Risks of the Campaign Against Obesity

If Michelle Obama thinks it is okay for children to diet, I fear you might too.

At President Obama’s first state of the union address he announced that First Lady Michelle Obama would champion the childhood obesity problem. Now, I will share that I am a huge fan of the President and Mrs. Obama, but I see the world through the eyes of an eating disorder specialist and was disappointed when I learned that Obesity would be Michelle’s focus.

In my practice I have seen many eating disorders triggered by medical interventions made in the name of obesity prevention. For this reason my heart sank when I read today of her comments about the weight of her daughters and her statements about putting them on diets.  I can only assume that Michelle Obama has the best intentions, but like so many well-educated people I meet is seriously unaware of the risks of dieting.

The scenario that Mrs. Obama described is one which I have heard far too often. A parent is told by a trusted pediatrician that the child’s BMI is too high and that the child needs to lose weight. There are numerous problems with this. One of them is related to campaigns against obesity. This movement has lead doctors to feel pressured to focus on the BMI (Body Mass Index) and make recommendations to families accordingly. What often gets disregarded in these assessments is genetics. Not everybody is genetically meant to be small or thin. What needs to be considered is the family history, weight, and eating trends for each child. I do not want to minimize the serious health risks that can often be related to poor diet and lack of physical activity, however, the anti-obesity movement has often focused only on numbers. I have had patients come to me who were told by physicians to lose weight based on their BMI but the doctors never bothered to learn that the patients had been restricting food and exercising compulsively in order to reach their current weight.

During my career there has been a shift in the demographics of eating disorders. While anorexia was once a disease predominantly in white affluent communities, it has moved into Hispanic and African American populations, among others. I attribute this change in part to the anti-obesity movement. Genetically, these individuals are not typically supposed to be small. If health is determined by size we should not be using the same measure for every racial population.

When a person begins to diet to become a size that is not genetically appropriate, there is a higher risk for an eating disorder. Often the adolescents or even children with anorexia that I have seen are prompted by a doctor’s orders to lose weight. Not everyone who diets will develop an eating disorder, but for those who are vulnerable to anorexia for a range of reasons are quite at risk when told by a doctor to diet. This can start a very tragic cycle. And anorexic thinking is quite rigid so for years, as they starve themselves and can barely function, they say, “but the doctor told me to lose weight.”

President and Mrs. Obama, by admission, refuse to miss a day of exercise. If this was reported to me by a family in my office I would have great concern for the message sent to their young daughters. I have held the Obama’s in such high regard that until now I never considered the meaning of their exercise routines. Clearly, through the lens of the media, it is hard to get the true picture of how restrictive Mrs. Obama has been with the girls’ food. However, drawing attention to their eating habits publicly and sending a message to the country at large that dieting is positive is alarming to me.

Laura Hauben, Psy.D.
Clinical Psychologist