Flying Under the Radar: Subthreshold Eating Disorders

At some point or another, most of us will develop an uneasy relationship with food. As your body goes through its normal changes, you might find yourself skipping meals, obsessing over calorie counts, or running to the gym after dessert. These behaviors might not raise alarms; they might even seem healthy.

But beneath the veneer of self-discipline and ritual, something deeper may be going on—something that clinicians call a subthreshold eating disorder.

Subthreshold, or subclinical, eating disorders are just what they sound like: patterns of disordered eating that don’t quite meet the criteria for a full diagnosis like anorexia nervosa, bulimia, or binge-eating. They exist in a gray zone—disguised as healthy, but not yet catastrophic. And for that reason, they’re easy to miss. Easy to normalize, especially in our diet culture that praises/demands the pursuit of thinness at all costs.

Yet these conditions can cause real suffering. A person might not purge (or binge) every day, but they might still live with intense guilt after eating. They might not starve themselves to dangerous weights, but they may restrict just enough to feel constantly hungry, anxious, or tired. Their lives are often shaped by an invisible, exhausting negotiation with food and body image.

Many people live in these in-between places. Adolescents, especially, seem to inhabit this psychological limbo. In one study, nearly 27% of teenage girls reported disordered eating behaviors that didn’t meet diagnostic criteria—but that were strongly linked to depression, low self-esteem, and even suicidal ideation. Boys, too, are affected, though they’re less likely to talk about it or seek help.

Why do subthreshold eating disorders fly under the radar? In part, it’s because they can masquerade as virtue. A teen who won’t eat carbs might be seen as health-conscious. An adult who “makes up” for meals with extra workouts might be praised for their discipline. The language of wellness often obscures the warning signs of a disorder. Yet subthreshold eating disorders can also cause medical complications. 

Subthreshold starvation, compensatory exercise, purging every once in a while creates wear and tear on a body. In time, it puts the body in a below optimal medical place.

And there’s another reason: many people struggling with subthreshold symptoms don’t believe they’re “sick enough” to ask for help. They compare themselves to the most extreme stories—hospitalizations, feeding tubes, emaciated bodies—and decide their pain doesn’t count. That belief can delay treatment and, in some cases, lead to more entrenched disorders down the line, particularly during periods of stress or transition, such as adolescence, job transitions, divorce, pregnancy, or menopause. As an eating disorders specialist, I have had numerous conversations with clients who tell they are fine or not sick enough, thin enough, etc to have an eating disorder. I have been in social situations where people, who know I am an eating disorders specialist, tell me they know somebody with a mild eating disorder. I have to tell them that mild eating disorders are concerning. 

But here’s the thing: you don’t need to be at death’s door to deserve care.

Early intervention matters. Therapy, support groups, and nutritional counseling can all help people change their relationship with food and their bodies. Even a single conversation—with a parent, a teacher, a doctor, a friend—can make a difference. It can break the silence and offer a way forward.

If we want to support people in our communities—and ourselves—we need to stop drawing such rigid lines between “disorder” and “not-a-disorder.” Mental health exists on a spectrum, and healing starts with recognition. We need to name the gray zones, sit with their complexity, and create space for compassion, not just diagnosis.

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References

The hidden burden of eating disorders: an extension of estimates from the Global Burden of Disease Study 2019; Damian F Santomauro , Sarah Melen , Deborah Mitchison , Theo Vos, Harvey Whiteford, Alize J Ferrari ; Lancet Psychiatry; 2021

Full syndromal versus subthreshold anorexia nervosa, bulimia nervosa, and binge eating disorder: a multicenter study ;  Scott J Crow, W Stewart Agras, Katherine Halmi, James E Mitchell, Helena C Kraemer;  International Journal of Eating Disorders; 2002

DSM-5 eating disorders and other specified eating and feeding disorders: is there a meaningful differentiation?; A Kate Fairweather-Schmidt , Tracey D Wade; International Journal of Eating Disorders; 2014

Defining "significant weight loss" in atypical anorexia nervosa; K Jean Forney, Tiffany A Brown, Lauren A Holland-Carter, Grace A Kennedy, Pamela K Keel; International Journal of Eating Disorders; 2017

Weight Loss and Illness Severity in Adolescents With Atypical Anorexia Nervosa; Andrea K Garber, Jing Cheng, Erin C Accurso , Sally H Adams, Sara M Buckelew, Cynthia J Kapphahn  , Anna Kreiter , Daniel Le Grange, Vanessa I Machen, Anna-Barbara Moscicki , Kristina Saffran , Allyson F Sy, Leslie Wilson, Neville H Golden ; Pediatrics ; 2019

Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature; Erin N Harrop, Janell L Mensinger , Megan Moore, Taryn Lindhorst; International Journal of Eating Disorders; 2021

Are diagnostic criteria for eating disorders markers of medical severity?; Rebecka Peebles, Kristina K Hardy, Jenny L Wilson, James D Lock; Pediatrics ; 2010

Subthreshold Eating Disorders: Diagnostic Issues, Natural Evolution and Treatment Implications;  P. Monteleone, P. Cotrufo, M. Maj; European Psychiatry; 2020

"Me Little Me": An Authentic Portrayal of Eating Disorder Recovery

At the beginning of November, I was thrilled to attend an online screening of the independent film Me Little Me! It’s a thought-provoking work that shows aspects of the eating disorder recovery experience not typically represented in the mainstream, making it an incredibly important film, and I thought I’d share a bit about what makes it unique in an effort to highlight all the ways society so often gets it wrong. Below is a list of the ways in which Me Little Me veers away from common – and highly problematic – tropes about eating disorders.

I have done my best to avoid major spoilers for those who wish to see the film, but please be aware that a few minor details are revealed below.

1. The representation is well-done and important.

The fact that the main character in this film is a working-class Black woman, likely in her late twenties or early thirties, whose body is neither noticeably small or noticeably large, is in and of itself a rebuke of the same old, tired tropes. Mya is not the ultra-thin white teenage girl typically represented in media about eating disorders, which made me very happy to see; nothing against ultra-thin white teenage girls, of course, but the fact remains that they are vastly overrepresented, and that this overrepresentation leads to rampant missed and incorrect diagnoses for anyone struggling with an eating disorder who does not fit the mold.

Additionally, the diverse cast of characters is fantastic, particularly in the scenes at Mya’s outpatient recovery program. People of varying colors, ages, genders, shapes, and sizes are shown in the program, which further underscores the point that eating disorders can happen to anyone.

2. The portrayals of Mya struggling with her eating disorder are thoughtful and trauma-informed.

It struck me while watching the film that Mya’s disordered eating behaviors were not actually shown – at least, not in the classic sense. Other media portrayals offer no qualms about displaying these behaviors explicitly, often going so far as to hone in on all the “strange” mannerisms and habits in a way that feels voyeuristic – a borderline fetishization. All the portrayal of eating disorders behaviors creates a person who is unrelatable instead of a person struggling that we can have compassion for and even relate to the pain a person with eating disorders carries.  Me Little Me does nothing of the sort. As someone with a history of anorexia, I often find films about eating disorders triggering in a tantalizing sort of way that is incredibly unhealthy. This was not the case with Me Little Me; the story was told in such a manner that the viewer did not need to be indulged with the nitty-gritty details in order to be drawn into Mya’s struggle and accept it as legitimate. This is a major breakthrough, in my opinion, as I imagine so many others, like myself, struggle to watch ED-related topics for fear that it may reignite harmful patterns.

3. Mya is the focus – not her eating disorder.

Just as with the respect granted in the refusal to document specific disordered eating behaviors, the film also refuses to reduce Mya only to her disorder. Instead, she is multifaceted and complex. Despite the characterization of Mya as a fairly guarded person who keeps others at a distance, she is nevertheless whole and real; we see her barely-contained excitement at having received a promotion, the discomfort she feels in certain situations, her attempts at dealing with loneliness, and a strong display of emotion when old familial wounds resurface, all of which serve to craft a life around her that includes her eating disorder, rather than a life that has become her eating disorder. This is vital, as it rejects broad generalizations and reflects the truth, once again, that eating disorders are a human issue that can impact anyone. 

4. The film offers a glimpse into recovery that is less medicalized and more focused on the mental health aspect.

Much of the mainstream media about eating disorders delves into the medical risks and the long-term consequences on the body. While these impacts are undoubtedly serious, I’ve found less representation than I’d like to see of the mental and emotional outcomes. Me Little Me does a great job with this aspect in particular, showing relapse less as a medical danger and more as a person in the throes of what looks a lot like deep depression: unable to get out of bed, missing work, and withdrawing from the world around them. The film also points to unresolved trauma and the ways it can contribute to disordered eating, especially in moments when trauma triggers render a person especially vulnerable.

Even the setting of Mya’s home and the treatment center, with inspirational messages of self-love and acceptance written on everything from signs on the walls to painted rocks on the porch, points to mental health as a vital central focus in conversations around eating disorders.

5. The film offers a glimpse into recovery to include finances and real world realities. 

As an eating disorder psychologist, I spend a great deal of time working with clients to manage the financial aspect of treatment. This includes writing letters for insurances, corresponding with insurance companies, and helping clients manage work and school loads so that they can participate in treatment. It is never easy and often involves negotiating aspects of treatment so that my clients can pay their bills. I have seen time and time again in mainstream films how people easily enter treatment with no discussion around financial impact. Mya is seen struggling to manage her work and her eating disorder treatment. She has to hide her treatment from her work and you can visibly and emotionally feel her struggle.This financial struggle is real for many people with eating disorders.

Everyone’s situation is different, of course, and no film will ever capture all the nuance of everyone who’s struggled with an eating disorder. However, Me Little Me does a lot for dialogue around eating disorders, and my hope is that mainstream media can pay attention to this beautiful film, take the hint, and – hopefully – learn from it.

Here is the website of the film and where you can watch it!

https://www.melittlemefilm.com

https://www.melittlemefilm.com/wheretowatch

Thank you Elizabeth Ayiku for your incredible work and determination to make this film a reality. I am proud to be a contributor to your film.

And thank you Project Heal for partnering with Elizabeth to support this film! 

https://www.theprojectheal.org

Same Anti-Fatness, Different Look: An Analysis of the "Ob*sity Bill of Rights"

Upon first learning of the existence of the “Ob*sity Bill of Rights,” it may be tempting to look upon it as a tool for addressing anti-fatness in healthcare settings. While the packaging is pretty, though, what’s inside isn’t nearly as appealing. I’ve put together an analysis of the contents of the bill, and though this isn’t a complete list, it will hopefully draw attention to some of the document’s glaring issues.

It is very important for me to acknowledge my thin privilege - the ways I do not and never will understand the impact of this bill on fat folks. 

1. It’s Pathologizing

The use of the O-word in the title indicates, right away, that fatness and fat bodies are viewed as a problem to be eradicated. At this point in time, we have mountains of data to support the fact that the correlation between fatness and health problems is overwhelmingly due to the real-life impacts of anti-fat oppression, rather than fat itself as something inherently harmful. With all the research and data available, it is irresponsible at best – and, in many cases, medically negligent – to pathologize fatness as a problem that needs to be solved. This only perpetuates the very anti-fat narratives that threaten the well-being of fat patients in the first place. 

Fat people have insisted, for quite a while, that the word “ob*sity” is a slur that pathologizes and problematizes plus-size bodies. A movement that claims to respect and care for fat patients while using a word identified as a slur by fat communities is obviously not listening to the very people it purports to advocate for.

Additionally, the preamble dangerously perpetuates the idea of fatness being unequivocally harmful, stating that “400,000 people are estimated to die every year from ob*sity.” This language is misleading and entirely inaccurate: a tired assumption that if deaths from conditions such as diabetes and heart disease occur in patients who happen to be fat, their fatness must be the cause. Such assumptions do nothing but further the very narratives about fatness that are so often used to discredit and dehumanize fat people.

2. It Doesn’t Challenge Assumptions Rooted in Anti-Fatness, Instead Passing Them Off as “Information”

The bill states that patients have the right to  “accurate, trusted information in culturally appropriate and easily understandable language that explains obesity as a complex chronic disease requiring personalized treatment” (emphasis added). While it’s indisputable that patients should absolutely have the right to information, what happens when the information they are given – information being taken for granted as tried-and-true fact – is deeply rooted in anti-fatness and, by extension, eugenics, ableism, and white supremacy? Under the guise of informing patients, this item encourages healthcare professionals to coerce fat patients into problematizing their own bodies–a coercion that can be so strong, it can lead patients to agree to certain treatments under duress. Claiming that fatness is a disease requiring treatment leaves fat patients without a voice with which to refuse the pathologization of their bodies. 

3. It Makes False Claims About “Safe & Effective” Weight Loss Treatments

We know by now that intentional weight loss methods simply do not work; the vast majority of those who pursue intentional weight loss regain this weight, and then some, within a few years. Thus, the “safe and effective” treatments mentioned in the bill do not actually exist. This is misleading at best.

It’s important to note that many fat people have spent much of their lives engaging with diets, exercise regimens, and various forms of restriction/starvation in an attempt to make their bodies smaller. For some, these attempts began as early as childhood. We know, though, that when the body is exhausted and depleted in pursuit of the thin ideal, the opposite happens over time. I once worked with a fat adult patient who had engaged in food restriction patterns since elementary school, leading to decades of weight cycling that resulted in a higher weight set point with each cycle. When she realized this, she had an outburst during one of our sessions, exclaiming, “So I anorexiced myself to ob*sity?!” Her experience is not at all uncommon, and it points to the flaws of the claims of “safe and effective” weight loss treatments made by the bill of rights.

4. It Insists On Using Person-First Language “As a Sign of Respect”

While many are taught that person-first language is the most respectful way to talk about marginalized identities, an overwhelming amount of people with those identities, including fat people, caution against its use. A colleague and fat liberation advocate explains it as such:

“For me, person-first language inappropriately distances my fat identity from the reality of my day-to-day life. Referring to me as a 'person with fatness' gives the inaccurate idea that the size of my body isn’t a major part of my identity. It wouldn’t have to be, in a world that didn’t actively hate fat people, but unfortunately that’s not the world we live in. I identify myself as a ‘fat person’ because my fatness is always the first thing people notice about me, and because anti-fat oppression is unequivocally the thing that makes my life the hardest.”

5. It Perpetuates the Eugenicist Notion that Fat People Should Not Exist

We all know what the authors of this bill mean when they refer to “ob*sity treatment:” the eradication of fat bodies. It is this mentality that contributes to poor body image and eating disorders: when we identify certain bodies as “wrong,” people will go to great lengths to avoid looking like them, causing themselves great harm, and sometimes even dying, in the process.

Additionally, it maintains a false binary between ”good fat people” (that is, fat people who spend their lives trying not to be fat) and “bad fat people” (those who do not “obey” societal standards by constantly trying to take up less space). The fat patients described in the bill are all the former: the ones who accept their ob*sity diagnosis and obediently seek “treatment” for the alleged wrongness of their body in an attempt to make it smaller. Perpetuation of this binary unequivocally causes harm – particularly to the "bad" fat people who choose not to pursue intentional weight loss – making anti-fat discrimination in healthcare settings far more likely for these patients, who are often slapped with labels such as "non-compliant" that can cause insurance companies to restrict their access to many different types of care.  

6. It Entirely Misses the Real Problem with Anti-Fatness in Healthcare

Nowhere in this bill are any conditions mentioned that aren’t correlated with fatness; yet, this is what so many people in large bodies struggle with. I hear horror stories from people about going to the doctor for an earache and being lectured about weight loss. The same colleague who I quoted about person-first language spent decades of their life with chronic pain that was blamed on their fatness. It wasn’t until age 38 that they were finally diagnosed with a progressive disability – a disability that, due to lack of treatment, has severely impacted their ability to stand and walk. Their diagnosis could have come so much sooner, and their mobility could have been preserved, if doctors had been able to look beyond their fatness and actually evaluate their symptoms, the way they would for a thin patient.

These problems are so common, nearly every fat patient can tell you a similar story–yet the bill of rights doesn’t even mention them. Instead, everything it advocates for has to do with fat people receiving treatment so that they can somehow magically not be fat anymore. It doesn’t address anti-fatness within healthcare – instead, it perpetuates it.

Make no mistake: while the Ob*sity Bill of Rights may appear to have the interests of fat patients in mind, it essentially only functions as yet another tool of anti-fat oppression. Rather than attempting to pathologize fatness and “treat” fat people out of existence, those whose care practices are truly rooted in freedom from oppression would do well to take the bill with a heaping tablespoon of salt and treat their patients like diverse human beings instead of walking, talking diagnoses.

Losing More Than Just Weight: Ozempic, Wegovy, and the Harms They Can - and Will - Create

By now, you’ve all likely heard much of the buzz surrounding the drugs Ozempic, Wegovy, and others like them, which are now being widely prescribed for weight loss. I’ve been deeply troubled by this for quite some time, and recently I watched a webinar from the Center for Body Trust, titled "Let's Talk About Weight Loss Injectables," with in-depth dialogues surrounding these issues. Today I am offering a very condensed synopsis of some of the points in the webinar and how they support my criticisms of these medications as tools for weight loss. I highly recommend watching the webinar, which is still available for purchase on a sliding scale if you would like to dive deeper.

A big thank you to Hilary Kinavey and Dana Sturtevant of the Center for Body Trust, as well as panelists Sirius Bonner, Ragen Chastain, Lisa DuBreuil, and Marianne McCormick.

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1. These are diabetes drugs - not weight loss drugs. The dosages at which they are prescribed  in order to have the intended effect on weight are obscene: double, even triple, what is recommended for diabetes. There are virtually no long-term studies at these dosages, which means we don’t even really know whether it’s safe or not three, five, or ten years down the line – a major issue, considering many will be taking these drugs for the rest of their lives.

Even if there were no health risks - even if there’d been decades worth of thorough testing and research to suggest these dosages are perfectly safe - the issue still stands that these drugs are intended for diabetes, and that the uptick in demand for the purposes of weight loss means that diabetic people who rely on these medications to stay alive now struggle to access them. Some diabetics report unsolicited pressure from healthcare providers to increase their dosage for the “added benefit” of weight loss. Further, a look at the history of the greedy pharmaceutical giants behind these drugs - namely, Eli Lilly and Novo Nordisk - shows us that when demand goes up, so does price, making them even harder to get for those who truly need them.

2. The decision to take these drugs is not an informed one. Even if doctors are giving their patients all the available information and people are using these medications willingly and as directed, the fact remains that anti-fatness is the reason they are being prescribed for weight loss in the first place. Using these drugs in this way is inherently skewed in favor of weight stigma and thus cannot be considered an objective and informed decision. The harmful impacts of anti-fatness are very real and deeply impact the lives of fat people, and any decisions made under the heavy burden of weight stigma can only be considered as having been made under duress.

Additionally, most people are told they will need to keep using these drugs for life in order to keep their weight off. Studies are showing, however, that weight regain is highly probable after prolonged use, even when still taking the drug. When this happens, other medications are likely to be added into the mix, bringing with them a whole new slew of side effects. The data is unmistakable: cessation of these drugs will cause the weight to come back, making the maintenance of any kind of weight loss (if even possible) an ever-complicating life sentence - which is likely not what patients are aware they’re signing up for.

3. The use of these drugs for weight loss is rooted in weight stigma and anti-fatness. Developers and proponents of Ozempic, Wegovy, and their ilk aren’t shy about stating their intentions to eradicate fatness. In order to accept that fatness should be eradicated, of course, we must first believe that fat people should not exist. This is the crux of anti-fatness: the idea that there is a certain point at which bodies stop being acceptable. In order to champion weight-loss injectables, one must believe that to be true.

Moreover, as I have heard pointed out by NAAFA’s Tigress Osborn, fatness as something that can be medicated away only opens the floodgates for increasing discrimination and oppression against those who choose not to, or cannot, take these drugs. Weight stigma already kills. Fatness is already largely seen as a choice in mainstream diet culture. These problems, in a world where fatness can be eradicated with medication, will only increase in severity.

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These are only three of the many, many reasons that I, and so many other care providers, sense inherent danger in the current iteration of the weight loss drug boom. We’ve seen this before; many have likened it to the opioid epidemic and the lack of caution that was exercised leading up to it. This scenario may be even more chilling, in fact, given who is most likely to be harmed. While the opioid epidemic was very clearly a massive problem, medical professionals and society at large will likely not show the same readiness to admit their mistake when it comes to weight loss injectables, for one simple reason: in a society of anti-fatness, we don’t care when fat people die. Instead, we justify it by blaming their weight - the very thing they were so desperate to address in the first place. It’s a downward - and deadly - spiral that both fuels and feeds off of anti-fatness and weight stigma.

Instead of trying to eradicate fatness and fat people, healthcare providers need to focus on eradicating bias. This is the underlying message of the webinar mentioned above, which I highly recommend purchasing if you are able. I am not an affiliate of the webinar, and I do not receive any compensation for referrals - I just believe deeply in its message and feel everyone should see it!

Lastly, I’m hosting an online overview training on March 29: “Eating Disorders Treatment: Applying a Social Justice Lens for Healing and Liberation.” It’s intended to provide a foundational understanding for care providers of the ways in which oppressive systems not only perpetuate eating disorders but also inform the way they are diagnosed and treated and thus disproportionately harm marginalized patients. For more information and to register, click here.

The Business of Body Hatred: How Meta Profits (Again) from Eating Disorders

Blame it on the algorithm.

It’s a sentiment most are familiar with in this age of clickbait, doom-scrolling, and digital footprints. The machinations of content dissemination to target audiences for profit have largely been regarded with a healthy dose of suspicion but ultimately accepted as a necessary evil: an inevitable byproduct of the conveniences and tech frills that accompany the age of information.

In 2021, the Facebook Papers painted a devastating picture of the lengths the social media giant had gone to for profit – and the harm that occurred as a result. This group of internal documents, leaked by whistleblower Frances Haugen, offered proof of the company’s willingness to not only allow pro-eating disorder content, but to intentionally encourage vulnerable populations to view it. Facebook, Haugen said, had gone to great lengths to hide “disturbing” research about how its use of the algorithm to promote such content led to teenagers’ heightened feelings of negativity about their bodies and increased their risk of developing deadly eating disorders.¹ Investigations revealed that the company had been struggling to engage young people–and that attracting them with dangerous pro-eating disorder content was part of a larger strategy to retain them as members of a core audience. Documents surfaced that proved Haugen’s claims that the company was well aware of the harm being caused, while continuing to perpetuate it.

Despite these damning revelations and a slew of lawsuits in 2021 and 2022, not much has changed. Targeted weight-loss ads are quite literally everywhere–even for those who have used ad preferences to indicate they do not wish to see such content. I currently work with someone who has shared that they’ve seen a huge uptick in weight loss and food restriction advertisements on their feed in the last month alone, despite having spent years reporting and blocking such content, as well as tailoring their ad settings against it.

With recent advancements in AI technology, the algorithm is only getting sneakier. Women who have announced their engagements on social media, for example, have suddenly found themselves inundated with targeted weight-loss ads that are specific to brides, using phrases such as “shredding for the wedding” and “intermittent fasting for your big day.”² The nonprofit organization Fairplay for Kids, which fights child-targeted marketing, released a report in 2022 that accused Meta of marketing weight loss to children as young as nine, through accounts tagged with “thinspiration” or “bonespiration” and obviously promoting disordered eating. The report found that out of the 1.6 million unique users following these accounts, many followed each other, too, which creates a “pro-eating disorder bubble”, or feedback loop, “that is worth at least $1.8 million per year for Meta, and the revenue generated from all users following this bubble is $227.9 million per year.”³

All this points to a clear need for regulation over algorithmic technology, which experts are currently calling for.⁴ In the meantime, Fairplay for Kids is helping people like you get involved. Click here for an easy way to contact your representatives about supporting legislation to help protect people under 18 from developing eating disorders as a result of social media marketing!

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¹ “The Facebook Papers and their Fallout.” The New York Times, 25 Oct 2021. 

² Khan, Aamina Inayat. “How Targeted Weight Loss Ads Can Haunt Future Brides.” The New York Times, 19 Nov 23.

³ “To help prevent eating disorders, regulate social media algorithms, expert says.” Harvard T.H. Chan School of Public Health, 27 Apr 2023.

⁴ Monahan, David. “New Report Shows Meta Profits from Pushing Pro-Eating Disorder Content to Children on Instagram.” Fairplay for Kids, 14 Apr 2021.

Brilliance? I'm Not Sure: Barbie, Body Image, and Legacy

We need to talk about Barbie.

This statement may feel fairly redundant. After all, it seems as though there are few places in which people aren’t talking about Barbie, and for good reason: the film has blown all expectations out of the water to become Warner Brothers’ highest-grossing global release in history. That in and of itself is quite the feat, particularly because of the film’s femme-forward storyline, direction, and cast. 

The movie certainly gives us much to discuss, and it does quite a lot of things really well. It’s a visually intoxicating tale of self-discovery, power, and persistence that’s laden with clever critiques of patriarchy – much of which are as hilarious as they are potent. What’s not to love? I laughed A LOT during the film. Watching Barbie in a body that is so glorified by impossible beauty standards was unsettling. Yet I just sat with it as there was so much in the film.

*Please note: spoilers ahead!*

A scene towards the beginning of the movie shows Barbie arriving at a middle school and having a brief and fairly contentious experience with an outspoken young woman, Sasha, and her group of friends. As someone who grew up knee-deep in Barbies and diet culture, I was thrilled when Sasha points out Barbie’s less-than-rosy legacy. “You’ve been making women feel bad about themselves since you were invented,” she bristles. “You represent everything wrong with our culture. Sexualized capitalism. Unrealistic physical ideals.” 

This accusation is certainly one that millions can get behind, and I’m sure I wasn’t the only one breathing a sigh of relief when the elephant in the room finally got roped into the conversation. I was disappointed, however, that the discussion about Barbie’s complicity within diet culture didn’t continue – at least, not in a particularly potent way. The mentions of it here and there throughout the rest of the film felt like crumbs we were being thrown and came nowhere near to doing the topic justice.

I suppose I’d been expecting – or at the very least, hoping for – a storyline that included Barbie taking accountability for her unfortunate legacy of impossible beauty standards. Sadly, though the film addressed important topics, this one felt like more of an aside.

I also felt uncomfortable later on,when America Ferrera’s character snaps the Barbies out of their subservient role with a powerful speech – one that’s been circulating all over the internet for weeks. It was awesome watching each Barbie realizing how they have been manipulated, and it did a lot to represent the way we so often fall prey to gaslighting from cultures of oppression. I loved the strong speech and have enjoyed seeing it come up again and again online. What I had to grapple with, however, was the fact that America Ferrera – who offered so much for challenging beauty standards in Real Women Have Curves and Ugly Betty – had lost so much weight that I did not recognize her. Further, what I found during an online search for America Ferrera was page after page of…her weight loss strategies. 

It’s important to note that I do not fault Ferrera for the desire to lose weight. How can anyone work in the context of Hollywood without falling prey to unrealistic beauty standards and body ideals at every turn? Ferrera isn’t to blame here – but the industry that does so much to create, perpetuate, and uphold these standards very much is. I get so frustrated with the entertainment industry: all the power it holds to influence societal norms, yet it takes none of the responsibility for doing so when those norms cause such devastating harm.

All that said, I walked out of the theater feeling conflicted: I was thrilled and amused at the creative critique of patriarchal culture I’d just seen, yet I was holding disappointment as well. 

Author and activist Virgie Tovar observes that “the film’s core conflict feels off, or at least askew. If the new Barbie movie is about addressing and righting past wrongs - and I think it is - the central plotline doesn’t tackle the right one, the big one. When it comes to Barbie, it’s not toxic masculinity that needs to be reckoned with. It’s Barbie’s long-time correlation with negative body image and lower self-esteem in girls.” Virgie does an incredible job of addressing why this movie is not the utopia it’s being made out to be – see her article here: https://www.forbes.com/sites/virgietovar/2023/07/28/theres-a-body-image-sized-hole-in-the-new-barbie-movie/amp/?fbclid=IwAR0Q_hnTPI35AdwTEF4qecWMnnraNbklc8qwAQGq_ZmwQNZG3Eg_z8py6pY

This fair and honest review of the film by Tabitha St. Bernard-Jacobs echoes a lot of my own feelings about it, particularly that of representation. Given Barbie’s ties to harmful beauty standards, one couldn’t be blamed for hoping a wide range of body types would be represented in the film. Sadly, this wasn’t the case: while two plus-size Barbies were included, played by Nicola Coughan and Sharon Rooney, they were given supporting roles and did not have any particular prominence in the film. As St. Bernard Jacobs notes in the review: “If we only get supporting roles, is it really representation?” 

Additionally, this review critiques the film from an intersectional and abolitionist perspective, offering strong points about the white feminism and desirability politics inherent to it, all of which are deeply entwined with patriarchy itself and could have been addressed in more impactful ways. I realize it would be impossible to address the entire structure of patriarchy, as well as its many intricate intersections with various systems of oppression, in two hours – and, I think acknowledging those limitations could have improved the Barbie experience for me, as well as for countless viewers with marginalized identities everywhere.

The Path to Wellness Isn't 10,000 Steps Long

The Origin of a Myth, and How it Perpetuates Harm 

It’s the default goal on a Fitbit or an Apple Watch. It’s recommended by official health and wellness authorities worldwide. At this point in time, the target of 10,000 steps per day has been burned into the collective consciousness, taken for granted as a given if one wants to attain good health. I remember working in Health Education over 15 years ago with such a focus on 10K steps and pedometers. We created promotions, health information, campaigns and even had team contests. 

When we question that target, however, we find a whole lot of information that doesn’t exactly support this widely known “fact.” This newsletter is focused on the myth of 10K steps, as I was inspired after I listened to Aubrey Gordon and Michael Hobbes explain in a recent episode of their excellent podcast Maintenance Phase. Their 10K podcast is just brimming with research facts, history, information illustrating the deep political roots of 10K steps. So I just want to focus on a few facts I took away from their super fabulous podcast episode (btw, every episode is just super fabulous):

• 10,000 is an entirely arbitrary figure in terms of fitness and health. The number itself was chosen by a group of Japanese researchers in the 1960s who determined that if the average Japanese person increased their steps to 10,000 a day, they would lose a certain amount of weight each year. These calculations, however, were based on the “calories in, calories out” model, which has since been thoroughly debunked, effectively turning their research into junk science. Moreover, it is absolutely worth mentioning that this fascination with step count was born out of a desire to make people thinner – not healthier. It is deeply rooted in anti-fatness.
• 10,000 was also chosen because the Japanese written language of 10,000 looked “good”. It was a “cool” symbol. Again, where is the focus on health?
• Citing an interest in children's health, McDonald’s released the Go-Active Happy Meal, which included pedometers for kids, in 2004 - the same year the film "Supersize Me” came out. Coincidence? Not really: McDonald’s sales plummeted after the movie and the Go-Active Happy Meals were a way to increase profits during an era that demonized fast food. So this Happy Meal was about profit, not health, despite their claims.
• Additionally, given that all our bodies and experiences are unique, it doesn’t take a whole lot of thought to realize how deeply meaningless this standard of health is. Research has shown that different bodies respond to different forms of movement in different ways – findings which only become more varied as differences in age are taken into account.¹  And while it is, for the most part, true that the human body benefits from movement in general, to suggest that 10,000 steps is the ideal for achieving health is ableist, on top of everything else. Many people with chronic pain, invisible illness, or other disabilities might be unable to achieve the 10,000-step mark. If this is our goalpost for what it means to be well, it implies that anyone who cannot meet the goal (or who chooses not to meet it) is unwell: an assumption that is simply not true.
• Happiness and enjoyment are components of wellness, too, and interestingly, as Gordon and Hobbes point out, emerging data shows that measuring the output of tasks can inhibit the enjoyment of said task. Simply put, people who track their steps may actually find less pleasure in their movement than people who do not keep track. Something definitive we know about human behavior: if we enjoy doing something, chances are good we will continue to do it. Therefore, if tracking our steps makes movement feel less like fun and more like a chore, we’re less likely to continue to do it with consistency–making striving for a certain step count something that could actually counteract our well-being in the long run.

On a final note, because this is so important: health has no moral value. A human being is worthy of respect and care, regardless of the status of their health. It might be tempting to read this post and walk away with the knowledge that the step count we should strive for is, simply, one that supports our health and well-being. While that’s not untrue, I want to offer a caution against the well-meaning but ultimately harmful caveat of “...as long as you’re healthy.” Why? Because in this day and age (and stage of neoliberal capitalism), health is a privilege. It should be a right–but it’s certainly not treated like one. Countless people in the United States and across the world do not have the resources to attain health. In the U.S. alone, many people cannot afford adequate healthcare even with health insurance coverage; additionally, those living under U.S. food apartheid (in places often referred to as “food deserts”) often lack access to meals that meet their nutritional needs. For other people, physical health may simply not be a priority–and that’s okay, too. The point is: no one owes their health to anyone else.

For a deep dive into the origin and history of step counting, listen to “The 10,000 Steps Myth” on Maintenance Phase!

¹ Paluch, Amanda E et al. “Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts.” The Lancet. Public health vol. 7,3 (2022): e219-e228. doi:10.1016/S2468-2667(21)00302-9

The Whale, Brendan Fraser, and Fat Representation: How Tired, Uncreative, and Harmful Tropes Perpetuate Eating Disorders

Several weeks ago, I happened to see the speech Brendan Fraser gave after winning an Academy Award for his latest film, The Whale. Having heard some concerning reports about the film itself, I’d decided against seeing it, but even Fraser’s acceptance speech was peppered with whale references. I was outraged, and as it turns out, I wasn’t the only one: Ragen Chastain of Dances With Fat tweeted that “Brendan Fraser making whale metaphors (jokes, really) while accepting an Oscar for cosplaying a fatter person in a film written and directed by thin people that rests on grotesque weight stigma, ableism, homophobia, and stereotypes is the end of my support for him.” Regardless of your feelings about the actor himself, there’s little doubt that The Whale leans on a stereotypical – and incredibly harmful – trope: that fat is the worst thing a person can be.

It is, of course, entirely possible for a person to exist in a fat body and still experience love, happiness, joy, fulfillment, health, and connection. Yet, looking at movies like The Whale, is it any wonder that so few people realize this is true? Representation of fat folks, particularly those on the larger end of the spectrum, is almost always limited to narratives like this, with fat people being portrayed as sad stories, wells of unrealized potential, or cautionary tales. Where are the movies about fat people experiencing elation, being promoted, falling in love, or living long and happy lives? 

This lack of representation only feeds into the idea that fatness is inherently bad–a paradigm which drives body dysmorphia and harmful patterns of disordered eating. For all the patients I’ve been able to help in my practice, there are others who make the choice to cease treatment, due solely to a fear of their body becoming larger as a result of recovery. These are people who are fully aware that their eating disorder is on the path to killing them, and do not pursue healing out of a fear of becoming fat. And yet their fear is real and their feared consequences are a reality. These moments are heartbreaking. There is pain in their voices: deep sadness, utter weariness. They know the decision they are making, the position they are putting their health in, and the dangerous consequences. But oppressive systems are insidious and oh-so-strong, and fatphobia is no exception. Patients tell me time and time again that our eating disorders clinic is the only space that supports their right for food liberation and nourishment and a weight restored body.

We won’t see an end, or even a reduction, in disordered eating behaviors until we, as a society, stop demonizing and dehumanizing fat people. In many ways, fatphobic discrimination and weight bias are still entirely socially accepted, even in a culture which is (far too slowly) moving toward curbing discrimination for other marginalized groups. For example, it is legal in 49 states to fire a person for being fat. Despite the very real consequences of, and casualties resulting from, fatphobia and weight stigma, body size is not considered a protected class, the way race, gender, and sexual orientation are, to name a few. The very fact that this is the case points to how socially, and even legally, sanctioned fatphobia is–and why so many people are so afraid of gaining weight.

The movement toward fat liberation is full of incredible people offering a wealth of resources for unpacking and untangling our own internalized fatphobia. Check out the following folks for (much, much) more information! 

Da’Shaun Harrison

• Website: https://dashaunharrison.com 
• Book: Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness

Aubrey Gordon

• Book: “You Just Need to Lose Weight” and 19 Other Myths About Fat People
• Podcast: Maintenance Phase

Sonya Renee Taylor

• Website: https://www.sonyareneetaylor.com 
• Book: The Body is Not an Apology

Ragen Chastain

• Website: https://danceswithfat.org
• Twitter: @danceswithfat

Lindley Ashline

• Website: https://bodyliberationphotos.com
• Twitter: @lindleyashline

Sonalee Rashatwar

• Website: https://www.sonaleer.com
• Instagram: @thefatsextherapist

Asher Larmie

• Website: https://www.fatdoctor.co.uk
• Podcast: The Fat Doctor

An Eating Disorder Specialist’s Response to the 2023 Guidelines from American Academy of Pediatrics

If you're reading this post, you are likely well aware of the new pediatric guidelines released by the American Academy of Pediatrics at the beginning of this year. There is much to sift through here, and I’ve been engaging in a lot of conversation with other care professionals who specialize in eating disorder treatment and health justice. To say we are concerned is a massive understatement, and it’s important that people know why.

I thought I’d share a summary of some of the reasons why professionals like myself are so vehemently opposed to these updated guidelines. There is a lot of complexity inherent in this topic, so I’ve broken things down into a list form to address the concerns I have about the harm the AAP is perpetuating with this guidance.

1. The guidelines are structured around the BMI scale, which is a tool capable of telling us absolutely nothing about the health and well-being of a person’s body. 

We know this, and have known it for decades. Still, the AAP insists on using it as a measurement to determine which bodies are diseased and in need of intervention, and which ones are not. This alone should be enough to discredit their guidelines. Further, little attention is given to the racist origins of the BMI and fatphobia. A statement from ASDAH sums this issue up neatly: “Despite several sections discussing the prevalence of higher BMIs among Black and brown people, the connection between racism and fatphobia was completely excluded from the guidelines as well as from their analysis and interpretation of the research. Fatphobia was born out of eugenicist and racist ideas. These racist ideas are then upheld systemically through tools like the BMI and recommendations such as these. This history and how it shaped research and current medical practice is missing entirely from the AAP’s recommendations. Its omission allows for the continuation of harmful, racist, and fatphobic practices.”  

2. The guidelines stress a focus on “non-stigmatizing” care - which, in this context, is impossible. 

The pathologizing of fatness, which is achieved here by classifying o*esity as a disease that must be eradicated, sends the message to children that their bodies are wrong and unacceptable–a determination which, again, is made on body size alone and not on any real measure of wellness. The very nature of this is fatphobic and stigmatizing; it is impossible to attempt to eradicate something (in this case, fatness) without sending the message that it is negative and should not exist. Keep in mind, too, that anti-fat bias is woven into the fabric of the U.S. healthcare system, and that most care providers operate from within an inherently stigmatizing paradigm and are unequipped and unprepared to provide “non-stigmatizing” care. 

3. The guidelines encourage dieting behaviors in patients as young as two years old. (Don’t be fooled by the “lifestyle change” terminology they’ve used: food restriction originating in a desire to make one’s body smaller is a diet, no matter what language one utilizes to describe it.) 

The AAP states that, because these “lifestyle” behaviors share much in common with eating disorder treatment programs, they carry virtually no associated risk of eating disorders. Consider, though, that most eating disorder treatment programs are not incredibly effective at helping patients heal: only 40-50% of those who have undergone treatment for an eating disorder remain in long-term remission.¹ Additionally, adolescent girls who engage in extreme dieting behaviors are up to 18 times as likely to develop eating disorders,² making the AAP’s risk-free claims sound dubious, indeed.

4. The guidelines recommend pharmacotherapy for children as young as eight and weight-loss surgery for children starting at thirteen years old. 

This is, frankly, appalling; given the lack of data available on pediatric pharmacological and surgical interventions, there is little reason to proclaim these treatment methods will not harm patients in the long-term. Keep in mind, too, that these recommendations are made in cases of what the AAP refers to as “severe o*esity”–which, again, is measured by BMI and has nothing to do with the health of the human as a whole. These recommendations may very well see providers performing surgery on perfectly healthy children.

5. Per the guidelines, all these recommendations are made on the grounds that “severe obesity is a harbinger of the establishment and cumulative progression of numerous related comorbidities, diminished long-term health status, and shortened life expectancy.” 

I’m incredibly concerned, however, at the exclusion of alternative explanations for the correlation between weight and health–explanations that are entirely plausible and factor in realities such as medical weight stigma, which keeps many in larger bodies from accessing quality care. To ignore these realities is to actively perpetuate harm.

6. The guidelines prescribe weight loss as a “solution” to the weight stigma that harms children and adolescents in larger bodies.

This posits that those who are harmed by weight stigma and anti-fat bias are at least in part to blame for the harm they receive. Putting the onus on solving oppressive environments on those who are directly oppressed by them only perpetuates harm and does nothing to address it.

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I’ll stop here, though there is still more to unpack, but I hope this has helped explain and clarify the alarm that so many care providers–particularly those of us specializing in eating disorder treatment–have expressed. For more excellent information, I strongly recommend reading the statements from the Association for Size Diversity and Health (ASDAH) and the Center for Body Trust, as well as thoughts and reflections from these incredible folks: 

Serious Issues with the AAP Guidelines

Letter to Parents and Caregivers

Letter to a Pediatrician

Dear Kids, The AAP Got It Wrong

Sources:

¹ McAleavey K. Ten years of treating eating disorders: what have we learned? A personal perspective on the application of 12-step and wellness programs. Adv Mind Body Med. 2008 Summer;23(2):18-26. PMID: 20664141.

² Patton, G. C., Selzer, R., Coffey, C., Carlin, J. B., & Wolfe, R. (1999). Onset of adolescent eating disorders: population based cohort study over 3 years. BMJ (Clinical research ed.), 318(7186), 765–768. https://doi.org/10.1136/bmj.318.7186.765

How Weight Stigma is Leading to a Less Kind World: Breaking Down the Myths Around Weight

They’re just lazy, unmotivated and they lack discipline. They must really not care about themselves. If they don’t care, why should I care about them?

These are some of the thoughts going through our minds when we come across someone in a large body. 

And yet, we don’t know this person at all. As Marilyn Wann says “ When you see a fat person, the only thing you know is your level of weight stigma”. Also isn’t it also none of your business why a person has the body they have?

Weight Stigma is Rampant

Weight Stigma is ​​prejudice or discrimination on the grounds of a person's size or weight. It’s a widespread problem leading to discrimination, violence, bullying, high stress levels, and unhealthy, disordered eating. Just like any other form of prejudice, it causes harm to those it impacts. 

Weight stigma plagues our world. Over 40% of US adults report weight stigma and body shaming, across all body types and weights. 

Weight Stigma also impacts children. Adolescents are bullied for many reasons. Tack on body shaming due to weight and it’s a rough ride. 71% of adolescents reported some form of weight shaming abuse over the last year alone. 

It leads to eating disorders and other self-harm behaviors. Because there’s such a stigma and bias towards folx in large bodies, they are bullied, mistreated, and harmed. It leads to increased stress levels and suicide. The impact is huge and it’s disheartening. 

Even their doctors assume the worst….assuming patients are unhealthy due to their weight without even assessing health behaviors. This type of shaming leads them to believe they are failing. They avoid return visits to the doctor. They feel ashamed and don’t want to be seen. 

Avoiding doctor visits leads to even worse health outcomes including death. This is not an ethical way of helping individuals. 

There has to be a better way. We need to unpack and rethink how we view bodies. Weight isn’t an indicator of health. Nor is it a holistic way of viewing health. 

Let’s start by debunking some myths about weight.

Myth One: Weight is an Accurate Measure of Health

alone, it’s only one number to be considered when evaluating a patient.

Researchers found “no clear relationship between weight loss and health outcomes.” Shedding weight doesn’t meaningfully lower blood pressure, diabetes risk, or cholesterol.

Instead of obsessing about one number, weight, we should be encouraging nourishing and connecting behaviors instead. 

Encouraging patients, friends, and loved ones to be in community, eat and produce foods together, get good sleep, and have a balance of self-care and collective care is more valuable. 

Let’s create welcoming spaces for all bodies. 

Let’s retool our culture and society to value holistic health. Not one metric….that doesn’t accurately measure health.

Myth Two: Fat People Aren’t Fit

I train in martial arts. In 2019, I presented with one of my training partners at a martial arts teachers’ conference on weight stigma in martial arts. We interviewed numerous people in large bodies sharing their experience of weight stigma in martial arts. Many of the people interviewed have advanced belts, some even more than one black belt. All people discussed having experiences where training partners, teachers, and tournament judges assumed they lacked skills due to their size. They also expressed being told that martial arts could lead to weight loss as opposed to skill and confidence development. Lastly, many expressed that they assumed they could take more physical contact due to their large body.

How sad and upsetting that we continue to focus on weight loss instead of the intrinsic and community benefits of physical activity and movement.

Researchers have found that losing pounds doesn’t always lead to healthy gains. 
Hunger points to a meta-analysis that found that even after dieters lost weight, their blood pressure, glucose, and other blood markers weren’t significantly better when they were reevaluated two years later.

A New View: Redefining how we hold Health

I am including this piece from ASDAH- Association of Size Diversity and Health as it articulates so powerfully how we need to hold weight, health and inclusivity
https://asdah.org/health-at-every-size-haes-approach/

“The Association for Size Diversity and Health (ASDAH) affirms a holistic definition of health, which cannot be characterized as the absence of physical or mental illness, limitation, or disease. Rather, health exists on a continuum that varies with time and circumstance for each individual. Health should be conceived as a resource or capacity available to all regardless of health condition or ability level, and not as an outcome or objective of living. Pursuing health is neither a moral imperative nor an individual obligation, and health status should never be used to judge, oppress, or determine the value of an individual.”

Need help?

Contact me. I would love to support you.

Workplace Food and Body Liberation

Picture this….you go into the mailroom and see a bag of cookies that somebody left for everybody. There are also a couple of your work colleagues there. You all are surrounding the plate of cookies. Then the comments start. “Ohhh I want one but I need to work out first”. “I am trying to lose weight so no cookies for me”. “ I am not doing sugar right now." Then you all start talking about your workplace wellness program and how you, “should all take a walk together right now and move away from the cookies.”

The problem with this scenario is that it’s commonplace. It’s not regulated. It has become acceptable. It’s assumed you are trying to “help” each other. But this is diet talk and is quite harmful. Also, it doesn’t feel good for anybody here.

Food Shaming In the Workplace

This is such a common occurrence. I hear it from individuals in the workplace time and time again.

Let’s start by answering what food shaming or guilting is.

Food shaming happens when another person judges or criticizes what another person eats. It can cause guilt, stress, and embarrassment to the person receiving the comment.

These judgments around what we should and shouldn’t eat stem from diet culture which is intersected with racism and other forms of oppression. And diet culture takes on a mindset that being thin matters above all else.

Some Examples of Food Shaming:

• "Wow, that’s a healthy serving."
• "Your plate looks like it could feed an entire family."
• "Woah, did you work out or something?"
• "Is that your whole meal? You’re already so thin."
• "That looks terrible. What is it?"

The story I shared in the beginning happens all the time. And yet, it’s not considered inappropriate or harassment. The problem is, it is.

The next time you decide to make a comment about what someone’s eating, ask yourself why. Take some time to think about how diet culture is impacting you.

Work needs to be a space where your colleagues can thrive… without diet culture looming in.

Weight Discrimination in the Workplace

Food shaming is not the only challenge in the workplace. Weight discrimination in the workplace is a serious problem.

Weight discrimination is real... and it’s harmful. And not okay.

When we judge people for their weight, it leads to other assumptions.

In 2017, 500 hiring professionals were shown a photo of a large-bodied woman by researchers at the job site Fairygodboss and asked if they would hire her. Only 15.6% of them said they would — and 20% said they thought she was “lazy.”

Furthermore, 21% of large-bodied individuals felt they had been passed over for a job or promotion because of their weight.

Both weight discrimination and food shaming are rampant issues… largely due to wellness programs.

Wellness is a new concept. It’s a broad term that seems to be a catch-all. And yet, it’s creating a lot of harm.

These weight-loss and wellness programs pressure employees to restrict their eating and sometimes over-exercise.

I don’t know about you, but that doesn’t sound like wellness to me. It is actually quite harmful.

Be Part in Creating an Inclusive Thriving Workforce

We are at work for such a large proportion of our waking hours. Our ableist work demands continue to increase. Yet the pressures of work demands make it difficult to eat away from our desks.

We want a work environment where we celebrate food, movement, and each other. We are already pressured by work demand. We do not need to add the pressures of diet culture to our work.

So how do we combat these challenges in the workplace?

Let’s be part of needed change…

If you see these challenges in your workplace, bring them to the attention of a leader at your organization.

Urge them to address these issues. If they don’t know how to do that, share resources for experts who can help.

I am deeply passionate about addressing these issues in the workplace.

In my Workplace Food and Body Liberation Workshop, you will:

• Learn about diet culture and how it impacts your work setting
• Explore your own weight stigma biases in a safe space
• Discover how to build a workplace culture that is connected and empowered to make changes in a way to create food and body liberation

Who this is for:

• Companies
• Nonprofits
• Small Business Owners
• Communities
• Organizations

Schedule Your Call Today:

Schedule Your Call

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You Don’t Need to have Bulimia or Anorexia to Have an Eating Disorder

You may be thinking, I don’t have an eating disorder. I don’t keep myself from eating food. I don’t throw up any of my food. So I’m okay.

But are you really ok? I recently spoke with a friend of mine who knows I work in the eating disorder space. She shared, “Marcella I just had an epiphany. I have an eating disorder. While I’m not throwing up my food nor am I avoiding eating food, I am struggling.”

“I find myself obsessing about working out. I hate the number on the scale even when I feel good. I struggle to eat certain foods because they have sugar in them. I find myself working out even when I’m exhausted because I’m afraid of weight gain. I am constantly aware of how I look.”

“I find myself comparing myself to others all the time. It’s exhausting. I don’t want to feel this way anymore. And I know it’s hurting my health. I’m getting injured all the time. I’m not eating enough to sustain my workouts. I need to figure this out.”

Perhaps you can see a bit of yourself in my friends' very vulnerable share.

This is why I want to bring more awareness to eating disorders. Because I believe that more people in our country and around the world are suffering and not realizing they have an eating disorder.

We live in a toxic diet culture. Diet culture attaches our worth and value to thinness. Diet culture actively encourages eating disorders by prescribing and praising restriction, excessive exercise, calorie tracking, food labeling, weight monitoring and just being hyper-vigilant about everything we eat and how much we weigh. Diet culture blames, criticizes and shames bodies that are different in any way.

Diet culture abusively demands that we work towards a privileged body by any means. If we do not work towards a privileged body and/or do not achieve it, diet culture says we deserve any negative outcome, including any harm that comes to our bodies. Diet culture is so thoroughly manipulative that it has become interwoven into mainstream living and is embedded in our vocabulary and ultimately our way of living.

Do You Find Yourself?

• Obsessing over your diet
• Judging how many pounds you see on the scale
• Being hyper-critical of what you see in the mirror
• Working out even when you’re exhausted
• Avoiding certain foods even when your body craves them
• Feeling bad about eating certain foods or missing an exercise day
• Controlling what you eat to an obsessive degree
• Using diuretics to control your weight

The reality is that eating disorders are complex and intersected with demographics and numerous oppressions in our society. People with eating disorders experience severe disturbances in their eating behaviors and related thoughts and emotions. People with eating disorders struggle with their relationship to their body. There are many different types of eating disorders:

• Anorexia Nervosa
• Bulimia Nervosa
• Binge Eating Disorder (BED)
• Body Dysmorphic Disorder (BDD)
• Avoidant/Restrictive Food Intake Disorder (ARFID)
• Pica
• Rumination Disorder
• Other Specified Feeding or Eating Disorder (OSFED)

It’s important that we understand eating disorders more fully as sadly, there are many stereotypes and misconceptions about eating disorders. In doing so, we can help loved ones, colleagues and communities get the support they need. We especially need to help marginalized communities who are struggling with eating disorders.

Eating disorders can be deadly.

Let’s raise our understanding around eating disorders to address this as a community.

Understanding Eating Disorders

I’m going to share three t common eating disorders. And how to identify if you or a loved one is suffering from this condition. 

Anorexia Nervosa

The most commonly known disorder is anorexia nervosa. 

They avoid certain types of food and severely restrict their calorie intake. 

They also have an extreme fear of gaining weight. They struggle with their relationship with  their body.  

Bulimia Nervosa

Individuals with this eating disorder will typically binge eat foods. During a binge, they feel they can’t control eating. 

After their binge, they use laxatives, enemas, vomiting or excessive exercise to compensate.

Similar to anorexia, these individuals have an extreme fear of gaining weight. 

Binge Eating Disorder

Binge eating is the most prevalent and common type of eating disorder. It’s also one of the most common chronic disorders among adolescents. 

People with binge eating disorder do not restrict calories or use purging behaviors, such as vomiting or excessive exercise, to compensate for their binges.

People with binge eating disorder often consume excessive amounts of food and are consumed with guilt, shame and /or negative feelings after a binge. 

If you or someone you know is suffering from an eating disorder, please share this article with them. Offer to listen and support them. 

I am happy to connect them with the resources and support they need. 

It’s important that we help each other given the amount of suffering eating disorders are causing.

The Rise in Eating Disorders

Eating disorders are on the rise. Due to westernization, social media, and the pandemic, we are seeing surges in eating disorders.

Some Concerning Statistics:

• Up to 70 million people suffer from eating disorders
• Severity and prevalence of eating disorders may be spiking even more due to the anxiety and stress unleashed by the COVID-19 pandemic
• Eating disorders prevalence has “increased over the study period from 3.5% for the 2000–2006 period to 7.8% for the 2013–2018 period”

We know we have a problem. The best way we can address eating disorders is by collectively building awareness. Educating ourselves about these challenges.

Need Help?

Navigating the world of eating disorders is not easy. It’s complex and nuanced.

That’s why I’m here to help.

If your team, company, school, community or organization is struggling with eating disorders, I’m would like to help.

No matter what specific challenge you are facing, I provide customized training around eating disorders.

Let’s connect and see what we can build to get you and your team back on track.

Speak soon.

Schedule a Call

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Why is Eating Disorder Training Being Left out of Medical Schools?

Eating disorders affect at least 9% of the population worldwide.¹ That means 28.8 million Americans, will have an eating disorder in their lifetime.² This poses as a significant financial burden as the economic cost of eating disorders is $64.7 billion every year.²

Of all mental illnesses, eating disorders have the highest mortality rate. 

And yet, studies show that medical students receive less than two hours of training on eating disorders. They study for 4 to 6 years and spend less than two hours on an illness with a high mortality rate. 

Individuals suffering from eating disorders have shared that doctors’ knowledge around eating disorders, or lack of it, can be the difference to continuing to suffer and recovery. 

According to a study done in the UK, only 42% felt that their general practitioner (doctor) understood eating disorders. Only 34% believed their doctor knew how to help them with their illness.

To Recap….

• Eating disorders impact millions of people
• They have a high mortality rate
• General practitioners are the frontline workers about individuals’ health
• Medical schools provide medical students with less than two hours of education on eating disorders 

What gives? 

It seems to me that there is a clear gap. And it doesn’t appear to be that difficult to solve. 

Closing the Gap: Training for Medical Practices 

I am passionate about closing this gap. This is why I have put together training to support practitioners. 

If you haven’t worked directly with eating disorders, addressing and treating them can be stressful. They can also become more complicated. Sometimes you know an eating disorder is present but your client/patient refuses treatment.

In my training, How to Treat Eating Disorders in Your Practice, you will learn how to navigate the complexity of eating disorders. You will discover tools and treatment ideas to help you support your patients. 

Who this training is for: 

• Therapists, psychologists, social workers, psychiatrists
• Mental health interns
• Post doc residents
• Physicians
• Nurses and dieticians

Over the years, I have discovered that we have many frontline workers. So I have built two additional training sessions to help us get ahead of this eating disorder epidemic. 

Eating Disorders in the Classroom 

Eating disorders are on the rise, and many teachers are not sure of how to approach it. There is all kinds of information about eating disorders. 

Teachers wonder what to do with that information. It can feel overwhelming. Especially with everything else a teacher must watch for among their students.

In my Eating Disorders in the Classroom training, you will learn about eating disorders and treatment options. You will discover how to handle circumstances with students. You will learn what questions to ask your students. 

Together, we explore your own fears, concerns and biases around eating disorders in a safe place. You will walk away confident and prepared to support your students. 

Who this training is for: 

• Elementary School to High School Teachers
• Teachers’ Assistants
• School Administrators

The classroom training helps address eating disorders from Kindergarten to High School. But this still leaves a big gap. 

That’s why I built my Workplace Food and Body Liberation training. To tackle eating disorders with adults, through their companies. After all, we spend 40+ hours a week at work. It has a huge impact on our day-to-day lives. 

Workplace Food and Body Liberation

We are at work for such a large proportion of our waking hours. Our work demands continue to increase. Yet the pressures of work demands make it difficult to eat away from our desks.

Many workplaces are adopting work programs that focus on food and physical activity. Many “healthy work programs “ take a restrictive approach to food. And a focus on weight loss with physical activity.

We want a work environment where we celebrate food, movement, and each other. 

We are already pressured by work demands, we do not need to add the pressures of diet culture to our work.

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In my Workplace Food and Body Liberation Training, you will learn about diet culture. How diet culture impacts your workplace. We will explore your own weight stigma biases in a safe space. And you will discover how to build a workplace culture that’s empowered to make changes for food and body liberation.

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Who this training is for:

• Companies

• Nonprofits
• Small Business Owners
• Communities
• Organizations

Change begins when we can individually and collectively embrace nourishment, our bodies and each other.

We all deserve to experience food and body liberation. 

We all deserve that freedom. It is vital. 

Need Help?

I also provide customized training around specific topics or needs.

Let’s connect and see what we can build to get you and your team back on track.

Speak soon. 

Schedule a Call

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¹Arcelus, Jon et al. “Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.” Archives of general psychiatry 68,7 (2011): 724-31. https://doi.org/10.1001/archgenpsychiatry.2011.74

²Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.

Examining Dated Eating Disorder Views With Dr. Marcella Raimondo

From https://erinskinner.com

I very much appreciated being interviewed by Erin Skinner on the Empowered Nutrition podcast to explore how to address eating disorders in nutritional settings. I appreciated how open Erin was in hearing how so many food plans, diets, mainstream eating approaches that involve eliminating foods are actually restrictive, depriving, and can cause all kinds of disordered eating. It felt great to have us hold a vision of body and food liberation/justice. 
Check it out - https://lnkd.in/gBDZj5Ht

Do you see patients in your practice that struggle with disordered eating and eating disorders?

In this episode, Dr. Marcella Raimondo discusses outdated perceptions of eating disorders and how we, as nutritional professionals, can best aid our mental health counterparts in treating clients with disordered eating.

I find, in my practice, that I encounter clients with eating disorders or disordered eating regularly. As nutrition professionals, it is important for us to be able to work cohesively with the mental health professionals that are treating these clients and stay updated on current treatment plans. 

Are you a nutritionist that sees these types of patients? Do you want to know more about what mental health professionals want from us to best aid their patients' recoveries?

Marcella Raimondo, PhD, MPH is a passionate and spirited clinical trainer speaking from her heart on social justice and eating disorders since 1995. Marcella received her B.A. from UC Berkeley and a Master's Degree in Public Health from the University of Michigan. Marcella's desire to address eating disorders drove her to pursue her doctorate in clinical psychology, receiving her PhD in 2012.

She completed her post-doc internships at an eating disorder outpatient program and an eating disorder residential program for adolescents. Marcella currently serves as a Licensed Clinical Psychologist (PSY # 27037) in Kaiser Permanente's eating disorder clinic in Oakland and runs a private practice. Marcella herself recovered from anorexia nervosa over 20 years ago.

In this episode we talk about: 

• Marcella's journey to becoming a specialist in eating disorders
• How to strike a balance between eating disorders and therapeutic medical diets
• Whether and how modern foods and diet culture perpetuate eating disorders
• How nutrition professionals can support mental health professionals  with meal plans, liberating from restrictive food mentality, support with health needs such as IBS and diabetes, education on metabolic processes, explanation of the physiology of dieting and its effects on metabolism and how it leads to malnutrition
• Marcella's process with eating disorder patients dealing with their behaviors, exercise,  body image, diet recall, goals, mental health and family history, risk, and their personal stories and how the disorders may serve to fill a need, and address those needs in a healthy manner
• How she helps practitioners improve their expertise with eating disorders

Connect with Dr. Raimondo at marcella@marcellaedtraining.com or 510 214-2865.

Visit Dr. Raimondo's Training Website: https://marcellaedtraining.com/speaking/

Facebook and Instagram: Dr. Marcella Raimondo

Check out the full episode at:

https://erinskinner.com/empowerednutrition/MarcellaRaimondo

Why it's So Hard to Treat Eating Disorders in an Oppressive Diet Culture World

As an eating disorder psychologist, I love my work. Sure, it can be hard, but it's not exhausting. I do believe that people can recover from eating disorders. I want to learn about my clients and hear how their eating disorders have served as their survival and protection and helped them make sense of their world. So, I lean in to hear folks' stories. By holding their story and honoring it, we can understand it so that healing can happen.

The biggest struggle and frustration of my work is not that it is difficult to treat eating disorders. The biggest challenge is always how toxic diet culture obstructs recovery.

What is Diet Culture?

Diet culture is everywhere. From intermittent fasting to no sugar or no-carb diets, to detoxes and cleanses, to "being bad " if we eat particular foods, or needing to "earn " our meals we are inundated with the belief and mentality that we must continuously strive to be thin. We are conditioned not to trust our relationship with food. We see it in so many aspects of our lives: thinness, weight bias, and privileged body types are glorified, while marginalized bodies are targeted. 

Diet culture runs so deep that when we sit with it, we realize how completely entrenched and pervasive it is in our society and in ourselves. I call it "white supremacy in a pretty pink bow. "

Diet culture attaches our worth and value to thinness.

Diet culture actively encourages eating disorders by prescribing and praising restriction, excessive exercise, calorie tracking, food labeling, weight monitoring and just being hyper-vigilant about everything we eat and how much we weigh.

Diet culture blames, criticizes, and shames bodies that are different in any way.

Diet culture abusively demands that we work towards a privileged body by any means. If we do not work towards a privileged body and/or do not achieve it, diet culture says we deserve any negative outcome, including any harm that comes to our bodies.

Diet culture is so thoroughly manipulative that it has become interwoven into mainstream living and is embedded in our vocabulary and ultimately our way of living. 

Diet culture also aligns with white supremacy because it specifically targets marginalized bodies.

My clients who are marginalized tell me about their daily experiences of being targeted. They also tell me how thinness can make up for it. It's the one place where I can have some control over my body, and thus how people see me. If I have to lose thinness, I lose the one privilege that I have. If I recover and my body changes, then society will see me for who I am and that's scary, if not dangerous, for me.

It Takes Courage

When folks tell me they are scared to recover because it means they will gain weight and they are fearful of the backlash that will come to them I wish I could say that's not true. But it is true.

My clients tell me all the time the ways that recovery is difficult:

• I'm getting compliments now that I have lost weight.
• If my body changes, my dating pool decreases.
• If I gain weight, I don't get love from my family.
• I'm assigned the boring or less visible jobs at work.
• People make negative comments to me about my body and express concern about my weight.
• I can't eat in public as I get negative looks and/or comments.
• People laugh at me when I exercise, even though I am told I should exercise.

When someone is making the decision to recover from an eating disorder and they seek treatment, they are being very courageous. Folks are terrified to give up an eating disorder. It may be the hardest thing that somebody has ever done. In addition to learning to have a new relationship with food and with their body, they have to struggle with all of the stigmas and biases attached to their recovery within our diet culture. Everyone who suffers from an eating disorder deserves to recover. They also deserve support for their recovery.

Weight is NOT the Problem

One of the greatest dangers of diet culture is that it presents itself as "healthy. " Our medical establishments regard thinness as health. There is a firm and commonly accepted belief that being in a large body is unhealthy, yet the studies that support this idea are inconclusive. BMI (body mass index) the standard by which doctors have measured whether a person is underweight or overweight for over 100 years is a haphazardly invented and flawed mathematical calculation. There is no actual science behind it. 

• https://www.medicalnewstoday.com/articles/255712#Is-it-too-simple?
• https://www.livescience.com/39097-bmi-not-accurate-health-measure.html
• https://www.npr.org/templates/story/story.php?storyId=106268439

Weight stigma repeatedly comes up during eating disorders treatment. My clients in larger bodies always tell me: 

• People are surprised when I tell them I have an eating disorder.
• People tell me that I don't look like I have an eating disorder.
• My doctor expresses concern about my weight and/or weight gain.
• My doctor encourages food restriction.

It is hard enough to recover from an eating disorder, and now folks have to endure weight bias as their body restores weight. I have had a number of clients tell me that they can't handle the weight gain and weight bias so they leave treatment. This breaks my heart and enrages me. It is unethical for healthcare to encourage people to control their weight through eating disorder behaviors that are medically dangerous. It is also unkind, given the internal suffering and shame that people hold in their bodies. Instead, we need to meet people with compassion and understanding. 

I work with a "health at every size " approach and professionals in healthcare tell me repeatedly that this approach is not common. Restriction, losing weight, and food labeling is a chronic focus in the world of healthcare. Anti-fatness is the norm.

Our medical establishments need to go beyond weight in their assessments and prescriptions for health. Weight is not the problem. If our focus for physical health primarily involves making changes through weight loss that's a failure. We're missing a whole spectrum of experiences and understanding, as well as the underlying sociological and emotional issues that contribute to health. We really have to be willing to challenge, and challenge with compassion, how we are all so wired to be anti-fat. 

If healthcare does not examine and address its anti-fat and weight biases, we are saying that only thin people with eating disorders deserve to recover. It's the same as saying that people in larger bodies deserve their eating disorder since it will manage their weight.

Everyone who suffers from an eating disorder deserves to recover. 

Creating Change, Embracing Nourishment

I remember one woman who called her obsession with food, her body, and weight a "mental prison. " She finally said I can't live like this anymore. When she gave herself permission to eat what she wanted, she felt liberation. My head isn't so preoccupied. It's becoming more and more a journey to embrace my body, and let go of having a smaller body. I can't live in all this excessive hatred.

Despite what society says you have a right to be nourished. You have a right to have food liberation and to have a relationship with your body that works for you. You don't deserve to have an eating disorder. You deserve a life that is more than your eating disorder.

We connect with others through food and through our body. 

Change begins when we can individually and collectively embrace nourishment, our bodies and each other. We all deserve to experience food and body liberation. We all deserve that freedom. It is vital.

The thoughts I conveyed here in this blog have been expressed by many activists. I have been in conversations and shared space with so many HAES (health at every size) and eating disorders social justice activists who raise how diet culture impede eating disorder recovery. There is a potent and collective advocacy to challenge diet culture. I encourage you to check out the work of many activists https://marcellaedtraining.com/resources/ I have learned so much from these incredible folks. I also encourage you to look at how diet culture has influenced you, and spend time challenging your own weight bias with compassion.

Marcella M Raimondo, PhD, MPH (PSY#27037)
Psychologist, Consultant and Trainer
Pronouns: She/her
Check out my site - http://www.marcellaedtraining.com/
working with folks with eating problems, eating disorders and body image issues