Eating disorders are complex illnesses. Diverse and multifaceted, they are associated with biological, psychological, and social factors that themselves are complex and interact with one another in complex ways.

One factor often overlooked in conversations about eating disorder development, illness, and recovery is food insecurity. Research about the link between food insecurity and eating disorders has emerged in recent years, as food insecurity has likewise seeped into the public consciousness more generally.  

This article describes what we know about food insecurity and eating disorders to date, how to screen for food insecurity, and how to integrate food insecurity support into eating disorder treatment and recovery. By addressing food insecurity in patients with eating disorders (and eating disorders in patients experiencing food insecurity), providers can play a critical role in intervening and supporting those dually affected.

What is food insecurity?

Food insecurity, as defined by the USDA, is the “limited or uncertain availability of nutritionally adequate and safe food” or the “limited or uncertain ability to acquire acceptable foods in socially acceptable ways.” Assessed on a household level, food insecurity is influenced by multiple factors and occurs at different levels of severity.  

We all live in diet culture, a society obsessed with thinness and dieting. Weight and food biases permeate the air we breathe, tingeing our thoughts and actions in ways sometimes hard to notice. Providers, patients—none of us—are immune to these biases. They’re often subtle and deeply embedded, and left unexamined and unchecked, they can manifest in interactions between patients and even the most capable, well-intentioned providers.

In this article, we define and discuss weight and food bias, including its perpetuating factors and health consequences. Learn the impact of weight stigma and how to recognize and counter implicit and explicit bias in yourself, your practice, and in our larger society.

What are weight bias and stigma?

Weight bias refers to negative attitudes, beliefs, or assumptions about others based on body weight or size. Internalized weight bias occurs when these negative weight-related beliefs are absorbed and held about oneself.

Weight bias can lead to weight stigma, or the disapproval of someone based on their weight. Stigma is seeing someone negatively because of their weight, which can in turn lead to treating someone negatively because of it. Stigma manifests in stereotyping, bullying, and discrimination on the basis of weight, as well as exclusion and marginalization in media, professional, health care, and other settings. While weight bias harms people of all sizes, those who live in bodies that do not conform to “normal” body size expectations experience the greatest weight stigmatization.

We are excited to share that The Emily Program and Veritas Collaborative have merged, joining two of the nation’s leading eating disorder treatment programs.

Both programs are known for their warm and authentic care for people of all ages and genders across the array of eating disorders diagnoses. The Emily Program and Veritas will retain their brands in their respective markets across the Northwest, Midwest, and Southeast and remain committed to maintaining the highest clinical integrity and standards of care, while expanding access to treatment.

“We are so pleased to be part of growing access to care for individuals and families dealing with these treatable, life-threatening illnesses,” said Dave Willcutts, CEO. “Our two companies together will set the standard for comprehensive care from outpatient through inpatient to equip clients and families with the understanding, interventions, and ongoing support they need to achieve recovery. We believe recovery from these fierce illnesses is rooted in relationships, and we are honored to be a part of people’s journey to recovery.”

Collectively, The Emily Program and Veritas currently have 20 locations across Georgia, Minnesota, Ohio, North Carolina, Pennsylvania, Virginia, and Washington, with outpatient individual, group, and family services; intensive outpatient programs; partial hospital programs; residential programs; and inpatient care — with various gender-inclusive programs focused on addressing the needs of children, adolescents, and adults. The combined thought leadership and reputation of our two programs is exceptional and positions us as an industry-leading voice in the eating disorders field for many years to come — all the while focused on how to best meet the needs of those we employ and those we serve.

Episode description:

Christie Dondero Bettwy is the Executive Director of Rock Recovery, a nonprofit that uniquely combines clinical and community care to help people overcome disordered eating.

In this episode of Peace Meal, Christie shares with us her personal and professional experience with eating disorders. She first traces her path through illness and healing, highlighting the risk factors that contributed to her disorder as well as the community that helped her find freedom from it. Then she unpacks her decision to enter the eating disorders field–including how and when she knew she was “recovered enough” to translate her personal experience and passion into a career at Rock Recovery. Finally, Christie helps us reflect on the tremendous impact of the COVID-19 pandemic on eating disorders. We discuss how COVID-19 has triggered and exacerbated these illnesses, and how we, as a field, must work collaboratively and creatively to meet the tremendous need for care now and beyond the pandemic.

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By Abby Couture

**Content warning: This is one person’s story; everyone will have unique experiences in recovery and beyond. Some stories may mention eating disorder thoughts, behaviors, and symptoms. Please use your discretion when reading and speak with your support system as needed.

At the age of 14, I was diagnosed with anorexia nervosa. My admission into intensive care was sudden. I had gone from starving myself for months to being fed three meals and snacks a day in a hospital bed. Needless to say, I didn’t exactly embrace this abrupt change in routine. Though as traumatic as living through an eating disorder was, I believe I was able to survive for a few main reasons.

The first was my reckoning with control. A common feature of individuals struggling with disordered eating is an underlying fear of lacking control in one’s life, or feeling powerless and uncertain with their sense of self.

Throughout my freshman year of high school, I struggled to feel grounded and secure in shifting family dynamics, redefined friend groups, and a fluctuating identity with academics. In middle school, everything seemed so much easier, my grades were above average, and I felt more or less socially safe. In high school, I found myself frequently shifting between different social groups that were often in conflict. I felt tethered between old ties and new ones, constantly shifting “selves.” This ultimately led me to constantly question how I could be defined. At the end of the school year, my grades had dropped and I was no longer on the honor roll. Compounded by a disconnection with my academic self was a feeling of alienation from my own bodily identity. As I navigated puberty, I began to gain attention from older boys, leading me to objectify my own body as I learned to view it as social capital.

**Content warning: This is one person’s story; everyone will have unique experiences in recovery and beyond. Some stories may mention eating disorder thoughts, behaviors, and symptoms. Please use your discretion when reading and speak with your support system as needed.

Lisa Whalen’s book, Stable Weight: A Memoir of Hunger, Horses, and Hope, is now available from Hopewell Publications. Her writing has also appeared in An Introvert in an Extrovert World; The Simpsons’ Beloved Springfield; Introvert, Dear; and Adanna, among other publications. Whalen has a Ph.D. in postsecondary and adult education and an M.A. in creative and critical writing. She teaches composition, creative writing, literature, and journalism at North Hennepin Community College, where she was selected Minnesota College Faculty Association Educator of the Year in 2019. In her spare time, she is an equestrian and volunteer for the Animal Humane Society. Learn more at her website, and follow her on social media @LisaIrishWhalen. 

“Describe how the antagonist drives your book’s plot.”

Those were the instructions 74 other authors and I received as we prepared to attend a conference in New York City. The conference would teach us how to pitch our books to agents or publishers, which involved a lot more time, research, and effort than I realized. We were told that to get the most out of each session, we should complete some assignments before we arrived. The first was describing how our book’s antagonist (villain) drives our story’s plot. It was a straightforward task for every author…except me. The others had written novels; I had written a memoir describing how The Emily Program helped me recover from an eating disorder. My story doesn’t have an antagonist, I thought, frustrated.