The Food Issue — April 1, 2012 11:36 pm

The Obesity-Eating Disorder Paradox

By and

America is suffering from two serious health crises that initially seem contradictory. Levels of obesity have risen to epidemic proportions in recent decades, while the high frequency of eating disorders has become cause for serious concern. Healthcare professionals are now charged with the difficult task of simultaneously fighting two diseases located on opposite ends of the health spectrum. While the diseases may seem antithetical, recent findings have shown that they may, in fact, stem from the same source: a fundamental problem within American culture that has injured the way Americans think about food, exercise, and their own bodies. American society is not suffering from two distinct health problems. It is experiencing two symptoms of one serious cultural disorder.

Two Serious Health Problems
The forces that promote obesity are ubiquitous in American society. Meals are being super-sized, food items heavily processed, and inactive forms of recreation, such as watching TV and playing video games, have become the norm. In an interview with the HPR, Sean Palfrey, physician and Professor of Pediatrics at the Boston University School of Medicine, emphasized the severity of America’s “Obesity Epidemic,” which is now at an all time high: “Some of these kids [in cities around the country] are literally eating themselves to death.” Talk of America’s epidemic has swept the healthcare world, engulfed the mainstream media, and exposed a gluttonous nation addicted to junk food and allergic to exercise.

On the other hand, while the nation of plenty struggles to reduce its intake of cheap and fatty foods, unhealthy obsessions with weight and body image persist. Experts argue that the nation’s anti-obesity emphasis has left Americans vulnerable to a wide range of mental health issues, including eating disorders. According to the National Association of Anorexia Nervosa and Associated Disorders, up to 24 million people of all ages and genders suffer from eating disorders in the U.S. alone. Even more, anorexia is the third most common chronic illness among adolescents and its mortality rate is higher than any other mental illness. These are startling figures, particularly as twenty-five percent of college-aged women report using binging and purging for weight management. Even amongst those Americans who don’t suffer from eating disorders, pressures to be thin complicate relationships with food.

A Culture of Discontent
During competition with the Soviet Union during the Cold War, government foreign policy exports feared that Americans were being seen as too “flabby.” Compared with the world outside of the U.S., they argued, Americans were drinking too much, eating too much, and not exercising enough. To combat this image, President Kennedy created the President’s Council on Youth Fitness and coined the term “Soft American” as a means of getting Americans to change their lifestyles. As a result, more Americans began going to gyms and investing in fitness products. But what began as steps towards a healthier America evolved into another beast entirely—fears of weight gain and health obsessions. These fears have since become an underlying force behind both obesity and eating disorders.

In an interview with the HPR, Dr. Richard Gordon, author of Eating Disorders: Anatomy of a Social Epidemic, described just how internalized this negativity towards fat has become. In his words, the assault on fat in American society is the “last sanctioned form of public prejudice.” Dr. Michael Levine, co-author of The Prevention of Eating Problems and Eating Disorders: Theory, Research, and Practice, agreed, in an interview with the HPR, that America has turned fat into a “dirty word.” To prove his point, Levine frequently asks people to imagine the hypothetical statement, “You are looking really good because you’ve put on some fat.” Because the word “fat” is included, many Americans struggle to consider it a compliment despite the actual intention of the statement–to tell somebody that they look good. In American culture, fat is almost always perceived as negative.

Capitalizing on this deep-rooted obsession with body image, products and services promoting dieting and exercise have formed a multi-billion dollar industry in recent decades. The media is filled with advertisements for the latest weight-loss programs, healthy meal plans, and ways to achieve that “perfect body.” Television shows such as “The Biggest Loser” and “Fat Chef” have successfully made their way into the American household. As such, the “war on fat” has actually extended beyond public policies and has seeped into American culture. In an interview with the HPR, Dr. Cynthia Bulik, a professor of eating disorders and nutrition at University of North Carolina (UNC) Chapel Hill, pointed to “Big Fashion, Big Diet, and Big Media” as the basic components of a “culture of discontent that makes [Americans] continually dissatisfied with [their] bodies.”

Frustrated and Fat
Even worse, America might be said to be a fat country with “fear of fat.” Though the war on obesity dates back to the 1960s, levels of obesity have risen steadily in recent decades. In an interview with the HPR, Dr. Allison Field, Associate Professor at Harvard Medical School, noted that as obesity has become more and more prevalent, the ideal standard of beauty has not changed, resulting in a growing gap between the average person and his or her ideal body image. A contrast which, he believes, has led both genders to become very concerned about weight and has further fueled the rise of obesity-eating disorder paradox.

Dr. Marian Tanofsky-Kraff, an Associate Professor of Medical and Clinical Psychology at the Uniformed Services University of the Health Sciences, has found that many personality characteristics that predict obesity are actually the same that indicate the existence of eating disorders. In an interview with the HPR, she cited depression, dieting behaviors, excessive weight concern, and most importantly what she calls, “loss of control eating” as predictors of both conditions. And dieting frequently, she noted, often backfires and can lead to more weight gain, as recent research has observed. Therefore, the country is caught in a vicious cycle of weight gain, separation from the ideal body image, dieting behaviors, and more weight gain. The ultimate result: a country of unhappy, unhealthy people.

Potential Solutions
Conceptualizations of new, more integrative approaches to addressing both eating disorders and obesity have emerged from the work of researchers who study the two issues together. Dr. Dianne Neumark- Sztainer, Professor of Epidemiology and Community Health at the University of Minnesota, explained in her article “Can We Simultaneously Work Toward the Prevention of Obesity and Eating Disorders in Children and Adolescents?” that the environment in which Americans live needs to change in order to foster healthy behaviors and prevent a situation that “further stigmatizes overweight persons.” For this reason, researchers like Neumark- Sztainer believe that energy should not be focused on weight and dieting, but rather on positive lifestyle changes for the sake of being healthy, not attractive.

The “Let’s Move” campaign, an initiative launched by Michelle Obama dedicated to solving the childhood obesity problem within a generation, is one potentially positive approach. In an interview with the HPR, Dr. Judith Palfrey, Professor of Pediatrics at Harvard Medical School who consults the “Let’s Move” campaign, praised its focus on healthy lifestyles as opposed to an idealized body image. “Let’s Move,” she explained, “stresses eating healthy food in appropriate portions… not too much but also not too little.” Palfrey noted that an added bonus of “Let’s Move” is that it decreases young people’s exposure to images of unattainable beauty from the media by getting them to turn off the television and exercise.

A priority of any program should also be to foster healthy relationships with food. The ways in which people perceive food and approach eating is a fundamental problem that fuels all sorts of unhealthy behaviors. Dr. Field proposed the idea of promoting home-cooked meals as a means of returning people to eating simpler foods and enhancing their feeling of connection with what they consume. Other positive approaches include education in schools, training kids to listen to their bodies’ internal cues, encouraging people to eat more slowly, refraining from classification of foods as good or bad, and promoting a general mindfulness about the kinds of foods people are eating.

Even though experts agree that the focus shouldn’t be on weight, they view the public’s growing awareness of obesity-related health concerns positively. “It is absolutely healthy to be health conscious,” Tanofsky-Kraff maintains. However, “It’s knowing when health conscious is health conscious” and not going to extremes that is most important. Indeed, American society will need to give up the extreme dichotomies it has created regarding dieting and exercise in order to find a healthier balance of moderation.

Failing to deal with the reality of America’s obesity problem for fear of perpetuating an unhealthy obsession with body image would be a disservice to the public and perilous for the health of the nation. However, it is equally detrimental to attempt to tackle obesity by promoting restrictive diets and extreme exercise regiments. Adopting approaches that focus on positive attitude and lifestyle changes not only protects against eating disorders and issues of body image, but also is actually more successful in preventing obesity. Therefore, America need not choose one fight over the other. The solutions to both issues are actually one in the same.

  • Anonymous

    There is an evidence-based
    compassionate alternative to conventional dieting: Health At Every Size®.
    Please consider this alternative prior to making a decision that may result in
    weight cycling.


    For more information on
    Health At Every Size, you can find a general explanation on Wikipedia
    ( or find in-depth
    research-based information in the book Health At Every Size – The Surprising
    Truth About Your Weight by Dr. Linda Bacon (

  • Anonymous

    It’s not paradoxical at all: when the culture interferes with an innate regulatory system like appetite, damage results. The culture (aided handily by the “experts” at Harvard, may I add) insists that to be “healthy” we all must fit into a very narrow weight range. The culture insists that certain foods are bad, and that we can’t trust our bodies, etc….   so dieting ensues, which causes weight cycling which inevitably leads to people becoming heavier and heavier.  And since bodyweights are on a bell curve, as a bonus those of us who are on the heavier end of the curve because that’s where our bodies naturally want to be get a nice big helping of stigma and distress as well!

    Big business figure out decades ago how much money can be made from people who are kept unhappy with their bodies, and besides encouraging dieting they also pay for most of the obesity research done at our leading research centers and hospitals. Most recently we have the VERY lucrative bariatric surgery industry creating thousands of permanently malnourished people who may be thinner but are vulnerable to the myriad illnesses that result from years of vitamin and nutrient deficiencies. 

    An increasing number of people are choosing to get off the rollercoaster. The risks of being overweight are exaggerated (remember who’s paying for all that research). By focusing on behaviors rather than chasing a number on a scale, it’s possible to be “healthy” at a wide range of weights. And focusing on behaviors rather than the numbers on a scale is also how eating disordered people get well, too. 

    I encourage the author to look into Size Acceptance as well as Health At Every Size (an evidenced based approach to health and wellness)  for information  on how people of ALL sizes can get off the weight-cycling rollercoaster and enjoy their bodies. 

    And remember – it’s MUCH harder to make money off of people who basically like themselves and accept and love their bodies :)

  • Robisonj

    Unfortunately, but not surprisingly, you missed the point. Obesity is not a disease – It is a measure of height and weight – It is not a measure of health – It is a measure of height and weight. Please do your research and look up the derivation and the lack of relevance to health (Google – Top 10   Reasons Why The BMI Is Bogus
    by NPR Science Guy, Keith Devlin).

    Secondly, your comments on the so-called “obesity epidemic” are outdated. The weight of the vast majority of the population has not increased in the last decade. Finally, The eating disorder nightmare is a direct result of the pressure (mania) to be thin, Do away with the pressure, teach people to make peace with their bodies and their food, and you will go a long way towards solving this nightmare. Suggesting everyone in the country should be under a BMI of 25 is as ludicrous as suggesting that everyone in the country should be under the age of thirty! People can be healthy at a wide range of ages and a wide range of sizes!~

  • Erin Smith

    What is the definition of insanity again? The medical/diet/beauty industries have been pushing weight loss by any means necessary for decade upon decade. It has not only *not* resulted in a thin or even thinner population, nor a healthier population, it has actually increased the number of people with both diagnosed and undiagnosed eating disorders. It has resulted in children so young they are barely out of diapers already worried that they’re too fat and they need to diet. We’re seeing diagnosed eating disorders in younger and younger children all the time, and more and more people who don’t have diagnosed eating disorders but whose views on food and health are so warped it is surprising they can even function.

    And it has led to a simply astounding and horrific amount of hatred being expressed towards fat people. Read some of the comments on main stream media articles which have any relationship to fat, and you’ll see people expressing sentiments that fat people should be herded into gas chambers, butchered and fed to starving populations, set adrift on ice floes, and forced to live underground where normal people won’t have to look at them.

    How about rather than continuing to encourage that train of thought and expecting it to somehow have a different result than the last several decades of going down that track, we do something different? How about we encourage people to move their bodies in ways they enjoy for enjoyments sake rather than suffer through for the reward of losing weight? Because people who are doing something they enjoy just because they enjoy it are going to keep doing it, while people who are enduring it as a route to some other goal will quit when that goal never materializes.

  • Lori Lieberman

    Re Michelle’s well-intentioned stab at childhood obesity: how can we support this campaign which labels kids based on absolute BMI values, not in context of their individual norms 

    How balanced is her thinking when she declared some summers ago that “Dessert is not a right”, something I couldn’t disagree more with? 

    And finally, what message does she send as a contributor to The Biggest Loser program, which endorses extreme measure for rapid weight loss, shames it’s large size participants and does little to support practical, long-term achievable behavior changes, with the radical way change is made for the TV viewer’s entertainment?
    Lori Lieberman, RD, CDE, MPH,

  • Dandelion Girl

    My post from May 2011 seems strikingly similar to this… not only in content, but in title… (

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  • bgirtz

    This is a great article. In america and all over the world, people are struggling with food.Trying to show people what they “should” look like is just asking for trouble. Just look at the number of men with eating disorders in the UK. 

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