As a mother, I am thrilled that issues related to healthy body nutrition and engaging in activity are making headlines in the media and being talked about in families and communities. I am happy the First Lady, through her "Let's Move" campaign, has decided to bring attention to advertising geared to children by food companies, and I support current legislation to tax sodas and encourage healthy, rather than just "healthier," choices on grocery shelves and restaurant menus. I am also relieved to hear that standards for school lunches and increases in activity are being addressed. I believe that, while all foods should be allowed, it is helpful to know what exactly is in the food my family is eating and to not be thwarted at every turn by the latest cartoon character selling processed, low nutrition food.
This said, there is a big piece of the puzzle missing, and I fear that, without it, "Let's Move" and any other program designed to curb childhood and/or adult obesity is unlikely to succeed in the long term.
The lack of any reference to weight- bias and the mental health aspects of being overweight and obese are glaringly noticeable to those of us who have spent our lives dealing with obesity on a personal level or in a professional capacity. Visit any weight management or eating disorder program in the United States and you will find a psychologist on staff to address issues of anxiety, depression, and bi-polar disorder, to name a few in their obese clients. These professionals know that the psychological strain of being overweight in a culture that values thinness takes its toll and may be one of the most important and overlooked contributors to our obese population in the US.
I have used food most of my life to avoid unpleasant feelings, mostly resulting from family situations, teasing, bullying, wanting to be accepted, and perfectionism. As a child, I engaged in "out of control" eating, which, as an adult, translates to bingeing. I was finally diagnosed with binge eating disorder (BED) 13 years ago. Recently, I realized my dream to begin a non-profit organization dedicated to building a community and increasing awareness around the disorder and the affects of weight bias.
The Binge Eating Disorder Association (BEDA) is in its second year and is growing quickly, given the 15 million individuals with BED and the millions more with some form of disordered eating and obesity.
I know first-hand the anxiety and depression that comes with being overweight. Anxiety has been strongly linked to obesity (National Co-Morbidity Survey Replication: http://www.nimh.nih.gov/health/topics/statistics/ncsr-study/index.shtml) and is also one of the cornerstones of an eating disorder.
Underlying genetic factors, along with obsessions around food, weight, and body image, are contributing to the growing numbers of those with eating disorders: a spectrum including those who starve and are very thin to those who overfeed and are overweight or obese, with every size, shape, and expression in-between.
These are serious, life-threatening conditions that manifest in silence and shame. We can learn a lot from the eating disorder community about how to help individuals, families, and communities in their efforts to address obesity and the stigma associated.
Whatever the reason we engage in weight-bias, it is the last vestige of outward rage toward a group of people which continues to be politically and morally acceptable in our culture. Those of us who are overweight, obese, or have been so at one time or another know exactly what I am talking about. It even comes from individuals who themselves can be considered overweight or obese. Those who talk about "will-power" and "calories in, calories out" do it with an air of righteousness, and we treat those who loose massive amounts of weight like rock stars without knowing the psychological impact of their journey and how it may affect their long-term mental status.
Individuals who live in overweight bodies are typically living in shame. There is evidence that they are less likely to be employed, are bullied in schools and social situations, and spend their days focused on the number on the scale, obsessing about ways to lose weight and dreaming of how their lives will change for the better if they are thin--all of which creates anxiety and feeds in to the reasons the person overeats or binges in the first place.
It is the classic "snowball effect" or "positive feed-back loop," to borrow from engineering jargon. In other words, the problem begins, builds, and can then lead to conditions which cause the problem to develop further. The problem builds on itself.
Knowing this, it is my opinion that no new or current obesity program should be funded without addressing the following questions in their efforts:
* What tools are we providing to increase resiliency and function in response to weight-bias?
* How are we helping individuals, families, and communities change the conversation from obesity as moral judgment to one of acceptance and understanding, in an effort to build self-esteem and diminish shame?
* Have we incorporated evidence-based psychological treatments to address the mental health issues related to obesity?
Take into consideration that both obesity and eating disorders are known to have genetic foundations. This does not mean that all individuals with a genetic predisposition to one or both will realize obesity and/or an eating disorder. What it does mean is that, in a culture rich in highly palatable foods and an ideal of thinness, we are having a difficult time reconciling the paradox and are, therefore, more likely to see an increase in food use as a way to ease the mind, however temporary, which allows the problem to build on itself.
And, indeed, the problem is developing further. Dieting has become big business and the ideal body is thinner despite a growing food supply and taste enhancements by food companies. Individuals, especially women, are no longer encouraged to base the value of their body on its utility for physical labor, but rather on its visual aesthetics. This mindless journey toward perfection of body and an imaginary ideal leaves many obsessed with losing weight and, at the same time, craving food as a pleasure reward.
Food is the easiest accessible drug and works to calm the anxiety we feel around our everyday lives and around the size of our bodies.
We must address the paradox and psychological consequences in order for obesity programs to be successful in getting people healthy.
In the short term, we can tax sodas and highly palatable foods. We can decrease the amount of processed foods we are eating to opt for "real foods," like meats, dairy, whole-grains, vegetables, and fruits, and make sure we eat them at a the dinner table to model good eating patterns for our children. We can even build more sidewalks and engage in life by gardening, biking, taking walks, etc.
But what about the long term? Let's not forget to talk about how to treat one another with respect and work toward a day when individuals of all shapes and sizes feel confident enough to get out and move with the knowledge they will not be taunted back in to their dark shame. Let's address mental health issues, such as anxiety and depression, in the context of eating behaviors and make it okay to admit that we use food to calm ourselves and escape our problems. Let's accept people where they are today, so they can begin the path to a healthy body without doing more physical or mental harm.
Chevese Turner, CEO, Binge Eating Disorder Association (BEDA)