January 19th, 2025
Destigmatizing Eating Disorders: A Viable Solution
Eating Disorders are Real Mental Health Issues
Eating disorders are serious mental health conditions recognized clinically but largely minimized by the healthcare industry and society as a whole.
This is especially true of binge eating disorder (BED), a clinical mental health diagnosis that involves discrete episodes of binge eating, in which individuals consume large amounts of food quickly and persistently (~1/wk for >3 months in 2-hour periods), often feeling a lack of control, guilt, and shame.
Like all eating disorders, BED can lead to significant distress and health issues. Understanding the factors that contribute to BED is essential, particularly as they relate to social justice and equity for recognition in healthcare.
Invalidation & Stigma Increase Eating Disorder Risk
In a recent study of eating disorder experts, Dr. Brenna Bray (PhD), founder of the NourishED Research Foundation, aimed to explore the environmental factors influencing binge eating disorder and other mental health disparities.
The research included 14 expert researchers, clinicians, policymakers, and healthcare administrators, chosen for their influence in the field. Interviews were conducted anonymously, allowing experts to express their views freely. The interviews revealed important themes that connect eating disorders and mental health disparity to broader social justice issues.
One of the most significant factors experts associate with mental health risk is invalidation. This includes invalidating experiences, environments, and systems as well as systemic issues and systems of oppression (Bray et al., 2022).
Invalidation & Stigma Cause Adversity and Trauma
Experts indicated that invalidation — in any form, by any individual, including parents, family members, healthcare clinicians, or government programs, mandates, and systems — can significantly impact development and maintenance of eating disorders and other risky health behaviors, including alcohol and substance misuse/abuse.
These maladaptive behaviors often provide innate means of coping with a large variety of negative adverse experiences that can include invalidation, oppression, discrimination and injustice, marginalization, stigmatization, lack of access to resource support and other forms of inequity, economic hardships, food insecurity, nutrition scarcity, predatory social media and food environments and practices, and more traditional forms of adversity and trauma, including physical, emotional, verbal, and sexual violence and abuse.
Invalidation & Stigma in the Home & Healthcare Systems
“The stigma that exists around eating disorders – and mental health more broadly – cannot be overstated,” Dr. Bray said.
“Of course, individuals themselves often feel guilt and shame but there are deeper levels of stigma we often fail to recognize.”
Dr. Bray’s research identifies stigma as an important factor that contributes to the development and severity of eating disorders – and also often prevents supportive care.
Dr. Bray’s work aligns with a growing awareness in the field of the impacts of stigmatization that exist at the level of the patient, but also within healthcare systems, among healthcare providers themselves, and socioculturally.
“I have a patient with binge eating disorder whose doctor told her, ‘you’re fat every day, so you should exercise every day.’ That’s from a health care practitioner. But that’s really . . . what we’re telling people [as a culture/society] . . . the practitioner just put [it into] words,” one expert in Dr. Bray’s study stated (Bray et al., 2022).
“That level of stigma, weight bias, invalidation… it not only hurts the patient and contributes to healthcare avoidance; it borders on malpractice,” Dr Bray said.
Stigmatization as a Barrier to Health Care
The stigma that many folks with eating disorders experience – especially those living in larger bodies – was identified by experts as a major barrier to care. “Many individuals with eating disorders feel immense guilt and shame about their already-traumatic experiences,” Dr. Bray stated. “The stigma really just compounds that.”
Moreover, the stigmatization and equity that exists within healthcare systems often leads to healthcare avoidance among individuals with eating disorders, and especially those living in larger bodies or who hold marginalized identifies.
“We have a lot of research now demonstrating the very real prevalence of healthcare inequity and injustice within healthcare systems,” Dr Bray stated. One expert in Dr. Bray’s study was quoted saying “The police are to black men as the medical establishment is to black women,” (Bray et al., 2022).
Changing Mental Health Disparities: Direct Health-Efficacy Support
As a means to move forward and impact change around the issue of mental health disparity broadly, Dr. Bray founded the NourishED Research Institue (NRFi, www.nourishedrfi.org).
NRFi is a tax-exempt, 501(c)(3) nonprofit organization that aims to impact sustainable change in eating disorder and mental health risk, prevalence, and experience by addressing eating disorder and mental health risk factors through a multi-faceted approach.
“At NourishED, we use integrative research and clinical expertise to raise the narratives of those who experience eating disorders and other mental health disaprities,” Dr. Bray says.
“We create and distribute accessible and affordable resources to support eating disorder and mental health management and care, based on the experiences and needs identified by those who experience them, including the ~95% of folks with eating disorders – and mental health illnesses more broadly – who never receive a formal diagnosis or care — because their experiences and needs matter too, if not more!”
Changing Mental Health Disparities in Healthcare Systems
“[The NourishED Research Foundation also uses] research to create clinical accreditation and training programs that can help support healthcare clinicians in managing eating disorder and mental health detection, screening, diagnosis, and care,” Dr. Bray says.
“So, for example, we provide training on how to navigate conversations about weight and its health risks – when present – in ways that are sensitive to patients’ traumatic experiences around this issue. We also emphasize the importance of placing equal (if not greater) value on the underlying psychopathology that often drives the disordered behavior and subsequent weight gain.”
We’re currently developing an online accreditation program that we’re calling the “JEDI-SAM-IV” because it offers an “IV-dose” of training in Justice, Equity, Diversity, Inclusion, Stigmatization, Access, Marginalization, and InValidation in healthcare systems that present major barriers to care,” Dr. Bray says, referring her upcoming 2025 publication (Bray et al., “Treatment Access Barriers in Binge Eating Disorder”).
Changing the Environments Mental Health Disparities Occur In
“Additionally, we use social media campaigns, public speaking engagements, posts, publications, all forms of media to raise awareness around these issues and change the environments eating disorders and mental health disparities occur in,” Dr. Bray says.
“Overall, we need to be changing the narrative around eating disorders. The question we should be asking [those who experience disordered eating] is not ‘what’s wrong with you and how can we fix you;’ but ‘what happened to you and how can we support you,” Dr. Bray said.
Sources
-
Bray et al. (2022). Binge Eating Disorder Is a Social Justice Issue: A Cross-Sectional Mixed-Methods Study of Binge Eating Disorder Experts’ Opinions. International journal of environmental research and public health, 19(10), 6243. https://doi.org/10.3390/ijerph19106243.
-
Bray et al. (2025). Treatment Access Barriers in Binge Eating Disorder: A Cross-Sectional Mixed-Methods Study of Binge Eating Disorder Experts’ Opinions. International journal of environmental research and public health [submitted].
-
Bray et al. (2023). Clinical aspects of binge eating disorder: A cross-sectional mixed-methods study of binge eating disorder experts’ perspectives. Frontiers in psychiatry, 13, 1087165. https://doi.org/10.3389/fpsyt.2022.1087165.
-
Bray et al. (2022). Mental health aspects of binge eating disorder: A cross-sectional mixed-methods study of binge eating disorder experts’ perspectives. Frontiers in psychiatry, 13, 953203. https://doi.org/10.3389/fpsyt.2022.953203.
-
The NourishED Research Foundation (NRFi). (2024). About the NourishED Research Foundation. Accessed June 1, 2024. www.nourishedrfi.org
![](https://aboutboulder.com/wp-content/uploads/2018/07/2-2.png")
