Weight Stigma Viewed Through the Eating Disorders Lens: Amy Pershing, LCSW, ACSW

BEDA promotes cultural acceptance of, and respect for, the natural diversity of sizes, as well as promoting a goal of improved health, which may or may not include weight change.  The views expressed by our featured bloggers are their own.

Amy PershingAmy Pershing began her career treating the spectrum of eating and body image disorders at the Center for Eating Disorders (CED) in Ann Arbor, MI, in 1991. In 1993, she developed “Bodywise™,” a comprehensive treatment program to serve a growing population of clients coming to the center with binge eating disorder (BED). Pershing became CED’s clinical director in 1998. In 2008, Pershing and Chevese Turner, CEO and founder of Binge Eating Disorder Association (BEDA), joined forces to found Pershing Turner Centers in Annapolis, Maryland. Pershing Turner Centers treat the full spectrum of eating disorders in adults and adolescents using a multidisciplinary “whole person” treatment approach to recovery.

Pershing has pioneered an integrated approach for the treatment of BED, based on more than 25 years of clinical experience. This unique treatment approach incorporates a variety of clinical paradigms, including internal family systems (IFS), dialectical behavioral therapy (DBT), mindfulness strategies, and a range of somatic trauma techniques. Her approach also integrates intuitive eating and movement and a “health at every size” philosophy. In addition, Pershing offers training and supervision to clinicians treating BED nationwide. She has developed two- and three-day Intensives for those in recovery, as well as “Hungerwise™,” a 10-week program for ending chronic dieting and weight cycling.

Pershing lectures nationally and writes extensively on the treatment of BED and her own recovery journey for both professional and lay communities. She has been featured on numerous radio and television programs speaking about BED treatment and recovery, relapse prevention, weight stigma, and intuitive eating and movement. Pershing has also served on a variety of professional boards and currently serves as the 2013 Chair of the Binge Eating Disorder Association. She maintains a clinical practice in Ann Arbor.

 

Weight Stigma and Binge Eating Disorder: Partners in the Dance

Weight stigma is a powerful contributor to the body shame that leads to binge eating disorder (BED). For the vast majority of people who have struggled with BED, disliking their body, even hating it, has been part and parcel of the voice of the disorder. Body shame is the primary precursor to dieting, one of the most correlated contributors to the development of BED. Dieting leads to short term weight loss and typically weight regain, a sense of failure, and thereby shame. This shame is perhaps the most powerful trigger for binge eating.

Body shame and anxiety are often constant companions for those with BED; the fear of being seen at all, of being labeled as “fat,” “out of control”, “ugly”, fundamentally undesirable, are there at every turn. When people dress in the morning, buy clothes, look in a plate glass window as they walk to work, decide what to order for lunch, or feel hot under long sleeves in the summer, they are reminded that they have something to hide. And ‘that something’ is their very physical Self, a place that can never be left, and can always be judged. In fact, just being in the world becomes a potentially stigmatizing experience. It is in this fertile ground of fear and shame that BED fully flourishes.

Binge eating disorder has myriad causes; genetics, biology, neurology, mood disorders, substance use disorders, trauma and loss, and family dynamics can all play a part. For many, weight related bullying is a contributor, an often-traumatic way of learning what happens to those who don’t “fit”. For many people dealing with BED, the belief that losing weight is the most important part of recovery is as old as the disorder itself. This mythology is reinforced by social and cultural environments (and even some treatment paradigms). Therefore, it feels right to hold body size or shape accountable for the disorder, not the systems responsible or the very eyes we use to see, and judge, our physical selves.

For those who felt considerable shame in childhood, who survived losses and traumas, or were strongly encouraged to be something different that they really are, weight stigma is as natural as can be. Whatever shame already exists can be transferred to weight and body shape, thereby giving people something about themselves to “fix.” The shame has a place to go. Feelings that may be unwelcome, or even frightening, can be masked with the obsessive business of weight control. For the “simple” task of weight loss, which is believed to be possible by an act of adequate willpower, a fantasy exists that all will be well.

As we know, in BED, there is the flip side of dieting: the binge. And it too is fueled by weight stigma. Eating regardless of the cost to one’s diet can be, among other things, a way to defy a system of restriction and rules, to allow a space without conditionality, and even a way to soothe hopelessness about losing weight. While it may seem paradoxical to binge in the face of body shame, it can in fact come from the healthiest part of someone with BED. The whole cycle of BED is predicated on body shape and size being connected to worth, lovability and ultimately connection to others. The binge can be a way of rejecting weight stigma, and other forms of conditional acceptance. It can be a way to say “I’m no longer buying in.”

We all need to challenge the messages of weight stigma, but for those with BED, rejecting this way of seeing their body is critical to recovery. Coming to see beauty inherent in diversity of shape and size is integral to the process. In addition, considering the body principally as one’s home, not as a billboard for approval, makes room for compassion, tolerance, and patience. It is this work that heals the shame underlying the disorder.

To begin this journey, consider these ideas:

  • Look at the images that you “consume” daily, including TV shows, magazines, Internet sites, etc. Which ones make you feel inadequate physically? Try changing to materials that are more celebrative of various sizes and shapes.
  • Connect with resources that honor true health over physical appearance.
  • Consider thanking your body for one thing it has done for you today (performing an activity, healing a bruise, the ability to walk or to see the world around you)
  • Consider wearing comfortable clothing – something that your body finds comfortable and feels good.
  • Treat your body to something that feels good: a manicure, new slippers, a foot massage.
  • Listen to your body; learn its language for communicating needs. We cannot meet these needs all the time. That’s ok; we just need to hear them, and meet “enough”.
  • Get mad! Something precious in all of us has been damaged by weight stigma. Consider being an activist; get involved in weight stigma efforts such as WSAW.
  • Write a blog about your experiences healing from weight stigma.
  • Teach your kids about weight stigma, and help them get involved in their schools to challenge damaging messages they encounter.
  • Be patient with your body, and your recovery. This is a journey, not a destination! Weight stigma is all around us, and will certainly catch us sometimes. Just notice it, how it made you feel, and imagine giving the message back. You don’t need it anymore. 

Remember, the goal is not about being immune to weight stigma. Like any cultural system of judgment, we are all impacted. The work is to be aware of these messages when they present themselves (from either the culture’s voice, or your own), and decide for yourself if this is the voice you wish to hear. Thankfully, we each have the power to decide.