Obesity, Overweight and their Connection to Eating Disorders
An Interview with Abigail Natenshon

The following interview was conducted by Olga Tantou, a reporter for a Greek National TV Alter Channel based in Athens, Greece.  The program, entitled “The Not Seen People” to be aired on February 1, 2005, is produced by the well-known and highly acclaimed journalist, Kostas Hardavelas

1. Could you please discuss the main reasons that lead people to obesity?

In discussing obesity, it is important to first dispel the commonly held myth that if you’re fat, it’s your fault.  Research shows that body weight in animals and human is not under conscious control.  Body weight is genetically determined, as tightly regulated as height.  Genes control not only how much you eat, but also the metabolic rate at which you burn food.  Therefore, a person who has the genes to be thin is not going to get fat because portion sizes increase; will power does not make fat people thin, and a lack of willpower does not make thin people fat. In actual fact, the control that people can exert over their weight exists within a 10-15 pound range.

Overweight, however….a condition distinct and apart from obesity… is another issue; there is an epidemic in overweight in our society today, among adults as well as children. A study in Australia showed that so many are gaining so much, that what once appeared to be overweight is now considered to be normal; in essence, our perception of what is normal has become flawed.

Obesity Statistics in Europe and the U.S.

• The rates of obesity in children are rising in developing nations as in the U.S., where 15% of school aged children are overweight and plagued by related medical problems including heart disease and diabetes, along with social and emotional  problems, including bullying, teasing and resulting depression and poor self-esteem.

• In Europe, more than half of adults are either overweight or obese. Researchers have found that the problem of obesity among European children and adolescents is increasing at an average annual rate of 10%.  The prevalence of overweight and obese adolescents in southern Europe is 15% to 25%.

• Studies that evaluated the dietary habits of adolescents in cities in Portugal, Spain, Italy and Greece concluded that large amounts of foods high in sugar and/or fat are being eaten between and during meals. Added sugar accounted for more than 10% of the caloric intake in several studies in southern European countries.

• An interesting point is that the increase in worldwide obesity parallels the increase in sugar consumption. Even though people are increasingly adopting a low-fat diet, obesity is more prevalent because manufacturers producing foods that are low fat or fat free are loading them up with sugar.  Excess sugar is converted into fat.  Sugars added to foods made up 11% percent of the calories of Americans in the 1970’s.  Today they are 16%.

Why are people becoming increasingly overweight?  Generally, a combination of genetics, lifestyle, unhealthy eating patterns, and lack of physical activity cause overweight.  The combination of living under stress and not moving much may compound the problem, predisposing some people to storing food as fat; the general increase in dieting has led to weight cycling, which in turn can lead to obesity.

In addition,

• Restaurant portion sizes are on the increase.

• Kids today spend more and more time in front of TV, computers and video games.  They ride to school on school buses or in are driven in carpools.  They even roll their backpacks on wheels to avoid stress to the backbone.

• The way adults work has changed, as well as how we spend our leisure time.  The average number of television hours watched per week is close to that of a full-time job. 

• The design of public spaces outside offices eliminates physical activity.  In skyscrapers, it’s often hard to find stairs.  In modern restrooms, toilets flush by themselves, sinks and towel holders required no physical contact.

• Cities are designed for cars, to the point where walking or biking becomes a hazard. 

• Fast foods have become increasingly available and affordable.  The kinds of foods that are least healthy for us have artificially low prices; the best foods, including fruits and vegetables, cost more.

• Cost-cutting in public schools generally affect physical education classes first. Fast foods are sold in school cafeterias; school vending machines contain soft drinks and candies.  

• All too many people have forgotten… or never learned… what healthy eating actually is.

2. Many Greek young children and adolescents face obesity. Are there specific reasons why this phenomenon occurs?

Children learn best from example.  Their parents are their most potent teachers and role models. Parental factors, both genetic and environmental, play an important role in determining whether children will become obese.  If both parents are obese, the child has 80% chance of becoming obese; if one parent is obese, there is a 40% chance of their children being obese; if neither is obese, there is only a 15% chance for their child to become obese.

An all too many cases, parents have forgotten what healthy eating is;  thus, children have no way to learn how to eat healthfully in the first place. Misconceptions about what healthy eating is are rampant.  For example, many people believe the following myths:

• Healthy eating is fat free eating. In fact, kids need fat in their diet to grow the neurons in their brain, and to feed their estrogen supply so that they can develop a healthy reproductive system.

• It’s okay to skip meals. “Nobody eats breakfast.” Breakfast is the most important meal of the day…particularly if a person is interested in controlling weight gain. “Frontloading” calories during the first two thirds of the day is an effective way to stimulate eating less later on in the day.

• Dieting is the best way to lose weight.  In fact, dieting is the least effective way to lose weight.  It damages the metabolism so that the body, as if in hibernation, burns fewer calories and gains or maintains weight on ever fewer calories. It has also been proven that when youngsters diet during their early childhood years, they are more prone to becoming overweight teens and adults.  Early overweight status increases the risk for maladaptive eating attitudes, elevated weight concerns, overeating in the absence of hunger, dieting, and girls’ negative self-evaluations and body dissatisfaction.

• A meal is anything you put in your mouth at mealtime.  A pretzel and a diet pop, or a Power Bar and an apple is hardly a meal.  Healthy eating is three-meals-a-day eating, each meal containing varied, balanced, and diverse nutrients, representing all the food groups and all eaten in moderation.

The child observing what well-meaning parents may consider to be a “healthy eating lifestyle,” may deduce unanticipated, skewed, and unrealistic notions about food and eating.  Parents who skip meals and go on diets or who complain about their own weight, model the idea that food is fattening and is the “enemy.” The mother of a bulimic child I treated explained to her daughter one night at dinner that “she was about to sin…she was going to order dessert.” This mother had no idea why her “healthy” eating lifestyle could be anything less than healthy for her daughter as well. The messages we send as parents are not always the ones we intend to communicate.

Cooking is becoming a rare and obsolete phenomenon in the face of fast paced lives, with women in the work force. Kids are often left alone to fend for themselves at mealtimes.  They reach for the fast and not always healthiest food choices.

Family dinners are fast becoming a thing of the past in the face of changing lifestyle patterns. Only 50% of American families dine together anymore. So parents are not only out of touch with how their children eat, but also how they think and feel. By not preparing dinner regularly, it also makes it harder to say, “Don’t eat those chips now…We’ll be eating in 15 minutes and you’ll spoil your dinner.”

Families are increasingly becoming more scattered; because of increased distances and diminished time together, families tend to be less active together. 

3. In contrast is anorexia nervosa. Why does that occur?

An eating disorder is an emotional disorder; anorexia and bulimia represent a misuse of food to resolve emotional problems.

Cultural and social mores defining beauty as thinness and other environmental factors may trigger the onset of a clinical eating disorder, but only those people who are genetically predisposed to developing these disorders will succumb to disease.  Symptoms leading to clinical eating disorders in young children are anxiety, OCD, and perfectionism, all tendencies that are genetically transmitted. When exposed to external stressors and messages about body image, these children become ripe to develop a clinical disorder.   Society with its emphasis on thinness stands in direct conflict with biology as girls reaching early puberty as young as age nine become anxious about their developing bodies, start to diet, and thereby become candidates for an eating disorder.

In teens and adults, genetic tendencies in combination with poor self-esteem and emerging issues around identity and control, as well as gaps and deficits in emotional development and coping skills, are likely to cause the onset of a clinical problem.

Eleven million people in the US suffer with anorexia and bulimia.  An additional 25 million struggle with compulsive overeating.  It is important to note that a person suffering from compulsive overeating or binge eating disorder (the third eating disorder,) need not be overweight.  The habits of eating disorders are such that through purging, over-exercise, or binge/starve cycling, victims of compulsive overeating can maintain a normal weight, with the disease going unnoticed by the observing eye… and a person who is morbidly overweight most likely does not suffer from an eating disorder. You can’t always know what is happening just by looking.

Similarly, weight loss is not necessarily the only or most critical factor in combating Type 2 Diabetes.  Diabetic patients become better as lifestyle changes create a healthier person inside and out. Improvement is marked by better glycemic control, blood pressure and lipids, by becoming more physically active, and by honoring their body’s hunger and fullness signals. Weight is but one of many factors indicating a healthier individual.

Is there a connection between anorexia and obesity?   

 There can be. One of the primary triggers for the onset of a clinical ED is dieting, or food restriction.  A natural consequence to food deprivation in humans and animals is gorging, which eventually can lead to binging and purging in a child genetically susceptible to developing an eating disorder.

Children who diet are at risk to permanently damage their metabolisms and develop unhealthy eating and exercise patterns that will affect their weight regulation and body image throughout their lives.  Studies have shown that dieting children are more prone to become overweight adults. In the U.S., by the time girls have reached the first grade, 50 percent of them have already dieted.  By the eighth grade, 80 percent of American girls have been on diets. 50 percent of women on college campuses today in the US are disordered eaters.

4. The media worldwide show a specific stereotype of the way people should look. To what extent do you believe that this leads to the increasing symptoms of anorexia nervosa?

Models that we see on television and in the media are thinner than 98% of people observing them.  Media influences can act as an environmental trigger setting off the onset of clinical disease in a genetically susceptible child. Children are most vulnerable to the influence of media images, as well as of peers, whose values may be shaped by these same images.  In an effort to look like the models they see on movie screens, in advertisements and on magazine covers, children begin to diet at young ages… which can trigger the onset of an eating disorder.

Parents cannot shield their child from harmful influences that are all around us…consider the influence of the pro-anorexic web sites that proliferate over the Internet today despite the efforts of the major search engines to eradicate them.  What parents can do however, is to teach their child good healthy eating habits, attitudes and values preemptively, instilling a strong and wholesome sense of self that will be resistant to pernicious forces.   Nature abhors a vacuum….when parents leave voids in a child’s emotional and physical education about self-care, these empty spaces, like magnets attracting the pernicious body image messages rampant in society, will not stay empty for long.

Children need to become actively and acutely aware of, and attuned to, the negative forces around them; they need to become critics of the media in their own right. They need to feel as though they are in charge in the face of influences that seek to take control of them. In the end, a child who is centered person, a healthy eater and a healthy problem-solver in life is a highly unlikely prospect to fall victim to an eating disorder, even where there may be a genetic predisposition, and even when part of a disordered-eating world.

5. Is there a relationship between relative body weight and clinical depression, suicide ideation and suicide attempts?

It has been shown that there is a direct correlation between malnourishment and the onset of depressive brain chemistries.  Anorexia has been called a slow form of suicide, yet I believe that the intention behind the disease is exactly the opposite: the emotional origin of eating disorders is self-preservation; the effort is to survive in a frightening and unpredictable world, to be special and remain strong and secure, not to disappear.

The means chosen to accomplish these ends, ironically, are lethal.  ED are the most lethal of all the mental health disorders.  They kill six to13 percent of victims, 87 percent of whom are under the age of 20, causing internal systems to shut down and electrolyte problems that result in heart failure.

Frequently, eating disorders co-occur with mood disorders such as bi-polar disease or major depressive disorder. Many people who suffer with eating disorders are addicts and/or self-mutilators; approximately a third of hospitalized bulimics have suffered sexual abuse. The leading cause of suicide is a person with bi-polar disease deciding to stop taking his or her prescribed medication.

6. How should parents help their children in case they suffer from obesity or anorexia nervosa?

In the case of Obesity:

Parents need to accept responsibility to serve as sources of authority and healthy role modeling for the child. Although some children may inherit a predisposition to developing obesity from their parents, parental influence on children’s nutrition and physical activity are significant factors in determining whether or not the child will develop obesity.

The most productive changes are delivered through the parent’s emphasis on a healthy eating lifestyle, rather than weight reduction.  The overweight child needs to learn to eat differently, not less, to walk more and ride less, to continue to eat lots of foods as long as they are nutritionally-dense foods and as long as they are eaten in moderation.  In order to lose weight, there is no need to go hungry, no need to diet and restrict food. Here, the emphasis needs to be on increasing parental nutritional skills and parenting skills.

•  Parents buy the food and plan the menu, so they should be constantly aware that they are both models and guides for their children in making the correct nutritional choices.

• Children learn to like what they are accustomed to eating and what they see others eating.

• Children will eat whatever is handy, so what parents have in the house can make a big difference.

• It is wise not to be so dogmatic as to make certain foods forbidden, since this will only make those foods more desirable and encourage behind-one’s-back cheating.

Parents who wish to instill healthy eating habits in their child, overweight or not, would do well to:

• Eat meals together with their children at scheduled times.

• Forbid mindless, a-social eating in front of the television.

• Encourage daily exercise

• Be alert to and address the stresses your child may be experiencing at home or at school.

• Set a good example. Don’t skip meals, and whenever possible, parents should participate in activities with their children, biking, hiking, dog walking, playing ball, skating - to establish movement as a family norm.  These times together are also a good opportunity for parents to tune into how their child thinks and feels, as well as moves.

• Accept and value every body, whatever size and shape.

• Assess their own personal issues regarding eating, weight management and size. Challenge their own size-prejudice beliefs.

• Identity their child’s strengths and abilities and build on his or her assets.

• Learn what healthy eating is.  Don’t be taken in by rampant misconceptions.

Parents can help their child recover from Anorexia in the following ways:

• Learn to recognize early signs of disease. Head off the eating disorder before it takes possession of your child.

• Watch for signs of disordered eating, (mild or temporary changes in eating patterns). 

  • Parents may see children eating less in the guise of eating “healthier and healthier,” or exercising more.

  • A child of normal weight may begin to hate his or her appearance and may commit to a diet.  If this is the case, a flag should go up. 

  • Your child may disappear into the bathroom during or after meals.

  • He or she may become uneasy about eating in front of others and dread family get-togethers.

  • Other signs include obsessive fretting about weight, overuse of laxatives, girls who fail to start menstruating ion their teens, or who suddenly stop having their periods, or dramatic weight loss in either girls or boys. 

• Recognize your important role as a parent in confronting and educating your child and bringing him or her to treatment. 80 percent of children brought to effective treatment, early on, will recover fully. If there is a “magic bullet” in a child’s successful recovery, it would be the healthy and appropriate intervention of concerned, loving and proactive parents.

• Find expert help. My book, When Your Child Has an Eating Disorder, will serve as a practical and hopeful guide providing the counsel and direction you seek to get started and to insure that you maintain your footing throughout what is typically a frustrating and convoluted recovery process.

• Don’t be afraid to seek counsel and support for yourself.  You can’t sell from an empty wagon.  You need education, support and bolstering so you can educate, support and bolster your child through a tough process to wellness.

• Role model a healthy eating and exercise lifestyle.