We all have that feeling. That stay-up-all-night-think-about-what-you-should-have-said feeling. You replay the situation again in your mind and perfect what you would have said had you been good at coming up with speeches off the cuff.
I recently attended the Academy for Eating Disorders’ International Conference on Eating Disorders. This is an amazing conference, and if you haven’t been to one yet, you should. So many of those people have become incredible friends and mentors and it has hard to believe that from knowing one person in 2011 at my first conference, I now know so many.
But I digress.
We had a plenary one afternoon regarding the intersection of eating disorders and obesity and if you’re familiar with the eating disorders field, you can imagine the uproar that most people expected it to be. As a field, we have been reluctant to join with the obesity field for many reasons, some due to understandable differences or misunderstandings.
The three speakers were all very good, but some of them were not as sensitive to aspects that would trigger eating disorders professionals’ dissent as well as people with lived experience. First, one suggested that obesity was an eating disorder or comparable to one. The second speaker aligned more from the eating disorder side and there was much support among the audience. And lastly, the final speaker suggested an addiction model for understanding eating disorders, which many ED professionals strongly resist.
How do I know this? Because there was a conversation going on during the lectures. Social media, and especially Twitter, can be a very useful way to share thoughts and pose questions to others throughout a conference. It keeps the conversation going and allows others who were unable to attend the conference to engage. Used in the right way, it can create a respectful dialogue. And to the most extent, that is what I saw. There were a few who were more militant or reactionary, which can provide needed catharsis, but may not advance the conversation much.
At the end of the talk, the discussant suggested that the two fields needed to work together and that eating disorders experts need to be at the table to help change public policy. An audience member suggested that ED professionals could help take on the dieting industry through policy. There are many benefits to having the two fields work more closely with each other. Another audience member expressed some of the reluctance and dissent that was being felt in the crowd, and it was an extremely brave and necessary thing to do. The colleague questioned how we could achieve these goals without alienating people in larger bodies, perpetuating weight stigma, and damaging people in ED recovery by labeling foods as good or bad or suggesting eating disorders are an addiction.
The panelists fielded the question appropriately and respectfully, validating the concerns and stating that this was why ED professionals needed to be at the table … to ensure this didn’t happen.
So, having set the scene, here are my thoughts on what I should have said.
I have been in both the obesity and eating disorders fields and have always felt that they would be more powerful as a united force. I do agree that there are many shared risk factors for both, but I firmly disagree that obesity is a disease or an eating disorder. It is not. It is merely a size categorized by an arbitrary number. Just as thinness is not a disease or an eating disorder, obesity is also not. You can be thin and not have an ED, you can be in a larger body and not have an ED.
However, we live in a society which has caused us to be very out of sync with our eating, with our hunger cues, and we are perpetually hounded by weight stigma and the dieting culture to be thinner and fitter. We know that dieting is one of the main triggers for someone with a genetic predisposition for an eating disorder. We know that higher calorie foods consumed by someone with a genetic predisposition to have a larger body can contribute to that larger body. That is not to say that a thin person can’t eat junk all the time and stay thin. They can. And that is mostly due to genetics. We cannot change that.
By joining with the obesity field, uniting under public policy, we could help to change the food system so that it is more conducive for everyone, no matter their shape, size, or economic status. No food is good or bad, but we are overwhelmed by our food and dieting culture and that is very hard for someone with an eating disorder or someone in a larger body who wants to eat, but feels judged by eating and pressured to restrain.
And here, I need to check my privileges. One of my colleagues has been inspiring in this regard and I think it is something we need to acknowledge more. I am a white, cis-gender, heterosexual female in a thin body. I can say things that a person in a larger body cannot. If I go to a restaurant and eat four hamburgers, I probably won’t get any judgmental stares, whereas a person in a larger body could never get away with that. We all hold weight stigmatizing attitudes to some degree. It is either conscious or subconscious, but it is so pervasive in our society that it is hard to avoid.
Despite these privileges, I also have a unique perspective. I have been on varied points in the size spectrum. I was in a much larger body as a child and adolescent. I was bullied mercilessly. I was judged. I longed to be thin. I thought when I was thin, my life would finally be perfect. And I finally did lose weight. A lot of weight. People were so supportive, so congratulatory. The positive feedback was overwhelming and it fueled my dieting. And then I lost too much weight. And people were judgmental again. I was an anorexic freak, I just needed to eat, I was a problem.
Now in recovery, I can see both sides. I am certainly not suggesting that people with EDs are more judged than people in larger bodies. No, for the most part, people cannot tell who have EDs. Size we can see and society judges and is unaccepting. You have to apologize for who you are when you are larger. You have to try to make yourself small, to fit in. It is unconscionable and it needs to stop.
I also am somewhat on the fence about whether eating disorders can be fully understood as addictions. There are many cases where perceiving substance use or alcoholism as an addiction has alleviated some of the stigma around it. Even the efforts in the ED field to pinpoint genetic underpinnings may have reduced stigma because EDs are beginning to be considered something people can’t necessarily control.
However, does it help us as a field to resist uniting with obesity researchers? I understand the HAES belief that obesity labeling and obesity research is a form of oppression. I do understand that. But can we help educate that field to focus more on health instead of weight? Can they help educate us on how to effect change on a large scale? I remain in awe of how clinicians and researchers change lives and improve the ED field, but also, as a public health professional, I realize what we could do on a broader scale towards prevention if we partnered together.
The American Academy of Pediatrics recently put out guidelines that stated to prevent both obesity and EDs in children and adolescent, we needed to focus on health and not weight. That needs to be the message for all of society. If we let the obesity field self-regulate without our influence, that may not be achieved. With our voices – with all our voices – we could achieve our mutual goal of creating an environment that helps people have healthy relationships with food and their bodies.
And those are my thoughts from 3am one morning, for whatever they are worth. If you read to the end, thank you and I welcome a respectful discussion on any of the topics I addressed.