Last week the Eating Disorders Coalition held a briefing on Capital Hill that addressed issues around the negative health outcomes that can result from weight-based stigma and discrimination. They also discussed how important it is to take the focus off of obesity and size, and instead shift the focus to healthy behaviors. The panel of speakers included:
- Rebecca Puhl, PhD, Deputy Director, Rudd Center for Food Policy & Obesity, Yale University
- B. Timothy Walsh, MD, Ruane Professor of Pediatric Psychopharmacology, Department of Psychiatry at the College of Physicians & Surgeons, Columbia University
- Chevese Turner, CEO & Founder, Binge Eating Disorder Association
- April Winslow, MS, RD, Founder of Choose to Change Nutrition Services
Below is a summary of their presentations:
Health Consequences of Weight Stigmatization and the Contribution to Obesity and Eating Disorders (Rebecca Puhl, PhD)
Rebecca talked about what weight stigma actually is — people being treated negatively based on their weight. At one time or another, we’ve probably all witnessed some kind of negative images and words associated with people of larger size. It’s become a pervasive problem in our society. They’re often categorized as lazy, sloppy, and lacking the self control to just be a smaller size. It can happen at any age, whether it’s a child being picked on at school, or an adult being denied adequate health care at work. For women especially, it’s one of the most reported forms of discrimination, along with gender, race and age.
People who are victims of weight bias become more vulnerable for depression, anxiety, low self-esteem, poor body image, and are even more likely to commit suicide. In addition to the psychological trauma, they also experience poorer academic performance, inequitable hiring practices, and lower wages.
What many people don’t realize is that many people of larger size who are criticized for their weight, may actually be suffering from an undiagnosed eating disorder, like binge eating disorder, (BED) the most common eating disorder.
Many times the stigmatization isn’t intentional. It’s coming from a place of wanting to guide a person towards health, but they don’t realize the negative implications that shaming a person to lose weight can have. Especially on children. She shared a number of examples of these misguided campaigns, for example:
She mentioned that research has actually found that ads like these that stigmatize larger-size people are less motivating and make them feel less confident about improving their health.
Campaigns were seen as the most motivating focused on healthy behavior changes instead of body weight and obesity.
She listed a number of other diseases/conditions that also had a stigma attached to them, for example leprosy, drug addiction and mental illness. However for these conditions (and many others) it’s been acknowledged that the stigma was a barrier to a person’s treatment, and as a result more research and funding was given to reducing that stigma.
The same needs to happen for obesity and eating disorders, so that proper treatment can be provided to the millions of people that need it. The key will be finding a way to shift our society’s focus to health as the ultimate goal, and not a specific body weight.
Binge Eating Disorder and DSM-5 (B. Timothy Walsh, MD)
As of May of this year, binge eating disorder is included as its own diagnosis code in the DSM-5. Dr. Walsh was able to share with us a little history behind how it came to be it’s own code, instead of continuing to fall under the umbrella of “Eating Disorder Not Otherwise Specified” (EDNOS).
Until this year, binge eating disorder was categorized under EDNOS, along with purging disorder and night eating syndrome. Binge eating disorder is defined as recurrent episodes of binging (without compensatory measures like purging), at least once per week for a period of 3 months. A binge episode is associated with at least 3 of the following: eating faster than normal, eating until uncomfortably full, eating large amounts even when not hungry, eating alone, or feeling guilt afterwards.
He shared the overwhelming evidence that supported BED as its own diagnosis, including, not limited to the over 1000 scientific articles published since the DSM-4, the lab testing that’s been done showing that binge eating behavior is abnormal, and the fact that people with BED don’t respond to routine weight loss treatments. This last piece being extremely important, as I’ve seen in my own counseling practice, because focusing on weight loss (for those with BED) actually can drive them deeper into their eating disorder.
Since it has become its own diagnosis in the DSM-5, one study that he shared shows the frequency of EDNOS has decreased from around 40% to around 15%, with BED coming in around 20%.
Why We Must Address the Intersection of Obesity and Eating Disorders (Chevese Turner)
Chevese started by pointing out that it’s first important to recognize that eating disorders are not rare. They affect around 20 million women, and 10 million men at some point in their lives, falling at different points in the “spectrum”. The perception that eating disorders can be seen as “rare”, yet obesity is an “epidemic” is just not true. In fact this “battle” that is going on against obesity, is actually happening at the expense of people’s lives (those people dying due to complications from eating disorders). She explained why it’s so dangerous to perceive eating disorders are so rare — that it’s due to the health complications that result from them going untreated, like:
- abnormal heart rate
- electrolyte imbalances
- decreased bone density
- muscle loss
- tooth decay
- high blood pressure and cholesterol
- type 2 diabetes
Around 70% of people with BED are considered overweight or obese, while 30% are considered a “normal” weight. Many people who struggle with it have suffered through countless weight loss treatments that not only didn’t work, but they actually exacerbate their disorder.
She called for people to have the courage to stop and look at programs that target people based on their size (whether it’s intentional or unintentional) like school BMI report cards or work wellness programs. The unintentional side effects are too damaging to ignore. 50% of kids who are overweight go onto have eating disorders later in life.
NIH spent $843 million on research related to obesity vs. $34 million on research related to eating disorders. In a perfect world she’d like those budgets to match, dollar for dollar, but that just isn’t the reality right now. The best thing we can do now, is to try and stop the stigma, so we can stop the shame, and the eating disorder cycle that can result from it.
The Invisible Eating Disorder (April Winslow, MS, RD)
April shared her very touching story about her struggle with and recovery from bulimia and binge eating disorder. Her binging started when she was younger, and then dieting/weight cycling as she got older. She was ridiculed at school, and pressured to lose weight by her family. During her constant losing and gaining, she talked about the fact that non one ever approached her about an eating disorder. The conversation was either “you’re too big, you need to lose weight”, or “you lose so much weight you look amazing” and then felt the pressure to maintain that new size. The latter was what led to the purging.
She recalled a doctor’s appointment while in the midst of her purging, when she was commended for her weight loss, and when she sought treatment and help, was turned away. It wasn’t until a close friend called her out on her purging that she began to acknowledge it, and then eventually could comes to terms with it to stop it. She changed her attitude about herself, and her behaviors. She started small, just walking a few minutes each night, and she started journaling to help work through her emotions.
Now, she’s a psychiatric dietitian, and celebrates food, friends and all life has to offer. Her story was so inspirational, and yet spoke so well to the need for changes about how we think about a person’s size and their health.