Tag Archives: eating disorders

Physicians Won’t be the Ones to Help You Lose Weight

Surprise! Your doctor may not be the best person to get you to lose weight – and it seems that it’s largely because they are averse to talking about it at all. A recent article from NPR breaks down some of the troubling reasons behind why this relationship isn’t making real significant strides in this public health fight.

78 million Americans are obese. There are 164,000 primary care doctors that are able to treat them. That’s a daunting division as it is, but when you think about the average amount of time a physician sees a patient – maybe 20 minutes, it seems impossible to achieve the task of vastly reducing the prevalence of obesity. The kind of personalized information that is needed for each patient would take longer than 20 minutes to gather, and creating a personalized subsequent behavior change and nutrition plan takes even longer. Interestingly, the NPR pieces cites the American Association of Family Physicians in reporting that not even 50% of primary care providers calculate a patient’s BMI (there are a lot of problems with BMI as a measure, and they’ve been widely discussed – how they don’t take into account muscle mass, for example – but for some obese patients, they can be a reasonable crude measure of where the individual is in terms of major health risks and how to initiate a weight loss program). But physicians who know the history of a patient and have tracked their health for years are in the best position in terms of knowing how risky an individual’s weight is.

Of course that’s not all that needs to be considered – I actually don’t think it’s even the most pressing or pertinent issue as to why physicians aren’t able to tackle the obesity epidemic. As the NPR article says, the psychologist in charge of the University of South Carolina’s weight management center calls the topic of weight loss and obesity a “mine field.” There can be resistance in going to the doctor for any number of reasons – shame or embarrassment, frustration, avoidance or denial, and even the very real fear of what a physician might tell them. And, importantly, deep concern and worry about not having the means – financially, mentally, community or family-wise, to tackle what seems like insurmountable changes in lifestyle. On the other side, doctors claim that some patients react defensively if they suggest that weight loss needs to be in their future.

This is a complicated dance, and I can’t help but draw parallels in these kinds of responses to the relationship between eating disorder patients and their physicians, psychologists, and nutritionists. Weight is so inextricably tied to identity, personally and culturally, for so many people, that the mere suggestion of a necessary change – either gaining or losing weight – can feel like an assault on the person’s actual self. How do we best navigate this? These conversations, first of all, can’t be brief. They just can’t. They require a meaningful relationship between those negotiating solutions, and for the individual who is in a precarious health position – whether it be due to restricting and bingeing and purging, or due to inactivity and unbalanced diets and genetic factors – it requires the sense that the person ostensibly helping them knows them personally, what their fears and concerns are, is patient, and most of all, is able to be consistently present and supportive through the successes and inevitable failures of the journey. And those relationships can be mighty hard to come by.

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Filed under Disordered Eating, Health Education, Public Health

Body Judgments Begin…Pretty Close to Birth

I know it’s been a while since I’ve written – I took six weeks off to finish my dissertation and prepare for its defense (I passed!), and to take a bit of a breather after all that required writing! But what better way to start a new month than with a new post?

One of the many reasons I went to graduate school to study adolescent female and women’s health was because I wanted to gain a better understanding of why women and girls develop disordered eating behaviors, what makes them worse, and most importantly, how to prevent them. And more and more studies are telling us what many researchers, clinicians, and patients themselves have been telling us for years.

A few recent studies in particular that have been published in the past few weeks highlight these issues well. One new study out of UCLA has again proven that strong self-perception is key to the prevention of risky behaviors in teen girls. The results of this study showed that overweight girls who had high body satisfaction and who were happy with their size and shape were less likely to engage in a range of unhealthy and disordered eating behaviors like fasting, skipping meals, and self-induced vomiting. And more importantly, the study also showed that these girls had lower rates of anxiety and depression, which are so disturbingly common among girls with burgeoning eating disorders.

And the best thing about the study’s results was the discussion that these public health experts, dieticians, and professors had, in which they emphasized that for effective, healthy weight-loss interventions for teens who may need to lose weight for real medical reasons (preventing the onset of diabetes or hypertension and increasing cardiovascular health, for example), these programs need to be rooted in positive self-esteem and the enhancement of self-image. When you feel better about yourself, you want to keep taking care of yourself. You are also more likely to want to share yourself with others, and creating positive social networks increases the likelihood that people will have supporters pushing them to stay healthy as well as a community that makes them feel worthwhile, appreciated, and worth the kind of self-care that diet and exercise changes require.

So why do companies, organizations, media outlets, and other vocal critics keep harping on the idea that shame, insults, and bullying will help people lose weight? To me, the root of this problem lies in the misguided thought that anyone else’s weight is anyone else’s business. It isn’t.

Another recent study has unfortunately shown something I find really upsetting. Preschoolers - remember, that’s ages 2-5 – show negative perceptions of overweight children. The way this study was conducted involved an adult reading four different stories to a group of children, in which one character was ‘nice’ and the other was ‘mean.’ They then showed the children pictures of one overweight figure and one normal weight figure, and asked them to select which one was the ‘nice’ character from the story and which was the ‘mean’ character. Nearly half of all students said that in all four stories, the overweight figure was selected as the ‘mean’ one. Mind you, these figures had no faces. No physical expressions. One was just bigger than the other. And because of that, the children thought they were meaner.

I mean…whoa. Ages 2-5 are in the early developmental stages, when children are absorbing and processing and incredible amount of information - verbally, visually, and physically – and learning how to reason. We do not need judgments about others’ weight getting ingrained at this age, creating perceptions that are very difficult to change. Of course, this one study bears repeating, and should incorporate additional measures of exploring these outcomes; nonetheless, these results are troubling.

Of course, this study begs the revisiting of one of my most pressing points on this blog. Weight, just like food, is not a characteristic that is inherent in measures of good versus evil. That’s very dangerous territory to traverse – once one allows weight to dictate the assessment of whether or not someone is not only of value and worth (societally speaking, this already happens, when overweight people are ignored, more easily dismissed, not taken as seriously), but whether or not they are actually truly ‘bad’ or ‘mean’ or capable of certain sins because they are overweight, one’s morality becomes game for critics. I also always remain shocked at some critics’ short-sightedness in this relam – if you yourself gain weight in the future – something which may happen for a variety of reasons – are you readily willing to take on the label of weakness, ‘meanness’, gluttony? The impassioned rhetoric around the blaming and shaming of overweight people is so starkly in need of an infusion of compassion.

What this shows is that children are inundated with messages, both direct and indirect, from so many different sources at such a young age, that the idea of being overweight is coded as bad in so many ways, that it seems nearly inescapable. To me, this means we have to keep making intense efforts to combat these messages, because we are climbing one steep hill.

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Filed under Child Development and Child Health, Disordered Eating, Health Education, Mental Health

I Still Don’t Think Yoplait Gets It.

I wrote about the Yoplait commercial that was pulled from the air a few weeks ago in a post that had some hope for a change of tune for the company. It seemed that given the outcry – from media critics to the National Eating Disorder Association – Yoplait understood that their presentation of an anxious and panicked woman weighing whether or not she was “good” enough to eat a piece of cake and how many pieces of celery she would punish herself with in return for this ghastly ingestion was both triggering and normalizing. Triggering for people who may have experienced battles with eating disorders in the past, and normalizing for those who may be on the cusp of such a struggle, ensuring them that their mental calculations and rewards were right on par with the rest of America’s women. I also saw the danger in the potential of the commercial subtly instructing young women that this kind of anguish over food was what they had to expect and look forward to in their future, thereby setting them up for young failure. (I want to note that I am not excluding this commercial’s impact on the men who suffer from eating disorders, I am emphasizing women here because of the construct of the commercial and the genders of those who were featured in it.) I’ve also discussed advertising’s effect on behavior elsewhere, and I think this post addresses some of my previously articulated concerns.

However. I fear I wrote with hope a bit too soon. Another of Yoplait’s popular commercials smacks me between the eyes every couple of days, and while it’s certainly not as yougottabekiddingme as the one with the celery champion, there is still a real issue here:

Classifying some foods as “good” and vilifying others as “bad” sets one up for failure in a most beautifully orchestrated series of events.  Certain foods may be healthier for you than others, but like most things, foods do not carry with them an innate characteristic of innocence or evil. In giving foods these kind of descriptions, they take on anthropomorphic identities that make it easy for one to associate with themselves. If cake = bad, and I consume cake, then I have consumed bad, ergo me = bad. Cake isn’t “bad.” It’s sweet. Sometimes sugary, sometimes tart. Sometimes in cup form. It isn’t “bad.”

And of course, you will eat cake at some point. Or a cookie, a brownie, a pie, pick your pleasure. If you don’t like sweets but are trying to calorie cut like a pageant contestant, perhaps it will be bread, or all carbs, or any drink other than water. Trying to eliminate the consumption of something either enjoyable (cake) or necessary (you know, food in general), the abstinence of which upon you have hinged your self-worth, leads you down a dark path resulting in you equating yourself with a monster when all you did was have some dessert.

While I noted above that men also suffer from eating disorders (they comprise about 10% of eating disorder cases), this commercial also does nothing to fight and everything to reiterate one of our oldest gender stereotypes. A woman obsessing over food and calorie counts and thinking herself to be deserving of punishment if she fails the arbitrary, socially sanctioned test of true character – resisting cake and losing weight! The fact that someone as talented as Jennifer Hudson recently articulated that her weight loss was more of an accomplishment than her Oscar shows just how far the socialization of this absurd test of character has gone for women and girls. Making the resistance of a slice of sheet cake the high point of one’s day (or the accomplishment of your life) really diminishes the much more astonishing achievements one is capable of.

Losing weight can be a healthy goal for a lot of people if they are at risk for complications like diabetes, heart disease, or high blood-pressure. But it isn’t everything – which is what most media messages seem to think it should be. If you’re trying to lose weight, talk to your physician about nutritional guidelines and an exercise plan. And first, clarify if you need to lose weight at all. I suspect that many of you don’t, but have been informed by a bear sheriff that you do not meet the specifications of his ideal woman.

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Filed under Defining Gender, Disordered Eating, Education, Feminism, Media, Mental Health, Pop Culture, Public Health, Sexism, Women's Health

How Images and Ads Impact Self-Image and Human Development

I got a lot of traffic and messages about my recent post regarding Duke Nukem. People in the gaming community condemned it for its lack of originality, how it strayed from the original premise of apparently ostensibly mocking the ’80s action-hero genre, and how it overall disappointed those who are used to more complex and engaging videos. Some replies also included people needing to “get over it” when discussing images of coerced sexual activity or the game’s encouragement of merging violent and sexually explicit content together (I don’t post comments that are condescending or don’t encourage dialogue), something I found…disturbing. My initial argument, however, did not change – that is, that the imagery and the actions the gamer supposes in this video are tragically abusive and in fact detrimental to both men and women.

Many gamers also respond that they know when they are playing a game, and that their non-virtual socializing is not impacted by the game’s content. This, along with the recent news that the American Medical Association finally condemned the use of photoshopping in advertising campaigns and photo shoots, got me thinking about what repeated exposure to images and actions actually does to our brain and with who and what we identify.

A well-known study published in the Journal of Consumer Research found that repeated exposure to images and advertisements ultimately were processed in people the same way actual experiences were processed. That is, if you see or watch something enough times - in a video game, in a fashion magazine in which models are photoshopped to near obscurity, in a parent abusing your sibling – you begin to process it as though it was you yourself experiencing the act and identify with the “player” (model, game character) you are watching. You see enough pictures of a model like this:

Courtesy fashion-o-lic.com

And you begin to think you are supposed to align yourself with her, that this image is what is normal (the image on the right was criticized heavily in 2009 for being so drastically photoshopped). After so many exposures, you begin to mold yourself after her, to think that since this is how we project women for adoration in our culture, that you should begin appropriating yourself to match her image. Just like a gamer, after so many exposures, can begin to mold themselves after the image of the character they are impersonating in a game. And while they may not go out on a shooting spree, they are desensitized to the effects of that reality, just as they are desensitized to the effects of coerced sex in a game, which can lead to difficulty distinguishing that from a healthy sexual relationship.

As I have also discussed in previous posts, a foundational theory in behavioral science and education is the Social-Cognitive Theory, which has informed educators and psychologists for years in explaining that people learn by watching, and that even one observation of a behavior can influence perspective. It also importantly points out that while full on adoption of behaviors witnessed may not occur, the more we see, the more our attitudes and beliefs about them change. This can be good and bad. It can make us more accepting of others’ opinions and outlooks, and it can also desensitize and normalize the opinions and behaviors that are harmful.

We’re humans. We learn by watching, by then mimicking and imitating what we observe. It doesn’t happen all at once, which is why fashion moguls or game designers claim they have no real impact. Are girls entering periods of self-mandated starving as soon as they open this month’s Vogue? Are adolescent boys heading to the hills for a sawed off shotgun fight after the first round of Duke or stealing cars after playing the new Grand Theft Auto? No, of course not. But can it impact their sense of compassion, affect their interpersonal relationships? Can it make violence seem less threatening, less damaging, and less impacting than it is? Yes. Can that change the way people behave, from nuance to imitation? Sure. Even researchers who admit that it won’t necessarily turn children violent admit that’s likely true (and, interestingly, still disallow their children to play). Human development takes time – language acquisition, understanding of and the processing of visual messages, being able to comprehend meaning from a block of text – these are all cognitive functions that take years to develop and perfect, and their influence lies in the words and actions of children’s families, friends, teachers. Unfortunately, messages of gender have been largely commandeered by the media. And the repeated exposure, over years, to these specifics of models’ physical appearance has resulted in the erosion of self-confidence that many girls and women – and boys and men – experience as young children becoming adolescents. And the repeated exposure, over years, to the specifics of war, sexual violence, and the presentation of hyper-masculinity, can also result in the erosion of what kind of impact violence truly has, as they become desensitized, and what a healthy understanding of and relationship with the opposite sex is (as opposed to its portrayal in my Duke Nukem piece). As the study articulated, it’s about changing people over time, it’s about how perceptions and perspectives change when a new definition of the norm that is not contested or dissected – a Ralph Lauren model, a Duke Nukem – enters the picture. Women who suffer from eating disorders and body dysmorphia, while not blaming the fashion industry, have emphatically articulated that it certainly has had an impact as it normalized this destructive self-image and behavior.

I think it’s also relevant here to bring up the Supreme Court’s decision about a week ago to shoot down California’s attempt to ban the sale of violent video games to children. Timothy Egan, a Times columnist, had a great commentary on this, noting how ridiculous it seems for there to be a perpetual ban on nudity and sexually explicit images, but not on virtually dismembering a human or sexually assaulting a woman. It does seem…well, more than troubling, that a game in which a player can simulate murder and rape is protected by free speech but a bare breast is the height of vulgarity. (I found a great post from a female gamer about this kind of sexual violence in video games, and I agree with her assertion that sexual expression can in fact exist without it also involving violence and degradation.) I don’t think any of the representations of sexuality that I have seen in video games are appropriate for children because they overwhelmingly associate it with abuse and/or coercion (I’ve done a lot of viewing in the past couple days after my Duke Nukem post). To say that sexuality would have a more harmful impact than violence seems questionable, when representations of both are equally unhealthy.

It should also be said that I am far from someone who believes nudity and sexuality itself is vulgar. I celebrate and support healthy (and protected!) sexual expression in any way the individual consents and desires. I firmly believe that discussions of sex and sexuality should be brought up early on, so children can ask questions, be informed, protect themselves when they do engage in sex, and have an understanding of what a respectful, consensual sexual relationship is. I also believe that when these discussions in families don’t take place, and when sex is a taboo topic, that it is a disservice to these children, and that any confusion they have about sex or uncertainty about what a healthy sex life actually is will be magnified by the messages the media sends them.  I’m an advocate of early onset, comprehensive sexual health and reproductive health education. Sex shouldn’t be confusing, and it shouldn’t be stigmatized. Sexual violence, however, and a misappropriation of the presentation of sexual relationships that are abusive, coercive, and violent, should be condemned.

This is also why a diversity of exposures is important. It’s important to not be inundated with the same message over and over again. Advertisers know that repeated exposure is key to getting people to buy what they want to sell. If you see an image of a Coke bottle once, it won’t register with much impact. If you see it every time your favorite TV show breaks for commercial, when you’re leafing through the pages of a magazine, when you’re driving down a freeway and it’s up on a billboard, when you’re listening to the radio and it breaks for the Coke jingle – it adds up, as do afternoons in front of a game console, as do hours reading “women’s” magazines and fashion spreads, as do episodes of spousal or child abuse, (which we know increases the likelihood of the child being in an abusive relationship him/herself and hampers healthy development - the others are logical extensions, to a lesser degree). We have to have enough positive images, positive games, positive and healthy discourse about relationships to not just equal the stream of negative imagery and messaging, but to overtake it. Positive, healthy messages, not abusive, harmful, violent messages, have to be in the majority. The norm. It’s nice that the docs finally said so.

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Filed under Advertising, Child Development and Child Health, Defining Gender, Feminism, Gender Stereotyping, Media, Mental Health, Pop Culture, Public Health, Sexism, Violence