Eating Disorder Recovery at Every Size

From our Friends at Within

Eating disorders are dangerous mental health conditions that require specialized treatment to overcome.

Unfortunately, there are many widespread misconceptions about these disorders, including that they only affect young, thin, white women. Eating disorders impact people of all ages, races, genders, and body shapes and sizes.

But just as people can struggle with these conditions at any size, so too can there be eating disorder recovery at every size.

Understanding eating disorders

Eating disorders may manifest in very physical ways, but at their core, they’re mental health conditions.

Each case is unique and developed through a complex combination and range of factors, but by and large, the disordered eating behaviors involved in these conditions arise as maladaptive coping mechanisms for stress and trauma. (1) Chronic low self-esteem has also been considered a nearly universal risk factor for developing eating disorders. (2)

Common eating disorders

The behaviors people develop to deal with these difficult feelings span a range. Some of the most common eating disorders include:

• Anorexia nervosa (AN): A restrictive type of eating disorder, AN involves the severe limitation of food intake, an extreme fear of gaining weight, a distorted body image, and a fixation on food, eating, and body image, among other telltale signs. It most commonly manifests as atypical anorexia nervosa (AAN), which happens when people have the mental health symptoms of AN, but are in an average or larger body or one that’s not traditionally considered “underweight.”
• Bulimia nervosa (BN): This disorder is powered by cycles. People with BN will engage in binge eating behavior—eating uncontrollably and consuming a large amount of food in a short time—then attempt to “make up” for these episodes with purging behaviors, including self-induced vomiting, excessive exercise, and fasting.
• Binge eating disorder (BED): Currently the most common eating disorder in the United States, BED also involves episodes of binge eating, but unlike those with bulimia nervosa, people with BED do not use compensatory behaviors to “make up” for these binges. However, restriction of food is still prevalent in this disorder as well. (3)

Many other eating disorders have also been identified, including different “types” of these three common disorders. Frequently, someone may be diagnosed with OSFED—or other specified feeding or eating disorder—which accounts for the many ways eating disorders can present beyond current diagnostic criteria.

What causes eating disorders?

There is no one cause of eating disorders. The conditions develop through a complex combination of biological, psychological, and environmental factors.

Aside from trauma, stress, and low self-esteem, eating disorder risk factors include: (4)

• Certain genetic traits
• Certain biological factors, such as changes in brain chemicals
• A family history of disordered eating
• A history of dieting
• Experiencing bullying, especially when targeted toward weight or appearance
• Struggling with other mental health issues, including anxiety, depression, and obsessive-compulsive disorder (OCD)

Some medical professionals may also inadvertently contribute to feelings of inadequacy or distorted body image. Some pediatricians “counsel” children about their body size, which results, in many cases, in a shaming experience. Other doctors may recommend specific diets or continually congratulate patients for losing weight, which can send the message that all patients should be striving to lose weight or achieve a certain body type.

Common misconceptions about eating disorders

Even as they’re thought to impact more than 28 million people, eating disorders are still widely misunderstood. (6)

People commonly believe these conditions are “just a phase” or that someone will “grow out of” these behaviors. Eating disorders are serious mental health conditions and generally do not get better on their own but often become more severe over time, making this a dangerous misunderstanding.

And again, eating disorders do not only impact one group of people as is commonly assumed. Reliable statistics can be difficult to find for several reasons, but some recent data suggests that different ethnic groups experience roughly the same amount of risk for developing eating disorders. (5)

Other studies show that males represent as much as 25% of people with eating disorders, with rates also high among transgender people. (6) And still, other studies have suggested that people in larger bodies are actually at the highest risk of developing eating disorders compared to people at lower weights. (6)

In fact, people in larger bodies may not only be at the highest risk but get diagnosed at lower rates due to weight stigma around eating disorders and body size.

What is Health at Every Size?

While misinformation about eating disorders is common and dangerous, there are groups working to spread more realistic ideas about these and related conditions, including the best ways to treat them.

Health at Every Size (HAES) was developed a countermovement. The advocacy group is working to move the world away from a weight-centric view of health and instead embrace the concept of health as holistic. That means giving equal attention to emotional and mental health and aspects of physical health beyond the number on the scale.

Viewing weight or body mass index (BMI) as the key, or even only indicator of health can help drive weight stigma and weight bias, even among medical professionals. (7) This sets up a series of false ideas, including that someone’s weight is their responsibility and that achieving a certain weight is the best or only solution for a number of ailments.

These ideas put undue pressure on someone to lose weight and can make someone feel like a failure if they can’t achieve that goal. This can fuel a preoccupation with intake, body, and worthiness. This, in turn, can lead to the development of disordered eating behaviors and possibly eating disorders. (7)

Rather than fixating on weight or BMI, HAES promotes overall well-being. Hunger, satiety, nutrition, and movement needs are all specific to the individual and can even change in the same person over time and circumstances. Instead of prescribed treatments, HAES asks people to focus on joyful movement and intuitive eating and urges healthcare workers to likewise broaden their concepts of health and well-being. (8)

Rejecting the “thin ideal” and weight stigma

Hand-in-hand with weight stigma and discrimination is the “thin ideal,” or the concept that thin or lean bodies are more attractive or healthy.

The concept has long been problematic on a cultural level, contributing in countless ways to bullying, low self-esteem, toxic diet culture, and other issues that can lead to disordered eating behaviors. The “thin ideal” has even bled into the healthcare world, where it can represent even more danger.

Studies have shown that many in the medical field have internalized ideas associated with the “thin ideal” and diet culture, mistakenly viewing patients in larger bodies as less self-disciplined and more annoying. (9) These same reports had doctors saying they felt less desire to help larger patients than those in thinner bodies. (9)

While it’s impossible to measure or prove scientifically, it may be that these types of biased thoughts contribute to the weight-centric medical view held by so many physicians and account for so many medical recommendations to lose weight, even if there’s no other indication that someone’s weight is negatively affecting their health, which is typically the case. If those in larger bodies are perceived negatively and as less deserving of help and even receive more hostile care and less support, it’s fair to suggest this will contribute to a poorer outcome for these individuals.

The “thin ideal” and weight stigma can have a devastating impact on a societal and personal level. But there are ways to move beyond this way of thinking, which may be especially helpful for those in eating disorder recovery.

Body acceptance and self-compassion in recovery

Recovering from an eating disorder is hardly ever a straight path. The journey is filled with ups and downs, many of which come from the physical and mental changes that take place during recovery.

One way to help make the process smoother is adopting the view of “body neutrality.” Just as HAES de-emphasizes weight as a measure of health, body neutrality decouples how a body looks from its worth. Instead, body neutrality asks people to consider what their body can do for them and see it simply as a physical vessel and only one part of who they are. (10)

Another way to get through the complex parts of recovery is to actively cultivate self-love and self-acceptance. This can be done in several ways, including:

• Reciting positive mantras
• Building—or relying on—a strong support system
• Pursuing hobbies that make you feel good and align with your goals
• Taking a break from social media
• Practicing gratitude for all that the body allows you to do and experience
• Participating in joyful movement by exploring which ways the body enjoys moving

Eating disorder professionals will likely have other, more specific suggestions for practicing body acceptance and self-love during eating disorder recovery. It’s important those in recovery keep in touch with their team as they move through the healing journey, especially when having trouble feeling positive about progress.

Support and resources for recovery at every size

Finding the right kind of support—and the right treatment team—is another important way to promote eating disorder recovery at any size.

While researching treatment programs, look specifically for healthcare providers who embrace HAES principles as a marker of physicians or programs with a broader sense of health and well-being. This can be helpful when looking for therapists, dieticians, and other professionals who may support your journey.

A strong support network is another way to make recovery easier and more achievable at any size. Finding support groups, whether in person or online, that share body-neutral or body-positive views can be a big help, giving you a community of like-minded individuals who can help raise you up, even on the hard days.

But the most important thing about eating disorder recovery is not to give up hope. The journey may have ups and downs, but recovery is always possible.

Resources

1. Ball, K., Lee, C. (1998). Relationships between psychological stress, coping and disordered eating: A review. Psychology & Health, 14(6), 2000.
2. Colmsee, I. O., Hank, P., Bosnjak, M. (2021, February 4). Low Self-Esteem as a Risk Factor for Eating Disorders. Hotspots in Psychology, 229(1).
3. Definition & Facts for Binge Eating Disorder. (n.d.) National Institute of Diabetes and Digestive and Kidney Diseases. Accessed April 2024.
4. Eating Disorders. (n.d.) Mayo Clinic. Accessed April 2024.
5. Cheng, Z. H., Perko, V. L., Fuller-Marashi, L., Gau, J. M., & Stice, E. (2019). Ethnic differences in eating disorder prevalence, risk factors, and predictive effects of risk factors among young women. Eating Behaviors, 32, 23–30.
6. Eating Disorder Statistics. (n.d.) National Association of Anorexia Nervosa and Associated Disorders. Accessed April 2024.
7. Penney, T. L., & Kirk, S. F. (2015). The Health at Every Size paradigm and obesity: missing empirical evidence may help push the reframing obesity debate forward. American Journal of Public Health, 105(5), e38–e42.
8. About Health at Every Size® (HAES). (2020). Association for Size Diversity and Health. Accessed April 2024.
9. Puhl, R., Brownell, K. (2006). Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity, 14(10), 1802-1815.
10. Sreenivas, S. (2023, January 30). What Is Body Neutrality? WebMD. Accessed April 2024.