Weight Stigma Viewed Through the Eating Disorders Lens: Carmen Cool, MA, LPC

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.

Carmen Cool

Carmen C. Cool MA, LPC cares deeply about creating a world where people of all shapes and sizes are celebrated.  She believes in a revolution of self-love, courageously embracing all you are, and the freedom that comes from trusting your body as an exquisite resource.  She helps people end the cycle of dieting and overeating.  Along the way, they unravel their body stories and learn to trust their bodies and themselves. Meeting each person’s experience with compassion and curiosity, she invites people to move away from the pursuit of weight loss and towards developing practices that are possible and sustainable in their every day lives  Because she believes that the way people are treated in this society affects their health, she engages in activism whenever possible. She is also a champion for youth to raise their voice and create new cultural norms around body image.

Carmen is a psychotherapist in private practice with a master’s degree in transpersonal psychology.  She is a also a certified Hakomi therapist, using a body-centered, mindfulness-based approach. A member of the Binge Eating Disorder Association (BEDA) and the Association for Size Diversity and Health (ASDAH), she has also been a Boulder County Leadership Fellow, was named “Most Inspiring Individual” in Boulder County in 2012, and won the Excellence in Eating Disorder Advocacy Award in Washington DC.

To learn more about Carmen, please visit her website www.carmencool.com.


An Open Letter to Eating Disorder Treatment Professionals

First, let me tell you how grateful I am for the work you do in the world.

We have quite a job, huh?  I respect our ability to stand in the fire, to advocate for life, for health, for nourishment and I honor the ways we have to do “damage-control” for our patients and clients in the face of such relentless cultural messages that say thinner bodies are more desirable.  But I think that as a profession, we can do better at advocating equally as hard for the rights of our clients of all sizes to be able to experience full lives, wherever their bodies happen to be.

When I think of the ways people of different sizes are viewed, I do so from three distinct perspectives: as a therapist who has worked with eating challenges for 13 years, as a person who has been recovered from an eating disorder for 26 years and is still “overweight”, and as a person who has lost her sister to anorexia.

If there’s one thing I am certain of, it’s this: weight does not tell you about someone’s health.  

I once sat in a community-based presentation given by a prominent eating disorder treatment professional and was shocked by what I heard.  This person said, ‘There is a war on obesity going on, and thank heavens!  We really need that because there are too many overweight people and it’s a big problem.’

I was stunned.  I felt embarrassed on behalf of my profession.  I wanted to say something, but I didn’t and instead, I got up, hurried out of the room and got in my car.  I was shaking with outrage.   I’m sure that I was afraid that if I spoke up to challenge the statement, I would start either screaming or crying but either way, risk losing my effectiveness.  I felt – and still feel – deep regret about not speaking out, both because I didn’t want the audience to think that all eating disorder therapists felt similarly, and because there could have been a larger-bodied person in the room who didn’t get to hear that somebody had their back.

There is an assumption that in our eating disorder treatment community, we would have the most generous and expansive idea of what normalcy looks like when it comes to the structure of the human body, but I have witnessed and overheard many stigmatizing comments about fatness within the context of eating disorder conferences and treatment facilities.   And yet it makes sense, given that even communities that work so tirelessly to heal an issue are still made up of human beings that come with their own biases.

What doesn’t make sense to me is that we help “normal” or even somewhat “overweight” clients and patients relax their focus on weight and thinness, but we support the idea that larger-bodied clients need to lose weight.    I hear it all the time – complete agreement that the societal idealization of thinness is hurting us, “but what about the person who is 400 pounds?”  It’s so easy to agree that our collective focus on thinness is unhealthy – but we really still must do something to help those at higher weights.

I know – it comes from a genuine desire to be helpful.  We go into this profession because we want to alleviate suffering.   I love that about us, but we also need to consider our own assumptions.

Imagine a group of people.  Who’s the overeater? Who’s the one restricting?  If you think you know – you’re wrong.  

The instinctive and automatic attachment to a diagnosis tied to the physicality that appears – is a problem.  That’s not your expertise – that’s your prejudice.

If someone comes to me and says that they really want to lose weight (as they often do)and I endeavor to help them do that, I am saying “You’re right.  Your weight is a problem and I agree you’d be better off at a smaller size.”

Which is to say – I’d be reinforcing weight stigma by sending the message that they aren’t acceptable just as they are.   And I don’t want anyone to receive that message – not on my watch.

I’ve had larger-bodied clients come to me who are healthy, eat normally, move their bodies and don’t have an issue beyond the fact that they believe they have one, given their weight.   To be clear, if someone has a disordered relationship with food and their bodies, I can assist them with that.  I can talk about the meaning behind the desire for weight loss.  I can help them address any health concerns that may be there.  But that’s different than treating weight as the problem.

  • Let’s use our role to take a stand against fat prejudice.
  • Let’s make sure that higher weight clients, and our staff for that matter, feel comfortable in our community and that they belong.
  • Let’s be mindful of our tag lines, making sure they don’t just speak to one form of eating disorder.
  • Take some time to learn about weight stigma and think about how it may unknowingly show up in our work.

I would love for us to have thoughtful conversations about this topic, and to stop treating fatness as problematic.   I’d like us to be conscious of the ways we make money off of weight stigma.  I want us to be aware that when we’re at a conference and talking about a fat patient in ways that assume that a weight-loss intervention is the best thing, there is a fat therapist sitting nearby overhearing that conversation.   And please, let’s stop referring to patients by their weight.

If I could go back and rewrite the story of sitting in that presentation where another professional was praising the war on obesity, I would have said this:

“With all due respect, I need to disagree with you that we need this war on obesity.   What we need, is to work together to end it.  Not by making fat people thinner, but by recognizing and celebrating the truth of body diversity.  Weight is not the problem.  The way we make assumptions about it is the problem.  I want to live in a peaceful world.  And a peaceful world starts with a peaceful self.  Rather than fighting fatness, why don’t we help people of all sizes feel peaceful in the bodies they have.”

Rich, meaningful, challenging conversations are what we do every day.  Let’s keep talking about it.