An Eating Disorder Therapist on Appropriate Treatment for All Bodies
Two women with noticeably different body shapes and sizes sit back-to-back

Shira Rose, LCSW

Knowing the trauma of weight stigmatizing treatment, Shira promotes weight-neutral clinical support as vital. Shira is an eating disorder therapist based in New York City.

I struggled with an eating disorder from the age of 10 and then spent years cycling in and out of treatment. I felt so much shame about the fact that I must be weak or broken because I couldn’t seem to recover. But there was a significant delay in my receiving treatment as no one believed I could have an eating disorder because I didn’t “look” the part. And when I finally received treatment, I was harmed by fatphobic clinicians again and again. All of this wasn’t particularly conducive to my recovery because the treatment I received was often further traumatizing.

While my peers in smaller bodies received appropriate nourishment and support in their healing process, my restriction was encouraged and my weight loss was praised. I was told to eat kid size portions of certain foods while my peers were given normal portions. I was made to measure and weigh every last ounce of food I consumed in treatment. All of this further drove home what I had learned from the age of 5; that my body was broken, my body was different, and I shouldn’t dare eat like other people.

Many people continue to believe that eating disorders only happen to thin, white girls. That stereotype is incredibly dangerous. Treatment is rarely safe for the millions that don’t fit that stereotype and things really need to change.

My experiences made me really passionate about going into the eating disorder field myself and offering safe and fat-positive care to my clients in all size bodies. I am a licensed clinical social worker and I treat eating disorders, disordered eating, and body image concerns from a strong Health At Every Size ® framework.

I often see clients, particularly children and teens, enter the treatment world and then spend decades cycling in and out of higher levels of care. Children and teens often learn new behaviors from the other clients and often the eating disorder identity takes a strong hold and treatment becomes their whole life. Community and family based treatment is rarely offered as the first option and I find that devastating and detrimental. Of course higher levels of care have its place but when family based treatment is appropriate, I believe it should be the first option.

I’m excited that Equip is now offering family based treatment that will be covered by insurance. I am hopeful that as Equip grows, increased accessibility will continue to be a priority because there are so many people struggling right now with no ability to afford the care they desperately need and deserve. I also hope that Equip continues to work on being anti-racist and fat-affirming as current treatment is built for the thin, white woman and that leaves out so many people who often can’t even get properly diagnosed, let alone access appropriate treatment. There is so much work that needs to be done in the eating disorder field and I hope Equip can start filling in some of the gaps.

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