The Oddness of Weight Bias in Eating Disorders

“There’s a huge fatphobia problem in the eating disorder world,” says Shira Rosenbluth. She is a Licensed Clinical Social Worker, an eating disorder therapist, and has her own life experiences with eating disorders. Obesity and eating disorders can appear in the same patients and some research would suggest they frequently do. But for each of these diagnoses, getting good care is difficult. Put them together and the challenges multiply. Weight bias is one of many factors that complicate the process of getting good care for both eating disorders and for obesity.

“Forget About Obesity”

One response we hear from some advocates for people with eating disorders is to dismiss obesity as a health concern altogether. Cheri Levinson is a psychologist and researcher focusing on eating disorders. She says:

“I don’t think there should be any form of treatment for obesity. I realize that I am at the extreme of this opinion.”

But she clarifies that it’s just fine to help people “be healthier, move more, eat regularly etc” so long as we dismiss any concerns about weight.

In a clinical practice limited to people seeking care for eating disorders, that philosophy might be just fine. But for people who need help with health problems caused by severe obesity, it becomes absurd. Having a therapist offer to help you with your behaviors so you can “be healthier” sounds an awful lot like the stereotypical assumptions people living with obesity encounter every day.

The term for this is weight bias.

Weight Bias and Eating Disorders

The understanding that weight bias is a problem in the eating disorder community is nothing new. Rebecca Puhl and colleagues documented it in 2014, concluding from their research:

“Like health professionals in other disciplines, professionals who treat eating disorders are not immune to weight bias, and these biases are associated with negative attitudes and frustrations about the clinical treatment of persons with obesity.”

Belief in a Singular Righteous View

The flaw that underpins most every expression of weight bias we encounter is the presumption that one size fits all. It’s false because people come in all sizes and shapes. Health needs are different for different people.

But more frequently we are hearing folks like Levinson say there is only one right way to deal with obesity – to look away. Remove the word from your vocabulary and let there be no such thing as medical obesity care. It crops up in response to evidence-based guidance for obesity care in youth. It also arises in response to the arrival of better medicines for treating obesity.

That sounds a lot like political rhetoric aimed at seeking to limit choices for healthcare. We want no part of it.

Click here for more on eating disorders, obesity, and weight bias. For perspective on diversity and respect for medical autonomy, click here.

The Sphere, woodcut by M.C. Escher / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.

April 29, 2023