Maria is a second generation Mexican American. In her early twenties, Maria experienced unbearable depression and was hospitalized for a suicide attempt. During the family's participation in her treatment, some individuals admitted they did not understand her depression or why she would want to take her own life; others simply refused to accept there was a problem. Her family would make comments such as, "She was just going through a phase." "She'll just snap out of it." "We can't let others know what is happening." Does this sound familiar to you?
However, Maria's depression served a very real purpose. Her depression and suicidality were hiding a history of sexual abuse; these unresolved issues were fueling her Binge Eating Disorder and struggle with obesity. Receiving treatment that would stabilize her suicidal thinking and depression began her journey to seek treatment for her eating disorder and eventually, her childhood sexual trauma.
Breaking Through the Issues
In my 30 years of treating patients at The Bella Vita, Maria's story is common within the Latino/a community. Over the years addressing these key issues have aided us in connecting with the Latino/a community:
The importance of focusing specifically on mental health needs of the Latino community stems from the multiple systemic factors that place this community at risk for health problems. Acculturation, or the adjustment to a new culture, carries both health risks and benefits; however, the negative effects of acculturation to American culture on diet and substance use are emerging in the research. Acculturation also carries health risks for both obesity, type two diabetes, and cardiovascular disease.
Income and wealth differences may also intersect with and exacerbate the vulnerability of Latinos to negative health outcomes. While income and wealth may vary within a specific group, Latinos consistently earn less than their white counterparts. Low income individuals must deal with barriers to affordable, quality fruits and vegetables, walking or exercising in unsafe neighborhoods, and finding the time to engage in healthy eating habits while struggling daily to make ends meet. In addition, food-insecure individuals may engage in a pattern of restricting food intake when food is scarce and engaging in overeating when food becomes available again, a pattern that increases the likelihood of obesity.
Additionally, the mental health professionals must consider the negative effects of racism and discrimination on mental health. Racism is a chronic exposure to stress that creates both physical changes in the body and a need to find a way to cope with the stress. The daily oppression and discrimination faced by people of color has tentatively been linked to higher BMI and obesity in some newer studies.
The Health Vulnerability
While obesity is a complex physical and mental health issue, it is no surprise when considering the above factors that Latinos statistically have higher obesity levels than the general US population. In the Latino/a community, 75.7% of Latina women are either overweight or obese; while slightly higher are Latino males at 81.7%. Another startling fact is that 38-40% of Latina/o girls and boys ages 2-19 are overweight or obese.
Compounding the problem is a lack of awareness and understanding of the correlation between obesity and potentially deeper, more insidious psychological issues driving this health problem. Eating disorders often develop around stressful events and serve as a way to cope with the numerous stressors one may encounter in their life. Doctors and healthcare professionals often only focus on losing weight and increasing exercise in their patients. This overlooks the potential for disordered eating fueled by biopsychosocial factors as a major contributor to the presenting problem.
Although anorexia and bulimia are present, binge eating disorder is most prominent in the Latino/a community. Binge eating disorder is associated 40-60% of the time with morbidly obese individuals; 20 ÔÇô 50% with obese individuals; and up to 40% normal weight individuals. In the Latino community, binge eating disorder is associated with obese individuals 4 to 6 times more often than those who were overweight.
As a community, we must recognize the health risk vulnerability of obesity, poor diet and sedentary lifestyle within the Latino/a community. Addressing concerns such as acculturation, income and racism will help encourage Latinos/as to embrace treatment. Also, it is important to identify eating disorders behaviors which manage deeper underlying mental health concerns.
What do you think we can do to help effectively bring awareness of eating disorders and associated mental health issues into the Latino community? Add the hash tag: #EDIncludesMe in your response to join the conversation.