Why Eating Disorders in Black Women Are Missed: What "The Pitt" Shows About ER Care & Medical Weight Bias

In this solo episode, Dr. Marianne Miller explores how the Emmy-winning and Golden Globe–winning medical drama The Pitt portrays eating disorders, emergency medicine, and bias in ways that feel both culturally meaningful and clinically relevant. She reflects on how the show separates two critical themes across seasons: the medical system’s tendency to miss eating disorders in Black women, and the role of weight bias in emergency department diagnosis and care. Drawing from years of clinical experience, Dr. Miller discusses how many clients first encounter medical crisis in emergency rooms, often because of dangerously low heart rates, dizziness, fainting, or other complications linked to disordered eating. She explains how ER responses vary widely, and how bias, time pressure, and assumptions about body size or race can shape whether clinicians recognize eating disorder symptoms. The episode highlights a season two storyline in which a Black woman presents to the ER without classic eating disorder signs, making diagnosis more complex. Dr. Marianne examines why missing textbook symptoms often leads clinicians to overlook bulimia and other eating disorders, especially in populations that medicine historically underdiagnoses. She also reflects on how the show names this reality directly and why that representation matters for visibility, validation, and future care. Dr. Marianne then turns to season one’s depiction of a physician challenging a resident’s assumption that body weight predicts health. She explores how medical weight bias affects diagnosis, delays treatment, and reinforces stigma in emergency medicine. She also shares the change she wishes the episode had made, noting that many people with bulimia live in bodies that are not thin, and that anti-fat bias and racial bias together create additional barriers for Black women seeking care. Throughout the episode, Dr. Marianne centers a liberation-informed lens that honors intersectionality, context, nervous system safety, and autonomy in eating disorder recovery. She invites listeners to consider how accurate media representation can shift clinical awareness and expand who medicine recognizes as deserving care. You can watch The Pitt on HBO and HBO Max. Topics Covered in This Episode Eating disorders in Black women Missed diagnosis in emergency medicine Low heart rate and medical risk in eating disorders Bulimia without classic symptoms Medical weight bias in ER care Race, stigma, and underdiagnosis Media representation and clinical awareness Liberation-informed eating disorder therapy Related Episodes Boundaries, Therapy While Black, & Eating Disorders with Kaela Farrise, LMFT on Apple and Spotify. Avoidance, Body Image Standards, & the Notion of the Strong, Black Woman with Jasmine Jacquess, MA, PLPC on Apple and Spotify. Recommended Books -Not All Black Girls Know How to Eat: A Story of Bulimia, by Stephanie Covington-Armstrong -The Body Is Not An Apology, 2nd ed., by Sonya Renee Taylor -Fearing the Black Body: The Racial Origins of Fat Phobia, by Dr. Sabrina Strings Resources and Support If you are looking for eating disorder therapy that centers intersectionality, lived context, and liberation-informed care, you can learn more about working with Dr. Marianne Miller through therapy or consultation on her website, drmariannemiller.com. Her approach honors autonomy, neurodivergence, trauma history, body diversity, and systemic realities that shape recovery. You deserve care that sees the full picture of your life, not just symptoms on a chart.