Weight Stigma and Binge Eating: What’s the Connection?
Karina, a 42-year-old obese woman, put off her annual doctor’s appointment again. The reason for her reluctance? Karina fears her doctor’s judgments and admonitions about her weight. Several years back, her doctor read her the riot act about her weight and since that visit, Karina’s weight has climbed even more.
Karina is not alone. Research indicates that higher weight individuals report experiencing weight stigma and negative stereotypes across a variety of situations and at the hands of family members, friends, doctors, bosses, teachers, and often, strangers.
Last month marked the second annual Weight Stigma Awareness Week. The annual event, hosted by the Binge Eating Disorder Association (BEDA), seeks to raise awareness around weight bias and offers tools for addressing weight discrimination in various settings, including schools and doctors offices. This year’s event was replete with contributions from diverse voices in the weight stigma community, and their messages trended powerfully online.
According to BEDA, biased behaviors include “bullying, hate-speech, and exclusions that limit the ability of a person to gain employment, healthcare, and education.”
BEDA defines weight bias as “judgment or stereotyping based on one’s weight, shape and/or size.” According to BEDA, biased behaviors include “bullying, hate-speech, and exclusions that limit the ability of a person to gain employment, healthcare, and education.” Weight bias is an unfortunate byproduct suffered by many who struggle with binge eating disorder (BED). BED, now a standalone DSM-5 disorder, affects approximately 2 percent of men and 3.5 percent of women. The majority of those with BED are overweight or obese.
Unlike their counterparts who struggle with bulimia nervosa, those with BED do not engage in any compensatory behaviors following binge episodes, such as vomiting, over-exercising, or restricting their intake. The result, for many, is weight gain over time. The DSM-5 notes that BED is more common in individuals pursuing weight-loss treatment than in the general public (APA, 2013).
The experience of weight stigma can contribute to the ongoing presentation of the BED. As with any psychiatric disorder, symptoms can intensify during times of emotional and situational stress. Encountering discriminatory and prejudicial comments, gazes, and practices can contribute to the emotional unrest that triggers a binge episode. So, while the public may criticize those at higher weights in an attempt to bully them into smaller sizes, these efforts often backfire. One study of 2,400 overweight and obese adults found that 79 percent responded to weight bias by eating more.
And thus the cycle continues…
The media presents significant information about the health consequences of being overweight. What it fails to do, though, is parse out the impact that weight discrimination has on patients’ physical health. In addition to increasing binge eating, weight bias can cause negative health outcomes through various pathways. First, higher-weight individuals may avoid doctor appointments due to fear of disrespect from their healthcare providers or shame around being weighed. Large bodies may not be adequately accommodated with respect to certain medical equipment, such as blood pressure cuffs, exam tables, and CT/MRI scans.
Additionally, research has shown that the experience of weight stigma is correlated with reduced exercise motivation, resulting in decreased fitness as a function of stigma and body dissatisfaction. Finally, experiencing stigma and prejudice can result in a chronic, elevated stress response, negatively impacting physical and mental health.
…research has shown that the experience of weight stigma is correlated with reduced exercise motivation, resulting in decreased fitness…
Weight bias can also impact those who don’t meet full criteria for BED. Many individuals, fearing judgments and bias around weight, have internalized their own weight stigma. They are preoccupied with their bodies and may engage in disordered eating in an attempt to manage their weight. Some may fall prey to the diet-binge cycle, in which they attempt to lose weight by dieting, only to gain it back by compensatory overeating. They may be searching for the latest fix – low-carb, gluten-free, low-fat, cleanses, juicing – whatever they believe might help them to control their weight. Some develop problems with compulsive exercise. Many others spend the majority of their lives with the nagging feeling that their bodies simply aren’t right.
So, what can you do to fight weight bias?
- Adopt a Heath at Every Size® (HAES) approach, focusing on health, rather than weight. Learn to eat and exercise intuitively and to respect your body’s natural size – along with body diversity in the community.
- If you struggle with BED, get help that allows you to address the behavioral aspects of the disorder without condemning you for your weight. Choose your providers carefully, as even health providers can be weight-biased. Ensure they, too, are proficient in the principles of HAES.
- Become an activist, even if you aren’t heavy. As Isabel Foxen Duke writes, “When we fight for ‘fat acceptance,’ we fight for our sanity around food and weight, regardless of whether or not we ‘qualify’ as ‘fat.’”
American Psychiatric Association: Diagnostic and statistical manual of mental disorders, 5th edition. Arlington, VA: American Psychiatric Association, 2013.
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