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As someone who was personally recommended dieting by doctors WHILE I was recovering from an eating disorder and for years after, I first learned about this subject from personal experience. At the time I was still fully enmeshed in diet culture so I didn’t even question it. Once I had extricated myself from that mentality I realized how many times healthcare practitioners had recommended the behaviors that I had been in eating disorder treatment to stop. The most succinctly I’ve heard this put was by the brilliant Deb Burgard who says “we diagnose and treat in thin people what we prescribe to fat* people.”
As I learned more about the research, I found that the evidence backs up the logical notion that weight stigma and diet culture perpetuate eating disorders and can make full recovery much more difficult.
A 2018 study by Hunger and Tomiyama found that fat-shaming [self-identified] girls, especially by family, does not lead to healthy behaviors but instead can lead to eating disorders. The lead author, psychologist Jeffrey Hunger, told Reuters, “Labeling young girls as ‘too fat’ will never spur positive health behaviors; it is simply going to result in poor body image, unhealthy weight control practices, and disordered eating.” He also pointed out that, while this harmed girls regardless of size, “heavier girls do disproportionately shoulder the burden of weight stigma, and stigma against heavier bodies is pervasive and systemic, so we should take care not to equate this to thinner girls’ experiences of weight labeling.”
It’s not surprising that being called “too fat” would lead girls to risk their health. We live in a culture where fat people are routinely told to risk our lives and quality of life with intentional weight loss attempts, dangerous drugs, and surgeries. If you support the message that it’s worth risking your life and quality of life to be thin, then you can’t logically turn around and tell someone with an eating disorder (of any size) that their behaviors (often the same ones that are recommended to fat people for “weight management”) are dangerous or irrational. Just to make sure it’s clear, the underlying issue here isn’t that these girls are called “too fat” — it’s the idea that there is anything wrong with being fat in the first place.
This isn’t the only study to draw this conclusion. Neumark-Sztainer et. al. found that “None of the behaviors being used by adolescents (in 1999) for weight-control purposes predicted weight loss (in 2006)…Of greater concern were the negative outcomes associated with dieting and the use of unhealthful weight-control behaviors…”
Pinhas et. al. found that school-based ob*sity-prevention programs that push “healthy eating” were triggering disordered eating in some kids. “They were all affected by the idea of trying to adopt a more healthy lifestyle in the absence of significant pre-existing notions, beliefs or concerns regarding their own weight, shape or eating habits prior to the intervention.”
The 2020 BEAT UK report found that government-sanctioned anti-ob*sity campaigns increase the vulnerability of those at risk of developing an eating disorder, exacerbate eating disorder symptoms in those already diagnosed with an eating disorder and show little success at reducing ob*sity.
If we truly want to prevent eating disorders and support full recovery, we have to leave the weight-centric model, diet culture, and the idea of “weight management” behind. and adopt a weight-neutral health paradigm.
That’s why it’s so disappointing when organizations that are supposed to exist to fight eating disorders perpetuate weight stigma and “weight management.” Unfortunately, that’s exactly what BEAT UK is doing. Despite their own report about the harms it does, they continue to support pathologizing larger bodies and trying to manipulate them.
As part of Eating Disorder Awareness Week, Emma Green, PhD and Jeanette Thompson-Wessen BSc(hons) PGCE have written a thoroughly sorted open letter to BEAT UK. I’ve copied it in its entirety below You can sign the letter here.
We are confused, disappointed and frustrated at your current stance on ‘ob*sity’ and weight management and believe it to be out of alignment with your mission, which is to ‘end the pain and suffering caused by eating disorders’.
We are aware of your previous work highlighting problems with the UK Government’s ‘ob*sity’ strategy, which included a call to move away from campaigns that increase weight stigma and encourage restrictive eating patterns. Indeed, there is substantial research highlighting the harms of weight stigma for mental and physical health, including increasing the risk of developing an eating disorder (Puhl and Suh, 2015).
However, conceptualising ‘ob*sity’ as a problem that needs to be addressed and advocating for ‘weight management’ reinforces the idea that being at a higher weight is ‘bad’ and thus is stigmatising to fat people. This is a problem that has been previously highlighted as prevalent in eating disorder literature (Gotovac et al, 2020).
‘Weight management’ (aka dieting) is not only ineffective in achieving long-term weight loss in the vast majority of individuals (Ayaad and Anderson, 2000 and Anderson et al, 2001) or improved physical health (Mann et al, 2007) but also increases the risk of developing an eating disorder (Green and Buckroyd, 2008 and Neumark-Sztainer et al, 2013).
In the minority of people who maintain weight loss over the long-term, high levels of stress and depression are common (Ogden et al, 2012), as is hypervigilance about food and weight (Wing and Hill, 2001).
There is an alternative: a weight-inclusive approach, which adopts Health at Every Size principles. This has been demonstrated to result in improvements in disordered eating and self-esteem (Clifford et al, 2015), body image and wellbeing (Bruce and Ricciardelli, 2016), as well as increased enjoyment and pleasure of food, and fewer dieting behaviours and decreased anxiety about food (Smith and Hawks, 2013).
As acknowledged on your website, eating disorders can happen to people of all body sizes, and this includes fat people. Eating disorders and fatness do not exist at opposite sides of a spectrum. Bodies are inherently diverse in both shape and size, as are the individuals who suffer from eating disorders. Stereotypes about who gets eating disorders has been highlighted as a central contributor to disparities in eating disorder treatment and outcomes (Sonneville and Lipson, 2018).
Fat people deserve access to ethical, evidence-based and effective eating disorder treatment and wider healthcare. They should not have their bodies pathologized, to be treated as a ‘problem to be fixed’ or conceptualised as needing ‘weight management’. We are calling on you to take the following actions:
1. Retract your position that ‘ob*sity’ is a problem and cease using stigmatising language about fat people
2. De-align yourself from weight management programmes, policies and campaigns
3. Promote a weight-inclusive approach in eating disorder services and wider health promotion activities which is informed by the lived experiences of fat people.
We look forward to seeing BEAT move forwards in developing its policy to include all bodies without causing harm. We welcome your response and consequent action.
Emma Green PhD
Jeanette Thompson-Wessen BSc PGCE
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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Hey Ragen, You mentioned that you are really fond of Deb's work. Is there somewhere that you subscribe to her or soak in more of her goodness outside of the books she has contributed to? Where do you get your Deb wisdom goodness from? Thanks! Vinny - Fierce Fatty