Like lots of you, we've been on diets many times in our lives—sometimes quite successfully, other times less so. That's why any news on the weight-watching front automatically attracts our attention. Recently two government initiatives struck us as somewhat dubious—if sincere—attempts to help people develop healthier eating habits. In France, where superskinny models routinely prance down haute couture runways, legislators have introduced a proposal that would make it illegal for fashion magazines, Web sites and advertisers to encourage extreme thinness or anorexia. In New York City officials scored a victory when a judge upheld municipal regulations that would require chain restaurants to post calorie counts. These two efforts, aimed at opposite ends of the scale, make it seem as though both anorexia and obesity can be fixed with just a few adjustments to what we read—either in fashion magazines, on the Web or on a menu.
If only it were so simple.
In fact, being too thin or too fat is the result of a complex set of social and personal factors that scientists are only beginning to understand. Helping people become healthier requires an equally complex response involving extensive nutrition and fitness education, more access to mental health facilities for people with eating disorders and certainly a more tolerant standard of beauty in the mass media. None of those goals is easily achieved—which explains why concerned politicians and public health officials take aim at only small pieces of the problem.
Certainly there is plenty to be concerned about, especially for women in this country. Both eating disorders and obesity are on the rise. According to a recent study by Self magazine and the University of North Carolina, 65 percent of American women between 25 and 45 reported eating problems—including regularly skipping meals to lose weight, dieting even though they're at a healthy weight and subsisting on less than 1,000 calories a day for periods of time. Another 10 percent reported symptoms that indicate they may be suffering from anorexia, bulimia or binge eating disorder. (In general, it's estimated that between 1 and 4 percent of the population has an eating disorder of some kind.) The Self study results indicated that 75 percent of the women surveyed have an unhealthy relationship with food or negative feelings about their body shapes. Equally alarming is the fact that two-thirds of American women are overweight or obese, which puts them at risk for cardiovascular problems and diabetes, among other diseases.
Doctors who specialize in women's health fight on the front lines of this increasingly frustrating battle to improve eating habits. Dr. Elizabeth Ricanati, an internist at the Cleveland Clinic, says she welcomes any help—even if it's only posted calorie counts at McDonald's. "Anything we can do to empower people to take matters into their own hands is a good thing," she says. "Educating about what they eat is a step toward that." She often urges her patients to read the food labels in the grocery store before they buy so they know what they are putting into their bodies. "Will everyone read them? No. Will everyone make a change? No. Will some people be offended? Of course. But it can open up a dialogue."
That dialogue could turn out to be the most significant result of the French and American initiatives. Both proposals have been fiercely criticized. Leaders of the French fashion industry say they will vigorously fight any attempt to impose what are, in effect, legal limits on standards of beauty. But as the measure goes through the French National Assembly in the coming weeks, it re-ignites the debate that began two years ago, when a Brazilian model died of anorexia-related causes. It also alerts many people to the disturbing subculture of "pro ana" (for anorexia) and "pro mia" (for bulimia) Web sites. These function as a kind of support group, giving tips on how to fast for days or which laxatives work best after an eating binge. It's not uncommon to find images posted of young girls proudly showing off their alarmingly visible rib cages. As upsetting as these sites are, it's not clear whether they are the cause of the problem or a symptom—or, most likely, some combination of the two. "Media images can contribute to disordered eating, especially in those who may already be vulnerable," says University of Missouri psychologist Anna Bardone-Cone, who has studied what happens to anorexics who visit these sites. In other words, these sites could trigger and encourage a pattern of unhealthy behavior for those already at risk.
Anorexia affects far more women than men, especially women in their teens and early 20s. Researchers don't know why, although some believe a genetic predisposition toward particular emotional disorders can be triggered by anxiety about emerging adulthood. "Often young women feel that their lives are out of control," says Marleen Williams, a psychology professor at Brigham Young University who specializes in eating disorders. The reasons for this feeling of helplessness can be simply the pressures of growing up or they can be more deeply rooted, such as an unstable family relationship or a traumatic childhood. Controlling food intake, she says, gives these women the illusion that they are more in charge. But altering just one factor—media images—won't stop the downward spiral, Williams says. "Helping women learn real solutions to life's challenges and making society safer for women would probably do more to decrease eating disorders," she says.
From a public policy point of view, prosecuting victims of a mental disorder—the anorexics and bulimics who typically run these Web sites—seems like cruel and unusual punishment. "Any law that targets victims is ill-considered," says Susan Scafidi, a law professor at Fordham University and an expert on fashion law. "Surely we can find a better way to help these people than criminalizing their speech." Providing more treatment facilities for those already suffering would be far more helpful—as would helping educators and parents learn how to spot early warning signs of trouble.
As devastating as anorexia and bulimia are for those who suffer from those disorders, obesity—the target of the New York regulation—is a far more widespread public health problem and one that seems ever more intractable. New York's public health officials have been fighting hard, with a publicity campaign to get people to eat less and exercise more and a ban on harmful trans fats in restaurants. The calorie-posting regulation is the latest weapon in this arsenal. Among other objections, restaurant owners claim their First Amendment rights are violated if they are required to post a government message. Some say they don't mind posting calories but they just don't want to be told to do it. (Curious customers can already find out the damage they're doing to their diets by logging on to the site of their favorite fast-food outlets and searching for nutrition info; most major chains now have it somewhere—although it can take some digging to find it.)
Whatever the ultimate legal resolution, news coverage of the court battle emphasizes the fact that many chain restaurants are serving up meals that contain almost a whole day's worth of calories and way too much fat. And as that message becomes more widespread, maybe people will begin to pay more attention to what they're putting in their mouths. Even small changes—like forgoing the fries, for example—can make a big difference. And there is evidence that heightening public awareness can be a successful strategy—although perhaps not immediately. Thirty years ago, when the antismoking effort was in its infancy, few believed that it would succeed. But today smoking rates are down significantly. Better public information was critical, as were warnings on packages, higher prices, and laws that limit smoking in public places.
How can those lessons be applied to the obesity epidemic? Public education is a start, but the sad truth is that information isn't always enough to get people to change deeply entrenched unhealthy habits, says Kenyon College psychology professor Michael Levine, who studies eating disorders. Levine uses himself as an example. He suffers from sleep apnea partly brought on by extra weight that his doctor has told him he should lose. And he understands how to make it happen better than most people. Still, he hasn't abandoned fast food. "I don't think the answer is posting calories," he says. Would a tax on high-fat foods help? Or a ban on eating desserts in public? Imagine the uproar if any public official suggested these measures. Eating disorders and obesity are major public health issues, and it's right and proper for the government to push measures that encourage change, but in the end it's up to each of us to act in our own best interest—one forkful at a time.