Weight Stigma and Eating Disorders

by | Eating Disorder Recovery

If you’ve done research into eating disorders, it’s very possible you have come across articles about “weight stigma”. Weight stigma and eating disorders are a “hot topic”. Thus, they are quickly gaining attention in the eating disorder field. Consequently, more eating disorder providers are learning how weight stigma affects clients and their work. Despite this, the field still holds a lot of weight bias.

This blog aims to address questions about weight stigma and eating disorders. If you’re a provider. I hope this shines light on how weight stigma might affect your work. If you’re a client. I hope this empowers you to see how weight stigma has affected your recovery.  In addition, I discuss resources if you wish to learn more about this topic. 

 

What is weight stigma?

 

By definition, weight stigma is discrimination or bias against individuals because of their body size. Mainly toward people in bigger bodies. Weight stigma exists on an individual basis. For example, getting bullied because of larger size. In addition, it exists on a systemic level. For instance, airplane seats being too small to accommodate certain body sizes. 

 

Is it new?

 

Unfortunately, weight stigma is not a new phenomenon. Actually, it’s an extremely common form of stigma. As a result, it can cause harm for all people. Especially those in larger bodies. In fact, it causes the most amount of harm for individuals at a higher weight. Meanwhile, smaller individuals might internalize weight stigma. For instance, fearing gaining weight or trying to lose weight. However, higher weight individuals experience weight stigma at all levels. This includes internal, external and systemic. 

 

Common Questions

 

Perhaps, you may be wondering. “What if someone has to lose weight for their health?” Excellent question. Lots of people have similar thoughts! I totally understand why. Our society associates weight loss and thinness with a “healthy lifestyle.” However, this is not always the case. In reality, there are plenty of smaller individuals who are not healthy. Similarly, there are plenty of larger individuals that are healthy. 

 

Regardless, health is not a moral obligation. Comments about body size are never helpful or wanted. If you’re interested in learning more about a concept called “Health at Every Size,” read our blog.

 

What are examples of weight stigma?

 

As previously stated, weight stigma exists on an individual level and on a systemic level. Let’s discuss some examples of both of these.

 

  • Getting bullied because of size 
  • Doctors or other medical professionals making assumptions about health status. Or misdiagnosing certain diseases. 
  • Doctors or other medical professionals assuming you are lying about your symptoms 
  • Not fitting into clothes at mainstream clothing stores 
  • Airplane seats or other public accommodations being too small
  • Being passed up for jobs or earning less money
  • Friends/family commenting negatively on your body because they’re “worried” about your health

 

What are the consequences of weight stigma?

 

Experiencing any type of stigma or bias is a form of stress on the body. For this reason, weight stigma has both physical and psychological consequences on individuals who experience it.

 

Physical consequences include weight stigma as an independent health risk factor for:
  • An increased (2x) risk of a high allostatic load. This is the effect of stressors on the cardiovascular, nervous and metabolic systems
  • Lipid dysregulation
  • Impaired glucose metabolism
  • Increase risk for inflammation
  • Elevated risk for type 2 diabetes, high blood pressure, cardiovascular disease and mortality
  • Increased cortisol (stress hormone)

 

Psychological consequences of weight stigma include: 
  • Body dissatisfaction
  • Increased risk for disordered eating/eating disorders
  • Elevated risk for depression
  • Lower rates of physical activity 
  • Avoiding care (like avoiding going to the doctor’s office)

 

Sources for the above:

Christy Harrison’s FNCE 2018 Presentation

Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults

The Weight of Stigma: Cortisol Reactivity to Manipulated Weight Stigma

Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review

 

How does weight stigma affect eating disorder treatment? 

 

Although they can be difficult, conversations about weight stigma should be happening. Regardless of the field. Thus, it is so important to highlight how weight stigma affects treatment. 

 

First, it’s not much of a stretch to say that weight stigma is a contributing factor to eating disorders. ED behaviors are encouraged to people in larger bodies. For example, medical professionals often suggest weight loss to higher weight individuals. In effect, a lot of these individuals will go on restrictive diets to try to lose weight. They may even be explicitly told to go on extremely low calorie diets. (Something doctors would never encourage in their smaller patients). Similarly, people engage in disordered patterns to avoid weight gain. 

 

Weight Cycling

 

Quick side note. Weight cycling is the act of gaining and losing weight over and over. It is one of the effects of weight stigma. First, people restrict themselves to lose weight. Then, they inevitably gain it back.

Why is weight gain inevitable? Anywhere between 80-95% of diets result in weight regain in the long term (5+ years). Think about that. For instance, imagine if diabetes medication worked only 5-20% of the time. To put it another way, what if your car brakes didn’t work 80-95% of the time? Most importantly, to this day, we do not have one single scientific study that says “Weight loss is attainable and sustainable long term.” 

 

Additionally, there is bias within the field that eating disorders behaviors only affect lower weight individuals. In particular, restricting, purging, compulsive/obsessive exercise behaviors. Additionally, that bingeing only affects higher weight individuals. All things considered, these biases can be extremely harmful. Hence, they allow eating disorders to go undiagnosed. In turn, this allows EDs to go untreated for a longer period of time. Therefore, providers should be screening all their patients or clients for eating disorders. Remember: any person at any size can struggle with any type of ED related behavior. 

 

If you’re a provider interested in resources to screen for an eating disorder. Click here to get access to our therapist and our physician screening tool.

 

It’s important for providers to do their own work and research around weight stigma. I’d recommend to reflect on these questions:

  • What are my judgments about people in smaller bodies? In larger bodies? 
  • What do I think of when I hear the word “health?”
  • How are my judgments about body shape or size affecting my work with patients/clients?

 

Resources:

Morelove.org– Ginny Jones

 

Virginia Sole-Smith

 

Katja Rowell- “the Feeding Doctor”

 

Embodied Kiddos

 

Weight Bias Journaling Prompts by Resilient Fat Goddex

 

Weight Normative vs. Weight Inclusive Approach to Health

 

Body Respect by Lindo Bacon

 

Maintenance Phase Podcast 

 

Food Psych Podcast 

 

Everything you know about obesity is wrong by Michael Hobbes

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Alex Raymond, RD, LD, CEDRD

Alex Raymond, RD, LD, CEDRD-S

Helping my clients cultivate meaningful connections and interests outside of their eating disorder is a true passion of mine. I like to think my clients and I are on a team to navigate recovery. I love working with high school and college students as well as athletes seeking to have a better relationship with exercise. I am a proud anti-diet dietitian and work with my clients through a Health At Every Size © and intuitive eating framework.

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registered dietitian for eating disorders

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