I do not think it is about changing the entire system or about reinventing the wheel. Rather than overhauling a system that may be helping many individuals and that is evidence-based, we recommend the development of an alternate system of community-based treatment and support. This system would focus on prevention and on counseling people before they develop chronic conditions. As well, alternative approaches to care may be more appropriate for individuals for whom mainstream approaches have not worked.
While we have accurate statistics about individuals who obtain a diagnosis, our research shows that there are many others who remain undiagnosed. These unnamed and unheard others may face stigma or be dismissed by community, family, medical providers, and others on the basis of their body size or on the basis of their race or ethnicity or their gender, among other factors. To better match services to complex needs, we envision a system with multiple points of entry and multiple approaches to care and support tailored to the needs of these different groups.
A number of barriers may prevent individuals from seeking needed care, not the least of which is how we talk about eating disorders. Though we are starting to see some shifts, a number of stereotypes persist in the popular imagination. Among these, we may still expect eating disorders to be a problem of young, white, middle- to upper-class heterosexual women with hyper-emaciated bodies.
Those who don't fit this stereotype may feel that their disorder is not legitimate in the face of this single story or single representation. This perception may be magnified if people confront negative experiences with health professionals, family members, and others.
Let me give you an example. Individuals from minority groups in particular may face a system that disbelieves in their disordered eating, while also feeling that to seek treatment is to broach and also to breach their ethnic or racial identity.
For example, in researching body image and eating concerns among diverse groups of Canadian women, I spoke with a number of racialized women—Asian women, South Asian, as well as African Caribbean Canadian women—whose eating disorders were misdiagnosed or dismissed by health care providers, an experience that complicated their recovery and that they attributed to race. In other words, they attributed it to health providers' not being able to imagine, because of this dominant mythology, someone of their racial group struggling with an eating disorder. Andrea has heard similar stories from her research participants.