Overweight and Underweight: What they have in Common

When people are obese, they are often told by their doctor to diet and lose weight. But when  treated for an eating disorder--whether it’s binge eating, anorexia or bulimia--patients are told not to diet. What is the overweight person who binge eats supposed to do? Abby Ellin writes about this conundrum and of the effort of professionals to incorporate knowledge about eating disorders into treatment for obesity. 

Whether they are underweight or overweight, both groups tend to go back and forth between severely restricting their food intake and overeating or bingeing. The treatment for binge eating is geared towards avoiding dieting, not focusing on weight, and on regularizing eating in order to break the restriction-binge cycle. At the same time, a common approach to obesity has been the diet--focus on calories, portion sizes, weight loss. This makes for mixed messages  for the overweight person who also binge eats. Recent changes in the upcoming Diagnostic and Statistical Manual of Mental Disorders includes the diagnosis of Binge Eating Disorder and will hopefully allow for more common ground in the treatment of eating disorders and obesity, according to Ellin’s article.

So where is the common ground? For both underweight and overweight people with eating disorders, low self esteem and body dissatisfaction is common. Both place excessive emphasis on appearance and body size, says one expert quoted in the article. Both groups also suffer from weight stigma and bias. Shifting the focus away from weight and dieting is helpful treatment for both groups.  “The focus should be on behaviors, not weight,” said Dianne Neumark-Sztainer in the article. She is a professor in the School of Public Health at the University of Minnesota. “We know from our research that talking about weight and diets is not effective, and for many leads to weight gain over time.” 

On a societal level, it would help to reduce weight stigma and to lessen cultural pressure to be thin. On an individual level, it helps to resist checking the number on the scale and to focus on changing individual behaviors:eating regularly, learning to respond to feelings of hunger and fullness, and coming up with non-food-related strategies to cope with troubling emotions will help.

Can you be too fat to be President?

There’s a new wrinkle in the 2012 presidential race: The idea that you can be too fat to be president.

The issue has gotten a lot of attention in recent weeks alongside discussion that New Jersey governor Chris Christie could be a viable candidate for the Republican presidential nomination. As speculation grows that he could enter the race, pundits are writing about his weight, and asserting that Christie is too fat to be president.

New York Times columnist Frank Bruni did his best Sunday to challenge the weight prejudice directed against Christie (who doesn’t talk about how much he weighs, but has referred to his long-running “struggle” with his weight).

We treat weight as if it is simply a matter of willpower, and equate thinness with virtue and weight with gluttony and slothfulness. Despite all the evidence that weight is much more complex than simple willpower, and is affected by many factors, including genetics, we continue to denigrate the overweight and to value thinness above all else. We act as if being thin is a sign of self-control, and being fat is a sign of no self-discipline. Bruni -- a former food critic for the Times and the author of Born Round, an excellent memoir revolving around eating -- writes that his thinness in college didn’t reflect self-control: “It reflected bulimia and laxatives,” he says.

Ironically, this focus on Christie’s weight occurred during the first Weight Stigma Awareness Week, an effort by the Binge Eating Disorder Association to make people aware of the stigma and discrimination that the overweight face. It’s a reminder of the importance of not making judgments about behavior based on weight.

How Not to Talk About your Child's Weight

This week, Michelle Obama, trying to promote efforts to combat obesity, described taking her kids to the pediatrician and being told that they were overweight. She also mentioned that President Obama had referred to one of their daughters as “chubby.” These remarks caused consternation among eating disorders professionals, because of their apparent overemphasis on weight and dieting, rather than on healthy eating and health in general. Too often, when people talk about the obesity epidemic, it sounds like an attack on the overweight.

There are better ways to promote healthful eating than to call a youngster “chubby.” Those who treat eating disorders strive to help their patients move away from dieting and strict rules about good and bad foods. They aim to help their patients be less rigidly focused on a number and a weight and instead aim for healthy behaviors. One of the challenges in treating people with eating disorders is when the culture at large supports exactly the same attitudes that get in the way of fighting an eating disorder. In this link, Laura Collins, the executive director of FEAST (Families Empowered and Supporting Treatment of Eating Disorders), writes about how some of the First Lady’s comments sound in the eating disorders world. In a later post, she also mentions speaking to a member of the First Lady’s staff and explaining these issues. It will be interesting to see if this will have any effect on the way Michelle Obama talks about her daughters’ eating habits in the future.