The “War” on Obesity: At What Cost?

The “war on obesity”, or “war on fat” as some have labeled recent obesity prevention initiatives, may have unintended consequences. A recent article “The Obesity-Eating Disorder Paradox” published in Harvard Political Review proposes that obesity and eating disorders represent extremes in the manifestation of “a serious cultural disorder”—a cultural obsession with dieting, weight and physical appearance. The article is a call for those working to fight these two problems to join forces in promoting an integrated approach to prevention.

While no study to date has clearly documented the impact of obesity prevention programs that emphasize diet and weight control strategies, it is not surprising that their impact is more complicated than anticipated. I recall a recent conversation with a coworker who described her six-year-old son returning from school looking worried and discouraged. He stated emphatically that he would not be eating dinner so as to avoid becoming fat. He had been subjected to school programming aimed at “educating” young children about the potential risks associated with obesity, the complexities of which were lost on his six year old brain, which only registered fear and horror.

The messages children receive about body weight and eating are not limited to the school environment. The role of “Big Diet, Big Fashion and Big Media” only promote what our own Dr. Cindy Bulik calls a “culture of discontent”, where advertising keeps people perpetually dissatisfied with their bodies, with the focus being on closing the gap between reality and a unattainable ideal that can border on obsession. Further, despite the fear and shame tactics applied in some obesity prevention measures, rates of obesity have only continued to rise (in fact, they have nearly tripled among children in the past three decades).

Obesity is a complex problem entangled with issues of social-equity and access to healthcare, healthy lifestyles, and food choices. Programs designed without considering these complexities may only serve to immobilize people with shame, guilt and hopelessness—emotions that psychosocial researchers have long linked to inaction. For example, the implementation in some states of BMI “report cards” to parents, touting the risks of overweight and obesity, or TV ads featuring dejected overweight children may further stigmatize children and adolescents in the presence of their peers, negatively impact body and self-esteem, and lead families to feel disempowered and helpless.

In a recent article published in the Public Health and Nutrition, Sánchez-Carracedo and colleagues provide a rationale for an integrated model of prevention simultaneously targeting both obesity and eating disorders. From studies suggesting that body dissatisfaction may actually predict excessive weight gain among adolescent girls, to the known fact that diets are generally unsuccessful, various “war on obesity” strategies may reinforce body image concerns, and either lead to additional weight gain or disordered eating. War is not the answer. Targeting both obesity and eating disorders requires carefully designed interventions at multiple levels (family, school, peers, and public policy).  Fortunately, this type of initiative seems to be gaining momentum as organizations like the American Psychological Association put forth guidelines as a part of its public interest policy. They recommend and integrated prevention approach targeting “improving nutrition and physical activity; increasing body satisfaction; decreasing weight stigmatization and weight-related teasing; promoting responsible marketing to children; supporting healthy home environments; and addressing cultural and socioeconomic factors related to obesity and disordered eating”. Other programs like Michelle Obama’s “Let’s Move” campaign may be a step in the right direction with a focus on being active and achieving a healthy and balanced lifestyle, rather than diet and weight control. Ultimately, future conjoint efforts from individuals with expertise in different sectors (mental health, prevention and treatment of eating disorders, and public health) are not only necessary, but have potential to re-shape our culture’s attitudes about and approaches to weight and body image.

To read more about APA’s specific recommendations and Michelle Obama’s “Let’s Move!” campaign go to the following websites:

By: Sarah Forsberg