Americaâ€™s Growing Waistline
A few months ago, for Jenna Broccolo's 15th birthday, she and her family took a trip to New York City to attend a festival in Little Italy. Jenna, a sophomore at Westerly High School, asked her mom for one more gift: a full-length mirror. "You go, girl!" said her mom, Ann Marie Broccolo. "We'll hang them all over your room!" It all started last May, when Jenna went for a routine visit to the doctor. She had always been substantially overweight, but when she stepped on the scale at the doctor's office, the result surprised her. "She said, 'Mom, if I go over 300, I'm in trouble,' " recalls Ann Marie. "She had eight pounds to go."
At 5'1" and 292 pounds, Jenna was among the 16 percent of Americans between six and 19 who are considered overweight, an amount that has more than tripled since 1980, according to the federal Centers for Disease Control and Prevention (CDC). This increase, of course, has hardly been restricted to children. The National Center for Health Statistics reports that an estimated 65 percent of US adults are either overweight or obese, a 16 percent increase over the past 10 years.
Three factors -- diet, physical activity, and genetics -- are widely recognized as the main influences in the obesity explosion, although the relative significance of each remains a matter of some debate. Regardless, some of the driving forces are clear: according to Eric Schlosser's Fast Food Nation (Harper Perennial, 2002), Americans spent about $110 billon on fast food in 2000, up from $6 billion in 1970. Snacks and packaged junk food are also more readily available to young people in schools and other locations, and adults have access to far more food and live far more sedentary lifestyles than in the past.
Although being thin remains the predominant beauty ideal for women, there are some glimmers of a larger cultural shift. As the New York Times reported last month, Kraft and PepsiCo have created rating systems to mark healthier foods, and Disney says it will remove characters like Mickey Mouse and Winnie the Pooh from food products it considers unhealthy for children. Dove soap launched a "Campaign for Real Beauty," using "real" average-sized women as models. Disguising herself in a fat-suit, uber-model Tyra Banks recently bitched out men caught on hidden camera for judging her for her XL-size, and overweight Americans striving to shed pounds are transformed into empathetic figures on NBC's The Biggest Loser.
Still, the U.S. epidemic of obesity seems unlikely to fade away anytime soon, and it exacts a certain toll. The National Institutes of Health puts the economic impact of overweight and obese Americans at $117 billion, including treatment costs for obesity-related health problems like heart disease and diabetes, as well as dollars lost on productivity when people are sick with these conditions. As American waistlines continue to expand, scientists and public health officials are scrambling to counteract what many see as a leading health crisis. And because overweight adults usually start their lives as overweight children, figuring out how to prevent obesity before it starts has become something of a holy grail.
Being overweight isn't just a health issue, however. It's also a political issue, one tied up with body image, sexism, discrimination, and self-esteem. Nowhere is this more the case, as countless Americans reflexively focus their New Year's resolutions on losing weight, than among adolescents, who are painfully aware of their own bodies, of their friends' bodies, and of how they fit in (or don't) among their peers.
A New Movement Strikes Back
The "fat movement," born in 1969 with the establishment of the National Association to Advance Fat Acceptance, has finally come of age. In addition to NAAFA, there are nonprofits such as the Council on Size and Weight Discrimination, a "Health at Any Size" Web ring with 28 fat-positive sites, and an irreverent magazine called Fat!So? Marilyn Wann, editor of Fat!So?, asserts in an e-mail, "Weight-loss, as a goal, almost always does harm and almost never does any lasting good. The only reason otherwise sane people continue to pursue it is because of crushing social pressure."
Some of the movement's goals are political. These advocates want Americans to rethink their beauty ideals, to ask whether such concepts are being bought and sold by makeup (and soap) companies, fashion magazines, and the diet industry. Some of the goals are practical. NAAFA, for instance, has agitated against Southwest Airlines' policy requiring especially large passengers to pay for two seats. Some of the goals are health-related. Up against the panicked consensus in the medical establishment that America has an epidemic on its hands, a small, but vocal contingent in the fat movement is arguing yes, there are more fat people than ever before, but there's no reason to make such a fuss.
Pat Lyons, a registered nurse and fitness consultant in Oakland, California, says the medical establishment has been "trying to shift obesity from what it has always been, which is a risk factor, to be a disease that insurance will cover treatment for. All of this hysteria around the obesity epidemic -- 'Oh, all those kids, they're going to get diabetes, they're going to be in the hospital, they're going to be dead' -- We don't know that yet."
The health activists in the fat movement generally agree on two points. First, they say that eating well and exercising are far more important than weight loss, and they contend that the medical establishment has focused so much on weight loss because of bias against fat people. "I don't think you can believe what doctors say about weight loss," says Lynn McAfee, director of the upstate New York-based Medical Advocacy at the Council for Size and Weight Discrimination. "Science has followed prejudice in this country."
Advocates also take issue with what they call the faulty practice of diets and dieting. In a study published in 2003 in the journal Pediatrics, researchers at Harvard Medical School, for example, found that adolescents who dieted actually put on more weight than those who did not over a three-year period.
"We believe that promoting calorie-restricted dieting for the purpose of weight loss is misleading and futile," writes Joanne Ikeda, a nutritionist at the University of California at Berkeley, in the Journal of Nutrition Education and Behavior. "We advocate the adoption of a health-at-every-size approach to weight management," which emphasizes "positive" behavioral changes, such as exercise and nutrition, regardless of weight. Lost weight may be more obvious, but Ikeda says the "metabolic fitness" measures tracked by she and her colleagues are "much better indicators of whether a person is healthy or not."
The medical establishment considers such strategies misguided. "We do know that if you change your diet without losing weight, that can be helpful," says Hollie Raynor, a Brown University assistant professor of psychiatry and human behavior, who specializes in weight control in adolescents. "But losing weight has a bigger impact, and generally produces better outcomes than just the diet alone."
One GirlÃ¢â‚¬â„¢s Story
Jenna Broccolo can't pinpoint exactly when she became overweight. But she and her family can identify some unhealthy habits. First, "we were all soda-holics," says Jenna, with the family going through several two-liter bottles each week. Second, says her mother, Ann Marie Broccolo, "Jenna would come into the house and go right to the refrigerator after school."
Instead of a light snack, Jenna and her brother would eat whole meals -- leftovers from the previous night's dinner, or packaged pot pies, and the family would sit down to dinner a few hours later. The Broccolos would go to McDonald's or Burger King on at least a weekly basis. Perhaps a bigger factor is that being overweight runs in Jenna's family. "I went through it," says her grandmother, Mary Ventresca. "I was always a big person. I tortured her," Ventresca says, motioning toward her daughter, Ann Marie Broccolo, who nods, adding, "I've been on diets, up and down, up and down."
Jenna has lots of friends and doesn't suffer from the painfully low self-esteem that dogs many overweight teenagers. "She was always on the go," says her mother. "It never stopped her." But there were little ways that her weight would crop up. In Disney World, for instance, Jenna couldn't fit into the safety bar on the rollercoaster. "That was embarrassing," she recalls. There were her clothes; Jenna refused to wear shorts, even on the hottest days of the summer. Not being able to keep up with physical fitness classes in school also proved embarrassing.
In the back of her mind, as she interacted with people at school, she always wondered if they thought less of her because of her size. "I'm not saying it didn't bother me," Jenna says. "I just didn't want to admit it."
Because diabetes runs in the family, and because her blood pressure was elevated, her doctor suggested she lose some weight. Last summer, Jenna attended Camp Kingsmont, a weight-loss camp located on the campus of Hampshire College in Amherst, Massachusetts. She lost 13 pounds during her three-week stay, and has continued to lose weight since returning home (she's now shed a total of 42 pounds). Her whole family is into it: her grandmother cooks healthy meals, Jenna and her mother go for walks, and she and her brother encourage each other to go for bike rides instead of watching TV and snacking after school. The family sits down to dinner by 5:30 every night, following Kingsmont's "no eating after 6" rule.
Not surprisingly, camps like Kingsmont are just one aspect of the booming diet and weight-loss industry. Americans spend more than $40 billion each year on diet books, diet foods, gym memberships, and other weight-loss strategies, according to Marketresearch.com. It's hard to say how much of this money is spent by, or for, children and adolescents, but the growing number of overweight children certainly constitutes a lucrative market.
Kingsmont, established in 1971, doesn't bill itself as a weight-loss camp, but as a "lifestyle-change program," combining physical activity, nutritional education, self-esteem building, and fun. However, there are no illusions among its campers and staff about what exactly "lifestyle change" means. Asked by a counselor why I was writing about Kingsmont, I told her I thought this was a very interesting topic. "What," she asked. "Fat camp?"
A Circle of Repetition
Despite its nutrition classes, its restricted-calorie "camper diet," and its weekly weigh-ins, Kingsmont feels distinctly like camp, as I discovered during a visit last August. Campers whisper to each other about secret crushes. Walls are decorated with pictures of heartthrobs cut from teenybopper magazines. Counselors can "gig" campers at whim, compelling them to climb onto a chair and sing a song during lunch or perform other embarrassing but secretly fun stunts.
In some ways, it is precisely because it is a weight-loss camp that Kingsmont has such a relaxed atmosphere. "You're all here for the same reason," says Dana, a counselor and Kingsmont 'lifer.' "You would never get made fun of because you're fat. And that's so comforting."
Because almost everyone is overweight, fatness becomes a sort of inside joke, fair game for poking fun, whereas in mixed company the subject might be too sensitive. Camper Jennifer Stone, 13, recalls a trip campers took into town the previous summer to see Fourth of July fireworks. "An ice cream truck passed by, and you can imagine fat kids and ice cream," she chuckles. "It was not pretty. Everyone at the camp got on their feet and chased the ice cream truck." The speech that Kingsmont's owner, Marc Manoli, gave afterward has become the stuff of legend, and ribbing, among the campers. "Sometimes," they intone to one another with mock-seriousness, "you have to let that ice cream truck pass you by."
No matter how much Kingsmont encourages campers to let loose and have fun, that struggle is never far from their minds. All of the kids I spoke with during my two days there knew exactly how much weight they had lost, almost down to the pound. Weekly weigh-ins reinforce this emphasis. During the summer's last weigh-in, kids were weighed and measured, and their new stats recorded in a binder. A counselor snapped the "after" portion of this summer's "before" and "after" photos.
This weight-reduction process is meant to offer positive reinforcement and encourage kids to feel proud of their accomplishments. But it had some unintended consequences. When a kid's self-emphasis shifts from overall healthiness to weight loss per se, that's when an unhealthy relationship can develop between that kid and food, or that kid and his or her body. As an 11-year-old girl told me, she sucks on Oreos to get the flavor and then spits them out, so she can avoid "all the fat and stuff."
Another unintended consequence of this emphasis is that everyone -- even many kids (and women) who don't have a weight problem -- begins to see themselves as fat. Scientists call this phenomenon body dysphoria. In one study, researchers found that more than 80 percent of adolescent girls wanted to lose weight, even though two-thirds of them were within the normal range for their age.
And even those truly overweight campers who lose a lot of weight at camp still return to the world where they lived before, so many of the kids gain weight back. Bharati Shapero, Kingsmont's administrative director, recognizes this reality. "They might lose 30 pounds here and gain 10 back," she says. "They might lose 20 the next summer and gain five back. It's hard in the real world."
In Shapero's scenario, the camper still ends with a net weight loss. Many kids, however, end up right back where they started. Camper Emily Isaac lost 27 pounds this summer, which she hopes she will keep off, but it's been the same story in her four years at Kingsmont: "lose a bunch of weight during the summer and then gain it back. Most people do."
Many of the campers were at Kingsmont for health reasons. Isaac, for instance, who is 15, has insulin resistance syndrome, which can be a precursor for diabetes. Many campers, however, were there simply because they didn't like how they looked. Clothes were a big theme. Shannon Grady, 12, said she came to the camp, because "I couldn't fit into any clothes I like, and I would cry at the mall." Her friend, Victoria Saxon, also 12, chimed in, "I cried at the mall once, too, because I didn't fit into a pair of jeans I wanted." Abby Rappaport, 11, says, "If I went to sleepovers, we'd all try on each other's clothes, but I wouldn't fit into them. I felt upset."
The fat movement and the medical establishment are each probably right. There is a bias against fat people -- if not in medicine, then in this country at large. And the main reason that people lose weight is not because it's healthy, but because they think it will make them more attractive.
Activists like the Council on Size and Weight Discrimination's Lynn McAfee are entitled to question the medical dogma that emerges in this cultural atmosphere. The fat movement is also right that overweight people -- kids especially -- could stand to be reminded that they are valued members of society. "The only time that people who are fat are taught to feel good about themselves [is] when they're losing weight," says McAfee. "That's a setup for a really bad life." These activists are right to recognize that the diet industry preys on insecurity, and that dieting can often be more psychologically damaging than healthful.
On the other hand, a knee-jerk opposition to weight loss may be a naÃƒÂ¯ve strategy. As Kingsmont's Bharati Shapero says, "I think it's great to empower yourself to love your body. [But] in promoting love for your 'phat' body at the expense of having a healthy body, I don't agree with that." Obesity is a risk factor for certain diseases, and while the links between fatness and disease may need more definition, that doesn't warrant ignoring the risks altogether.
In many ways, a place like Camp Kingsmont incorporates the best of both worlds. In an environment where everyone is overweight, kids can be themselves without being judged or ostracized. However, many of the kids I met there, who had unhealthy relationships with food and with their own bodies, offered examples of what can happen when young people are taught to diet. The "lifestyle change" shtick also seemed a little disingenuous. Lifestyle change is not necessarily measured in pounds or inches, and yet this seems to be the primary yardstick of success at Kingsmont. If the goal is weight loss -- which, according to the medical establishment, is a laudable goal -- why not just acknowledge it?
It's also very difficult to deliver a lifestyle change in seven weeks. A real lifestyle change program for an overweight child would have to involve the whole family, as did Jenna Broccolo's, and would have to be ongoing. Putting the emphasis on eating healthfully and exercising would help to redirect adolescents' emphasis from changing their bodies to taking care of their bodies. This strategy won't always help kids to lose weight, but it could enable them to establish a healthier relationship with their bodies. Then, later, if they need to drop some pounds for health reasons, perhaps it wouldn't be so fraught with emotional baggage.
In fact, a camp like this could be a positive thing for anyone, regardless of weight. As McAfee puts it, "We could all use a healthy lifestyle camp, couldn't we?"