An Open Letter to the Eating Disorder Community

I had the privilege of presenting at The Australia & New Zealand Academy of Eating Disorders Conference in Melbourne, on 3rd & 4th of August, 2018. I was fortunate enough to be a part of a plenary panel with the late Sarah Harry, Scott Griffiths and Jo Doley as our chair. Whilst we didn't get a video of the actual presentation itself, I recorded this the following day. I have since included the written aspect in this post.

This post is dedicated to the late Sarah Harry (1972 - 2021) Sarah was, an will continue to be, such a shining light in the eating disorder, yoga, health at every size and fat community. Her presence made as all braver, stronger and fiercer.

It’s hard to feel like you belong in a world that so often criticises, stigmatises and dehumanises you solely because you live in a fat body. Harder still, it’s difficult when you have a lived experience of an eating disorder, and you live in a fat body, because there is seemingly no room for you in this narrative. This is a long overdue conversation, but a courageous conversation that desperately needs to be had. I want you to listen, and to reflect. I don’t want your pity, or for you to feel like you need to rescue me. I need you to listen. I want you to take off your expert hat for a moment, and I want you to hear me. This is not a calling out, but rather a calling in. This is an invitation to act.

I believe that as a community, we are truly doing some amazing and ground-breaking work. I use the term we, because alongside my lived experience with an eating disorder, I am also a clinician working in this space. I wholeheartedly believe that everyone who works across the eating disorder space wants the best for the people they work with. I truly believe that eating disorder providers are some of the most caring and compassionate humans on the planet – it takes heart. But with that being said, I also believe that as a community, we still have quite a way to go. Weight stigma shows up in places we don’t believe it should, and the eating disorder community is no exception.

The terrifying reality is that fat people are continuously harmed in this space. Despite our best intentions, eating disorder treatment spaces are not always safe spaces for ALL bodies. I was lucky enough, for the most part, to have access to the treatment I needed at the time to support my recovery. But that treatment was not free from weight stigma or fatphobia. This is where we fall short. Microaggressions exist, and they are rampant. If you are sitting here thinking to yourself that these microaggressions don’t exist, then think again. There is NOTHING more humiliating, degrading and dehumanising than having to change into a gown that barely even covered my body and step on the scales. Those in smaller bodies who were also completing this program did not have to worry about trying to hold their gown closed at the back as to try to maintain a shred of dignity. Or, again, as the token fat person in treatment, being provided with a piece of fruit for morning tea as opposed to the snacks those in smaller bodies received. What implicit message do you think this sent?

These microaggressions do not stop here. I cannot tell you how many times I have heard clinicians reassuring their clients that they won’t “get fat.” Or, in a group setting where clinicians are very distinctly outlining where people ‘should’ sit within a ‘healthy weight range’ according to BMI. I want you to think about how this may feel for a fat person sitting in that group setting? How do you think those messages, which were very clearly directed at those in smaller bodies, would make a person in a larger body feel? Ashamed. Unworthy. Failure. When we reassure those in smaller bodies that the aims of treatment are not to ‘make them fat’ we are perpetuating fatphobia. Plain and simple. We are reinforcing the idea that fat is the worst possible thing you could be. This once again dehumanises those who are actually living in larger bodies. We are unconsciously driving people out of this narrative. Fat people ALREADY feel as though they have no place here because our treatment spaces are seemingly only set up for one type of body, a smaller body. This hurts. This runs deep; the hurt, the shame, the disgust, the unworthiness… it swims inside your veins and threatens to drown you. Please do not shame us, or dehumanise us further.

For me, these experiences weren’t just just humiliating, they were insulting. These experiences erased my lived experience as a person in a larger body. The implicit messages are everywhere - you have no place here. You don’t belong here. Your body is wrong. It doesn’t matter whether or not you are sitting here thinking, “this isn’t our intention…” - this is beside the point. The point is, experiences like this aren’t just happening to me, they are happening for many fat people, and this isn’t OK. Our treatment spaces need to be safe spaces for ALL people, in ALL bodies. I will even go so far as to say that we absolutely cannot be in the business of treating eating disorders, without also simultaneously addressing weight stigma and fatphobia. If we are not prepared to examine our own levels of weight bias, and address the rampant fatphobia that already exists in these spaces, then I honestly question our intentions. Can we truly say that we treat eating disorders, because, if these microaggressions and blatant fatphobia continue, and we allow them to continue by reinforcing them, we’ve actually become a huge part of the problem we are trying so hard to solve. Fat people are continuously spoken for and about by those in positions of power and privilege. In this space, clinicians and researchers speak for us, as “experts” on OUR lives. I am tired and I am fed up of clinicians and researchers claiming expert status on something they know nothing about. The obesity rhetoric we hear day in, day out, positions fat people as problems to be solved - the aim of obesity interventions is to eradicate fat people. Why on earth are we continuing to morph eating disorder and obesity treatment? Why are we even considering this approach. This only seeks to benefit those in smaller bodies, whilst those of us in larger bodies are again, rendered humanless and again, pushed outside of this narrative. If we are truly serious about supporting people to heal their relationships with food and their bodies, we have to first stop positioning bodies as the problem. When you position yourself as an expert in treating both eating disorders and obesity, you become part of the problem. When you are so invested in making larger bodies smaller, you become part of the problem. When you essentially prescribe behaviours for larger people that would be deemed pathological for those in smaller bodies, you become part of the problem. Fat people are repeatedly harmed in this space. Our bodies reduced to mere problems, our humanity stripped. Fat people constantly feel the need to have to explain, justify and apologise for our bodies - please do not reinforce this shame, blame and disconnection.

If you are struggling to understand why positioning eating disorders and obesity together is so harmful and traumatising, then I ask you to consider the following:

• Has your body ever been referred to as an epidemic?

• Has your body every been referred to as a national health crisis?

• Have you ever been told time and time again that your body is a disgrace, that it is abhorrent, that it is wrong?

• Have you felt pressured every single day to have to justify your existence on this earth as a fat person?

Just stop, and think. According to public health standards, I am a walking epidemic. My body is a national health crisis. I am a drain on our public health system. My body is wrong. And whilst obesity in itself is not officially classified as an illness, a disease or a disorder, bodies like mine are certainly seen in this light. I am somehow rendered less of a human being simply because of the body I inhabit.

All of the obesity rhetoric positions fatness as something that is pathological, that somehow fatness is a problem to be solved. We need to be clear that weight is not a behaviour. Fatness is NOT pathological and at no point should fat bodies EVER be positioned as problems to be solved. The focus on obesity and eating disorders provides a platform for eating disorders to flourish. Fatphobia breeds eating disorders. Fat bodies are not the problems in this equation.

If you are feeling uncomfortable sitting here, listening to all I have said thus far, I’m glad. This discomfort you are feeling right now is absolutely NOTHING compared with the the discomfort, the stigma, the prejudice and the hatred that people in larger bodies have to deal with on a daily basis. This is nothing in comparison. Feel it, and get a sense of why things need to change. Feel it, and think about the ways in which we are absolutely damaging some of the most incredible human beings on this planet. Feel it, because if you hold an incredible amount of body privilege, this is about as close as I can get to you feeling even a fragment of what it is like to navigate this world in a body that is deemed an abomination to our society. How dare I exist in this body.

Yes, I am angry. Yes, I am sad. When clinicians assume the role of ‘expert’ this seeks to diminish the capacity for an individual to trust their own body and to claim autonomy over their own experience. If you are speaking for and about fat people, without having considered the lived experience of those who are actually living this reality, then please reconsider. This further marginalises and silences those whose voices need to be heard in this space. When voices are silenced, and experiences are erased, we miss out on so many valuable learning opportunities. This is a balance of evidence based practice and practice based evidence. Lived experience is a powerful teacher. You can learn a lot if you are just willing to listen.

You may be wondering why I have used the word fat so many times today? You may even be sitting here cringing each time you hear me say it. You may feel uncomfortable, or uneasy with the word fat. You may even be sitting here having such a visceral reaction to the word - this is the point. This is proof. This is where the work is. Fat is a word that has held so much stigma. We equate fat with bad and fat with lazy, and fat with unworthy whether we like it or not. For me, fat had always been a word that was so fraught with fear. I grew up being afraid of fat, being afraid of my body. Fat was always a word that was hurled in my direction, but it was cloaked in shame and dripping in insults. I have worked hard over the years to reclaim this word for myself - fat is now a benign, neutral descriptor of my body, much like my brown eyes. My point being, that I have had to do this work myself. I have had to unlearn everything I have been taught, and everything our society still believes about fat. At the moment, this is an individual process, when really, we need to be making huge systemic shifts. I use the word fat to describe my body, and if this makes you uncomfortable, then this is rather telling - it says much more about your own beliefs than what it does about me.

I have always felt as though I have no place in this space; that somehow my experience of an eating disorder and recovery were not as valuable, that my voice was not as important. That somehow my still being fat somehow excluded me from both practicing as a clinician and sharing my recovery success. This is the way that I have been conditioned to think, and unfortunately, this is also supported by the dominant narratives in eating disorder spaces. I don’t see larger bodies represented in our national media campaigns. People in larger bodies are not represented in recovery narratives. People see bodies like mine and automatically assume that I must still be experiencing an eating disorder because I can’t possibly be this fat all of the time. The sad reality is, bodies like mine are still some people’s before photos. Weight stigma tries to strip you of your worth. Fatphobia tries to reduce your humanness into wrongness. I am not wrong. I have value. I will not apologise for standing on this stage today. I will not apologise for taking up space. I will not apologise for bringing these issues into light. I am done with apologising.

When it comes down to it, the question we must be asking is not “how can I best support my client in a larger body to lose weight” - but instead, “how does my client experience their own body?” What impact does weight stigma have on their life? How can I validate this experience of systemic oppression, discrimination and downright hatred of fat bodies, without also reinforcing in some way that my client’s body is a problem that needs to be fixed? Most importantly, I want you to ask yourselves, “how can I challenge my own bias and prejudice” “What are my beliefs about people in larger bodies?” “How much of this am I unconsciously bringing into the work that I do?” As providers, you have a responsibility to do no harm. This HAS to be at the very core of everything you do. Bodies do not need to be fixed. Human beings need to be heard.

Weight stigma harms everybody. Most importantly, it harms those whose bodies come under constant scrutiny. People in larger bodies spend their lives attempting to shrink themselves, and those in smaller bodies spend their lives being absolutely terrified of one day looking like me. I cannot even begin to tell you how much that hurts my heart. I am only one person, one voice, one story. But there are many other stories like mine. I have been afforded the privilege today, to share my voice, to speak from experience, and to bring these issues into the forefront of all our minds. Today, I am not only speaking for me, but I am speaking on behalf of all people in larger bodies who have been hurt and silenced in this space. Sharing this reality with you today isn’t just for me - sharing this reality with you today is for every single person whose voice has been lost, whose body has been shamed, whose worth has been brought into question. I don’t want you to feel sorry for us, or pity us. I want to see action, to see change, to see the work being done by those who need to do it the most. Your commitment to helping others heal means nothing if you are not willing to do the work yourself. This is everybody’s responsibility.

The reality is that it takes courage to take up space in this world. It takes courage to show up in a body that our world does not make room for. It takes courage to show up in an eating disorder space and say that we are doing harm and need to be doing better. And what makes me angry and incredibly sad, is the fact that as a fat person, it shouldn’t be an act of bravery for me to claim space for myself in this world. I shouldn’t feel as though I’m ruffling feathers and rocking boats by saying all that I have said here today. What I have realised is, this discomfort I am feeling is not mine alone to own. This discomfort is yours, it’s ours to own. I will not take responsibility for holding the discomfort of others any longer. I will not take responsibility for holding the fear others have around bodies like mine. We, as a community need to lean all the way in, we need to own it and we need to take responsibility for it. If we are not prepared to do so, then we are wasting everybody’s time. Yes, it’s confronting to hear that as a clinician your past or current practices are perpetuating harm. Yes, it’s confronting to hear that as a collective of leaders in our fields, that we are getting it wrong and still have so much more to learn. I believe that we can do better. If we are silent in the face of weight stigma, then we are giving it permission to thrive. If we are giving weight stigma permission to thrive, we are continuing to fertilise a breeding ground for eating disorders. Silence = complicity. If we are not prepared to respect and hold space for the lived experience of all human beings, in all bodies, then what is the point? Why are we here?