We interviewed María Calado about the situation of women in relation to eating disorders, the weight of social networks, the media, the family, the school and the health system in perpetuating misconceptions such as confusing thinness with health.
María Calado is the author of a recent study entitled Informe sobre mujeres jóvenes y trastornos de la conducta alimentaria: impacto de los roles y estereotipos de género (Report on young women and eating disorders: the impact of gender roles and stereotypes), commissioned by the Instituto de las Mujeres.
With a degree in psychology and a doctorate in psychopedagogy, Calado is a gender expert and researcher at the International University of La Rioja. Her work has largely focused on eating disorders from a gender perspective, since her thesis on the role of the media in their development.
We spoke to her about her latest report, institutional violence against large women in education and health care, and the common confusion between thinness and health. “It is a risk factor, but there is no causal link,” says the researcher.
What is the situation of young women and adolescent girls in relation to their bodies?
Very worrying. Although there is no epidemiological research that gives us real data on the prevalence of eating disorders in our country, there is data, for example, on hospital admissions. The Women’s Institute has published some infographics on this and what they have found is that since Covid-19 the number of cases of eating disorders has skyrocketed. This is not the real situation, but it is an indication. On the other hand, what you also find in hospitals, in the specific ED (eating disorders) units, is that the onset seems to be getting earlier and there are more and more cases of girls. This is very worrying.
Covid-19 was a turning point. A lot of girls are spending more time in front of screens, with the disadvantage of accessing content that is very harmful. Previously, when I was growing up, girls saw content that could be harmful in magazines, because they objectified women, but it was only once a week; or a certain TV show or music videos. But now they are exposed all the time because they have a tablet, a phone or some other device that gives them access to these harmful messages about their body image.
In the report, you point to the media and social networks as important elements in all this. What is the logic of the algorithms or how do you think they affect young girls?
I don’t really know how it works. What I do know is what the experts say. Teenage girls are concerned about body image and that drives a lot of economic interests. The algorithm shows you the kind of content from brands, music videos, influencers that they think will have an economic impact. And it turns out that this content is closely linked to a traditional woman. For example, there is the case of Roro, the tradwife, an influencer who seems to have a certain lifestyle and at the same time is making money. There is a certain dissonance, but the girls who follow her probably don’t realise it, they don’t realise how contradictory her message is to what she actually does.
There is a huge business in various industries – food, lifestyle, fashion, pharmaceuticals – that exploit women’s concerns about their bodies and body image.
Should the operation of the algorithm be regulated as part of possible measures to mitigate the damage it does to young women’s mental health?
I am not an expert, but I think there is already legislation in place, and it seems that it is not being enforced. With new technologies in general, not just social networking, we face a lot of problems that are new, that are happening for the first time. For example, not only in the issue that concerns us, but also in hate speech. I think it is necessary to regulate certain issues, such as pornography, where violence and the objectification of women, dehumanisation and hypersexualisation are at their peak.
It is necessary to regulate what is happening with AI, which is also very much in line with women experiencing degrading situations. What happens to a woman when she is exposed on social networks, because of the kind of comments she receives, often related to her physique. We are finding situations of harassment that used to be confined to the school environment. But these boys and girls or teenagers, when they go home, they don’t stop because they continue on social networks. And for women, the kind of harassment they receive is often related to their physical appearance.
We need to rethink the existing legislation and regularise and review it. For example, the one that deals with sexism in advertising. If you walk down the street, turn on the television or go on social networks, you see nothing but sexist and degrading images of women. It seems that issues that have been regulated for years are not working.
You also talk about the family in the report. There seems to be a need to work with them in a very specific way because they are the spearhead of a lot of social pressure to be thin as a synonym for health. How should this be?
Yesterday (a few days ago) I launched a small campaign to raise awareness of the Observatorio de Violencias Institucionales Machistas (Observatory of Institutional Violence against Women). I took up two aspects of the report: health and education. And there was a colleague on the social networks who said to me: ‘What about families, María? If you read the report and especially what the women with non-normative bodies say, girls with big bodies, you will find that they have all experienced super humiliating situations in their families. And when we go to the online survey, the same thing happens. We find that 80% of the women say that at some point they have received comments from their families about their body, their appearance, what they eat, the exercise they do.
Social networks, like the media once did, send messages that reify women, and these are at the root of eating disorders, which is why they are becoming more and more common among women in Western societies. But it is also true that the media and social networks reproduce the messages that women encounter in their daily lives with their families, with their classmates at school, with their friends.
“We live in a society in which it is normalised to talk about women’s bodies”
We live in a society in which it is normalised to talk about women’s bodies. We live in a society where it’s internalised that if you don’t have a slim body, if you don’t have a normative body, it’s because you’re not doing the right things, because you’re not eating right, because you’re not doing the necessary exercise.
We forget about all the factors related to health and disease that have nothing to do with what we can do, such as the postcode, whether we live in a neighbourhood where you can afford a healthier diet or not, because the cheapest products are the ultra-processed ones; or whether your family has the time to cook or not, because they are out of the house all day. They don’t have time to shop, or to think about what they’re going to buy and cook. They don’t have time to eat as a family.
There are a lot of factors around habits, around what is supposed to be healthy, around body image that we can and must work on with families.
The work that is being done in schools with children and young people is totally unhealthy, linking health and weight and stigmatising certain people.
We talk about thinness as a synonym for health and the pressure that is put on even in schools when it comes to healthy eating. The focus is on being thin, something that I understand happens in families too, doesn’t it?
From my point of view, the work being done in schools with children and young people is totally unhealthy. On the one hand, they are not giving a real picture of what health or illness is in relation to weight; there can be health and illness in all body shapes and sizes. They are stigmatising those children or young people who, at any given moment, because they are different, because they have a large body, probably already have a lot of chances of being bullied.
On the other hand, they say that everything depends on control, on what we do at home. Issues like biology are ignored. It is not just a question of purchasing power or socio-economic status and time available, it is also a question of biology.
In the focus groups I interviewed a patient with a non-normative body based on weight, who told me: ‘I had restrictive anorexia, but the only criterion I didn’t meet was weight, and yet I was very restrictive, I had menorrhagia, I was compulsive about exercising, my life revolved around it, to the point where I wanted to die. And I wasn’t considered by health professionals because I didn’t have the excessively thin body that is in the current DSM criteria. And that has implications for treatment.
How is the institutional violence you are talking about exercised in schools? Beyond healthy food and health programmes.
It is based on paradigmatic cases related to the issues of inequality that are dealt with in coeducation.
In many educational centres in our country, in the playgrounds, there is often only one playground, and it is for football, and it is the boys who play, while the girls are on the periphery and have no space to play, to move around. When I walk around my city and I see the playgrounds, you see that even the games where we girls had an active role, where we had physical activity, have disappeared. All those games are gone.
In my time, we were exhausted when we came to school. I see that my daughter doesn’t have that experience. In her school I managed to get them to make a break plan, and they started to rotate the playgrounds and one week was for one thing and another week for another. But when I got to high school, no matter how much I insisted to the guidance department, forget about it. They told me that football was untouchable, that if I touched it, everyone would be all over it.
Another paradigmatic, cross-cutting case is that of school textbooks. There are no examples of women. When my daughter studied prehistory, they always talked about it from a masculine or neutral masculine point of view.
or neutral male point of view. For example, when you read about the research on cave paintings, it says that they were probably made by women because of the physiological characteristics of the type of fingerprints. How is it possible that this kind of thing is not in the textbooks? There is already specific research. But there is still a completely patriarchal and sexist view.
It happens in many subjects. In philosophy there are no women authors. Now they talk about Simon de Beauvoir and Hannah Arendt, but until yesterday there were no female authors. What is it that women don’t think? We do think, but it’s different when what we think is made visible, as are our problems.
In the ‘values’ class, where we could work with class dynamics on issues such as bullying or gender equality, they devote themselves to giving theoretical concepts and exploring them. There is no training for teachers in these subjects, which would be wonderful to work on.
“Obesity prevention campaigns are terrible.”
In the skills project, you have a biology teacher who has a totally egocentric perspective, and because of the way she teaches the subject, she can be damaging to the mental health of the pupils. Because if there are girls who are at risk, who are vulnerable to these things, you’re telling them what to do to have an eating disorder if they haven’t thought to look for it at home.
As you can see, it’s all very transversal, from the themes and content to more specific things related to the weight-centric perspective. Obesity prevention campaigns are terrible.
You point out in the report that many of the women you spoke to were afraid to go to the doctor because they didn’t want to feel judged. I’d like to talk a little bit about these situations where women who are outside the canon of thinness, who are big or fat, get to the point where they don’t want to go to the doctor because they’re afraid of being judged.
In terms of girls with non-normative bodies, let me tell you. The girls who are activists, and in the report, for example, the ex-patients were all activists, say to me: ‘Maria, I defend the word fat because it is an adjective. After that, all the stereotypes that exist are social, but they have nothing to do with a qualifying adjective like tall or short’.
When I interviewed girls with eating disorders who had non-normative bodies, they told me: ‘I just don’t feel like myself. When people call me fat, it makes me feel very uncomfortable’. That’s why many professionals now use big instead of fat. It’s true that women activists are demanding it and I think it’s great, but there are women who have said to me: ‘I remember the situation when I had this kind of comment at school and it’s like I’m reliving it and I feel very bad’. We have to respect each person and call them what they feel.
“If you have a body with certain characteristics, the first thing they do before asking you the reason for your visit to the doctor is to weigh you.”
Regarding your question about the doctor. Activists in the world of fatphobia tell very hard stories, not just on an emotional and mental health level. How bad you can feel when you go for a consultation; and if you have such a body, before they ask you the reason for the consultation, the first thing they will do is weigh you and probably tell you that your ailments are related to your weight and that you need to lose weight. These people are not treated as equals or with the same dignity as someone who is not their weight.
In the interview Eli did with me on his podcast, he talked about a very striking case of two patients he had, one with a large body and one with a thin body. Two girls with an eating disorder and a similar injury. The thin girl had a lot of tests done, everything there is, and the fat girl was told: ‘Get thinner and we’ll talk about it later’. It’s discriminatory, it’s violent, it’s a lot of things that shouldn’t be in a health consultation.
These situations can affect your mental health, your willingness to go to the doctor. One of the women I interviewed said to me: ‘I have stomach pains, and I feel sick, and I have a family history of stomach cancer, but I put it off as long as I can because I am panicking about what they are going to tell me about my weight’.
It also means that if you’re not taken seriously, if you don’t get the right tests, the outcome can be fatal. We are talking about something as sensitive as people’s health, both physical and mental. There could be cancers that go undetected, or diseases that take longer to heal because the right treatment is not given, or women who are at an advanced stage of their disease because they delay going to the doctor as long as possible because of all the situations of violence. The treatment they receive in the health centres takes away their health.
There is not always a causal relationship between your weight and your health, so what is wrong? Why do health professionals confuse one thing with another?
On the one hand, the lack of critical thinking and training of health professionals outside the box. I mean, they tell me that I have a protocol around BMI, and I don’t read the 2023 article where medical professionals completely discredit body mass index as an indicator of… Or they tell me that there is a cause-and-effect relationship between weight and disease, and I call it obesity and talk about it incessantly without taking into account that it is not a cause-and-effect relationship but a risk factor.
I always use the same example. I am very white, and I have problems with moles; my biology means that I may be predisposed to developing skin cancer. Imagine I go to the doctor and the first thing he says to me is: ‘Ah, this is a white girl’, in other words, they invent a word for something that is a risk factor but does not mean that I am sick. There is no causal relationship. It is another risk factor, along with others, for having certain diseases.
In your experience, what is the problem we have as a society with obesity?
I come back to capitalism. What women have had in common throughout history is that we have been objectified, that it has been considered good for us to have beautiful bodies, that we have been objects. What has changed over time are bodies, through time and across cultures. There was a time when bigger bodies were in fashion, or a certain colour.
Since the 70s of the 20th century, the ideal of a woman has not been thin, but excessively thin. It may be that plump lips, thin lips, a pale complexion, a dark complexion are more fashionable at a certain moment in time. Because it may be operable, and you can sell products to a woman who is obsessed with aesthetics. Thinness is something you are obsessed with. Not just fashion, but many industries thrive on women’s insecurities and concerns.
The standard has become the excessively slim woman. Why is that? Because we have women who are self-confident and potential buyers of many products. From the fashion industry to the pharmaceutical industry to the aesthetic industry. And we shouldn’t touch that because it’s the goose that lays the golden egg.
And what can we do about it?
The key is to start doing serious work to raise awareness and sensitise society. I wrote my thesis on the media and eating disorders in 2008, and in 2011 I published a book called Liberarse de las apariencias, género e imagen corporal (Freedom from appearances, gender and body image).
It was about all these things. What happened? At that time, I was called ‘Maria’s mad woman’, they didn’t give me a loudspeaker, they didn’t give me interviews. Something changed. When I went to congresses and talked about it with my colleagues, they did not tell me that it was a cliché, that it would not change, that there were many vested interests.
We professionals have known what I am telling you for decades. The research on risk factors, those of us who have to act, have known about it for decades, it’s been published. What we are doing is claiming, and now there is a bubble that says we have to change. There are many activists in feminism, in the anti-fatphobia world, who want that change.
When I was studying psychology in the 90s, I had a professor who worked on smoking and we would have debates in class and we would say ‘what about working on health promotion and changing society and doing awareness campaigns and legislation? And he would tell us that it was not going to happen because the tobacco industry was moving many millions. And it has.
It is clear that it is a change of social mentality that will not only involve social networks.
They will publish what sells and what is the dominant discourse on the street, no more and no less. You have to start by sensitising and raising awareness in society. And if you know that there are key points like health, education, as I mention in the report, that you have to touch, touch them, even before the social networks. If they see that there is a discourse against what they are selling, they will want to continue selling and they will go to the dominant discourse.
The problem is that the dominant discourse now is weight centric. And women continue to be objectified, personalised and dehumanised, for example with music that is degrading. The lyrics of reggaeton are a translation of what they see in pornography and what they are sexually educated with.
Yes, it’s clear that the causes are everywhere at the same time, that’s why it seems so complicated.
That’s why I gave you the example of smoking, it’s the same thing that was done with smoking or driving and alcohol. The same thing that was done with condom use among adolescents in my time. We need to use the same health promotion and public policy strategies that we know work if we want real change.
You talk about raising awareness in society, what should these more general awareness campaigns look like?
The first thing we need to be clear about is that women are not an object, we are a subject, we don’t just need to talk about weight, we need to talk about other women. On the other hand, we don’t talk about women’s bodies. Expressions about the weight a woman gains after giving birth, for example, should disappear. We are objectified in all these things. When you walk down the street after Christmas, you say to yourself that you have to go back to the gym. When I was in Madrid, at the Eating Disorders Congress, I went into a cafeteria and asked for a Coca-Cola. Can you believe they told me that not only did they not have any, but they also didn’t sell ultra-processed food and I don’t know what else? I was stunned. How can this happen? This is fascism pure and simple. And then they brought me a menu where the cheapest thing they had was almost 6 euros. The products they gave me to replace Coca-Cola. Why is this happening? Because Coca-Cola costs about 3 euros in the most expensive place, and here they want to charge me 6 euros for what I order. Do you understand how it works?
What we have to do is change and be aware that obesity or the body and shape that a person may have does not necessarily mean health and what we have to work on is healthy habits, but without blaming the person, taking into account that there are many other factors.
“Many women’s eating disorders are related to body dissatisfaction associated with thinness and the objectification of women.”
You mention the need for a gender perspective in women’s health care. Could you elaborate on this in relation to another phrase you have used on several occasions: ‘Women’s bodies are not discussed’?
I will explain this with an example from the focus groups. I asked patients from both normative and non-normative bodies: ‘And what helped you get out of your eating disorder? The activists told me: ‘Fat activism, the realisation that I am not an object’, in other words, the feminist gender perspective. We talk about the fact that the key in most cases of women who start with an eating disorder has to do with body dissatisfaction. Body dissatisfaction related to thinness, gender and the objectification of women. If you take that away, if you say that women are more than that and that they need to aspire to more in their lives to feel fulfilled, then you take away a foundation.
How important is it for health workers to have a certain feminist perspective?
Very much so, and here I refer you to female authors in our country, such as Eli Cousteau or Conchi Fernández from ‘Mi Dieta es mía’ (My Diet is Mine), who participated in the study and who tell you, as professionals themselves (Eli is a psychologist and Conchi is a nutritionist) and as patients themselves, that many things need to change in the treatments and protocols for eating disorders. From a gender point of view and from a regulatory point of view.
The underweight girls in the eating disorder discussion groups used a phrase that struck me: ‘We felt that the professionals were afraid that we would go over to the other side, that we would start binging or getting fat even if we ate normally’. So they gave them very strict guidelines. One of them told me that in the middle of her treatment for anorexia nervosa, she left the hospital and went to the cinema one day and said: ‘Popcorn was forbidden to me, it was a forbidden food for me. So I went to the doctor very happy because I had eaten my packet of popcorn while I was watching the film, I was happy because I had broken with a forbidden food, I didn’t feel bad and then I told my doctor that I had eaten the popcorn and that of course I didn’t have a snack afterwards because I had an upset stomach. And they scolded me because I hadn’t eaten the prescribed snack, that what I should have done was not to eat the popcorn and to eat the prescribed snack.
So Eli and Conchi told me that they thought the protocols needed to change in terms of feedback and the gender perspective of those who deal with health issues in eating disorders.
