Amy’s* parents made reservations at a popular buffet-style restaurant to celebrate her sister’s 18th birthday. At 5′ 3″ and weighing 200 pounds, twenty-five-year-old Amy dreaded going to the birthday party. She knew the restaurant would be extra crowded on a Friday night. Crowded with people who she knew would brazenly stare at her when she went to the buffet tables, eye her overweight body from head to toe and pointedly gaze at the food she had chosen to put on her plate.
Since gaining so much weight over the past year due to a treatment-resistant thyroid disorder, Amy’s experiences with online “fat-shaming” and public “fatphobia” have devastated her psychologically. She recently started taking an antidepressant for depression and anxiety and has significantly curtailed her social life. Except for going to her job as a veterinary assistant Monday through Friday, Amy rarely ventures out with her closest friends. “I’ll start going out again once the doctor gets my thyroid under control and I start losing weight,” she tells them on the weekends. For now, Amy’s weekends consist of watching Netflix and “emotional eating” even though she isn’t hungry.
Fat Shaming vs Fat Phobia – What’s the Difference?
Primarily spread via social media posts, fat-shaming typically involves an overweight or obese person posting a picture of themselves in a swimsuit or other type of clothing that does hide their body. That person’s post is then swamped with critical and demeaning messages from people they don’t know who “shame” their obesity. Examples of “fat-shaming” comments include:
- “You might be pretty if you lost 20 pounds.”
- “Whales don’t wear swimsuits so why should you?”
- “Instead of eating your next meal, you should go workout.”
- “Only lazy people weigh as much as you do.”
Even people (mostly women) who are just 10 or 20 pounds overweight are often fat-shamed on social media sites. What makes this even more insidious is that some girls who are fat-shamed have never been told they are overweight. A study published in the Journal of Experimental Social Psychology found that fat-shaming and weight-stigmatizing articles led overweight women to eat more food than women who were not overweight. Researchers also discovered that weight stigma diminished the ability of overweight women to control their food consumption. Alternately, non-overweight women who read fat-shaming articles increased their motivation to control what they ate. In other words, fat-shaming someone who is overweight does not encourage them to lose weight.
Fatphobia differs from fat shaming because it does not involve verbal or written criticisms directed at a particular person. Instead, fat-phobia is an abnormal and irrational fear of being fat or of being around fat people. The clinical psychological term for extreme fat-phobia is cacomorphobia. People suffering from real cacomorphobia experience the same kind of overwhelming panic and terror felt by individuals with a fear of enclosed spaces (claustrophobia), fear of heights (acrophobia) or a fear of spiders (arachnophobia). In most cases, someone with cacomorphobia has had a terrifying and traumatic encounter with a fat person as a child. This fat person may have bullied and intimidated them in school. Or, the fat person may have been an abusive stepparent or family member.
As a societal and cultural phenomenon (especially in Western countries), fat-phobia may be viewed as the oppression of overweight or obese individuals. Hundreds of research studies regarding discrimination of fat people support the fact that body/appearance discrimination continues to exist in the workplace, in healthcare settings and elsewhere. One study found that weight-related workplace discrimination occurs just as frequently as workplace racial discrimination.
An Epidemic of Eating Disorders
Since the 1920s and the rapid industrialization of the U.S., society has viewed thinness as a sign that someone is self-disciplined, hard-working and concerned about making an impression. Before the 20th century, being thin was seen as a negative–that you were poor, lazy, drank too much and didn’t want to work for food. Instead, pre-Industrial Age, overweight people were thought of as having enough to eat and, therefore, hard-working and well-off.
The belief that “fatness” equates with laziness or lack of self-control remains pervasive today. The news agency Reuters conducted a poll asking people what they blamed obesity on. Over 60 percent of people polled said that obese individuals are obese due to “making personal choices about exercising and eating.” This belief is further based on the fact they were not given any information about a hypothetical overweight person’s medical or psychological reasons for being overweight.
Decades of clinical research regarding the negative consequences of fat-shaming, fat-phobia, and weight stigma show that discrimination against overweight people has contributed to the rise of eating disorders. This has happened even though we know that obesity is not a “personal” choice. Genetics, parenting styles, the diminishing availability of manual labor jobs, economic status and undiagnosed medical problems are all proven causes of obesity.
Another alarming trend involving the increasing need for treatment of eating disorders is the number of children being diagnosed with anorexia nervosa, bulimia nervosa or another unspecified eating disorder. A study conducted by the Agency for Healthcare Research and Quality found that the percentage of pre-adolescent children hospitalized for eating disorders rose nearly 120 percent between 1999 and 2006. Eating disorder experts are quick to point out that statistics showing evidence of an eating disorder epidemic do not take in account the “many other people who don’t seek treatment or fall ‘under the radar’ of medical professionals,” according to Douglas Bunnell, a clinical director previously working for Monte Nido-affiliated eating disorder treatment centers. Bunnell further states that “rates of sub-clinical bulimia and food restriction disorders causing weight loss may not meet a specific threshold for a doctor to officially diagnosing an eating disorder.”
What is the Most Common Eating Disorder Today?
Fat-shaming, fat-phobia and society’s pervasive belief that people who are overweight are “lazy,” “ugly” and somehow less of a person has led to anorexia nervosa remaining as the most problematic of eating disorders. Individuals with anorexia nervosa will severely restrict calorie intake, spend hours exercising to expedite weight loss, abuse laxatives, and diuretics and refuse to admit they are underweight. Many people entering a residential anorexia nervosa treatment center report that being the victim of fat-shaming on social media contributed to the development of their eating disorder. Once they began losing weight by not eating, exercising obsessively and abusing laxatives or diuretics, anorexia nervosa patients said the positive feedback they received on social media further encouraged them to intensify their eating disorder behaviors.
For individuals with binge eating disorder, early symptoms may mimic anorexia nervosa when the person tries to limit food intake and starts losing weight. But due to a variety of physical and/or psychological factors, they instead feel compelled to eat large amounts of food in a short period. Feeling tremendous guilt and shame after a binge eating episode, they will then start dieting again to lose weight, only to be overwhelmed by the need to “binge eat.” People with binge eating disorder may or may not be overweight or obese, but they are extremely sensitive to fat-phobia and seeing others get fat-shamed on social media.
Other symptoms of potential or full-blown eating disorders include:
- Obsessive preoccupation with appearance – (constantly looking in full-length mirrors, commenting often about how “fat” they are, admiring thin celebrities)
- Abnormal eating patterns – (claiming they eat plenty of food when they are many pounds underweight, counting fat grams and calories, avoiding restaurant outings with family and friends, drinking large quantities of water or diet soda instead of eating)
- Disappearing into a bathroom after a meal – (this may be a sign of binging and purging eating disorder where the person eats what appears to be a normal amount of food but then excuses themselves to throw up in the bathroom)
- Preoccupation with “healthy food” – (eating disorders commonly begin when someone decides to lose weight by eating only organic, vegetarian, low-calorie and/or low-fat foods. They may spend hours researching the nutritional content of food online and even keep a notebook of food they can and cannot eat)
- Excessively exercising – (ritualistic exercising for hours every day, talking constantly about how many calories they “burned” while exercising and getting upset or even panic-stricken over being unable to exercise may be a sign of an eating disorder)
Residential Anorexia Treatment Center vs. Outpatient Anorexia Treatment Center
When does an eating disorder necessitate outpatient (day) treatment or residential (live-in) treatment? Doctors recommend a residential anorexia treatment center for individuals who have:
- Serious health problems that require immediate medical attention
- A blood test or other lab result indicating health issues needing immediate treatment
- Major depression or thoughts of suicide
- A history of attending outpatient anorexia nervosa treatment programs without success
- Psychiatric illnesses such as schizophrenia, schizoaffective or bipolar disorders
Residential anorexia nervosa treatment involves patients staying in a treatment center 24/7 while undergoing intensive counseling and psychotherapy. Living temporarily in a structured environment where they cannot engage in eating disorder behaviors facilitates the ability of counselors to help patients understand why they have an eating disorder and how to cope with negative thoughts and emotions fueling their disorder.
An outpatient anorexia treatment center may be appropriate for individuals who have school or work obligations and are not immediately endangered by health issues caused by anorexia. Additionally, outpatient treatment is not intended for people who have serious psychiatric problems.
Patients enrolled in an eating disorder outpatient treatment program typically meet at least three times a week for individual and group counseling sessions. Outpatient anorexia treatment is recommended for individuals who have never been in a treatment program and therefore, do not have a history of relapse.
Both outpatient and inpatient eating disorder programs may include individual or group counseling sessions that involve the patient’s family members or close friends. Since family dynamics often play a central role in the development of an eating disorder, the patient’s therapist may want to employ a family-based therapeutic model called the Maudsley Approach. Designed specifically for adolescents with eating disorders and their families, the Maudsley Approach requires a strong commitment from parents who are required to be with their teens at every snack or meal to monitor eating habits. Maudsley Approach counseling sessions teach teens how to regain their ability to make healthy food choices, re-establish boundaries regarding their eating habits and understand the importance of good weight management.
With the overwhelming popularity of social media sites and sharing just about every aspect of one’s life online, fat-shaming and fat-phobia are fast becoming a leading cause of eating disorders. Although the media continues to glorify thinness and criticize celebrities who are just a few pounds overweight, fat-shaming on social media has been found to exert the same, powerfully negative impact on a person’s self-esteem and self-perception.
*Amy is a fictional representation of the issues raised in this article