Stereotypes influence us in so many ways – even in ways we might not be aware of until they are brought to light. Even some stereotypes that we are aware of persist – when someone hears the term “runway model,” what comes to mind? Most of the time, it’s a skinny, cis woman. Even though the presence of more diverse body types is being pushed to the forefront in terms of modeling, social media influencing, and similar industries, the old stereotype is still the norm. As potentially devastating as these stereotypes can have on the general public, they can be even more harmful to people with eating disorders that involve body dysmorphia – including those in eating disorder treatment.
Body image rehabilitation is central to most eating disorder treatment programs; although some eating disorders such as pica or ARFID aren’t necessarily caused or triggered by body dysmorphia, distortions in body image influence the development of anorexia nervosa, binge eating disorder, bulimia nervosa, and others. Stereotypes about what a person with an eating disorder looks like are pervasive, too. Just like hearing the term “model” can bring up certain preconceived notions, hearing “eating disorder” often raises specific images. Usually, it’s one of a young woman who’s malnourished and dramatically underweight.
Although this can happen, it’s by no means the rule. Eating disorder patients come in all shapes and sizes.
Our Biases Affect Our Self-Image
In a 2012 study, 500 men and women of various backgrounds were asked to express their opinion of three body types. This study was not specifically focused on people with eating disorders. These types were ectomorph, mesomorph, and endomorph, which refer to thin, muscular or athletic, and round, respectively. The majority of respondents replied positively for the mesomorph category, and the most negative response came for the endomorph type. Although older respondents replied more positively toward the endomorph type, perhaps reflecting the natural tendency to gain weight as one ages, the younger respondents were much more negative toward that type. This shows that younger people tend to carry a negative bias against bigger, rounder bodies.
The younger group in this study ranged from age 6 – 25, which not coincidentally contains the average age of onset for eating disorders, which is generally from age 13 – 21 (although disordered eating behaviors and negative body image have been observed in children as young as 6). This bias can lead adolescents and young adults to make efforts to either lose weight or prevent weight gain, both prominent symptoms of an eating disorder. Weight control efforts can present as more “benign” actions like dieting or strict portion control (we say “benign” because these efforts can have negative effects on mental and physical health as well as being potent triggers for eating disorders), as well as more recognizable disordered eating behaviors like binge eating, purging, and restriction. They can also lead to compulsive or excessive exercising, which can be a disorder in its own right.
Among people with eating disorders, a bias against the endomorph body type is usually even more prominent. Body dysmorphia can be any kind of dissatisfaction with one’s body, but the most common form is a feeling of being overweight or fat, even if the person is medically underweight. Because the onset age of eating disorders is roughly the same age when a person is most likely to have negative reactions to bigger bodies, it increases the risk for self-perception to be negative, which triggers dangerous, disordered eating behaviors. It also creates certain stereotypes about what people in treatment for eating disorders “should” look like, as we’ll see.
Overcoming “Skinny” Bias During Eating Disorder Treatment
As we mentioned earlier, the term “eating disorder” often conjures up an image of an extremely thin, possibly malnourished person. Although this is not necessarily true and is largely associated with extreme cases of anorexia nervosa, this stereotypical notion is just as common among people in treatment for all kinds of eating disorders. This can lead to several kinds of misconceptions among people in the eating disorder community.
The first myth is that people in bigger bodies don’t need to be put on a restoration plan. A prime example of this would be treating a person with binge eating disorder only behaviorally, taking steps to cease the binge eating episodes, and even encouraging them to lose weight. This might often result in a worsening of the symptoms, though; many people with binge eating disorder are on strict, fad diets, and the combination of this and binge eating episodes causes nutritional imbalances and psychosocial troubles. In this situation, it’s better to introduce a plan where the person eats regular nutritional meals to satiety while eliminating binge eating episodes. If they gain weight, so be it. It’s worthwhile to challenge their body dysmorphia and regain healthy eating habits.
Another pervasive bias concerning weight that happens among people in treatment is the concept that people in bigger bodies aren’t “sick enough” for treatment. This misconception leads some patients to believe if they are not showing signs of malnutrition or extreme weight loss, they don’t need treatment for their disordered eating behaviors. The danger here is that a bigger person with an eating disorder can be at as much a risk for physical problems due to their eating disorder, as well as carrying the same psychological risk factors, as a thinner person. This can lead to the under representation of people with disorders such as atypical anorexia nervosa, bulimia nervosa, and binge eating disorder (the most common eating disorder) when it comes to treatment.
Healthy At Every Size Treatment Can Help Overcome These Biases
In recent years, eating disorder treatment has become increasingly centered on the concept of challenging the stereotypes of what a person with an eating disorder “should” look like. The HAES (Healthy At Every Size) philosophy is key to these efforts. This movement helps people challenge cultural and societal biases that relate to body image and learn to accept their bodies. The concept that being overweight guarantees a person is unhealthy is problematic for many people, and not only those who have eating disorders. HAES aims to promote the understanding to the medical community that the preeminent factors that cause health problems are driven by social, economic, and environmental factors, not by one’s weight.
As important a lesson as this is for the general public, it’s even more essential for people with body dysmorphia and eating disorders to embrace. For many eating disorder patients, becoming overweight or being unable to lose weight is their greatest fear. The eventual outcome of gaining weight can hold individuals back in their eating disorder recovery; if the final goal is to achieve what their disordered self considers to be the worst outcome, they won’t become fully committed. That’s why, in addition to the various psychotherapy, mindful movement, nutritional therapy, and meal planning aspects of a typical treatment plan, eating disorder professionals now include HAES and other body-positive concepts.
Eating disorder treatment professionals are also beginning more and more to challenge the stereotypes of eating disorder patients being young white women. Some eating disorders like binge eating disorder are as prominent in men as in women and notoriously happen in older people almost as often as in younger ones. As part of the body positivity movement, which is largely credited to BIPOC as a way to challenge Eurocentric body and beauty standards, more attention is being paid to different ethnic and racial groups’ needs as regard eating disorders.
Many implicit biases must be overcome to help people with body image distortions and eating disorders recover to a healthier, happier lifestyle. Thankfully, awareness is on the rise, both in the patient population and among mental health care providers.
Reach Out for Help
Oliver-Pyatt Centers is dedicated to providing the best, evidence-based eating disorder treatment with the highest level of care available outside a hospital setting. Our staff is HAES-informed and ready to help our clients unpack any biases and stereotypes that might be contributing to disordered eating behaviors. If you or a loved one is struggling with any form of eating or exercise disorder, please reach out as soon as you can. We’re standing by to hear your story, and to help get you started on the path to a full recovery,