When we talk about what makes eating disorder treatment successful, we often focus on weight restoration, skill development, and identity formation—all building blocks of evidence-based treatments like family-based treatment (FBT). But there is an additional, more subtle defining factor: culture and community.

“Our culture is a primary dimension of our identity, and we cannot treat the ‘whole person’ without accounting for the customs, beliefs, and behaviors a person holds. Incorporating a patient's culture into treatment presents opportunities to better understand potential motivating factors for recovery which providers may otherwise be unaware of if adhering to Westernized treatment paradigms,” says Equip’s Senior Manager of Diversity, Equity, Inclusion, and Belonging, Scout Silverstein.

Experts also believe that incorporating community aspects into treatment—which is inherently built into FBT—can greatly impact a patient’s chances for recovery.

“It takes a village to overcome an eating disorder,” says Equip dietitian Isabel Vasquez, RD, LDN. “Incorporating a patient's community empowers the patient to know they do not have to fight the eating disorder alone. Eating disorders can be tough to overcome and thrive in isolation, so having a whole community backing a patient in their recovery gives the eating disorder less opportunity to survive.”

Equip Lead Family Mentor Chita Gastelum knows first-hand how incredibly important both culture and community can be in the recovery process. “My ancestors were Indigenous healers and in our culture we practice Curanderismo [a holistic form of traditional healing],” she says. “Curanderismo was a huge part of my ED recovery. Having this spiritual guidance allowed me to connect with something greater than myself and it gave me the faith and courage to face the beast—the eating disorder. The ED spends most of its time creating fear and anxiety to continue staying in control; incorporating the patient’s community into ED treatment creates more safe spaces for the patient to feel supported.”

Why culture has to play a role

There’s no single way to define “culture,” but in most cases, the term can encompass everything from a person’s religion and systems of belief to the languages they speak, their manner of dress, behavioral norms, rituals, and more.

“When we think of the ways culture impacts someone, it is impossible to fully separate who someone is from the cultures to which they belong,” says Equip Research Intern Bek Urban, MA. “When providers ignore culture, they cannot see the client as a whole individual. Cultural ideals around food and body vary, and when conversations around culture are left out of treatment it results in treatment providers assuming everyone has the same ideals related to food and body. This assumption causes further harm as patients are often forced to conform to the dominant cultural narrative in the United States.”

Urban also notes that this narrative has often resulted in things like diet culture and anti-fat attitudes, so by opening the door to other ways of being, providers can help deconstruct these ideals and offer treatment that is individualized and effective.

“Given that certain cultural foods are put on a pedestal over others, individuals from marginalized communities often become disconnected from their cultural foods,” Vasquez says. “Incorporating a patient's culture helps a patient connect with their authentic self and develop a more positive relationship with food. Part of the beauty of recovery is being able to rediscover the various ways food nourishes us. And in many cultures, such as my Latin culture, food is not just nutrition, it's love! Incorporating the cultural component into treatment can help a patient reclaim their relationship with food in a way that resonates with their cultural values.”

To ensure all patients receive adequate and effective treatment, it’s also important that providers practice “cultural humility,” which means being open to genuinely understanding a patient’s cultural identity and how it influences them, as well as shifting the dynamics of the clinician-patient relationship by being self-reflective and building partnerships with communities.

“Cultural humility is an appreciation of someone else's culture and an acknowledgement that you are not the expert in their cultural norms,” Vasquez says. “It entails being curious and open-minded. It means doing the work to understand someone's cultural traditions while understanding that individuals from the same cultural background may have different levels of connection to their culture. Cultural humility is key to successful treatment because if we don't fully understand the nuances of their experience in their body and their relationship to food,we may mistakenly stereotype someone or offer suggestions that don't fit within their cultural norms or values.”

But getting to know a person’s culture is only part of the equation — taking action is also critical. “It’s important for people to know that cultural humility isn’t just about getting to know someone,” Gastelum says. “It’s about creating accessibility and equity in eating disorder treatments for diverse cultures.”

Why community has to play a role

One of the primary perks of community is social support — something Silverstein says is essential to the recovery process. “For many, eating disorders can be all-consuming — impairing relationships, increasing hypervigilance, and at times leading to the false belief that one does not have a life worth living,” Silverstein says. “Incorporating community can help to remind patients that they are unconditionally loved, that they are more than their eating disorder, and that they have a safe place to turn to in a world that may feel unsafe. It is incredibly difficult, if not impossible, to heal in isolation.”

Urban agrees, adding that as social creatures, humans crave connection — something that can be lacking in traditional care. “When people are in traditional modes of treatment, they often have to leave their community behind to heal, which can feel isolating and alienating,” Urban says. “Our communities and the social networks we rely on are one of our greatest assets as humans. When we can use these assets, we are truly able to heal and see change throughout a whole family and community, something that can help foster lasting change for individuals.”

How community and culture impacted these real-life Equip patients

When 15-year-old Arya began eating disorder treatment, her East Asian culture played an integral role in her recovery. BBC Writer Ritu Agurwal described in her essay, Why India is a Nation of Foodies, “for many Indians, ‘sitting down’ with their family for a meal is one of the most important activities of the day,” a concept that resonated with Arya’s family who felt “the family that eats together stays together, and meal time is a strong source of family bonding, talking, and sharing.”

Through FBT’s focus on meals and family inclusion, Arya’s siblings were able to join in sessions and learn how best to support their sibling and their parents at the table and beyond. Arya’s mother was able to feed her recovering child familiar, nutrient-dense foods that made meal times less stressful for everyone.

For 18-year-old Talia, food has always been central to her family’s faith. Coming from a Hasidic Jewish background, her family keeps kosher, carefully maintaining the separation of meat and milk products, and engaging in the labor-intensive preparation necessary to abide by their religious rules. In FBT, Talia and her family could access effective treatment while staying aligned with their faith, and use the support of their team to navigate cultural challenges like fasting holidays.

Practical tips for parents and providers to incorporate community and culture into eating disorder treatment

Equip’s team members offer their top tips for parents and providers to successfully incorporate community and culture into ED treatment:

• Be mindful of one’s cultural languages, communication differences, beliefs, and behaviors
• Talk to your patient or loved one about who they would like involved in their treatment as a support or advocate – a friend, partner, teacher, religious leader, etc.
• Ask them: “Are there aspects of your identity you feel are important for your provider care team to know about? What do you want me to know about you and your experiences and who you are that might impact this process?”
• Inquire about cultural norms related to foods, eating patterns, and family dynamics