TCS Daily

The War on Fat's Casualties

By Sandy Szwarc - July 24, 2003 12:00 AM

With all of the pressure to be thin, the onslaught of diet messages finds a ready audience. At any given time, up to 80 million American adults are on a diet.


Women and children are the primary victims of this relentless harping. Almost half of all first graders and 90 percent of high school girls are already dieting, even though only 10 to 15 percent of them are over recommended weights. By college, almost all students have dieted, disproportionate to the number with real weight problems, according to multiple studies. One study, led by Lori Clayton Pereyra, M.F.C.S., R.D., C.D.N., and published in a 1997 Journal of the American Dietetic Association, found half of students were currently on a diet even though only 18 percent were outside recommended weights.


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To Do List
A Simple Plan
Mikey Doesn't Like It

It has been well documented that dieting and insufficient calories and nutrients in growing children contribute to poor learning, stunted growth, delayed puberty, and behavioral problems, according to Kenneth Davis, M.D., of Mount Sinai School of Medicine in Total Nutrition (St. Martin's Griffin, 1995). "Many teenage girls, already the most poorly nourished of any group in America, have stopped drinking milk or eating meat in their extreme fear of fat," Frances Berg, M.S., editor-in-chief of Healthy Weight Journal, said.


Researchers in the February 1999 Physician and Sports Medicine, cautioned physicians that active adolescents often believe red meat is fattening and eliminate it from their diet to reach or maintain a low body weight, and that these girls may legitimize their eating behavior by calling themselves vegetarians. They noted a number of resulting nutritional and health problems. In a 1996 study of Canadian women ages 14 to 19 years published in the Journal of Adolescent Health, Dr. Ursula Donovan found a high prevalence of inadequate energy, protein, calcium, iron and zinc intakes among these young vegetarians as compared to their counterparts who consumed animal foods.


Dieting alone, let alone any diet that eliminates certain foods or food groups, can pose very real threats to the health of teens and college-age women. "The more you restrict your diet, the more difficult it is to get all the nutrients you need," said Marilyn Stephenson, R.D., of the Food and Drug Administration's (FDA) Center for Food Safety and Applied Nutrition in the May 1992 issue of FDA Consumer. "To be healthful, vegetarian diets require very careful, proper planning."


The problem is that "often, these young vegetarians lack the knowledge and motivation needed to plan healthful vegetarian meals," said Kathleen Meister, M.S., in Vegetarianism (American Council for Science and Health, July 1997). They're often motivated by ethical concerns over eating animals or have become fearful of dangers, as purported by various environmental and animal-rights groups. These groups are very active on school campuses, she notes, and young people "are especially vulnerable to ideology, and their strong feelings and limited life experiences may lead them to make questionable choices."


Hidden Disordered Eating


For many years, eating disorder specialists have been seeing so many young women who've become vegetarians, they consider it a marker for an eating disorder, according to Frances Berg in her book, Women Afraid to Eat -- Breaking Free in Today's Weight-Obsessed World (Healthy Weight Network, 2000). Many, such as Monika Woolsey, M.S., R.D., CEO of A Better Way Health Consulting, Inc., and associate editor of Healthy Weight Journal, have cautioned that it has become a politically correct way to have an eating disorder, enabling them to mask their dieting and eliminate entire food groups from their diet. Indeed, Sheree A. Klopp, M.S., and colleagues reported in last month's Journal of the American Dietetic Association that over one-third of vegetarians appear to be at risk for an eating disorder.


Researchers studying teen vegetarians in Minnesota found over 80 percent were women. In their study, published in the December 2001 Journal of Adolescent Health, the researchers reported that compared with non-vegetarians these vegetarians were more likely to be dissatisfied with their bodies and exhibit signs of depression, as well as almost twice as likely to diet frequently, four times more likely to intentionally vomit and eight times more likely to use laxatives for weight control.


A female who is both vegetarian and eating disordered is also much more likely to be malnourished, leading to an increased severity in their illness, Berg said.


Not Dieting?


Even most adult women not "on a diet," practice controlled eating to the point where normal eating is considered "cheating." A recent national study showed the median calorie intake for women in the United States is about 1,600 calories, according to Berg: "This is considerably below the Recommended Dietary Allowance (RDA) of 2,200 calories for women in their childbearing years, as set by the Food and Nutrition Board."

It's no wonder the average woman in her childbearing years is short on iron, calcium, and multiple minerals and vitamins -- shortages that largely extend through older ages.


Malnutrition rates and a number of nutritional deficiencies are becoming increasingly prevalent among young females. Numerous studies, for instance, have shown direct links from dieting to osteoporosis in all ages, and osteoporosis is appearing in increasingly younger women, leading the National Institutes of Health (NIH) to declare a "calcium crisis" in 2001. On June 6, 2002, the American Medical Association released findings of Nancy C. Andrews, M.D., Ph.D., an iron metabolism expert, which showed 20 percent of women and many children were at risk of iron deficient anemia, especially those not eating meat.


"Sensible" weight-loss diets prescribe an amount of food far below the normal amount people need, said Dawn Atkins, M.A., research coordinator and director for the Body Image Task Force from 1988-1994, and former Research Chair for the National Association to Advance Fat Acceptance. Ask any woman how few calories she believes is necessary to lose weight, or look at the calorie counts on most diet meals, and "sensible" seems anything but. "Most commercial weight loss programs range from 945 to 1,200 calories a day. The World Health Organization (WHO) defines starvation (the point at which the body is dying) as 900 calories or less a day. That means that most programs are starvation or semi-starvation programs," Atkins said.


The effects of dieting on quality of life, whether you're a man or a woman, are pronounced. The 1998 Minnesota Starvation Study found men on even modest 1500-calorie diets went into starvation mode and shut down physically, mentally, emotionally and spiritually and become obsessed with food. Certainly, most women in our society know these feelings well, as they've spent years of their lives dieting and worrying about their weight.


The hidden cost of dieting, said Paul Ernsberger, Ph.D., associate professor of Medicine, Pharmacology and Neuroscience, Case Western Reserve School of Medicine, is "the reduction in human performance, learning, and possible loss of potential, particularly among young women."


Risky Business


The actual risks associated with dieting are rarely mentioned.


In 1992, the NIH held a conference on Methods for Voluntary Weight Loss and Control in which the country's top experts reviewed the body of scientific evidence on weight and dieting. Their consensus statement was stark and startling: Most studies, and the strongest science, shows weight loss, although seemingly to reduce risk factors, is actually strongly associated with increased  risks of death -- by as much as several hundred percent.


These risks weren't a result of excessive weight loss or extreme diets, but as little as 10 pounds and even moderate calorie restrictions. Moreover, the NIH determined that studies that appeared to show opposite results, such as a famous Metropolitan Life Insurance study, were seriously flawed.


Berg, summarized the research in Health Risks of Weight Loss (Healthy Weight Journal, 1995) and showed in study after study -- Framingham Heart Study, CARDIA study, the CDC NHANES I, MRFIT, Harvard Alumni Study, Dutch Elderly, Alameda County, Baltimore Aging, Honolulu Heart, Lipid Research, British Heart -- that weight gain with age, or stable weights, for both men and women offered the lowest death rates, while dieting, weight loss or fluctuating weights, significantly increased the risk of death, cardiovascular diseases, diabetes and cancers. Follow-up studies since the 1992 conference have found similarly strong results, Berg reported.


Typically the risks attributed to obesity aren't separated from those independently due to dieting and regaining weight, David Garner, Ph.D., and Susan Wooley, Ph.D., noted in their comprehensive review of research on diets published by Clinical Psychology Review in 1991. When they are, such as the large-scale study from the American Cancer Society and the CDC published in 1995, premature death rates for women who've dieted to lose just 1 to 19 pounds (over a year or longer) increased as much as 70 percent, cancer mortality as much as 62 percent and heart disease and stroke by up to 167 percent compared to those who were equally overweight but weight stable. Equally alarming results have been found in men. A 1993 study of more than 10,500 high risk men led by Steven Blair, M.D., published in the Annals of Internal Medicine, found weight loss of about 10 pounds increased their mortality from heart disease 61 to 242 percent, compared to men who maintained their body weight or gained weight.


"Although no one can prove definitively that someone's heart attack was caused by dieting, there's strong compelling evidence to warrant warnings," Glenn Gaesser, Ph.D., associate professor of exercise physiology at the University of Virginia, said.


A number of clinical studies have attributed other dangerous heart problems, electrolyte and arrhythmia problems, myocardial ischemia, and sudden deaths in otherwise healthy people to dieting. Starvation can result in the heart muscle shrinking, slowing down, and beating irregularly, according to Western Washington University Counseling Center, which warned: "The potential for heart failure must be taken seriously." About 285,000 Americans died of heart failure last year, according to University of California at Davis; but it's unknown in how many dieting may have been a contributing factor.


No, No to Yo-Yo


Almost no one diets just once. Most of us hope against hope that we'll find a diet that will actually work over the long run so try another diet, only to later regain the lost weight again, in what's called the yo-yo syndrome. Even a one-time regain of lost weight has profoundly dangerous effects, but repeated weight cycling is even riskier.


A study published in the 2001 Journal of Hypertension, according to Ernsberger, found that weight cycling exacerbated high blood pressure, kidney disease and heart damage, and preferentially increased visceral fat deposited in the abdomen. Among yo-yo dieters, a 1994 Swedish study found kidney cancer risks increased almost 300 percent. Yo-yo dieting was associated with higher risks for heart attacks, strokes, diabetes and hip fractures, regardless of BMI, in the Iowa Women's Health Study. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of NIH adds high cholesterol and gallbladder disease to the list of health problems related to weight cycling.


In his book,  Big Fat Lies: The Truth About Your Weight and Your Health (Fawcett Columbine, 1996), Gaesser noted a potentially serious dilemma for women based on research demonstrating that yo-yo dieting significantly increases the chemical markers for DNA damage in breast tissue and may be an important risk factor for breast cancer.


Diagnosed breast cancer rates have certainly skyrocketed since the mid 1960s, in line with dieting, and "one has to wonder how many of the nearly 200,000 new cases of breast cancer each year in the United States might be attributable in part to our obsession with weight loss," he wrote.


In Nutrition in the Prevention and Treatment of Disease (Academic Press 2001), authors Cheryl Rock, Ph.D., R.D., and Wendy Demark-Wahnefried, Ph.D., R.D., L.D.N., reviewed the research on breast cancer and nutrition and noted that a majority of studies have found leanness to be a significant risk factor for breast cancer in pre-menopausal women, as is higher amounts of visceral fat (the type that accumulates with yo-yo dieting and sedentary behaviors) in older women; while obesity itself appears protective. As is true of all cancers, breast cancer involves an interaction of genetic and environmental factors, and dieting may prove once again to be the most significant of all.


"Of all the studies done on weight loss and weight cycling," Gaesser said, "none show it to be good, and those showing it's hazardous outweigh those showing it's merely benign by two to one."


Extreme Eating


Too bad diets don't come with warning labels for the lifetime of adverse effects they can inflict. The very act of starting any diet increases the risk of eating disorders, reported researchers at the University of Missouri. In fact, Barbara Altman Bruno, Ph.D., a clinical social worker and author of Worth Your Weight (Rutledge Books, 1996), said, "I believe that most, if not all, eating disorders start from dieting."


The moment you attempt to control your eating, you begin to ignore your body's natural hunger, fear food and develop dysfunctional eating patterns. Frances Berg defines dysfunctional eating as chaotic eating -- dieting, fasting, bingeing, skipping meals, undereating -- anything regulated by external controls and separate from normal controls of hunger and satiety.


Over a third of "normal dieters" progress to pathological eating, a 1995 study published in the International Journal of Eating Disorders documented. For up to 4 percent of the population, according to the American Psychiatric Association, it takes the form of compulsive eating problems, also called "binge eating disorders," which may or may not contribute to obesity. "Compulsive eating tends to heal and normalize once people stop dieting," Bruno said.


A destructive relationship with food -- seen in growing numbers -- is an obsession for eating "correctly" and fearing "bad" foods. Dr. Steven Bratman, medical director for Prima Health, chronicled this disturbing condition in his book, Orthorexia Nervosa: Overcoming the Obsession with Healthful Eating (Broadway Books, 2000). He found people adopt progressively rigid and unhealthy diets that eliminate food groups, until it ultimately costs them their health, personal relationships and emotional well-being. Like traditional eating disorders, it begins with a diet.


When eating takes on a life of its own, a full-blown eating disorder results. The two most life-threatening eating disorders, focused on the quantity of food eaten, are anorexia nervosa and bulimia.


A number of pressures play a role in the development of these eating disorders. Among the causes for them listed by the Eating Disorder Referral and Information Center of the International Eating Disorder Referral Organization and the American Academy of Pediatrics (AAP) are:


·        cultural pressures that place extreme value on thinness and obtaining the perfect body.

·        persistent messages encouraging dieting.

·        a history of being ridiculed because of size or weight.

·        preoccupation with eating and weight.

·        unrealistic expectations for achievement.


All of these are consequences we've seen from the war on obesity and our culture's fixation on weight over the past 30-some years. In societies that don't value thinness, eating disorders are very rare. Not unexpectedly, eating disorders are on the rise in the United States and have doubled in the past 30 years, the U.S. Department of Health and Human Services (USHHS) Office on Women's Health reported.


Up to 10 million Americans suffer from eating disorders, said the National Eating Disorders Association, costing between $5 billion to $6 billion a year to treat, despite these disorders being "tremendously under-reported and under-treated." Eating disorders are closet illnesses with many victims appearing normal weight or even overweight. They rarely get the media attention or government funding of say Alzheimer's, which by comparison afflicts 4 million.


Eating disorders are most often seen as a female problem, according to the National Institute of Mental Health. Although they are most common among female adolescents, one in 10 anorexics and four in 10 bulimics are boys.


Eating disorders are also increasing in children, males and older Americans, many of whom carry their problems into adulthood. The constant harangue that we're all fat and need to lose weight is difficult enough for adults to deal with, heightening anxiety and fear, but it's poisonous for innocent youngsters, who have limited coping mechanisms. Kids are the victims in 90 percent of eating disorders and doctors are seeing cases in as young as 3 years of age. By age 10, 81-percent of girls have disturbed eating -- are afraid to eat and feel guilty when they do. A three-year cohort study led by Allison Daee, RD, published in the 2002 British Medical Journal, found girls on strict diets had a one in five chance of developing eating disorders. That's 18 times more likely than nondieters. These researchers concluded that "dieting appears to have more negative than positive consequences on the psychologic health of adolescents."


A Brigham Young University study of 498 high school girls, published in the July 25, 2001, Journal of the American Medical Association, found over half restricted their calories to 1,200 a day or fewer to control their weight, 15 percent took diet pills, 11 percent used laxatives and 9 percent made themselves vomit after meals.


Young people resorting to unhealthy weight loss methods have stronger likelihoods of engaging in other problem behaviors such as drug and alcohol use, school delinquency, unprotected sex, and with suicide attempts, according to the University of Missouri.


The Die in Diet


Anorexia is the third most common chronic illness among American teens, states the USDHHS Office on Women's Health. Bulimia is 20 times more common still, affecting 8 to 20 percent of young women, according to the AAP. Together they have the highest premature mortality rates of any psychiatric diagnosis, reported Dr. Pauline Powers, founding president of the Academy for Eating Disorders.


Drs. Jerome Knittle and David Katz of Mount Sinai School of Medicine in Total Nutrition (St. Martin's Griffin, 1995) said 10 to 15 percent of anorexics die of starvation or related problems, including heart or kidney failure, and another 2 to 5 percent commit suicide. They're 12 times more likely to die than the general population of similar ages, according to a study published in the New England Journal of Medicine, April 8, 1999. It's estimated that in the United States alone as many as 150,000 die annually from eating disorders.


The heartrending and personal sufferings of eating disorder victims and their families have been well documented -- as have the life-threatening and long-term complications such as malnutrition, reproductive problems, kidney dysfunctions, heart problems, and gastrointestinal damage. And most all start with a simple diet.


Fattening Up On Dieting


Lest we overlook the financial costs of dieting: "As our level of weight obsession rises, so do the profits of the weight-loss industry," Berg noted in a speech given in Northampton, Mass., in March 2000. Americans spend somewhere between $30 and $60 billion on diets and weight-loss products each year, she said, and many will become chronic or yo-yo dieters. The diet industry knows it is "guaranteed repeat business."


American consumers, frantic to be thin, are subjected not only to tens of thousands of different and questionable diets and diet products, they also fall easy prey to outright scams. An FTC analysis showed over 55 percent of diet product advertisements made false or unproven claims. Last October, J. Howard Beales, III, director of the Bureau of Consumer Protection speaking for the FTC to Congress said the incidence of false and deceptive weight loss claims has increased over the past decade, during which time the FTC filed "as many actions as in the prior seven decades combined." Nutriwatch posts them but no study has tallied the physical and emotional harm they've caused.


Weighing in on the unintended consequences of our current war on obesity are the early recipients of the "thin" message, now reaching baby boomer age. Many of them have adopted extreme exercise -- rather than moderation -- in an attempt to keep their weights down. CNN recently reported that according to orthopedic surgeons, baby boomers are a more active group than previous generations. The result, cleverly named "boomeritis," is an explosion of bone and joint ailments and injuries among boomers attributed to intense exercise. It's a growing trend, increasing 33 percent just since 1991. The American Academy of Orthopaedic Surgeons estimates more than $18 billion a year is spent on medical costs resulting from these preventable injuries in baby boomers.


The war on obesity is costing Americans a lot -- not just in their pocketbooks, but also in their health and well-being. But this is only the half of it.


Next week: The War on Obesity becomes Extreme Makeover and Fear Factor rolled into one.


© 2003 Sandy Szwarc. All rights reserved.

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