Weight Stigma and Eating Disorders

By Shira Rosenbluth, licensed clinical social worker (LCSW), weight-neutral approach.

When a thin person develops an eating disorder, we express concern and fear. We worry about how much weight they’ve lost and want to do whatever we can to make sure they get adequate help. We desperately want them to start eating again and will often do whatever it takes to get there.

When a person in a larger body develops an eating disorder, not only does it often go largely ignored, the restrictive behaviors – those same behaviors we are so horrified about when thin people engage in them – are often praised and encouraged.

This was the case for me and so many people who struggle with eating disorders in bodies that  are not the stereotypical thin body we see portrayed in the media over and over again. Those false stereotypes are part of why there is often a significant delay in people with atypical anorexia accessing treatment. And this delay can be the difference in whether or not someone recovers because allowing the disorder to go untreated for years can make it much harder for someone to heal.

My eating disorder started when I was 10, when instead of viewing my changing body during puberty as normal, the adults in my life sent me to a junior weight watchers program. Within two weeks my eating disorder developed. But because I wasn’t thin and I wasn’t losing weight, it took four years for anyone to recognize my eating disorder and by then, the disorder was severe and ingrained.

My eating disorder started as bulimia. And because I was in a larger body, the school counselor and therapist both shrugged it off. “Oh, she binges,” is what my first therapist said when I was around 12 years old. And then she proceeded to give me a restrictive diet plan which only fueled my bulimia and the shame I felt about it. Of course, the more I tried to restrict, the more I ended up bingeing and purging. And four years later, it had gotten so severe that I was purging each course during a Passover meal and my family was finally forced to realize that I had a problem. It should never have gotten to that point.

Years later, my bulimia switched to anorexia. For the first time in my life, I was thin because I starved myself down to a body that fit society’s beauty standards. I was congratulated every step of the way – congratulated for starving myself. I was finally doing it “right.” I was making myself smaller like I was supposed to. The praise partly felt like a relief because I was doing what I was supposed to be doing. But the praise also came along with a sinking pit in my stomach with the realization that I was only worthy of acceptance and approval if I were smaller. And this smaller body was a body that I was dying in. Yes, I “looked” fine. But I was far from it.

Not only do people with atypical anorexia have all the same medical issues that people with anorexia have, it often comes with even more extreme behaviors, because restriction is not seen as a problem due to our thin-obsessed world. So many people believe that people in larger bodies should lose weight at any cost. And if we continue perpetuating that narrative without recognizing how deadly eating disorders are for people in ALL size bodies, we are leaving so many people without adequate help.

I remember being in treatment with someone who had lost some weight due to her anorexia. She was put on a restorative meal plan and not allowed to exercise. I came to treatment having lost 3 times that amount in a few months with all the same behaviors as my thin peer. I was put on a maintenance meal plan, allowed to exercise vigorously within 2 weeks, and told that if I kept to this meal plan maybe I could maintain this body weight; this weight I had starved myself down to.

The problem is that while that may have been the case, I was hungry all the time. But I had anorexia and could not get myself to ask for more food. It also didn’t feel safe to ask for more because then my behaviors might seem like bingeing to the treatment staff. The other problem was that though my weight was “fine” according to the ridiculous BMI, I was extremely malnourished. My body is not naturally small and was only at this weight because I starved myself there. So my anxiety, rigidity around food, counting, calculating… all these behaviors that got me in trouble in treatment for being “resistant” or “non compliant” were happening because I needed more food and weight restoration for my brain to be adequately nourished. 

I can say this all in hindsight now and as someone who is a therapist and sees this play out again and again with my clients in larger bodies who end up in treatment. But if we continue to fear weight restoration for those that aren’t in thin bodies, we are continuing to set them up to struggle with disordered eating and a brain that isn’t working at full capacity.

If you’re struggling with your child’s weight, please consider seeing a therapist if you notice yourself having difficulty refraining from commenting on your child’s body. Kids absorb and understand everything. If your child has an eating disorder in a larger body, it is critical that it is treated with the same concern as if your child were in a smaller body. Restriction (and other eating disorder behaviors) needs to be seen as serious and problematic regardless of your child’s size. Your child needs to know that they are safe and given full permission to eat all food for full healing to happen; just like a thin person with an eating disorder. 

The same way some people are a size 5 shoe while others a size 11 shoe, body diversity will always exist. We need to honor that and only then can we truly give people a chance to achieve full recovery. I know that parents want to protect their children from the world’s cruelty and there’s a lot of fear associated with children gaining weight. But it’s really important to remember that not only is it common for kids to gain an average of 40 pounds before puberty, but that we need to accept and let our children in larger bodies just BE. I promise that your child being heavier is way healthier than your child battling a lifetime of disordered eating and negative body image.