“You are fat everyday so you should exercise everyday”. The 38 year old female cringes as her doctor scolds her about her lack of regular exercise in the face of her “obesity”.
“She is very heavy…” The 7 year old African American is smart enough to figure out that what the doctor is saying is not good…and that something is wrong with her. She looks inquisitively as the pediatrician tells her mother how to implement a lower calorie diet.
The athlete who has amenorrhea and who is at risk of infertility, who over-exercises to the point of exhaustion each day, while receiving constant praise at her gym for her low body fat…
The examples go on and on…The macro-trauma, bullying… the micro trauma, the silent judgments that are none-the-less felt.
Inside of so many individuals who I have provided care for, who struggle from anorexia nervosa, I eventually meet that part of him/herself who fears their desire for food, their need to consume, their fear of bingeing and ultimately the social price they expect they’ll pay should they gain weight—social isolation, judgment and rejection. And inside every person who has gained weight due to binge eating, I can readily meet that part of him or herself that wants to starve away the shame.
And those with no eating disorder at all, who happen to live in a larger body, who are judged and told to diet, to “eat less and exercise more”, live in a day to day quandary with what to do about their need for food. The judgments cast and the shame induced, the minute by minute messaging about food, and their bodies, and the onslaught of mandates dictated by doctors, schools, family and friends about what they should or should not be doing with their body, comes with a high price–internalized shame.
Weight stigma also known as weightism, weight bias, and weight-based discrimination, is discrimination or stereotyping based on one’s weight, especially larger or thinner people. Weight stigma reflects internalized attitudes towards body size that affects how those who are the targets of bias are treated.
Why does talking about this matter? Weight stigma is possibly the most endorsed, medically and socially reinforced, promoted form of discrimination that exists (this is NOT to minimize other forms of discrimination). Whether subtle, or overt, weight stigma induces, in a most visceral, painful manner, a sense of shame, isolation, defectiveness, alienation, and humiliation.
The thoughts we have in our mind when we see a larger person and a smaller person–it is vital we explore these thoughts with curiosity and compassion, and honesty.
It is a most amazing, meaningful experience, when each person in treatment develops compassion for another, with a different form of eating disorder, and sees something of themselves in the other. When the person experiencing anorexia nervosa, begins to understand what is behind “the binger” inside of him or her…a part that is buried. And for the person who binges, while the world is blind to their shame, reinforces that shame and the belief that they are not worthy and do not deserve food (and other forms of self-care). When shame is transformed into compassion, healing becomes possible. This kind of healing is what our field needs as well.
Weight stigma is about shame, body hatred and judgement. It is something very real in our day to day lives, whether we personally experience weight stigma or not. With Weight Stigma Awareness Week, NEDA has bravely embraced this concept. Raising awareness is an important part of our overall approach to caring for patients and addressing eating disorders, and in line with the bio-psycho-social approach. This foundational approach was popularized by psychiatrist Dr. Hilde Bruch when describing the approach to treatment for anorexia nervosa.
Eating disorders are multi-factorial as we all know. Based on my experiences, which is my own clinical evidence, all forms of eating disorders are connected in various ways to weight stigma, which is rooted into our cultural norms. It is important that our community work together to be united in understanding the complexities involved in healing, including dreaded fear of the rampant social consequences of “over-weight”– weight stigma.
It is time we face this pernicious force, and encourage our patients, families and communities to include weight stigma awareness, and its impact on our lives, into our community, and our mission to prevent and cure eating disorders. Intolerance of any form of judgements based on size should be voiced in our field. We should give our patients, and families a way to talk about this.
Martin Luther King said, “Love is the only force capable of transforming an enemy into friend.” Weight stigma is a force around us, and even within us, that promotes body as enemy. Love is the force that can fight off weight stigma and provide a sound voice of self-reflection, understanding and self-validation.
Wendy Oliver-Pyatt, MD, FAED, F.IAEDP
Author: Questions and Answers about Binge Eating Disorder, A Guide for Clinicians (Jones and Bartlett Learning, 2017)
Dr. Wendy Oliver-Pyatt is a world-leading expert on treating eating disorders. With more than 20 years of clinical experience, Wendy has developed a unique treatment approach that delves into the underlying issues that place a person at risk for mental health conditions and eating disorders and lead to healing, health and inner peace. Wendy, Mental Health Speaker, Eating Disorder Educator, and Mental Health Advocate, currently delivers keynote speeches for leading organizations on topics such as eating disorders, treating serious mental health issues, and healthful approaches to weight concerns. Contact Wendy for your next keynote!