Taking Weight Stigma Out of the AN Treatment Equation

Like wisps of smoke, weight stigma can slip quietly into the treatment of eating disorders, according to a recent report. Weight stigma is “the social denigration of an individual on the basis of weight and body shape,” and development of negative attitudes toward an individual because of his or her weight. Larger people often face criticism that they are lazy or less competent amid assumptions that their body size and shape are somehow the result of a moral failing (Obesity. 2009.17:941). The individual then may internalize this and criticize herself on the basis of others’ judgments.

Focusing on the patient’s weight during eating disorders treatment can add to weight stigma, leading to poorer treatment results, according to researchers at Arizona State University, Phoenix, and the Mayo Clinic, Rochester, MN. Dr. Mindy L. McEntee and her colleagues at Arizona State University write that healthcare providers may be a primary source of weight stigma (Front Psychiatry. 2023. 14:1157594. doi: 10.3389/fpsyt.2023.1157594). As a result, a clinician may spend less time with and be more critical of patients with higher weights. This then interferes with communication, leads to loss of trust, respect and support. Patients may withdraw from or refuse to follow treatment recommendations.

Misuse of BMI

One area to be aware of is using body mass index (BMI) during the initial diagnosis of AN or to gauge treatment progress. Referring to BMI and using terms such as “overweight” or “obese” reinforces arbitrary classifications not supported as a measure of individual health, according to the authors. BMI is a diagnostic criterion for AN, leading to higher-weight individuals being labeled as having “atypical AN,” or AAN, which leads it to be perceived by some as less severe; this can then interfere with immediate and lifesaving services. Weigh-ins can also be problematic, and the authors argue for clear communication about weighing at the outset of treatment.

The authors recommend a number of steps to encourage weight inclusion in eating disorders treatment and research. These include understanding and communicating with patients and policy makers that weight is not synonymously linked to health, clarifying that weight is not a sole criterion for an eating disorder diagnosis or for recovery, and shifting from weight-centric to weight-inclusive care.