Advocating for our healthcare needs in a medical system that is rooted in patriarchy, capitalism and white supremacy is challenging and harmful for many of us, and it’s especially challenging for folks living in the margins.
Of any conference, we feel most at home at BEDA. We adore the smart, passionate and loving people that work in this field. BEDA and NEDA joined forces to offer a joint conference for the first time, which has the potential to be a hopeful step towards more equity and inclusion work. This union also revealed two communities in the eating disorder field that don’t know each other as well as they could, and illuminated some of the challenging spaces between us.
As healers, we partner in a change process with our clients—people who may be doing some of the bravest and most uncomfortable healing work of their lifetime—and we, as a field and industry, must be willing to parallel this deep process if we are to move forward together.
As we absorb our experiences at the conference and hear some of the critical and fear-based reactions to weight-inclusive ideals, we want to offer some suggestions for moving forward together:
- Embracing the neutral and inclusive use of the word FAT would be of substantial benefit to the eating disorder field. You don’t have to love it or use it yourself, but your support is needed. We, as providers, need to offer a unified front against the propagation of individual and systemic weight stigma. Other interests and passions in the field must become secondary to addressing this primary human rights issue. We have a problem in this field when we align with the pursuit of “effectiveness” over the pursuit of doing what is right. (These are neither opposite nor mutually exclusive). If the field continues to ignore the necessity of inclusion and equity work, it is unlikely to survive in any meaningful way.
- We do not need to shield our most vulnerable ED sufferers from the word “fat”. We do need to shield them from our own engagement with diet culture and from our collective fatphobia. We do need to re-center body acceptance and liberation in our efforts to improve “body image.” It’s time to vehemently acknowledge that fat people suffer from the same eating disorders as thin people. This is indisputable if only you are willing to think outside of the traditional weight paradigm.
- Our credentials are the least valuable part of what we bring to our work as providers. The continued reliance on hierarchy in the field seems to reinforce some ideals that are far from worker supportive. The clinicians in this field are individuals who are irreplaceable. Pay attention to those who are doing the most labor in the field and ask them what they see, hear and do. Go to where the listening is for information about how to innovate and move forward.
- If it isn’t trauma-informed, it isn’t truly healthcare. During the conference, we could not get breakfast without having to hear conversations from neighboring treatment center tables about good/bad food, weight loss, and other such disembodied conversations about nourishment. We thought this was stunning at an ED conference where we know (though aren’t overtly acknowledging) the sheer number of people that could be triggered by overhearing these conversations. This mechanistic view of bodies and food is not what enables healing. Folks that work from this viewpoint often seem to be working towards having “the answer” for people’s bodies but seemingly care little about how they may be impacting those within earshot. This doesn’t add up for us.
- The single story narrative (thin, white, female with resources) that has dominated the ED field is deeply limiting our understanding of how to help all ED sufferers heal (and we do mean heal). The keynote presentation by Keesha Middlemass and Carolyn Black Becker titled “Eating Disorders in Marginalized Populations: What is the impact of food insecurity?”, shows us that marginalized and previously unstudied populations get eating disorders, and that our common narrative about eating disorders is non-inclusive and lacking. This unearthing would not be possible without the dedication these researchers show in including populations that are not otherwise seen in ED research. It is time to suspend expertise and engage in an inquiry process (rooted in research justice) that could truly expand our clinical and research worlds. This is a research ethic, is it not? If we are willing to see our own liberation as directly linked to the liberation of all of those who have been underserved, unseen and not included, we will find our way through.
- Fat people’s stories are rarely heard and told in the first person. They are rarely truly listened to and believed. The stories we do hear always seem to contain an arc of weight loss or sexual trauma that is somehow adjacent to diet culture and fatphobia. We need more listening and reflecting, listening and reflecting. This needs to be done over and over again until you feel deeply impacted and full of more righteous rage rather than suggestions for planning and fixing. Assume that your role as a clinician is to locate the problem outside of the body of your clients.
- Fat people’s bodies are not a billboard for selling the potential for change or healing (this brilliant line comes from Mikalina Kirkpatrick who does not see her body as a billboard or cautionary tale). This damages all of us, including our clients of all shapes and sizes. This approach is not aligned with ethical marketing, feminism, or with the 30+ years of data that shows us how motivation actually works. There are inclusive, informed marketing strategists out there. They will likely be far more pleasant to work with than those who advise you to leverage weight stigma in your marketing.
- There is no such thing as a Health at Every Size® extremist (although we would buy the t-shirt because it’s just so ridiculous). This type of labeling and grouping of people seems almost Trump-like in strategy, don’t you think? The propensity to alienate and “other” in this field is emotionally disturbing and overwhelming. Liberatory beliefs do not make anyone extremist. Liberatory consciousness is an approach to healing and trauma-informed care that could upgrade our industry through asking us to responsibly and ethically name harm as harm. Exposing and critiquing unsuccessful paradigms such as “obesity medicine” is an ethical path. We imagine nearly 100% of HAES clinicians and activists are available for conversation and consultation about this.
- Our field is sorely lacking in mentorship that centers diversity, equity, representation, and justice. Consider changing this in your organizations to amplify your work, to lessen turnover, to manifest engaged sustainability, and to create opportunities for healing that have been previously unavailable.
Before you call our words divisive or toss us in with a group that is definitely not yours, we ask you to claim the emotions our words have stirred in you and consider them an active invitation to address what comes between us. We will do our work too. This form of truth will offer a foundation from which we can collectively support the acknowledgment of body oppression and heal eating disorders across the spectrum of sufferers.