By Rachel Millner, Psy.D., CEDS
Dr. Millner has specialized training and experience working with eating disorders and body image issues. In this time in our culture, many men and women deal with concerns about food, weight, and body image. Dr. Millner understands the significant impact these issues can have on the individual’s life as well as on their family and friends.
Several weeks ago I had the honor of attending and speaking at the BEDA/NEDA conference in Brooklyn, NY. As a psychologist who has been working in the eating disorder field for over ten years, I have been to my share of eating disorder conferences. Anytime I attend a conference, I think about it not just through the lens of a provider and what providers at the conference might be learning, but I think about it through the lens of my clients and considering what they would be hearing and be exposed to if they attended the conference. If they attended, would they hear eating disorder clients talked about with respect and care, or would they hear them being judged and pathologized? Would they hear messages about body size that perpetuate weight stigma or would they hear the dismantling of weight bias and naming of size oppression? Would they hear discussions of social justice issues and the naming of the patriarchy and white supremacy as significant contributors to messages people get about their bodies or would they hear the same stereotypes about eating disorders being the problem of white women and individual control? If my clients were to walk through the conference at a time that a meal was being served, would they hear providers talking about their passions, their love for their work, what drives them and fulfills them; or would they overhear talk of diets and weight loss and complaints about the food being served and the exercise they need to do? Would they see providers in all different size bodies and skin colors or would they see primarily thin white women walking around? And, would my clients in larger bodies feel comfortable in the space- would they be able to move through the conference space without getting the message that they aren’t welcome? Even though most conferences I attend are professional conferences that are geared towards those working in the field, I think about the perspective of my clients because, ultimately, they are the measure of how well we are doing as a field. Are we helping and healing or are we harming?
The BEDA/NEDA conference made a conscious effort to center social justice issues and to talk about weight oppression. There was a widening of the lens to acknowledge that eating disorders don’t exist in a bubble and that making eating disorders individual problems leaves the “fixing” to the individual person. There were sessions that focused on eating disorders in marginalized groups and a keynote that discussed research that truly considered the needs of the people being studied and centered them in the designing and implementing of the research. It was refreshing to hear acknowledgment that research and science are not value free and that most of the research around weight and health is biased. There was discussion of how much we don’t know and an awareness that different people will need different things in their healing process. It seemed that the conference worked hard to find a balance between the discussion of social justice, activism, and provider responsibility to push back against diet culture and offered sessions that focused on specific treatments and interventions. There was a clear Health at Every Size (HAES) message incorporated throughout the conference. This should be the norm at all eating disorder conferences but, unfortunately, it is not. I was relieved to see that there were no talks equating body size with eating disorders or using pathologizing language about body size in the title. There were no talks that suggested weight loss should ever be recommended or that talked about weight loss in the treatment of BED, which I have seen done at other conferences. And yet, with all the positives at the BEDA/NEDA conferences, there were still things that felt problematic. The main conference space was not set up in a way that was comfortable for fat people. There were several talks that fell short of their intended goal and either lacked the expertise one would hope to find in a conference talk or did harm in their discussion around eating disorders among people of color by using articles that were further stigmatizing and stereotyping. While there was more size diversity than some other eating disorder conferences I have been to, the majority of attendees were still white and in smaller bodies. In the time I spent walking through the exhibitor area and overhearing discussions amongst providers, I heard several conversations about diets and body dissatisfaction as well as comments about the food being served.
I have been in the field long enough to not be too surprised to hear that some of the feedback or “criticism” about the BEDA/NEDA conference was that the HAES messaging was “too strong” and social justice issues were “too focused on.” There was also feedback that people were uncomfortable with the use of the word “fat” in talks and amongst attendees. My reaction and response to this kind of feedback is that it’s not that we’ve gone “too far” it’s that we haven’t gone far enough. Even at a conference that was consciously committed to centering social justice, centering marginalized voices, centering fat people, not equating body size with eating disorders, not pathologizing people, not viewing weight loss as something to ever recommend, there were still problems. There was still space that was not set up for fat people. There were still talks that did further harm to marginalized people. There was still discussion about weight loss and diets amongst providers. There were still people discussing using weight loss messaging to “attract” clients or claiming that in order to “meet people where they are at” we need to be vague about where we stand regarding the recommendation of weight loss and diets. There were still things that I would not want a client to be exposed to. In contrast to people who say we have gone “too far,” I would say that at this conference, and even more so as a field, we haven’t gone far enough. We need to keep working until social justice issues are centered at every conference. We need to recognize that we will make mistakes, but that we can take steps to try and prevent further harm from being done. We need to make not only conference spaces, but the field in general more welcoming to fat people. We need to come to an agreement as a field that we will no longer use stigmatizing language, that we will no longer equate body size with eating disorders or see body size as a marker of health, and we need to be clear that recommending weight loss is always harmful. We need to commit to doing our own work, dismantling our own internalized biases, and to recognize that discussions about diets and weight loss amongst eating disorder professionals is problematic and harmful. We can’t just shift to whispering conversations about our own diets, or conversations about recommending weight loss to clients. We need, as a field, to fully embrace weight-inclusive care and be clear that fat people will not be pathologized or asked to become thinner.
Overall, my experience at the BEDA/NEDA conference was a positive one. It was great to connect with both old and new friends and to see the efforts to focus on topics that the field has neglected for far too long. As always, I am grateful to BEDA for pushing the field in the direction it should have always been heading and for naming the biases that the eating disorder field has stood behind for far too long. I came away with the reminder that we are still evolving as a field and that we still have a ways to go before we can claim to be safe for people in larger bodies, and with a commitment to continue speaking up and being clear about where I stand. I also came away with the reminder that there are many strong, passionate, and dedicated people following in the footsteps of past visionaries and leading the way in the evolution of the field. I hope that those who left the BEDA/NEDA conference saying that the field has gone “too far” or who were uncomfortable with the HAES messaging will take time to reflect on where their discomfort is coming from. Change can be uncomfortable, but staying stuck where we are cannot be an option. We have work to do as a field, and the BEDA/NEDA conference was both a reflection of the incredible work that has already been done and a reminder of how much work is still left to do.