Impact of gender stereotypes on women with eating disorders

The increasingly younger onset of eating disorders and their link to mental health disorders in adulthood, such as anxiety, depression, or self-harm, has been a concern for healthcare professionals for years. While acknowledging the multiple factors that influence the development and maintenance of eating disorders, it is important to highlight the role of gender ( Infographic I ):

• There is a ratio of nine cases of women to one of men.
• Women without eating disorders are insecure and dissatisfied with their normative bodies.

These data suggest that the socialization of women linked to our gender roles and stereotypes is highly relevant and a source of distress for women in contemporary Western society. In this regard, the report "The Impact of Gender Stereotypes on Young Women with Eating Disorders ," published by the Women's Institute (Spanish Ministry of Equality), aims to analyze how sexism and weight stigma underlie body image-related violence , which influences the development and maintenance of eating disorders in vulnerable women. To this end, a review of the literature published in scientific journals in the field of health, as well as the reflections of feminist authors and the anti-fatphobia movement, was conducted.

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Discrimination and symbolic violence

Analysis from this sociocultural, gender, and integrative perspective has made visible the discrimination linked to a type of symbolic violence that women suffer: aesthetic violence . This discrimination is normalized by society and internalized by women with eating disorders.

The messages reproduced by both direct socialization agents (family, peer groups, work or school, but also in medical consultations or by teachers) and indirect ones (audiovisual culture, mass media, and social networks) have changed over the years. For centuries, beauty and success have been associated with women, but today we also see the association between the ideal (thin) body and health; thus, messages linked to diet culture and supposedly healthy lifestyles are normalized. Therefore, the pressure exerted on women to conform to body standards is enormous and comes from multiple sources.

Beauty and success have always been associated in women, but nowadays we also find the association between the ideal (thin) body and health.

To all of this must be added the socially established hierarchy of bodies based on their approximation to normative body ideals, primarily with regard to weight. Women with non-normative bodies , fat women, experience numerous situations of discrimination firsthand. These situations of discrimination are sustained by prevailing stereotypes linked to the stigma of weight.

• Body weight can be controlled.
• The simplification to explain weight, exclusively, through eating habits and physical activity.
• Lack of body diversity in the media, social networks or audiovisual industry.
• Normative weight is associated with success and health; non-normative weight with failure and poor health.
• Associations between weight and certain negative personality characteristics in fat women, such as laziness or lack of willpower.
• Culture of healthy diets and lifestyles.

Sara Fernández

Playwright and actress

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It can be said that we live in a society where multiple forms of systemic discrimination against women prevent true equality of opportunity, and these oppressions intersect: for example, sexism and weight stigma. These forms of discrimination overlap and present unique challenges for those affected. The discrimination women experience firsthand in their interpersonal relationships, coupled with systemic and structural inequality, contributes to disparities in women's health, which, in the case of body image, are linked to low self-esteem, body dissatisfaction, eating disorders, and mood disorders .

Women have internalized, and society has normalized, this symbolic violence ( Infographic II ). Symbolic violence can be defined as those stereotypical patterns, messages, values, icons, or signs that transmit and reproduce domination, inequality, and discrimination in social relations, thus normalizing the subordination of women in society . Symbolic violence becomes a mechanism for the reproduction of gender inequality. In this way, it is assumed that things "have always been this way," and therefore, our values, beliefs, and places within society are unquestionable and immutable. Living in a violent and patriarchal society toward women has emotional consequences that permeate women's experiences and are reflected in a higher prevalence of various mental health diagnoses , including eating disorders in women. To better understand the situation, the report presents:

• Proposal of discrimination indicators that should be addressed in health promotion in this area.
• The pyramid of symbolic violence ranges from the most subtle and invisible forms experienced in family, healthcare, or educational settings related to weight, to the most visible, emphasizing the stigma associated with weight in non-normative bodies (situations of pressure from close friends or family, institutional violence experienced in healthcare, and even physical violence that can result in death due to failed interventions linked to body image). Women can also experience other types of violence based on their appearance, typically involving comments related to sexuality and physical appearance that are hypersexualized and dehumanizing: for example, in cases of school bullying or online harassment within the manosphere (the online world that promotes toxic masculinity, misogyny, and opposition to feminism).

Only by considering the vast industry surrounding women's body image insecurities can we understand why no measures for social transformation have been proposed until now. Another important aspect is reflecting on the double standard inherent in the objectification of women . This consumerist society fosters:

• Self-consumption to conform to the ideal body shape of beauty and thinness that is associated with success.
• The commodification of women's bodies: pornography, prostitution, or surrogacy.

Ultimately, the root of all these problems lies in the objectification of women's bodies (sexism) and the business that revolves around it.

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A sociocultural and gender approach

The study was conducted in three phases ( Infographic III ):

1. Online discussion group for professionals from different fields: health, education, anti-fatphobia activism, families or media.
2. Online discussion group with young women who have or have had eating disorders.
3. Online survey with young women who have or have had eating disorders.

A comprehensive approach is carried out with a sociocultural and gender focus:

• Intrapersonal variables: individual vulnerability factors that predispose women to be more affected by gender stereotypes.
• Interpersonal variables: situations experienced through social agents of belonging. Teasing, harassment, and discrimination related to body image by peer groups, family, as well as educational, medical, or work environments.
• Structural variables: the opinions of the women surveyed regarding the role of key social agents and the need for social transformations. These include media (analog and digital), social networks, the audiovisual industry (music, film, and video games), sexist advertising, fashion, the food industry, and the pharmaceutical industry. The survey also explored opinions on the role of education, public administrations, and current policies, laws, and regulations.

Sexism and weight stigma are present in the lives of women who have or have had eating disorders, through subtle symbolic violence that is normalized by society and internalized by women.

Specifically, the interpersonal perspective related to direct violence experienced by socialization agents ( Infographic IV ) and reference socialization agents ( Infographic V ) is novel. Taking into account the information from the online survey of women who have or have had an eating disorder, as well as the focus groups (professionals/women who have or have had an eating disorder), it can be concluded that:

• Sexism and weight stigma are present in the lives of women who have or have had eating disorders, but it takes an effort to see it, since it works through subtle symbolic violence that is normalized by society and internalized by women with eating disorders, and amplified in the media, audiovisual industry and social networks.
• Everyday experiences are described that focus on weight so that "you take care of your health": first-hand experiences with families, medical professionals and schoolmates.
• Normalized violence against women's bodies must stop.
• All bodies, regardless of gender, appearance or size, age, or ethnicity, should have the same rights and opportunities. Inclusion is a matter of social justice.
• Social transformations cannot happen on a single front, nor at a single level.
• We need perspectives from all over the world , intersectionality, and collaborative work.

Regarding the young women surveyed who have or have had eating disorders ( Infographics VI , VII and VIII ):

• They are aware of the influence of sexism and weight stigma.
• Society needs to change in multiple areas and at multiple levels. They demand interventions in all the socialization agents involved (belonging and reference) to promote a healthier society, with less oppression and greater equality between men and women.

A social transformation from various areas

We have spent decades investigating which sociocultural risk factors should be addressed in health promotion without doing anything about it ( Infographic IX ):

• Symbolic violence, media violence, digital violence, aesthetic violence, or institutional violence are concepts that have been raised throughout this work, addressing the influence of gender roles and stereotypes in women in our society on eating disorders.
• Women's lives are filled with situations of inequality and violence. We live with subtle forms of violence in our daily lives: in the media and audiovisual industry, amplified on social networks. But also in our direct interactions with our families, partners, peer groups, teachers, or medical professionals. All of this occurs in various settings: medical, educational, or work-related.
• The stigma of weight. Such violence has a greater impact on women with non-normative bodies in terms of weight, because they experience more oppression and discrimination.

Women experience subtle forms of violence in their daily lives, both in the media and in their immediate surroundings. This violence disproportionately affects women with non-normative bodies based on weight.

Therefore, change, social transformation, cannot be on a single front or at a single level:

1. From a psychological point of view: work should be done on treatments that are more respectful of women of all body shapes and sizes, and on interventions with neutral weight.
2. From a structural point of view: it is necessary to address, from an interdisciplinary and collaborative perspective, the structural changes needed in the agents of socialization of reference and belonging.

Among the actions to be developed, emphasis is placed on the need to change the gender roles and stereotypes that persist in patriarchal culture and to carry out awareness campaigns against discrimination related to body image and the objectification of women's bodies. According to the final recommendations, these actions should be directed at young people, families, the medical and educational communities, as well as industries and sectors such as audiovisual, communications, fashion, food, and pharmaceuticals.

It is a matter of social justice to achieve gender equality by implementing interventions to transform society in those risk factors linked to the objectification of women and the stigma of weight, overcoming gender inequalities and the business established around women's bodies.