As a result of the obsession with thinness in this country, people, particularly women, are constantly being pressured to engage in weight loss practices that have no demonstrated efficacy. The failure to produce sustained weight loss is not, however, the only disturbing consequence of this obsession. Chronic dieters "must learn to not eat when hungry and to terminate eating in response to arbitrary signals that occur well before satiety."¹ With each new diet regimen, a new set of externally imposed rules and regulations determines the amount, type and combination of foods that should and should not be eaten. Over time, this chronic disuse of innate hunger and satiety signals results in the inability to use normal physiological cues to guide food intake.²  Studies show that restricting food intake to lose weight results in a variety of problems, including preoccupation with food and eating, bingeing, and over time, weight gain.^2,3

    Additionally, the arbitrary rules and regulations accompanying these dietary interventions often lead to an elaborate "morality" involving "good" foods (fruits and vegetables, whole grains, etc.) and "bad" foods (fats, simple sugars, etc.) and feelings of virtuosity and guilt related to eating.⁴  This "diet mentality"⁵  has contributed to greatly increased anxiety and disordered eating in the general population. The prestigious Tufts University Diet and Nutrition Letter recently commented on the dangers of this trend, saying:

"Good nutrition is getting a bad name-one that smacks of rigidity, guilt-making and extremism . . . Worse still, some eight out of ten (Americans) think foods are inherently good or bad-that is, the decision to eat a particular item has nothing to do with its context in the diet as a whole, but every single bite they take represents an all-or-nothing choice either for or against good health. (For example)-Two out of 10 Americans are even under the false belief that all fat should be eliminated from the diet."⁶

    Many leading obesity and eating disorder researchers have suggested that heightened concerns about body shape and weight and the resulting epidemic of dieting have contributed to the increased incidence of dangerous eating disorders including anorexia and bulimia nervosa.^2,4,7,8 Research indicates that negative eating attitudes and behaviors are widespread and strongly ingrained by adolescence^9,10 and that bingeing is commonplace among females by the age of 10.¹¹  Additionally, clinical and laboratory research indicates that bulimia is almost always triggered by dieting.^12,13

    Finally, the relentless pressure to conform to unrealistic body shapes and sizes is wreaking havoc with the body image and self-esteem of women of all sizes. A recent survey in Psychology Today involving more than 3,400 women in their 30s and 40s, with an average weight of 140 pounds, is illustrative of the problem. Among the findings, 24% of the women said they would give up more than three years of their lives to lose weight, 35% considered pregnancy a major source of body hatred, and 50% reported that they smoked cigarettes in order to control their weight. The author of the article concluded that: "the magnitude of self-hatred among women is astonishing. Despite being at a weight that most women would envy they are still plagued by feelings of inadequacy."⁸ A substantial body of literature supports this extreme body dissatisfaction as a "normative discontent" in our culture, especially among young women.^14,15

Following is a partial list of the likely consequences of the continuing obsession with thinness; potentially grave consequences that are all too rarely discussed:

Consequences of the Obsession with Thinness

• anorexia nervosa
• bulimia
• binge eating
• disordered eating and exercise behavior
• increasing rates of smoking in young girls
• body hatred
• heart valve damage
• leaky stools
• children being abducted from their families for being fat or being subjected to dangerous medical procedures because their parents are fat, etc.
• exportation of ineffective and potentially dangerous interventions to other countries

    What we as health professionals are doing, despite the best of intentions, IS NOT HELPING PEOPLE TO BE HEALTHIER!! Until such time as we have safe, effective, long-term interventions for weight loss, we must focus on helping people to be healthier by creating more balance in their lives, trusting that the body knows how much it ought to eat and what it ought to weigh. To do anything else, in the face of what we know to date about traditional interventions is unscientific, uncompassionate and unethical!
 

References
 

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© Fall 2001