*TW: Discussion about weight based stigma and discrimination.
Isabella Robinson kindly invited me to join her for an Instagram Live for Eating Disorder Awareness Week. This, unfortunately, falls on the same week my baby is due so I’ve pre-written a short blog post instead. The theme this year is Binge Eating Disorder (BED), and I feel that this topic cannot, and should not, be covered without also discussing the implications of weight stigma.
Many conventional approaches to treating BED involve some sort of weight management, as it’s often assumed (thanks to weight stigma) that folks who suffer with BED need to lose weight. This is part of the pervasive stigma that envelopes those who are struggling with BED. Implied in this idea is the discriminatory belief that folks become fat or ob*se because they engage in bingeing behaviours. But this is only one narrow and stigmatizing piece of a complex puzzle.
In my clinical work, the experience of weight stigma and weight based discrimination often precludes the development of binge eating and other disordered eating behaviours. Weight based teasing in childhood and adolescence, dieting and weight loss talk in families, weight based discrimination in medical settings, and early efforts at weight management consistently emerge in my clients stories: An observation that is backed up by research.
A 2016 review of the literature on weight stigma and eating behaviour highlighted how the experience of weight based discrimination, stereotypes, and prejudice has an impact on health behaviours, including relationship with food and body (Vartanian & Porter, 2016). The studies examined showed links between weight stigma and increased body dissatisfaction and disordered eating pathology, namely bingeing behaviours. Weight stigma was also linked with lowered self-esteem, decreased engagement with health promoting behaviours (ie: visiting the GP), increased physiological stress responses (ie: increased cortisol), depression, anxiety, and more.
Further evidence shows how weight based discrimination increases physiological stress and biological dysregulation, which is referred to as Allostatic Load. The higher our Allostatic Load, the higher our chances of illness and mortality. Specifically, weight stigma is linked with metabolic and glucose metabolism dysregulation and heightened inflammation (Vadiveloo & Mattei, 2017). It’s important to note here that these are the same physiological processes that weight stigma narrowly blames on higher body weight.
Ultimately, weight is incredibly complex, and yet the rhetoric and much of the research around weight – especially ob*sity - remains largely centred on relationship with food in a way that promotes individual blame, thus further perpetuating discriminatory and stigmatising behaviour and attitudes towards higher weight individuals. This also, sadly, continues to feature in the treatment of eating disorders through the inclusion of weight management for BED.
I’ve worked with too many clients who have received weight management as part of previous treatment for bingeing. I’ve listened to hours of stories about how these experiences led to stress, shame, anxiety, increased disordered eating behaviour, and avoidance of further support. Not to mention the fact that weight management techniques involve food restriction, which has consistently been shown to increase binge eating behaviour and even contribute to weight gain – the very thing that weight management seeks to address (Dulloo, Jacquet & Montani, 2012). Sadly, all of this contributes to the belief that one needs to lose weight in order to stop bingeing, or that weight loss is the indication of a 'successful recovery'. Sadly, this has proven to be a barrier for treatment and recovery for some folks, leaving them feeling discouraged, shamed, and as though recovery is out of their reach.
Put simply, weight management needs to be avoided in the treatment of eating disorders because it perpetuates and reinforces harmful weight based stigma that contributes to the very behaviours that we’re trying to heal. The research on weight stigma shows how it can have a significant impact on both physiological and psychological health and wellbeing. It also paints a picture of how weight stigma needs to be considered an underlying factor in the development of eating disorder pathology, especially BED, and thus addressed accordingly in treatment.
*Note: I have censored the word ob*sity as a nod to the stigmatizing and medicalised language that surrounds it.
References:
Duloo, A. G., Jacquet, J. & Montani, J.P. (2012). “How dieting makes some fatter: from a perspective of human body composition autoregulation”. Proceedings of the Nutrition Socitey, 71.
Vadiveloo, M & Mattei, J. (2017). “Perecived weight discrimination and 10-year risk of Allostatic Load amongst US Adults’. Ann of Behavioral Medicine, 51.
Vartanian, L.R. & Porter, A.M (2016). “Weight Stigma and Eating Behavior: A review of the literature”. Appetite, 102.