I had the great fortune of being invited to speak at Pint of Science 2019 in Guelph. This event brings science to the pubs, with researchers giving 15-20 minute talks in local venues. It was a fantastic experience; an audience of around 50 people asked wonderful questions, there was a specially-created beer, and trivia! I thought I would share the talk I wrote, though as per usual I did not do the talk exactly as written (#WordyProblems).
[Please note that I use the term “people in large bodies” rather than fat in places; many fat activists have proudly reclaimed the word fat and I do not consider the word to be a negative word. Given the audience for this particular talk, moving away from the language of “obesity” might be conceived as a step toward fat acceptance and—ultimately, hopefully—celebration. Language is imperfect, and my use of language is at some times more clumsy than others. I have also provided a few citations in places where I anticipated being asked questions; the audience was very receptive, and it’s always good to have a few key citations in one’s back pocket. That said, the content in this post is assembled from various thoughts, academic learning, and, most importantly, learning from interacting with people with varied experiences of living in their bodies in a world that tells them not to trust their bodies. That is, to me, the most valid form of expertise there is.]
I am standing in a pub filled with people, with my dark hair down, wearing a black top with pink flowers and black jeans.
When you think about someone with an eating disorder, who do you picture?
There are a lot of preconceptions about who might experience an eating disorder that circulate in our world. Common answers to the question of “who gets eating disorders” include thin, young, white women; the term “eating disorder” conjures images of hospital wings and feeding tubes. But what if I were to tell you that eating disorders come in all shapes and sizes? The statement might seem obvious on the face of it; and yet, there is still this idea that even if all kinds of people get eating disorders, the “sickest” are those who are very, very thin.
I’d really like to dispel a few myths tonight, so I may as well just name those myths as a way to begin.
Firstly: the myth that everyone shares a definition of what constitutes “normal eating”
Next: the idea that in order to get over an eating disorder, all you need to do is eat normally
Then: the concept of food and body morality—or, the idea that some foods are good and some are bad, and that you can tell what someone is eating by looking at them.
Eating disorders are life ruiners. They are also extremely helpful illustrations of some of the broader problems that exist around how we talk about food and bodies in society in general. Thinking about eating disorders makes a person think about food, and bodies, and our social surround. And in my opinion, everyone benefits from an approach to food, bodies, nutrition, and movement in a way that rejects binaries and rigidity and embraces diversity, difference, and intuition. So let’s think about this.
I’d like to start by asking you all: what is normal eating?
Is it normal eating to track calories? How about food groups? How about macronutrients?
Is it normal eating to restrict whole food groups? Are there cases when this is normal?
Does normal eating look the same for everyone? Does normal eating change depending on the time of year?
Do you eat normally? Why or why not?
When you start to think about normal eating and peel back the layers of our relationships with food and body, we open up a whole can of worms. Doing this work, I can’t remember a time when I’ve mentioned my work and NOT been greeted with a comment along the lines of “I’ve struggled” or “I know someone who has struggled.” Another common response, which I feel more unsettled by, is a comment to the tune of “I have the opposite problem.” To truly support recovery and body tranquility, I’d like us to take a minute to unpack that relationship.
The main body and dietary concern of the day is what has been labelled the “obesity epidemic.” In the circles I run in, this language and approach is not popular. Bear with me for a moment; I know it can be hard to move away from that framing. Some popular organizations have taken to using what is called “person first” language for “obesity,” saying things like “person with obesity.” This aligns with the framing of “obesity” as a medical disease. The problem, though, is that a body size is not a disease. Calling a body size a disease holds all kinds of possible problems for people who live in bodies the size that is labelled diseased. This is a problem because we know that the stigma against people who have larger bodies is actually linked to very poor health outcomes. People who are larger face social disdain; they may be shamed when out and exercising, or else patronized by people telling them they are “doing a great job!” even when they have been exercising for a long time (Ragen Chastain writes about this brilliantly on her blog Dances with Fat). There are assumptions made about people in large bodies no matter what they do; when doing behaviours that are deemed to be “healthy,” like drinking a green juice, people assume this is something new for the person or that they are trying to lose weight. When doing behaviours that are deemed to be “unhealthy,” like eating a cheeseburger, people assume that the person’s diet consists of 90% cheeseburgers (again, I am not the first to comment on the challenge of eating in public in a larger body in the face of weight stigma; Stacy Bias wrote about the “Good Fatty” trope and other fat activists have drawn on this to explain the expectations we put on people in large bodies). There is no winning. The kind of stigma tossed at people in large bodies has real consequences on a health and social level. There is research that shows that people in large bodies are discriminated against everywhere from workplaces to the doctors office—and that this discrimination has negative effects (e.g Tomiyama at al., 2018; Bacon & Aphramor, 2011; Danielsdottir, O’Brien & Ciao, 2010). There is research that shows that health risks like cardiovascular disease are related to weight stigma through the route of increased stress hormones—cortisol—in the body (e.g. Pearl et al., 2017). People in the weight stigma field, including researchers and activists, are calling for a reconsideration of what is causing the most negative health impacts—the weight, or the stigma.
We are all exposed to negative and stigmatizing messages about larger bodies. Jokes about people in larger bodies exist everywhere from the locker room to the wedding shower to the Avengers movie screen. Another layer to add is that stigmas can be cumulative and layered; the daily aggressions faced by people in larger bodies can build up and live in relation to other daily aggressions around other aspects of a person’s life; daily racism, sexism, classism, ableism, and more. As people move through their lives in their bodies, there is a sense of being “on display,” and only some bodies are accepted as “healthy” and therefore “moral.” Even those who exist in privileged bodies are taught, often from a very early age, that they need to be on the lookout for “letting themselves go.”
Now, this is not a talk against engagement in health behaviours. I am not going to tell you not to eat vegetables (though “health” looks different for all, and there is no moral obligation to “be healthy”—but that is a whole other talk I could give). However, I do think it is important to distance those behaviours from what results they might have on the body. This sounds outlandish in relation to a lot of health messages, but you really cannot tell how healthy someone is based on what they look like. There are many more markers of health than body size.
Most of all, we can’t put “obesity” and “eating disorders” on opposite ends of a spectrum. They do not exist in binary. People of all sizes can be engaging in behaviours that are eating disordered—and people in larger bodies are not only, as people tend to assume, only bingeing. Increasingly, there is an awareness that binge eating disorder has an element of restriction involved in its enactment. Basically, what can happen is that a person restricts their food intake, perhaps because they’ve been told by a well-meaning friend or a doctor that they need to lose weight. Well, our bodies are equipped to protect us, and to make sure that we are getting enough food to live and function. So, at the end of a long day of restriction, what do you think will happen? People reach for whatever food they can find to fill that void. Bodies react; bodies respond. Bodies need, and they want.
Most of the research on eating disorders is still on anorexia. When we think about, and talk about, eating disorders, another thing that I’d argue we need to keep in mind is that—when we admit to ourselves—there is a part of us that is fascinated by the idea of restriction. I think this lies in relation to the culture around food and bodies I have described. Anorexia is highly dramatized in the popular imagination. It is treated as an object of fascination, because many cannot imagine restriction to the point of starvation. But importantly, anorexia is not purity, and binge eating disorder is not gluttony. Both are manifestations of an intricate dance between brain chemistry and cultural surround. And neither are easy to recover from in a world that doesn’t know up from down when it comes to food and exercise.
I mentioned before that what a person in a large body eats is scrutinized, a fact named by many activists in the sphere. So imagine: what if the person is also used to their eating being scrutinized, in the context of recovering from an eating disorder? In eating disorder treatment, people are called to essentially march in the opposite direction of diet culture and “anti-obesity” messages; a piece of chocolate cake might be on the menu and prescribed. In good eating disorder treatment—and I don’t have enough time to delve into eating disorder treatment which itself perpetuates weight stigma—there is room for people of all sizes to eat freely and develop a relationship with food outside of the scrupulous counting of calories and macronutrients desired in larger society. At the same time, eating disorder treatment often prescribes a kind of rigidity around food that can itself be hard to break out of. The transition from a highly supported eating disorder treatment system into the rest of the world can be an abrupt one: which messages about eating is a person in eating disorder recovery supposed to follow, especially if their body is no longer, or never was, small or emaciated? It is easier for many to encourage someone who is very small—who falls into that previously-described category of body-on-display, assumed to have anorexia—to eat a Dairy Queen blizzard than it is to encourage the same in a person who is in a large body—or even someone who looks like me. We are all told we are on the precipice of tumbling into ill-health by virtue of our body size and “poor health habits”. So why are we surprised that it is hard to recover from an eating disorder?
So, what can we do about this? How can we support eating disorder recovery, and how can we build positive relationships with our bodies?
It starts inside of us, as writer/activist/speakers like Sonya Renee Taylor make very clear. It starts by truly examining our own biases about size, about food, and about the link between these. When we become aware of our biases, we have a fighting chance against them. Overcoming body shame—and body shaming—is not just about pretending that you do not notice someone’s body size, or even what they are eating. In our world, we live in a visual culture that bombards us with glossy images of stylized and “indulgent” foods on Instagram, peppered with toned bodies that claim they have the next big diet and exercise secret—and really just have a very specific genotype that allows them to exist in a body that is revered as disciplined and pure. Navigating this mess is hard on a good day; for those who have a predisposition to assuming that their bodies are the problem and/or to develop eating disorders, it can create and excruciating dance between shame and blame. Many of these people will go their entire lives without having their eating distress validated as a “real concern,” living instead with the idea that they are only “good” when they are eating restrained.
If we want to get real about supporting eating disorder recovery, we need to get real about creating spaces for all bodies to be welcome. Because until we do that, we will only be half-heartedly pursuing recovery-oriented spaces. We need to recognize that we, as a society, aren’t very normal about eating. More than that, we need to make room for varied relationships with food. Ones that support cultural, personal, socioeconomic, ability-based, and other variations on what normal eating will look like. We need to build out food systems that do not generate food deserts or make cultural staple foods suddenly inaccessible when they become popularized. We need to talk to children about the value of foods beyond “good” and “bad,” “junk” and “healthy.” We need to stop talking badly about our bodies, because kids hear this. We need to make clothing that fits different bodies. We need to believe and trust people to take care of their bodies in a way that works for them, and make spaces that make this trust and care sustainable.
Ultimately, eating disorder recovery—and food and eating in general—is a social justice issue. This is true for many reasons, but among them that we’ve made recovery an impossible and inaccessible for so many people; through not recognizing eating disorders in anyone but the thinnest, the richest, the whitest, and the female, we are failing to provide support for everyone else. Our treatment systems and our broader worlds are designed with such a narrow population in mind that we forget that eating disorders are more than a fascination with skeletal thinness. And we forget that eating can be really, really hard. So let’s remember. Let’s remember, and let’s make space. It’s beyond time to move beyond revering kale above humanity.
References
Bacon, L. & Aphramor, L. (2011). Weight science: evaluating the evidence for a paradigm shift. Nutrition Journal, 10(1), 9.
Daníelsdóttir, S., O’Brien, K.S. & Ciao, A. (2010) Anti-fat prejudice reduction: A review of published studies. Obesity Facts, 3(1), 47-58
Pearl, R.L., Wadden, T.A. & Hopkins, C.M., et al. (2017). Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity. Obesity (Silver Spring), 25(2), 317-322.
Tomiyama, A.J., Carr, D., Granbert, E.M., et al. (2018). How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Medicine, 16, 123.
And countless fat activists, weight stigma scholars, and eating disorder researchers whose work inspires me every day.