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. |