, according to a Cornell University study. Of course, poverty is hardly news to much of Indian country. Yet despite the heightened risk for disordered eating, Native sufferers may be less likely to recognize when they have a problem.
“Possibly we’ve got women who aren’t reporting, or providers who aren’t assessing,” says Bartgis. “It’s not seen a lot, so there’s an idea that it’s something that affects other people.”
Even if a sufferer reports her symptoms to a doctor and is properly diagnosed, proper care can be hard to come by.
“If we had a patient who had a serious eating disorder as a primary diagnosis, I’d probably want to send them to a specialty clinic for that—but that’s a luxury within the Indian health-care system that we don’t have,” says Bartgis. “Even when someone has a chronic history of trying to commit suicide, we have a hard time getting them access to specialty care. So the system’s ability to address these problems is probably an issue.”
Still, there are ways available to get support. The National Eating Disorders Association and the Binge Eating Disorder Association offer referrals for eating-disorder recovery groups. Overeaters Anonymous, which is a 12-step program modeled on the principles of Alcoholics Anonymous, holds meetings in every state and also hosts support groups online and over the telephone. It may be hard, but it is possible to recover from eating disorders, including binge eating.
“No matter how hard things get, you must keep moving slowly, steadily, gently forward,” says Gold, who spent 15 years suffering from and battling BED, in Food, The Good Girl’s Drug. “That’s how you’ll get to freedom and recovery—and when you do, you’re going to be blown away by how good it feels.”