In Gilda Radner’s 1989 memoir, the comedian confessed to “having every possible eating disorder by the time I was nine years old.” She desperately wanted to be as thin as her SNL co-star Laraine Newman, but New York City was filled with delicious temptations, “hot dogs and falafels, pizzas, ice cream, pretzels, charbroiled steaks with smells that steamed out of street vendors’ stalls.” So Radner figured out a way to manage her weight: “I became bulimic before medical science even gave it a name.”
In the decades since, the medical establishment — and the media — has given bulimics and binge-eaters plenty of names. We’ve been labeled “failed” or “aspirational” anorexics; in 2004, The British Journal of Psychiatry described bulimia as “anorexia’s ugly sister.” Bulimics have come to represent the “bad girls” of the Diagnostic and Statistical Manual, psychiatry’s bible. Yet behaviors like binge-eating and purging actually account for the most common eating disorders in America. In 2012, writer Cat Marnell called them “part of being a woman.” In fact, fifteen percent of women develop an eating disorder by their 40s or 50s, and 65 percent report nonspecific disordered eating habits. In Dead Weight: Essays on Hunger and Harm, author Emmeline Clein challenges the diagnostic hierarchy in which bulimics are the “unserious disciples” in the world of “girl diseases,” with its harmful dichotomy of “chaos and control, disgust and purity, virtue and vice.”
The ways that goodness and badness are attached to particular foods and eating behaviors, as well as to particular body shapes and sizes, is one theme of Dead Weight, a spirited polemic delivered to an audience of young women in pain. It’s also the theme of a new memoir, Vogue writer Emma Specter’s More Please: On Food, Fat, Bingeing, Longing, and the Lust for “Enough.” Together these works usher in a new wave of eating disorder literature. They argue that, in Clein’s words, “the ways we think about eating are sick, moralizing, and misleading, and are making a lot of us ill.” They’re part of a current reckoning with diet culture, beauty standards, and the wellness industry, explored by podcasts like Maintenance Phase and reignited on social media whenever old photos of Jessica Simpson remind millennials where our body image issues originated. More so than their predecessors, Dead Weight and More Please implicate fatphobia, the problem that once had no name, as a culprit — casual, pervasive, and deadly. If our culture is poised to revert back to something like the heroin-chic aesthetic (as the rise of Ozempic suggests), Clein and Specter assess how much damage it wrought the first time around.
“Bulimics have come to represent the “bad girls” of the Diagnostic and Statistical Manual.”
Clein considers the shared economic incentives that diet companies, treatment facilities, and the pharmaceutical industry have in retaining a permanent customer base of people with eating disorders, connecting the dots in a way that suggests deliberate collusion. (Think of that old meme: “they feed us poison/so we buy their cures/while they suppress our medicine.”) Specter sticks more closely to her personal journey. More Please is candid and vulnerable, but its author inhabits a rarified world of plenty (“who can ever really resist abundance?” she asks) and assumes an audience for whom daily meal delivery and the “astronomical out-of-pocket cost” of a private nutritionist are within reach. For many working Americans, a lack of leisure time and material resources are barriers to healthy eating; the problem isn’t so much abundance as it is scarcity.
Both new books contribute to a rich archive of eating disorder narratives which emerged in Radner’s era and peaked around Y2K. The idea, back then, was that bulimia and anorexia were secret behaviors shrouded in shame. Remember the teenage bulimic played by Calista Flockhart in 1992’s Lifestories: Families in Crisis, orgasmically devouring French fries in her bedroom and then furtively puking into jars she hid in her closet? Revealing the shocking reality of eating disorders was supposed to lead to greater understanding and empathy. But American empathy reserves are chronically low, especially for ailments imagined to be rooted in excessive feminine appetites and dangerous feminine vanity. The increased awareness provided by the outpouring of eating disorder stories over the past thirty years — not only the memoirs, but also the television dramas and after-school specials, the breathless teen magazine confessionals and tabloid exposés — has not, it turns out, translated into improving women’s relationship to food or to our bodies. Studies show that the prevalence of eating disorders has grown sharply since the pandemic and, according to Clein, is expected to continue rising over the next several years
Visibility alone cannot solve a public health problem, but it can enable fellow travelers to connect, and eating disorder patients have done so online since at least the Tumblr era. In now defunct “pro-ED” communities, members offered a twisted form of solace and validation to one another. Clein’s boldest move may be defending the young women who gathered in these taboo online spaces as “simply reading the room they have been locked into.” Pro-ED forums often reposted the same celebrity photos and diet tips the mainstream media had published for decades, but they were roundly condemned by journalists who, argues Clein, wished to evade their own complicity. Dead Weight rejects the artificial boundary between what we think of as “normal and laudable” calorie-counting content and the “disturbing and dangerous” world of the pro-ED blogs and message boards.
It makes sense that such communities emerged to fill a vacuum where accessible, effective medical treatment should exist. Only a small subset of people with eating disorders are underweight enough (according to the criteria of insurance companies) to qualify for the most comprehensive form of treatment, inpatient care. They often find it punitive and infantilizing. Clein says residential clinics operate like “carceral finishing schools,” robbing patients of autonomy. Between solitary confinement, feeding tubes, constant surveillance, and the confiscation of personal belongings, such programs look “eerily reminiscent of the Victorian rest cure.” If eating disorders are, at their heart, about bodily control — something difficult to wield and protect as a teenage girl — then depriving patients of it seems especially cruel.
Typical therapeutic intervention involves teaching a patient to separate her own thoughts from her “disordered” brain, to distrust her own insight and disbelieve her own memories. (“Negotiating with an eating disorder is like negotiating with a terrorist,” one treatment guide states.) Psychology as a profession is no longer dominated by men, yet in Clein’s telling, the echoes of its patronizing misogyny ricochet off the treatment center walls. Rebellious young women become reprimanded “perma-girls,” kicked out of programs when their weight changes, blamed for “failing” treatment, and then labeled “chronic” cases, making them less likely to qualify for further care. Ironically, it costs a lot of money to be treated so poorly. The average price of a one month inpatient stay runs $30,000, requiring some families to mortgage their houses. Yet 40 to 50 percent of patients relapse within a year.
“Can self-love really neutralize the harm inflicted by the trillion-dollar diet industry?”
Outpatient options aren’t much better. First line treatment includes pharmaceuticals combined with Cognitive Behavioral Therapy (CBT). Clein is among the critics of CBT who argue that the modality has become popular because it favors productivity, ultimately creating subjects who are able to work, spend, and fulfill “what is expected of adults under capitalism,” which is not the same thing as healing. And so eating disorder patients have been “guinea pigs” and “sacrificial lambs” of the efficiency-minded post-1980 approach to mental health care, their mortality rates second only to those with substance use disorders. Two years ago in Colorado, a 36-year-old woman chose medical assistance in dying for her “severe and enduring” anorexia; to Clein, this outcome is “capitulation to the failing system, an admission that literal death is less painful than receiving treatment as it currently exists.”
What causes eating disorders in the first place? Reading Dead Weight, I kept thinking of Lenny Bruce’s knowing aphorism: “It’s society that’s sick.” Clein rejects the “entrenched lie that bodies are built by individuals instead of systems,” and suggests that developing anorexia or bulimia can be understood as the rational and inevitable response to a weight-obsessed culture, which persists even amid the body acceptance movement. The intense allure of thinness appears immune to a handful of fat-positive celebrities and inclusive lingerie advertisements. The fundamental association of bodily discipline with moral purity (and its corollary, the “sinfulness” of sensory pleasures) has proven more enduring than whichever physique reality television stars favor during a given trend cycle.
In More Please, Specter explores social factors that contributed to her eating disorder, including the isolation of the pandemic and the ease of ordering fast food to binge in front of the TV (a form of self-anesthetizing that readers will recognize, but one which also depends on the unacknowledged labor of a class of low wage gig workers). She considers how we inherit ideas about food and beauty from older generations of women (she is tethered to her mother “by an invisible umbilical cord of judgment”) as well as from pop culture (she recalls the impact of Keira Knightley’s hip bones). Specter learned to see her hunger as “feral, out of control—an untamed animal,” and her weight gain as a moral failing. As in Clein’s book, here too, the harms of the diet industry loom large. Returning to Weight Watchers repeatedly throughout her youth, Specter was drawn to the “shimmering promise” of thinness, a proxy for the real needs of love and acceptance. Diet companies “stand to profit when you continually gain and lose the same ten pounds,” she realized. “It’s in their best interest for you to slot everything else in your life — romance, friendship, work, family — around your diet. The real question is; is it in yours?”
In a world of ubiquitous diet content that plays on our deep emotional needs, it’s no wonder that some people “take it too far” and develop disordered eating. After spending money on programs like Weight Watchers or on “fat-burning” supplements and shakes, yo-yo dieters who become ill are often routed into the Eating Disorder Industrial Complex, where, by paying for treatment, they become consumers once again. All the while, Clein notes, grimly, “the men in suits count their cash.” Pro-ED groups, as “sites of collective despair,” challenge this cycle and the false promises that undergird it. Clein stops short of glorifying these online spaces, but she does see them as an alternative coping mechanism, outside the bounds of medical gatekeepers and profiteers. This calls to mind critic Audrey Wollen’s “sad girl theory,” which poses self-destruction as a form of resistance. To Wollen, “girls’ sadness is active, autonomous, and articulate, a way of fighting back.”
For Specter, fighting back has meant attempting to unlearn self-loathing. Despite the 1990s feminist assumption (which lingers in Clein’s Dead Weight) that patriarchal beauty standards are inescapable, passively and uncritically consumed, Specter has developed a positive self-image as a fat person. In More Please, she grows to embrace both her sexuality and her size over time, buoyed by the affirmations of fat queer activists. But can self-love, which increasingly feels like a mandate for everyone, really neutralize the harm inflicted by the trillion-dollar diet industry? Not without social support, which Specter sought in 12-step recovery meetings for food addicts. These programs have the benefits of being free and detached from the broader Eating Disorder Industrial Complex. Although she found they can still reinforce restrictive eating and a “pulsing, unspoken desire for thinness,” Specter credits them with providing a sense of fellowship, even family. For Clein too, the answer must be communal, a version of solidarity that eschews competition and individualism. She proposes a feminism of “sororal attention,” an approach which rejects medical authorities and corporations as the stewards of our recovery. This is less like group therapy and more like the consciousness-raising practice of 1970s women’s liberation, in which personal problems were reframed as social and political ones. “What I want is to level with you, to sit cross-legged and talk about the thoughts that almost killed us,” Clein tells readers. It sounds a lot like sisterhood.
Sascha Cohen is a writer living in Boston.
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