Recently, greater attention has been given to the diversity of individuals afflicted by disordered eating – historically associated with young, white women of privilege, characterized by extreme thinness and restrictive behaviors. Fortunately, this misconception is garnering greater attention in the media and scholarly publications. A recent article by Alexis Conason, PsyD in Psychology Today, sheds light on the “hidden faces of eating disorders” and how those who are actually at higher weights often go undiagnosed, or rather, labeled as simply overweight and prescribed to diet, which actually perpetuates the problem. Perhaps the reality is that the problem is disordered eating and the solution that is posed (weight loss through dieting) only leads to further disordered behaviors around food and eating.

Conason sites two studies that found that overweight or obese subjects were under-diagnosed for eating disorders and were actually at greater risk than their normal weight or underweight peers for developing eating disorders. A 2017 study by Lispon and Sonneville examined 9,713 college students and found that body weight was the most consistent predictor of eating disorder symptoms. Specifically, it was the students with a BMI in the “overweight” or “obese” range that were at the highest risk and those with a BMI in the “underweight” range were surprisingly at the lowest risk.  Therefore, adolescents in the overweight or obese range who exhibited eating disorder symptoms were “not only under-diagnosed, but symptoms were actually encouraged by medical professionals who congratulated these patients for losing weight.”

A similar study by Lebow and Billings found that overweight and obese adolescents are in fact at risk for eating disorders, and that “patients with a weight history in the overweight or obese range represent a substantial portion of patients presenting for eating disorder treatment.” Furthermore, due to their weight status and history, it takes significantly longer for these patients to be diagnosed with an eating disorder than patients without a history of overweight or obesity. More often than not, these adolescents were not diagnosed with eating disorders, but were instead encouraged to keep up the “good work” in their attempts at dieting and weight loss and encouraged to continue such behaviors. This ineffective approach is also damaging to the psychological perspectives around body image, food and importance of proper nutrition.

This article goes on to pinpoint precisely why those at higher weights may be at higher risk for eating disorders:

  • First and foremost, it cannot be denied that we live in a culture that villainizes “fat”. Inhabiting a large body is seen as a moral failing.
  • Overweight people face the scorn of society and are open targets for discrimination and bigotry.
  • Conversely, overweight people are often shunned and overlooked by society.
  • Eating disorder prevention and intervention efforts are often targeted at people in the “underweight” range while people categorized as “overweight” or “obese” are targeted for weight loss interventions (which often consist of dieting and restrictive behaviors, rather than behavioral lifestyle changes).
  • Overweight people are told to diet, even though dieting is one of the strongest predictors for both the development of eating disorders and further weight gain. It is well-established that weight loss efforts start with dieting or “healthy eating,” and can give way to disordered eating.

Here, at Behavioral Nutrition, we strongly believe that it is about time medical professionals stop promoting and “prescribing” the same damaging behaviors to people at higher weights, that we attempt to treat for those at lower weights who exhibit eating disorder symptoms. As Conason clearly states, “food restriction, purging food (either through laxative use, self-induced vomiting, or exercising to compensate for calories consumed), viewing foods as “good” or “bad,” and defining our self-worth based on the numbers on the scale are unhealthy at any weight.” Eating disorders do not discriminate and as research efforts and awareness grow, we now know that they affect people of every age, race, gender and socio-economic status. It is time to realize that eating disorders affect us all!

Read more at: The Hidden Faces of Eating Disorders: Why people at higher weights go undiagnosed by Alexis Conason Psy.D. Alexis Conason Psy.D. Posted Feb 10, 2017 – https://www.psychologytoday.com/blog/eating-mindfully/201702/the-hidden-faces-eating-disorders