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Eating disorders and the fat acceptance movement

28th September 2007

Eating disorders and the fat acceptance movement

It amazes me that, though historical records of eating disorders date back centuries, just how very little these disorders are understood, even today.

Take, for instance, a “conversation” I engaged in this week – and I use the term conversation lightly, because it was really more of a haranguing, self-absorbed monologue on the other’s behalf. The blogger, who coincidentally happens to describe themself as a fat acceptance activist, dismisses scores of women with eating disorders as simple cases of thin-envy.

Apparently, the notion of “acceptance” isn’t all-inclusive for some.

As a practicing Buddhist, I believe that the way to attract positive vibrations and experiences to oneself is to surround oneself with people who are themselves filled with positive energy. There’s a saying in the bible I like: “He that hangs with fools shall be destroyed. He that hangs with wise men shall be made wise.” I will use gender-neutral pronouns henceforth, because while I have no particular wish to either draw negative attention to this blogger or engage said blogger in additional debate, I do want to address the fallacy of the blogger’s claim.

The blogger denies the very real experiences of many women with eating disorders, with the claim that many of these women are simply “clinging” to an eating disorder in hopes that “recovery” will make them magically thin.

For one who makes it a point of their activist platform that fatness is not a character flaw, it seems hypocritical to then accuse women with binging disorders of using their disorder disingenuously to conceal their so-called true weight-loss intentions.

I view it much in the same vein as accusing someone, who insists they eat a balanced diet, of secretly overeating and/or eating “bad” foods simply because they are overweight.

Because the very DSM-IV criteria for anorexia is a “refusal” (or inability, as I prefer) to maintain at a minimum body weight, it must follow that the disorders women allegedly beguile themselves with include bulimia and binge eating or collectively, binging disorders. (Note: all of these disorders can exist independently of obesity).

All of the leading professional organizations devoted to the study and treatment of eating disorders – ANRED, NEDA, ANAD, and the AED to name a few – acknowledge the often extreme shame and guilt characterizing these disorders. It’s been well documented that many patients with these disorders report that they will often binge in private, away from prying eyes, due to the extreme shame they feel over their uncontrollable urges.

In fact, the DSM-IV diagnosis for binge eating, which has received wide empirical support as a distinct eating disorders category, requires a marked distress about the binge eating.

Ellen Shuman is the director of A Weigh Out Life Coaching programs and the Acoria Eating Disorder Treatment, and also co-chairs the International Academy for Eating Disorders special interest group on “Health at Every Size (HAES).”

Shuman’s facility adopts the HAES approach in dealing with patients with binging disorders, NOT a continued cycle of dieting and starving as assumed by the blogger referenced above. As a former patient of the Acoria Center, I can attest this to be true.

As a recovering binge eater herself, Shuman is well aware of the shame associated with the disorder. She writes:

We feel out of control with food. We try to keep what we’re doing a secret. (Not easy as my weight soared to 289 pounds.) We eat in bathrooms and we thank God for the relative anonymity of drive-throughs. We know all the most isolated parking spots in the tri-state. That’s where we do much of our eating because we wouldn’t dare do it where anyone might spot us. We hold our breath and pray for the strength to pass a UDF without going inside. When we’re not feeling numb from the effects of our latest binge, we feel shame.

You can read Shuman’s experiences with binge eating disorder and the resultant shame and guilt it instills in an article previously featured in Cincinnati Magazine.

Simply said, an eating disorder isn’t something one admits to readily or easily, with the hopes of a magical get-thin-quick cure. In fact, making the decision to get help is often the most difficult and arduous point in the entire recovery process.

Shuman admitted of her own decision to confess all about her disorder, “I know it takes soul searching and guts to go public with a problem that held so much shame in years past.”

As a recovering anorectic and bulimic myself, admitting that I had an eating disorder which had become uncontrollable was probably the most difficult point of my entire recovery process. Admitting you need help is never easy, but confessing to shameful behaviors and practices like binging makes seeking recovery even more difficult. From speaking with countless other women who have or have had eating disorders, I have found this to be a common thread amongst the disordered.

The blogger’s overarching blanket statement is therefore not only erroneous, it’s highly offensive to the legions of women who experience very real, psychological-based eating disorders.

Zie also erroneously assumes that treatment for binging disorders involves a confessional of the sufferer, that they “did this to themselves,” which they then use to justify a continued cycle of dieting. This could not be further from what actually occurs behind closed counseling doors.

Sufferers aren’t led to believe their actions to be consciously self-inflicted, but are often given information on new research which increasingly shows binging disorders to be the cause of biochemical differences. Patients are made to understand that their disorder is a psychologically-based one, and not something one can “choose” to have. And because most with binging disorders have already engaged in cycles of dieting, it would be unethical for a therapist to then prescribe further intentional weight-loss as means to recovery.

Let me reinforce this very important point: You can not choose to have an eating disorder.

Another important point: The acknowledgment and treatment of eating disorders is not a threat to the fat acceptance movement.

Eating disorders are psychological disorders which, to be diagnosed, must meet a host of diagnostic criteria. Obesity has more complex origins, both cultural and organic, with recent studies showing genetics to be more influential in one’s weight than simply a lack of willpower.

I can see where some may fear that acknowledging these disorders may lead others to the belief that all obese people must naturally have an eating disorder. But obesity and binging disorders can exist independently of one another, and they can also be interrelated. This is not to say that such disorders necessarily cause obesity, but studies have shown that those who are predisposed to obesity have a greater risk factor for developing binge eating disorder (C.G. Fairbum et all. Arch. Gen. Psychiatry. 55, 425 1998 and also Yanovski, Susan Z. Int. Journal of ED. 34, S117 2003.)

Considering the prevailing pressure to diet and the known psychological and physiological effects dieting can bring, the correlation that a naturally overweight person might develop disordered eating is a logical one. Instead of altogether denying that a relationship may exist – and again, this is not the case for all people – we need to encourage more awareness and education on both eating disorders and obesity.

As a historian, I must often traverse two worlds when writing of the past. There is the past as narrative, a recounting of the events which actually happened. And then there is the experiential past, the past according to those who lived through the events and have formed their own truths. Both are two halves, necessary in reconstructing the past as a whole.

One does not need academic journals or “scientific studies” to validate the experiences and truths people have. If a person feels they have an eating disorder, and a medical professional agrees that they do, let’s not discount their treatment and recovery with false assumptions, asinine statements and manipulation of data to meet our own preconceived and politically motivated agendas.

Instead, let’s offer sufferers our support, our empathy and our compassion. Anything else would fall outside the realm of true “acceptance.”

For more information on shame and guilt associated with binging disorders, or on eating disorders in general, read on…

Publications:

Bakalar, Nicholas. “Survey Puts New Focus on Binge Eating as Diagnosis.” The New York Times. 13, Feb. 2007.

Burney, J, Irwin, HJ. “Shame and guilt in women with eating-disorder symptomology” J Clin Psychol 56, (2006), pp. 51-61.

EDNOS: Eating Disorders Not Otherwise Specified. Eds. Claes Norring and Bob Palmer. Routledge, 2005.

Fairburn, Christopher G. and G. Terence Wilson. Binge Eating: Nature, Assessment & Treatment. Guilford Press, 1993.

Fairburn, CG, Cooper, Z. The eating disorder examination Fairburn, CG Wilson, GT eds. Binge Eating: Nature, Assessment, and Treatment , (1993). 317-360 Guilford Press New York.

Fairburn, CG et all. “Risk Factors for Binge Eating Disorder.” Arch. Gen Psychiatry. 55 (1998) pp. 425 – 432.

Potts, Nickilee. “The Secret Pattern of Binge/Purge.” The American Journal of Nursing. Vol. 84, No. 1. (Jan. 1984), pp. 32-35.

Roth, Geneen. Breaking Free From Emotional Eating. Plume. May, 2003. (or any of Roth’s other publications).

Sacker, Ira M. and Marc A. Zimmer. Dying to be Thin. Warner Books, 1987.

Saftner, JL, Crowther, JH. “Variability in self-esteem, moods, shame, and guilt in women who binge.” Int J Eat Disord 23, (1988), pp. 391-397

Thompson, Becky. “A Way Outa No Way”: Eating Problems among African-American, Latina, and White Women.” Gender and Society, Vol. 6, No. 4 (Dec., 1992), pp. 546-561.

Thompson, Becky. A Hunger So Wide and Deep: American Women Speak Out on Eating Problems. University of Minnesota Press, 1996.

Wilfley, Denise E. et all. “The clinical significance of binge eating disorder.” International Journal of Eating Disorders. Vol. 34, Iss. S1 (2003), pp. S96 – S106.

Other related publications found at Gurze.

Organizations:

National Eating Disorders Association
Anorexia Nervosa and Related Eating Disorders
Multi-service Eating Disorders Association
Academy for Eating Disorders
Eating Disorders Coalition
International Association of Eating Disorders Professionals
National Eating Disorders Information Centre
Something Fishy

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This entry was posted on Friday, September 28th, 2007 at 5:09 pm and is filed under Eating Disorders, Fat Acceptance, Personal. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

There are currently 10 responses to “Eating disorders and the fat acceptance movement”

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  1. 1 On September 28th, 2007, Meowser said:

    Good analysis, Rachel.

    I do think it’s worth noting that even fat people who do have problems with bingeing or compulsive overeating (not related to diets) don’t necessarily become thin as a result of getting their ED into remission, and that if weight is lost permanently it’s often a relatively minor amount. The same is true in reverse, of course, of many thin anorexics and bulimics; even if they start eating or keeping their food down, they will often gain only a relatively small amount of weight. Permanent variance in weight as a result of variance in eating habits is often not what many people assume it will be.

    I also think the “if only I weren’t such a carb addict I’d be thin” myth is one that needs to be put to bed. Yeah, if you can stick to a ketogenic regime you’re likely to be thinner, but that doesn’t mean you deserve to be kept in a closet on a leash for eating a bowl of rice. It’s frigging HARD to stick to a ketogenic regime forever, and possibly not necessarily desirable to do so from a health standpoint. Not being able to do so doesn’t make you an “addict,” for Pete’s sake.

    But I definitely agree that an ED is not a “choice” and that it sucks to feel out of control around food regardless of what your weight is. People who have this problem and feel they need support and treatment for it don’t need a giant shame trip thrown on them for it, even if they’re fat. Probably a good therapist would keep the emphasis off weight, in any case, and let the patient know that hoping for a giant weight loss as a result of treatment is potentially setting oneself up for torpedoing the treatment, since the patient’s body may not respond that way.

  2. 2 On September 28th, 2007, Fillyjonk said:

    “Hang with”? The Bible seriously says “hang with”?

    Anyway, I completely agree with you on this one. Here, I think, are some sticking points people have:

    - It’s easy for “some fat people have eating disorders” to be read as “some people are fat because they have eating disorders.” As you point out, it’s quite likely that the causation goes the other way. But I think some people bristle at fat folks with acknowledged binge eating or compulsive eating disorders because it seems like they’re reinforcing the idea that fat people can’t stop eating. (Of course, all they’re really reinforcing is the idea that some people can’t stop eating, and some of those are fat.) While it’s counterproductive — for the movement, and certainly for those individuals — to reject the binge eating diagnosis because it has the potential to support stereotypes, it’s also true that the fat/eating link hurts those with eating disorders as much or more than it hurts everyone else, since their disorder is treated as simply a bad habit. So we have to find a way to continue countering that while acknowledging that compulsive eating and binge eating are very real phenomena.

    - Some people claim that fat folks self-diagnose compulsive eating, when in fact they just need to eat more calories per day than most people eat. I have no idea if this is true, just putting it out there. Again, in no way does this counter the reality of eating disorders.

    - Finally, it is of MONUMENTAL importance that binge eaters and compulsive eaters in treatment do NOT expect to lose weight as they recover, and I think that’s one of the things that sets people off. It’s another way in which the eating->fat connection is harmful — people who are not in HAES-inspired programs may think that once they control their eating, they will also lose weight, and become discouraged and despondent when they don’t. I think that’s one of the concerns — that people are (rightly or wrongly) thinking “well, I have an eating disorder, so I just have to stop eating so much and I’ll lose weight.” You can see how that might be a danger. Basically, I think all ED treatment has to be firmly rooted in HAES, and treatment for binge/compulsive eating might have to start with a thorough grounding in FA.

  3. 3 On September 28th, 2007, Rachel said:

    Thanks, Meowser. Like you, I feel people flippantly use the term “addiction” (carb addict, sugar addict, etc…) which may contribute to this view that eating disorders are a cover for wanting to lose weight. But what defines an eating disorder, particularly binging disorders, is a true lack of control on the behalf of the disordered patient.

    In some of the studies I noted on binge eating disorder, especially Susan Yavnoskis, researchers found that treating binge eating disorder often resulted in only a moderate to small amount of weight loss. Of course the more important things that should be measured included a dramatic upswing in one’s relationship with food and body image.

    do think it’s worth noting that even fat people who do have problems with bingeing or compulsive overeating (not related to diets) don’t necessarily become thin as a result of getting their ED into remission…

    I totally agree. I think it is physically impossible to permanently thwart what your body is genetically predisposed to weigh. I think many naturally fat people who have problems with binging or compulsive overeating developed these disorders in response to attempts to diet and change their bodies – which, as studies show, is most often a futile attempt. Dieting, which is really code for disordered thinking about food, often turns into much more dysfunctional relationships with food.

  4. 4 On September 28th, 2007, Harriet said:

    Interesting conversation, and it enables me to pull out my rant of the week, which is: it’s the relationship, stupid. Meaning that it’s our relationship to food and eating, rather than how fat or thin we are, how many carbs or calories we’re ingesting (or not), that sets the tone of your life, really, and that is the measure of health. The new research that’s out about Ellyn Satter’s eating competence really dazzled me, because it’s the first time we’ve got a double-blind randomized study looking at significant differences between groups according to their attitutes toward and relationps with food–NOT how much they weigh or how many units of carbs they eat. Read it here: http://live.psu.edu/story/25988

  5. 5 On September 28th, 2007, Heidi said:

    Wonderfully written and I couldn’t agree more. The idea that disordered eating in an individual would magically go away if that person decided they were okay with being fat is, frankly, disgusting and completely myopic. It’s like saying people don’t need therapy, they just need to decide to stop being depressed! Don’t go to the doctor, just decide to stop being sick! Welcome to the magical world of easy answers and black and white thinking.

  6. 6 On September 29th, 2007, attrice said:

    Thank you so much for this post.

    Very often, when trying to be both an FA advocate and to be honest about my history of bingeing, I’ve felt trapped by other people’s insistence on one negating the other. Some see it as proof that I ate myself fat and others that I think all fat people are compulsive eaters. I always had such a hard time explaining that my being fat in a fat-hating world is what led to extreme dieting which led to the compulsive eating and that the path to healing was, in fact, to let go completely of the diet and thin=good mentality.

    Now I can just send them a link to your post!

  7. 7 On September 29th, 2007, Rachel said:

    Exactly Harriet. One’s relationship to food is a very relative thing – what can be a problematic relationship for one, can be easily dismissed by another. Who are we to declare ourselves arbitrators of one’s own personal mental health? And thanks for the link. I’ll be sure to check it out.

    Attrice: I’m so glad this post has helped you. Like you, I often feel that if I don’t adhere to this strict fat acceptance party line mantra, I am typecast as anti-fat, even though I consider myself to be a body acceptance activist.

    Heidi: I’m oft finding this same black/white thinking to exist even in fat acceptance. Read on…

    Fillyjonk said But I think some people bristle at fat folks with acknowledged binge eating or compulsive eating disorders because it seems like they’re reinforcing the idea that fat people can’t stop eating.

    Okay, I am going to tread lightly here with my own personal take on what I perceive to be a BIG contradiction within the fat acceptance movement.

    The fat acceptance movement is predicated on fighting stereotypes of fat as the result of gluttony and sloth – as it should. Fatness is the result of complex and myriad issues, the least of which can be summed up to a lack of willpower.

    But I do believe that one holds a genetic predisposition to fat metabolism and how/where fat is stored in one’s body. There are some people who can overeat and not gain weight, and yet there are others who will gain weight if they overeat. Just as with variances in hair and eye color, this represents a normal genetic spread. There are no absolutes in genetics; we simply cannot make the overarching statement that “fat people aren’t fat because they overeat.” Just like we cannot make the statement that “all thin people are healthy and eat healthy.”

    To deny that this is the case, is only stigmatizing people who do overeat and/or eat poorly and/or do not exercise regularly. By drawing lines and insisting that fat people only eat healthy and all exercise regularly, we’re distancing ourselves from fellow fat people who admittedly, do not.

    Fat acceptance should not be inclusive only of those people who say they eat a balanced diet and exercise regularly. Fat acceptance should recognize that all fat people, regardless of how or why they are overweight, are deserving of the same basic human rights and respect as all people.

  8. 8 On September 29th, 2007, Peanuts said:

    Rachel said:
    “I think many naturally fat people who have problems with binging or compulsive overeating developed these disorders in response to attempts to diet and change their bodies”

    Quite possibly. I don’t know of any data on this.

    When I myself had an eating disorder (a long time ago now) it wasn’t from dieting. I wouldn’t say it had nothing to do with dieting, but I had dieted only very rarely and I think it was a minor factor. Instead of the eating disorder being a consequence of dieting, rather the two things were both consequences of the same causes: the shame I had been taught to feel for my body, and the restrictions in my life, some of which were imposed on me.

    So the eating disorder (compulsive overeating) stemmed from a lack of control in my life, my secret eating being a way to express some control over what I did. Part of the lack of control came from being forbidden to eat certain foods. So naturally those foods were obvious implements when my sub-conscious was trying to get me more control. The shame I had been taught to feel with regards to my body also fed into the compulsive overeating cycle.

  9. 9 On September 29th, 2007, Rachel said:

    Peanut: True, eating disorders stem from a myriad of reasons, which can run the gamut from trauma; physical, sexual and/or mental abuse; poverty; or they can be entirely organic in nature. And there’s more, I’m sure. The truth is, there is no one cause to point the finger of blame on. We can only work on examining our own lives and what we feel may be contributing causes, and work forward from there.

    You say you had a disorder a long time ago – I hope you have come to a good place in your life now.

  10. 10 On September 29th, 2007, Peanuts said:

    I agree with you that eating disorders stem from a lot of reasons.

    Oh the eating disorder got fixed long ago (thank you for asking), I have other things to deal with now!

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