Recap of “When Atypical is Typical: Anorexia in Diverse Bodies
Written by Taylor Pisel, Vice President of the Winston Salem Eating Disorders Coalition
In case you missed the latest event in the Best Practices in the Prevention and Treatment of Eating Disorders speaker series presented by the Winston Salem Eating Disorders Coalition and Northwest Ahec, Dr. Elizabeth Wassenaar, MS, MD, CEDS and Meredith Nisbet, MS, LMFT, CEDS provided a wonderful presentation on Atypical Anorexia and debunked many of the popular notions about the diagnosis. Here’s my summary of the presentation and the major points:
If you’re a person in a larger body and you struggle with food restriction, you may have noticed that you do not fit the criteria for Anorexia Nervosa according to the DSM-V. The criteria specifically targets folks who have low body weight:
To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met:
Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
Intense fear of gaining weight or becoming fat, even though underweight.
Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
information provided by NEDA
A competent provider will notice that this criteria discriminates against patients who severely restrict food intake but do not occupy an underweight body. Many providers assume that a larger patient cannot have anorexia. Dr. Wassenaar and Meredith Nisbet rightfully asked their audience to consider his/her own biases and assumptions that may influence treatment. Our society does not affirm the realness of eating disorders when folks are in larger bodies but we know that the medical consequences can be severe. Eating disorders affect every organ system in the body, after all.
My biggest takeaway from this presentation is that language matters. Providers must be cognizant of the language used and whether it is inclusive. The presenters put it this way: “Because we have our own duty for non-malfeasance, we have our own duties to dismantle systemic body oppression.” The current diagnostic criteria excludes larger bodies and therefore perpetuates fatphobia. Providers may consider discussing the DSM-V’s diagnostic limitations with patients and emphasizing that treatment remains geared toward a restoration of sufficient caloric intake.
As a proud member of the Winston Salem Eating Disorders Coalition, I pride myself on HAES principles and supporting equity for all bodies. This presentation challenged me to examine the biases and beliefs that I bring to session. I also learned that I can help patients achieve therapeutic goals without prioritizing the scale by emphasizing behavioral change and quality of life.
Ultimately, we are obligated as providers to meet patients where they are. This can be tricky when patients desperately want to lose weight but we know that body acceptance can bring peace and end the grueling cycle of disordered eating behaviors. The presenters eloquently highlighted this challenge while also educating us to combat systemic body oppression and fatphobia embedded in the gold standard of diagnoses.
Info about the Presenters
Dr. Elizabeth Wassenaar, MS, MD, CEDS, University of Colorado Anschutz Medical Campus and Meredith Nisbet, MS, LMFT, Eating Recovery Center and Pathlight Behavioral Health