4 Types of Harmful Fatphobia in Eating Disorder Treatment Centers

Recently, The Renfrew Center, a for-profit eating disorders treatment center group that is currently celebrating its 35th year and uses the tagline “First in Eating Disorders,” sent out the summer edition of “Perspectives,” a quarterly publication that they call “A Professional Journal of the Renfrew Center Foundation.” It contained a horrifically fatphobic article entitled “In The Grip Of Hunger: Large Women and Their Therapists” by Harin Feibish, LCSW.

The article was problematic on nearly every level, especially within an eating disorders context — the use of the client’s weight, the idea that higher weight people need to be “fixed,” the conflation of higher weight with poor health and not “caring for oneself,” the validation of feeling discomfort and fear just being in the presence of a higher-weight person — and that was literally just the first sentence. The remainder of the article was about how the therapist tried to work through her fatphobia during sessions with a fat client, and ultimately was able to support the client in getting a dangerous surgery that risked her life and quality of life in order to surgically force the client to engage in behaviors that mimic an eating disorder.

The response was swift from within the eating disorders community, forcing an apology. Unfortunately, the apology was for publishing a “14 year old” article “without context or nuanced examination of where the field was at the time and more importantly where the field has evolved to today.”

And this is where a huge part of the problem lies — neither fatphobia, nor working through fatphobia during your client’s sessions, were appropriate 14 years ago, or ever. And the industry hasn’t evolved that much or they would have known better than to publish this without “context or nuance” instead of, say, centering the voice of a fat therapist, or commissioning an article from a fat expert on how practitioners can do the necessary work to avoid making Ms. Feibish’s mistakes. There were so many things that would have been better than this article in terms of discussing working with higher-weight clients, including no article at all.

This is just one example of the ways in which many eating disorders treatment centers are deeply fatphobic, causing them to fail clients of all sizes. Here are three more:

1. Concurrently running “weight management” programs.

In this model, an eating disorders treatment center also runs a program that claims (without good evidence) that they can control people’s weight. This amounts to prescribing to their “weight management” clients precisely the behaviors they are trying to stop in their eating disorders clients, and even giving fat clients surgeries that force them into disordered eating behaviors. This directly harms fat clients in obvious ways and can even create eating disorders where none previously existed. It also harms all of their clients by normalizing eating disorder behaviors — suggesting that if you’re fat these behaviors are completely reasonable and even positive steps toward health. This model is unethical in the extreme and any eating disorders treatment center that also profits from “weight management” should be avoided if at all possible.

2. Forcing fat patients to restrict food.

This is something that has been discussed by people of all sizes who survived fatphobic eating disorders treatment. Shira Rosenbluth has written about how she was utterly failed by her treatment program for anorexia nervosa, including when her dietician insisted the rest of her cohort order two scoops of ice cream but told Shira “you’ll get a kiddie cone.” On another occasion she was told to eat only 70% of her sandwich. Just for clarity, someone with anorexia nervosa was ordered to restrict food, by a dietician working for an eating disorders treatment program while patients in thin bodies with the exact same diagnosis were specifically ordered not to restrict food.

When in treatment for an eating disorder that included food restriction, Erin Harrop was given far smaller portions than her thin peers. She explains “Being given such drastically different meals from my peers caused multiple harms: (a) it affirmed my disordered beliefs that my body was somehow ‘different’ or ‘broken,’ incapable of ‘handling’ — or needing — food, (b) it affirmed my peers’ disordered beliefs that larger or fatter bodies should be starved or restricted, (c) it visibly separated me from my peers with similar diagnoses and behaviors, solely based on my physical appearance, and (d) my body continued in a state of caloric deprivation for two additional months during the inpatient process, which necessitated refeeding on an outpatient basis.

Nechie Fischman remembers seeing fat patients in treatment given half portions of food and, as she regained weight in treatment, wondering “how I would know when to cut my own portions in half?”

When fat people are given smaller portions than thin people it tells every person in treatment (some of whom are fat, and some of whom live with body dysmorphia and believe they are fat) that if you are fat, then food restriction is appropriate even in the midst of an eating disorder. There is literally nothing that could justify this practice.

3. Fatphobic staff.

I was teaching dance as joyful movement in an eating disorders treatment center. I arrived one day and was greeted by a therapist who told me that she was “so glad to see me” because there was a new patient who “really needed exercise.” I asked about why, since it’s far more common for new patients to be put on exercise restriction because an unhealthy relationship with exercise is often part of their pathology. This patient happened to be fat. When I inquired as to her relationship and history with exercise I learned that they hadn’t asked because “she’s obviously not overexercising.” That is patently false — many fat people also engage in overexercising. This is pure, unadulterated, dangerous incompetence.

As Ms. Feibish’s article showed, becoming qualified to treat people with eating disorders does not indicate that someone has done the work to uncover and dismantle their own weight stigma. In fact, unfortunately too often it’s quite the opposite. Far too many eating disorders professionals have normalized their disgust at the idea of fat bodies and horror at the thought of they, themselves, gaining weight.

To be clear, it’s not surprising that in a fatphobic society people internalize fatphobic messages. And many people who have experienced eating disorders — including fearing the idea of being/becoming fat — become eating disorder professionals. That’s not the problem.

The problem is a treatment culture that doesn’t insist that everyone working within it do their own personal work to dismantle their fatphobia, and that doesn’t have policies in place to protect their clients from the dangerous effects of weight stigma, in some cases choosing instead to profit from it.