By Chelsea Ekwughalu •
Content warning: eating disorders, body image, anorexia, and bulimia •
Cassie Ainsworth, Shannon Reed, Matilda Hunter, Blair Waldolf, Imogen Willis, Linda Carter, Honey Mitchell, and Cleo McQueen. The preceding names are those of film and television’s most prominent depictions of body dysmorphia. Although each of their bearer’s suffer from a range of eating pathologies from bulimia to anorexia nervosa, they also share a multitude of striking commonalities; all of the preceding characters are young, white, women whose psychological conditions are characterized by their desire to achieve the white, Western ideal of thinness. Art imitates life and, from these characterizations, it can be anticipated that the social and scientific perceptions of body dissatisfaction in the West circumnavigate the desire or lack thereof in women to be skinny. However, beauty standards are respective across cultures, and what is perceived as physically ideal by one group of individuals may be undesirable for another. Although risk factors for body dissatisfaction amongst white women are high, Black, Asian, and Latina women are also susceptible due to their unique, intersectional relationship with their culture and American, white beauty standards (Burke & Schaefer, 2021). Such a phenomenon is particularly applicable to Black and white women in the United States. The differences in beauty standards for the two groups are strong determinant factors in the differences between body dissatisfaction among them. While both Black and white women exhibit body dissatisfaction and experience eating related disorders, Black beauty standards are generally more accepting of diverse body types. Consequently, a significant degree of body dissatisfaction among Black women involves skin tone, hair texture, and Afro vs. Eurocentric features, the etiology of which are rooted in the intersectional identities of Black women and their unique relationship with bigotry due to gender (or sex), weight, race, and other facets of their social or political identities.
The definition of body image (BI) is in itself much more multidimensional that media depictions of the concept convey. Body image exists within affective and perceptual dimensions, wherein how one feels about and envisions their own body is susceptible to both positive and negative manipulation (Burychka et al., 2021). A plethora of psychological studies have provided evidence to support the sociocultural model of body image evaluation. Therein, societal ideals of beauty are disseminated via various sociocultural channels—medical practitioners, peers, parents, and popular media— and internalized by individuals. The environment of said individual informs either a positive or negative perception of their body, formally defined as body satisfaction or body dissatisfaction (Cash & Smolak, 2011). It follows that the manifestation of BI among Black communities compared to white communities would vary widely due to their differing beauty ideals and stereotypes.
Black communities interpret beauty and physical ideals differently from other races, a dissonance that informs their perception of their own bodies. Research indicates that Black communities are generally more receptive to larger body types and boast a higher average body mass indices (BMI) than white communities. Thus, body dissatisfaction among young Black women typically manifests when Black women present on the more extreme side of BMI (Cash & Smolak, 2011) as opposed to the moderate. Various biological, behavioral, and socio-cultural factors contribute to the differences in BMI between Black women and other groups, including higher rates of cardiovascular disease on account of psychosocial stress (from discrimmination), dietary intake, leptin resistance, and lower adiponectin levels (Agyemang & Dr. Powell-Wiley, 2013). However, Body Mass Index is calculated by dividing one’s weight in kilograms by their height in meters squared, and while certain BMI ranges are indicative of nutrition related health risks, BMI alone is not an accurate measure of health or fat distribution. As a result it is often subject to intense scrutiny and mistrust among patient populations (Cleveland Clinic, 2022), especially older Black women that correlate weight with strength of maternal capability (Andews et al, 2015). In the research examined by Franko and Roehrig, adolescent Black girls did not typically identify as being insecure with their bodies in the same manner as adolescent white girls who generally aspired to thinness due to what they perceived as societal pressure from their families, popular media, and the opposite sex. However, body dissatisfaction among Black women is an inarguable reality.
The key question when analyzing the nature of body dissatisfaction among Black women should not regard its existence, but its composition. Self-reported responses and academic Black feminist literature gathered from African-American, female students at Southwestern University support the involvement of hair insecurity, microaggressions, sexualization, and racism. Many of the Black women interviewed had a very nuanced relationship between themselves and their hair in which they expressed great pride over its versatility, but frustration with its stereotype as unsuited for professional settings. These women claimed that there was a political implication to the texture of their hair in which women who wore their natural hair were more artistically inclined, politically conscious, and insubordinate. While some of the respondents thought highly of this correlation, others avoided it to increase their financial and professional opportunities and avoid standing out. Similarly, the Black community’s preference for lighter skin which originated from institutionalized slavery and discrimination, were also supported to inform body dissatisfaction among Black women to where lightness of skin tone was cited to influence feelings of social acceptance in both white and Black environments (Awad et al, 2016). Perhaps the most prominent determinant of body expression in Black women is curvaceousness or the distribution of weight as opposed to the presence or absence of weight itself. Some women express body dissatisfaction due to their inability to adhere to the physical stereotypes of curvaceousness that pervade across their communities (Hughes, 2020). Although curvaceousness is supported by academic literature and first-person accounts to be preferential in Black communities, women who rejected it and expressed a desire to be thin, did so to conform to the white ideal of thinness and be viewed as more palatable and desirable in predominantly white areas (Cash & Smolak, 2011; Hughes, 2020).
Addended to every source of intersectional body dissatisfaction is a psychological remedy for it. However, many of the coping mechanisms utilized by Black women to rectify their BI counterintuitively promote fat phobia whilst stigmatizing the physiognomic distinctions that define their racial group. For example, many Black women remedy negative BIs by recreating a body ideal for themselves that falls into neither the stereotypically Black nor white ideal of physicality through healthism; they reconcile their lack of a curvaceous figure and afro-centric feature using their belief in regimental exercise, “calorie-counting”, and laxative misuse out of a fear of excess weight (Hughes, 2020; Lin & Gillikin, 2022). However, healthism is known to moralize BMI and attribute stereotypes of laziness and irresponsibility to individuals of greater weights, diverting the blame for the first-world’s obesity and cardiovascular disease epidemics from inefficient healthcare systems to individuals who may or may not have accessibility to balanced nutrition. Furthermore, healthism has led to the pathologization of Black communities as the scapegoats for the United States’ obesity academics (Andrews et al, 2015). This accompanied with the medical gaze and the stigmatization of Black bodies dating back to the height of institutionalized racism makes healthism an inadequate coping mechanism for intersectional body dissatisfaction (Andrews et al, 2015; Strings, 2019). The healthism driven moralization of weight has led many Black women to feel ashamed by their aspirations to fulfill the ideal of curvaceousness outlined by the Black ideal (Hughes, 2020).
Healthism is not only a politically and personally flawed philosophy that corrodes perceptual body image, but it negatively impacts the quality of clinical encounters between Black women and their physicians in the United States and United Kingdom. Health institutions in wealthy nations where cardiovascular disease and diabetes comprise the bulk of the nation’s infirmities have endeavored to mitigate the rise of obesity rates in their nations by encouraging the “medical gaze” that positions the body as an object of scrutiny and attaches a moral identity to weight. Clinicians’ interactions with their patients are defined by not only the medical gaze, but their preconceptions and stereotypes that, in this case, regard the moral indications of weight (Andrews et al, 2015). Societally, correlations have been drawn between excess weight, poverty, and laziness (. Ingrained in all consciences cultivated within the confines of society are its prejudices expressed or repressed in infinite configurations. These prejudices, although unjust, permeate throughout the medical field and a Hippocratic oath is not an impenetrable safeguard against the expression of cultural and physical biases.
As per the intersectional identity, a further layer of scrutiny is placed upon the bodies of Black women with above average BMIs in their subliminal comparisons with “mammy and matriarch” stereotypes. The “mammy” is a caricature of Black female presentation in which darker skinned, heavier Black women with coarse hair textures are portrayed as domestic and subservient. Their bodies are seen solely as an avenue for strenuous labor. The mammy stereotype faced backlash in the 1960s Black Power movement but is a nonetheless prominent stereotype among heavier-set Black women. The matriarch stereotype portrays Black women as aggressive, demanding, and emasculating and is typically described as “The angry Black woman” (Hill Collins, 1990). The adulation of Black women in recent years has cultivated the archetype of the “strong Black woman” that forgoes personal disturbances for the good of her family and community (Andrews et al, 2015).
From a medical perspective, the aforementioned biases may provide an explanation for the disproportionate amount of physical health consultation Black women in the United States and the United Kingdom receive needlessly of their higher rates of obesity and cardiovascular disease compared to other ethnic groups. Demographic analysis posits that 67% Black Women in the United Kingdom are more susceptible to cardiovascular disease, insulin dependent diabetes, and BMIs that constitute obesity compared to 57% amongst White British women (Andrews et al, 2015). Consequently, Black women are more subject to the dangers of the medical gaze and victimization at the hand of fatphobic and racist stereotypes. The mammy and matriarch stereotypes represent intersections in race, class, and gender to dehumanize Black women by diluting their identities to their bodies and its capacity to serve a broader goal. They are perceived as indestructible and immune to psychological pathology, which evidence supports contributes to underdiagnosis of Black women with depression, anxiety, and body image disorders.
A combination of a lack of medical consultations, cultural expectations, the popularity of the white ideal of thinness, and mocking portrayals of Black women (as the mammy and matriarch stereotypes) confuse Black women’s perceptual body image and make them less confident to seek medical assistance in physical health prospects (Andrews et al, 2015). Societal solutions to the issues proposed involve the de-pathologization of cultural differences as the cause of their different health prospects as opposed to inequality and discriminatory practices in healthcare (Hughes, 2020; Andrews et al 2015, Cash & Smolak, 2011).
Individually, many (Black) women prefer to combat body image distortion by shifting their perception of what makes a woman beautiful from the external to the internal self, seeking satisfaction with their identities as Black women and as individuals rather than their socio-cultural environments (Andews et al, 2015). However, the process to self-satisfaction is arduous and, in complex cases, requires an active defiance of one’s instinct for self-criticism. Several, long term clinical interventions are proven to improve body image, namely Cognitive Remediation Therapy (CRT), media literacy training, and General Cognitive-behavioral techniques (CBT). All of the preceding interventions seek to correct BI incrementally by increasing the afflicted individual’s understanding of beauty’s subjectivity, and dissect the cognitive processes that have contributed to their BI. Patients are encouraged to discuss their feelings about their body unabashedly and open themselves to new interpretations of body image.
While the origins of body dissatisfaction between racial and ethnic groups often differ, the remedies are, similar to the remedies for many psychological disorders, based in the reassessment of one’s self-perception.
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Chelsea Ekwughalu is a young, Black woman dedicated to pro-Black feminism. She is inspired by the work of Black, literary women such as Zora Neale Hurston and Claudia Jones to pursue a career in scientific journalism and pro-Black political activism. Said activism and scientific work is focused on recognizing biases inherent to the health care system and academia against the integration of Black women into these fields. She believes in intersectional feminism and increased accessibility of literary, medical, and scientific careers to Black women.