Bridging the Divide: The Potential Benefits of a Stronger Dialogue Between the Eating Disorder and Obesity Fields

 

Introduction

The domains of eating disorders and obesity have historically operated within distinct scientific and clinical frameworks. Specialists in eating disorders have predominantly concentrated on psychopathology, disturbances in body image, dietary restriction, and extreme weight-control behaviors. Conversely, specialists focusing on obesity have emphasized metabolic health, energy balance, weight management, and medical complications associated with obesity.

Historically, this separation seemed justified. Anorexia nervosa and obesity were regarded as opposite ends of the weight spectrum: the former mainly driven by psychopathological processes, and the latter by complex metabolic, endocrine, environmental, and behavioral factors, each necessitating distinct conceptual models and treatment strategies. Nevertheless, growing evidence indicates that this dichotomous perspective is excessively simplistic. Numerous patients exhibit characteristics that encompass both domains, and several mechanisms implicated in the etiology and perpetuation of eating disorders are also pertinent to obesity (Camacho-Barcia et al., 2024).

The frequent occurrence of binge eating disorder, bulimia nervosa, atypical anorexia nervosa with obesity (Melville et al., 2025), as well as the coexistence of obesity with disordered eating and disordered eating after bariatric surgery (Hilbert et al., 2022), highlights how important it is for different disciplines to collaborate and support each other. Plus, new public health challenges like weight and internalized weight stigma, the impact of social media, and the common use of anti-obesity medications mean that experts from both areas need to come together to find effective solutions.

This paper examines the potential advantages of promoting enhanced dialogue between specialists in eating disorders and obesity. It is argued that increased collaboration may lead to improved outcomes for patients, clinicians, and researchers alike.

Shared Risk Factors and Maintaining Mechanisms

Although obesity and eating disorders differ significantly in important respects, they share several risk factors and maintaining mechanisms.

Body dissatisfaction is among the most significant predictors of both disordered eating and unhealthy weight-control practices (Sharpe et al., 2018). Individuals who experience dissatisfaction with their appearance are more prone to engaging in dieting, restrictive eating, binge eating, and compensatory behaviors (Goldschmidt et al., 2012; Stice et al., 2017). Such behaviors may elevate the risk of developing eating disorders and weight gain over time.

Similarly, weight and shape concerns occupy a central role in various manifestations of eating disorder psychopathology. These concerns are increasingly acknowledged as significant factors influencing obesity-related behaviors. An excessive preoccupation with body weight frequently fosters cycles of dietary restriction, overeating, guilt, and subsequent attempts at dietary regulation.

Dietary restraint represents another important area of overlap. Research from the eating disorder field has consistently demonstrated that rigid dieting can increase the risk of binge eating and other forms of disordered eating (Fairburn, 2008). Obesity research has similarly shown that highly restrictive weight-loss approaches often fail to produce sustainable long-term outcomes and may contribute to weight cycling (Nordmo et al., 2020).

Emotional eating, impulsivity, difficulties with emotion regulation, and exposure to weight-related stigma have also been identified as common factors associated with both obesity and eating disorders (Khalid et al., 2025; Treasure et al., 2022).

Recognition of these shared mechanisms suggests that collaboration between the two fields may facilitate the development of more comprehensive explanatory models that address the complexity of weight-related psychopathology.

Improving Clinical Assessment

A stronger dialogue between the obesity and eating disorder fields could substantially improve clinical assessment.

Patients seeking treatment for obesity are not routinely screened for eating disorders despite evidence that binge eating disorder, bulimia nervosa, atypical anorexia nervosa, and other forms of disordered eating are relatively common among individuals seeking weight-management treatment (Dalle Grave, 2023). Failure to identify these conditions may compromise treatment effectiveness and increase psychological distress.

Conversely, eating disorder services may sometimes underestimate obesity-related medical complications, including type 2 diabetes, cardiovascular disease, sleep apnea, and metabolic dysfunction (Dalle Grave, 2025).

A more integrated assessment approach would encourage clinicians to evaluate both psychological and physical dimensions of health. Such an approach could identify patients whose difficulties cannot be adequately understood through the lens of either obesity or eating disorders alone. The adoption of shared screening protocols and common assessment frameworks could facilitate earlier identification of complex presentations and promote more individualized treatment planning.

Enhancing Treatment Approaches

Collaboration between the two fields may also improve treatment. The eating disorder field has developed sophisticated psychological interventions targeting dietary restraint, body image disturbances, over-evaluation of weight and shape, and maladaptive eating behaviors. Enhanced Cognitive Behaviour Therapy (CBT-E) (Dalle Grave & Calugi, 2020; Fairburn, 2008), for example, addresses many of the cognitive and behavioral mechanisms that contribute to both eating disorders and problematic eating patterns.

The obesity field has generated valuable knowledge regarding long-term behavior change, physical activity promotion, nutritional management, obesity-related medical complications, and pharmacological treatments.

Bringing these perspectives together may help clinicians develop interventions that simultaneously address psychological well-being and physical health outcomes when eating disorders are associated with obesity. This integration may be particularly valuable for individuals with binge eating disorder and clinical obesity (Dalle Grave et al., 2024). Historically, treatment providers have often struggled to determine whether clinical obesity management or eating-disorder recovery should take priority. Greater dialogue between the two fields may facilitate the development of treatment models that balance these objectives while minimizing harm.

Addressing Weight Stigma and Internalized Weight Stigma

One of the strongest arguments for greater collaboration between the eating disorder and obesity fields is the growing recognition of the harmful effects of weight stigma and internalized weight stigma. Although these issues have traditionally been studied separately, evidence increasingly suggests that they represent shared challenges that contribute to both obesity-related difficulties and eating-disorder psychopathology.

Weight stigma refers to the social devaluation and discrimination directed toward individuals because of their body weight. It is increasingly recognized as a major public health concern associated with psychological distress, depression, anxiety, social isolation, unhealthy eating behaviors, healthcare avoidance, and poorer quality of life (Rubino et al., 2020; Tomiyama, 2014). Researchers in both fields have documented its harmful effects across healthcare, educational, occupational, and social settings (Puhl et al., 2021).

In the obesity field, weight stigma is increasingly viewed not merely as a consequence of obesity but as a factor contributing to its maintenance through stress, emotional eating, reduced physical activity, healthcare avoidance, and diminished self-efficacy (Rubino et al., 2020; Tomiyama, 2014). Similarly, in the eating disorder field, weight stigma has been associated with body dissatisfaction, dietary restraint, over-evaluation of shape and weight, and greater symptom severity (McEntee et al., 2023). These findings suggest that weight stigma may function as a common risk and maintaining factor across a broad spectrum of weight-related psychopathology.

A related construct is internalized weight stigma, also known as weight bias internalization, which occurs when individuals adopt negative societal stereotypes about body weight and apply them to themselves (Durso & Latner, 2008). Internalized weight stigma has been linked to depression, anxiety, low self-esteem, body dissatisfaction, disordered eating behaviors, eating disorder psychopathology, reduced physical activity, healthcare avoidance, and poorer quality of life in people with obesity (Calugi et al., 2023; Pearl & Puhl, 2018; Puhl et al., 2017). Evidence also suggests that self-directed weight stigma may contribute to binge eating, emotional eating, social withdrawal, and difficulties with weight management (Tomiyama, 2014).

Within the eating disorder literature, internalized weight stigma has been associated with dietary restraint, body checking, body avoidance, extreme weight-control behaviors, and eating disorder psychopathology (Calugi et al., 2023; Levinson et al., 2024). Its relationship with binge eating is particularly relevant to both fields, as weight-related shame and self-devaluation may trigger binge eating as a means of coping with negative emotions (Pearl et al., 2014).

The growing recognition of weight stigma and internalized weight stigma provides a compelling rationale for greater dialogue between obesity and eating disorder specialists. Both fields increasingly acknowledge that weight-related shame is not a therapeutic tool and may instead undermine psychological well-being, behavior change, and treatment outcomes. By developing shared research agendas, integrated prevention initiatives, and coordinated advocacy efforts, specialists from both disciplines may be better positioned to challenge societal attitudes that contribute to weight-related suffering and promote more compassionate, evidence-based models of care (Sánchez-Carracedo et al., 2012).

Prevention Opportunities

Prevention represents another area in which closer collaboration between the eating disorder and obesity fields may yield substantial benefits. Historically, obesity prevention programs have focused on healthy eating, physical activity, and weight management, whereas eating-disorder prevention initiatives have emphasized body image, media literacy, and reducing unhealthy dieting behaviors.

However, many of the risk factors targeted by these interventions overlap. Dieting, body dissatisfaction, weight teasing, and exposure to unrealistic appearance ideals have been identified as risk factors for both obesity and eating disorders (Haines & Neumark-Sztainer, 2006). This observation has led to the proposal of a shared risk factor approach, suggesting that integrated prevention programs may simultaneously reduce the risk of both conditions (Golden et al., 2016).

Such initiatives could promote healthy lifestyle behaviors while also addressing body dissatisfaction, weight stigma, and unhealthy weight-control practices. This approach may be particularly important for children and adolescents, who are increasingly exposed to social media environments that promote appearance-based ideals and weight-loss behaviors (Fardouly & Vartanian, 2016; Holland & Tiggemann, 2016).

By recognizing common risk factors and developing coordinated prevention strategies, the eating disorder and obesity fields may improve both physical and psychological health outcomes while avoiding potentially conflicting public health messages.

New Challenges: GLP-1 and GIP Receptor Agonists

The rapid expansion of GLP-1 and GIP receptor agonists represents a contemporary challenge that further highlights the need for greater dialogue between the obesity and eating disorder fields. Medications such as semaglutide and tirzepatide are transforming obesity treatment, producing substantial and sustained weight loss while improving cardiometabolic outcomes (Aronne et al., 2025; Lincoff et al., 2023). As their use becomes increasingly widespread, important questions have emerged regarding their impact on eating behavior and eating-disorder psychopathology.

Emerging evidence suggests that GLP-1 and GIP receptor agonists may reduce hunger, food cravings, loss-of-control eating, and binge-eating episodes in some individuals with obesity and binge eating (Jebeile et al., 2026). However, it remains unclear whether improvements in eating behavior are accompanied by changes in the psychological processes that maintain eating disorders.

This distinction is particularly important from an eating-disorder perspective. While GLP-1 and GIP receptor agonists appear capable of modifying eating behavior through biological mechanisms, they may not directly address key cognitive maintaining mechanisms such as the over-evaluation of shape and weight, body dissatisfaction, and dietary restraint (Fairburn, 2008). Consequently, some patients may experience reductions in binge eating while continuing to base their self-worth on body weight and shape.

Another concern is that rapid and highly visible weight loss may inadvertently reinforce the importance attributed to weight and shape in self-evaluation. Positive social feedback regarding weight loss could increase fear of weight regain and encourage the pursuit of further weight reduction, particularly among individuals vulnerable to eating disorders. Conversely, appetite suppression may mask emerging restrictive eating disorder symptoms, delaying their recognition and treatment.

At the same time, GLP-1 and GIP receptor agonists offer a unique opportunity to better understand the relationship between biological and psychological mechanisms involved in eating behavior. They may help clarify whether reducing appetite and binge eating is sufficient to improve overall eating-disorder psychopathology or whether psychological interventions remain necessary to address body image concerns and the over-evaluation of weight and shape.

The growing use of GLP-1 and GIP receptor agonists, therefore, creates a compelling case for collaboration between obesity specialists and eating-disorder clinicians. Neither field alone possesses all the expertise needed to address the clinical, psychological, and ethical questions raised by these treatments. Collaborative research, shared screening procedures, and multidisciplinary clinical guidelines will be essential to maximize benefits while minimizing potential risks.

Potential Challenges to Greater Collaboration

While stronger dialogue offers many advantages, potential challenges should also be acknowledged. Some clinicians may worry that increased integration could dilute specialized expertise or create confusion regarding treatment goals. Eating disorders and obesity remain distinct conditions requiring different interventions in many circumstances.

There is also a risk that obesity-focused approaches emphasizing weight reduction could inadvertently reinforce eating-disorder psychopathology in vulnerable individuals. Conversely, exclusive focus on eating-disorder recovery may sometimes lead clinicians to underestimate obesity-related medical risks.

For this reason, collaboration should not aim to eliminate distinctions between the fields. Rather, it should promote mutual understanding while preserving specialized knowledge. The goal is not integration at all costs but constructive dialogue that enables clinicians and researchers to learn from one another.

Conclusion

The historical separation between the eating disorder and obesity fields has contributed to significant advances in both disciplines. However, contemporary clinical and public health challenges increasingly reveal the limitations of this divide.

Eating disorders and obesity share important risk factors, maintaining mechanisms, and treatment challenges. Weight stigma, dietary restraint, body dissatisfaction, binge eating, and emerging obesity treatments represent areas where collaboration could generate substantial benefits.

A stronger dialogue between specialists in both fields may improve clinical assessment, treatment planning, prevention efforts, research initiatives, and public policy. Such collaboration does not require abandoning disciplinary identities. Instead, it requires recognition that many patients experience difficulties that transcend traditional diagnostic and professional boundaries.

Moving beyond disciplinary silos may ultimately facilitate a more comprehensive understanding of weight-related psychopathology and support the development of more effective, compassionate, and patient-centered care.

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