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Everyone says that I should love my body, but how can I when it feels like it’s changing everyday?
Throughout my years as an eating disorder dietitian, so many of my clients have repeated this exact line. Sometimes spoken loudly, sometimes with tears, and sometimes apprehensively waiting for me to tell them that they’re wrong. That loving your body is easy if you just will yourself.
Love your body. Love your fat. Fat is normal. Embrace your rolls. All of these well-meaning messages are blasted on eating disorder recovery accounts online. Often repeated by friends, family, and treatment teams of those in recovery. Although body acceptance is an essential part of recovery, sometimes some of the steps required to get there are messy and consequently missed by support networks, leaving those in recovery feeling isolated or ashamed.
Once people in recovery reach the outpatient setting, many of them turn to support groups in order to find a community that they can relate to- an essential part of anyone’s healing process. But many of them have also left defeated, deciding not to return because they have been discouraged from expressing any amount of discontent with their bodies. Although the intent by facilitators is well meaning- to encourage body acceptance and avoid triggering other participants- it often inadvertently invalidates folks and shames them from exploring inevitable stages of recovery.
Physical image is a key aspect of our identity
As much as we may not want to admit it, physical image makes up part of our identity. Our physical appearance allows us to communicate our identity to others, and for others to identify us. Certain features can reflect specific phases of our lives, such as colored hair reflecting our youth. Dense muscle mass of our years playing competitive sports. A flatter stomach of life before kids. A scar of an incident. A round nose of a parent. Hair length of our culture. Natural changes in our appearance are often unsettling to most of us. A reminder that living, aging, and loss are non-consensual. The reminder of our losses staring us in the face every time we look in the mirror.
Many of us find ways to cope with these changes. Maybe we dye our hair, get back into childhood hobbies, scrapbook, or change our wardrobe. Sometimes, we ignore the change, able to cope by focusing on the aspects of our present lives or appearance that give us joy and make us feel secure.
Eating disorders lean heavily on physical image to define one’s identity
Folks with eating disorders often have more difficulty coping with changes in their physical appearance as they develop an identity that is overwhelmingly dependent on their weight and body size. Researchers have observed that Anorexia Nervosa often develops when an individual experiences identity disturbance and weaker self of sense. This leaves adolescents particularly vulnerable to developing eating disorders as identity formation is a key development stage for this age group (Vankerckhoven et al. 2023). Croce et al. state in their narrative review of identity and Anorexia, “…it is this coping mechanism of bodily control, aimed at alleviating distress caused by identity disturbance, which ultimately becomes the driving force of AN development and maintenance” (2024).
When an individual enters eating disorder treatment, they are taught how to engage and strengthen other parts of their identity to help improve their self-image. Although it is an empowering process, it can also be quite challenging as it requires people to let go of their eating disorder which many have depended on for years.
The reality of letting go of their self-image becomes even more surreal when the individual is required to gain 2 lbs per week for several weeks, if not several months, in order for their body to properly heal from malnutrition. Even folks who are not required to weight restore often gain weight during eating disorder recovery as their bodies are adjusting to being consistently nourished. Often for the first time in their adult lives.
Many of us have probably seen the models of what a pound of fat looks like. If not, imagine a lumpy grapefruit that you can hold in your hand. Now imagine adding two of these lumps onto a body with very little fat to begin with. The change can be alarming especially since many of these people are gaining fat in ways they have never experienced before.
Now consider that many of these clients developed eating disorders during adolescence, leading to arrested puberty. Some fat gain on another wise healthy adult would simply fill out the already established contours of one’s body. But fat gain on one of these patients will stimulate otherwise stunted physical maturity, potentially leading to the development of shapes that they have never experienced before. And due to the necessary aggressive weight gain requirement in treatment, at an alarming rate.
Although their weight gain is necessary for the improvement of both their physical and mental health, why are we expected to act as if the process isn’t scary? As if their distress is unusual?
We need to create safe spaces for people to navigate their experiences
A difficulty that most people in these situations experience is being able to find a community to process their feelings with, but without inadvertently harming others. Processing issues with body changes can trigger other members of the group to be critical of themselves. It can also bring up or inadvertently come across as fatphobia. This is especially challenging in treatment milieus where a wide range of body sizes and backgrounds exist. So how do we support those undergoing significant body changes?
First it’s important for providers and support systems to acknowledge the significant changes that people in recovery are experiencing. Even if their body changes may not seem significant to you, they are certainly significant enough to them. Their shape is likely not just changing but maturing. This can be quite unsettling especially for someone whose identity may be entirely centered around their youth.
That being said, the identity that the eating disorder latches itself onto bears great significance to the client. For example, some folks with eating disorders desire a specific body type, as the size of that body may have protected them from sexual or physical harm. A trans teen may restrict their intake as a teen, afraid of developing sex characteristics of a body type that they feel alien to. Providers need to be attuned to the fact that when a client is grieving their malnourished body, they are grieving more than a lower body fat percentage. Often they are experiencing the loss of safety, of their youth, of comfort, of stability. Their body image is not just informed by the characteristics of their body, but mostly by their image of themselves.
Although body acceptance is the ultimate goal, allowing folks to experience the full range of emotions that come up as their body changes is essential to get there. Don’t they deserve to? Eating disorder treatment requires so much from clients to begin with, can you imagine letting go of the central part of your identity too?
The anger, grief, or anxiety that may come up during weight restoration is not a lack of commitment to recovery. It is growth. It is a symptom of an adequately nourished body and supportive therapeutic process that allows the individual to develop enough confidence to experience their feelings deeply. Feelings that have often been buried by the eating disorder for years. If we invalidate their distress, we risk them burying it again to avoid feeling the shame of “not doing recovery right”. But if we create a supportive space in which they can feel these feelings, they may eventually be able to accept them and let go.
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Sources:
Croce, S. R., Malcolm, A. C., Ralph-Nearman, C., & Phillipou, A. (2024). The role of identity in anorexia nervosa: A narrative review. New Ideas in Psychology, 72, 101060. https://doi.org/10.1016/j.newideapsych.2023.101060
Vankerckhoven, L., Raemen, L., Claes, L., Eggermont, S., Palmeroni, N., & Luyckx, K. (2023, March). Identity Formation, body image, and body-related symptoms: Developmental trajectories and associations throughout adolescence. Journal of youth and adolescence.
Zebrowitz LA, Montepare JM. Social Psychological Face Perception: Why Appearance Matters. Soc Personal Psychol Compass. 2008 May 1;2(3):1497. doi: 10.1111/j.1751-9004.2008.00109.x. PMID: 20107613; PMCID: PMC2811283.
Effects of physical appearance on self-esteem. Changing Faces. (n.d.). https://www.changingfaces.org.uk/advice-guidance/confidence-self-esteem/appearance-self-esteem/
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