There are many ways to understand culture. Cultural identity can include race, ethnicity, family, gender, community and spiritual practices. 

In Canada, Western culture and colonial policies continue to shape our lives. Healthcare systems are also still rooted in colonial and racist policies. This makes it hard for different cultural groups to access care for eating disorders in a safe way, when they need it. 

Many communities are still excluded or treated unfairly within BC’s healthcare systems due to system-level racism. These communities, which include but are not limited to, Indigenous Peoples, Black and racialized communities, disabled people, gender diverse populations, neurodivergent people and those facing economic injustice often face extra barriers to care.

Food carries a lot of different cultural and spiritual meaning and can be a way to connect with others. Culturally meaningful food is also important for health and well-being. Some cultures have special rituals with food for different ceremonies, prayers or seasonal cycles. In many Indigenous communities, food is medicine, connected to land, language, harvesting and ancestors. 

People connect to food in different ways, and this connection can be important to them. But if a youth’s experiences are different from their family’s culture, having an eating disorder can be more challenging. Some youth growing up in BC come from cultures that eat different foods, in different amounts, and at different times than their peers. This can be stressful as youth try to understand how their way of eating fits in with what they see around them.  

Cultural communities may face barriers to accessing foods that are familiar and significant to them. 

These can include systemic barriers, such as income inequity, that make it harder to access enough nutritious, safe and affordable food that fits their cultural preferences. This is known as food insecurity. Not having reliable access to the food that you need or want can affect your relationship with food and may increase the risk of eating disorder symptoms.

Traditional foods can have deep connections to the land. Many cultures and communities have used traditional foods to support wellness for generations. Colonial policies, loss of land, and destruction of the environment all affect access to traditional food systems. 

Body image is not just about how we look. It is also how we feel about our bodies and their value in the world around us. Ideas about “ideal” bodies vary across cultures. For example, dominant Western standards around beauty and health are rooted in whiteness, thinness, and gender norms. These ideas appear in messages that surround us everyday. Standards of beauty and health can be harmful when youth do not see themselves represented in media and healthcare. This is especially true for Indigenous, Black, racialized, gender-diverse, and larger-bodied youth. 

Some cultures have different ideas of what an eating disorder “looks like.” That can influence whether youth think they have an eating disorder. A harmful misconception is that eating disorders mostly affect thin, white girls. This stereotype can cause harm through misdiagnoses, under‑diagnoses, and not taking the symptoms of Indigenous, Black, racialized, gender‑diverse, male and larger‑bodied youth as seriously.

Sometimes, people may feel like they don’t fit the typical profile of someone with an eating disorder. Media, society and eating disorder research do not always reflect the experiences of people from different cultural backgrounds. This can make it harder to recognize eating disorder symptoms or feel comfortable seeking help.

People may also experience stigma or concerns about seeking mental health support, which can create another barrier to accessing care. Being aware of these barriers can help health care providers offer culturally safe care and create a welcoming space where youth and families feel comfortable seeking support.

Family influences our understanding of culture and often helps shape our identity, the language we speak, our race or ethnic background, and faith or religion. Families can also play a big role in how eating disorders are experienced by youth. 

Every family’s experience with an eating disorder is different. Taking time to talk about your family’s values and strengths can help you stay connected and support open communication. The questions below are meant to help you start these conversations and explore what matters most to your child and family.

• What aspects of your background, culture, or identity feel most important to you? Are there traditions, customs or expectations around food?
• Are there parts of your background, culture or identity that may affect your child and your family’s experience with receiving eating disorders care? For example: what does mealtime look like in your household? 
• What would healing look like to your family? For example: are there cultural, traditional, or other healing practices that are important to your family? 
• What kinds of support have been most helpful in managing your child’s experience with an eating disorder? For example: support from family, friends or your community?
• What kinds of stressors make supporting your child more difficult? For example: financial pressures, family dynamics or other challenges?

Some of these questions are informed by the Cultural Formulation Interview developed by the American Psychological Association.

Communities that often experience racism and discrimination can face unique challenges getting support for eating disorders. Negative experiences within healthcare systems may make it harder for some communities to build trust with their provider and the system as a whole. For example, some cultures may have important traditional healing practices that they may hesitate to bring up to their health professional. These approaches may be different from the treatments you find in a doctor's office or hospital, but they may still play an important role in your family’s approach to healing and care. 

There can be many reasons why someone may not be able to get the help they need. Everyone has the right to access support that is meaningful to them. Community members, clinicians, and decision-makers continue to work together to make eating disorders care more inclusive and accessible for everyone. At BC Children’s Hospital, ongoing work led by Dr Sharon Hou and her research team continues to contribute to this important topic. 

Culture is part of care

It is hard for anyone to live with an eating disorder. But it can be more difficult if treatment doesn’t fully consider your background and culture. As a parent or caregiver, you know your child best and what cultural factors are important to them. You can support your child by working with your health care provider to help ensure your cultural considerations are discussed. Healing works best when it looks at the whole person, including their culture.