How can we make therapy safer for fat people with eating disorders?

I recently saw “Your Fat Friend”, a documentary about Aubrey Gordon made by Jeanie Finlay. I’m a big fan of Aubrey’s work, her books, blogs and podcast - Maintenance Phase, and she’s been a huge influence on me both personally and professionally. I am a counsellor and trainer working with people struggling with eating, body image and the impact of weight stigma. I’m passionate about highlighting the importance of helping those in larger bodies with eating disorders, and training other counsellors in understanding disordered eating and weight stigma, and this film just lit even more of a fire in me.

Image: https://www.yrfatfriendfilm.com/

In the film, Aubrey talks about having an eating disorder and the barriers for fat people trying to access help, she says eating disorder treatment/support for fat people literally doesn’t exist. This broke my heart to hear, even though I’ve heard so many stories like this from people who have been judged, dismissed and turned away. I’ve worked for eating disorder charities in different roles for over 7 years now and it’s always disheartening to hear stories of being turned away from NHS services for not being “thin enough” and the assumptions made about fat people. As Aubrey says in the film, if a fat person has an eating disorder it is assumed that must be binge eating. This is absolutely not the case; people in smaller bodies can struggle with binge eating, and fat people can struggle with restrictive eating. Binge eating can often include restriction anyway (eating less than your body requires), it’s part of what keeps the cycle going – restrict, binge, feel guilty/ashamed, and double-down on restriction again. It’s called a binge cycle and can also be applied to dieting – diet, “fail” at the diet, shame, back to dieting. This is how diet companies make money (sometimes now not using the word diet, but “wellness” or some other fluff), because it’s never the diet’s fault, right? It’s ours for lacking willpower, being lazy/not good enough etc. This is why dieting does not “work”, it’s just creating more shame, more anxiety, more self-blame, and ultimately creating more eating disorders.
 
Aubrey also mentions Atypical Anorexia, basically just the same as anorexia but not fitting the low BMI threshold to tick the box of being “sick enough”. This is extremely harmful as it’s stopping so many people from accessing services (though in the UK this is likely largely due to significant underfunding of ED services), and means we have no hope of “early interventions” which the NICE Guidelines state are so important for eating disorders. Being turned away for help, or anticipating not being able to get help, can often just exacerbate the disordered eating, with people feeling there is nowhere to turn. This was very much the sense I got from Aubrey talking about having nowhere to go as a fat person with an eating disorder. It’s so hard to have trust in professionals when they have all grown up in the same fatphobic, diet culture, and have little to no training in this. 

​When I was training to become a counsellor I realised this was very much the case for our industry too – nobody talks about eating, body image, weight stigma or fatphobia, yet it is extremely likely all counsellors will encounter people affected by these issues at some point. This is why I am so passionate about this work and filling this gap – we must make it safer for fat people to access therapy.  Counsellors must know about eating and body issues through an intersectional lens, looking at power, privilege, class and biases. Sadly, in my experience, this is not happening anywhere near enough as the industry is prominently white and middle class, and this is even more so in the eating disorder world. A huge amount of research into eating disorders, and treatment centres and charities, are run by thin, white, middle-class women, focussing on helping thin, white, female clients. There are so many people left out of eating disorder treatment, not only fat people but black people, disabled people, trans and non-binary people, and many more minoritized people. Treatment and therapy isn’t safe enough for so many people. This has to change.
 
In all honesty, the difficulty I find in writing about all these issues is that I don’t want to scare people or put them off trying to find help and support. I want to raise awareness of what’s going wrong so we can work on changing it, but for individuals seeking help, I don’t want this to be another thing that reinforces the idea that there is no help for them. There is help, there are people doing great work out there, and I believe it is possible for fat people to access the help they deserve. As Aubrey says in the film, “you can’t self-love your way out of oppression” which I totally get, but you deserve help to be able to cope, as a bare minimum. There are ways to start healing. It may always be hard navigating the world as fat person but there are ways to build resilience and compassion for yourself, and help create a better relationship with food, if that’s what you would like.

 I’m holding in mind that people reading this may be either looking support for themselves (or individuals who are just interested) or some may be counsellors/therapists or professionals looking for what they can do. So I’ll suggest some ways counsellors/therapists/ED services can help, and if you are looking for support you can perhaps use these as green flags (good things) to look out for!

• Read/listen to everything that Aubrey Gordon has ever done and watch Your Fat Friend!
• Use diverse images, including fat people, on websites/social media
• If working in-person, make sure the room is accessible with larger chairs/no arms on chairs
• Do extra CPD training on weight stigma/fatphobia (I offer this, check out my workshops page)
• Reflect on your own relationship with food, your body, and about fat bodies. We have all grown up in an anti-fat culture so nobody is exempt!
• Reflect on how body size intersects with other aspects of identity eg gender, class etc (this is something I cover in more detail in my training)
• Avoiding using weights, numbers, BMI etc where possible and avoid food diaries and encouraging tracking as this can be very shaming (if working for eating disorders services this may not be possible)
• Throw weight loss out the window – healing should not revolve around weight (again, in ED services this will not be possible). Weight is not a measure of health, and health is not a prerequisite for respect.
• Services and charities can help by elaborating on the popular slogan “eating disorders don’t discriminate” (erm, yeah but people do!) We keep being told that ED’s can come in all genders, bodies, ages etc, so why aren’t we seeing and why aren’t people experiencing that? How can you show that you don’t have discriminatory practices against fat people and minoritized groups?
• Just let fat people be fat, alright?

 
I am proud to work with people in larger bodies (and all kinds of bodies) who are struggling with a range of eating problems and body distress. Sometimes I feel like I’m the only person in their life who doesn’t tell them they need to lose weight or make them feel like their body is not good enough. We need more counsellors, therapists and people working in the eating disorder field to help fat people feel that they are safe, welcome, and cared for. I’m keen to hear other ways we can help fat people access help safely as I know there’s way more needed than just the tiny list above. We need to share ideas, so please let me know!
 
Thanks for reading. If you’re interested in having counselling please head to my counselling page for more info. If you’re interested in my workshops and trainings, I’ll be offering more soon so check out my workshops page and sign up to my mailing list and I’ll let you know when more dates come up. Thanks!

​Your Fat Friend trailer: