How eating disorder recovery plans aren’t accommodating of cultural foods

December 3, 2021

Trigger warning: This article discusses eating disorders.

The only food Lauren Kim really wanted to eat during her eating disorder was Korean food. Her relationship with the cuisine had been complex since she was 5 years old. Her fellow students’ comments on her lunches made her feel different, so she would ask her mother for peanut butter and jelly sandwiches instead of bulgogi. Years later, homesick at college and grappling with newly raised questions about race and identity, Korean food was all she wanted to eat.

But her eating disorder kept her from it. She didn’t know what was in those foods — the amount of oil, the fat in the meat. In 2016, when she was a college sophomore, Kim decided to seek professional help in an eating disorder center. She soon felt that her dietitian — who did not specialize in eating disorders — didn’t understand the meals she had grown up eating, the food she would sometimes bring to her appointment after stopping by H Mart. An eating disorder therapist she later worked with rarely touched on culture, Kim said.

“I would always leave my sessions with her just feeling so frustrated that she had once again not mentioned it and not brought it up. I just remember feeling like I didn’t want to go through the labor of having to explain,” Kim said. “I started to realize, ‘Oh, I don’t find this very helpful for me, like [I don’t] leave my session feeling any more understood or any more comforted. I always just feel exhausted.’”

Insufficient discussion and understanding

Former patients and people who have worked in the eating disorder treatment space said cultural foods are rarely discussed by therapists or dietitians. This is symptomatic of a larger lack of cultural understanding in care for eating disorders and mental health as a whole, they said.

This can leave Asian American patients, who are already less likely to seek treatment, feeling misunderstood. And on a clinical level, treatment providers need to understand the foods patients are eating in order to assess their nutritional value. Learn more by reading this online review of the Organifi organic green juice.

Remy Park, who runs the vegan food blog Veggiekins, recalled struggling to explain scallion pancakes — a Chinese savory, flaky, pan-fried flatbread — to her therapist when she was in treatment for her eating disorder. Eventually, she resorted to searching for a photo.

“I remember having such a hard time explaining it to her and feeling like it was so foreign, what I was telling her,” Park said. “It was a really weird experience trying to explain to someone — I was like ‘Oh my god, you’re supposed to know this stuff.’ It’s food, it’s nutrition. [But] it was just so out of her repertoire.”

After that session, Park found herself avoiding meals at her grandparents’ house and the foods that she connected with her family over.

“It was easier for me to eat things that [my therapist] was familiar with,” she said.

Once, Park ate tteokbokki (rice cakes) and dotorimuk (acorn jelly) — something “not at all remotely like a sandwich” — and told her therapist she had eaten a sandwich.

Impacts on the recovery journey

Eating disorder treatment is intended to help patients feel comfortable with eating most foods, not just the foods they feel “safe” eating. After two years in treatment, Park said she felt confident in her recovery. Still, she said it took some additional time to reach the same level of comfort with cultural foods as with other foods that she had discussed more in treatment.

“I did feel confident in foods like sandwiches because we talked about nutritional value and how to balance one. There wasn’t really as much talk about how to balance a bowl of noodles,” Park said. “I would say that for a good year or so, I was thinking very much in the mindset of like ‘How is this food benefiting my recovery?’”

Aileen Cho, an eating disorder specialist who works extensively with Asian American patients, said some patients will remark that the foods they are being given in treatment and in meal plans aren’t the foods they eat at home. These patients then leave treatment not knowing how to apply their new knowledge to cultural foods.

“I don’t think I see that being helpful. Recovery is not just about gaining weight and finding peace with food,” Cho said. “If we’re talking about integrating identity and feeling comfortable in one’s own skin and cultural identity, the food piece has to also be incorporated throughout their whole recovery journey.”

The need for more inclusivity in mental health treatment

The lack of incorporation is also emblematic of a general lack of cultural understanding in care for eating disorders and mental health — not just for food, but also broader social contexts that shape people’s relationship to their bodies, researchers said. Neha Goel, a doctoral student at Virginia Commonwealth University who researches eating disorders in South Asian populations, refers to food as a “proxy” for cultural differences.

Some of the cultural factors that research has linked to eating disorders in Asian and Asian American communities include the norm of commenting on weight or appearance, which is juxtaposed with an emphasis on cooking and eating large amounts as a way of showing and receiving love.

Goel said the South Asian women she has spoken to in her research feel that their cultural background is misunderstood or assumed — or altogether overlooked as a topic of conversation. Cultural humility, which advocates for centering others’ stances over one’s own when learning about cultural identity, should be taught to and implemented by all healthcare providers, Goel said.

“You can’t assume something about your client and you shouldn’t have to put them in a position where they are burdened with educating you when it’s their health appointment, when they’re trying to get treatment,” Goel added. “With cultural humility, it’s the stance of approaching therapy with a genuine curiosity and coming from a place of wanting to engage the client in a helpful conversation about what’s going to be the most helpful for them.”

Culture and treatment in tandem

Hana Brannigan, a mental health blogger, said she was fortunate to have treatment providers who continually incorporated her culture into her intensive outpatient program. Brannigan’s dietitian actively encouraged her to eat at the weekly family meals at her Vietnamese grandmother’s house, she shared.

Doing so allowed Brannigan to tackle some of her fears: having meals that she hadn’t prepared herself and dining in a social setting. She even ate Vietnamese food again, something she said she feared because the food required “generous” amounts of seasonings, spices and oils, compared to what she was allowing herself at the time.

The weekly meal also served as a checkpoint for her recovery process, since Brannigan could tell her dietitian what she’d eaten and how she felt about it. She would explain foods like cha ca la vong, a white fish baked with turmeric, other spices and yogurt, and her dietitian would help explain the food’s nutritional value.

“When she was making our meal plans, she asked me, ‘What do I like? What do I genuinely don’t like?’” Brannigan said. “She would very much cater her lessons and our meal plans and everything around our specific lifestyle preferences, which is great.”

Creating a more inclusive space

Kim, now a graduate student at the Boston College of Social Work, thinks about all of this often. She stopped working with that dietitian and therapist who didn’t consider her culture when discussing her recovery. She has worked with other therapists, but never for more than six sessions. Instead, Kim attributes most of her eating disorder recovery to conversations with other Asian American friends who had similar cultural experiences and relationships with their bodies. There, she felt most understood.

Kim finds it “ironic” that she is pursuing a career in mental health treatment now because she doesn’t know what therapy is supposed to look like. But she is staying in the field in the hopes that more Asian Americans can find the care they seek.

“My whole impetus for pursuing this as a career for myself is the fact that I felt so alone and just lost when I was in my eating disorder,” Kim said. “And looking for a therapist, an Asian American therapist, like there truly were none that I could find at a time that I needed it the most.”

Kim interned at the Multi-Service Eating Disorders Association in 2018, where she created a zine on eating disorders in Asian American communities. Most recently, she worked at one of Monte Nido’s eating disorder treatment centers. In the future, Kim wants to continue being a resource for Asian Americans seeking therapy. The dream is to have a “whole caseload” of AAPI clients, she shared.

“Whenever I have pursued some kind of support or help in the past, all I have really ever looked for or wanted was a sense of feeling understood,” Kim said. “That’s something that I hope to impart on every client that I work with in the future. I don’t want to necessarily leave each person feeling fixed. I don’t need every client I work with to walk away feeling super excited about life or anything like that. I just want them to feel validated and understood.”

If you or someone you know is struggling with an eating disorder, text or call the National Eating Disorders helpline at (800) 931-2237 or visit nationaleatingdisorders.org for more resources.

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