Do you think it is easier for someone to recover from an ED when they have a more normative or stereotypically desirable body? Versus, say, an obese person who will never stop hearing extremely triggering stuff about their body type everywhere they turn? . . .
This post was originally written in response to the above question that was posed to Tetyana on the SEDs Tumblr (you can see the full question and Tetyana’s response here).
This is an interesting and timely question, and one that drives much of my research: I’m interested in knowing which bodies are easily accepted as “recovered,” and how body privilege (i.e., unasked for benefits associated with having a body that is perceived as “normal” in sociocultural context, to oversimplify) might play into the experience of recovery.
Tied into the question, I’ve been wondering, lately: Can one only hold themselves up as a beacon of hope and recovery when their body conforms to that slim middle ground where body and weight stigma is minimal (e.g., neither “too fat” nor “too thin”?). In our society, body size is taken as indicative of a number of things, including but not limited to:
- Eating patterns and behaviours
- Moral value
- Status as productive member of society
- Level of activity
We are peddled the wares of a consumer culture while, in the same breath, told to restrain ourselves. You’ll see an advertisement for SlimFast on one page, and a recipe for a triple chocolate cake with caramel filling and buttercream icing on the next. You’ll be told to indulge in December and hit the gym in January.
You’re instructed to work hard on your body (e.g., by eating certain things, exercising in certain ways), but in a way that is not too “excessive” or “extreme” or else people will question your motives, because of course, your motives have to be “good.” In doing this, you are told that you will achieve a normative body that lives in the slim (pardon the pun) middle ground that is acceptable and non-threatening to others.
When I think about the question posed, I think about how my own body is interpreted in doing the research I do: I research eating disorder recovery. I have traditionally identified myself as recovered for the reason that I enjoy a life full of things that are not at all related to food and exercise, one that is starkly different from the hellish life I lived in five years ago.
My body is easily “read” as recovered because it is normative. I have body privilege. I recovered into a body that fits into that space of not-too-fat and not-too-thin. Interpretations of my body vacillate based on who I am with and what I am talking about, but ultimately my body has lead to perceptions of my legitimacy in ways that I can’t ignore; legitimacy to different groups and to different degrees, but generally living in a “middle” body allows me to access spaces to do research that might not otherwise be available to me.
For example, when I talk about weight stigma, I might be taken seriously in part because of my body size. I am privileged to be able to speak about these issues without being labeled an “angry fatty.” At the same time, my body is generally read as “recovered,” allowing me to talk about eating disorders without anyone suggesting that I am still struggling, even if they know my history.
Despite evidence that body size is not the same as health (see, for example, this, this, and this), and evidence that stigmatizing larger bodies does little (read: has the opposite to intended effect) to combat health issues (see this, this, and this, to start) people still use bodies as currency. The double binds I mentioned above still exist and continue to constrain our ability to understand people who occupy non-normative bodies as having legitimately suffered from eating disorders, let alone being able to recover.
Scouring the literature for qualitative work around this difficulty, I kept coming up short. However, there is some evidence around how body appearance and subjective norms around what “severe enough” looks like in eating disorders impacts decisions to seek treatment. We can think about the implications of these kinds of insights and apply them to the idea of eating disorder recovery (which we can agree is ill-defined and elusive…)
WHAT DOES THE LITERATURE SAY?
Narrowing Landscape of Acceptable Bodies
In the critical qualitative literature around body size, we can see how bodies and morals are tied together. For example, Malson, Riley & Markula (2009) describe how bodies are framed in popular and scholarly messages. The article foregrounds an issue of the Journal of Community and Applied Social Psychology on body management.
The authors point out that looking at body image from a narrow, individual perspective (e.g., by measuring body image using a quantitative scale) may miss the reasons behind dissatisfaction with bodies. This makes it difficult to actually change “negative body image” or disordered eating because instructing individuals about how they should feel about their bodies does little (read: nothing) to change the broader social landscape where bodies are tinged with morals (see also this post).
Further considerations raised in the article:
- “Obesity epidemic” discourses (including the “war on fatness”) make legitimate a kind of global surveillance over bodies that makes normal submitting bodies to continual scrutiny, in the name of health
- Body size can become “a signifier of belonging, personhood and citizenship” (p. 333)
- Body size and health are assumed to follow from diligent self-surveillance and work, making it a personal responsibility despite conflicting evidence about the links between food intake, exercise, and size
Within this context, is it any surprise that our body size might impact:
a) Our willingness to seek treatment for an eating disorder if said eating disorder does not change the body to make it visibly “eating disordered” according to social understandings of what an eating disorder looks like?
b) Our ability to understand ourselves as recovered if our body does not fit into the middle ground between “too thin” and “too fat”?
With respect to the first point, Meyer (2005) published an article about why some individuals with eating disorders might not seek treatment. She surveyed 294 young women (aged 17-32, mean age 19.33) in the US, screening for:
- Eating disorders psychopathology (using the Eating Disorder Examination Questionnaire)
- Attitudes about therapy (using the Thoughts about Psychotherapy Scale)
- Personal opinions about attractiveness (Beliefs about Attractiveness Scale Revised)
- Defensiveness (Defense Style Questionnaire)
- Demographics and eating concerns
Some key results:
- 25% of the sample showed elevated (subclinical) eating disorder psychopathology
- 11% scored in the clinical ranges
- Of those in the clinical range, only 15% were currently involved in treatment
- Only 3% of the subclinical group were involved in treatment
- Overall, 56% saw their behaviours as not being severe enough to require therapy
In this study, participants who thought their behaviours did not require treatment actually showed less buy-in to sociocultural norms around attractiveness (counter to an “everyone with eating distress has horrible body image” argument). It is interesting to consider why, then, these participants felt as though they did not need treatment.
Meyer suggests that those who did not seek treatment were in denial (or in kinder terms use immature defense mechanisms). I would challenge this perspective (or at least complicate it) and suggest that there might be something else going on here: what is it about how EDs are represented that might lead someone to think that they don’t fit into a certain category of people warranting treatment?
Relatedly, Becker et al. (2010) looked at barriers to treatment seeking. The authors analyzed transcripts from interviews with 32 ethnically diverse individuals (29 women, 3 men) with “affirmed current or past concerns, symptoms or problems regarding eating or weight.” They identified barriers to treatment seeking including geographic distance, cost/insurance issues, and social inhibitors. Among these social barriers to care, participants identified:
- Stigma and shame associated with seeking help (i.e., if the individual comes from a cultural background where seeking help is not socially sanctioned and/or problems are “kept in the family”)
- Stereotypes around eating disorders, including dismissal of symptoms by family, friends, and health care practitioners if they did not fit what society deems as the “profile” of an eating disorder
(Saren has written about this in a past post here.)
While in this article the social barriers to care relate primarily to participants’ ethnic identities, these barriers indicate the unfortunate reality that social perceptions impact upon the identification of eating disorders and their affirmation as socially legitimate concerns both in society more broadly and in health care settings.
Importantly, if one’s eating disorder goes undiagnosed, what are the implications for understanding recovery? Even if one’s eating disorder is eventually clinically validated, if one’s body does not respond in the “expected” way to treatment (e.g., showing the outward body performance of recovery–fitting into that space between thin and not thin), how might we interpret the body?
BACK TO RANTING
I wrote a book chapter about this “unrecoverability” that should be coming out in the near(ish) future; it is about how standards for recovery operate in our fatphobic culture in a way that make it difficult for people to determine what set of standards to follow when seeking to recover from distress around food, weight, and bodies. Getting back to the question at hand, I personally think, based on both my own experiences and much of the critical feminist eating disorder scholarship I’ve read, that there is body privilege is associated with recovery. Would recovery have been more difficult if my set point were higher? I think it is likely.
I think I’ve taken this in a completely different direction than anticipated, and perhaps haven’t answered the original question. I’d be curious to know if by “easier” the individual asking the question means physically, psychologically, socially, or a mix of all of the above? I don’t know of much about the physical side of things, and as Tetyana noted it would depend on how the researchers defined “recovery” and could be hard to examine based on the difficulty of determining normative bodies.
Psychologically and socially, though, I would say that yes, I think it would be harder to recover when one’s body does not conform to social norms, whatever those norms are (cross culturally). The literature has focused on how things like family and cultural messages around bodies and weight can make recovery more difficult, and I think this can be exacerbated by actual body size, though I can’t specifically think of studies that explicitly make this link.
I’d love to hear more thoughts on this from readers. What role do you think cultural messages about bodies play in recovery? How might these messages constrain the ability to recover, or even to feel “legitimate” about your eating disorder and recovery if your body does not fit cultural standards?
Perhaps most importantly, what kinds of questions do you feel researchers should ask to get at this kind of issue?
Meyer, D. (2005). Psychological Correlates of Help Seeking for Eating-Disorder Symptoms in Female College Students Journal of College Counseling, 8 (1), 20-30 DOI: 10.1002/j.2161-1882.2005.tb00069.x
Malson, H., Riley, S., & Markula, P. (2009). Beyond psychopathology: Interrogating (dis)orders of body weight and body management Journal of Community & Applied Social Psychology, 19 (5), 331-335 DOI: 10.1002/casp.1019
Becker, A.E., Hadley Arrindell, A., Perloe, A., Fay, K., & Striegel-Moore, R.H. (2010). A qualitative study of perceived social barriers to care for eating disorders: perspectives from ethnically diverse health care consumers. The International Journal of Eating Disorders, 43 (7), 633-47 PMID: 19806607