Combatting Weight Bias

Internalized weight bias – combined with the macro- and microaggressions regularly faced by people in larger bodies – can contribute to the development of health conditions such as anxiety, depression, post-traumatic stress disorder (PTSD), and eating disorders.

“The daily stress of living in a body that doesn’t meet society’s biased standards can have wide-ranging effects,” says Rebecca Boswell, PhD, Supervising Psychologist at Penn Medicine Princeton Center for Eating Disorders. “It’s interesting that people praise others for physical changes that may be dangerous, such as significant weight loss. In trying to meet these ideals, many people in larger bodies – and bodies of all sizes – are malnourished due to dangerous dieting behaviors.”

Along these lines, a misconception exists that body size is controllable. Dr. Boswell points out that this misses the science of what influences body size, including the many genetic and biological processes that contribute to an individual’s natural weight, or set point, where the body is functioning exactly as it should. In fact, the body’s physiological adaptations to dieting may defy weight loss efforts in the long-term.

An Emphasis on Behavior

Weight bias likely exists in the assessment and diagnostic process for eating disorders, according to Dr. Boswell. For example, she notes that placing an emphasis on body mass index (BMI) may obscure important health indicators such as heart function, muscle mass, lab work, medical history, and health behaviors.

As the field of eating disorders treatment evolves, Dr. Boswell recommends that providers focus more on behaviors such as restricting, bingeing, purging, and excessive exercise than on body size or weight.

“When someone loses a significant amount of weight quickly, treatment recommendations are to restore weight to the point where the body reaches an equilibrium and can function as it should,” explains Dr. Boswell. “Our ultimate goal is to reach that natural set point that’s best for each person rather than relying on arbitrary standards for populations, like BMI.”

To help combat weight bias, Princeton Center for Eating Disorders has resources like body image and advocacy groups that assist patients in embracing self-compassion and identifying effective strategies for discussing sociocultural factors that contribute to eating disorders.

Understanding Intersectionality

Historically, treatment hasn’t been culturally adapted to understand the intersection between race, gender, and body size – and research shows an additive effect of stress-related illness when people are faced with multiple bias stressors.

“For example, women of color in larger bodies are often targeted with more severe and frequent weight-based discrimination,” says Dr. Boswell. “We’re working to acknowledge this intersectionality, provide sociocultural context to treatment, and validate concerns to help people feel more empowered and understood.”

"Despite at-times overwhelming cultural forces, we’re working as eating disorders treatment providers to advocate for changing biased beliefs and policies,” she adds. “Little by little, we’re building a sense of advocacy for those facing bias in our clinics and communities.”