Harm Reduction is Not an Excuse for Medical Neglect: Addressing Inequities in the Eating Disorder Field for BIPOC Patients

Written by: Dr. Whitney Trotter DNP, PMHNP-BC, RDN/LDN & Glo Lucas

Disclaimer: Harm reduction extends well beyond the walls of medical institutions and is widely practiced in community settings. While this article centers on harm reduction within institutional care, it’s important to recognize the immense impact and power of harm reduction practices when embraced in community-based environments.

The field of eating disorder treatment has come a long way in acknowledging the need for compassionate and individualized care. Harm reduction, an approach that emphasizes minimizing the negative consequences of high-risk behaviors, has gained traction as an effective method for treating a variety of conditions, including eating disorders. However, when providers begin using harm reduction without fully studying or understanding it, it risks turning into a form of neglect, especially for Black, Indigenous, and People of Color (BIPOC) patients.  It can become a default term when working with clients deemed low-liability because of underlying racial and class inequities.

Harm Reduction in Eating Disorder Treatment

At its core, harm reduction is a philosophy that meets individuals where they are, prioritizing their immediate safety and well-being over demanding complete abstinence or recovery from harmful behaviors. In the context of eating disorder treatment, this might mean focusing on stabilizing a patient’s health even if full recovery from disordered eating is not immediately achievable.

For example, a harm reduction approach might prioritize nutritional stability over completely eradicating binge-purge cycles in the early stages of treatment. For many patients, this approach allows for a gradual, realistic path which can be especially beneficial for those who have long-term, severe disorders.

However, while harm reduction in clinical settings can be a powerful tool in eating disorder treatment, it must be applied with caution, particularly in relation to BIPOC patients who are already facing systemic inequities in healthcare.

Harm Reduction is A Rich BIPOC Politic; It’s Meant to Serve BIPOC

Harm reduction is not new; it stems from centuries of Indigenous practices and was pioneered by movements like the Black Panthers and transgender sex workers. These communities built radical, life-saving strategies for health and safety. Yet, harm reduction has been co-opted, corporatized, and whitewashed, erasing its radical, community-driven origins. This betrayal weakens its core mission to genuinely serve and transform the lives of BIPOC. Harm reduction should never be an afterthought or an excuse to underdeliver in a field historically designed to prioritize saving the lives of white and thin women.

The Intersection of Harm Reduction and Medical Neglect for BIPOC Individuals

BIPOC patients often face a unique set of challenges in receiving appropriate care for eating disorders. Despite studies showing that BIPOC individuals experience eating disorders at comparable or even higher rates than their white counterparts, they are significantly less likely to be diagnosed or referred for treatment. Furthermore, cultural stereotypes, biases, and a lack of understanding of how eating disorders manifest in different racial and ethnic groups contribute to this gap in care.

• Bias in treatment goals: Medical professionals, consciously or unconsciously, may adopt lower standards of care for BIPOC patients, assuming they are less likely to recover or are less deserving of intensive treatment. Harm reduction is realistic care, but providers might utilize it in a way to cut corners and fai to invest in BIPOC individual’s overall health and best interest.

• Cultural misconceptions: Many eating disorder treatment programs are not equipped to address the cultural, intergeneration, neurodiversity, & socioeconomic factors that contribute to disordered eating among BIPOC populations. Superficial and white washed harm reduction approaches may overlook these complexities, leading to the perpetuation of stereotypes and a failure to provide culturally appropriate care. For instance, assumptions about "traditional diets" or "body image preferences" in communities of color may be used to justify minimal interventions.

• Narrow Focus: A key issue with the current treatment model is its heavy emphasis on weight and physical restoration, which, while essential, can become limiting when also implementing harm reduction. The problem arises when the same Western frameworks are replicated. Overemphasizing or exclusively focusing on biomedical benchmarks, even within harm reduction, can overlook other critical determinants of well-being—such as cultural and relational factors—that are crucial for meaningful and lasting progress.
  

Why Culturally Centered Care Matters

Culturally centered care is essential for communities, but it is especially critical in the care of eating disorders among BIPOC. Practicing harm reduction is crucial in the care of people with eating disorders, but it must be done in a way that is genuinely culturally centered, deeply aware of systemic inequities, and celebratory of BIPOC ingenuity in survivorship, while remaining committed to providing the highest quality of care. Without this intentional approach, harm reduction risks becoming superficial and ineffective.

Eating disorder care must not only adopt anti-racist principles while remaining a predominantly white field. It must fundamentally transform to be inherently BIPOC-centered, actively prioritizing and uplifting the experiences, voices, and needs of Black, Indigenous, and People of Color. Only when the most oppressed are centered in care can EVERYONE receive adequate and effective treatment. This means acknowledging the ways in which the medical field has historically dismissed or mistreated BIPOC patients and actively working to counter those patterns. Medical professionals must commit to seeing BIPOC as fully deserving of care that is actually meant to serve them and genuinely provides harm reduction rather than scraps. 

Accountability in Harm Reduction

The principle of harm reduction should never be used as a means to justify subpar treatment. Healthcare professionals must hold themselves accountable for ensuring that harm reduction practices do not become the go-to for providing leftover care that is ultimately medical neglectful, particularly when working with marginalized populations. When applied correctly, harm reduction has the potential to create more compassionate, realistic pathways to improving life quality but this requires an active, ongoing commitment to a fundamental shift in eating disorder care paradigms. Without this intentional change, the field will continue to fall short in addressing the needs of marginalized communities, especially BIPOC individuals.

Key Takeaways for Practitioners

1. Recognize and address biases: Examine how unconscious biases may be affecting your treatment approach with BIPOC patients. Ensure that harm reduction is being used as a tool for better care, not as a way to justify reduced standards of care.   

2. Culturally centered care: Integrate cultural understanding and anti-racist practices into harm reduction strategies, ensuring that care is tailored to the unique needs of BIPOC patients.

3. Set equitable treatment goals: Avoid the tendency to lower expectations for overall health improvement of BIPOC based on stereotypes or biases. All patients, regardless of race or background, deserve the best chance for quality and effective care. 

4. Advocate for systemic change: Acknowledge the broader systemic issues that lead to disparities in eating disorder treatment and work within your practice or institution to push for more equitable treatment standards.

Harm reduction is a valuable tool in eating disorder care but it must be wielded responsibly. For BIPOC patients, who are already navigating the harmful effects of medical neglect and systemic racism, harm reduction should be used to build trust and create a pathway to actually meeting people where they are at—not as a justification for providing less care. It's time for the eating disorder field to ensure that its practices reflect the dignity and humanity of all patients.