People Living in Larger Bodies & Eating Disorders
Living in a larger body (or 'obesity’, as it is referred to in a biomedical context) is not an eating disorder or mental disorder. Language is important as labels can be stigmatising. While there is not one universally agreed-upon term for people at higher weights, the terms ‘people at higher weight’ or ‘living in a larger body’ are used to replace the terms ’overweight’ or ‘obesity’ here as many people with a lived experience have indicated this as their preference.
Body diversity is a fact of life and eating disorders can occur across the weight spectrum. An eating disorder diagnosis may be missed for individuals living in larger bodies as the perceived traditional stereotype of a person with an eating disorder is not observed. Weight stigma (discrimination or stereotyping based on a person’s weight) may also be experienced.
People at a higher weight are at increased risk of disordered eating compared with the general population, while individuals who use unhealthy weight control practices (e.g. fasting, purging, and diet pills) are at increased risk of being at a higher weight. Eating disorder risk factors are shared by people of all body sizes, including individual factors such as dieting, unhealthy weight-control behaviours, weight and shape concerns, and self-esteem issues. Other risk factors include social factors, such as parental and peer weight and shape-related behaviours, and societal factors, such as sociocultural norms, media exposure and weight discrimination. In addition, weight stigma experienced by people living in larger bodies increases the risk of eating disorders.
There is a significant co-occurrence of eating disorders among people living in larger bodies. Many people in larger bodies have disordered eating patterns, and Australian evidence shows that the prevalence of both binge eating behaviours and severe restriction among people in larger bodies is increasing rapidly and increasing together (Da Luz F.Q., Sainsbury A., Mannan H., Touyz S., Mitchison D., Hay P., 2017). This may be due to social pressure for people living in larger bodies to lose weight and is of concern due to the medical and psychosocial risks of strict dieting.
Body size and eating disorders are interrelated. Larger body size is both a risk factor for developing an eating disorder and a possible outcome for people with eating disorders. People with eating disorders who live in larger bodies experience a higher rate of physical and psychological problems than people in larger bodies who do not have eating disorders.
Media and public health messages
Eating disorders are characterised by extreme concerns about body weight and shape, and unhealthy relationships with food. This can apply to people at any size, and people in larger bodies may be at greater risk because of the messages that society sends them about their body needing to be changed or ‘fixed’.
A person may respond to this by:
- Restricting food intake and initiating a starvation response in their body, which can occur at any size;
- Feeling a loss of control around food and consuming a lot of it in a short space of time (a binge eating episode), which may or may not be followed by attempts to rid the body of the food consumed (through compensatory, or purging behaviours).
Some public health campaigns may perpetuate eating disorder risk factors such as preoccupation with body weight and shape, or restrictive eating.
Weight-loss services and eating disorders awareness
People with eating disorders are more than twice as likely to contact health professionals or weight-loss centres for weight reduction assistance than they are to seek treatment specifically for their eating disorder. Weight-loss treatments may contribute to the onset of disordered eating behaviours in people of any age, by increasing anxiety about body shape and weight and the development of unhealthy behaviours.
Some signs and symptoms of eating disorders may initially be misinterpreted as treatment benefits. For example, increased physical activity and control and discipline over hunger and eating may be viewed as positive outcomes from weight-reduction interventions, but are also signs of increasing severity for individuals with eating disorders.
The NEDC has published a systematic review of 134 studies which reported on obesity treatments and eating disorders, including dietary, exercise, behavioural, psychological, pharmacological and surgical interventions for weight loss.
The full review, including discussion of all treatment modes and their impact on eating disorder outcomes, study limitations and recommendations for practice and research can be accessed here.
As this report was published in 2017, it contains outdated terminology.
Disordered Eating & Dieting
Disordered eating sits on a spectrum between normal eating and an eating disorder and may include symptoms and behaviours of eating disorders, but at a lesser frequency or lower level of severity. Disordered eating may include restrictive eating, compulsive eating, or irregular or inflexible eating patterns.
What is body image?Body image is a combination of the thoughts and feelings that you have about your body. Body image may range between positive and negative experiences, and one person may feel at different times positive or negative or a combination of both.
Risk & Protective Factors
Like most other psychiatric and health conditions, the development of eating disorders is likely to involve a combination of complex factors, including psychological, sociocultural and genetic. Risk FactorsGenetic factorsGenetic vulnerability refers to a person’s ability to inherit an eating disorder from their biological parent.
Research indicates that there are generally low levels of mental health literacy in the community; however, general beliefs and misunderstanding about mental health affect community responses to eating disorders. It is important that everyone understands the facts about mental health and eating disorders.