By Molly M. Ginty
Thursday, April 21, 2005
As body image activists plan to celebrate International Size Acceptance Day next week, obesity among American women has hit record levels.
(WOMENSENEWS)--Pass the double fudge. And hold the Sweet 'N Low.
Next Tuesday, the Austin-based International Size Acceptance Association is urging Americans to drop their diets in honor of International Size Acceptance Day, now in its seventh year.
Hailing the "plus-sized seats" at McDonald's and warning of the health risks of weight-reduction surgery, this campaign has sparked mixed reactions among women's health advocates.
"This day is exactly what women need," says Connie Sobczak, founder of The Body Positive, a health advocacy organization based in Berkeley, Calif. "Whether they are 17 or in their 70s, most women are in emotional pain around their body size and need an opportunity to heal."
Madelyn Fernstrom, director of the Weight Management Center at the University of Pittsburgh Medical Center, has a different response: "This event shouldn't mask the dangers of our epidemic weight gain. For the sake of our health, we must start choosing the apple over the apple pie."
Health experts' conflicting views on this event reflect a larger debate on how to deal with Americans' record weight gain.
With one third of American women obese--and with women 20 percent more likely to be obese than men--many conventional health practitioners are exhorting women to slim down. But a growing number of grassroots activists say it's more important for women to improve their body image than to focus on body size.
According to the Atlanta-based Centers for Disease Control and Prevention, a record two-thirds of Americans are overweight and half of those are obese.
The number of obese adults in the United States has doubled in the past 15 years, and the number who are more than 100 pounds overweight has tripled in the past five years.
More than 35 million American women are obese, and their number is steadily growing.
Repeated studies show that being overweight boosts a woman's risk of high blood pressure, high cholesterol, heart disease, diabetes, infertility, osteoarthritis, breast cancer and sleep apnea (breathing cessation during sleep).
According to the Washington-based American Obesity Association, obesity now costs the United States $75 billion per year in health costs and lost wages and is on the verge of surpassing smoking as the No. 1 cause of preventable death.(An April 20 study in the Journal of the American Medical Association has thrown this finding into doubt, leading some experts to believe obesity is actually the seventh-leading cause of preventable death).
Heath experts say a flurry of factors may explain our bulging girths, from a lack of exercise to greater consumption of sugar and high fructose corn syrup. But they say the number one culprit is likely stress.
"In many American families today, kids are on the run, parents are juggling two jobs, and people are grabbing food on the go," says Fernstrom. "Worried about making ends meet and feeling anxious and fearful after 9/11, people are nervous and are overeating for relaxation and comfort."
In response to Americans' record weight gain, the Office of Research on Women's Health at the National Institutes of Health in Bethesda, Md., moved last year to make the "emerging epidemic of obesity" a top research priority.
In January, the Department of Health and Human Services issued the first dietary guidelines for losing weight, urging Americans to eat nine servings of fruits and vegetables daily (versus the five previously recommended) and to get 90 minutes of moderate exercise daily (versus the 30 minutes recommended before).
Physicians are battling the bulge by firing off prescriptions for two new obesity drugs: sibutramine (brand name Meridia), making patients feel full more quickly, and xenical (Orlistat), inhibiting fat absorption in the intestines. A third drug, rimonabant or Acomplia, which blocks a protein in the brain that triggers hunger, is in development and may be available later this year.
Some grassroots health activists however, say women don't need to lose weight as much as they need to stop judging themselves and start embracing their bodies as they are.
These health advocates say there is something wrong with a society where mainstream magazines peddle razor-thinness, where airlines charge heavy customers for two seats instead of one, and where three of the most popular television shows--"Fat Actress," "The Biggest Loser" and "Fab to Flab"--poke fun at the overweight.
They say stereotypes of the overweight as lazy or weak--which isolate them and boost their risk for depression--have become as epidemic as obesity itself. They quote a 2003 Yale University study that found even health professionals who specialize in obesity have "a significant pro-thin, anti-fat bias." They cite a 2004 Dole Nutrition Institute poll that found 40 percent of college students would sacrifice a year of life if it guaranteed they could remain thin for life.
These activists' advice to overweight women? Stop buying into anti-fat bias. Instead of worrying about slimming down, just try not to gain more weight. Reduce the stress that may be spurring you to overeat. If the pounds melt off, beautiful. If they don't, that's beautiful, too.
"The message is one of radical self-acceptance," says Alana Free, a New York City activist whose one-woman show "Beginner at Life" chronicles her seven-year battle with anorexia. "There is so much hype and so much conflicting advice about weight gain that we have to make love the motivating factor, not fear."
Some body acceptance activists go so far as to oppose conventional dieting. That, for instance, is the position of the 2,000-member International Size Acceptance Association and the 11,400-member National Association to Advance Fat Acceptance, based in Sacramento, Calif.
These activists point to a January study by the University of Pennsylvania that found commercial weight loss programs don't work. They cite a 2004 study by the University of Washington that found "yo-yo dieting" can damage a woman's immune system, and a 2004 University of California at Berkeley study that showed women who diet are more likely to be obese.
They note that stomach-stapling surgeries (which totaled 140,000 in 2004, double the number done in 2002) can cause severe gastrointestinal upset and carry a 2 percent risk of fatality.
"We strongly condemn any diet marketing strategy based on guilt and unrealistic expectations," says Peggy Howell, a spokesperson for the National Association to Advance Fat Acceptance. "Such approaches cause untold suffering to fat people by ruining their self-esteem."
As the debate over weight loss versus size acceptance continues, there is one principle on which both sides agree: health and fitness should be a goal for women of every size, and if women accept their bodies as they are, it may slow or even reverse their weight gain.
"Whether you're heavy or thin, real health comes from eating a variety of well-balanced, nutritious foods and stopping when you're full," says Sobczak of The Body Positive. "Health comes from exercising for the joy of it and from letting your body's wisdom guide you."
Conventional health advocates add a note of caution.
"Focusing on fitness and not on fat will work for some people," says Morgan Downey, executive director of the American Obesity Association. "But others must lose weight because their lives depend on it. It's one thing to agree we should all be considered worthy members of the human community. It's another to overlook the health risks associated with rampant obesity."
Molly M. Ginty is a freelance writer based in New York City.
American Obesity Association:
The Body Positive:
National Association to Advance Fat Acceptance: