Separating Fact from Fiction in the Age of Obesity

Personal Health

Feminist theorist Susan Bordo once wrote, "People used to try to develop a better self and act out all the projects of transcendence, transformation and purification in the context of community or religious work. Now they go to seminars with diet gurus." If dieting has become the new religion, then we are not only financially daft but spiritually bankrupt. The good news is that there is a growing movement trying to wake us up from our calorie-counting hypnosis and target the fat-pocketed CEOs behind the swinging crystal.

The pathetic success rate of diets isn't news, but what is groundbreaking is the growing awareness of just how unethical the $34 billion-a-year (some estimate as high as $50 billion) diet industry is. Organizations like the National Association to Advance Fat Acceptance and books like Laura Fraser's "Losing It: America's Obsession with Weight and the Industry That Feeds It" and the just published "Rethinking Thin: The New Science of Weight Loss -- and the Myths and Realities of Dieting" by New York Times health writer Gina Kolata, reinforce that it is not a lack of willpower that is standing between the average American dieter and her perfect body but a corrupt industry that keeps so many of us -- women in particular -- unsatisfied, obsessed and misinformed.

Separating fact from fiction in the age of obesity
If you've just emerged from an ashram or a remote cave, let me fill you in: The last few years have seen a wild spike in the media coverage and public conversation of all things fat. The obesity epidemic became the topic du jour for every nightly news program, sending America racing off to Weight Watchers meetings and downing diet teas in terrified droves.

Most of the diet industry big-hitters toe the party line between quick-results dieting and long-term lifestyle change (Weight Watchers, Jenny Craig, etc.), but there is a whole underbelly of the industry chock-full of dangerous schemes. These fast-fix pills, exercise and diet plans promise rapid weight loss -- sometimes at medically unsafe levels -- to desperate consumers.

There have been two dozen deaths from ephedra-based products in the last decade. Americans take 6 billion doses of PPA (what Fraser calls a "close chemical cousin" to amphetamines) every year even though it can causes a rise in blood pressure, anxiety and stroke; it is a common ingredient in diet pills like Dexatrim, Acutrim, Thinz and Appedrine. Many of the makers of these drugs have profited from the seemingly ubiquitous public conversation about fat in America.

J. Eric Oliver, a political scientist at the University of Chicago, asserts that the advent of the obesity epidemic story was less about fact and more about funding. In "Obesity: The Making of an American Epidemic," he explains that the hullabaloo was the result of "a relatively small group of scientists and doctors, many directly funded by the weight-loss industry, [who] have created an arbitrary and unscientific definition of overweight and obesity. They have inflated claims and distorted statistics on the consequences of our growing weights, and they have largely ignored the complicated health realities associated with being fat."

Instead of talking about the food industry, genetic predisposition, or sedentary, fast-food lifestyles, nightly newscasts featured fat, headless B-roll edited with voiceover from the nation's doomsday celebrity nutritionists spreading fear and misinformation. Being slightly overweight raises risk of death! Life expectancy plummets for the first time in two centuries!

Thanks to books like Oliver's -- and "The Obesity Myth," by Paul F. Campos -- public hysteria over the obesity epidemic seems to have finally come to a more sober summit. The truth is that many of us are overweight -- according to Scientific American, six out of every 10 of us, in fact. After decades of speculation, and let's face it, downright discrimination when it comes to fat Americans, researchers are finally finding out how genetics, environment, and psychology play into our overweight millions. And they are finally asking the question that women, pulling on waistbands and frowning in mirrors, have been asking for years: "Why doesn't my diet ever work?"

The set point makes diets obsolete
The world's largest study of weight loss by a group of researchers at the University of California has proven that two-thirds of those who diet gain the weight back. The study confirms what many researchers have already postulated -- that rapid weight loss and gain is actually more unhealthy than simply being overweight. Yo-yo dieting puts women at risk for a range of scary side effects -- like heart attack, stroke, diabetes and eating disorders.

A host of studies covered in Kolata's new book indicate that, in part, diets don't work because they can't override the body's innate "set point." Dr. Susan Albers, author of "Eating Mindfully: How to End Mindless Eating & Enjoy a Balanced Relationship with Food," explains: "According to the 'set point' theory ... your body has a genetically predetermined weight range. Your body tries to keep your weight within that range and will automatically adjust your metabolism and food storage capacity to keep you from losing or gaining weight outside of that range or set point."

The set point theory was thought to be just that -- a theory -- until now. Too many studies prove its legitimacy. For example, Dr. Ethan Sims of the University of Vermont found that a group of svelte prisoners who increased their weight by at least 20 percent over six months also saw their metabolism increase (by 50 percent!), making it impossible for them to continue to put on weight even with their whopping 10,000-calorie-a-day consumption. Flip the coin and you get the same results: Rockefeller researchers found that genetically fat patients who were put on strict diets actually went into psychological and physiological starvation mode even though their body weight was still technically very safe.

In our extreme makeover culture where women are led to believe they could look like Halle Berry if they just had enough will power or money, this is a powerful conclusion. Your body is genetically predisposed to exist in a certain range of weight. Your range might be higher than Paris Hilton's, or your next door neighbor's, or even your sister's, for that matter, but it doesn't mean anything about your character. In fact, you can diet with utmost determination and your body will continue to adjust your metabolism to fit its genetically determined size.

The frightening power within
Americans have poured themselves into dieting for decades. From Atkins to South Beach to Fat Busters, we've actually spent the gross national product of Ireland each year on trying to slim down. It turns out, it was free all along.

Susan Levin, a registered dietitian at the Physicians for Social Responsibility, explains: "What nobody talks about is that being healthy is not a matter of dieting, it is a matter of changing your life forever, eating healthy forever, moving your body, everyday, forever. No one wants to talk about that because it scares people to have that much control."

Levin recommends rejecting the pharmaceutical therapies and unhealthy diet plans (cutting out whole food groups, she asserts, is undeniably unhealthy) and seeing food as medicine instead. She described a patient with a stomachache who arrived at his doctor's office begging for a pill to make it better. In typical American quick-fix fashion, the patient hadn't even considered what food he had put in that stomach to make it ache in the first place.

Medical schools, it turns out, aren't much help either, as most of them don't require any kind of curriculum on nutrition. So the average American is not only being bombarded with false advertising and hyperbolic weight-loss claims in magazines, on television, radio, the internet and billboards, but often faces a similar fate at his or her own doctor. The "expert" may have little training in talking about weight loss without plugging a pill. Worst-case scenario, that doctor may even be paid to testify to its effectiveness by the pharmaceutical company that makes it.

With the potential of manipulation at every turn, where does the American look for the truth about health? Of all places, inward. "Let's talk about eating that makes good, intuitive sense," Levin insists. "Let's look at countries that eat high plant-based diets like Japan and Greece. These are the healthiest people on the planet, and they don't portion control or calorie count. They eat a natural, close-to-the-earth kind of diet."

The notion that we have everything we need to be healthy (or in diet industry parlance, "lose weight") within renders an entire industry impotent. If only we could believe it. Levin says, "People are afraid. They ask, 'So you're telling me I have that much power?'"

Feminists vs. the diet industry
It is hard to believe that the power to be healthy is so simple and internal, after decades of complex, contradictory, and profit-driven messaging on the part of multimillion-dollar corporations.

The dominant script of diet industry parlance is that, first and foremost, we are inadequate, and only they have the unique cure for our inadequacies. Commercials preach the gospel of thinness and equate it with success, happiness and love -- the thin girl waltzes through a sunny day with a handsome man on her arm and stacks of her own money in the bank, all a not-so-subtle result of her recent weight loss. The chance to slim down becomes more than a dwindling number on the scale in the world of weight-loss marketing. It becomes an answer to all of life's problems.

The obsession and self-hatred that the diet industry engenders has long topped feminist academics and psychologists' list of evils. Clinicians like Catherine Baker-Pitts, LCSW, and her colleagues at the New York and London-based Women's Therapy Centre Institute, encourage patients to look at the ways that "eating problems" are both internally (upbringing, personality) and externally (media, patriarchy) shaped. Baker explains: "Obviously the morality surrounding women's appetites is entirely loaded and connected to female identity -- messages to be less powerful, less emotional, less hungry, and to assume less space in the world."

Efforts to reclaim the beauty of the natural body have been numerous. Love Your Body Day now occupies a celebrated space on most college campuses in late October, as do feminist theory classes on body image year-round. Off-Broadway theaters have recently become a hot spot of plays -- like "Beginner at Life" and "Beauty on the Vine" -- both pushing audience members to come to terms with their inner critics and participate in dialogues afterward (ala Eve Ensler's "The Good Body.")

A wealth of literature, ranging from the academic (Susan Bordo) to the talk show-oriented (Jessica Weiner), urges women to stop pouring their critical time, energy and money into dieting. (Note: I have recently published a book that deals with many of these issues, Perfect Girls, Starving Daughters: The Frightening New Normalcy of Hating Your Body.) But for all of our go-girling, expose-writing and finger-pointing, the diet industry marches on as lucrative and deadly as ever.

Some feminists are considering taking the rallying cry against dieting out of the classrooms and into the courts. Given recent research that proves the ineffectiveness of diets as a whole and the inaccuracies, therefore, littered throughout diet advertising -- are there legal grounds to take down the industry? Can the diet industry be prosecuted into warning labels and public education efforts the way the tobacco industry has been?

Prosecuting the magic pill makers
Susie Orbach would like to think so. The British psychologist and author of the 1978 classic "Fat is a Feminist Issue" has been threatening to sue 40-year-old company Weight Watchers International, which she views as merely a symbol of the diet industry as a whole. She explains, "Dieting has a 97 percent recidivism rate. Where does that appear in the advertising? The failure rate is crucial for the profits of the diet industry. If it worked, there would not be return customers and no profit. It surely contravenes the Trade Descriptions Act."

The Act Orbach referred to prevents manufacturers, retailers or service industry providers in the United Kingdom from misleading consumers as to what they are spending their money on. It empowers the judiciary to punish companies who make false claims as a strict liability offense.

Here in the United States, the Federal Trade Commission recommends a "healthy portion of skepticism" to those evaluating weight-loss products, but has done little since 1990 and 1992, when congressional hearings on the diet industry led to a spurt of crackdowns on outlandish weight-loss claims. Around the same time, the Food and Drug Administration created a list of 111 ingredients used in over-the-counter diet aids that were ineffective or unsafe. In 1992, a National Institutes of Health task force declared that diets don't work.

Since then fraudulent weight-loss schemes have flourished. The Dietary Supplements Act of 1994 put the burden on the FDA to prove that a product is fraudulent -- as opposed to on the manufacturer -- so most diet drugs simply slip through the cracks due to a deluge of undone paperwork. And consumers' rights groups appear to do little when it comes to exposing diet rip-offs.

It does seem like class-action lawsuits -- ala the tobacco industry takedown -- may be the most effective answer. In recent years the number of lawsuits against drug companies, in particular, have skyrocketed. Dr. Phil's reputation was sufficiently tarnished when he was sued three times over his bogus diet supplements. Before Anna Nicole Smith's untimely death, she and TrimSpa were the target of a lawsuit alleging their marketing of the weight-loss pill was false or misleading.

These individual cries for restitution and truth are chipping away at the industry, but it remains to be seen if fed-up physicians, feminists and anti-diet activists can band together to demolish the whole glittering mirage.

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