“Not underweight. Doesn’t meet criteria”: The Discrimination of Higher Weight Eating Disorder Patients

By Ashley Solomon, PsyD, CEDS, USA

“Not underweight. Doesn’t meet criteria.” I’ve heard this statement far too many times to count in my years as an eating disorders specialist, and yet it never ceases to leave me seething.

In my community, and in others around the world, patients of higher weights with eating disorders are routinely unrecognized by their healthcare providers and denied life-saving care by their insurance companies.

These practices fly in the face of evidence that eating disorders occurring at any weight cause significant medical, psychiatric, and emotional problems for the sufferer. Our newest research highlights how eating disorders change our neurobiology and our gut bacteria, not to mention our vocational status, our relationships, and our chance at a values-driven life. These changes are not unique to people who are severely underweight. They impact people of all weights, shapes, and sizes.

Denying Treatment is a Social Justice Issue

Perhaps the group most discriminated against by the lack of community knowledge and unfair insurance practices are those individuals with binge eating disorder. When these patients see their family doctor, they are given prescriptions for weight loss drugs or told to cut back on carbohydrates. Meanwhile, when needing to access necessary and life-saving care, too many of these people are denied coverage or provided inadequate coverage by insurance. This occurs when insurance companies systematically exclude binge eating disorder as a covered benefit, do not include higher levels of care as an option, or deny care based on an individual’s BMI not being “dangerously low.”

I personally see these practices and the systematic discrimination of higher weight patients for eating disorder treatment as a social justice issue. Failing to recommend or denying treatment that can interrupt life-threatening symptoms and help a person heal their body and mind is dangerous and unfair.

So what are we going to do about it?

First, we have to start talking about this and not allowing these issues to go unaddressed. We have to educate community providers, particularly the medical community, to recognize eating disorders in higher weight patients, to stop telling them to diet, and to provide appropriate referrals for care when needed. We need to advocate for higher weight patients to get the care that they need and deserve. We have to educate the individuals themselves to know their own rights when it comes to advocating for care.

Perhaps it’s unfortunate that eating disorders aren’t as simple as a series of numbers on a page, as some would have us believe – BMIs and phosphorous levels and percentages of ideal body weight – because if they were a simple math equation, there should be a simple solution. But the reality remains that there are human beings behind each of those numbers. And human beings are, fortunately, never simple.

About Ashley 
Dr. Solomon is a psychologist and eating disorder advocate. She serves as the Executive Director of Eating Recovery Center, Ohio, where she ensures that patients are treated with the highest quality of evidenced-based care. She is actively engaged in helping patients of all shapes and sizes have access to the treatment that they deserve. She also serves as the co-chair of the Academy for Eating Disorders’ Social Media Committee and has worked to disseminate the important messages of World Eating Disorder Action Day. Dr Solomon has a special interest in how technology and social media can enhance treatment, provider education, and advocacy.

Join Ashley in supporting World Eating Disorders Action Day. Be sure to follow along on Twitter @WorldEDDay and hashtag #WeDoAct, #WorldEDActionDay, @WorldEatingDisordersAction on Instagram and World Eating Disorders Action Day on Facebook.