Individuals with Binge Eating Disorder (BED) often face significant barriers when seeking support, largely due to a healthcare system that remains steeped in weight stigma. As clinicians, it is essential not only to address the symptoms of BED but also to actively challenge the stigma that can exacerbate these symptoms. This is where weight-inclusive care comes in!
In this post, we’ll explore what it means to provide weight-inclusive support for individuals with BED—and why this approach is critical for compassionate and effective treatment.
Understanding Binge Eating Disorder
Binge Eating Disorder is characterized by recurrent episodes of binge eating and may include eating very rapidly, eating past the point of being full, eating when not hungry, and eating in secret or alone. These behaviors are often accompanied by intense feelings of shame, guilt, and a perceived loss of control. BED affects people of all body sizes and backgrounds, yet those in larger bodies are often met with added stigma, making their recovery journey even more complex. Shame, guilt and weight stigma don’t just result from BED—they often fuel and perpetuate the cycle.
Harms of Weight-Centric approaches
Often, individuals with Binge Eating Disorder are recommended treatment centered on weight loss as a primary goal. This weight-centric approach not only overlooks the root cause but can also worsen symptoms. Consider the following:
-
- Many people with BED have a history of dieting or food restriction, which may have been the catalyst for developing binge eating behaviors
- Dieting and calorie restriction will intensify binge eating and reinforce the binge-restrict cycle
- Focusing on weight reinforces harmful messages about body worth and health and can increase feelings of guilt and shame, and may make it more difficult for clients to feel safe, understood, and engaged in the treatment process.
What is Weight-Inclusive Care?
Weight-inclusive care is an approach that rejects the notion that health or value is determined by body size. Rooted in the Health at Every Size® framework, this model emphasizes:
-
- Respectful, compassionate and equitable treatment for all bodies
- Recognition of the harms of weight stigma and systemic fatphobia
- A focus on behaviors that support overall well-being—not weight
This approach supports long-term recovery by creating a therapeutic environment where clients feel safe, seen, and respected.
5 Ways to Put Weight-Inclusive Care into Practice
1. Checking our own bias: Reflect on personal assumptions and stereotypes related to body size. Commit to ongoing learning and understanding
2. Avoid Making Assumptions: Don’t assume a client’s health status, behaviors, or goals based on their body size
3. Consider the language you use: Avoid terms like “obese” and “overweight” as these pathologize body size. Consider more neutral terms such as “people in larger bodies” or ask your client what terms they prefer when referring to body size
4. Revise intake forms and questionnaires: Replace questions like “What is your weight goal?” with open-ended alternatives like “What are your health and well-being goals?”. Leave questions about current weight or weight history as optional to answer
5. Name and Validate Experiences with Weight Stigma: Listen and acknowledge the impact that weight stigma and fatphobia has had on their lived experience. Create a space to acknowledge and process these experiences without minimizing or redirecting
Evidenced Based Treatment Approaches to BED
These approaches align with the non-weight centric model and can be included in effective and compassionate treatment
- Intuitive Eating: Helps challenge diet culture beliefs and rebuild body trust by focusing on unconditional permission to eat and enjoy food and reconnecting with internal hunger and fullness cues
- Cognitive Behavioral Therapy (CBT)- Helps individuals to identify and challenge unhelpful belief and behavior patterns related to body image, food and emotions while also developing helpful coping strategies
- Body image work: Supports clients in healing their relationship with their body which is often a central part of BED recovery.
Final Thoughts on Using Weight-Inclusive Care in Binge Eating Disorder
Providing weight-inclusive care for individuals with BED is an important step toward dismantling the harmful systems that perpetuate disordered eating. When we shift the focus from weight to well-being, we help clients reclaim autonomy over their bodies, rebuild body trust, and foster an environment where true healing can happen.
Julia Fulk, RD
Julia Fulk is a dedicated Registered Dietitian specializing in nutrition therapy for individuals with disordered eating patterns. With a compassionate approach, she empowers her clients to develop a healthier relationship with food and their bodies. Julia’s expertise lies in providing weight-inclusive care, focusing on holistic well-being rather than weight-centric goals. Her commitment to dismantling weight stigma and promoting body positivity makes her a valuable asset to the Courage to Nourish team.