Table 3.

Themes and Illustrative Quotes of Weight Stigma Pre-Treatment for ED

Weight Stigma Pre-Treatment for ED

Provider Encourage or Congratulate ED Behaviors

Riley: Some of the worst damage that I have done to myself has been through dieting and has been supported by my doctors. Doctors… helped me find better ways to starve myself for 30 years.

Tori: Two weeks later… I had lost like 20 pounds… She was like “oh how did you do it?” I was like “I just haven’t been eating…” “Oh… it’s okay I’m so proud of you for losing weight…” I just remember thinking, huh… alright, as long as I’m losing weight, I guess it’s okay. I knew it wasn’t… My size has made it so that I am laughed at, and told to continue my ED…

Amanda: I just got reamed out for 20 minutes by this [OBGYN]… I needed to lose weight. That I shouldn’t be fat. I was terrified and mortified. Yeah, it just solidified my ED.

Providers Not Noticing or Seeing ED

Lynn: [Doctors] just look at you, and if you look healthy, you’re good to go. But there can be a lot going on underneath even if you’re in a healthy weight range…

Lexi: I’ve had a doctor say, “Well, you don’t look anorexic. You don’t look underweight... do you want to look like someone who is anorexic?” I was like, “I have no idea why you are asking this or how to answer this question.”

Jen: If you’re round, you just don’t have a restrictive ED. You never did. Or maybe you did, but what was your lowest? Oh, your lowest was a BMI of overweight? Well, you know… It doesn’t count. Nobody sees it except for, you know, true, true, true ED professionals. Nobody sees it as possible.

Missed Screening Opportunities

Bette: I was running at least 3 miles a night, and I was not really eating. …I would eat equal packets and ice... When I had, sort of like, talked to a doctor about this, their sort of response was like, “Well, your weight looks good. You know, your blood pressure is low, your heartbeat’s low. That means you’re healthy.” And I would think that if I had a smaller body, those behaviors would have been looked at in a different way.

Arati: I don’t remember their ever talking about [my ED] other than to say to put it in the context of some of my labs and to say you really need to exercise more. You really need to lose weight...

Gretchen: There was never a concern [for an ED]. I think the doctor was like, “Maybe you’re losing [weight] too fast…” I don’t even know if I got that… There was always just a pat on the back.

Providers Discounting or Minimizing ED

Joanna: I think that if I had been smaller and not having a period, they might have looked at my nutritional intake as a consideration of why I’m not having a period, but that wasn’t ever considered.

Eli: I [told my doctor] that I thought I had an ED... he said that I was doing just fine... and I could actually probably lose a little bit of weight… I knew that I was sick… but I just wasn’t sick enough. I wasn’t physically emaciated or thin enough to be considered.

Bette: All the times that I tried to communicate that I’m really tired, and my hair’s falling out, and my skin is just bleeding; it’s so dry... and all these other things. And providers would just answer back with... you know, “Are you putting on lotion?”

Delay of Care

Riley: I have been before doctors my entire life, and no one diagnosed me with an ED until I went into treatment and said, “I have an ED and I need you to pay attention.”

Sisu: I think my body size is the reason why I was never diagnosed with an ED until this study… I think my body size has affected everything about my medical care and ED care.

Charlie: I could have potentially been diagnosed really early on this—Before I had, like, really deeply-entrenched behaviors, and thoughts and coping mechanisms, and I could have lived a less stressful life.