Has Obesity Prevention Led to a New Epidemic?

We have spent the last 20 years fighting a war against obesity. While we are still searching for a “cure” to obesity, we have witnessed the rise of a different epidemic: widespread body dissatisfaction and disordered eating. It is estimated that 1/2 of all teenage girls and 1/4 of all teenage boys are dissatisfied with their body. For children classified as “overweight” or “obese,” there is even more body-hatred. Eating disorder treatment centers have developed programs for children as young as 8 years old. Preschool children already show anti-fat biases. Children get the message loud and clear: fat is bad.

Our war on obesity began in 1996 when former surgeon general C. Everett Koop issued a call to action:

“The sad fact is that the medical community has been sitting on the sidelines while the disease of obesity has mushroomed into a public health crisis”

The medical community sprang into action. New guidelines were developed, diet programs and pills were dispersed, and surgeries were approved. Public policymakers created obesity prevention campaigns ranging from Michelle Obama’s “Let’s Move” campaign, which encourages children of all shapes and sizes to engage in healthy eating and physical activity, to shame-based ad campaigns such as this one which ran in Atlanta in 2011. Most obesity prevention campaigns are fear-based. They warn parents about the medical and emotional dangers of obesity, depict fat children in unflattering images (often wearing clothes that are too small, engaging in sedentary behaviors such as watching television or playing video games, and eating gluttonous amounts of junk food), and overall make it clear that—in case you haven’t gotten the message yet–obesity is a really bad thing.

As we’ve waged war on childhood obesity, the rates of eating disorders in certain subgroups have skyrocketed. From 1999-2006, hospitalizations for eating disorders in children under 12 years old increased 119%, diagnoses of anorexia nervosa increased in girls aged 15- to 19-years old increased, and eating disorder rates rose overall amongst males and minority youth.

Are eating disorders the collateral damage in our war against obesity?

Eating disorders often begin when adolescents and/or their parents misinterpret obesity prevention messages and start trying to “eat healthy” by eliminating foods that they consider to be “bad.” Adolescents classified as “overweight” or “obese” may be particularly at risk. One study revealed that 36.7% of adolescents seeking eating disorder treatment had a previous weight greater than the 85th percentile. Weight loss is often praised and rewarded in “overweight” and “obese” children. Healthy behaviors quickly spiral into an eating disorder when adolescents become fixated on weight loss by any means necessary. Unfortunately, eating disorders in these children often go undiagnosed – or are even inadvertently encouraged – by parents and pediatricians who always see weight loss as an accomplishment.

There is some good news: The American Academy of Pediatrics (AAP) has just released new guidelines for the prevention of obesity and eating disorders in children and adolescents that are a welcome departure from the weight-focused guidelines of the past. These guidelines recommend that pediatricians focus on health instead of weight, promote positive body image in children of all shapes and sizes, discourage dieting (a well-recognized risk-factor for eating disorders), address weight-based teasing, and encourage family meals. In addition, pediatricians are encouraged to assess for eating disorders in all children who exhibit rapid weight loss, regardless of the child’s starting weight.

Do you think that these guidelines will change the way that we address weight with our children?