Weight stigma is pervasive in the eating-disorder-treatment world. Addressing weight stigma is essential for lasting recovery.

Eating disorders don’t have a certain body type, and bulimia nervosa is no exception. Though we often think of small, emaciated young girls when we conjure up an image of someone struggling with an eating disorder, this is most often not the reality of those experiencing these conditions. In fact, it is much more likely that someone struggling with bulimia will be in an “average” sized or larger sized body.

If being emaciated isn’t a precursor for struggling with bulimia nervosa, then why is there such a focus on weight within treatment facilities? The eating disorder treatment environment is one rife with weight stigma, and as a result, this weight stigma finds its way into treatment. This can show up in various ways, including setting weight restoration goals too low or even including a weight-loss element within a treatment plan.

Those struggling with bulimia are especially at risk for these weight-stigmatizing experiences in treatment, partially because they are more likely to be in a larger body that some would regard as requiring intervention, and partially because the binge component of bulimia terrifies many fatphobic treatment providers. They fear that through healing someone’s purging or compensatory behaviors, they will actually have a hand in harming them through weight gain. This perception of bulimia recovery, however, is rooted in weight stigma and does absolutely nothing to help an individual struggling with the disorder.

Instead, it is essential that those attempting to recover from bulimia, and from any eating disorder for that matter, do so with a team dedicated to Health at Every Size ® (HAES), a healing modality that focuses on health behaviors outside of weight and believes strongly in advocating for people of all sizes to pursue the health goals that feel best for them.

A Health at Every Size ® approach to eating disorder recovery also interrogates any attempts that clinicians make at keeping someone’s recovering body from gaining “too much” weight. This statement in and of itself is fatphobic. When recovering, the body needs to obtain as much nourishment as possible. Often, this results in weight gain. By setting an upper threshold on what someone in recovery is supposed to weigh, eating disorder clinicians play right into the disorder and reaffirm their client’s fears around weight gain and becoming “too” large.

Instead, focus should be placed on how the client feels in their body, what fears they may have about weight gain, what those fears are truly about (often these fears are fed by the desire to be loved, accepted, and seen by those around the person struggling with the eating disorder), and why those fears are likely unwarranted. Re-nourishment is something that takes time, and something that should be guided by the client, not by ambiguous BMI growth charts.

A Health at Every Size ® approach to eating disorder recovery also encourages an individual experiencing  an eating disorder to learn more about diet culture, the “thin ideal,” and the sociological and cultural context in which we live that so often stokes the fire of a propensity for eating disorder development. This is essential for someone struggling with bulimia, as there are likely to be many thoughts running around in their head about what foods are “good” and “bad,” or why they should feel ashamed about their bingeing behavior.

To put it simply, we live in diet culture, which means that many of us implicitly favor thin bodies over larger ones. We also associate eating past fullness with weight gain, despite the fact that this is flawed logic, and associate weight gain and fatness with gluttony, laziness, greed, and more. None of this sounds very good, does it? For someone struggling with bulimia, every single binge is mired by these self-hating thoughts that very much have their origin in diet culture and the ways our society view food and our bodies. This shame spiral, accompanied at times by physical discomfort, is often what propels someone to engage in purging or compensatory behaviors. When we interrogate and dismantle diet culture and weight stigma, we remove a lot of the negative messaging that drives this behavior in the first place.

Though there is much to unpack and uncover in everyone’s personal recovery journey related to diet culture and weight stigma, this does not mean that recovery is out of reach. Recovering from bulimia nervosa can be a long process and one that often requires the support of the right clinicians, but it is very much possible. By making sure that your care team acknowledges and tackles the sociological and cultural elements of the eating disorder, we can better help guide you away from disorder and towards healing.

About the Author
Ashley M. Seruya is a social work student, virtual assistant, and content creator specializing in eating disorder recovery, Health at Every Size, and weight stigma. Learn more about her work at ashleymseruya.com or on her Instagram at @cozibae.