Could the Obesity Fight Backfire?

In a recent study, more than half the women trying to lose weight were not overweight. Why do people who are not overweight think they need to lose weight?
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At a time when two thirds of Americans are either overweight or obese, health officials are correctly warning that most of us need to lose weight. But we may be setting ourselves up for a surge in eating disorders.

The two main types of eating disorders are food restricting (commonly referred to as "anorexia") and binge eating and purging (commonly referred to as "bulimia"). The disorders typically begin in adolescence and affect women much more commonly than men.

Statistics are tough to come by -- partly because of under-diagnosis and incomplete reporting -- but a recent review estimated that 500,000 women in the U.S. have anorexia and 1-2 million women have bulimia.

The National Eating Disorders Association has a higher estimate, with "as many as 10 million females and 1 million males" suffering from either one of the two disorders. Recent reviews have reported that 90 percent of patients with bulimia are female but the rate in men appears to be increasing in recent years.

A key feature of an eating disorder is the disparity between perception and reality. Over the past thirty years, obesity (BMI greater than or equal to the 95th percentile) in teenagers increased from 5.0 percent to 17.6 percent. While that rate has skyrocketed, it's still much lower than the perceived rate of obesity among students. Among children in grades nine through 12, 10 percent of females were obese and 15.5 percent were "at risk" for becoming obese (BMI greater than or equal to the 85 percentile but less than the 95th percentile). Yet 38.1 percent of the female students described themselves as overweight and 61.7 percent were trying to lose weight.

Put another way, more than half the women trying to lose weight were not overweight.

Why do people who are not overweight think they need to lose weight? There's no simple explanation. Experts believe that genetic, environmental, psychological, and social factors can all play a role in eating disorders. Studies suggest that movies, magazines, and television contribute to eating disorders by idealizing overly thin women and exacerbating body dissatisfaction, especially in people with low self-esteem. Fashion magazines often feature models with obvious signs of anorexia. The theme is clear: less is more.

My intuition tells me we're at a tricky point in the national discussion of weight. Since research suggests that the wrong public message can be especially dangerous for patients at risk of an eating disorder, we need to be very careful as we develop strategies against obesity. As they create their plans, agencies such as the Centers for Disease Control (CDC) should include experts in eating disorders.

For this week's CBS Doc Dot Com, I talk to Leslie Lipton and her father, Roger, about how Leslie has successfully battled anorexia. Click below to watch the video:

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I also interviewed Dr. B. Timothy Walsh, a renowned expert on eating disorders and Professor of Psychiatry at Columbia University Medical Center and author of the book, If Your Adolescent Has an Eating Disorder. Click below to watch the video:

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