Thursday, January 06, 2011

Obesity and eating disorders: they're connected


When I talk with doctors about eating disorders, I often end my presentation with a caveat to them, to be aware of how the current
"war on childhood obesity" can trigger eating disorders in those who are vulnerable. That's the point in the program where I often see one or two audience members sit back and cross their arms in a way that telegraphs plainly their disbelief and even disgust. (I've had people walk out at that point, too.)

If you think that's pushing things a bit too far, I'd like to call your attention to just one of the many "anti-childhood-obesity" websites I've run across lately. This one is particularly egregious, as it offers up cartoon characters that are both offensive and poorly illustrated (not to mention an obnoxious soundtrack, which you can turn off at the lower lefthand corner of the screen). The "cast" of characters here includes O-Bee-Sity, described herein as "s "the supreme fat lord of the universe" who can "turn kids into globs of fat with one slimy touch"; Phat Cells, which "have the ability to multiply and wreak havoc on the human body"; and--rather unbelievably--Anna-Rexia, who apparently hails from the planet Bulimia (don't these folks get the difference?) and both "infects little girls with eating disorders" and "despises" the rest of the cast (shown above).

Aside from the bad art and wild overuse of copyright symbols, there's some just plain bad information here. The site claims that childhood obesity causes not just diabetes, high blood pressure, and heart disease (all of which is still up for discussion, especially given the fact that we don't know whether obesity causes these ailments or whether the ailments themselves contribute to obesity), but also cancer, liver disease, asthma, and eating disorders.

Hello? Considering the fact that one of the "characters" here is "Dr. Smart," billed as the "secretary of health and fitness at the Pentagon," I'd like to think that someone was actually doing some research and not just spewing ill-founded and unsupported opinions as facts. Sadly, this is not the case. And I'd have to say that this is the norm for sites like this, which remind me of other zealous-but-ignorant campaigns.

In fact, as readers of this blog probably know, it's not obesity that causes eating disorders, but rather a combination of factors, mainly genetics and dieting. It's the war on childhood obesity--and on adult obesity--that's responsible for triggering anorexia, bulimia, and other eating disorders, not the condition of obesity itself. And the prejudice and stigma directed against the obese is likely responsible for many of the negative health outcomes we associate with weight.

Any way you look at it, websites like this one are not just ignorant or misguided; they're dangerous. And that's why I'll keep sounding the alarm when I talk to doctors. They need to know the consequences of their crusades.

26 comments:

familyfeedingdynamics said...

Thanks HArriet, They don't get it, alas. I have an editorial in the St. Paul paper about their school "wellness policy" that bans all "treats" and second helpings. the schools are piling on. Please read the tragic student essays I pulled from on my post. Kids are being taught if you're fat it's your fault, bullying and teasing is OK, the "no sweet" policy will prevent diabetes, obesity etc, all the things you mention. It's maddening. I'll check out the site you mentioned, but there are dozens and dozens popping up. Harming our kids, for sure!
http://familyfeedingdynamics.com/2011/01/why-im-sour-on-st-paul-schools-sweet-free-status/

Anonymous said...

I really love the Gymanimals and what they are doing as far as getting children to identify with childhood obesity. Unlike you, I understand thier concept of trying to put a face to this disease.Instead of being so negative and so opinionated to what these guys are doing, maybe you should join forces with them and maybe come to a medium where both you guys can do whats really important: SOLVE THE PROBLEM! Everybody is just running around trying to sound intelligent, but nobody is dealing with these children who suffer! And by the way, I love "Whip Your Hair" by Willow Smith. These guys are on to something, and your just coming across very negative! Go Gymanimals!!!

Anonymous said...

Also on Disney Channel and Nickelodeon there's commercials of "healthy eating" sometimes starring Mrs. Obama, or some other "obesity expert", shaming kids for eating "too much". The kid being shamed for eating "too much" was a tall skinny boy which the amount of food he was eating would have been considered a normal amount for a boy his age and weight during an earlier era.

Also two years ago during the Halloween season I heard a PSA over a grocery store intercom of Demi Lovato and Miley Cyrus telling kids how "fattening" Halloween candy is and to eat fruit instead. A few years later and I see the irony of these two "role models" falling off their pedestals from eating disorders and sheer stupidity.

Ashley said...

Just out of curiosity, where are you when talking to your doctors about obesity and eating disorders that you have an audience?

I went to that site and I see your point about it. It makes some bold statements and right out says that obesity causes diabetes and all that, which like you said, has never been actually proven. It has been proven, though, that if one is obese then they have a greater risk for those things, but that and the other are two different statement.

Harriet said...

@Anonymous 1: You can "love" the Gymanimals all you want, but I think you're missing the point that they are actually doing harm rather than good. If you can come back with an intelligently argued case rather than simply making accusations of negativity and rah-rahing this website, I'll be glad to listen. Otherwise, you're not being effective.

@Anonymous 2: One thing we know for sure is that shame is not a good motivator for positive health outcomes. It leads only to angst and self-destructive behaviors.

Ashley, I do a lot of public speaking, and some of it is to doctors. Hospitals bring me in sometimes to speak at Grand Rounds or to give presentations. One of the thoughts about diabetes in particular is that the underlying mechanism of the illness is what makes people gain weight, rather than the other way around. We really don't understand metabolism very well yet.

JeninCanada said...

Well said Harriet, as usual. :) Doctors, teachers and parents need to be aware that pushing "OMG OBEEESITYYY!" might push their kid right into an eating disorder. Sadly, there as some out there who would rather their kid be bulemic or anorexic than obese, simply because thin is so venerated in our culture.

Anonymous said...

@Harriet
The first problems to occur in obese children are usually emotional or psychological.[5] Childhood obesity however can also lead to life-threatening conditions including diabetes, high blood pressure, heart disease, sleep problems, cancer, and other disorders.[6][7] Some of the other disorders would include liver disease, early puberty or menarche, eating disorders such as anorexia and bulimia, skin infections, and asthma and other respiratory problems
The following passage is from the health professionals at Mayo Clinic. This is my argument. With the influx of video games, computers, and movies, Kids are living sedentary lifestyles. As a parent I'm all for something that can get the children up and off the couch and interested in getting healthy. I love what the Gymanimals stand for. Have you read any of their story lines? have you been to their blog? The Gymanimals are doing a great job, and your reporting from a huge dis advantage because you know nothing of what the Gymanimals are about. You are simply looking at a drawing and making an uneducated assessment. It is you who has no argument, so you're trying to invent one. Go Gymanimals!!!

Harriet said...

@Anon:

I think Mayo Clinic is usually pretty good for medical information. However, I have spent the last five years researching eating disorders and obesity, and I can tell you that obesity does not cause eating disorder, or asthma, or mental and emotional problems. What does cause psychological problems in obese children is the prejudice and stigma they face from living in a fatphobic world.

And FYI, I've read the blog and spent a lot of time on the website. Way too much time. The site is simplistic, poorly executed, and inaccurate. It's designed to make kids feel shame for their weight, and I can tell you that shame leads only to self-destructive behaviors, not to better health outcomes. So no, I don't agree with you, and I don't actually appreciate your other comment (the one I didn't post) either.

Sleepydumpling said...

Add to this that eating disorders are ignored or even encouraged/sanctioned in fat people, and you get an even more dangerous situation.

Eating Alone said...

Glad I'm no longer a kid.

wriggles said...

Stop shilling for them anonymous.

anon said...

Dieting does not work. It makes things worse. There are many studies like the one below that demonstrate this.

J Neurosci. 2010 Dec 1;30(48):16399-407.
Caloric restriction experience reprograms stress and orexigenic pathways and promotes binge eating.
Pankevich DE, Teegarden SL, Hedin AD, Jensen CL, Bale TL.

Department of Animal Biology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Abstract
Long-term weight management by dieting has a high failure rate. Pharmacological targets have focused on appetite reduction, although less is understood as to the potential contributions of the stress state during dieting in long-term behavioral modification. In a mouse model of moderate caloric restriction in which a 10-15% weight loss similar to human dieting is produced, we examined physiological and behavioral stress measures. After 3 weeks of restriction, mice showed significant increases in immobile time in a tail suspension test and stress-induced corticosterone levels. Increased stress was associated with brain region-specific alterations of corticotropin-releasing factor expression and promoter methylation, changes that were not normalized with refeeding. Similar outcomes were produced by high-fat diet withdrawal, an additional component of human dieting. In examination of long-term behavioral consequences, previously restricted mice showed a significant increase in binge eating of a palatable high-fat food during stress exposure. Orexigenic hormones, melanin-concentrating hormone (MCH) and orexin, were significantly elevated in response to the high-fat diet only in previously restricted mice. Furthermore, administration of the MCH receptor-1 antagonist GSK-856464 [4-(4-ethyl-5-methylsulfanyl-1,2,4-triazol-3-yl)pyridine] significantly reduced total caloric intake in these mice during high-fat access. These results reveal reprogramming of key central pathways involved in regulating stress responsivity and orexigenic drives by moderate caloric restriction experience. In humans, such changes would be expected to reduce treatment success by promoting behaviors resulting in weight regain, and suggest that management of stress during dieting may be beneficial in long-term maintenance.

Anonymous said...

@WRIGGLES Not shilling for them, just love with they are doing! Kids need stuff like this

chutti said...

Harriet-
Thanks for pointing out the potentially dangerous nature of this website.

I have worked in educational publishing and technology for decades and am always ready for a critical ( in the academic sense)review of the latest home-made 'solution' to an educational or developmental issue which arises around funding made available for such. You can't tell me the influx of grants for 'fighting childhood obesity' aren't a factor here.

Fact is, there is not a lot of solid info here, and the presentation is less than stellar. I can get past the hokey art and website design, and can even appreciate that the creator of this program likely has some genuine concern for children, but this one just boggles the mind.

There is no lasting curriculum here, just a quick fix assembly style presentation. I see no real interaction for kids on the website, just scary videos. Oh, sorry, there are some recipes and nutritional info that are all easily available elsewhere. Not to mention the frequent opportunities to court corporate sponsorship. Hmmm.

I suspect there is some sort of competitive behavior mod program ( i.e.; exercizing for prizes) lurking in here down the line. I do not fall in line with pedagogy using incentive to teach/reward behavior as effective. There is plenty of research to the contrary ( google Stephen Krashen for starters).

This looks like it has the potential to cause a lot of damage socially, and certainly not to stem issues around ED. Like other ill-conceived and executed programs, it could likely keep individuals, families and institutions away from solutions (programs, therapy, food access issues, anti-bullying efforts, etc.) that are actually helpful.

Scary stuff, in my book.

Anonymous said...

I find this disscussion so facinating!I hear a lot of big words and posturing, but no solution to the problem. If what these guys are doing is so wrong, what are you guys doing that's right? Everyone is so scared of what a cartoon is going to do to the social dynamic. But then boycot the Simpsons for promoting sex, drinking, and just plain stupidity. I havnt heard ONE solid solution from no one who has commented. Why dont all you guys email the makers of the website and offer them your views and advice so that perhaps "together" you smart and socially responsible people can come up with something that can help children get healthy. Thats what social responsibilty is. Not bashing someone elses efforts, but offering none of your own....@Harriet: Sorry, but no Five year old is going to be interested in your book. Im sure of that....They view it as scary stuff, in your book.

Harriet said...

@Anon, we don't even agree on the "problem." And you sure as heck don't have any solutions. Dieting makes people fatter. Stigma and prejudice makes people . . . fatter. (And more miserable to boot.) In fact, not a single school-based intervention intended to make kids thinner has ever worked. Nor has any "dieting" strategy.

So you tell me: Let's say thinner is better (and there's a lot wrong with that statement, but let's go with it for a moment): There is no way to make people thinner reliably and without harming them further. So isn't it a better strategy to support self-acceptance and healthy behaviors without emphasizing weight issues?

As for the "big words," I'm sorry you feel so outclassed on the vocabulary level. Can't help you there.

And I have no idea what you're talking about regarding my book, which is not and never has been intended for children.

chutti said...

@ anonymous:
The reason why I don't rush in to help Gymanimals ( TM) "solve the problem" of childhood obesity, is that I don't consider it a problem, or appropriate fodder for a school or education based campaign. It's not just poor execution. Maybe I didn't make that clear enough in my earlier comments.

The science does not conclusively show an INCREASE in childhood obesity ( read up on the changes in BMI, nor does science prove that obesity CAUSES high blood pressure, diabetes and heart disease. Did you read the next post here on Dr. Sharma? Diets do not work, and cause more harm to health than being fat and fit.
If you can't find on this very website links to substantial information on the science here, you're not looking very hard.

As a fat child, I ate healthy home cooked whole foods and swam over 2 hrs a day on a competitive swim team. Nothing in this 'curriculum' would have changed my dietary and exercise habits, nor would it have made any difference in my overall health, appearance or size. I have no problem encouraging children to eat healthy foods and exercise. I DO have a problem when these behaviors are promoted as a strategy to impact weight.

The combative language and imagery offends me, but is also potentially harmful to children.

Each character has a "weapon of choice"....making for a combative and not so positive dialogue.
I am pretty repulsed by the overly small waist of Gina the Giraffe. NOT a realistic role model or body image. Yes, she's a GIRAFFE...but why give her a waist at all then?

"O-Bee-Sity© is the supreme fat lord of the universe. He can turn kids into globs of fat with one slimy touch. He is The Gymanimals© sworn enemy." ....does this not influence children to think at the very least unkindly towards the "obese" among us? SLIMY?
Globs of Fat?

Fat children are GLOBS OF FAT???
What would my childhood peers hearing this think of me and my size, despite following all the healthy prescriptions on the website? Do you think I'd be treated respectfully in this dialogue?
We already have issues with bullying with all students. Why would we want encourage this kind of thinking? Fat children (and adults) are humans with a wide range of activities, accomplishments and abilities; not globs.

chutti said...

@ anonymous:

There are specific issues I have with the creation and execution of this website and characters.

Each Gymanimal(TM) has a 'weapon of choice' to 'combat O-bee-Sity', which sets up an inherent confrontational attitude.

Gina the Giraffe's absurdly small waist is not useful in combating negative body image. She's a GIRAFFE! Why does she need a waist?

...the evil "O-Bee-Sity", who seeks to dominate the world by turning children into lazy, unhealthy blobs of fat.

Fat children and adults are not GLOBS. They are human beings with a full range of thoughts, activities, abilities and accomplishments. The implied connection to the enemy glob does nothing to address the "psychological cost of obesity" but might just give rise to aggression and bullying toward fat children.

As a fat, happy and active child ( and adult!) , I ate nutritious home cooked meals and swam 2 hrs a day on a competitive swim team. No food or exercise strategy on this site would have been news to me, nor would it have changed my shape, weight, or health. It just might have changed the attitude of my peers towards me, though.

I am fortunate to have not fallen victim to an Eating Disorder, as have many other fat children, teens and adults. Were I involuntarily placed in groups where my size was compared to an evil glob, I don't know what my situation would be.

I just can't get behind this effort.

chutti said...

I do not think "childhood obesity" is a "problem to be solved", so am not interested in working with anyone on such a project. Literacy and equitable access to education are my passions. I worry that folks who genuinely want to better quality of life for children will use time and resources for Gymanimals (TM) that would be better used elsewhere.

Working to create safe recreation and play spaces for all ages, meaningful after school activities, promoting the enjoyment of movement in itself, anti-bullying counseling, ensuring safe and affordable access to foods for all families, and appropriate career counseling would all be efforts I would consider "problems" worthy of "solving". I have worked in communities to address these issues.

I don't see a registered dietician, trained counselor or psychologist associated with this program on the website. Nor do I see any consulting with such listed. I do see a lot of generally available resources (most for free) posted on a website which appears to be promoting a fee based service.
Once you enter the professional arena, you open yourself and your work up to professional criticism.
There is nothing creative or original here worth funding with scarce school and private agency dollars. If you want to play in the big leagues, you need research and efficacy studies about YOUR particular program, not just generalized scientific info.


So I am not interested in "bashing someone else's efforts", but do think a bit more effort should have been taken in creating this program, which I feel has the potential to cause great harm.
I will continue to focus my own efforts on well-organized and EFFECTIVE ways of helping children and families, thank you.

Anonymous said...

The website is so horrendous. Just awful. It is so ignorant and the character Anna Rexia just makes me angry. I have an ED and this site just makes me want to scream! They don't even know what they are talking about! It makes me so mad!

concernedparent said...

The creator of Gymanimals has an associates degree from a community college -- not that there is anything wrong with that -- but I see no nutritionists or medical advisers that are behind the site. It's an amateurish and dangerous.

AB said...

"@Anonymous 2: One thing we know for sure is that shame is not a good motivator for positive health outcomes. It leads only to angst and self-destructive behaviors."

I can attest to that as my eating disorder started due to being shamed due to my weight, and also getting ideas from celebrities of how to loose weight.

BTW I was Anonymous #2.

J at www.jellyjules.com said...

I am horrified by the obsession with childhood obesity, personally. We have a very busy street nearby, and recently a pedestrian bridge was built over it. At the opening ceremony, some stupid politician got up and said how this bridge was going to allow kids to ride their bikes to school, thus contributing to the war on childhood obesity. My recovered (I hope) anorexic niece was standing right there. I wanted to slap the politician. Couldn't she have just said that the bridge would allow children to safely ride their bikes, and leave it at that? Similarly, couldn't Mrs. Obama have made her issue about getting more healthy food to children? I don't see that any of her actions are bad...trying to get healthier food in school lunches and corner stores in poor neighborhoods. It's the wording that she uses that is dangerous. The fight against obesity, vs. what it really is, which is a fight against poverty. But that wouldn't fly, politically, would it. Grrr.

Anonymous said...

Harriet,
I read your book after seeing the last part of an interview you did on public television. I have known for many years that treatment for anorexia and other eating disorders is way off and that parents suffer because they don't know what to do. My parents struggled because I was the only over weight child in the family.I started dieting in first grade and was prescribed diet pills in high school. My parents tried many strategies and nothing worked. The bad advice from doctors really made things worse and hurt my relationship with my parents and siblings. I think your approach might have helped me to feel loved, supported and helped. I am now in my late 50's and I have lost over 100 pounds four different times in my life. This is not good...it has not been easy on my body. I have learned to trust myself about nutrition more than most conventional expert advice. Growing up and still to this day I am the most active person in my family. Like many overweight people I do not fit the stereotypes. I am not able to maintain a low weight or what they would say is a healthy weight unless I severely restrict calories. I have been fighting this battle for so long that I try to keep a level head about it. I am always fighting to keep some of the weight off -if I don't fight I go back up to a weight I cannot live with. I feel that I can relate to people with eating disorders because most days involve a struggle related to self esteem, healthy eating and backwards thinking people (including M. Obama in regard to how to help people). I knew from the time that I was very young that I would have to fight to be okay and to be successful. I no longer like to read about diets, eating disorders and I can't stand to see the the cropped videos of heavy people walking down a street on the news. I read your book because I wanted to read about you after hearing you speak. That is what is most interesting to me now. There are a few rare really good people who are thoughtful and strong enough to learn how to put things in perspective ... we have a lot to learn from these people. Also I wish the field of medicine/ science would get with it. It is frightening to go for help and realize that they do not have much to give. Thanks for sharing your insight and very informative story.

Lisa

Harriet said...

Lisa,
I'm so sorry you've been through so much. But your strength, insight, and quiet thoughtfulness are remarkable and inspiring.

Your story makes me think about a friend of mine, who has since died of ovarian cancer. She was always the "heavy" one in her family. She landed in a mental hospital at age 9 with anorexia, and knew even then that she, as you say, would have to fight to make herself OK. She wound up being inspirational to so many people. It was a tragedy when she died at 40.

Keep thinking. Stay strong. You're worth it.

--Harriet

Amber said...

I realized that some of the recipes on that site looks like the diet food ( except I never liked avocados) I used to eat when I was dangerously dieting as a teenager. It took me a year to start eating "normal" food after eating just tiny amounts of grilled chicken, veggies, rice, and potatoes (and noting else) every day for almost three years. I still have to remind myself that red meat isn't poison and that too much water can be as bad as to little.