Images of Eating Disorders and Weight Stigma

by Lizabeth Wesely-Casella

Images of Eating Disorders and Weight Stigma


HeadshotFollowing is the text from the presentation for the Senator Harkin/EDC Briefing “Photoshopping, Weight Stigma and Eating Disorders: What They Have in Common and Why They Matter” held July 24, 2014.  Fellow presenters included Dr. Rachel Adatto, Former member of Israeli Parliament (Knesset), Rosie Buccellato and Allyson Kapin, Co-Founder of Rad Campaign and Founder of Women Who Tech.

Good afternoon everyone.

My name is Lizabeth Wesely-Casella and I’m an advocate for weight stigma prevention.

I work with people at every level of government, from the White House to the grassroots, to identify language and messaging that contribute to people being discriminated against and that promote disordered relationships with food.

Because I think about this all the time I’ve drawn certain conclusions about how to reduce the public’s appetite for practices like Photoshop.  From my perspective, we’re going to have to come at this with a combination of legislation and a cultural shift; sort of like the classic ‘pincer’ strategy in battlefield combat.

Since you all know what legislation is, I’m going to focus on the part about “cultural shift” today.

So, how do we begin a movement that large?

Well, it starts by understanding two basic concepts; that healthy bodies come in all shapes and sizes and that you can’t estimate a person’s health based on their shape.

It’s not possible to diagnose a person without a full medical examination, and yet because of practices like Photoshop and weight biased commentary, we’re encouraged to make assertions about people as ‘healthy’ or ‘unhealthy’ all the time.

My point is, preventing weight bias is about taking the old assumptions, like that you can look at another person and estimate their health based on how they look, and putting that aside.  It means filling that void with concepts like “size diversity” and “health at every size” (HAES®), both of which are designed to support the idea that healthy bodies are due to healthy behaviors, not chasing after a shape or a number.

I’d originally planned to play a clip from an upcoming documentary called Fattitude in order to demonstrate what weight bias looks and sounds like in pop-culture but unfortunately it got lost in the shuffle of the approval process.  Though it would have been helpful to watch the montage of weight representations in TV and movies, I’m certain that we can each scroll through our own experience to draw examples of what we know to be weight based jokes and body shaming stereotypes.

If we’re going to make that cultural shift I’m focused on, we must encourage decision makers in both marketing and entertainment to examine their sales behaviors.  This includes the lazy creation process of defaulting to the fat person as the butt of the joke and stereotyping ultra thin women as hard and shrill. 

If you’re interested in weight bias in pop culture or cultural competence around size diversity, I highly recommend that you check out the trailer for the Fattitude documentary at  The director/producer team of Lindsey Averill and Viri Lieberman is creating something that will be really influential.

12So changing gears, let’s look at what weight bias in conversation sounds like.

For the larger body it might sounds like:

“She’s so unhealthy! Look at how big she is!”

“She’s undisciplined, I mean, she can’t even stick to a diet!”

“She’s not going to be a good staff member, she’s clearly lazy.”


2Or conversely, for thin people weight bias sounds like:

“OMG! She’s anorexic! She’s probably nasty too.”

“I bet she’s spoiled.  Just look at her! She thinks she’s all that.”

Or, most concerning, coming from a doctor “I don’t have to spend a lot of time on her exam, she’s clearly healthy.  Just look at her”

Weight bias in the medical setting is a particularly serious problem for people with both of these shapes. 

For the thin-bodied person it may mean they aren’t properly examined because they are assumed to be healthy and that’s dangerous.

The person in that thin body deserves all the benefits of a thorough exam. They deserve, but may not receive, a full inspection of the organs, inspection of food relationships and discussion about eating habits.  It’s because they fit into a set of assumptions due to their shape that they may be receiving inferior care.

For the large-bodied person, weight bias in the medical setting means that the doctor assumes the patient is lazy and non-compliant; that they lack the discipline to follow directives that support their own care and health.

Frequently, larger bodied people report that their doctors won’t investigate health concerns without leveraging some sort of weight loss program to influence their behavior.  Translated that means the fat person walks into the doctors office with a 30 lb axe in their head complaining of a headache and the doctor says, “You need to lose 30 pounds.  Have you tried Medifast?”

Clearly both scenarios are unacceptable if not unethical but the good news is that they’re being addressed more frequently as we talk about weight bias and how to prevent it in the medical setting.

There are a number of organizations that are doing really good work around patient advocacy; the Binge Eating Disorder Association (BEDA), the Association for Size Diversity and Health (ASDAH) and the National Association to Advance Fat Acceptance (NAAFA) are the first to come to mind.  These groups have developed toolkits that assist people in having “The Talk” with their doctor and they are trying to educate the medical community while at the same time empowering people to speak up about their needs and to be aware that they have a voice if they feel they’re being discriminated against.

So, that’s weight bias.   The quick definition being: Weight bias is the external behavior we display due to our beliefs about what other people’s body size says about them.

The quick definition of weight stigma is the internal dialog we have because we’ve learned to believe we deserve the bias we’ve received.

Stigma is the more insidious of the two because it builds off of bias.

Stigma has many voices but often it sounds like:

“Yeah, they’re right. I am worthless.”

“I am a loser.”

“I am gross.”

“I must  be unhealthy.  Everybody says so.”

“I don’t deserve better medical care, I’m hopeless.”

Now, before I go any further, it’s clear to everyone which one of these images has the eating disorder, right?

Side by Side

Yeah, no it isn’t.  Trick question – they both do.

Both of these shots are of a woman with Binge Eating Disorder (BED) – and if you didn’t bring your glasses today, they’re both photos of me.

The reason I mention this is because a large part of BED is the restricting piece.  We binge and then starve ourselves out of shame for both having lost control around food and for the added bulk which inevitably finds it way on to our bodies. 

That restricting piece is emboldened by the fact that we are constantly reminded how unacceptable the larger body is – by both Photoshop and biased commentary.

It’s a catch 22 that starts out with

  • anxiety provoking messages,
  • which builds inner turmoil,
  • which is then soothed by disordered eating behavior,
  • which triggers shame,
  • which is again soothed by restricting,
  • which is encouraged by anxiety provoking images and messages.

It’s a cycle that, if left unexamined, could go on forever – and that’s what we’re looking to stop.

So what can we do to help that person?  What can WE do for that human Venn diagram of eating disorders and weight bias and weight stigma?

We can act on the topics that brought us here today.

We can change the discussion, revealing the false equivalency of size and weight and health and we can choose to support media that doesn’t Photoshop.

If we reduce occurrences of weight bias, promoted by Photoshop and other weight biased commendary, we return permission to people to love and care for their bodies.  To live with a sense of trust that the body is a good thing, not a casing to fight against or a form to be ashamed of.

To be clear, not all people with eating disorders are suffering due to pressures from bias and/or stigma.  Some people are simply terrified of food while others get a bio-chemical high from their behaviors.

But for those of us who are triggered by influences that shame us for being who we are and that promise acceptance if we achieve being something we are not, reducing the volume of that message by reducing the number of occasions that we’re subjected to those messages – by media, family, friends, doctors, national programs…  It will have a tremendous impact.

If even 1/5 of the 35 million Americans with eating disorders benefit from a reduction in weight bias in our culture; that’s 7 million less triggered people in the US alone – that’s more than 2 times the population of the entire state of Iowa.

For me, practices like Photoshop and a culture that feels free to be vocal and critical of my body were a HUGE part of my eating disorder.

As I learned more about the factors that contribute to my build and my life, it turns out that I should be shaped like…

Great Great Great Grandma Knickerbockermy great, great, great grandmother.

I’m supposed to be shaped like a German farming peasant – only with better shoes and a flirty skirt.

As it turns out, if I eat healthfully, engage in proper exercise, get the right amount of rest – I look like this, and my insides are thriving.  I cannot be a different shape and in better health because taking the best care of me produces this result.  I’ve learned to love the fact that health looks like this on me.

So what am I asking you to do here?

I’m asking you to help me create that cultural shift.

  • Influence policy and guide your boss’s messaging.
  • Provide your constituents with safe harbor from weight bias by talking about healthy habits rather than using examples of “good” and “bad” body shapes or equating body shapes to character.
  • Encourage others to disconnect the “shape equals health” rhetoric.
  • Be my partner and make policy that supports the grassroots and advocates like me to end weight bias promoted through Photoshop and similar stigmatizing practices.

I’m asking for us to work together to put and end to all of it.

Thank you!


  1. Becky Henry
    Becky Henry08-08-2014

    Thank you Lizabeth for your advocacy work in helping to reduce both weight stigma and weight bias.

    I’m also grateful that you’re so clear that these messages are triggering for some people with eating disorders and not all. And , that these messages can be triggers not causes of eating disorders.

    I look forward to meeting you at the M.O.M. March on D.C. On September 30th.
    Becky Henry
    Founder, Hope Network, LLC

    • Admin

      Thank you! Laura Collins and I talked a lot about the roll that images and commentary have on ppl with ED and whether of not it/they have more or less impact on each form of ED. I think we both came away with the same answer, ‘there is no one size fits all’ and I certainly can’t claim to speak for everyone. I appreciate your words and thank you for sharing them with me!

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