After self-advocating for 10 years, I finally have a diagnosis for my chronic pain and can start managing it. I can’t help but wonder how my quality of life would have improved if my weight hadn’t been blamed for so long.

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We strive to share insights based on diverse experiences without stigma or shame. This is a powerful voice.

Spoiler alert: Plus-size folks, People of Color (POC), men, and masculine folks can and do have some of the same eating disorders as underweight white women.


Sometimes we have a medical condition beneath the surface, wearing down our mental wellness and damaging our internal system because Western medicine, popular culture, and even our self-perception can’t get past “what’s seen.”

Here’s why.

A note on language

Terms such as “average,” “below average,” and “above average” are statistical terms to denote the median distribution of weight characteristics. In medicine, they are not intended to communicate a value judgment.

In this article, these terms are solely used to mirror the terminology within the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a reference book for mental health care professionals, and the studies and medical criteria mentioned below.

Psych Central acknowledges that health and beauty standards often default to discrimination and invalidation of people in larger bodies.

Though we use these statistical terms throughout, we aim to dispel myths rather than lean into them.

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For those with what’s considered an “average” or “high” weight or body mass index (BMI) in Western medicine, sharing experiences can be difficult.

Add to the complexity some of the typical signs of an eating disorder (overeating, starving, or purging behaviors), and the medical journey for wellness and healing can be cut short or dismissed based on our sizes.

I’ve long endured pain — unidentifiable, acute, and recurring pain.

But in my adult years, each of my medical appointments has been ransomed by unsolicited diet advice.

I recall going to a doctor for strep throat in college, struggling to swallow, let alone speak during the physician assessment. The doctor asked me to first recount my diet and exercise regimen and wouldn’t send my labs back until I appeased her.

If this is the norm for routine illnesses, how can folks be expected to reveal their personal complications around food and their bodies?

Body size and anorexia

A note on BMI

BMI (body mass index) is used within the medical field to determine diagnostic criteria and health outcomes for patients, despite some evidence that it’s out of date and not as effective as it could be.

BMI solely accounts for just a person’s weight, not their body composition, environment, or cultural norms.

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Signs of anorexia can include dermatological issues, such as weak nails, dry skin, and hair loss. Other signs include visible discomfort around food, isolation, and masking the body with baggy clothes. Depression and mood shifts can occur too.

But for the person labeled as having an “average” or “high” BMI, these signs are often explained away as something else.

Extreme food restriction, bingeing, or purging are all hazardous to your health, regardless of your weight.

Supporting research

Some research has found that clinicians often miss an eating disorder diagnosis if they’re only looking at body weight.

For example, many eating disorder behaviors, such as severe food restriction and purging, occur across the weight spectrum.

In “atypical anorexia” — which is a type of “other specified feeding or eating disorder” — a person can experience significant weight loss, but not to the point of being severely underweight.

According to the DSM-5, weight is the only difference in diagnosis. Both groups of folks have intense feelings about their outward appearance, including fear of gaining weight, that lead to food restriction.

A 2019 study affirms that some of the health effects — including impacted menstrual periods and heart complications — were the same for people with atypical anorexia features as for those receiving an anorexia diagnosis.

One of the study’s authors, Dr. Andrea Garber, is a dietitian and professor of pediatrics in the division of adolescent medicine at UCSF Benioff Children’s Hospital.

In an article discussing her research, she said “patients with large, rapid or long duration of weight loss are more severely ill, regardless of their current weight.”

Our culture often envies, then frowns on, the average or below-average-size individual who loses significant weight in a short span. But it applauds and approves when an above-average-size person loses a dozen, 50, or 100 pounds in a shorter period.

The study added that a dramatic dip in weight loss can be harmful to anyone, and suggests medical professionals keep a watchful eye on all of their patients.

Fatphobia, or discrimination against people in larger bodies, is sometimes referred to as “weight bias” or “weight stigma.”

It’s a documented occurrence affecting people’s experiences with weight bias and mental health, and the way we make assessments about people’s hygiene, job readiness, and financial security.

Diet culture

It wasn’t until adulthood when I realized that food was necessary for everyone to function properly, not just those without “extra” weight.

Both media and my interpersonal relationships taught me that not only should I withstand consuming less regularly, but it would also be beneficial in the long run. So I did — never mind the headaches, dizzy spells, and low energy.

My response to being judged did nothing but set me up for a long-term, unhealthy relationship with my body and food.

Unfortunately, this is the case for many people like me. Diet culture is ever-prevalent in the United States despite the data on the inefficacy and bodily damage diets and food restrictions not prescribed or monitored by a doctor can have on people.

Extreme food restriction, bingeing, or purging are all hazardous to your health, regardless of what your weight was when you began.

The intersection of gender, ethnicity, and health and beauty standards

Fatphobia can be polarizing within Communities of Color, particularly within Black communities, and more so for Black women.

There’s a particular idea of how we’re supposed to look: curves in all the right places, hourglass figures, all those monolithic stereotypes.

A comprehensive 2012 study collected BMI, waist circumference, and full metabolic panels of thousands of white women and men as well as African American women and men.

Researchers determined that African American women have higher thresholds for “optimal” BMI and waist circumference compared with white women.

Still, Black women — and other POC — are force-fed the same beauty standard tropes from the media and the same BMI-shaming from the medical community.

You might see how this perpetuated narrative can make it difficult for people indexed as being overweight or obese to speak up or get treatment for disordered eating or other health issues.

To that end, People of Color in larger bodies often go undiagnosed for medical or eating disorders:

  • A 2006 study details how eating disorders are grossly under-researched and less likely diagnosed in Women of Color.
  • Binge eating disorder is commonly associated with clinical obesity but is still often overlooked in people of size and dismissed instead as folks “being lazy” or “unconcerned” with their health.

And even if POC in larger bodies are diagnosed, affordable treatment might not be an option, potentially increasing the severity of ongoing symptoms.

For example, a 2011 report based on National Alliance on Mental Illness (NAMI) research explains that many Asian Americans, Pacific Islanders, and folks from other underserved communities are less likely to have employment that offers health insurance.

Having medical professionals fixate on your weight, or having them automatically blame your weight instead of ruling out other differential diagnoses, is a common occurrence for people in larger bodies.

Many of them have shared or had their negative medical experiences documented.

Countless times I’ve had my chronic pain dismissed as a pure result of being overweight, despite the details I’ve given about its progression and how it leaves me debilitated.

After 10 years of back-to-back doctors’ visits, I was finally granted a referral for an MRI. Doctors discovered concrete explanations for the pain I’ve been dealing with.

While irreversible, my condition has the potential to be managed. Even so, I can’t help but wonder how my quality of life would have been altered if my weight weren’t blamed. If I’d learned how to advocate for my health sooner, or if I didn’t have to advocate at all.

Dorender Dankwa, a medical student at the University of Washington School of Medicine, created a clip explaining self-advocacy for POC who have reported their symptoms being dismissed by healthcare professionals.

A 2015 meta-analysis reviewed studies over a 3-year span and looked at stigma in obesity and eating disorders.

The findings were revealing:

  • Shame over weight exacerbated or introduced eating disorder symptoms — particularly with binge eating and purging.
  • Weight shaming can also damage one’s mental health.
  • As a result of weight-related shame or bias, both adults and children were more likely to have depression, low-self esteem, and higher rates of substance misuse.
  • The negative weight-related events led to potentially harmful behaviors and outcomes rather than the weight itself.

Countless times I’ve had my chronic pain dismissed as a pure result of being overweight, despite the details I’ve given about its progression and how it leaves me debilitated.

It’s clear to me now that weight bias, or the perception about someone else’s weight, impedes creating healthier environments and outcomes.

The myth that you have to be dangerously thin for your health to suffer from disordered eating has to be dispelled — for our collective safety and health.

Maybe you feel like your relationship with food isn’t ideal, but you don’t quite meet the diagnostic criteria for an eating disorder.

This doesn’t invalidate your experience.

Both media and my interpersonal relationships taught me that not only should I withstand consuming less regularly, but it would also be beneficial in the long run. So I did — never mind the headaches, dizzy spells, and low energy.

Even though I didn’t navigate a diagnosed eating disorder, I have ample experience with feeling silenced and shamed for my weight and how peers, family, and medical professionals perceived it as a problem.

Whatever your present situation, you have options for support. If you don’t know where to start, consider:

It can be tough to maintain a place of body neutrality — where you accept your body for what it is — when it seems like only certain types of beauty have value.

Figuring out what you need to have body neutrality and be your best self may be a process, but remember that you don’t have to do it alone.

Weight does not dictate a person’s health. Eating disorders are widespread due to the pervasive nature of diet culture in the United States.

Science is an integral tool, but it also evolves. The future of healthcare is bright, with some researchers looking to account and make room for folks’ diverse body compositions and cultures.

You can take the time to assess the potential of your own weight bias, especially if you’re in a profession that works directly with clients or patients.

It’s pivotal to consider the person as a whole, not a set of symptoms spurred by a “high” BMI.

Taneasha White (she/her) is a Black, Queer lover of words, inquisition, and community. She loves conversations around gender and sexuality, Black representation, and mental health, and is excited to continue that work with an intersectional approach as a staff writer with Psych Central.

You can find some of Taneasha’s work in the mental health and wellness space, as well as pieces on activism and inclusion, in Well + Good, Verywell, mindbodygreen, Asparagus Magazine, among others.

You can view more of Taneasha’s work on her website, including her current projects and creative nonfiction work.