So many of you shared your own horror stories. The scope of this is hard to capture in words.
Putting it bluntly: Eating disorder recovery centers are failing their patients in larger bodies. And their inability to treat patients of size has done immense harm on a scale that just can’t be understated.
Many of you asked, “What can we do? I backed the GoFundMe, but how do we fix this for everyone else?” I asked myself the same thing.
The long game, obviously, is dismantling fatphobia wherever it exists. But there are people in treatment right now who need support. So, with the input of Shira and some fabulous babes in recovery, I created this printable letter that patients of size can give to their providers.
Explaining what shouldn’t have to be explained is painful. It’s traumatic to have to outline the most basic information just to secure dignity in treatment.
If having this letter handy eases that burden, and educates providers along the way, I’m hoping it’s a step in the right direction.
While this doesn’t dismantle systemic fatphobia, it does offer an advocacy tool for this immediate moment. The most important thing was just getting this resource out into the world for anyone who needs it — which unfortunately was far, far too many of you.
I hope that this can help ease the unfair burden that folks are facing in treatment. You deserve the very best in recovery.
Please know that I won’t stop fighting for that until it’s a guarantee.
Allies and especially providers: If you appreciate the resource and have the ability to do so, please donate to Shira’s GoFundMe for treatment, and share among your networks.
When Shira and I first connected, I had a feeling in my gut that we were meant to cross paths.
She had read my article on how I used body positivity to avoid confronting my years-long battle with anorexia nervosa, and we clicked immediately.
As a fellow blogger and advocate, no one could come closer to understanding how I felt than Shira did. (Not to mention, her winning combination of New York attitude and snark, and love of all things sparkly, captured my heart immediately.)
While her organs were literally shutting down, and a terrifying fall left her badly concussed and her nose broken, she existed in a private hell that few knew about. The outside world only knew Shira as the same beam of sunshine and powerful advocate for body liberation she’d always been. But in private, Shira was dying.
In those earlier days of my recovery, Shira was a lifeline to me. To be honest, she still is.
Because even in the depths of anguish, Shira has the biggest heart of anyone I know. No matter how far down she’s fallen, she is a relentless cheerleader for those that she cares about, and the thousands of followers who have been inspired by her journey.
That’s because as a therapist, as a blogger, and as a friend, her sincere belief is that no one — not one single person — gets left behind.
Shira fought tooth and nail for four months in residential treatment, making enormous strides.
And while she was there, in a moment of extraordinary courage, Shira revealed to the world her 20-year-long battle with an eating disorder — putting her reputation as a therapist and advocate on the line to tell an undeniably powerful truth about the reality of eating disorders.
She wanted to affirm that, yes, eating disorders are a mental illness that doesn’t discriminate, even among healing professionals.
And even those who know everything there is to know about an eating disorder, about body positivity, about health at every size? Can still suffer from these relentless illnesses.
Her bravery in that moment has stuck with me every day in my recovery since then.
Throughout this past year, over texts and calls and audio messages on the train, we took on our eating disorders together. I watched Shira fight her way from the brink of death in a residential facility for four months, in awe of the grit and determination she showed up with day after day.
On the days when I didn’t want to keep going, she’d somehow telepathically sense it, I swear, because it would be less than five minutes later that I’d get a text asking, “What’s for lunch?”
After she was medically stable and eating consistently, it was time to transition to a partial hospitalization program back home, which would help ease her back into her daily life. We were both hopeful that she was well on her way to the recovery she so deserved.
Miraculously, she was able to secure a full scholarship for PHP, as insurance providers seldom cover eating disorder treatment. We were elated and hopeful.
I want to be able to tell you that, once in program, the momentum continued. But this is not that story. That program nearly destroyed her.
I don’t say that as an exaggeration. I say that as someone who listened helplessly on the other end of the phone, filled with rage, shock, and horror at everything my friend had to endure.
As an advocate, I’m not unfamiliar with the mental health care system and its horrors. As a survivor, I have stories of my own. But despite that knowledge and experience, what happened to Shira shook me to my core.
From day one, the first text I got from Shira about her new treatment team told me everything I need to know about the place: “They mocked Health at Every Size and the fact that I’m a therapist.”
My blood went cold. “Wait, what?” I typed back.
“Yeah,” she replied. “My case manager said, ‘Health at Every Size therapist? How does THAT work?’ And then when I tried to explain, she said, ‘Well, you seem to have ALL the answers.’”
But a snide comment from a case manager was just the tip of the iceberg. Things were about to get much, much worse.
The day program Shira was a part of had a “three strike” rule as part of a contract they require patients to sign.
In her gut, Shira knew that a strike system would bring out perfectionistic tendencies (a fear of failure is super common in folks with eating disorders). She voiced that, in the past, this sense of shame had sabotaged her recovery efforts.
Her concerns were brushed aside. They insisted that their “three strike” rule helps them determine if someone needs a higher level of care, and that these “boundaries” were an important part of the care they provided.
This became a pattern, though: Whenever Shira tried to voice that something wasn’t working, she was told that her “malnourishment” and her eating disorder’s “tendency to manipulate” made her an unreliable advocate for herself.
This part, of course, comes as no surprise to me. Clinicians often treat people with mental illnesses as if they aren’t competent enough to vocalize their needs and expectations.
But the strike rule would become a sticking point, because within one month, Shira — despite all of her success in her four months of residential care — would accrue all three of her allotted strikes.
The first strike happened when she refused to eat ice cream. She did so not because she was unwilling to eat it, but because of the instructions her dietician gave her cohort.
“The dietician said, ‘You three get two scoops of ice cream.’ She then looked at me and said, ‘You’ll get a kiddie scoop.’”
Some of you won’t understand the gravity of that comment. To be clear, a dietician told a patient with anorexia nervosa to eat less food than her peers, because she is a patient in a larger body.
The message here being, of course, that Shira needed to eat a child-sized portion of ice cream, because she wasn’t thin enough to “safely” consume more than that.
This plays directly into the eating disorder’s conviction that she needed to tightly control her food intake and her body. Her peers could eat a “normal” amount of ice cream. But she couldn’t and was singled out, because something was “wrong” with her body.
“This was the message I received my entire damn life,” Shira told me. “That I couldn’t eat like everyone else.”
This dietician perpetuated a fear of food and implicitly encouraged restriction, all of which are absolutely inappropriate to suggest to someone with anorexia nervosa, regardless of size.
Restriction is never an appropriate recommendation for someone with an eating disorder.
And yet that’s what she was told… in a prestigious treatment center.
Shira refused to eat the ice cream, grappling with an immense amount of shame, self-loathing, and fear. And by refusing to eat the ice cream, Shira earned her first strike.
This became an ongoing problem in treatment, in which she was told, for example, to eat 70% of her sandwich (yes, seriously). It left her feeling guilty about eating, and when she was still hungry afterward, she wondered if something was wrong with her.
Even after the center agreed to stop controlling her food intake with numbers, the damage had already been done — she knew she only “needed” to eat a percentage of what she was given, both from what she was told and what she overheard when other patients were given their food.
She began to backslide in her recovery.
Prescribing restriction for larger patients, though, wasn’t the worst part. It was the silencing of Shira’s voice, particularly around size inclusion.
Whenever Shira tried to address the complexities of recovering in a larger body, she was shut down by clinicians and peers alike.
She was discouraged from discussing her fears around returning to a bigger body, as someone who had lived in one most of her life, and understood that her recovered body would likely be a fat one.
“I needed them to acknowledge, just ACKNOWLEDGE, that recovering in a fat body is terrifying in a world that hates fat people,” she texted me once.
Instead, she said, they remarked that she needed to “take her therapist hat off” and suggested that she was being difficult, and lacked commitment to her own recovery.
Being surrounded by a treatment team that couldn’t validate her fears, suggested that she restrict her intake, and questioned her investment in recovery, began to erode her sense of faith that she was supported.
Shira accumulated two more strikes as she continued to struggle. And rather than ask how they could better show up for her, they called her in for a meeting, and immediately blamed her for not progressing quickly enough.
That’s when they told Shira she needed to start calling residential centers, and ‘prove’ that she wanted to recover.
I remember how she described the heartbreak, realizing that her treatment team didn’t at all honor how hard she had been working, nor did they hear her when she explained how she needed the space to talk about recovery in a larger body.
She felt defeated, wondering if she had failed. Calling her outside providers, the feedback from her external therapist and dietician was unanimous: Shira didn’t need to go back to residential. She needed trauma-informed, size-conscious care at the outpatient level.
Having accrued three strikes, though, the contract dictated that Shira couldn’t continue in their program.
Shira didn’t want to give up. After meeting with her therapist, she sent a powerful email to her treatment team at the center, explaining that she would like to come back.
She reiterated her commitment to her own recovery, expressing that she simply wanted a care team that could affirm her experiences of fatphobia in the outside world, and one that could create an environment that had more consciousness around what might trigger someone in a larger, recovering body.
After sending that email, she heard nothing for two days. Wracked with guilt and self-blame, she relapsed — hard.
How could she not? In their last meeting, she was blamed for being unable to “comply” with treatment, and was told over and over again that her “manipulative” eating disorder was making it difficult — if not impossible — to help her.
When she finally heard back, she was invited to meet with her treatment team again… one week from then. Mind you, Shira’s outside providers have been contacting the center, warning them of the relapse and acute state that Shira is in.
This is the same center that told her that she needed to come to their center within an hour of her plane landing, for fear of being left with any lapse in care. Now, they’ve told her to wait an additional week to “discuss” the future of her care.
When Shira asked what she should do to keep herself safe in the meantime, the answer was short. “You left,” they told her, not acknowledging that the contract they had her sign meant she was being kicked out.
She was told to rely on her outside providers, suggesting that maybe they could’ve come up with an alternative if she hadn’t left.
Once again, the buck was passed.
Shira spent that entire week unable to afford much care from outside providers and, in an acute relapse, she unraveled quickly.
She and I held out hope, though. After all, why have a meeting at all if not to discuss how they could help her? I had read the email Shira sent, and it was gracious and encouraging, emphasizing that she was hopeful that they could find a path forward.
Clearly they were going to regroup and find a way to support her, I thought. Her email was so reasonable, and it was a powerful moment of self-advocacy for someone who struggled to find her voice.
But I thought wrong. After a week-and-a-half without care, now navigating a dangerous relapse brought on by her traumatic treatment experience, Shira attended a “meeting” with the center.
I put “meeting” in quotation marks, because it wasn’t a meeting at all. They, instead, took it as an opportunity to reiterate her failures under their care.
They told her that they would be discharging her and revoking her scholarship. Their rationale? She was ‘non-compliant.’
They went on to tell her that it was a “slap in the face” that, after being given a scholarship, she wasn’t trying harder. Shira listened, heartbroken and in shock, as she was told that she was to blame for her treatment being unsuccessful.
They would not be helping her secure care elsewhere. They called her into a meeting to simply tell her she had failed.
They knowingly allowed Shira to relapse for a week-and-a-half with a deadly mental illness, and kept her in limbo with no intention of helping her, for what reason, exactly?
They could’ve told her from the beginning that she needed to arrange for some other form of care. They could’ve offered some kind of contingency support to transition out of their care. They, at the very least, could’ve called her on the phone earlier rather than have her wait.
“She’s in a bad way,” one of her outside providers warned them that week, impressing upon them the dire stakes. During that week, Shira was fainting, and again at risk for serious esophageal injuries due to her purging behavior, which had reemerged fiercely during the relapse as she struggled to cope.
No one can know for certain why a clinical team would deliberately string someone along in an acute crisis in that way.
Only they can answer to that.
That’s where we find ourselves now: Shira was abandoned by her day treatment team, and she cannot afford another program.
Furious doesn’t even begin to describe how I feel, watching this all unfold from a distance.
Shira is dying — there’s no other way to describe what happens to our bodies in these states of ED relapse. And the hope she once carried for a life on the other side of this was pummeled by clinicians she had trusted to support her.
But somehow, she still wants recovery. After everything that’s happened, she still wants to fight. Not that I’m surprised, because Shira already sacrificed so much to get to where she is.
But after everything she’s endured, both at that center and others, I wouldn’t have blamed her at all if she’d given up.
And this is the part where I get extremely, uncomfortably honest with you all: I don’t want to lose Shira. I can’t lose Shira.
This is the first fundraiser like this that I’ve ever been a part of, and believe me, I wouldn’t be asking if this weren’t important to me.
I believe that the advocacy and clinical work that Shira does is invaluable, and it’s work I want to continue doing alongside her. I want to believe that those of us with mental illnesses can recover, and go on to help others — as healers, as writers, and YES, as therapists.
I want Shira to continue to be a shining example of what happens when those of us who are wounded go on to become healers.
But Shira needs help — desperately. And somewhat selfishly, I don’t want to do this whole recovery thing without her.
I want us both to get better. I want us to start our own treatment center one day (I’ll admit, Shira is making me seriously consider becoming a therapist myself), to fight for policies that protect people like us, and hold accountable any and all clinicians who do harm to their patients.
I know you probably see hundreds of GoFundMes every week, floating across your screen. And I won’t try to convince you they aren’t all worthy of your support.
But this one, for me, is personal. Because of everything Shira represents, but more than that, because of everything she’s done to pull me out from the depths of my anorexia, even as she struggled with her own.
Y’all, I did this super scary thing where I talked, unscripted, for half an hour about the intersections of fatphobia and transness, along with sharing SO many feelings that I have about body positivity.
I did this with the amazing Elizabeth Cooper, founder of the Queer Body Love Speaker Series! You can learn more about it by clicking this link right here.
Their introduction to my interview is super generous and makes me feel important! Check it out:
More people have recommended Sam Dylan Finch as a speaker for this series than anyone else. He’s the most famous advocate for trans inclusivity within the body positive movement, and in this candid interview he shares about his own experience as a non-binary trans person who has both learned from and has critiques of the body positive movement. This topic of navigating a fatphobic, transphobic society is SO important and has something to contribute to us all.
Why “every body is a bikini body” body positive beach photoshoots are exclusive (and how to reframe such projects to be trans inclusive)
2 impactful lessons Sam has learned from body positivity
Why Sam literally sits in front of a mirror staring at his body (this is a unique exercise I haven’t heard of before)
How to deprogram internalized voices of oppression
The difference between dysphoria and dysmorphia
What it means for Sam to be a non-binary trans person & how this relates to his relationship to his body
I’m not sure if I’d call myself famous (read: I would not call myself famous), BUT OKAY ELIZABETH. I am flattered!
If you sign up on the website – which just involves sharing your email address – you’ll gain access not only to my interview, but to dozens of other interviews from queer folks and queer-competent clinicians, talking about the many complexities of queer body image!
And before you tell me, “Sam! You’re only saying this because they paid you,” umm, EXCUSE ME. I did this for free!
I did this because I genuinely believe these are some of the most important conversions to be having right now, in a society which tells transgender people in particular that they are inherently broken, and as fatphobia and gendered ideals fuel disordered eating in our community.
And if you’re not interested in watching my face make weird expressions while I talk about this, or if it’s simply not an accessible format for you, there’s also a transcript available so you can simply read what I (and all the other speakers!) had to say.
It’s rare that I put myself on video without a script to talk about these things, but this was a unique occasion in which I wanted to connect directly with folks who, like me, are trying to navigate body positivity – which is a profoundly cis-centric movement – while also being transgender or non-binary.
So really, go sign up! I promise it’s not a scam (well, if it is, we can be victims together, okay, because I totally signed up too). It’s just a bunch of queer people who want to talk about our bodies in a way that we seldom have the space to do.
And be sure to spread the word! I can think of countless queer and trans people who need access to these conversations. Let’s bring everyone to the table. Let’s support and uplift one another in our journeys toward self-acceptance.
Arbour’s video “Dear Fat People” is symptomatic of a fatphobic culture.
When I watched Nicole Arbour’s video to fat people, I couldn’t help but be struck by her complete conviction that shaming fat folks would motivate them to be healthy.
The research does not back this claim – in fact, it consistently refutes it – and fat folks have asserted time and time again that shaming them does real psychological harm.
So I’m confused on how making people feel like shit is supposed to be encouraging, but okay.
Throughout the video, Arbour takes jabs at the body positivity movement, stating, like many trolls have before, that it promotes unhealthiness (while her very original insults and hatred of fat folks, comments that they certainly haven’t heard before, will definitely promote health).
Yes, against my better judgment, I watched the video. And Nicole Arbour’s fat-shaming did nothing to motivate me as a person who is “overweight.” Body positivity, on the other hand, has motivated me – it has made me a healthier, happier, and stronger person.
I spent most of my life as a very thin person. But secretly, I was also terrified of being fat. Most of my family was, which made me feel like I was constantly trying to outrun my so-called genetic fate, and being constantly praised for being thin made me feel like I had to work hard to maintain it, to make sure I didn’t lose it.
So when I was a teenager, I started skipping meals. And worse, I felt accomplished when I did. I felt like I did something good, something I should be proud of. In fact, if Nicole Arbour had seen me a few years ago – underweight and depressed – she would have assumed I was healthy and applauded me for my efforts.
No one ever told me to diet, but I started restricting my intake anyway. At one point, I wasn’t eating much more than an apple at lunch time and a protein bar at dinner. Because we live in a society that teaches us that there’s nothing worse than being fat. Controlling my food intake gave me a certain kind of pride, a sense of moral superiority to my fat relatives who just needed to “get their act together.”
You see, I wasn’t much different from Nicole Arbour when I was thin. I was an asshole that had a lot of problematic ideas about fat people. And I think that’s why I take it so personally – because it hits close to home, because I know deep down that the problem isn’t with Arbour so much as it is the society that teaches us to fear fatness, to shame fat people, and to reject them as fully-formed human beings.
When we place this morality around fat bodies and food, we create a very toxic culture that lends itself so easily to eating disorders, depression, anxiety, and yes, discrimination against and hatred towards fat bodies.
My disordered eating was rooted directly in the ideas perpetuated by Nicole Arbour’s video – a panic and a fear around fatness, a call for self-control even if it means self-harm, and a disgust with fat people – and those same ideas were what led to me being underweight, unhappy, and destructive.
I finally felt a sense of peace and stability that I needed to get my life back.
But the universe, in some kind of act of karmic retribution, gave me weight gain as a side effect of that medication. I went from being thin to gaining sixty pounds, and hearing a doctor tell me I was “overweight” for the first time.
And despite being in the healthiest place I had ever been – finally mentally sound and capable – people who had never been concerned about my health before suddenly started asking if I was okay, if I wanted dieting tips, and encouraging me to “take control.”
Ah, yes, taking control. You mean when I was restricting, underweight, and depressed as hell.
Internalizing all of that negativity around my weight gain, I started to feel self-loathing and I couldn’t even look at myself in the mirror. I debated going off of the medication that had saved my life – because to me, it was better to have unmanaged bipolar disorder with all of its dangerous lows than to be fat.
I think the real sickness in our society is that someone who finally achieved mental health would risk everything just to be thin.
And to the rest of the world that saw my round belly and my big thighs, they, too, would rather me be back in that dark place and be thin than be mentally healthy, happy, and “overweight.”
Attitudes like those present in Nicole Arbour’s video are the same attitudes that I started wrestling with when I looked in the mirror and no longer saw someone who was lovable, desirable, and worthy. Somehow having fat on my body made me “less than,” and made other people treat me as such.
When I finally lost the privilege of being thin, I had to come face-to-face with the fatphobia that I had clung to for my entire life – and I had to acknowledge that I had been perpetuating really awful ideas about fat and fat people, and doing harm to the people in my life that I claimed to love.
I can understand why Nicole Arbour would resist that kind of criticism from viewers, because she, too, would have to acknowledge that she is actively doing harm. It’s not fun to admit that you’re hurting people, that these beliefs that you’ve bought into are actually causing real suffering to people of all sizes.
I, at first, felt helpless when I realized how fatphobic I really was. I didn’t know how to unpack those ideas, and I didn’t know if I could ever feel okay about myself and be “overweight.”
The hashtags that Nicole Arbour mocked in her video are the hashtags that ultimately turned my life around. I discovered the body positivity movement through social media, and realized that my self-worth did not need to rely on an impossible ideal that most of us will never attain.
I realized that being thin is not a requirement for being happy or healthy or fulfilled, and when we break away from diet culture and fatphobia, it can be transformative in the best way.
When I gained weight, I was convinced that it was the end of my self-esteem – I had no idea that it was actually the beginning of an unconditional love for myself.
It’s a kind of love that we all deserve to have, a self-love that is not a privilege reserved for a select few that fit into our norms, but rather, a relationship that we are all entitled to by virtue of our humanity. Outsiders do not get to dictate the kind of relationship I have to my body and myself.
Body positivity taught me that health cannot be measured by a number on the scale, cannot be observed by a stranger, and is something that we, ourselves, get to navigate and define on our own terms. I learned that we all get to exist in our bodies, whatever they may be, and that we set the rules.
Body positivity taught me that love, and confidence, and happiness are possible and do not need to be determined by our size.
Body positivity taught me that I do not need to resort to restricting and starving just to be worthy, and that the real problem was never my weight, but rather, the poisonous conflation of thinness and happiness that I was convinced held the secrets to self-esteem.
Body positivity taught me that hatred disguising itself as “health advice” is still hatred.
Here’s the thing: What people like Arbour don’t seem to understand is that loving myself was the healthiest decision I’ve ever made. Living without shame enabled me to make good choices for myself, because no choice that is rooted in self-hatred is ever sustainable and no choice rooted in self-hatred can ever be healthy.
Being thin never made me feel confident. Being thin never made me a better person. Being thin never made me healthy. But now, with a body that most would consider undesirable, I finally feel happy and I live a meaningful life, one in which I contribute positively to the world, one in which I do everything I can to reduce harm towards myself and others.
And for naysayers who insist that I’m unhealthy because of my size, I can only laugh. Because if it weren’t for the medication that caused this weight gain in the first place, my bipolar disorder would have ravaged what remained of my life until I could no longer bear to live it.
But when you look at me, you can’t see that. Because health is not a size.
If that’s the kind of world you want to live in, you need to own the fact that you are making it that way. You need to understand that these attitudes about fat people are actually harmful and discriminatory – stop hiding behind this so-called “health” crusade – because you aren’t motivating, you aren’t helpful, and you aren’t saying anything novel or new that the diet industry isn’t already profiting off of.
You do harm. And if you can live with that, so be it. But realize that you aren’t helping fat people – you’re hurting them, along with anyone who has ever struggled with their body, because at the root of that struggle is a fear of fat.
Honestly, sure, if I had watched this video when I was younger, I definitely would have felt motivated. Motivated to keep skipping meals. Motivated to celebrate my disordered eating. Motivated to scrape my dinner into the trash again. Motivated to starve myself into oblivion. Motivated to keep being cruel to fat people and making assumptions about strangers.
And if I hadn’t found body positivity, I would have been motivated to reject the medication that ultimately saved my life, because I thought it was better to be thin than to be sane.
And if that’s what health looks like to you… then I don’t want to be fucking healthy.
Editor’s Note: We use the word “overweight” in quotations because it is, indeed, a problematic term that suggests a normative weight. However, it is used for clarity and to make a distinction here because while Sam is not perceived as fat, he is also not perceived as thin, necessitating a term that acknowledges this “in-between” kind of space.