What is an eating disorder?

Wrong. Weight and size are not indicators of health. Your BMI is not an indicator of anything at all.

BMI (Body Mass Index) is an antiquated equation originally created by a statistician to define the ideal European man (based on French and Scottish men). At the time that the BMI was developed, there was a racial preference for white bodies in Europe, and seeing that individuals in black bodies tended to be larger, they placed a lower social value on larger bodies and described them as gluttonous. It was not developed as a determinant of health and was inappropriately selected as a metric with defined categories that were arbitrarily set. Truly, mathematically, it is meaningless and unfortunately has been, and continues to be, misused in research and by insurance companies, and impedes access to individualized healthcare.

Importantly, even HE disagreed that it should be used as a metric to assess an individual’s health.

You know who isn’t a European man? More than half of the US population! According to the 2022 US Census, 50% of the US population identifying as female, 25% of the US population identifying as non-white, and 28% of the US population 18 years of age and under (though really, development does not finish until age 25 so this number is likely much larger).

What we see is that BMI overestimates health risks in the Black population and underestimates health risks in the Asian population. Again, someone in a normal sized or larger body by standard measurements can still have an eating disorder and have the same risks of mortality as a result of malnutrition as someone with a BMI under 18.

• At least 30 million individuals of all ages, races, ethnicities and genders suffer from an eating disorder in the US alone.
• Athletes have an increased risk
• LGBTQAI+ individuals have increased risk.
• Neurodivergent individuals and those with Autism Spectrum Disorder have an increased risk.
• Poor individuals and unhoused individuals have an increased risk.
• Individuals with OCD, Anxiety, Depression, and trauma have an increased risk.

Please read more- Marginalized Voices

1. Something “Needs Improvement,” But It’s Not Your Body

There are different levels of care depending on the severity of an individual’s behaviors and their psychological and medical statuses. The main goals of treatment are nutritional restoration and behavior interruption. Treatment programs offer medical, psychiatric, therapy and dietary services to assure advantageous care with a multidisciplinary approach.

• Inpatient/ Residential (IP, RES) programs provide 24 hour care and supervision. When individuals struggle to interrupt harmful behaviors, lack motivation and have lost more than 15% of their total body weight, they do better in 24 hour care. This may include medical stabilization at a traditional hospital before admitting to a care facility. The average IP/RES admission is 12 weeks with nutritional restoration as a primary focus as it can be extremely difficult to achieve this at lower levels of care.
• Partial Hospitalization Programs (PHP) are the next step and allow time for “dress rehearsals” for individuals before they return home. This level of care is structured with day treatment 5-7 days a week, 8-10 hours a day depending on the program. Usually the program is 4-6 weeks in length. Meal plans are stabilized at this level or right before admission if individuals are stepping down from higher levels. This allows focused therapeutic and dietetic support as the individual continues to adjust to changes in habits, coping mechanisms and is reintroduced to other stressors.
• Intensive Outpatient Treatment (IOP) allows further practice for individuals, reducing programming to 3 days a week, 3-5 hours a day. Now the individual can return to school, work, and life while still staying connected with treatment supports.
• Outpatient Treatment (OP) is usually the longest period of treatment for an individual on their recovery journey. The first 6 months after an individual discharges from any of the higher levels of care are the most critical for prognosis and avoiding relapse. The brain actually takes a year to recover from the effects of malnutrition! It is also essential to find eating disorder informed providers before an individual’s status declines. This can improve the chances of full remission and repeat treatment admissions. Outpatient treatment is most successful when utilizing a multidisciplinary approach as seen at higher levels of care to continue to support the individual medically, therapeutically, and dietarily. This is often hard to find and assemble in most areas of the country.

It does! Recovery IS possible! Prognosis for full recovery is improved with early recognition and prompt intervention with intensive treatment.

Studies show that the 95-97% of individuals who engage in intentional restriction (reduction of caloric intake) will regain weight + 10% more

35% of “normal dieters” progress to pathological dieting. Of those, 20-25% progress to partial or full-syndrome eating disorders

Weight stigma is real! Western culture/diet culture confirms, affirms and insists that losing weight is the most important measurement of “health”.

We all have implicit bias and that includes weight and it’s important to find providers that get it.