5 Ways Fatphobia Impacts Eating Disorder Diagnosis
Fatphobia, a negative bias toward folks with larger bodies, is the result of entrenched cultural, interpersonal, and institutional narratives that equate fatness with poor health, lack of discipline, or even moral failure.
While it often fronts as a “health concern,” research describes fatphobia as a form of social devaluation and oppression that contributes to weight discrimination, stigma, or unequal treatment in healthcare and other areas of society.
This systemic issue shows up in medical settings, public health initiatives, media stereotypes, and even normal daily interactions. It shapes how human beings are perceived or treated in relation to their body size, influencing assumptions of who needs access to care versus who just needs to “lose weight” or “exercise more will-power.”
Fatphobia also creates diagnostic barriers and treatment delays for those with larger bodies who suffer from eating disorders. Clinicians are more prone to minimize or dismiss the symptoms of folks who don’t reflect their impression of how someone with this illness “should” look.
This leads to poor interventions, high relapse rates, and worse health outcomes, especially among those who also face other types of discrimination like racism, classism, sexism, and trans- or homophobia.
It’s vital to recognize and call out the harmful ways in which fatphobia can inhibit folks from receiving the help they need to heal. Learn more about how this negative bias impacts both the diagnosis and treatment of serious eating disorder behaviors.
1. Weight Stigma in Healthcare Masks Eating Disorder Symptoms
Medical professionals are not immune to fatphobia and weight stigma. In fact, BMC Medical Education Journal suggests many clinicians still use body mass index (BMI) as the dominant metric to evaluate the overall health of their patients.
We know now, however, that BMI is a deeply problematic method of measuring individual health. As Ragen Chastain described in her Weight and Healthcare Newsletter, BMI has come to be used to pathologize bodies based on their size, despite the fact that two people with the same BMI can have vastly different health statuses, and two people with vastly different BMIs can have the exact same health status.
Despite this, the physicians who default to this marker often prescribe weight loss as a catch-all solution. This is a primary reason why the American Medical Association changed the role of BMI in healthcare back in 2023. And yet, fatphobia still infiltrates healthcare spaces, leading to issues like:
Disrespectful communication from doctor to patient
Inadequate physical accommodations (small waiting room chairs)
Inadequate clinical materials (small gowns, blood pressure cuffs, exam tables, needles, etc.)
Read our blog post, Weight Bias in Healthcare and How to Find Inclusive Practitioners, to learn more about this issue.
When this happens, it rules out the reality that high-weight individuals can suffer from a psychological condition that requires holistic intervention. Worse, it reinforces a common belief among medical professionals that fatness is the result of “laziness” or “incompetence” that can be “fixed” with rigorous discipline.
2. Internalized Fatphobia Alters How a Person Sees Their Own Behavior
Internalized fatphobia occurs when someone with a larger body absorbs interpersonal or societal weight bias and uses that narrative to diminish their self-worth.
According to the Journal of Eating Disorders, 40 - 50 percent of U.S. adults have internalized fatphobia. This can lead to intense shame, poor body image, chronic stress or depression, self-surveillance, healthcare avoidance, and a higher risk of eating disorders, all of which are directly harmful to health.
Internalized fatphobia can make it harder for someone to recognize their own symptoms and seek out help. Instead, they might not feel worthy of treatment, staying stuck in a cycle of false beliefs, like:
Minimize the condition: “I am not underweight, so it can’t be that serious.”
Hide the behaviors: “If no one knows what I’m doing, it won’t raise alarm bells.”
Put off intervention: “Asking for help will cause others to invalidate or judge me.”
Adopt a weight-centric lens: “I won’t suffer like this anymore once I lose weight.”
3. Narrow Diagnostic Criteria Mischaracterizes Eating Disorders
Traditional mental health diagnostic frameworks, like the DSM-5, emphasize low body weight as a primary indicator of common eating disorders such as anorexia nervosa. The truth is, not everyone who suffers from an eating disorder will exhibit severe weight loss. Quite the contrary, fewer than 6 percent of people with eating disorders are medically diagnosed as “underweight.”
While that doesn’t make their condition any less serious, a narrow or biased interpretation of mental health criteria can lead to inequities in who receives a formal diagnosis.
This is particularly rife in cases of atypical anorexia, in which someone restricts their food intake but isn’t clinically underweight, as defined by the BMI. Physicians practicing with fatphobia beliefs (whether or not they’re doing this consciously) are likely to misdiagnose anorexia in folks with larger bodies, even if their eating habits are noticeably restrictive. This allows harmful, often life-threatening, behaviors to continue and ultimately worsen.
4. The Fear of Fatphobia Undermines Community Support
Fatphobia and weight-based stigma don’t only present in clinical environments. They also impact interpersonal and community experiences. Meaning, this can deter folks from feeling safe enough to disclose their symptoms to others who might be able to point them toward healing resources.
More than 40 percent of U.S. adults encounter or anticipate weight stigma in their daily lives, ranging from judgmental stares to physical barriers, like seats that are too small. This not only exacerbates mental health concerns and eating disorder behaviors but can also make them less inclined to reach out to their community networks.
What’s more, 80 percent of folks with an eating disorder will never access help. Instead, they suffer in isolation and silence due to a fear that they aren’t “sick enough” to be taken seriously. And this fear is legitimate. Many folks with larger bodies face consistent ridicule within their families, workplaces, academic settings, or other public sectors. Sometimes the easier option is to avoid asking for support.
5. Intersectional Discrimination Amplifies Diagnostic Barriers
Fatphobia is not monolithic. It intersects with other forms of systemic oppression, too. Racism, sexism, classism, ableism, ageism, and anti-LGBTQIA+ biases can further compound the barriers to a formal diagnosis and positive treatment outcomes.
Folks with marginalized or intersectional identities are more likely to face discrimination for both their weight and other stereotypes based on Western societal norms.
This can increase levels of harm in the following ways:
Negative assumptions and attitudes that result in symptom dismissal or misdiagnosis.
Lack of cultural awareness and sensitivity to the connection to a specific food heritage.
Devaluing of one’s identity if it does not reflect the mainstream “thin white” beauty ideal.
Fatphobia Is Real, But Healing Is Still Possible
Whether it takes root through the healthcare system, internalized shame, or interpersonal dynamics, fatphobia is a major obstacle to the accurate diagnosis and equitable treatment of eating disorders. As a result, countless people are left to needlessly suffer without an accessible path toward long-term recovery.
At Project HEAL, we know the importance of affirming, weight-neutral resources and interventions, and we’re on a mission to make them more accessible. Learn about our inclusive treatment access programs to see if we can support you in your healing journey.
