Weight Bias and its Role in Binge Eating Disorder Experience

by Lizabeth Wesely-Casella

Lizabeth Wesely-Casella

One of the cultural intersections people with obesity have with many in the binge eating disorder (BED) community is the painful, often traumatic, experience of people acting on weight bias. For those in large bodies, comments, jokes, exclusion, discrimination, humiliation, and even violence are not unusual occurrences and may even happen on a daily basis. Weight bias is unacceptable behavior that runs the spectrum from socially condoned to blatantly unlawful but there is an increasing awareness surrounding the very real harm it causes.

B.E.D. is a non-compensatory eating disorder meaning, the individual does not engage in behavior such as purging or over-exercising to mitigate the binge. B.E.D. is the most common eating disorder in the United States affecting an estimated 3.5 percent of women, 2 percent of men, and 30 percent to 40 percent of those seeking weight-loss treatments can be clinically diagnosed with B.E.D. The disorder impacts people of all races, levels of education and income; including adults, adolescents, and children.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) edited by the American Psychiatric Association, the characteristics of B.E.D. include:

      • Recurrent episodes of binge eating occurring at least once a week for three months
      • Eating a larger amount of food than normal during a short time frame (any two-hour period)
      • Lack of control over eating during the binge episode (feeling you can’t stop eating or control what or how much you are eating)

These binges are followed by feelings of severe guilt, shame, isolation and often severe restrictive dieting and starvation.

Because people with B.E.D. don’t compensate for the binge, a majority of those who suffer gain weight and live in larger bodies. In turn, those people suffer weight stigma at the same rates as other people who, for whatever reason, are also large in size.

Nobody enjoys being stigmatized. Being made fun of and experiencing overt expressions of disapproval are as discomforting as having to ask for accommodations due to size and shape in a public setting. Stigmatization happens both intentionally and by accident and so it contributes to a belief system that says, “I deserve this because I’m not good enough. And I am not good enough because my body is bad.”

When a person holds this type of belief system, it is a Herculean effort to build self-confidence and self esteem and for those with B.E.D. it’s even harder because there is an additional layer of shame involved due to the disorder itself. For a person with B.E.D., they may see themselves as deserving the abuse twice – once for being large and once for having a mental health condition.

Because self worth is such a critical piece of the puzzle with eating disorders, often times a person with B.E.D. suffers from feelings of body shame and self-loathing prior to experiencing any external messages about their appearance. A person with B.E.D., even in a thin body, may have an inner dialog that says to them they aren’t good enough and their body is unacceptable and they don’t deserve things like a good job, a good meal, good friends, love, compassion or joy. A person so self-conscious and unable to accept their whole person is likely buy into the narrative that they are worthless and worth less than a person in a thin body.

These messages can lead to depression, anxiety, poor self-care and even self-harm. A person with B.E.D. will often starve and restrict, go on diet after diet, to chase a body size or shape just to be acceptable enough to simply be left alone (a far cry from the idea of being glorified).   This behavior and the anxiety that accompanies it, only set the person with B.E.D. up for another binge which translates to another failure, which reinforces the negative messages and beliefs.

What many in our culture don’t realize is that weight bias and stigmatizing actions are preventable. The fat joke isn’t funny; the unsolicited comment isn’t helpful; the decision to hire the “more fit” candidate isn’t sound business, and in 1 state (Michigan), firing, censuring or passing over an employee due to size or weight is breaking the law.

Here are a few interesting facts about weight bias and weight stigma that apply to anyone:

      • Family members are often reported as the most frequent sources of weight bias. – Rudd Center on Food Policy & Obesity
      • The likelihood of being bullied is 63 percent higher for a child affected by obesity compared to a thinner peer. – Rebecca Puhl, PhD
      • Because of the fear of being the “fat kid” hospitalizations for eating disorders in kids under 10 are on the rise – this includes B.E.D. – American Academy of Pediatrics (AAP)
      • Weight-based discrimination has been shown to lead to…Depression
        • Poorer body image & self-esteem
        • Decreased education/work outcomes
        • Suicidal ideation

-          Dr. Janet Latner

      • Weight-related teasing in adolescents is associated with:
        • lower self-esteem
        • depression
        • suicidal ideation in victims

-          Dianne Neumark-Sztainer,PhD

      • Children as young as 3 have internalized anti-fat attitudes. – Jennifer A. Harriger

Whether you have B.E.D. or you find yourself the target of weight bias for any other reason, you must understand that it is NEVER acceptable or deserved.

If you have concerns about the treatment you receive at work, at the doctor’s office, within your community or at school, there are resources to help you address the situation.  Many organizations have tools and information to assist you, including the Obesity Action Coalition’s Weight Bias and Stigma page and the Binge Eating Disorder Association’s Toolkits for both individuals and providers.

If you have additional questions about B.E.D., treatment, resources or communities, please visit the Binge Eating Disorder Association (BEDA) website at www.bedaonline.com.

About the Author:
Lizabeth Wesely-Casella is a weight stigma prevention advocate and a binge eating disorder (BED) expert. She works in Washington, DC as a coalition builder and speaker addressing the impact of size discrimination on communities and industry and the profound effect that weightism has on individuals with eating disorders, especially BED. 

As a speaker, Lizabeth blends science, humor, and cultural wisdom to engage her audience, creating a clear understanding of the disconnect between health and body shape and underscoring that shape and size do not reflect personal value or character.  She also connects the dots between weight discrimination as a civil rights issue and the negative consequences to our economy, education, and workforce.

Lizabeth’s advocacy has afforded her opportunities to speak in the Senate, on film, and in radio. Her advocacy work has positively influenced program design from college campuses to the White House including the Let’s Move! initiative. Lizabeth lives in Washington DC with her loving husband and delightfully spoiled dog Noodle. 

Disclaimer: This blog post does not reflect the views of the OAC, the National Board of Directors or staff. The OAC does not endorse or support any merchandise, program or hyperlink mentioned in this blog post.

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