I wrote this post four months ago, right before I was miraculously given a scholarship to treatment. At that point I assumed I had no treatment options and my doctor told me I was going to die without treatment. I planned to submit it somewhere anonymously but now that I’ve shared my story, I decided to share it here. TRIGGER WARNING as this discusses weight lost and eating disorder behaviors so please take that into consideration before reading.

Last week I was rejected from an inpatient eating disorder program because I’m not underweight. I’m not underweight and therefore my eating disorder is irrelevant. I shouldn’t be surprised as this has been my experience in my twenty year battle with an eating disorder. But I still felt somewhat disappointed as it was my only option for help with the insurance I have and now I’m currently out of options.Never mind that I lost more than 1/3 of my body weight by starving myself, never mind that I force myself to throw up every single day. Never mind that my pancreas has been starting to show signs of strain or that I had a tear in my esophagus. Never mind that I passed out in the shower after my workout last week. My eating disorder is invisible and my eating disorder is irrelevant because I’m not underweight.

I often have a tough time believing that my eating disorder is problematic. Denial is pretty common in eating disorders but I have treatment centers and insurance confirming that my eating disorder doesn’t warrant additional help. Admission to inpatient and residential treatment centers are largely based on BMI. So someone who was slim to begin with, lost weight due to their eating disorder, and is now underweight can easily be admitted for treatment. Myself on the other hand? I lost 60 lbs in a couple of months and purge 2-6x a day but I only got to an average BMI. My body is always going to be naturally larger due to genetics, PCOS, and years of starving myself.

fatphobia in eating disorder treatment

And you know what’s been absolutely fascinating? I’ve watched my best friend struggle with her eating disorder alongside mine for the last 12 years. And I’ve watched her insurance pay for one inpatient and residential stay after the next, whenever she needed it. No questions asked, no insurance battles. She would become  underweight and it’s BMI, not the behaviors, that apparently determine whether or not someone is worthy or sick enough to receive help for their eating disorder.

I’m so damn tired of fighting. My eating disorder started when I was 10 but no one caught on until I was 14 because…. you guessed it, I wasn’t underweight. I had a raging eating disorder for 4 long years and even confessed my dirty secret to a school counselor and a therapist who dismissed it because I couldn’t have an eating disorder in the body I had. Well, by the time the adults in my life caught on, it had spiraled well beyond my control and I was put into a treatment center where I was congratulated for trying to lose weight.

I struggled in secret with my eating disorder throughout my 20’s. It was particularly bad in my mid 20’s but I was congratulated and praised by everyone around me for my weight loss – including medical professionals. After losing 70 lbs by completely starving myself and throwing up the little I did eat, my doctor told me, “Ok, you can stop now.” He knew about my eating disorder, was really concerned about my health, and STILL had that reaction. If any thin person had engaged in any of the behaviors I was engaging in, they would’ve been thrown straight into a hospital. But me? I was congratulated and praised because in our culture, fat people are hated so much that you better make sure you try and lose weight at ANY cost.

Exactly a year ago, I started struggling intensely again. I tried to remind myself that going back to the eating disorder wouldn’t solve anything or make me happy. But I felt trapped in my body and couldn’t seem to handle the assumptions and judgements people made about me based on my size. I couldn’t seem to shake off the intense anxiety and shame I felt every time I ate. I just wanted to be smaller so that I wouldn’t stand out or be seen. Obviously, this is not just about acceptance from the world as my eating disorder also has a strong biological component along with childhood trauma. But our culture’s attitude toward larger bodies adds fuel to the existing fire and makes it feel unbearable to me to exist in my larger body.

So I starved myself down to an average weight and now it’s one year later and I can’t seem to stop this cycle. I promised myself I’d stop after 10 lbs and then of course I changed it to 10 more and then 10 more. Every day I promise myself I’ll make better choices and every day I succumb to the eating disorder. On some level I recognize that I need help because the thoughts and behaviors are all consuming. But on the other hand, when I finally agreed to pursue additional help after a lot of insistence from my dietitian, I was essentially told that I’m too fat for treatment.

I’ve seen countless people die from their eating disorders because they couldn’t afford to get the help they needed. Inpatient and residential care can cost around $2000 a day so if you’re not rich or underweight, you don’t really have the options to get the care you need. Eating disorders have the highest mortality rate of any mental illness and I’m worried that I’m going to become another statistic. People in ALL size bodies suffer with eating disorders and they all deserve to get the help they need to treat it- not just the underweight ones! Treatment centers and insurances need to stop using weight as their barometer of assessing how sick people with eating disorders are or more and more people are going to die. Things need to change.