On July 16^th, Monte Nido Walden Medical Director, Child & Adolescent Psychiatry Dr. Nicole Christian-Brathwaite and Dietitian & Eating Disorders Specialist Lissa Denis RDN, CEDS-C, LD/N, presented "Where Culture Meets Care: Tailoring Interventions in Eating Disorder Treatment."  

Why Cultural Competence Is Essential in Eating Disorder Treatment

Culture plays a critical role in how individuals see themselves, experience illness, and engage in recovery. In healthcare, especially in eating disorder treatment, it’s essential to view each patient through a comprehensive, intersectional lens.  

Overlooking the impact of race, ethnicity, gender identity, socioeconomic background, and other intersecting identities can result in treatment that is ineffective or even harmful. To provide truly equitable, evidence-based care, we must actively commit to culturally humble and anti-racist approaches. This means moving beyond “color blindness,” which denies the lived realities of our patients, and instead recognizing that we all hold biases. The work lies in continually examining those biases and ensuring they do not compromise the quality or integrity of the care we provide.

Eating disorders can affect anyone. Yet, many individuals in the BIPOC community have not had equitable access to care or positive experiences within the healthcare system. Institutional racism has shaped every level of eating disorder treatment, from underdiagnosis and misdiagnosis to insurance limitations, geographic inaccessibility, and language barriers. Historically underrepresented and marginalized groups often face significant obstacles to receiving eating disorder care, as bias and discrimination are embedded in the history of healthcare. To provide effective, compassionate treatment, we must acknowledge that culture is an essential part of who we are, and that care must reflect and respect each person’s identity and lived experience.

What is Cultural Humility?

Cultural humility means embracing the fact that we don’t know everything and being open to learning from our patients. It can be difficult to admit that we need to learn, especially when working with someone from a similar background. But each individual’s experience is unique, and we must approach eating disorder care with curiosity and collaboration.  

Cultural humility invites us to build treatment plans with our patients, not for them - honoring their culture, their choices, and their voices throughout the process. This means asking how their food traditions, faith practices, and cultural values impact their relationship with food and body. For example, are we considering how religious observances like Ramadan may shift nutritional needs or treatment recommendations? Are we making space to explore what “healthy eating” looks like through a culturally relevant lens, rather than imposing a narrow standard?  

When providers make assumptions, it can lead to misdiagnosis and deepen the distrust many marginalized individuals already feel toward the healthcare system. Instead, we can choose to celebrate where our patients come from, invite their perspectives into care, and challenge rigid rules that don’t serve them.  

Cultural humility isn’t just a value, it’s a practice that brings healing into reach.

What is Trauma-Informed Treatment?

A trauma-informed stance is rooted in person-centered eating disorder care and it honors all parts of a person, not just their diagnosis. Oppression, racism, sexism, and other forms of discrimination can significantly impact how a person presents in treatment, how they respond to care, and even what food choices feel safe or accessible.  

This approach emphasizes emotional and physical safety, invites open dialogue about past experiences (including those that fall outside traditional definitions of trauma), and makes space for each person’s lived reality. Many families affected by eating disorders may be navigating this for the first time, and it’s important to create an environment where patients feel permission to share their stories without fear of judgment. The message should be clear: You can handle it, and we are here to support you.

Being trauma-informed means looking for potential triggers, being attuned to both comfort and discomfort, and committing to ongoing education. It also involves reflective listening - a core tool for building trust and improving communication. This means restating or paraphrasing what a patient shares, confirming your understanding, and conveying empathy. By doing so, you give patients the chance to clarify, feel heard, and experience connection.  

Nutrition Therapy and Cultural Sensitivity

At the heart of effective eating disorder care is a deep understanding that food is never just food. It is culture, history, emotion, identity, and community. That’s why culturally attuned nutrition therapy must go beyond structured meal plans - it must honor the lived experiences, traditions, and realities of the individuals we treat.

Traditional treatment meal plans often reflect dominant cultural norms, foods like sandwiches or cold lunches, for example, may feel unfamiliar, unappetizing, or even inappropriate for clients from diverse backgrounds. Instead, we must ask: Are we offering a wide enough variety of foods so that meals feel relevant, comforting, and recognizable to each individual?

Exposure to variety can help reduce food anxiety - but it's also important to recognize that not all clients have access to variety at home. Food insecurity, for example, may lead to hoarding, binging, or limited food experiences, and should be treated with both clinical insight and compassion. If food insecurity is still present, we work with clients to find realistic, affirming solutions without shame.

Weight, Body Image, and Cultural Ideals

Nutritional rehabilitation often includes structured meal plans, addressing weight control behaviors, improving overall nutritional status, and restoring weight when needed. Weight restoration is not about aesthetics, it’s about stability, healing, and protecting against relapse. Physiological changes that support full recovery often don’t occur until a person is nourished at their biological set point.

However, weight gain, especially for clients reaching a weight they’ve never been at before, can be deeply emotional, particularly when family or cultural ideals are tied to thinness, light skin, or Eurocentric beauty standards. In some communities, body image concerns may be compounded by colorism, body-based nicknames, or pressure from family members around body modification or appearance.

That’s why it’s essential to work not only with the individual, but with their support system as well. Families may not be familiar with eating disorders or may unintentionally reinforce harmful beliefs. Navigating these dynamics with empathy and education is a key part of recovery.

Real-World Integration and Collaboration

Culturally attuned care includes building meal plans with clients, not for them. Do we ask how observances like Ramadan may impact nutrition needs? Do we explore how food and faith intersect, and adjust treatment recommendations accordingly?

By integrating cultural humility, trauma-informed practices, and client collaboration, we not only improve outcomes, we affirm each person’s full humanity. Eating disorder treatment that meets people where they are, honors who they are, and supports where they want to go is not just more inclusive - it’s more effective.

Have you seen our list of upcoming, complimentary CE webinars? Monte Nido’s live CE events are now available on-demand—so you can watch (or re-watch) when it works for you.

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