“I think I have binge eating disorder.” The words hung in the air.
The trainee doctor looked terrified, left to ask someone more qualified what to do, and came back with a recommendation to join what was essentially Slimming World disguised as a medical intervention. Off I went, supposedly cured.
I’m not alone in experiencing inadequate, triggering treatment in the face of an eating disorder, but that my course of action revolved around a fortnightly weigh-in and forced exercise made one thing clear; I was being judged on my weight rather than supported for my mental illness.
Beat, the UK’s leading eating disorder charity, estimates around 1.25 million people have an ED in the UK, around 89% of which are female.
Before the latest change in diagnostic criteria, it was estimated that only 10% of ED sufferers were anorexic, 40% were bulimic and the rest, including those with binge eating disorder like me, fell into the EDNOS (or Eating Disorder Not Otherwise Specified) category.
If you picture someone with an eating disorder, what do you see? According to depictions of EDs in the media of late, such as Netflix’s ‘To The Bone’, or even Louis Theroux’s ‘Talking to Anorexia’ documentary, they’re likely female, probably white, and definitely thin.
For a long time, I looked at my plus size body in the mirror and the piles of food wrappers hidden in my bedroom, and thought I couldn’t possibly have an eating disorder, because I was so far outside of the mainstream image of what one looks like.
When I visited the doctor almost a year later about something completely unrelated, I was casually offered weight loss tablets. They tried to prescribe behaviours that, in a body much smaller than mine, would be diagnosed as disordered.
This problem is rife within eating disorder treatment and perceptions about EDs in wider society. People are denied care because they ‘weigh too much’, but by the time they’re thin enough for treatment, it’s too late. Those who never reach that point are left to attempt recovery on their own.
We desperately need to stop assuming we know anything about a person’s relationship to food based on their size.
Author and mental health advocate Hope Virgo, who was turned away by doctors during a relapse of anorexia because she wasn’t considered thin enough, has recently launched a #DumpTheScales petition, calling for medical practitioners to take a new approach when treating eating disorders. The petition has almost 60k signatures so far.
I used to get frustrated when I heard experts say that ED recovery meant overcoming restrictive behaviours. I thought that restriction was the very thing that I needed to recover. I was so ingrained in the weight loss mindset, fooled by the misconception of what eating disorders look like, that I welcomed the triggering and stigmatising treatment I received, even though it ultimately ended up doing more harm.
It was only when I realised that someone my size could have an ED that I understood how to move towards making peace with food. I stopped mentally restricting myself, gave myself unconditional permission to eat, and my binge eating behaviours have vastly improved.
Eating disorders don’t discriminate. They affect people of all colours, genders, sizes and abilities, and so we need to change the way we expect eating disorders to look. We need to take a weight inclusive, non-stigmatising approach to treatment of all EDs.
And most importantly, we need to treat eating disorder patients according to their actual illness, and not the number we see when they stand on the scales.