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Why It’s So Hard To Treat Eating Disorders In An Oppressive Diet Culture World

Written by: Dr. Marcella Raimondo, Executive Contributor

Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.


As an eating disorder psychologist, I love my work. Sure, it can be hard, but it’s not exhausting. I do believe that people can recover from eating disorders. I want to learn about my clients and hear how their eating disorders have served as their survival and protection and helped them make sense of their world. So, I lean in to hear folks' stories. By holding their story and honoring it, we can understand it so that healing can happen.

A photo of broken plate, diet, eating set.

The biggest struggle and frustration of my work is not that it is difficult to treat eating disorders. The biggest challenge is always how toxic diet culture obstructs recovery.

What is Diet Culture?

Diet culture is everywhere. From intermittent fasting to no sugar or no carb diets, to detoxes and cleanses, to “being bad” if we eat particular foods, or needing to “earn” our meals—we are inundated with the belief and mentality that we must continuously strive to be thin. We are conditioned not to trust our relationship with food. We see it in so many aspects of our lives: thinness, weight bias, and privileged body types are glorified, while marginalized bodies are targeted.

Diet culture runs so deep that when we sit with it, we realize how completely entrenched and pervasive it is in our society and in ourselves. I call it “white supremacy in a pretty pink bow.”

Diet culture attaches our worth and value to thinness.

Diet culture actively encourages eating disorders by prescribing and praising restriction, excessive exercise, calorie tracking, food labeling, weight monitoring and just being hyper-vigilant about everything we eat and how much we weigh.

Diet culture blames, criticizes and shames bodies that are different in any way.

Diet culture abusively demands that we work towards a privileged body by any means. If we do not work towards a privileged body and/or do not achieve it, diet culture says we deserve any negative outcome, including any harm that comes to our bodies.

Diet culture is so thoroughly manipulative that it has become interwoven into mainstream living and is embedded in our vocabulary and ultimately our way of living.

Diet culture also aligns with white supremacy because it specifically targets marginalized bodies.

My clients who are marginalized tell me about their daily experiences of being targeted. They also tell me how thinness can make up for it. It’s the one place where I can have some control over my body and thus how people see me. If I have to lose thinness, I lose the one privilege that I have. If I recover and my body changes, then society will see me for who I am—and that’s scary, if not dangerous, for me.

It Takes Courage

When folks tell me they are scared to recover because it means they will gain weight and they are fearful of the backlash that will come to them—I wish I could say that’s not true. But it is true.

My clients tell me all the time the ways that recovery is difficult:

  • I’m getting compliments now that I have lost weight.

  • If my body changes, my dating pool decreases.

  • If I gain weight, I don’t get love from my family.

  • I’m assigned the boring or less visible jobs at work.

  • People make negative comments to me about my body and express concern about my weight.

  • I can’t eat in public as I get negative looks and/or comments.

  • People laugh at me when I exercise, even though I am told I should exercise.

When someone is making the decision to recover from an eating disorder and they seek treatment, they are being very courageous. Folks are terrified to give up an eating disorder. It may be the hardest thing that somebody has ever done. In addition to learning to have a new relationship with food and with their body, they have to struggle with all of the stigmas and biases attached to their recovery within our diet culture. Everyone who suffers from an eating disorder deserves to recover. They also deserve support for their recovery.

Weight is NOT the Problem

One of the greatest dangers of diet culture is that it presents itself as “healthy.” Our medical establishments regard thinness as health. There is a firm and commonly accepted belief that being in a large body is unhealthy, yet the studies that support this idea are inconclusive. BMI (body mass index)—the standard by which doctors have measured whether a person is underweight or overweight for over 100 years—is a haphazardly invented and flawed mathematical calculation. There is no actual science behind it.

Weight stigma repeatedly comes up during eating disorders treatment. My clients in larger bodies always tell me:

  • People are surprised when I tell them I have an eating disorder.

  • People tell me that I don’t look like I have an eating disorder.

  • My doctor expresses concern about my weight and/or weight gain.

  • My doctor encourages food restriction.

It is hard enough to recover from an eating disorder, and now folks have to endure weight bias as their body restores weight. I have had a number of clients tell me that they can’t handle the weight gain and weight bias—so they leave treatment. This breaks my heart and enrages me. It is unethical for healthcare to encourage people to control their weight through eating disorder behaviors that are medically dangerous. It is also unkind, given the internal suffering and shame that people hold in their bodies. Instead, we need to meet people with compassion and understanding.

I work with health at every size approach and professionals in healthcare tell me repeatedly that this approach is not common. Restriction, losing weight, and food labeling is a chronic focuses in the world of healthcare. Anti-fatness is the norm.

Our medical establishments need to go beyond weight in their assessments and prescriptions for health. Weight is not the problem. If our focus for physical health primarily involves making changes through weight loss—that’s a failure. We’re missing a whole spectrum of experiences and understanding, as well as the underlying sociological and emotional issues that contribute to health. We really have to be willing to challenge, and challenge with compassion, how we are all so wired to be anti-fat.

If healthcare does not examine and address its anti-fat and weight biases, we are saying that only thin people with eating disorders deserve to recover. It’s the same as saying that people in larger bodies deserve their eating disorder since it will manage their weight.

Everyone who suffers from an eating disorder deserves to recover.

Creating Change, Embracing Nourishment

I remember one woman who called her obsession with food, her body, and weight a “mental prison.” She finally said I can’t live like this anymore. When she gave herself permission to eat what she wanted, she felt liberation. My head isn’t so preoccupied. It’s becoming more and more a journey to embrace my body and let go of having a smaller body. I can’t live in all this excessive hatred.

Despite what society says—you have a right to be nourished. You have a right to have food liberation and to have a relationship with your body that works for you. You don’t deserve to have an eating disorder. You deserve a life that is more than your eating disorder.

We connect with others through food and through our body.

Change begins when we can individually and collectively embrace nourishment, our bodies and each other. We all deserve to experience food and body liberation. We all deserve that freedom. It is vital.

The thoughts I conveyed here in this blog have been expressed by many activists. I have been in conversations and shared space with so many HAES (health at every size) and eating disorders social justice activists who raise how diet culture impedes eating disorder recovery. It is a potent and collective advocacy to challenge diet culture. I encourage you to check out the work of many activists here. I have learned so much from these incredible folks. I also encourage you to look at how diet culture has influenced you and spend time challenging your own weight bias with compassion.

Follow me on Facebook, Instagram, LinkedIn, and visit my website for more info!


Dr. Marcella Raimondo, Executive Contributor Brainz Magazine

Dr. Marcella Raimondo, Ph.D., MPH is a passionate and spirited clinical trainer speaking from her heart on social justice and eating disorders since 1995. Marcella currently serves as a Licensed Clinical Psychologist (PSY # 27037) in Kaiser Permanente’s eating disorder clinic in Oakland and runs a private practice. She has dedicated her life to addressing eating disorders and body justice through her treatment and activism.



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