"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.
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!
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.
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
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:
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.
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.
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.
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.
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/.
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
The invisibility of marginalized folks who suffer from eating disorders
Eating disorders are often viewed as occurring in Caucasian, thin, affluent, cisgender adolescent girls. The way our current media portrays those suffering from eating disorders reinforces this myth.
How current treatment systems continue to be inaccessible for marginalized communities
I am a queer cisgender,
Eating disorders are often viewed as occurring in Caucasian, thin, affluent, cisgender adolescent girls. The way our current media portrays those suffering from eating disorders reinforces this myth. In 2017, Netflix released the movie "˜To the Bone " whose main character fits this exact stereotype from her appearance, narrative and even the way her family easily accessed treatment. It is also important to point out that the actress who portrayed the lead character with an eating disorder suffered from eating disorder years ago. She reported that she worked with a nutritionist to lose a drastic amount of weight in a "healthy " way so that she could have the emaciated body needed for this movie role. Newsflash: you can't lose a drastic amount of weight in a "healthy " way after suffering from an eating disorder. Would you ever ask a person who recovered from substance abuse to do a significant amount of substances and risk an overdose for a part in a movie or play?
Let's focus on the stereotype of an individual with an eating disorder. Here are some statistics from the Marginalized Voices project. The National Eating Disorders Association's Marginalized Voices campaign, supported by Reasons Eating Disorder Center, is confronting the prevailing myths about who struggles with eating disorders, underscoring that everyone's experience is equally as valid and deserving of care and recovery.
- Black teenagers are 50% more likely than white teenagers to exhibit bulimic behaviors, such as bingeing and purging.
- A 2014 study found that rates of disordered eating have increased across all demographic sectors, but at a faster rate in male, lower socioeconomic and older folks
- Transgender college students were significantly more likely than members of any other group of college students to report an eating disorder diagnosis in the past year- 2015 study.
- Teenage girls from low income families are 153% more likely to struggle with bulimia than girls from wealthy families.
- Only 20% of those with eating disorders fit the "emaciated body " stereotype.
The myth that eating disorders only occur in affluent Caucasian girls is damaging to the many people across all races, genders and sexual orientations in all age groups that suffer from eating disorders. This narrow viewpoint continues to reinforce an invisibility that is often felt by marginalized communities. The narrow viewpoint of who gets an eating disorder continues to limit our understanding of eating disorders and not appreciate the deep complexities and layers of eating disorders that need to be revealed for true healing to occur.
As a psychologist who specializes in eating disorders, I continue to be dismayed by how inaccessible treatment is for eating disorders. I recently participated in a retreat for women of color with disorder eating. It was held in Southern California and it was indeed an effort that involved a coming together of many people like myself to create space for women of color with disordered eating. The women described waiting for over a year for a retreat of this nature, these women also reported driving from 20 minutes to 3 hours to get to the retreat site. The question that came up for me is then what? What will these women do after the retreat. There are some incredible community efforts like the work of Gloria Lucas in Nalgona Positivity Pride, who runs an online disordered eating support group for people of color- Sage and Spoon. Yet we need more of these spaces.
Now, let's take a look at trans folks with eating disorders. In a large population study of college students, trans students reported significantly higher eating disorder diagnosis rates, including use of diet pills, vomiting, and laxatives use when compared to all other groups (Diemer, 2015). Yet trans folks struggle with accessing treatment and when they access treatment for their eating disorder, their interactions with treatment was alarming. In a study of 84 trans folks with eating disorders and treatment, not one reported a positive experience, most regretted treatment even after knowing how life threatening eating disorders are. (Duffy, 2016).
Like many mental health illnesses, eating disorders treatment programs, advocates and clinicians must work together to change the current treatment landscape. All individuals affected by eating disorders need to be afforded the means, opportunities and intersectional treatment options needed for recovery.
What can you do as a clinician who does not specialize in eating disorders but sees clients with eating disorders?
- Learn about eating disorders from a wide varied source of information available. My website has some great resources: https://marcellaedtraining.com/resources/
- Assess for eating disorders in all your intakes, continue to assess for eating disorders. Some clients come to see you for substance use or other self harm behaviors. Some come to see you for trauma and the various ways they are disconnected from the world. Assess for an eating disorder.
- Ask people to tell you their experience in their bodies. Ask them what is it like to navigate in the world with the body they are living in. Most body image and eating disorders screening focus on weight and size. It is important to expand our lens on why people may engage in an eating disorder.
- Attend local conferences. Eating Disorders Recovery and Support (EDRS) and International Association of Eating Disorders Professionals (IAEDP) host local educational events in the San Francisco Bay Area.
- Apply for scholarships for your clients with eating disorders: https://marcellaedtraining.com/treatment-scholarships/
*This article was first published in Gaylesta's newsletter.- Summer 2018
Marcella M Raimondo,
Psychologist, Consultant
Pronouns: She/her
Check out my site - https://marcellaedtraining.com/
working with folks with eating problems, eating disorders and body image issues