Symptom Mismanagement: Eating Disorders Awareness Part 3

Full disclosure: talking about weight can be as uncomfortable as discussing religion and politics at a dinner party.

Welcome back.  If you are just joining the conversation make sure you check out article one and two of this three part series aimed to support our online community during National Eating Disorders Awareness Week (NEDAwareness Week). It would be amiss to discuss risk factors, warning signs, and symptoms but not address the elephant in the room— weight and symptom management.  

If anything in this article feels triggering please discuss it with your dietitian, counselor, and/or medical provider.  

Our culture is inundated with messages about weight, so much so that the term “thin ideal” was coined well over 20 years ago.  Thin Ideal refers to the celebration and idealization of a thin body.  Thin-ideal internalization refers to the degree of which an individual cognitively believes in the thin ideal and engages in behaviors to achieve it (Int J Eat Disord, 2018). 

It is important to understand the thin ideal as a social construct so that you can recognize what it is not—synonymous with health.  

Our culture has intertwined body weight, aesthetic, and health, through BMI and other constructs, in a way that is oppressive and harmful.  Which is why thin ideal internalization is a risk factor for eating disorders. 

The premise that dieting and over exercising for weight loss is the cure to most symptoms is wrong.  In fact these behaviors can INCREASE stress, weight, and risk for disease such as eating disorders, depression, and metabolic syndrome.  

Experts have estimated that around 80% of people who lose weight gain it back (Am J Clin Nutr, 2005). Losing weight and gaining it back multiple times is known as “weight cycling” and is linked to many diseases, including some gastrointestinal disorders. 

Weight cycling is NOT about willpower. That's right. Gaining weight back after a diet is not a weakness on the dieters part, but a biological message that diets don’t work.

Thin idealization and weight cycling do more harm than good and being in a small body is not equivalent to healthy. So, what do we do- throw in the towel? NEVER! We just need to look at things from a different angle, create cognitive dissonance between thin ideal/weight, aesthetic and health. 

The Association of Size Diversity and Health suggest the The Health At Every Size® (HAES®) approach, describing it as “a continuously evolving alternative to the weight-centered approach to treating clients and patients of all sizes. 

It is also a movement working to promote size-acceptance, to end weight discrimination, and to lessen the cultural obsession with weight loss and thinness. The HAES approach promotes “balanced eating, life-enhancing physical activity, and respect for the diversity of body shapes and sizes”.  Does this sound great in theory but difficult to apply to your daily life? 

Get started by reviewing the HAES principles and making small changes each day! 

Health at Every Size Principles®

WEIGHT INCLUSIVITY

Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.

HEALTH ENHANCEMENT

Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional and other needs.

EATING FOR WELL-BEING

Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.

RESPECTFUL CARE

Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socioeconomic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.

LIFE-ENHANCING MOVEMENT

Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

If you or someone you know may be suffering from disordered eating behaviors, find a local eating disorder professional in your area for further evaluation.

The National Eating Disorder Helpline has a number of resources to help.