Weight is Not the Illness When it Comes to Eating Disorders

We need to end traumatic and destructive anti-fatness rooted racism, shame, and discrimination.

I got so angry while at the Eating Disorders Research Society Conference in September of 2023.

If you’ve been following my reels on Instagram (totally ok if you’re not), you may have seen me sharing some of my takeaways and highlights from the conference earlier this month.

Most of my experience there was pretty fantastic. Listening to researchers share their research on how to expand treatment efficacy and access (yay!), support the integration of adaptive and healing exercise into treatment (great!), and brilliant models for intersectional studies (whoopie!) was all really exciting and mind-expanding. (Ok, some of it was super-duper boring and not for me, but there was a lot of great stuff.)

But everything burst into a flaming pile of anti-fat bias on the final day. I simply could not capture my thoughts in a 90-second reel, so I am sharing them here with you.

**Content warning: please take care of yourself. The content below addresses eating disorders in higher-weight individuals. If the topic of weight-centric care in the treatment of higher weight folks is difficult or destabilizing for you, please skip it.

Conference chair and organizer, Marian Tanofsky-Kraff, pulled together a symposium titled, “Eating Disorders and *besity: The State of the Science, Intervention Opportunities, and Knowledge Gaps.” She did so under the misguided opinion that we need to seriously consider treating high weight alongside an eating disorder since the majority of individuals with an eating disorder are at a higher BMI. (Marci utters the first F-bomb in the first 60 seconds of the 90-minute symposium.)

eating disorders in higher-weight individuals

At this juncture, I don’t have the capacity to thoroughly critique the research from each of the 5 presentations. So, instead, I will offer a 5-point higher level critique of the symposium and the more general movement to conflate weight as illness within the eating disorder profession.

  1. If there is going to be a panel to explore a weight-centric approach to treating higher-weight individuals with eating disorders, the conference planners have an ethical duty to include “both sides.” All of the researchers on the panel so clearly aligned with a weight-centric approach. I felt I stepped directly into an *besity conference where all of the rules about sound research are promptly tossed out the window. Researchers whose work could have been considered include, but are not limited to: Jeffrey Hunger, Erin Harrop, Janelle Messinger, Tracy Tylka, Angela Meadows, and many more.
  2. Any research that assumes pathology based on body size, without consideration for social and systemic contributions is incomplete and harmful, propelling the false narrative that correlation equals causation.
  3. In the words of Deb Burgard, we cannot advocate for interventions for fat people which are deemed disordered in thin people. I cannot believe that we are trying to convince ourselves that it is ok to encourage the use of eating disorder behaviors for higher weight folks. This delusion is what happens when we dehumanize fat people and see size as a surrogate for health.
  4. We must take a stand against allowing behavior by researchers which is disrespectful, arrogant, rude, and rooted in stigma. We should expect that researchers respond to valid questions about study design with respect rather than flippancy. One researcher’s work seriously proposed interventions for higher weight individuals akin to the electric shock therapy used to “treat” homosexuality 40-50 years ago. Any intervention rooted in dehumanization should not be tolerated in our profession.
  5. Any presentation on a weight centric approach must admit to and transparently reckon with the absolute failure of the *besity interventions of the past century. Additionally, presenters must also include the very real physiological and psychological harms of weight cycling, the known side effect of weight loss interventions. To pretend as if weight loss research has demonstrated long-term “success” without serious harm and thus should be foisted upon individuals with eating disorders is simply unacceptable. It is particularly unacceptable for an organization that prioritizes objectivity, scientific rigor, and critical thinking.

If you’ve made it thus far, I’m sorry if I ruined your day with this bleak critique. But I can finish this off with some very good news. If you haven’t already heard, Weight Stigma Awareness Week is back, and it’s here RIGHT NOW!

Please head over to the website, Weight Stigma Awareness Week, and get yourself registered for some empowering education to “end traumatic and destructive anti-fatness rooted racism, shame, and discrimination.”