I talk about eating disorders a lot. It’s kind of my thing (don’t worry, I’ll explain later). When talking about this disease with people who are unfamiliar, I like to highlight two key concepts: diet culture and weight bias. Eating disorders are extremely complex and it’s impossible to dive too deep with a 2,000-word limit but I’m not typically one to back down from a challenge, so let’s jump in!
Diet culture is a system of beliefs that idealizes thin bodies as a model of health and higher moral value. It reinforces the idea that larger bodies are inherently unhealthier and in doing so encourages poor treatment towards anyone who does not fit the thin ideal. Diet culture is INCREDIBLY sneaky. It shows up in painfully obvious ways like “My 600lb Life” and “The Biggest Loser”, two shows that exploit people in larger bodies as they starve themselves and exercise until they puke – all in the name of “health”. Diet Culture also shows up in more subtle ways like “clean eating” and “wellness culture”. Typically, the latter will use phrases like “It’s not a diet, it’s a lifestyle change!” or “You can eat anything you want in moderation”. Maybe someone has just had a big meal and they flippantly make a comment like, “Man! I’m going to have to run an extra mile tomorrow!” or “So much for my summer bod!”. There are still rules and expectations for how you should be eating and how your body should look. So, why is this problematic? Why shouldn’t people want to “look and feel better”? A couple of reasons:
1. The diet industry is worth $66 billion dollars, as of 2017. 95% of people who lose weight through dieting will re-gain that weight, and more, within five years. If diets worked, they wouldn’t be a billion-dollar profit center.
2. In a study conducted by the National Eating Disorders Association (NEDA), they found that “of 14– and 15-year-olds, dieting was the most important predictor of a developing eating disorder. Those who dieted moderately were 5x more likely to develop an eating disorder, and those who practiced extreme restriction were 18x more likely to develop an eating disorder than those who did not diet.”
There is a direct correlation between dieting and eating disorders. Eating Disorders continue to boast the highest mortality of rate of any other mental illness and yet we continue to normalize restrictive behaviors like Intermittent Fasting without seeing that what we are actually doing is tantamount to promoting disordered eating behaviors.
Now, let’s talk about weight bias. Society paints a very clear picture of what someone with an eating disorder looks like; emaciated, white, heterosexual, cisgender, upper middle class. The truth is that anyone can develop an eating disorder. Anorexia Nervosa and Bulimia Nervosa have nothing to do with weight (unless you’re looking at DSM-5 but for the sake of time, we won’t) and everything to do with someone’s FEAR of gaining weight and the behaviors used to keep that fear at bay.* A thin person and a larger bodied person could walk into the doctor’s office, saying basically the same thing: “I’m terrified of gaining weight. I’ve stopped eating more than ____ calories a day”. At this point, there is a good chance that the doctor will express concern for the thin patient, perhaps even help them seek a mental health professional. The odds of that doctor having the same response to a larger bodied person who presents with the same FEARS and BEHAVIORS is very slim. In fact, the likelihood of the doctor dismissing the patient’s claims and maybe even praising their efforts to lose weight is far more realistic. Many people in larger bodies express fear around going to the doctor and report a consistent pattern of weight discrimination. Additionally, there is a growing evidence to suggest that the effects of weight bias are far more dangerous than simply existing in a larger body. I could go on but there’s a word limit so I will just say this; google “Health at Every Size” and prepare to have your mind blown. Let’s look again at society’s portrayal of eating disorders. We’ve discussed the “emaciated” element but how about that part where they’re always white? Always straight? Always upper middle class (or at least able to afford treatment)? Think about movies and television shows that you’ve seen depicting people with eating disorders. How many of those characters exist along the margins of society? You may again be asking, “Why is this problematic?” Representation matters. The fact of the matter is that people in marginalized bodies (including larger bodies) are less likely to seek treatment for disorder eating behaviors even though they remain some of the most at risk:
Black teenagers are 50% more likely than white teenagers to exhibit bulimic behavior, such as binging and purging.
In a survey of college students, transgender students were significantly more likely than members of any other group to report an eating disorder diagnosis in the past year.
Teenage girls from low-income families are 153% more likely to be bulimic than girls from wealthy families. (www.nationaleatingdisorders.org)
When I entered treatment for bulimia in 2016, I didn’t know any of this. My eating disorder started out as a diet in 2011 after years of being shamed about my weight. For the next five years, I avoided a number of foods, exercised to the point of physical injury, and purged. It was a slow and painfully progressive disease. What kept me sick all that time was the constant praise that I received. It was as if the only thing that I was good at was making myself as small as possible. Few people knew the truth because on the outside, I looked like I was doing everything I was supposed to be doing; posting “healthy” meals, posting work out videos, and highlighting “inspiring” before and after pictures on social media (still one of my biggest regrets).
Eventually, I couldn’t hide the pain anymore. People noticed that I wasn’t okay, and a good friend of mind told me that I either needed to get help or she “wouldn’t stick around and watch me kill myself”. To this day, it is one of the best examples of boundaries that I have ever seen. Recovering from bulimia was a two-fold process. I worked with a therapist to unlock years of trauma that led to my using bulimia as a way to self-medicate, and I worked with a Health at Every Size (HAES) informed dietitian who taught me how to have a healthy relationship with food. For example, “good” and “bad” food don’t exist. Food is not linked to morality. For years, I believed that my body was incapable of processing certain foods, exclaiming “those foods aren’t for me”. I learned that my body is actually pretty smart and can process most things– even carbs! Even sugar! (again, MIND. BLOWN.) My dietitian sparked an interest in the Health at Every Size framework which inspired me to research everything I could find about diet culture. I devoured books, blogs, articles, and Podcasts – I became OBSESSED with unlearning how to hate my body. Once you see how incredibly pervasive diet culture is, you can’t un-see it.
Today, I still struggle with preconceived ideas of how my body should look. Sometimes, I still question whether or not I should eat something. I’m human and still very much residing in a world that is riddled with diet culture and toxic messages demanding that I remain quiet and small. The difference now is, no matter how loud that voice is, I know that I don’t have to listen to it. Because I’ve spent years sharing my story on various platforms, I have found many people who have recovered from this disease and I can reach out to them when times are hard. My support system is bountiful. I’m in graduate school studying to be a Licensed Marriage and Family Therapist with an end goal being to work with people in marginalized bodies who struggle with disordered eating. I still live in a privileged body which is why I spend a majority of my time highlighting the stories of people who don’t. My journey through recovery from bulimia is important but I had many opportunities that others simply don’t; access to care, family support, transportation, and a body that “looked sick enough” to people who had the power to help me.
I always try and encourage people to be mindful when they’re talking about their bodies. Imagine that you are standing in front of an impressionable child, absorbing everything you say like sponge! How are you talking about your body? The food you eat? How about other peoples’ bodies? The next time you’re out with a group of friends, try and keep track of how many times diet culture works its way into the conversation. I swear, noticing the subtle ways in which I was taught to hate my body was revolutionary. It pissed me off enough to want to recover from a disease that nearly took my life. My wish is that maybe you’ll get a little pissed off too. If you do, you know where to find me. *there are many more eating disorders beyond Anorexia Nervosa (AN) and Bulimia Nervosa (BN). All of them are different and do not necessarily manifest in a fear of weight gain and/or restrictive behaviors. In this case, the author chose to highlight AN and BN because of personal experience and because they are the most commonly researched (unfortunately).