“Eating disorders can affect anyone of any shape or size.”
“Eating disorders don’t discriminate.”
You may have seen these statements online and most people would agree, right? But in reality, is this ethos really working in practice?
When plus-size model Tess Holliday spoke out about having anorexia, people on social media lost their minds. It seemed impossible for people to comprehend someone in a larger body restricting their eating. After all, our society teaches “eat less, move more” as the simple equation for weight loss, so there was an assumption that she must be lying because if she was really restricting, how could she possibly still be fat? Of course this resulted in a lot of online trolling for Tess, and in turn the underlying reinforcement of the idea that only thin people can have restrictive eating disorders.
When I say restrictive eating disorders, I’m referring to Anorexia and Bulimia. I think many people automatically picture a thin person, usually white, young and female, associated with these eating disorders. Often, fat people are associated with binge eating, but in reality thin people can binge and fat people can restrict. Many people aren’t familiar with the term OSFED - Other Specified Feeding or Eating Disorder – which is actually the most prevalent diagnostic category, because eating disorders don’t fit into tidy boxes like we expect them to. They are complex and nuanced; there’s no one reason someone develops an eating disorder (and all the many reasons are way too long to go into here!) Atypical Anorexia can come under this category, which is anorexia but at a “healthy” weight or above. The issue here is what is deemed as “healthy” is based on a flawed BMI system, created for white European men only, so it has been recognised as not an accurate predictor of health.
There are also biases and assumptions of medical professionals, plus the limited resources on offer for eating disorder treatment, which often results in the “sickest” people getting help (i.e. thinnest). It’s a reactionary system, based on restoring someone's weight, though of course as eating disorders are to do with mental health, having a “healthy” weight does not mean the person has recovered. The short version of this is, the entire system is broken and people are not getting the help they need. (No disrespect to anyone working in the NHS, you’re just trying your best and I thank you for that.)
My focus is usually on the societal and cultural aspects of eating disorders and disordered eating. I use the term “disordered eating” as that includes people struggling with eating who don’t fit the diagnosis criteria too – of which there are a lot! I’ve worked for eating disorder charities for about 5 years now and I continue learning more every day. I’ve heard more and more stories over the years from people who are frustrated, unheard, not believed, passed off, sent to weight management services or Slimming World, and judged because they don’t fit what an eating disorder “should” look like. All of this is causing an incredible amount of harm, discouraging people from seeking help. Even writing this here, I’m concerned about creating more fear. Do we warn people of this and risk putting them off asking for help? Or is warning them needed so they can be prepared?
If you’re reading this and you’re considering reaching out for help with an eating problem, please still do – there are good people out there who can help you. If you don’t find one initially, see someone else. If you’re at a higher weight, a focus on anything to do with intentional weight loss will NOT be helpful so do set boundaries around this. You can refuse to be weighed too, or if they say they need to, tell them you do not want to know it. I tell healthcare providers that I do not want to know my BMI every time I visit and they are fine about that. I used to feel awkward about setting those boundaries, but with practice I now definitely don’t! Boundaries are self-care!
My work has led me to learn so much about people’s relationship with food, and to continue reflecting on my own. Everyone has a body, and everyone needs to eat, so it’s really important for professionals to consider their own relationship with food and their body. Sadly there is a lot of weight stigma, bias and discrimination in the medical world, in the therapy world, and…well, THE WORLD. Nobody is immune to weight stigma and fatphobia. When I talk about weight biases in the medical profession I don’t blame individuals but rather recognise that we’ve all grown up in a society that tells us thin is good and fat is bad. This is why unpacking and challenging weight stigma and fatphobia is so important.
On an individual basis, the fear people hold about being fat is both deeply understandable and so saddening to me. There is no shame in holding these views, there is no shame in chaotic eating, or having tried every diet in the world, or having purged, and there is certainly no shame in having difficult emotions around food and your body. We live in a world where this is created and normalised.
If you’re in a larger body and you’re embarrassed or ashamed that you just can’t seem to lose weight or keep it off, please know that this is not your fault. Many people’s bodies just aren’t naturally made to be thin, and the focus on thinness often drives disordered eating. Sadly, this focus on trying to do something which supposedly makes you “healthy” is likely the very thing negatively impacting your physical and mental health.
The fear driven by narratives such as “the ob*sity epidemic” is very real and can make some people terrified that being fat will kill them. It will not; fat is not the killer but rather associated illnesses, plus the stress and trauma of living in a world that terrifies people into unhealthy behaviours such as yo-yo dieting, disordered eating, eating disorders, compulsive exercise, self-harm and more. This fear is not driving change, it’s only making things much, much worse. Fat is not an evil thing to be eradicated, but weight stigma, fatphobia and discrimination is extremely harmful and needs to stop.
Many professionals will say that not all eating disorders are about body image and weight, which is true, however dieting is the biggest risk factor for an eating disorder. Dieting is often a result of wanting to lose weight to fit with the societal narrative of thinner equals healthier (not true), so it’s all rooted in weight stigma and fatphobia. Eating disorder professionals, medical professionals, therapists/counsellors, and other professionals working with anyone who may struggle with eating (which is A LOT of people) need to understand weight stigma and fatphobia for this reason. Many people are avoiding reaching out for help, being refused help, being wrongly diagnosed, and being judged for not being “thin enough” to have an eating disorder (sadly this is very common) so things need to change now.
When I see statements like “eating disorders don’t discriminate” it makes me think about how eating disorders can often be seen as a disease that suddenly grips people, as if in a bubble from the rest of the world. Eating disorders are created from, and influenced by, a world full of inequality and discrimination. We cannot separate the person from the society and culture that has shaped them. The eating disorder treatment world is largely white, middle-class and able-bodied (professionals and researchers, and well as patients) which means this is the centred experience and everyone else is potentially left out. Also, recognising that fatphobia has roots in racism (see Sabrina Springs' work) and the impact of transphobia too, in the wider context of a capitalist system… the people who need help the most are sadly so often the ones being failed.
Until we as a society can get our heads around the fact that most with people eating disorders are fat, AND that those people may also be black, trans, disabled, and/or a mix of identities, we will continue not to meet people’s needs. Saying “eating disorders don’t discriminate” is all well and good but sadly the systems designed to help and treat people often DO discriminate.
I offer training for professionals on weight stigma and disordered eating, and I run Body Acceptance Workshops for people wanting to improve their body image. Find out more here.
I am in the final stages of training as an Integrative Counsellor and I will be taking on clients in 2023. Please contact me to find out more.