The current health-care debate, when it focuses on food at all, focuses on obesity. Two-thirds of Americans are either overweight or obese. That is shocking, but in the national panic about obesity, we run the risk of making things a lot worse.
More people could get caught in the grip of eating disorders. Already, an estimated 11 million Americans have anorexia or bulimia. Hospitalizations are increasing. Even more worrisome, the American Medical Association found the greatest increases among boys and girls younger than 12, and among adults ages 45 to 65.
We could save a lot of pain, suffering and money by incorporating obesity into the range of illnesses now classified as eating disorders, and focusing on prevention. Agencies that are working on ways to combat obesity should include experts in eating disorders.
Maybe you didn't feel fat, just a touch overweight, before the U.S. Centers for Disease Control and Prevention revised the height/weight tables, and now your weight hits the category of "morbidly obese." Do you automatically exercise more and eat less? More likely, you feel bad, blame your genes or your lack of willpower, try a new diet, fail, feel worse, eat more.
Practically all disordered eating begins with a diet.
Eating disorders and obesity have increased spectacularly in the past 20 years. How is that possible? Did our genes suddenly change? No, but our eating habits did. We eat while walking, driving and working. Families have a hard time sitting down to a meal together, and even gas stations sell food.
We eat out a lot more, spending close to 50 percent of our food dollar away from home. Eating out, it's hard to avoid sugar, fat, and salt. As Dr. David Kessler, former commissioner of the Food and Drug Administration, writes in his bestseller, The End of Overeating, "Eating foods high in sugar, fat, and salt makes us eat more foods high in sugar, fat, and salt."
With food relatively cheap and highly available, we also have more opportunity to eat badly at home.
What else has changed in two decades? While America has become a 24-hour buffet, the pressure to be thin has increased.
Girls, particularly, get the message from movies and fashion magazines that the ideal body type is a wire hanger. But who among us doesn't obsess about weight? Pounds and Body Mass Index can feel like the sum of our worth.
Which means just about everyone gets to feel bad about his or her body.
If agencies attacking obesity aren't careful, they could inadvertently encourage more disordered eating. Obsessively counting every calorie as an enemy isn't hard. Moderation is hard. As generations of dieters know, changing habits is hard.
In the health campaign against fat, we should avoid bashing obesity and idealizing thinness, which only foster the self-destructive thought processes that characterize eating disorders from anorexia to obesity. Anorexics with jutting collarbones think they're fat. Binge-eaters often think, after eating too much, that they've already done the damage so they might as well keep eating.
No eating disorder is a lifestyle choice. Besides the serious, often life-threatening physical dangers, there is shame, loneliness, and depression.
But environments can change. Not that long ago, people smoked everywhere, just as we eat everywhere today. The health campaign against cigarettes worked. We can change the way we deal with eating disorders as well.