This week’s guest post is by Lydia Jade Turner. Ms Turner is a psychotherapist and the Managing Director of BodyMatters Australasia. In this research article she explores the connections between body image, weight, the media, and food-related industries. The Alliance of Girls’ Schools Australasia (AGSA) invited Ms Turner to write this piece and it appears in the current edition of their journal, In Alliance. Full references were provided and may be obtained by contacting Ms Turner and / or referring to her original submission for AGSA.
Australia is currently facing a public health crisis. On one hand, approximately one-quarter of school-aged children are reported to be ‘overweight’ or ‘obese.’ On the other, the National Eating Disorders Collaboration (NEDC) reports eating disorders have increased two-fold over the past five years. Working out how to foster resiliency against both extremes may feel daunting for many. While some are taught to put their children on diets, others are watching their daughter refuse to eat. Despite all the anti-obesity rhetoric and warnings about eating disorders, many are getting sicker. This paper argues for a paradigm shift away from a weight based approach to health, and makes the case for tighter regulation of the industries contributing to eating and dieting disorders in young people.
The effects of dieting and weight loss
Popular shows like The Biggest Loser suggest shaming and stigmatising ‘obese’ individuals inspires health-giving behaviours. It is troubling that many adolescents and children are exposed to such programmes, as ‘weight-based stigma’ was recently identified as a shared risk factor for both ‘obesity’ and eating disorders, in a research summary prepared by the NEDC. While such shows encourage dieting for weight loss, a landmark study by Dr Dianne Neumark-Sztainer demonstrated that adolescent girls who engage in weight-control behaviours are significantly more likely to gain weight and be heavier than their non-dieting peers five years later.
A consistent finding was demonstrated in a study published in the 2003 Journal of Paediatrics, which explored the relationship between dieting and weight change amongst ‘tweens’ and adolescents. Tracking 15,000 participants, the research found those put on diets were significantly more likely to gain weight than those who were not. Paradoxically, dieting for weight loss appears to increase the likelihood of becoming ‘obese.’ It is theorized this is due to our bodies adapting to famine periods over hundreds of thousands of years. It has only been a relatively short period of time that we have existed in a cultural mixing pot with the convenience of high calorific, nutritionally devoid foods and often sedentary lifestyles.
A study published in the New England Journal of Medicine found the appetite stimulating hormone ghrelin actually increased by approximately twenty percent even one year after participants were put on a weight-loss diet. Leptin, which helps to suppress hunger and raise metabolic rate, was found at lower levels than expected. The appetite suppressing hormone peptide YY was also found at unusually low levels. It is not yet known how long these changes remain. The Basal Metabolic Rate (BMR) which controls the amount of energy expended for the body’s basic survival functions also reduces. In essence, for many, the body works against the efforts to lose weight.
Those who engage in repeated cycles of dieting are significantly more likely to suffer from binge eating, as binge eating is the body’s survival response to deprivation. It overrides a person’s desire to restrict their intake to an uncomfortable level. Anorexia however presents an exception to this response, with emerging research showing it may be a brain disorder exacerbated by starvation, rather than a matter of unshakable willpower. For reasons not fully understood, the patient’s physiology does not ‘kick in’ to protect them from their desire to starve.
Perhaps this explains why nearly fifty years of research have demonstrated that weight loss approaches fail approximately 95% of the population over the long term. While many can lose weight in the short term, research has yet to show a dieting approach that works for most over two to five years. In fact one in five obese Australians is now reported to have eating disorder symptoms, despite appearing to have ample fat stores.
The US National Weight Control Registry provides some interesting insights into the lives of those who have maintained weight loss over the long term. The registry has enrolled over 6000 participants who have maintained an average weight loss of 15 kilograms for at least one year, and is often heralded as ‘evidence’ that weight loss maintenance is achievable for most. Yet a critique of the registry by Ikeda and her team of researchers as far back as 2005 found participants had to restructure their entire lives around food and weight, with many resorting to extreme measures to maintain their lost weight.
It’s clear dieting for weight loss carries many unintended consequences. Some would argue that the solutions prescribed to combat ‘obesity’ are the same behaviours eating disorders clinicians are diagnosing in their patients. The focus needs to shift onto disordered eating which damages the health of people at any size.
The unintended consequences of dieting include: food and body preoccupation, weight cycling, distraction from other health goals, reduced self-esteem, eating disorders, weight stigmatisation and discrimination. Dieting has also been identified as the biggest predictor of an eating disorder, while weight cycling has been shown to be more harmful to health than maintaining a higher but steady weight. For these reasons and more, focusing on weight loss as a goal is not recommended.
Weight-based stigma occurs when size is the primary focus instead of health. It is linked to a reluctance to engage in physical activity, which perhaps is not so surprising when one considers that exercise typically takes place in a public space. Weight stigmatisation is particularly harmful for young people, for example one study found obese children to be 63% more likely to be bullied, regardless of socioeconomic factors, race, gender, or what type of school they attended. Bullies often engage in bullying behaviour not because their target is fat or has big ears, but because it makes them feel comparatively powerful.
Instead of putting a child on a diet, the following factors are protective against an unhealthy lifestyle and eating disorders: fostering a positive body image, helping students find physical activities that they enjoy, modelling healthy behaviours, having students eat breakfast everyday, participating in regular and family meals, as well as fostering high self-esteem.
Anti-obesity messages are especially harmful to children. Public health messages must honour the principle of ‘first, do no harm.’ In a key research document by Professor Jennifer O’Dea, it was identified that “health education for child obesity prevention may result in the iatrogenesis of inappropriate weight control techniques whereby the health education program generates unplanned, undesirable and health damaging effects such as starvation, vomiting, laxative abuse, diuretic and slimming pill usage, and cigarette smoking to suppress appetite and as a substitute for eating”. Children and adolescents are also more susceptible to distorting anti-obesity messages, for example, by thinking that if low-fat milk is a good option, then no-fat milk must be even better.
Given the high failure rate and unintended consequences that accompany weight loss goals, a global shift away from a weight-based approach to health is currently being explored. The health-centred paradigm, also known as Health At Every Size®, acknowledges that health-giving behaviours have been shown to mitigate many of the diseases typically associated with obesity. Its key principles include finding pleasurable physical activity, engaging in intuitive eating, and viewing health as a multi-dimensional, ongoing process including physical, intellectual, social, emotional, spiritual, and occupational aspects. We can feel good about ourselves for engaging in health-giving behaviours, instead of focussing on a certain number on the scales.
Negative media and industry practices
It is sometimes argued that parents are ultimately responsible for their child’s development of a healthy body image. While parents have some responsibility and can increase risk or resiliency, it is also the case that exposure to media images overwhelmingly contributes to increased risk of body dissatisfaction, which in turn is linked to eating and dieting disorders. A meta-analysis of seventy-seven carefully selected studies involving 15,000 participants showed that media images have more impact today on young people than they did in the nineties. Despite all the body image initiatives, ultimately media has greater impact.
In an attempt to regulate the industries contributing to poor body image, Australia’s 2009 government initiatives saw the National Advisory Board for Body Image introduce a voluntary code of conduct. Unfortunately this led to minimal change. It’s clear our current approaches to reducing harmful messages in our community are failing.
In contrast to Australia other countries have explored the possibility of legislative changes. For example in Spain there have been attempts to ban ‘cult of the body’ advertisements, which target dieting and plastic surgery products, before 10pm each night. France’s lower house of Parliament adopted a law in 2008, making it illegal for anyone, including magazines and advertisers, to incite ‘extreme thinness’. Just a few months ago, the Israeli government passed a law banning the use of underweight models in advertising and on the catwalk. It’s time Australia adopts a less compromising stance towards media images and the beauty industries.
It’s not only the beauty industries that need to face tighter regulation. The food industry should also adopt more ethical marketing practices. Specific industry practices need to change, such as supplying toys with Happy Meals, advertising ‘fun’ foods during children’s television timeslots, and encouraging eating past fullness. Ultimately a shift in health paradigms and a fresh approach towards the relevant industries will be necessary if we want to see a healthier future for Australian girls.