Mini Workshop 6 - Eating Disorder Therapy for All Bodies: Bridging the Inclusivity Gap with CBT-WI

Although CBT is a criterion standard eating disorder (ED) treatment for individuals in larger bodies (Ralph et al., 2022), existing protocols perpetuate weight stigma and harm by emphasizing a “healthy weight range,” recommending weight loss, and promoting “binge-proof dieting.” Further, they ignore the role of oppression, trauma, and the social determinants of health in the development and maintenance of EDs. Consistent with other sub-fields of CBT, the ED CBT field has acknowledged that we may unintentionally inflict harm on marginalized people (e.g., Levinson et al., 2023). Many providers and social justice activists reject CBT for EDs in favor of more inclusive approaches. Without modification to CBT for EDs to minimize harm and increase inclusivity, it risks becoming seriously underutilized.

Evidence-based practice acknowledges the need for clinicians to modify a treatment approach when it has utility but does not seem adequate for the particular patient, problem, and context (Morales & Norcross, 2010). Despite the vocalized limitations of CBT for EDs when treating size-diverse individuals (Millner & Muhlheim, 2021), no formal adaptations exist to address treatment components that perpetuate weight stigma and cause iatrogenic harm. We’ve adapted CBT to provide a weight-inclusive approach (CBT-WI) that promotes personalized treatment for culturally diverse patients across the size spectrum.

CBT-WI adaptations include removing recommended weight loss and collaborative weighing, modifying the case formulation, and using alternative body image interventions. In personalized psychoeducation, further attention is placed on social determinants of health, self-compassion, harm reduction, BMI limitations, and weight suppression. CBT-WI addresses undereating while acknowledging weight stigma’s impact on dietary restriction. Values and justice-based exposures are used to minimize harm to patients with marginalized identities, with resources and examples for more diverse bodies. CBT-WI also encourages building a body-accepting community and self-advocacy.

Recommended Reading 1: Byrne, S. M., & Fursland, A. (2024). New understandings meet old treatments: putting a contemporary face on established protocols. Journal of eating disorders, 12(1), 26. https://doi.org/10.1186/s40337-024-00983-4

Recommended Reading 2: McEntee, M. L., Philip, S. R., & Phelan, S. M. (2023). Dismantling weight stigma in eating disorder treatment: Next steps for the field. Frontiers in psychiatry, 14, 1157594.

Recommended Reading 3: Millner, R. and Muhlheim, L. (2021) Anti-fat bias in evidence-based psychotherapies for eating disorders book. Can they be adapted to address the harm? In Weight Bias in Health Education: Routledge.