When Eating Disorders, Obesity, And Genetics CollideS

America — third-fattest country in the world, according to the WHO — has a schizophrenic relationship with food. Could the union of obesity activists and eating-disorder advocates generate any real insight? Strangely, at a recent panel, it kinda did.

It seems like I spend half my life going to panels about women's bodies. Most of the time, each is depressing in a wholly different way from the last. This latest panel, held on Friday, was hosted by the NEDA, the National Eating Disorders Alliance, the Obesity Society, and STOP Obesity Alliance — a combination of voices that could have been highly combustible. Competing for scarce health research dollars, the ears of legislators, and cultural legitimacy could make enemies of the anti-ED and the anti-obesity "sides." There is also the common argument that there is a kind of an either/or dichotomy between obesity and disordered eating, that if we push too hard to rationalize our relationship with food, and to encourage active lifestyles, we will end up encouraging people to develop eating disorders. (This is mostly false. Like it says on the NEDA pamphlet, eating disorders are illnesses, not choices.)

But instead of anger and resentment, there was common ground. It was nice to see a panel about health, weight, and the media that treated the discussion of body size as neither a sideshow or as a smokescreen. Rather than having a "debate" about whether or not women can take up space, or giving fashion's leading lights another opportunity for their furious buck-passing, here were some doctors and some medical journalists — look, a lady from Newsweek! — and, hello, Emme, talking about obesity, eating disorders, and the culture that feeds them, in a reasonable way, a way that suggested there was common ground for change. Meme Roth was notably absent.

The Obesity Society's Dr. Donna Ryan began by talking about how overweight and obese people have been shown to face discrimination and stigma, and how that can lead to poorer health outcomes. "When I'm talking to my patients," she said, "I never mention the O-word. It creates a barrier, and it's not helpful." Joe Nadglowski, Jr., of the Obesity Action Coalition, an advocacy group that represents people affected by obesity, talked about how the construction of body weight as an issue of physical beauty is harmful, because it trivializes and obscures overweight as a potential health issue. I'm sure America's 10 million eating disorder sufferers, who are pretty tired of hearing that their disease is just the result of misdirected vanity, would agree. "We have to break the association with cosmetics, with cosmesis," he said. In a culture which glorifies an extraordinarily thin beauty standard, especially for women, and where the imagery of the diet industry all revolves around how great you'll look after a X weeks of drinking chalky tasting shakes or counting points, it would indeed be nice to decouple size from beauty once and for all. "We need to shift our focus from body size to health," said Dr. Ryan.

Nadglowski mentioned that Americans spend around $55 billion on the diet industry annually, yet longitudinal studies show 95% of us eventually gain the weight we lose back; our obesity has become a profit center, and we are no healthier for it. "The diet industry doesn't want you to be successful," pointed out Emme. "They depend on repeat customers." Meanwhile, growers of cheap calorie sources that often end up in processed food, like corn and soy, are subsidized, while fresh fruit and vegetables aren't, and obesity isn't even covered under most health insurance plans. If you want to consult with your doctor about your weight, chances are it'll have to be on your dime. And yet obesity, we are constantly told, is the Number One Health Issue facing the country, correlated with heart disease, certain types of cancer, Type 2 diabetes, orthopedic problems and osteoarthritis. Dr. Ryan, an obesity researcher, said investment in obesity-related medical research is far too low, considering the number of people affected. We still don't even understand how obesity causes many of the diseases and conditions it's associated with.

Dr. Ryan said studies show that body size as an adult is approximately 70% due to genetic factors, not all of which are yet well understood. (There's no single "fat gene.") Fraternal twins, who are exposed to roughly the same environmental conditions growing up, often have very discordant body types, while identical twins are generally extremely close in size. Dieting for aesthetic reasons encourages dramatic, short-term weight loss, and as so many women know, eating at odds to your own body makes you that much more likely to regain the weight and then some.

Glamour magazine sent its deputy editor, Wendy Naugle, to the panel — Naugle and Emme, who now works for NEDA's Body Image Council, were the only representatives of the fashion industry present. (Where were Vogue and Elle and the Council of Fashion Designers of America? Why weren't they willing to talk about how the beauty standard sausage gets made, and the sickening effects it can have on those who consume it?) Since what Naugle called "the woman on page 194 phenomenon," Glamour "had a huge surge in subscriptions." Glamour has continued to feature at least one plus-size model in its pages in every issue since — most other ladymags treat body diversity as a gesture to be made once a year. "There is an array of beauty," said Emme. "We're not all supposed to be the same."

And, of course, beauty standards weigh more heavily on women than on men. "Why is the conversation about Precious all about Gaby Sidibe's weight?" asked Emme. "And not about the incredible job she did as an actor, and the amazing feat of being nominated for an Oscar in her first ever role?" The former plus-size model compared Sidibe's treatment in the press to that of The Blind Side's Quinton Aaron. Both are young, black actors who had breakout roles in two of the top films of 2009. Both happen to be overweight. But because Sidibe is a woman, we talk a lot about her appearance. (Sometimes we do it in the guise of concern for her health.) And because Aaron is a man, we talk about his talent.

Dr. Ryan had a useful take on body-mass index, that much-maligned statistical indicator. Dr. Ryan explained BMI is simply not intended as any kind of individual predictor of health. "It correlates well, on a population basis, with body fatness, which correlates well to certain health outcomes," she said, defending it as a statistical tool. "There is a correlation that as BMI increases, health risks increase," said Dr. Ovidio Bermudez, the former president of NEDA. "But it needs to be part of a series of diagnostic tests. And it is also true that as BMI decreases, health risks increase." Paying too much attention to BMI alone is a trap, Dr. Ryan said, because "the cut points [on the continuum] reinforce the idea that there are magic numbers." Reaching 25 or 30 on the BMI scale on its own doesn't say anything about your health. But knowing what percentage of a country's adult population is in those cohorts can give researchers a basic idea of the health of that country.

Which is not to say that obesity isn't a pressing health issue. Nadglowski said that one third of Medicare dollars are currently spent on Type 2 diabetes — an eminently preventable and treatable disease that, thanks to our poor diet and lack of activity, is affecting people at younger and younger ages. Writer Abby Ellin, who was in the audience, asked a sharp question: if weight is just weight, and health is a matter of behavior not size, then why do we talk about, in the words of panel member Dr. Max Gomez, the "obesity crisis"? (Gomez, definitely the dud of the group, had just one other notable contribution: to say that exercising and eating right is primarily a matter of "personal responsibility." Dr. Ryan retorted, "It is not just an individual responsibility. It's a social responsibility." Emme added, "It's also about corporate responsibility.")

But back to Ellin's point: Why fight "obesity" if the problem is truly unhealthy behavior, and the former isn't the sole or even best indicator of the latter? Well, said Dr. Ryan, studies show that almost everyone who experiences negative health effects associated with their weight sees those health problems ease with the loss of just 5-10% of their total body weight. Still, to say people with obesity-linked health problems will see improvements if they lose weight is kind of a truism: what about people classified as "obese" or "overweight" according to BMI, who have no real health problems related to their size? Dr. Ryan went on to mention studies that show that on average, people who are technically overweight or obese, but fit, are healthier than people who are of "normal" BMI who are unfit. "It is not realistic to expect that we could get everyone down to a BMI of under 25," she said. Some people eat mindfully and have healthy activity levels and will never be the size we call "normal." A person's overall health should count for more than just a BMI equation, or a dress size, or a number on the scale.

Of course, to bring that about is going to take a lot more than just a panel discussion in a conference room.