Who’s Considered Thin Enough for Eating Disorder Treatment?
Anorexia has serious implications at any weight, but heavier patients face a pervasive, harmful stigma
Shira Rose and I are eating avocado toast at a Bluestone Lane in midtown Manhattan. Or rather, I’m eating avocado toast and Rose is looking for her phone. “I need to take a picture,” she says. Rose is a well-known body positive style blogger and influencer, but this photo isn’t for the ’gram; at least, not entirely. After she eats everything but a few crusts, Rose needs to text a photo of her empty plate to her dietitian — to prove she’s eating.
Now 30, Rose has struggled with anorexia nervosa since she was 10 years old. Earlier this year, she spent four months trying to stabilize her condition at a California eating disorder center. By the end of that stay, everyone on her treatment team was optimistic that she would be able to continue to make progress back at home in New York with the support of a partial hospitalization program, where patients live at home, but receive several hours of therapy and supervised mealtimes daily.
But it’s now a month after her return to New York and things aren’t going so well. When Rose woke up this morning, she passed out as soon as she stood up. “The same thing happened yesterday morning,” she tells me. “I know I cannot go on like this.” Until this slice of avocado toast, Rose stopped eating everything except broccoli, cauliflower, and bell peppers two weeks ago, when she was challenged to eat ice cream during a program outing. But it wasn’t just her eating disorder telling her to reject a forbidden food. “The program’s dietitian pointed at two other clients and said, ‘You each get two scoops,’” recalls Rose. “Then she pointed at me and said, ‘You get a kiddie scoop.’” A spokesperson for the treatment center declined to comment on the specifics of Rose’s case citing HIPAA regulations, but said that all clients are given individualized meal plans based on their nutritional needs and therapeutic goals. But Rose believes she was told to order the smaller serving for one reason: “I’m in a bigger body than everyone else.”
I can’t tell you Rose’s weight or clothing size because discussing specific numbers is triggering for eating disorder patients…