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I recently wrote about an NBC News article that included a quote from Tom Hildebrandt, PsyD who runs the Hildebrandt Lab at Mount Sinai in New York, which houses Mount Sinai’s Center of Excellence in Eating and Weight Disorders.
I promised that I would write a separate article about their troubling conceptualization of higher-weight as an eating disorder, and this is that article.
Content note: this piece will discuss eating disorders and weight stigma, please take care of yourself. You can skip the screen shots and indented sections to reduce harm.
The heart of the issue here is that they seem to consider simply existing in a higher-weight body to be an eating disorder. I came to that conclusion because they have it on a bulleted list of Types of Eating Disorders on a page labeled Eating Disorders:
They also have this on their homepage
We have more than a decade and a half of experience helping children, adolescents, and adults with eating disorders. Our psychologists, dieticians, social workers, and psychiatrists work as a team to diagnose and treat anorexia nervosa, bulimia nervosa, binge eating disorder, ob*sity, and other conditions… Eating and weight disorders are complex mental health disorders
Eating disorders are absolutely complex bio/psycho/social disorders that can do incredible harm and can be fatal. The problem is that “ob*sity” simply does not qualify.
To be clear, they aren’t the only ones making this mistake, but they doing it with the power of a massive and very well regarded institution and so I will talk about this specific case with the understanding that these issues apply broadly.
I’ve written extensively about the false claim that “ob*sity” is a “chronic lifelong disease” and some of the same issues apply including and especially that ob*sity is simply a body size. On their “ob*sity” page, Dr. Hildebrandt’s lab says “Ob*sity means you have excessive body fat” and “Doctors measure ob*sity by calculating your body mass index (BMI), which is the ratio of weight in kilograms to height in meters.” It’s actually a ratio of weight to height in any measurement, but that’s neither here nor there.
We know that BMI is deeply problematic on many levels, but beyond that, notice that their own definition says nothing about eating or shared behaviors in any way. This stands opposed to actual eating disorder diagnoses which have shared symptomatology which is used to diagnose them.
Their definition rests on stereotypes about how higher-weight people eat. The “ob*sity” page on their website says
“The most common cause of ob*sity is overeating.”
They don’t’ offer any research to support this, but state it as if it’s fact. They also admit that other factors including genetics and other medical conditions can be involved, but they fail to point out that, for example, the most common outcome of intentional weight loss attempts is weight regain, with up to 66% regaining more weight than they lost. (They also discuss higher rates of “ob*sity” in “African Americans” and “Latinos” but failed to mention that, for example, BMI was created using white bodies. I urge them, and everyone, to read books like Fearing the Black Body – The Racial Origins of Fat Phobia by Dr. Sabrina Strings and Belly of the Beast – The Politics of Anti-Fatness as Anti-Blackness by Da’Shaun Harrison to have a better understanding of these issues.)
At any rate, the suggestion that an eating disorder can be diagnosed based on a height weight ratio or body fat percentage is ludicrous. It also does a lot of harm because it suggests that eating disorders are simply a matter of weight. They make a similar mistake on their page about anorexia nervosa when they state:
“If you have binge/purge anorexia, your weight is very low whereas bulimia nervosa patients have body weights that are not critically low, but may still be unhealthy for that individual.”
This is dangerous misinformation. People of all sizes can have all types of eating disorders. The most recent edition of the Diagnostic and Statistics Manual (DSM-5) specifically includes the information “Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia.” (“Atypical anorexia” is a controversial diagnosis since it’s not so much “atypical” as “previously ignored” but that’s a subject for another day.) I’ll also point out that the DSM-5 does NOT include “ob*sity” as a feeding or eating disorder.
Less than 6% of people with eating disorders are medically “underweight.”
High weight people with eating disorders are exponentially more likely to be encouraged to engage in eating disorder behaviors (restriction, over-exercise, etc) in order to lose weight than to be screened for an eating disorder by their doctors.
The misinformation being trumpeted by “Mount Sinai Center of Excellence in Eating and Weight Disorders” is only likely to exacerbate these issues and given that eating disorders can be fatal, that is a very serious problem.
It also seems to be a problem that they are actively part of, since they offer a “weight management” program that claims (without citing any evidence) that their program can help “you or your child make lifestyle changes that support weight loss and ongoing maintenance.” Given 100 years of data that finds that only a tiny fraction of people actually experience significant, long-term weight loss, I find this difficult to believe.
In addition to having their own maintenance program, Dr. Hildebrandt’s lab performs research for the diet company Noom.
So, is it just me or is this study essentially - which is better - Noom or Noom?
Dr. Hildebrandt also holds equity in Noom:
So, to sum up, I believe that, based on their current webpage, the work of the Mount Sinai Center of Excellence in Eating and Weight Disorders under the Hildebrandt lab is likely to hamper the ability of higher-weight people who have actual eating disorders to get diagnosed while simultaneously misleading people into believing that simply existing in a higher-weight body is an eating disorder for which, apparently, weight loss (likely in the form of prescribing behaviors that are, in fact, red flags for eating disorders) is a treatment?
Again, they are far from the only group making these mistakes, and they may be very well-meaning. Still everyone who is making these mistakes must stop if we are to have any chance of actually appropriately diagnosing and treating eating disorders in people of all sizes.
In the meantime, there are some excellent ideas here about practical changes that could be made.
Edit: Chevese Turner let me know that Thomas Hildebrand was one of the original members on the Research Advisory Council for the (deeply problematic) National Eating Disorders Association (NEDA).
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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.
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.