Government nutrition advice could be making some people too thin
Is it time for more regulators to crack down on eating disorders?
When British regulators recently yanked an ad because they deemed a model in it too skinny, they sparked yet the latest round in a debate over what, exactly, is too thin — and who gets to say so.
They also pointed to a thorny and counter-intuitive dilemma.
Governments in developed countries have, for years, told their populations they’re too fat and have dispensed nutrition advice intended to trim expanding waistlines. But that, some people believe, has created a culture that drives people to starve themselves — to become so thin that governments are now taking steps to warn against thinness.
Heard of yo-yo dieting? Well, this is sort of related.
In the US anyway, the government issued its earliest dietary advice in the 1890s to ward off malnutrition and help people reach a healthy weight. But by the 1950s and 1960s, with middle-class Americans getting pudgy thanks to post-War abundance (and lethargy, perhaps), the government began to step in more formally. At the height of the Cold War, politicians began to worry that America’s increasing flabbiness projected a kind of weakness, prompting President John F. Kennedy to launch the President’s Council on Youth Fitness. In the 1970s, a special Congressional committee wrestled with developing dietary advice, a process that culminated in the first-ever Dietary Guidelines for Americans, published in 1980.
Around the same time an odd, and perhaps related, thing happened: Obesity rates started going up, while eating disorders, including anorexia or bulimia, also began to escalate. At first these disorders weren’t taken seriously, but when the singer Karen Carpenter died from anorexia-induced heart failure in 1983, the idea that a person would starve themselves to death firmly sunk in. Anorexia still has the highest mortality rate of any mental illness.
So why? Why this “obesity-eating disorder paradox,” as some researchers call it?
“As the governments have gotten involved, there’s more of a stigma about obesity,” said Maria Rago, the board president of the National Association of Anorexia Nervosa and Associated Disorders (ANAD). “It’s deeply, deeply entrenched in the culture that being fat is bad.”
Of course, being really fat is, generally speaking, a bad thing. Obesity is linked to a range of illnesses, including diabetes and some cancers, and increased risk of heart attack. The “obesity epidemic” translates to an estimated $190 billion in healthcare costs each year in the US, making it Public Health Crisis Number One.
But all of the messages around weight — the “war” against fat — has given some developed countries, including the US, a serious fat-phobia, which may drive some people in the other direction. Some 24 million Americans suffer from eating disorders, including anorexia, and increasingly these are not just well-off, white teenage girls, as early research suggested, but men and women from all backgrounds and ethnicities.
“There was always anorexia, but it was extremely rare,” Rago said. “We just have a culture where it’s much more prevalent because of the pressure people feel to not be obese, the pressure to look like a supermodel.”
Images in magazines and body-types on TV are definitely part of the problem. Marilyn Monroe, the ideal body type in the 1950s, was a size 14. Today’s models are Size 2s. The shrinking ideal has led to ample evidence that a majority of young and teenage girls are unhappy with their bodies and that it has contributed to eating disorders. Lawmakers in France last year banned extremely thin models and now require them to have a doctor’s approval before taking modeling work. Reuters headlined the news this way: “France bans super-skinny models in anorexia clampdown.”
But it’s not just images in fashion and popular culture contributing to the problem. It’s the food.
The prevailing wisdom in nutritional science has long held that fat, particularly saturated fat, is unhealthy — wisdom that’s become enshrined in government dietary advice, like the US’s Dietary Guidelines. Food manufacturers removed the offending ingredients, but added sugar to compensate. At the same time, the food industry began a decades-long shift toward cheaper, less healthy, more highly processed food, peddled with bigger and bigger marketing might.
All the highly processed, sugar-rich food has contributed to a situation where many people, especially those with underlying risk factors, like depression or anxiety, feel the only way to take control is to stop eating. Or as the psychiatrist Emily Deans wrote, people with “disordered thinking” believe that “restrictive or purging behaviors may be the only ways to remain ‘skinny’ on a standard diet.”
Complicating matters, the same risk factors often underlie eating disorders and obesity.
“The interaction of genetics with the unhealthy, ‘toxic’ food environment likely cause individuals to overeat and-or work too hard to avoid overeating which can lead to either under-eating or binge eating,” explained Marian Tanofsky-Kraff, a professor or medical and clinical psychology at the Uniformed Services University of the Health Sciences. “In general, the lack of moderation in our society translates to eating and weight.”
Some experts warn against the correlation between government dietary advice and rates of obesity or eating disorders.
“Just because things happen at the same time does not mean they are causally connected,” explained Cynthia Bulik, a professor of eating disorders at the University of North Carolina at Chapel Hill. Bulik said there might be an “illusory correlation” between dietary advice and rising obesity, but that growing waistlines have as much to do with a decrease in physical activity, inflated portion sizes, more fast food and more screen time.
There is, she explained, “absolutely no data to link eating disorders to government dietary advice at all that I am aware of.”
Still, some eating disorder specialists puzzle over the confluence of factors. And now, some governments have stepped in to mandate against “too skinny” even as they continue to warn against “too fat.”
