Discrimination within the healthcare system meant I struggled to get help.
How we see the world shapes who we choose to be — and sharing compelling experiences can frame the way we treat each other, for the better. This is a powerful perspective.
Although my eating disorder started when I was 10, it took four long years before anyone believed I had one — the result of not being a body weight that’s so often associated with eating disorders.
Before my diagnosis, I was sent to a junior Weight Watchers program. As it turns out, this would be the catalyst for my 20-year battle with bulimia, and eventually anorexia nervosa.
I followed the diet for about two weeks and was over the moon about losing some weight. But two weeks later it was like this switch was turned on. Suddenly, I couldn’t stop bingeing.
And I was horrified.
I couldn’t understand why I had so little control when I desperately wanted to lose weight more than anything in the world.
I had learned early on that to be thin was to be loved in my family, and eventually, I began purging daily. I clearly remember telling the school counselor at age 12 about what I was doing. I felt an intense sense of shame sharing this with her.
When she reported it to my parents, they didn’t believe it was true because of my body size.
Yet even after having been diagnosed, my weight meant accessing the right treatment was still an uphill battle.
From an early age, I learned my size meant limited access to treatment
From day one I found obstacles around every corner when it came to getting the help I needed — almost always because of my weight. During my first bout of treatment, I remember not eating and my doctor on the ward congratulated me for losing weight.
“You lost so much weight this week! Look at what happens when you stop bingeing and purging!” he commented.
I learned very quickly that because I wasn’t underweight, eating was optional — despite having an eating disorder. I would be praised for the exact same behaviors that were of huge concern for someone in a smaller body.
To make matters worse, my insurance confirmed that my weight made my eating disorder irrelevant. And so I was sent home after only six days of treatment.
And this was just the start.
I would go on to spend much of my teens and early 20s in and out of treatment for my bulimia. And while I had great insurance, my mother would spend those years battling with my insurance company, trying to fight to get me the length of treatment I needed.
To make matters worse, the continuous message I was given by those in the medical field was that all I needed was self-discipline and more control to achieve the smaller body I so desperately wanted. I constantly felt like a failure and believed I was weak and repulsive.
The amount of self-hate and shame I felt as a teenager is indescribable.
By not eating I was harming myself — but society was telling me differently
Eventually, my eating disorder turned to anorexia (it’s very common for eating disorders to change throughout the years).
It got so bad that a family member once begged me to eat. I remember feeling a profound sense of relief because, for the first time in my life, I was given the permission I needed to engage in something that’s so necessary for my body’s survival.
It wasn’t until 2018, however, that I was officially diagnosed with anorexia by my treatment team. Yet, even though my family, friends, and even treatment providers were concerned about my severe restriction, the fact that my weight wasn’t low enough meant that options for receiving help were limited.
While I was seeing my therapist and dietitian weekly, I was so malnourished that my outpatient treatment was far from sufficient in helping me manage my disordered eating behaviors.
But after a lot of persuasion from my dietitian, I agreed to go to a local inpatient program. As had been the case so often throughout my care journey, the program wouldn’t accept me because my weight wasn’t low enough. I remember hanging up the phone and telling my dietitian that clearly my eating disorder couldn’t be that serious.
At this point I was passing out regularly, but the inpatient program turning me down fed right into my denial of the severity of my eating disorder.
Even as I got closer to finding the right treatment, I was still met with fatphobia from healthcare providers
Earlier this year I began seeing a new dietitian and was even fortunate enough to receive a scholarship for residential and partial hospitalization. This meant I had access to treatment that more than likely would have been denied by my insurance company due to my weight.
Yet even as I inched closer to receiving the help I so desperately needed, I still encountered healthcare providers who pushed a fatphobic narrative.
I once had a nurse repeatedly tell me that I shouldn’t be eating all the food I was during my recovery process. She told me that there are other ways to manage “food addiction” and I could abstain from certain food groups once I left treatment.
The dangers of food restriction Limiting entire food groups for any eating disorder is incredibly problematic as anorexia nervosa, bulimia, and binge eating disorder are almost always rooted in restriction, or feeling guilt or fear around eating. Abstaining from food groups either leaves you feeling as though you have no control around that food group or that you want to avoid it completely.
Telling me to abstain from food when I was terrified of eating was ludicrous, even to me. But my eating disordered brain used that as ammunition to rationalize that my body just didn’t need food.
Getting the right treatment meant learning to feel safe enough to nourish my body
Thankfully, throughout these last few months, my current dietitians viewed my food restrictions as a serious issue.
It played a large part in my ability to be compliant with treatment, as I was able to feel safe enough to eat and nourish my body. I had learned from such a young age that eating and wanting to eat was shameful and wrong. But this was the first time I was given full permission to eat as much as I wanted.
While I’m still in recovery, I am working every minute of every day to make better choices.
And while I continue to work on myself, it’s my hope that our medical system begins to understand that fatphobia has no place in healthcare, and that eating disorders do not discriminate — this includes among body types.
If you find yourself struggling with an eating disorder, but don’t feel as though your current healthcare providers are offering treatment that’s best suited for you, know that you’re not alone. Consider seeking help from eating disorder professionals who work from a HAES framework. There are also a number of helpful eating disorder resources here, here, and here.
Shira Rosenbluth, LCSW, is a licensed clinical social worker in New York City. She has a passion for helping people feel their best in their body at any size and specializes in the treatment of disordered eating, eating disorders, and body image dissatisfaction using a weight-neutral approach. She’s also the author of The Shira Rose, a popular body positive style blog that’s been featured in Verily Magazine, The Everygirl, Glam, and laurenconrad.com. You can find her on Instagram.