Eating Disorder Awareness Week

This week — February 22–28 2021 — is eating disorder awareness week. The theme for this year is “Every Body Has a Seat at the Table.” The conversation around eating disorders often leaves certain bodies and experiences out, so it’s great to see NEDA raise awareness around these disorders as well as how we can show up better for all bodies.

For example, people in larger bodies face weight stigma when seeking help and support with eating disorders, and are often celebrated for engaging in behaviors that would otherwise raise concern for those in smaller bodies. Instead of getting help, they are told to continue to do all they can to lose weight, and their health will improve. This not only leaves those in larger bodies without support for eating disorders, but it also encourages the incorrect assumption that smaller bodies are healthier bodies. More than 50% of “overweight” people and more than 30% of “obese” people (by BMI standards, which are a problematic measurement on their own, but that’s another article) are metabolically healthy. Studies from the Centers for Disease Control and Prevention repeatedly find the lowest mortality rates among people whose body mass index puts them in the “overweight” and “mildly obese” categories. And recent research suggests that losing weight doesn’t actually improve health biomarkers such as blood pressure, fasting glucose, or triglyceride levels for most people. Add to that the fact that dieting does not work long term and weight cycling has significant health effects, and we are setting up people in large bodies to fail by encouraging harmful behaviors that don’t even work.

People at a higher weight are at increased risk of disordered eating compared with the general population, and individuals who use unhealthy weight control practices (e.g. fasting, purging, and diet pills) are at increased risk of being at a higher weight. Weight stigma itself is a significant risk factor for depression, low self esteem, and body dissatisfaction, which create an environment ripe for eating disorders. Among adults in larger bodies, those that experience weight stigmatization engage more in binge eating, are at an increased risk for eating disorders symptoms, are more likely to have a diagnosis for binge eating disorder, and report eating more to cope with weight stigma. People in larger bodies are at high risk for these disorders, and are being missed in diagnosis and support. We need to expand the conversation to include them and understand how their lived experience influences their quality of care.

Then there is the impact of racism. Despite similar rates of eating disorders across races, people of color are significantly less likely to receive help for their eating issues. Medical racism shows up here — in a study from 2006, clinicians were presented with identical case studies that demonstrated eating disorder symptoms. The rate at which clinicians identified these symptoms as problematic was directly tied to the patient’s race: 44% identified it when the patient was white, 41% when the patient was Hispanic, and only 17% when the patient was Black. The clinicians were also less likely to recommend that the Black woman receive professional help. Another study found Latina and Native American participants specifically were less likely than Caucasians to receive a referral for further evaluation or care no matter how severe their symptoms.

In August 2019, the results of the largest population-based study of Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (DSM-5) eating disorders was presented. The researchers found discouragingly low rates of help-seeking behavior in adults with anorexia nervosa (34.5%), bulimia nervosa (62.6%), and binge eating disorder (49.0%). These findings also showed that the rate of health-seeking behavior was influenced by sex and ethnic/racial disparities. Meaning that not only are those with eating disorders not likely to seek help, but that men and ethnic/racial minorities were significantly less likely to seek help than were women and non-Hispanic white individuals. Unconcious bias and white supremacy create very real and very serious challenges for people to get the care they need, and this can lead to these patients not seeking care at all.

So this week, as we bring awareness to eating disorders, we should make sure we include in that conversation how different aspects of identity affect eating disorders and those of us that struggle with them. We should challenge the parts of our society that drive people to these disorders in the first place, and address the parts of society that make it harder to receive care for different types of people based on their identity. The best known environemental contributor to the development of an eating disorder is the socio-cultural idealization of thinness. As we challenge that part of our culture, can we have a conversation that challenges idealization of thinness for more than white women? Can we have a conversation that doesn’t allow for a double standard when it comes to those in larger bodies? Can we have explore an expansive view of care that includes everyone and builds a world where all bodies belong?

If you want to be part of the conversation, here are some ideas to get you started from me — a fitness professional of over 17 years and a person that has struggled with an eating disorder.

• Reject the idealization of thinness in your own life. Get rid of the scale. Challenge the idea that a diet will deliver your goals in life. Reflect on your here and now body and acknowledge if you feel pressure to change or shrink it — can you reject that? Where is that pressure coming from? Who told you that you need to be thin to be (fill in the blank)? What would happen if you embraced and celebrated your body as it is, today? What would that look like? Try journaling about it a few days this week and see what comes up for you.
• Divorce morality from thinness. No body is better than another. Fat and thin should be neutral descriptors like tall and short. What can you do to start to shift your mindset around worth and body shape and size? Can you believe that your body is worthy as it is, and that other bodies are worthy as they are, exactly as they are today? Start to notice what messages you get throughout the week that thin = worthy. How can you let go of that false narrative and reframe worthiness as something inherent to all people — all sizes, all shapes, all genders, all races, all sexualities, all abilities, all of us?
• Let food be food! Diet culture tries to convince us to live by so many food rules and tells us food is good or bad. Eating a salad is right, eating a cookie is wrong. The truth is, food is just food! You can eat a salad and a cookie, or a salad, or a cookie, or something else entirely, and it is all ok. Sit with what stories you tell yourself about your food choices this week and see if you can start to challenge those that ask you to judge yourself for eating. Maybe keep a note running on your phone and jot down what thoughts come up for you each time you eat. How often are you judging yourself? What patterns do you notice? Can you start to let go of those negative thoughts and let yourself eat with joy and acceptance?
• Curate your feed. Social media can be an empowering place, and it can be a place full of weight bias and damaging messages that lead to body dissatisfaction. Notice what you see in your feed this week. If any posts make you feel poorly about your body, hit that unfollow button immediately. You can always come back to that account, but unfollow for a bit and see what you notice. Then, see if you can add accounts that make you feel positive about your body. There are loads of accounts out there doing great work around body liberation; try searching that hashtag and see what speaks to you. We all react differently in this space, so find a few accounts that make YOU feel good. It could be an artist, it could be an athlete in a larger body, it could be an account that posts inspirational quotes. I help run an account called PHIT Society that might be a place to start. As you do this, be mindful of adding accounts from perspectives outside of your own. Are there accounts that speak to disability justice you could add? What about people of different races than you to bring in more insight around their experience? Are you adding accounts that bring size diversity to your feed? How about accounts that speak to different gender identities or sexualities? As you diversify your feed with all sorts of bodies, take note of how it makes you feel about your own. In my experience, the more types of bodies I see lifted up and celebrated, the easier it is to celebrate my own.
• Hype up your people! Notice how often body size comes up in conversation. If you are surrounded by diet culture, it is probably a lot! Can you shift the conversation? Instead of listening to a friend berate their body, can you let them know that you think their body is awesome and you love how much energy they have? Or that you think they are cute all the time and you love the way they light up a room? Sometimes I will remind them that I don’t appreciate them talking about my friend that way. Gentle challenges to negative self talk can help those we love start to talk about bodies in a different, more empowering way. And when we make space to have a different conversation, those around us can help keep us accountable as well.
• Learn about body liberation. There is a whole world of incredible scientists, researchers, activists, and artists challenging diet culture and creating space for a world without the triggers of eating disorders. Lindo Bacon has 3 wonderful books I highly recommend around changing your relationship with your body. Sonya Renee Taylor is a gift and her voice is transformative in this space. Christy Harrison offers a great perspective on leaving dieting behind, and Intuitive Eating from Evelyn Tribole and Elyse Resch is deeply informative. Sabrina Strings teaches the history of fatphobia and racism in a revolutionary way. Aubrey Gordon shares an eye opening perspective of living in a larger body, as do Virgie Tovar and Jes Baker. And that just scratches the surface. Grab a book, read an article, watch a TED talk and expand your view of bodies.

Eating disorders are ugly and a part of our society that I hope we can eradicate. Having these conversations is an important step towards a world where all bodies belong. As we learn about different ways that different bodies are affected, we can make real systemic change towards that world. Here’s to freedom and acceptance for all bodies, and a table expansive enough for us all to pull up a chair.