In this critical episode of Inclusive Minds, Dr. Carolyn Coker Ross is joined by esteemed colleague and friend, Paula Edwards Gayfield, a leading expert on eating disorders in BIPOC communities. They dive into a powerful discussion about the unique and often invisible struggles that Black women face when seeking help for eating disorders. From systemic barriers in healthcare to the complex realities of body image that go far beyond weight, this conversation exposes how deeply racism is intertwined with diagnosis, treatment, and recovery.
In This Episode, We Discuss:
- (01:35) Barriers to Access: Why the cost, time, and lack of insurance coverage for eating disorder treatment disproportionately affect Black women.
- (05:10) Systemic Racism in Diagnosis: How the stereotype of who gets an eating disorder leaves Black women unseen, unheard, and misdiagnosed in clinical settings.
- (07:25) Binge Eating Disorder vs. “A Weight Problem”: Paula explains how clinicians often mistake Binge Eating Disorder in Black women for a simple need to lose weight, prescribing diets instead of addressing underlying trauma.
- (10:00) The Impact of New Weight-Loss Drugs (GLP-1s): A look at the dangers of prescribing drugs like Ozempic without screening for eating disorders and how they can disrupt the recovery process.
- (13:45) Beyond Size: Body Image, Colorism & Hair: A nuanced discussion on how body image for Black women is complex and includes skin color, hair texture, and facial features—issues rarely addressed in traditional treatment.
- (21:50) “You’re Acting White”: Tackling the stigma within the Black community that can prevent individuals from seeking or accepting help for an eating disorder.
- (24:30) How to Advocate for Yourself: Paula shares empowering, actionable advice for Black women on how to interview providers and demand culturally competent care.
Resources Mentioned
- Paula’s Book: Treating Black Women with Eating Disorders: A Clinician’s Guide
- Dr. Ross’s Book: Anti-Blackness and the Stories of Authentic Allies
- National Eating Disorder Association (NEDA): Provides resources, support, and screening tools.
- Project HEAL: Offers support for treatment access.
- The Loveland Foundation: Helps Black women and girls find affordable therapy.
- Therapy for Black Girls
- Therapy for Black Men
- Institute for Antiracism and Equity: Co-founded by Dr. Carolyn Coker Ross.
Connect with Our Guest
- Paula Edwards Gayfield, LPC, CEDS-C: Learn more about Paula’s work at The Renfrew Center and in her private practice.
Follow the Host
- Dr. Carolyn Coker Ross: Find more from Dr. Ross at her official website.
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Dr. Carolyn Coker Ross: Hi, this is Dr. Carolyn Coker Ross, bringing you the Inclusive Minds Podcast. This podcast was inspired by the book of which I’m a co-editor entitled Anti-Blackness and the Stories of Authentic Allies. Lived experiences in the fight against institutionalized racism. If you’re a psychologist, a social worker, an addiction professional, or a healthcare provider, or anyone who wants to broaden your horizons, then this podcast is for you.
The goal of the podcast is to help you understand some of the more complex issues facing our culture today. My guest. Are experts in their fields, and we’ll be talking about a wide array of topics including cross-cultural issues, the intersection of race and trauma, social justice and health inequities.
They will be sharing both their lived experiences and their expert opinions. The goal is to give you a felt experience and to let you know that you are not alone in being confused by these complex issues. We want to provide nuanced information with context that will enable you to make your own decisions about these important topics.
Hi everybody and welcome to the Inclusive Minds Podcast. Today I have a very special guest, Paula Edwards Gayfield who’s a friend and a colleague, and she’s the regional Assistant Vice President and diversity and inclusion co-chair at the Renfru Center, where she oversees clinical and administrative operations for multiple sites.
Yeah, she’s definitely a busy woman, including Renfrew’s Virtual Program, Renfrew At Home. She is the co-author of Black Women with Eating Disorders, clinical Treatment Considerations, and she’s a contributing author to treating Black Women with eating disorders. A clinician’s guide with over 20 years of experience treating, eating disorders and co-occurring mental health concerns.
Paula works extensively with adolescents, adults, and families, and presents nationally on topics related to eating disorders, culture, and equity. She’s a certified eating disorder specialist and approved consultant through IEP, and currently serves on the boards of the National Eating Disorder Association.
Project Blackbird and the advisory board for the eating disorder recovery support. Paula is deeply committed to advancing culturally responsive care and amplifying the voices of bipoc communities. And she also maintains in her tiny bit of time she has left private practice. Welcome to the show, Paula.
Thank you, Carolyn. Oh, it’s my pleasure. I am so honored to be here with you, and thank you for saying a friend, because I think that’s what I always think about with you. Of course. Even though I know I hold you in such high regard and esteem, but then it’s like, yep, I know Carolyn. Like, um, you know, versus when I hear people say Dr. Ross, I’m like, oh, Carolyn, you know
Dr. Carolyn Coker Ross: who she,
Paula Edwards Gayfield: yeah, exactly. So thank you.
Dr. Carolyn Coker Ross: Yeah. So you are, as your bio states, ultimately one of the most qualified people to talk about treating black women with eating disorders, can you share some of the unique challenges that black women face when they’re trying to access treatment for an eating disorder?
Paula Edwards Gayfield: Yeah, I think, you know, interestingly, I, in my free time, as you stated, I do, if I can say a Bipoc outpatient support group and actually just did that proceeding, this discussion and That was actually one of the topics of conversations that came up with really being able to truly be committed to treatment when they can participate in treatment.
But even the challenges of getting there. So as you questioned, when I think about some of the unique challenges is, and my caveat is I don’t wanna make it like all black women are, uh, you know, the socioeconomic status that they cannot afford treatment or don’t have access to insurance. But I think about the, the cost of.
You know, the impact on family, the cost of, you know, how do I balance a job or how might I need to balance other responsibilities,
Dr. Carolyn Coker Ross: the time taking off from work.
Paula Edwards Gayfield: Absolutely. Especially if they don’t have that additional support. So, and I think unfortunately as providers, we sometimes see that as, oh, you’re not motivated.
For treatment, but my life may not align with what you’re asking me to do treatment wise. Yeah.
Dr. Carolyn Coker Ross: You can’t expect someone to go bankrupt just to get help.
Paula Edwards Gayfield: Agreed. Agreed.
Dr. Carolyn Coker Ross: And, and we know across the country, black people are underinsured and that’s only gonna get worse now. So. They may have insurance, but it may not, not cover treatment.
Paula Edwards Gayfield: It may not cover. Absolutely. And I think that’s, or higher deductibles or something that frequently see issues. Yes. Yeah.
Dr. Carolyn Coker Ross: So, um, my next question is how do you see systemic racism and its effect on the diagnosis and care provided to black women with eating disorders? How does that impact them?
Paula Edwards Gayfield: Gosh, in so many different ways.I think in terms of, you know, does the culture of a treat if they’re in a treatment facility, let’s start there down to like a individual outpatient, but does the culture that’s in a treatment facility support diversity, does it reinforce, um, a sense of safety connectedness that this is for people of color, for black women?
And I think that even in an Ultimate space that let’s say, yes, you still have individual people, do they? And so as a system in a, in a eating disorder treatment facility, how do they continue to reinforce training, addressing biases amongst their staff? How are we continuously talking about the needs of black women as well as other people of color with respect to treatment?
I think systemically we still have this belief of who gets an eating disorder, who’s impacted by it, even if you didn’t think black women. It’s still just this sense of thin, white adolescent, higher socioeconomic status, you know, young sort of thing. And that’s not the only people who are impacted as we know.
And I also think sometimes when we think an the diagnosis of anorexia, it’s the smallest like. Subset of full criteria according to the DSM and,
Dr. Carolyn Coker Ross: and actually binge eating disorder is more common than anorexia bulimia.
Paula Edwards Gayfield: Absolutely, it is. Yeah. But interesting. You know, Carolyn, I think that if we saw binge eating in black women, it gets seen as, oh, out of control.
Like maybe is it really binge eating? Because then if it’s resulted in a larger body size, then it’s out of control. The focus is on weight, weight loss versus eating patterns. What’s going on? You know, what’s underlying,
Dr. Carolyn Coker Ross: what kind of trauma do you have? What kind?
Paula Edwards Gayfield: Absolutely. And these missed opportunities to even ask those questions.
A client once said to me, even in. Westernized medicine just to identify it that way. Even when you have black providers, they’re still, they’ve sort of taken on the systemic beliefs of, you know, who gets impacted and maybe not necessarily listening to their black clients as well.
Dr. Carolyn Coker Ross: Yeah, exactly. Mm-hmm. What do you think about, you know, the, because one of the things that you mentioned is really something I.
See a lot of, which is, you know, black women with binge eating disorder who are in larger bodies being told, oh, you don’t have an eating disorder, you just need to lose weight. You know, and then being sent to weight loss programs, which can exacerbate their eating disorders. Do you think the use the current, you know, use of GLP ones and those types of drugs are making that worse?
Or, or have you seen that in, in your centers?
Paula Edwards Gayfield: We’ve seen it a little bit. I do think it makes it worse, in part because it’s not a long-term solution. kinda like what we say with diets, like they don’t necessarily work. I think people who have been on or used GLP ones, maybe you have to keep using it in order to have the same, you know, effect that you or desired result.
But what we’ve sort of noticed. In our treatment facilities to some extent, especially in our non-residential facilities. Is that the impact of a person being able to have the meal, you know, that then has sort of, you know, at, in treatment and so, and part of that, because they’re full, they may feel sick, you know, they, they can only.
Consume so much before feeling fuller, but also,
Dr. Carolyn Coker Ross: so the whole component of nutrition and how you try to teach a, a patient how to eat differently.
Paula Edwards Gayfield: Correct.
Dr. Carolyn Coker Ross: Learn what is a normal portion and all of those things then will be skewed because their appetite has changed and they. It may be having side effects from the GLP ones.
That’s a good point.
Paula Edwards Gayfield: Absolutely. And that’s what I think happens. And even though we may try to address. How do we address that with maybe some other protocols that we have in place, but Right. The behavioral change isn’t there as well as the understanding of why. I think about, I don’t know about you, but I think about if I feel sick and nauseous, I don’t wanna eat either, you know, realistically because I’m fearful of what that consequence may be.
Yeah. But then if that’s what the drug is doing to help decrease your appetite, and that’s one of the, um, side effects, then yeah, it, it’s a uphill battle, I think. And then getting individuals to understand that as well, because just like with eating disorders, there’s a outcome, right? There’s the benefit to doing any of the behaviors that a person may engage in.
Dr. Carolyn Coker Ross: Yeah, exactly. Like restricting. And the question will be once a person loses weight and they get off, everybody I’ve talked to has regained most of their weight, unless they continue on the GLP once, maybe at a lower dose. And I have seen that work like once a month. Almost like a maintenance. Yeah, like once a month instead of every week.
And that’s what we did with, you know, with Suboxone, the buprenorphine for opiate use disorder and you know, the maintenance dose really. Worked and reduced mortality and relapses and so on. So it’ll be, it’ll remain to be seen, but it’s, it is, my concern is it’s so drastic and the fact that they’re not screening for eating disorders,
Paula Edwards Gayfield: not screening, and it doesn’t have to come from a doctor either.
And so if you’re, it’s about I can, or absolutely a person can order it online and then you can. Increase the dosage too, and so I don’t know how that gets managed. When you’re ordering online, I’m imagining somebody, you’re having to talk with someone, but it may not be a medical doctor.
Dr. Carolyn Coker Ross: I think even the online places, they’re still medical, but most of them will not be trained in eating disorders, that’s for sure.
Paula Edwards Gayfield: Got it. I know someone who. I was on the GLP one and they got it from, I guess their medical, but someone who had like a, like a PA or aesthetic, they might have been a pa, but like one of those like aesthetics practice where maybe they did, you know, some Botox or some sort of, you know, not right. Surgery.
Surgery, but some different weight loss things as well as like. Injections and stuff, but that person was prescribing that probably a, I think it may have been a pa.
Dr. Carolyn Coker Ross: Yeah. Okay. Well, well, let’s talk a little bit about stereotypes about race and body image that can sometimes prevent black women from being.
Properly diagnosed or from seeking treatment. Mm-hmm. Like there was this, uh, kind of accepted understanding that black women, you know, love to be in a bigger body, love to be thick. And so if you’re, you know, if you’re thick, then you’re okay. You’re not gonna be worried about your size or shape. Um, and that, I just think that’s, you know, treating us as monolithic, you know?
Paula Edwards Gayfield: Yes, yes. Yeah, as you said that, I was thinking one size does not fit all. You know, because it
Dr. Carolyn Coker Ross: literally and figurative
Paula Edwards Gayfield: Exactly. Uh, because it, it does, it takes away the individual’s idea of what’s attractive, appropriate, acceptable for themself. And like you said, we’re not a monolith. I think that. If we are focusing on body image and the traditional sense in which we frequently connect it to eating disorders, then that’s how we’re missing someone’s, I guess if there are any concerns, body image wise, as well as just how they define it and look at it as we know body image.
I think about the, you know, kind of the definition of, it’s not only how we see ourselves, but how we think other people see us. And as black women and other women too, people of color. It may not just be size, shape, and weight, it’s the other things that. Connect back to racism in many ways, cultural standards, beauty standards that then, is it hair, is it skin color?
It could still be size and shape of hips or even your facial features as well. What sort of creates the standard of beauty for some black clients.
Dr. Carolyn Coker Ross: But I think then in people of color, most other non-black or indigenous people of color don’t really think much about. You know, skin color. Mm-hmm. And what we call colorism in most societies, whether it be Latinx or Caribbean, you know, the skin color is a huge determinant of body concern
Paula Edwards Gayfield: Mm-hmm.. Mm-hmm. So it really is, I think because I’ve had. Well, we’ve identified as cousins, but it was people who we really grew up with, like since I was a child and they were from Puerto Rico and they really were family like, but they biologically they weren’t, but they were family. And so I think about my cousins who were from Puerto Rico who were very much darker skinned.
I think initially that was like my exposure to people who were from Puerto Rico that were of darker skin. And so I knew that they. Would’ve considered themselves Latinx, but then to get older and see lighter skinned Puerto Rican individuals who did not necessarily identify as black was really a a difference for me.
And so to see that someone may have put on whatever documentation that they were white, I’m like, no, you’re not. You’re like, you’re Puerto Rican. And so it was just this awareness along the way developmentally of. Like you stated how colorism could exist because maybe what were the privileges that that lighter skinned individual received versus the darker skinned one?
Dr. Carolyn Coker Ross: Yeah, for sure. And you know, I, I think one of the things that comes to my mind is just the sense of, um, you know, that the, also the issue of, of hair, whether your hair is straight or curly or kinky or mm-hmm. Whatever. And you know, in my family, we actually, my family is. All of the rainbow, you know?.
My brothers, one of my brothers looks black. One looks Puerto Rican because he had kind of that wavy straight hair that darker skin and so on. But you know, each of us had a different feeling about, you know, how we looked and about. The color of our skin, the our hair, and all of that. Are you seeing that a lot in your clients as well?
Paula Edwards Gayfield: Absolutely. I think because we’ve been conditioned, and again, talk about societal messages, right? Where we people have adopted lighter skin is better. And so when I’ve seen it in families, there’s sometimes this conflict just over that, like even a sense of you think you’re better even if that person doesn’t.
Again, when I think about the things that come into the therapy room and what we’re addressing as providers, are we talking about family dynamics with respect to. Skin color and other, uh, body and size, shape. I know again, we talk about size, shape, but are we talking about features? Are we talking about, you know, hair the size of your hips too?
Absolutely. All of that.
Dr. Carolyn Coker Ross: Yeah, because those, but you know, we, we say racism, a social construct. If there wasn’t such a thing as systemic racism, you know, this conversation would be different. And how do you think that? Over time, this social construct of race has evolved or changed, if at all. I know that’s a tough one.
Paula Edwards Gayfield: That’s a great question. There’s a, that’s a great question. I think in some ways. Personally, it has not evolved. Because it’s still there. If we go back to slavery, we’re still talking about lighter skin. Darker skin, who got to be in the house, who wasn’t in the house, you know, sort of thing. But then,
Dr. Carolyn Coker Ross: and it’s still in society, you know?
Absolutely. I mean, even though it’s a social construct, it’s, it’s very much believed in. Yes. And we, we are seeing that even more nowadays, you know? Where people are talking directly about, you know, white supremacy and all of that kind stuff.
Paula Edwards Gayfield: Mm-hmm. And I, you know, I don’t know, I some, I know we all kind of explore what, so the impact of social media and things like that, and clearly there are some good aspects of social media and some that are not so great.
Mm-hmm. There are sometimes I think this conversation I want to hear, you know, from social media, if it’s spreading awareness, I get it that people still have their messages tailored to what, you know, kind of how their viewpoint may be. But I guess maybe I sometimes hope that something will seep in. You know, that what the impact really is on.
A person that you care about? Carolyn? I don’t. This isn’t necessarily connected and maybe it is. I don’t know if when, if you recall when we did a presentation together some, a few years ago and we were talking about your first racialized experience. And how there was a, um, person
Dr. Carolyn Coker Ross: that was Beverly Tatum’s exercise.
Paula Edwards Gayfield: Yes. But I will never forget the person in the room who talked about her first racialized experience when she was like, she had slept over her cousin’s house and had wanted to watch like, that’s so Raven. Because it was one of her favorite television shows. Yeah. And um, her cousins were like, oh, we can’t watch Colored tv.
And she was like, but you have a color tv. You know, and how that was like such a. Like Shocky, I think she said maybe she was like nine or 10 or something. And that was just so, I don’t know. I, I think that’s what I was thinking about when you said, ha have we improved any
Dr. Carolyn Coker Ross: that’s a, that’s a really good point because when you think about children, you know, when Beverly Tatum did that exercise and has done it, I guess probably hundreds of times.
Mm-hmm. And she always says that most people have that first racialized experience when they’re. Between five and maybe nine or so. But before that, just imagine what it’s like to be a child who hasn’t had that racialized experience. That’s what kind of the promise of what it could be if systemic racism, what didn’t exist.
Children are just playing with children. They just love their friends. They just, yeah.
Paula Edwards Gayfield: You know, there’s, you’re my friend. Exactly. Yeah. I just love my friend. Yeah, exactly.
Dr. Carolyn Coker Ross: So anyway. I’ll stop being so philosophical. Sorry. Well, it, it, I, that’s something that just frequently plays in my mind though.
Paula Edwards Gayfield: Like I, that was so powerful for me to hear someone speak and appreciate if you’re by chance listening, your vulnerability that you display, like in that, in that presentation. Yeah. Yeah. Yeah.
Dr. Carolyn Coker Ross: What about the role of family and community? Because we, within our own black and people of color community mm-hmm.
There’s a lot of, you know, bias as well. How does that play into. Or support, you know, stigmatizing those with eating disorders who are black women or bipoc women. Or men. Or men, right?
Paula Edwards Gayfield: Yeah. I think education awareness, we have to incorporate families in this process to help them, one, have an understanding of eating disorders, but also of your loved one’s eating disorder and how it presents and what the concerns are.
I think how do we also make sure that. Our black clients, I do believe that they are the experts on them. And so instead of us taking sort of this colonial view of things and then we’re gonna talk about independence and that sort of thing, and sure you can identify some independence, but if they’re a part of a system that they system is connected, we need to incorporate that, not sort of again, what we believe.
Yeah. Should be happening with our black clients. I think also addressing sort of the stigma that still is connected to mental health, but definitely eating disorders. I, I frequently still hear that people think that, you know, it’s a white, again, going back to who gets an eating disorder, so sometimes if a black person presents with it, then you’re just acting white.
You know, I’m versus for the life of me, I think about. If it’s a, if human beings could be impacted by, fill in the blank, why does something have to be, you know, only, um, applicable to a certain group of people?
Dr. Carolyn Coker Ross: Yeah. Yeah. So what advice do you give to black women who really feel that misunderstood or unseen by traditional eating disorder treatment programs?
Paula Edwards Gayfield: You know, be willing to ask them questions. I do think that asking questions sort of like, how do you address. Race and diversity. How? How does what my cultural background, the context in what I experienced as a black woman get incorporated into not just the program, but even my individual sessions, my sessions with the dietician.
I do think that I would encourage black women and individuals to not avoid discussions of race. I think my hope is that providers are bringing it up, but even if they don’t, you bring it up. You know, my, I would want you to bring it up, and then I think that’s where you get to see if they kind of pull away.
Yeah, this the person or the place for me, but not to sort of shrink yourself or tailor your, I think we do that so much already, not to tailor who you are and not to bring your whole self into the room, because then you’re not getting what you need from treatment. Yeah. I think as providers we really, really need to think about if I am treating the whole person.
Race, culture, you know, family, that’s the whole person. For lots of clients of color, it should be, in my opinion, for everybody, but also thinking about what the racial stressors may be and body politics, food traditions, again, ideally would want providers to bring that into the room, but as black clients.
Throw it out there. See what happens.
Dr. Carolyn Coker Ross: Do it. Yeah, do it yourself. Don’t, yeah. Wait for them to,
Paula Edwards Gayfield: absolutely. Do you have a copy of your book right there with you that you can hold up? I do. Yay. Let’s see it.
Dr. Carolyn Coker Ross: Okay, so that is so cool. Like women with eating disorders, it’s hot off the presses, right? Yeah. Just published.
So certainly for clinicians, this is a wonderful resource. Is it something specifically geared towards clinicians or.
Paula Edwards Gayfield: I think the language sometimes says like your client or your patient, but really we were writing this book for everyone. So whether it was a doctor, a dentist, a dietician, a therapist, a prospective patient, you know, even though I know it’s written in the context of a provider, but even that sense of.
Maybe you take it to your provider and say, you need to purchase this book. But being able to encourage that person to think about, yes, it’s okay for me to bring all of this into the room, and it’s up to the provider to be open to that and explore their biases. And dare I say this, I really do believe that opportunities to meet with a client.
As a provider, I am interviewing them. I’m trying to get a picture of them. I’m getting to know them, but as a patient, I am doing the exact same thing with that provider.
Dr. Carolyn Coker Ross: You should be interviewing the provider as well.
Paula Edwards Gayfield: Exactly. And if it feels at any point along the way that this isn’t matching or you’re not getting what you need.
Being open to saying that, being willing to seek, you know, additional resources. And I think that’s really important. I think access to care requires us to be seen and heard. I know we say those things.
Dr. Carolyn Coker Ross: You have to be proactive in many cases though.
Paula Edwards Gayfield: Yeah. But I wanna feel supported as a black woman in the process of any therapeutic relationship.
And if that support isn’t there, acknowledging it, I think that treatment in general should be, it should feel welcoming and affirming. If it doesn’t, then how are we addressing that versus we shouldn’t have to.
Dr. Carolyn Coker Ross: There’s nothing wrong with you because you don’t feel seen. Are there any other resources or you know, any organizations that people might be able to.
Access if they’re a patient or even if they’re a therapist. I think we’ve given good advice to therapists. But what if you’re a patient, a black woman with an eating disorder, Latinx, you know, Afro-Caribbean, all of all of th. Variety that we have in our. Our groups.
Paula Edwards Gayfield: Yes. You know, I do think if you’re just, if you’re questioning and you’re not certain, if you have an eating disorder, if this is disorder eating or what it arises to, I think any treatment facility you could contact and say, Hey, I’m just questioning.
Maybe you do an assessment is not a commitment. But also I think organizations like the National Eating Disorder Association, like Project Heal, like the Alliance may have Assessments or you know, tools on their websites to even start questions. Yeah, you know what this is. But I do think some of those places also have resources of providers that identify, you know, if you’re looking for a provider of color as well, that might be a place that you can start to, this place does not necessarily treat eating disorder specifically.
But the Loveland Foundation, I, you know, I love them. I know they work to find like therapist color.
Dr. Carolyn Coker Ross: What, what is the name again?
Paula Edwards Gayfield: The Loveland Foundation. And they’re usually identifying like black therapists, therapists of color, but there are also other websites like Therapy for black girls and Therapy for black men.
so there are places that are out there that are like clinicians of color. So absolutely do your research on therapy and. People of color or something, you know, that then maybe it’ll, it’ll, result with some of these places as well.
Dr. Carolyn Coker Ross: Wonderful. Well, it’s been great having you on the podcast.
Paula Edwards Gayfield: Thank you.
Thank you. Appreciate all your wisdom and experience, so thank you so much. Have you come back again.
Dr. Carolyn Coker Ross: Thank you. My pleasure. I appreciate you.
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