Public health messages addressing obesity may increase eating disorders

Public health messages aimed at addressing the “obesity epidemic” risk creating yet another rationale for women to lose weight dangerously and the issue may in fact increase eating disorders, according to research from The University of Auckland, New Zealand.

Dr Maree Burns, who completed her PhD research in psychology in the Faculty of Science earlier this year, studied the overlaps between public health messages that emphasise “healthy weight” and the justifications used by women with bulimia, for their radical body management activities.

Her findings, which have been published in the latest Journal of Health Psychology from the United Kingdom, suggest that public health messages aimed at reducing the obesity epidemic can support unhealthy practices such as unhealthy dieting, binge eating, vomiting, laxative abuse and excessive exercising.

“Women are already concerned with being thin, regardless of the health implications of weight loss. By focusing on the ‘appearance of health’ that is, being a certain weight, health promotion messages are unintentionally supporting unhealthy behaviour,” she says.

For her PhD study Dr Burns examined a combination of public health messages and material from media and food, fitness, fashion and cosmetic industries. She also interviewed health professionals and 15 women who have bulimia aged between 17 and 50 to discuss their ideas about and experiences around eating, compensating for eating, bulimia, and their bodies.

“What emerged from my study was that women believe a healthy body is slender and ‘fat free’. These women with bulimia were meticulous in regulating their body’s energy intake and expenditure and despite undertaking unhealthy practices to do this, they rationalised such practices as healthy because they were getting rid of fat.

“This idea that weight loss and weighing less is healthy cannot be separated from the current focus on the ‘obesity epidemic’,” she says.

Dr Burns says overweight and obesity have only recently become understood as “disease states” as biomedical research has linked obesity with ill-health. Public health efforts have adopted the position that weight gain and being overweight is dangerous for both individual and national health.

“But I think that in the rush to get a ‘health’ message out to the population, advice about obesity and weight has been oversimplified. Public health is failing to consider how messages are being taken up by different groups and that emphasising weight loss for health is often interpreted as a dieting message.

“That can have a devastating effect on anyone with weight concerns but especially women with eating and weight management difficulties. It can feed into an obsession with body size,” she says.

The notion that being overweight is dangerous to health has also been taken up by commercial industries to sell products and Dr Burns says this reinforces messages that any excess bodyweight or weight gain is a bad thing.

Dr Burns says her work with the Eating Difficulties Education Network in Auckland during her PhD studies demonstrated to her that weight and body image difficulties, including anorexia and bulimia continue to be significant problems for many women and increasingly for men.

“So-called obesity affects a percentage of the population. There are however, a large number of people who are at so called healthy weights or even underweight. Yet you never see public health warnings about the health dangers of weight loss or risky weight management,” she says.

Dr Burns says that growing up as a young woman in New Zealand she was always aware how normative dieting was and how negatively being fat is portrayed.

“I have always been curious about the impact of living in a fat phobic society where slenderness is idealised and promoted in so many places. So my interest in this whole area was sparked by my own experience,” she says.

Since completing her PhD, Dr Burns has shifted to Britain where she is now a research fellow in the School of Psychology at the University of Exeter.

She is hoping to develop a collaborative project between Britain and New Zealand to look at how the idea of healthy and unhealthy weight is understood and what the implications of these understandings are in terms of obesity, disordered eating and weight management practices in both countries.