by Andrea LaMarre
I am an eternal optimist. Despite all evidence to the contrary, I do believe that people in general hold at the heart of their various opinions a desire to help those in need and to share their expertise in a way that will benefit others. That I am an optimist may surprise those who follow me on social media, where I regularly engage in critique of dominant models of thinking about health in particular; in these spaces, I refer to myself as a “squeaky wheel,” ever discontented with the status quo, especially where talk about bodies is concerned. I think it is important to critique, but also to be generous and creative in our critique – to push ourselves to not only identify the issues with how we are treating topics, but also productive alternative ways of thinking. By identifying spaces of tension, I aim to open up space for us to both individually and collectively think about how we can do better – how we can be more open, more welcoming, and more thoroughly centering of difference.
By virtue of my privileges, including my academic access and (possibly temporary) economic advantage, I am able to attend a number of conferences each year and bring my critique and creativity offline. I recently attended the 3rd Annual International Weight Stigma Conference in Vancouver and the International Conference on Eating Disorders in San Francisco. Both conferences offer us the opportunity to think about the status quo related to how we think about, talk about, and interact with bodies of various shapes and sizes. Both conferences, if we engage with their subject matter to the fullest extent, offer us the opportunity to reconsider whose expertise counts, how we configure systems designed to minimize bodily distress, and how to better engage those who have been – and continue to be – marginalized.
I might best comment on these two conferences as complimentary – but starkly different – spaces of engagement. The Weight Stigma Conference (WSC) is a small gathering of international colleagues from professions that vary from psychology to law to dietetics. Most attendees adopt a Health at Every Size® informed approach, and the majority of the presentations feature at least a cursory nod to ideas familiar to those who take a social justice lens in their practice. These concepts include intersectionality, the acknowledgment that people’s spaces of belonging interact and combine in ways that render their experiences of marginalization and/or privilege complex as they shape their lives. Another important consideration is privilege, or the concept of how power circulates in our society in such a way that leads to some people having an easier time navigating their social worlds. They also urge us to consider the role of stigma, or the undue calling out of some attribute as worth of shame and disapproval.
Presentations at the 3rd annual WSC focused on how to move our reflections about weight stigma, and the negative impact it has on people’s health, into action. Presenters discussed theoretical frameworks that might help us learn from other types of stigma as we address weight stigma. Some presenters, including keynote Kevin Lindsey, explored the benefits and problematics around obtaining protected class status for body size discrimination. Others, like Lauren Munro, highlighted how we might consider weight stigma through the lens of microaggressions, or “brief, everyday exchanges that send denigrating messages to certain individuals because of their group membership” (Sue, 2010, p. xvi). Jolanda Jetten, another keynote presenter, offered a perspective on why weight stigma is so tenacious, noting how society tends to position weight as controllable and thus a matter of personal fault.
Presentations made evident the ways in which the subtle workings of weight stigma in society, and how weight stigma compounds with other spaces of marginalization to create and entrench oppressions. Even the way we define and measure weight stigma may itself contribute to problematic perspectives on the phenomenon. Patricia Cain presented a compelling talk about her work to create a new quantitative measure for weight stigma; in her talk, she noted how existing scales are rife with assumptions about the survey-taker not themselves identifying as fat, reproduce language that is stigmatizing, and reinforce that belief about the controllability of weight. Another theme that emerged from the conference around the tenacity and subtle workings of weight stigma was that many larger organizations that speak the language of reducing weight stigma simultaneously call for the elimination of fat bodies; that is, they argue for reducing weight stigma because it is not an effective way of promoting weight loss (which remains their central goal). As Marilyn Wann noted in her keynote talk, “there is no non-stigmatizing way of being anti-obesity.” When weight remains the dominant marker of health, talk about reducing weight stigma falls flat and ineffective.
Weight stigma, of course, also combines with other spaces of marginalization to make people’s lives more challenging. Navigating this world in a body marked for its non-belonging, whether that is by gender, race, class, sexuality, ability, or other spaces of belonging, is not made any easier by perspectives that present health as something that is an individual responsibility. When we ask people to become more resilient by shouting to the rooftops about their body love without also aiming for changes at a broader systems level, we risk body positivity being co-opted, twisted, and turned against those who are told their bodies do not, and never will, fit. In order to ensure that body positivity becomes as tenacious as weight stigma has been, we need to be pushing policy makers for funding for social support for marginalized folks, advocating for treatment for bodily distress that is not only financially and physically accessible but also culturally and individually appropriate, and calling out how our capitalist, neoliberal society expects of us impossible feats of striving and productivity.
So where does this change begin? One might look for the impetus of change within communities ostensibly designed to support people experiencing distress in their bodies and/or around food and/or exercise. This is where the WSC intersects with the International Conference on Eating Disorders (ICED). ICED is a large, interprofessional gathering hosted every year by the Academy for Eating Disorders (AED); it is designed to be a space to share research and clinical knowledge about eating disorders. In my opinion, this space would ideally be one in which we support each other to study and treat eating disorders and bodily distress, honour people’s lived experiences, and dialogue between researchers and clinicians to push ourselves to consider how we can collectively do better to be more inclusive and helpful in our research and practice. Indeed, much of the focus of ICED is bridging the research-practice gap.
What I’ve observed, however, is more than a research-practice gap around eating disorders – I’ve been referring to what I’m working through in the aftermath of the conference as the “research-practice-lived experience gap.” This is in no way to denigrate the AED for the conference; in many ways, the conference achieved its goals of advancing knowledge around eating disorders and building community. The sessions certainly encouraged me – and like others – to consider how we might do things differently as a field to better attend to the needs of diverse folks with eating disorders. Perhaps more than ever, I found a social justice oriented community at ICED who were willing to ask the “tough questions” about eating disorders – including “who is not at the table?”
Approaching eating disorders as a social justice issue means centering lived experiences. It means acknowledging how stigma – including weight stigma – lives not just on the periphery of our research and treatment communities, but also pervades these spaces in subtle and harmful ways. The way that we ask research questions, the way we recruit for research studies, the types of treatments deemed evidence-based, and the perspectives on recovery we share with clients or participants are informed by our own spaces of belonging and what we believe to be true about eating disorders on a theoretical level.
A great example of how asking critical questions about eating disorders can present us with ways of filling not only the research-practice gap but the lived experience gap as well is the social justice plenary at ICED, a session that will stick with me for some time. Chaired by Theresa Fassihi and Chevese Turner, with panelists Ilan Meyer, Marcella M Raimondo, and Sigrún Daníelsdóttir as well as discussant Deb Burgard, the panel invited us all to think about how we need to do better in our recognition of and meaningful engagement with diversity amongst those with eating disorders.
There are a number of steadfast stereotypes about eating disorders that we can’t seem to shake and that impact who seeks and receives treatment for their distress. Contrary to popular belief, clinicians are not immune to stereotypes and stigmatizing attitudes; these are embedded in the very instruments we use to diagnose eating disorders, as well as some of the evidence bases we draw upon in treating them. When people do not fit the “told” story of the eating disorder – read, the thin, young, cisgender, heterosexual, middle class, white girl imagined as being unduly influenced by media ideals – their stories are dismissed out of hand, or their experiences relegated to the stuff of one-off case studies (not often taken seriously in terms of building an evidence base for treatment).
This is a major problem for reasons obvious and subtle. On the more obvious face of things, as panelists pointed out, early intervention for eating disorders is critical. If, as Raimondo pointed out, 90% of gender non-conforming folks report barriers to care, and 27% report having been refused care, how well are we serving diverse people? Our presumptions of immunity to restrictive eating disorders for people in larger bodies, LGBTQ+ folks, racialized people, older individuals and men are only some of the problematic social imagination around eating disorders that are not only untrue but that significantly impact people’s ability to access treatment. Other barriers panelists highlighted included legal obstacles, difficulty obtaining insurance coverage, strained financial resources, language barriers, and cultural stigma around mental illness and help seeking.
Perhaps less self-evidently, once those who are marginalized obtain diagnosis and treatment, there is little guarantee that the treatment will be appropriate for them. Treatments built for those who do fit the stereotype may fall flat for those who do not. For instance, a great deal of treatment is designed to address body image and the thin ideal, presuming that people with eating disorders have bought into a thin ideal in the interest of being more attractive, socially. But what if the pursuit of thinness is being used to protect oneself from further marginalization when already oppressed? What if a major contributor to the eating disorder is the significant prejudice people face simply from living in their bodies in this racist, classist, sexist, ableist, and otherwise inequitable world?
It was also clear from this panel and from several other conference sessions that weight stigma and other types of stereotyping are present within the eating disorder field. Given that recovery studies still often define eating disorder as between a BMI of 20 and 24 and that the messaging around recovery tends to be “gain weight, but not too much weight,” I think it is worth thinking about how we might start at home in addressing stigma. We might think about who we are rendering unrecoverable by maintaining damaging stereotypes about who gets eating disorders – and what recovery might look like for them.
I left the conferences feeling emotionally and physically spent, and yet galvanized around the potential for change. Harnessing the energy of those interested in pursuing social justice in the eating disorders and weight stigma fields, I offer several next steps that I hope we might take together:
- Listen to people’s stories and believe them, no matter how well they jive with your own experiences. One story is considered an anecdote, but many stories have the power to make our understandings more complex and complete.
- Having said that, avoid tokenizing those who occupy socially marginalized spaces – it is not always safe for these folks to publicly share their stories. Offer space, but don’t impose the “you must tell me!” imperative.
- Think critically about which instruments are being used to diagnose eating disorders and those being used to assess the presence of weight stigma. Language matters, and these questionnaires were not created in a social vacuum. They are provisional measures for marking potential spaces of intervention, not truths that are fixed and objective forever.
- Lobby for policy changes and funding that support a broader array of treatments for eating disorders and distress in bodies; systemic change is not possible without political will and funding.
- Work simultaneously for body love and systems change – “love your body” is a wonderful, well-meant sentiment; but, it falls short and may leave people behind if they are told that their bodies are not human, not welcome, and not valued. We need nothing less than a paradigm shift.
Sue, D.W. (2010). Microaggressions in everyday life: Race, gender, and sexual orientation. Hoboken, NJ: Wiley.
Andrea LaMarre, MSc. is a PhD candidate and Vanier Doctoral Scholar (CIHR) in Family Relations and Human Development at the University of Guelph in Canada. In her work, she takes a critical feminist and social justice informed approach to exploring eating disorder recovery. She is also an eating disorder activist and blogs at Science of Eating Disorders.
Email: firstname.lastname@example.org Twitter: @andrealala