Experiences from a 10-week weight-neutral treatment program for patients with clinical binge eating disorder and higher weight

Abstract

Background Weight based stigma might drive the development of both higher weight and binge eating disorder (BED). To improve treatment and outcomes, a deeper understanding of how stigma and shame are related in health-care practices is needed. The current study was designed to gain insight into how participating in a 10-week weight neutral treatment program for patients with binge eating disorder and higher weight was experienced. Methods Semi structured interviews were conducted with 10 patients who had completed the BED-treatment. The intervention was group based, emphasizing stigma and shame, using models of attachment and affect regulation in the presentation of BED. Interviews were analyzed guided by van Manen’s hermeneutic-phenomenological approach. Results A profound feeling of inferiority due to higher weight appeared to have kept the participants stuck in a behavioral cycle of dieting, weight loss, bingeing and weight regain. In addition, participants, and health care professional’s mutual acknowledgement of driving elements of binge eating in treatment, and less focus on behavioral change related to weight and eating, appeared to stimulate a feeling of equality. Feeling equal was described by participants as facilitating increased awareness and tolerance of bodily sensations and emotions, and a deeper understanding and self-caring attitude towards themselves. Feeling less shame was described as important for self-disclosure in family relationships, leading to increased understanding and support from others. Simultaneously, our findings indicate that uncertainty related to coping with food, eating and weight in unchanged, stigmatizing surroundings was profound after end of treatment. Conclusions The results indicate that relational dynamics of inferiority and equality may maintain and reverse BED-symptoms respectively. Health-care professionals engaging in a more equal distribution of power trough recognition, compassionate acceptance, and mutual investigation of subjective experience might contribute to reducing stigma and shame and the burdensome notion of inferiority among people with higher weight suffering from binge eating disorder. Trial registration The study was approved and registered by the Data Access Committee at Nord-Trøndelag Hospital Trust August 8th, 2019, registration number 2019_2335.