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.
Dr. Deb Burgard (DrBurgard@hushmail.com) is a psychologist in the San Francisco Bay Area who specializes in eating disorders. She is one of the founders of the Health at Every Size® (HAES) model. She is also a long-time activist, author, speaker, blogger, hula hooper, and lover of recess.
To see more of Dr. Burgard’s writing you can follow her on the HAES Blog at http://healthateverysizeblog.org/category/deb-burgard/.
Why Do We Call Them Eating Disorders?
A little geek talk, and then I promise to get to the point:
Remember a fantastic short film from the late 70’s called, Powers of Ten? It began with the image of someone’s hand at a distance of 1 meter from the camera, and then systematically pulled back by an order of 10 – so 10 meters up from the hand, then 100, then 1000, and so on till we begin to see the outline of the park where the person is napping, then Lake Michigan, then the US, the earth, the solar system, the galaxy, and so on. Then the view reverses and plunges into the ever-smaller world of a cell, molecule, atom, nucleus, proton, and so on.
Dizzying and magnificent and awe-inspiring! Synthesizing the details at each level to get a glorious and grand big picture is my favorite kind of thinking, and it is kind of the opposite of medicine, which tends to be much more about isolating variables and removing the clutter of big systems to see the details.
So, keep Powers of Ten in mind as we turn to the subject of how we understand what the medical world calls, “Eating Disorders.”
The diagnostic manuals used in clinical practice focus on behaviors like restricting, binging, and purging; cognitions and emotions like a fear of gaining weight, hatred of the body, and low self-worth; and physiological manifestations like very low weight. This level of observation is where Powers of Ten starts, i.e., what we observe right in front of us. It seems like eating disorders are about eating.
But we are making some progress in the treatment of eating disorders by going deeper, “into the hand,” into the study of processes on the level of our metabolic functioning, our brains, and our genes. We have also done good feminist work beyond the medical model that parallels Powers of Ten‘s opposite direction of wider-angled views, by documenting the cultural over-valuation of thinness.
Sometimes the people working at each of these levels find it annoying to talk with each other, but if we work a little Powers of Ten magic here, what do we see? I promised you I would get to the point, and here it is: Thinking about eating disorders in terms of weight stigma gives us a way of tying together the science at many levels.
Imagine calling eating disorders, Disorders of the Pursuit of Weight Loss. That covers a great deal* of what we see – AN, BN, BED, EDNOS: restricting, consequent binging and/or purging, growing self-disgust, a deepening spiral where the “goal” just keeps receding no matter how long you try – and that name would make apparent the broader cultural milieu of prizing not-fatness, to avoid weight stigma. People are stigmatized when they are not thin and people are trying to escape being treated badly. But to take it up a level, we could ask, why is there weight stigma? Why do we treat higher-weight people so badly?
So on this level we find issues of gender and class and racism and healthism/ableism, and anxiety about the environmental crises we face and the challenges of being a village on a global scale, and how that brew ends up making higher-weight people targets in this cultural, historical moment. Maybe when we get overwhelmed we turn to the illusion that we can control our bodies. Is it a coincidence that the “War on Obesity” really cranked up after 9/11? Or maybe the people controlling most of the resources have to prove with their body sizes that they don’t consume too much. Oh, not me, that is what those fat people do. They need to stop costing us all so much money, causing climate change, and not contributing to the GNP. Now, let’s get that oil pipeline approved, shall we?
The way we define the problem determines where we look for solutions. Our current system focuses on individual sufferers as if the entire problem is in their genes or their psyches, which, while part of the explanation, replicates the “fundamental attribution error”: Observers (i.e., people defining eating disorders) are biased in favor of explanations that reside in the individual actor, whereas if you ask the actors why they are acting that way, they focus on the environmental demands they are experiencing.
Most people have eating disorders as a result of the attempt to be not-fat, because not-fat is safer, because weight stigma endangers them, because other people are using weight stigma to keep themselves safe from existential dread or guilt about their resource consumption, because there are huge injustices in the world and we are beginning to see that resources are not unlimited. The dread/guilt/anxiety/powerlessness gets deeper and so do our real problems that fail to be addressed while we are all trying to make our bodies – which under normal circumstances, fall into a range of thinness and fatness – thin enough to imply that we are only consuming our fair share – even though it is more likely for people with fatter bodies to be poorer and actually consuming the fewest resources.
So the problem to be solved is this massive unfairness in opportunities for a good life, in a context where we may be running out of time and resources, which creates all kinds of distress and suffering, not just eating disorders. And maybe when we connect those dots, we see the work that needs to be done to not just help people who are already suffering, but change the conditions that trigger the need for disordered eating in the first place. In a world where opportunities for a good life are more available to everyone, where we are working to solve the biggest environmental and social problems rather than trying to distract ourselves with weight loss, our weights might just vary like our heights and have much less social meaning. And that lack of social meaning would mean that the motive of proving worth through restricting food consumption would be gone.
My hope is that this push to think broader and higher, not just focus on the discoveries in the direction of the cells/genes/neurons, will make it possible for the people who have never been recognized as suffering from eating disorders to get the help they need. When we think about weight stigma, we are suddenly at a high enough altitude to see ourselves down below and to realize that our own weight biases affect how we define eating disorders. One example is the low weight criterion for anorexia nervosa. Why should you have to wait to get diagnosed and treated for all the symptoms of AN till you are at a population-based, rather than an individually-based, “low” weight? Granted, “Anorexia at Higher Weight” doesn’t exactly trip off the tongue – and calling it AHW is unpronounceable – maybe we could reverse the letters and call it WHA? for the inevitable expressions of shock and surprise that people could be starving at a higher weights too. Or here’s an idea: just call it anorexia rather than being a “successful” dieter, if you have all the same symptoms of weight suppression.
Weight stigma allows us to think at a level that includes economic and social structures that affect health. The many communities being policed in the “War on Obesity” are especially vulnerable to the consequences of weight cycling and weight discrimination in medical and workplace settings. People of color, LGBTI people, people who are disabled by the average environment, poor people, indigenous people – can you imagine our largest eating disorders organizations doing fundraising for these communities? Actively working to make visible the needs of people with multiple marginalized identities? Can you imagine a public health approach that doesn’t police the weight of the bodies of marginalized people but rather broadens to ask how to make racism and structural inequality a thing of the past?
To prevent eating disorders, make the world safe for fat people. To make the world safe for fat people, empower disenfranchised communities. To empower disenfranchised communities, work for social justice. To prevent eating disorders, work for social justice.
*I want to acknowledge that there are people whose disordered eating may not be related to negative ideas about fatness or pursuing weight loss – people for whom food insecurity, medication side effects, reactions to food components, depression, or other factors may have a causal role. I do not wish for any theory of eating disorders to render any sufferer invisible.