The EDC was invited to be a guest blog for Disruptive Women: Are anti-obesity efforts causing body image problems in kids?

Written By : Jeanine C. Cogan, Ph.D. on July 31, 2012

The Eating Disorders Coalition for Research, Policy & Action (EDC) is a non-profit organization working to advance the federal recognition of eating disorders as a public health priority.  Through education, lobbying and advocacy efforts we promote policies that address the problems faced by people with eating disorders, and that may prevent further people from developing eating disorders. We are a coalition of more than 35 organizations in the eating disorders education, prevention and treatment communities and represent millions of people impacted by eating disorders and their families, providers, researchers and advocates.  In this article we highlight two efforts currently underway.

Challenging Anti-Obesity Efforts

Anti-obesity efforts such as the one initiated by Michelle Obama, while often well-intentioned, are causing harm. A report published January 24, 2012 in Science Daily from the C.S. Mott Children’s Hospital National Poll on Children’s Health examines the association between school-based childhood obesity prevention programs and an increase in eating disorder symptoms among children.  The poll asked parents about obesity prevention programs in their children’s schools and about food-related behaviors and activity that may be worrisome.  Since the implementation of an obesity prevention program in the schools 30% of parents report at least one worrisome behavior in their children that could be associated with the development of eating disorders.  Additionally, 7 percent of parents report that their children have been made to feel bad at school about what or how much they were eating. These behaviors include inappropriate dieting, excessive worry about fat in foods, being preoccupied with food content or labels, refusing family meals and having too much physical activity.

Reports from Australia also indicate a high increase in eating disorders since anti-obesity campaigns began. A Medical Director of Mental Health at Australia’s Austin Hospital said he believed some of the 9 and 10-year-olds being treated for anorexia were becoming ill from “the panic” created by anti-obesity campaigns.

A substantial body of evidence from the eating disorder literature demonstrates that when important agents in children’s social environment (e.g. parents and peers) endorse a preference for thinness and place an importance on weight control, this contributes to body dissatisfaction, dieting, low self-esteem and weight bias among children and adolescents.  Studies show that body dissatisfaction and weight-related teasing are associated with binge eating and other eating disordered behaviors, lower levels of physical activity and increased weight gain over time.

The Solution

The focus of future “obesity interventions” should focus on health, not weight. Future interventions should focus not only on providing opportunities for appropriate levels of physical activity and healthy eating, but also specifically seek to promote self-esteem, body satisfaction, and respect for body size diversity.

The implementation of many anti-obesity programs is causing concern in that they may be promoting some negative consequences like an increase in eating disorders.  We urge any company, agency or department who is offering such a program to incorporate the latest scientific evidence and best clinical practices developed by the Academy for Eating Disorders:

• Studies show that body dissatisfaction and weight-related teasing are associated with binge eating and other eating disordered behaviors, lower levels of physical activity, and increased weight gain over time. Therefore, constructing a social environment where all children are supported in feeling good about their bodies is essential to promoting health in youth.

• Programs should be careful not to use language that has implicit or explicit stigmatizing anti-fat messages, like “fat is bad,” “fat children are not healthy,” or “fat people eat too much.” Interventions should focus not only on providing opportunities for appropriate levels of physical activity and healthy eating, but also promote self-esteem, body satisfaction, and respect for body size diversity.

• There is ample scientific evidence that an environment focusing on weight and thinness is a risk factor for eating disorders.  Moreover, a reliance on BMI as a proxy for health leads to many “false positive” assumptions of illness in healthy heavier children, and many overlooked problems of disordered eating and harmful weight loss practices in average-weight children.

• Interventions should be health-centered, not weight-focused, as weight is not a behavior and therefore not an appropriate target for behavior modification.  Children across the weight spectrum will benefit from a healthier diet, and more opportunities for physical activity. Therefore, interventions should be weight-neutral, i.e. aim to increase healthy living at any size rather than promoting specific goals for weight change.

The EDC has communicated our concerns directly to Michelle Obama urging her to change her anti-obesity (Let’s Move) Campaign.  We also worked with Congressman Hastings and 34 additional Members of Congress who sent a letter to Michelle Obama in 2010 asking her to expand the Let’s Move Campaign to focus on health more broadly and address the prevention of eating disorders.  Two years later, after no action on the part of Michelle Obama’s office and new evidence pointing to the harm created by anti-obesity initiatives in the schools, EDC worked with 22 Members of Congress on a follow-up letter sent in June of 2012. We also gained support from more than 40 organizations who endorsed this Congressional effort.

What You Can Do

Challenge anti-obesity initiatives and urge them to stop their potentially harmful efforts or change their focus.  Use this article as support for your efforts.

Join the nearly 100 other advocates that come to EDC National Lobby Days we hold twice a year and share your stories and perspectives.  For more information go to eatingdisorderscoalition.org.

Holding Insurance Companies Accountable

In early 2011 the EDC initiated the Hold Insurance Companies Accountable Campaign (HICA) in response to continued and consistent stonewalling tactics and inappropriate denials by insurance companies for life saving eating disorders treatment.  Consequences of not receiving necessary health insurance coverage include financial ruin for families paying out of pocket, a lack of life saving care, which leads to the worsening of symptoms and in some cases death.  Anorexia has the highest mortality rate of all mental illnesses, upwards of 20%.  Individuals with anorexia nervosa are 11 times more likely to die than their peers and they are 57 times more likely to die of suicide. Mortality rates are also higher for people with bulimia nervosa (3.9%), and eating disorders not otherwise specified (5.2%).

According to the nationally recognized law firm of Patton Boggs, the mental health parity statute clearly states that limits on the scope and duration of treatment must be applied no more restrictively in the mental health benefit than in the medical/surgical benefit. The statute defines treatment limitations as “limits on the frequency of treatment, number of visits, days of coverage, or other similar limits on the scope or duration of treatment.”

Not complying with the parity regulations is a calculated effort to avoid costs at the expense of people’s health and lives.  Treatment should be determined by the treating professional based on severity and type of illness, rather than what is arbitrarily allowed by an individual’s insurance company. Through legal and political advocacy, the EDC’s Hold Insurance Companies Accountable Campaign is working with specialized attorneys and experts in the field to put an end to such discriminatory and deadly practices.

What You Can Do

1. Write to your insurance commissioner. Insurance commissioners have the responsibility of protecting the interests of the consumer. They need to hear from those who are not receiving necessary treatment because insurance companies refuse to pay. The more people who write, the bigger the impact. To write your commissioner go to eatingdisorderscoalition.org and click on the HICA link.

2. Call your Members of Congress. A key role of legislators is to take care of constituent concerns. In fact every Member of Congress has staff hired specifically to do so. If your insurance company is stonewalling care, legislators need to know and may be able to help. To look up your legislators for the Senate go to senate.gov and for the House go to house.gov.