Weight Stigma in Eating Disorder Treatment

How weight stigma impacts care and what to do about it

An overemphasis on weight in healthcare and in the treatment of eating disorders can have counterproductive effects. In fact, this weight focus may hinder recovery or even encourage disordered eating patterns, especially for individuals in a larger body size.  

As a Registered Dietitian and Certified Counsellor working in the field of eating disorders, I am constantly reminded of just how big the concept of weight is in the treatment of eating disorders. A person would think that especially in this world, the understanding of weight and the many influences impacting a person’s weight would be greater. Unfortunately, the stereotype of eating disorders is that the illness is only serious when a person is significantly underweight.  

This is incorrect. And our care system doesn’t manage the discussion of weight in receiving treatment well.  

While weight is one factor that may be used in assessing for severity of the illness, there are many other factors that are extremely important including blood values, presenting symptoms, eating disorder behaviours, and overall patterns of intake. In fact, disordered eating and eating disorders present in all body sizes. Less than 10% of eating disorders are in persons who are underweight.  

Knowing that the majority of eating disorders present in average or larger body sizes, what role does weight stigma play?  

Well first of all, it is important to clarify what I mean by weight stigma, also known as weight bias. This has been defined as the discriminatory acts and ideologies targeted towards individuals based on their weight and body size.  

Unfortunately, many well-meaning healthcare practitioners still make errors in their approach to weight discussions. This may be due to their training or their internalized biases that have not been properly addressed.  

Weight based discrimination increases the risk of issues in mental and physical health. The research shows us that when talking to individuals in larger bodies, healthcare providers tend to give less health information, spend less time with them, or view them as undisciplined and noncompliant. It is no wonder that individuals in bodies that are not seen as underweight are hesitant to reach out for support for an eating disorder.  

Weight bias in health care has been linked to increased risks for the development of an eating disorder related to the idealization of thinness. We already experience significant cultural pressure to be thin, so, if a medical professional implies that a person has a lack of self control or they blame the individual for their body size, the risk for disordered eating patterns grows even higher.  

Knowing that an overemphasis on weight can encourage eating disorder behaviours and be counterproductive, what can you do? 

1. As a human, address your own weight-based assumptions & monitor your own language and biases around weight

• How do you talk about weight and bodies related to yourself and others? 
• Do you make any assumptions about a person in a larger or smaller body size? What if those assumptions are wrong?   

2. As a health care professional, provide assessment without judgment.  

• Ensure to assess a person’s behaviours around food and movement regardless of their body size. Weight is only one small assessment point when it comes to disordered eating behaviours. 
• Believe what the patient tells you regardless of body size.  

3. As a patient or client, strongly advocate for yourself or bring a support person who can advocate on your behalf.  

• Do not accept recommendations if a full assessment was not completed. This will include medical values and a discussion around food and exercise related behaviours. 
• Trust yourself. If your relationship with food and your body feels off, regardless of your body size, reach out to medical providers who are eating disorder informed. 
• Get a second opinion if needed. If you do unfortunately encounter weight stigma in the pursuit of receiving treatment, please, give that feedback and try again! You deserve support.  

Eating disorders are serious medical disorders with dangerous outcomes if not addressed. Do not let body size and weight stigma prevent you or someone you care about from receiving qualified care.  

If you or someone you know is struggling with disordered eating behaviours, seek out a medical professional who has adequate training in this area. Our team of experienced and compassionate eating disorder dietitians are here to help. Contact us today. 

If you are a parent, partner, or family member of a loved one with an eating disorder, I have created a program: Caregivers United, that’s designed exclusively for you to help navigate recovery for your loved one. Caregivers can have a profound impact on recovery. Join me and my colleague, Britney Lentz for a safe space to discuss challenging situations with food, weight, meal support, and more. 

Check out my video below discussing weight in the recovery process: 

Other resources:  

Caregivers United –  An online program providing more education and guidance for caregivers supporting a loved one with an eating disorder.

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