Young People, Body Image and Eating Disorders
Feeling fat. Is this an experience that you have had recently or that you have heard your partner, daughter, son or colleagues share? It is a relatively common expression and appears to transcend cultures and languages. There is an equivalent expression in most languages.
While those who identify as women and girls may be heard using the expression ‘feeling fat’ more frequently, it seems to describe an experience shared across all genders and identities.
Whilst ‘feeling fat’ can be linked to eating disorders and a distorted view of body image (for example, in body dysmorphic disorder), it is clear that this commonplace expression is also used in general populations and by those who are not impacted by eating disorders.
Over-evaluation of Shape and Weight in Eating Disorders
Those who meet the criteria for a diagnosis of anorexia nervosa, bulimia nervosa, binge eating disorder or body dysmorphic disorder appear to experience and notice ‘feeling fat’ more intensely.
The same group associates this feeling with higher levels of distress, over longer periods.
This can lead to compensatory behaviours, including restricting energy (food and liquid) intake, over-exercising, vomiting or purging, laxative use/abuse, obsessive thoughts and behaviours, self-harm and ultimately thoughts or actions linked to suicide.
Let’s take a look at why we ‘feel fat’ and why this feeling is closely linked to disordered eating, and body image concerns for teenagers, young adults and the families who love them.
Between Over-evaluating and Strict Dieting in Eating Disorders
The sensation of ‘feeling fat’ sits somewhere between the over-evaluation and over concern in body shape and size and the harsh, strict, restricting dieting regimen that follows.
It is a cycle that can be incredibly difficult to break but is remarkably easy to self-reinforce. The negative beliefs held in relation to the body, reinforce the hard, internal critical messages that push teenagers, young people, and adults to feel that they need to correct or change the outcome.
Diet leads to diet. Diet leads to over-evaluation, obsession, rigidity and control. The longer the cycles continue, the more difficult the pattern is to break.
Fat is Not a Feeling
‘I feel fat’ is a universal expression, but we understand that ‘fat’ is not really a feeling. The physical fat stored in our bodies is not an emotion and therefore is not something that we can ‘feel’. ‘Feeling fat’ is descriptive and a narrative that we share with ourselves or others to describe a (usually) negative state of being.
Feeling fat has nothing to do with the scales.
It is clear from talking with many young people (and adults) from every corner of the world that the feeling or bodily sensation that we personally associate with ‘fat’ has absolutely nothing to do with body shape, size or weight. Those in larger bodies, as well as those in smaller bodies, experience the feelings and sensations that are unique and descriptive for them.
Hour by Hour, Day to Day
There is no doubt that ‘feeling fat’ is a powerful and sometimes overwhelming narrative.
Young people and adults alike describe the ‘knock-on’ effect on their days. Mood changes, changing plans, social withdrawal, anxiety, disgust and rage are all regularly described.
It can also be immensely changeable. Feelings can change rapidly or sometimes last for hours or days. The feelings can come and go on the same day, or even the same hour. On each occasion, it will be experienced as real and powerful.
Physical or Biological Change
The sensations and related experiences can be very powerful and of varying duration. However, we know that the body does not change in this way; daily or even hourly changes to shape, size and fat distribution are just not possible.
We mislabel ‘fat’. So, what is actually happening when we ‘feel fat’?
If the fat that we ‘feel’ is not a ‘feeling’, we may be attempting to describe a state or sensation that has a particular and descriptive meaning for us. Research indicates that people in general, and specifically people with food and body issues, equate ‘feeling fat’ with ‘feeling bad’. In turn, we reinforce that being ‘thinner’ equates to being healthier and happier. It is, however, the bad feeling that we attempt to describe in all of its complexity. It turns out that our feeling of fat is a shorthand internal rule or message for many more subtle events and changes.
There are three reasons why we may experience this ‘feeling’:
1. We experience increased bodily awareness
Something caught our attention and made us more aware of our body at that moment. (For those meeting the criteria for diagnosis for eating disorders and body dysmorphic disorder, there is a heightened awareness or high alert state for much of the time.)
Factors that may increase our bodily awareness include:
- Someone commenting on our appearance (in either a positive or negative manner)
- Feeling sweaty
- Feeling movement or wobbles during exercise
- Clothing that feels tight or feels unusual against the skin
- Body checking
- Bloating
- Feeling unwell.
2. We experience an uncomfortable or adverse physical state
We may mislabel or misfile other uncomfortable, unpleasant or adverse bodily or physical states. The experience of these may trigger us to label ourselves negatively or critically.
Examples of adverse physical experiences include:
- Bloating
- PMS (premenstrual syndrome)
- Feeling excessively full
- Feeling sleepy, tired or exhausted
- Feeling bloated, puffy or sore.
3. We may be experiencing other emotions
We may mislabel emotions that we find uncomfortable, unpleasant or exhausting. These emotions may be difficult for us to place, and we associate them with a negative bodily experience.
Some examples of negative emotional states and experiences:
- Feeling low
- Feeling bored
- Feeling lonely
- Feeling unloved.
How Can We Look at Our Unique Experiences?
Having a really good look at anything that causes us to experience emotional turmoil, change of mood or affects our wellbeing is hugely beneficial. Great therapy can help us access answers to many of these things and find peace with even the oldest of the skeletons in the closet.
For those concerned about eating disorders or matters related to food and body, finding a solution to intense and often limiting beliefs is essential. Working with an eating disorder specialist can be the first step towards full recovery.
Journaling and Keeping Notes
Your therapist may ask you to keep a note of the times you describe ‘feeling fat’. They may ask you to journal this is a therapy journal or provide you with ‘Food and Mood’ worksheets, similar to the workbooks we use in The WaveED programs.
Your therapist will ask you whether you ever experience times where you feel or have felt ‘fat’. They may ask how this differs from your usual heightened body awareness or general bodily dissatisfaction. They may ask you to notes ‘peaks’ in the feelings you experience or note the times that feel worse or more intense than others.
Unpacking the Feelings
When you share your notes of feelings with your therapist, they will help you to further unpack the associated feelings. They may ask you to further explore what was happening externally and internally on the days that you recorded having intense feelings in your body and mind.
Unpacking the more subtle changes, the clues, the experiences and the increased bodily awareness sensors helps us begin to notice what triggers our change in sensation and perception. This, in turn, helps us practice choosing new ways to react to these triggers in the moment, without the burden of translating them into internally critical messages.
CBT-E
Enhanced Cognitive Behavioural Therapy (CBT-E) is an evidence-based psychotherapy and one of the preferred treatment modalities in The Wave Program for Eating Disorders.
It was developed by Professor Christopher Fairburn, at Oxford’s Department of Psychiatry.
In May 2017, NICE (National Institute for Clinical Excellence, U.K) recommended that CBT-E be used to treat all forms of eating disorders in adults, with adaptations for special populations including adolescents and complex cases, such as chemical dependency (substance use disorder or addiction) and personality or mood disorders (borderline personality disorder or histrionic personality disorder).
A Celebration of Us – All of Us
In writing this short article, we celebrate body diversity. We honour the differences in size, race, ethnicity, gender, dis/ability, sexual orientation, religion, class and other human attributes, in line with ‘Health At Every Size’ (HAES) principles and excellence in eating disorder treatment.
* ’Fat’ is used in this article as a descriptive term, used by young people and adults in consultation and colloquially. There are no pejorative connotations.
Fiona Yassin is the International Clinical Director at The Wave Clinic, Kuala Lumpur. She is an accredited psychotherapist and supervisor, specialising in children, teenagers and families.
Fiona is:
- a member of the National Council of Psychotherapists (UK) and International Council of Psychotherapists (Registration Number #361609)
- a trained EMDR therapist (Level 1 & 2) and member of EMDRIA (Registration Number #100054651)
- a member of the Association of Child Protection Professionals
- a member of the International Association of Eating Disorder Professionals
- trained in CBT-E (Oxford’s Department of Psychiatry – CREDO) and FREED (King’s College, London).
- accredited and licensed to supervise clinicians (UNCG)
- a fellow of APPCH.
Fiona has a specialist interest in eating disorders and borderline personality disorder. She is co-founder of The Wave Clinic, Kuala Lumpur, home to Asia’s only Eating Disorder and Adolescent Mental Health Programs.
She is also a director of The Wave Trust, a charitable enterprise supporting mental health, child poverty and educational developments in South East Asia.
