Alex sat nervously in her doctor’s waiting room, palms clammy as she fidgeted with a thread on her jumper. After battling with herself for weeks, she was finally seeking support for her horrendous relationship with food. But, glancing around at the posters of slim bodies promoting health and wellness, dread overcame her. She didn't fit the stereotype of eating disorders. She wasn't underweight, her bones weren't protruding, and she did not look like the images plastered across magazines. Yet, thoughts about food, guilt after meals, and a constant compulsion to exercise consumed her.
The mirror reflected an unbearable image. Failed attempts at every diet increased her shame and self-loathing. She counted each calorie as she battled between hunger and fear of weight gain. Her body betrayed her by continuously increasing in size. Food became the enemy, a source of anxiety and despair. Each meal was a battle between hunger and guilt, she punished herself for nourishment. Yet, bingeing offered a fleeting escape from the pain.
Sitting in the doctor's office, she wondered how she would explain her struggle. Would he believe her when she said she couldn't stop thinking about food? Would he understand the guilt that plagued her every time she indulged in a meal?
As the doctor called her name, Alex felt her heart racing. She took a deep breath, trying to gather her thoughts. When she finally sat across from the doctor, she hesitated, the words catching in her throat." I... I think I have an eating disorder," she finally managed to whisper. The doctor’s eyes lingered on Alex’s body for a moment too long, and Alex felt the familiar pang of shame. “You don't look like you have an eating disorder," he stated matter-of-factly. Her heart sank. She tried to explain but saw judgment in his eyes. “Just try to eat healthier and exercise more," he advised.
Leaving the office, Alex felt the weight of shame growing heavier. She tried to follow the doctor’s advice in the following weeks, but the cycle continued. Restriction led to bingeing, which led to further restriction. Alex’s relationship with food became more destructive and the self-loathing was too much to cope with. The doctor's dismissive remark, “You don’t look like you have an eating disorder,” replayed relentlessly in her mind, driving the knife of shame deeper.
She was trapped in a silent war with herself. With flushed cheeks, she retreated into solitude, the burden of her unseen struggle growing heavier by the day.
Eating disorders have been long associated with specific stereotypes perpetuated by media and societal perceptions. Media plays a significant role in shaping our perceptions of eating disorders. Images of severely underweight people dominate headlines, movies, and social media, creating a false narrative that associates an emaciated appearance with an eating disorder. This narrow portrayal not only oversimplifies the spectrum of eating disorders but also creates a barrier for those whose symptoms don’t match the depiction.
Healthcare settings are not immune to societal biases, including those related to body weight. Research has shown that healthcare providers, like the general population, may hold implicit biases against individuals with larger bodies. When someone like Alex presents with a normal or higher weight and an eating disorder, they may encounter disbelief or minimisation of their struggles due to this bias.
Arriving at a doctor's appointment while struggling with an eating disorder, but not fitting the stereotypical image of extreme thinness, can be an incredibly daunting experience. People who have eating disorders often face unique challenges, including feelings of shame, invalidation, and fear of not being taken seriously by healthcare professionals.
Individuals with eating disorders already battle intense feelings of shame and guilt about their behaviours and body image. When their body size does not align with the stereotype, this shame can be amplified. They may question the validity of their illness, feeling like they are not "sick enough" to deserve help. This internalised shame can lead to a reluctance to disclose their struggles, even to healthcare providers.
The misconception that eating disorders are solely about weight can have detrimental effects on treatment for individuals with normal or higher weights. Healthcare providers may focus solely on physical health metrics, such as BMI, rather than exploring the psychological and behavioural aspects of the disorder. This can lead to inadequate treatment plans that do not address the root causes of the eating disorder.
The internal pain associated with managing an eating disorder, including negative thoughts and restrictive behaviours, is profound. Already contending with an abundance of shame, those in larger bodies may experience extreme emotional pain for not conforming to societal norms. It is vital to recognise that we cannot measure the severity of an eating disorder solely by the size of the body. The true severity is measured by the depth of emotional pain, the self-harming behaviours, the pervasive self-loathing, and the internal belief that one's worth is tied to their body size. As professionals, we are responsible for observing the relationship between food and the body, and not judging based on someone’s size. Understanding and addressing these emotional aspects is vital in providing effective support and treatment for individuals with eating disorders.
We cannot simply weigh the severity of an eating disorder on a scale. The true measure lies in the depth of emotional anguish, the self-harming behaviours, and the pervasive self-loathing. Understanding this complexity is the first step towards true empathy and effective support.