Once again, Ragen, you are the light shining in the weight-stigma desert. As a person with binge eating disorder (BED) I'm so offended by this doctor's financial conflict with a weight-loss program and by the inclusion of ob*sity as an eating disorder on a website associated with a reputable health care system. This casual inclusion of size as a type of eating disorder is simply to support the so-called 'cure' of a weight-loss program and Dr. Hildebrandt’s research is clearly about creating a market for a company that he holds equity in. This wouldn't pass an ethical review if anyone cared enough (other than you, Ragen) to take a deep look at the motivation behind this kind of money-making failure in medical ethics. I can't imagine the emotional pain the patients in this program must endure.
I'm so tired of being assaulted by the myth that my size is my problem, when I know from painful experience that it is the SHAME and misinformation that stigmatizes BED that keeps many of us sick and unable to understand what we're really dealing with. The more this myth is reinforced, the more we try to diet our way to a cure, making us sicker and sadder with each failed attempt.
The only path to recovery for those of us with eating disorders is to remove weight as a success factor from the treatment plan altogether, something Dr. Hildebrandt and his ilk would never understand because getting people thin is a visual confirmation that they are right. What is never discussed or measured, is the metabolic and emotional damage that intentional weight loss creates, because it never deals with the root cause of any disorder: Why? Why do we overeat, undereat, avoid and restrict or try to sustain ourselves by eating objects rather than food? How did we learn to rely on such maladaptive coping skills to create safety and securty?
The answer to these questions are far too complex for a quick and easy cure, and certainly not one that makes a lot of money for well-healed clinicians who wish to burnish their reputations as well as their stock portfolios.
Okay, off my soapbox! Time for the next one, Ragen!
cw: my comment will talk about specific ED behaviors.
Wow, I continue to be amazed by the lows these people will sink to in order to eradicate us from the planet. One of the things that led me to fat liberation and fat studies was the fact that I was a fat person starving myself and not getting any smaller. I would make it a game to see how long I could go without food (2 days without anything but water, or weeks if I had a little fruit everyday. I don't know why my body is so good at hoarding nutrients (maybe it was my fat childhood with undiagnosed celiac and chronic malnutrition) but it doesn't matter how little I eat or how much I move, I will never lose any significant amount of weight.
I do not understand how these dipshits can get away with publishing such blatant lies, let alone get a steady stream of funding to keep up the act.
Even if these people genuinely think they're trying to help us (and honestly, it's obvious that their motivations are profit-centered, not patient-centered), this shit puts our lives at risk. This shit is eugenics.
Yeah at one point I wondered if every thin person was actually starving themselves. It took me a while in my disordered thought patterns to realize that other people were eating food AND thin and some of us were never meant to be thin. I hate the frame of fatness is caused by overeating, but I wonder what would have happened if I hadn’t been through all the weight cycling of my 20s and had never developed an ED.
Yes! I remember in HS being flabbergasted at how much all my classmates ate (they actually bought hot lunch! and ate the whole thing! and the thin girl who sat in front of me when we were seated alphabetically who had a backpack full of candy and snacks and munched all day on top of hot lunch and the school's breakfast program) and meanwhile I felt like a failure if I allowed myself any sustenance.
I often wonder how I would feel and what size I'd be now if my body was just allowed to develop naturally and I was encouraged to nourish it and take care of it and listen to it. I've always been fat, and I'm sure I'd be fat, but I think I'd have way fewer stress-related health issues and anxiety (and no ED) if people like us were just allowed to exist.
The idea that "[higher body weight] is always the result of overeating" is one of those myths that's held by the rule of Everyone Knows. Lots of people have their tale about how they "ate too much" and gained five pounds and wow, that's science right there! (A dog came near me. I sneezed. Therefore, I'm allergic to dogs. It had nothing to do with the flowers nearby or some person's strong perfume!)
It's also found in a lot of research articles. These articles will reference another article that claims this, which in turn cites another article, which also cites a different article, until you have this massive game of telephone. Keep digging - hope you have hours to spend - and you will find one of two things:
- a never-ending string of papers all citing each other with not one ounce of proof offered, with the exception of anecdotes or maybe some observational study [such as the one paper that looked into whether fat people are more likely to overeat that only looked at fat people - no comparisons to anyone else. Imagine doing a study of only white people and then saying, white people are more likely to get seasonal allergies].
- a paper that in its conclusion said something like, "It is our belief that this might be caused by people who are overeating" which in turn got cited as if this was a fact, not a guess.
I had no idea Mt. Siani was doing that. Thanks for the informative article. I'm a bit confused though in terms of why/how Mt. siani can make their own definition of what an "eating disorder is". I thought it was a mental health disorder and therefore needed to be defined by the DSM. As you mentioned the DSM does not include ob*y as an eating disorder, so it doesn't have a billable code. Does that then mean that patients that fall under that heading would not have any insurance coverage? (Not that it is great for eating disorders to begin with). It just seems a bit unethical for them to make up a definition for their own monetary benefit. But i would certainly not be the 1st case of corporate greed running the show in this area. sad state of affairs.
You are right -it's a problem that they are making up their own definitions for things that already have definitions. They are also taking advantage of the fact that there isn't a clear, scientific definition of "ob*sity". This whole thing is an absolute mess.
Interesting that being underweight isn't listed as an eating disorder. Plenty of underweight people don't have anorexia; by the logic displayed here, shouldn't they also be listed? Being underweight is correlated with quite a few health problems too, after all.
First, the mindless embrace of BMI by this clinician is disappointing. (Also, nice work pointing out his mathematical illogic lol!) Second, his deviation from DSM-5 diagnosis (which is already lagging in our time) regarding ob*sity is alarming as a psychologist. Lastly, his involvement on the "scientific advisory board" at Noom should have been brought to more upfront and more closely examined by Mount Sinai as a leading medical institute.
Medical "science" with its traditionally (thin-bodied, able-bodied) white male authorship benefits from pathologizing the bodies of people in "other" groups, especially women and women of color -- precisely those who have a disadvantage in BMI calculation. In this case, the benefit is financial.
Relics of psuedoscience find their way through every crack in medicine and bleed into our daily practice. Let this be a cautionary tale for all of us who hold the "power" to do more harm than good.
Thank you for this, it hits squarely at both a disturbing conflict of interest/unscientific practices and at my own experiences, so it was an especially helpful and validating read. Even though my lifelong struggle with food led me to a different healthcare system than the one you're digging into here, I've encountered the same biases, and it's research like yours that helped convince me I wasn't crazy when dealing with 'experts' who looked up my symptoms in the DSM-5 and then told me directly that I couldn't have an eating disorder because I wasn't bedridden and on a feeding tube.
Because the disorder I was seeking help with, ARFID, isn't about weight loss (though I have lost an scary amount in two years while still remaining fat) it's been really frustrating to try and go along with the help I've been able to receive, while being constantly reminded that we're only there to treat my symptoms and we mustn't act like I actually have a disorder, because my weight means I don't 'fit the criteria.' Even if it won't come soon enough to benefit me, I hope that the work people like you are doing will spread through the industry enough that more healthcare professionals will someday have the knowledge and training to recognize and treat disordered eating in all patients.
Once again, Ragen, you are the light shining in the weight-stigma desert. As a person with binge eating disorder (BED) I'm so offended by this doctor's financial conflict with a weight-loss program and by the inclusion of ob*sity as an eating disorder on a website associated with a reputable health care system. This casual inclusion of size as a type of eating disorder is simply to support the so-called 'cure' of a weight-loss program and Dr. Hildebrandt’s research is clearly about creating a market for a company that he holds equity in. This wouldn't pass an ethical review if anyone cared enough (other than you, Ragen) to take a deep look at the motivation behind this kind of money-making failure in medical ethics. I can't imagine the emotional pain the patients in this program must endure.
I'm so tired of being assaulted by the myth that my size is my problem, when I know from painful experience that it is the SHAME and misinformation that stigmatizes BED that keeps many of us sick and unable to understand what we're really dealing with. The more this myth is reinforced, the more we try to diet our way to a cure, making us sicker and sadder with each failed attempt.
The only path to recovery for those of us with eating disorders is to remove weight as a success factor from the treatment plan altogether, something Dr. Hildebrandt and his ilk would never understand because getting people thin is a visual confirmation that they are right. What is never discussed or measured, is the metabolic and emotional damage that intentional weight loss creates, because it never deals with the root cause of any disorder: Why? Why do we overeat, undereat, avoid and restrict or try to sustain ourselves by eating objects rather than food? How did we learn to rely on such maladaptive coping skills to create safety and securty?
The answer to these questions are far too complex for a quick and easy cure, and certainly not one that makes a lot of money for well-healed clinicians who wish to burnish their reputations as well as their stock portfolios.
Okay, off my soapbox! Time for the next one, Ragen!
Beautifully said (though I wish it didn't have to be said at all.) Thank you!
cw: my comment will talk about specific ED behaviors.
Wow, I continue to be amazed by the lows these people will sink to in order to eradicate us from the planet. One of the things that led me to fat liberation and fat studies was the fact that I was a fat person starving myself and not getting any smaller. I would make it a game to see how long I could go without food (2 days without anything but water, or weeks if I had a little fruit everyday. I don't know why my body is so good at hoarding nutrients (maybe it was my fat childhood with undiagnosed celiac and chronic malnutrition) but it doesn't matter how little I eat or how much I move, I will never lose any significant amount of weight.
I do not understand how these dipshits can get away with publishing such blatant lies, let alone get a steady stream of funding to keep up the act.
Even if these people genuinely think they're trying to help us (and honestly, it's obvious that their motivations are profit-centered, not patient-centered), this shit puts our lives at risk. This shit is eugenics.
Yeah at one point I wondered if every thin person was actually starving themselves. It took me a while in my disordered thought patterns to realize that other people were eating food AND thin and some of us were never meant to be thin. I hate the frame of fatness is caused by overeating, but I wonder what would have happened if I hadn’t been through all the weight cycling of my 20s and had never developed an ED.
Yes! I remember in HS being flabbergasted at how much all my classmates ate (they actually bought hot lunch! and ate the whole thing! and the thin girl who sat in front of me when we were seated alphabetically who had a backpack full of candy and snacks and munched all day on top of hot lunch and the school's breakfast program) and meanwhile I felt like a failure if I allowed myself any sustenance.
I often wonder how I would feel and what size I'd be now if my body was just allowed to develop naturally and I was encouraged to nourish it and take care of it and listen to it. I've always been fat, and I'm sure I'd be fat, but I think I'd have way fewer stress-related health issues and anxiety (and no ED) if people like us were just allowed to exist.
The idea that "[higher body weight] is always the result of overeating" is one of those myths that's held by the rule of Everyone Knows. Lots of people have their tale about how they "ate too much" and gained five pounds and wow, that's science right there! (A dog came near me. I sneezed. Therefore, I'm allergic to dogs. It had nothing to do with the flowers nearby or some person's strong perfume!)
It's also found in a lot of research articles. These articles will reference another article that claims this, which in turn cites another article, which also cites a different article, until you have this massive game of telephone. Keep digging - hope you have hours to spend - and you will find one of two things:
- a never-ending string of papers all citing each other with not one ounce of proof offered, with the exception of anecdotes or maybe some observational study [such as the one paper that looked into whether fat people are more likely to overeat that only looked at fat people - no comparisons to anyone else. Imagine doing a study of only white people and then saying, white people are more likely to get seasonal allergies].
- a paper that in its conclusion said something like, "It is our belief that this might be caused by people who are overeating" which in turn got cited as if this was a fact, not a guess.
I had no idea Mt. Siani was doing that. Thanks for the informative article. I'm a bit confused though in terms of why/how Mt. siani can make their own definition of what an "eating disorder is". I thought it was a mental health disorder and therefore needed to be defined by the DSM. As you mentioned the DSM does not include ob*y as an eating disorder, so it doesn't have a billable code. Does that then mean that patients that fall under that heading would not have any insurance coverage? (Not that it is great for eating disorders to begin with). It just seems a bit unethical for them to make up a definition for their own monetary benefit. But i would certainly not be the 1st case of corporate greed running the show in this area. sad state of affairs.
You are right -it's a problem that they are making up their own definitions for things that already have definitions. They are also taking advantage of the fact that there isn't a clear, scientific definition of "ob*sity". This whole thing is an absolute mess.
Interesting that being underweight isn't listed as an eating disorder. Plenty of underweight people don't have anorexia; by the logic displayed here, shouldn't they also be listed? Being underweight is correlated with quite a few health problems too, after all.
This "eating disorders" page sounds like an infomercial for Noom.
A voice of reason (and data) as always!
First, the mindless embrace of BMI by this clinician is disappointing. (Also, nice work pointing out his mathematical illogic lol!) Second, his deviation from DSM-5 diagnosis (which is already lagging in our time) regarding ob*sity is alarming as a psychologist. Lastly, his involvement on the "scientific advisory board" at Noom should have been brought to more upfront and more closely examined by Mount Sinai as a leading medical institute.
Medical "science" with its traditionally (thin-bodied, able-bodied) white male authorship benefits from pathologizing the bodies of people in "other" groups, especially women and women of color -- precisely those who have a disadvantage in BMI calculation. In this case, the benefit is financial.
Relics of psuedoscience find their way through every crack in medicine and bleed into our daily practice. Let this be a cautionary tale for all of us who hold the "power" to do more harm than good.
Thank you for this, it hits squarely at both a disturbing conflict of interest/unscientific practices and at my own experiences, so it was an especially helpful and validating read. Even though my lifelong struggle with food led me to a different healthcare system than the one you're digging into here, I've encountered the same biases, and it's research like yours that helped convince me I wasn't crazy when dealing with 'experts' who looked up my symptoms in the DSM-5 and then told me directly that I couldn't have an eating disorder because I wasn't bedridden and on a feeding tube.
Because the disorder I was seeking help with, ARFID, isn't about weight loss (though I have lost an scary amount in two years while still remaining fat) it's been really frustrating to try and go along with the help I've been able to receive, while being constantly reminded that we're only there to treat my symptoms and we mustn't act like I actually have a disorder, because my weight means I don't 'fit the criteria.' Even if it won't come soon enough to benefit me, I hope that the work people like you are doing will spread through the industry enough that more healthcare professionals will someday have the knowledge and training to recognize and treat disordered eating in all patients.