Statement of Lisa Berzins, PhD, at the APA Co-Sponsored Congressional Briefing

We must go beyond struggling to treat and prevent eating disorders to look at our cultural preoccupation with thinness and dieting. Our worship of thinness has made low self esteem and poor body image, as Naomi said, an expectable aspect of female development. Girls and women often quip in a self-deprecating manner about the inviting prospect of catching anorexia. As of yet, I have not heard of comparable desires to become schizophrenic or depressed or develop any other psychiatric disorder. Contemporary women view their bodies more negatively than at any other time in history and are more likely than not to believe they are fat, even when they are underweight. For men, self esteem is usually associated with achievement. As Dr. Striegel Moore said, for women, worth is often measured in terms of physical attractiveness and thinness. It no coincidence, then, that prior to the onset of puberty there are no difference between depression rates between boys and girls, by age 15, girls are twice as likely to become depressed and 10 times as likely to develop an eating disorder than their male peers.

Young girls have indicated in surveys that they are more afraid of becoming fat than they are of cancer, nuclear war, or losing their parents. Surveys also report that as many as 30 or 40% of 9 year old girls and 80% of 10 and 11 year-old girls have dieted. The prejudice against our heavy citizens , which is known as sizeism, runs deep... Disdain towards fat begins early in life. Both normal weight and overweight preschool children describe obese silhouettes as stupid, dirty, lazy, sloppy, mean, and ugly. When presented with a choice between a friend who is handicapped, disfigured, or fat, the vast majority of children as young as 3 and 4 shun the fat child. Sadly, fat children do not differ from their peers in this regard. In one study, a boy who was fat himself, when asked why he chose the fat child last, he said, 'Because he looks just like me.'

Research has shown that obese individuals are denied educational opportunities, jobs, promotions and housing because of their weight. Americans spend billions in their quest for weight loss only to discover that the only thing that has shrunk is their bank account. The diet industry preys on the desperation and false hope of dieters so as to make hefty profits. 95% of dieters fail to maintain weight loss, but this failure is ironically blamed on the dieters themselves. And in the meantime, despite the proliferation of dieting aids and low-calorie food products, American obesity rates are increasing steadily. In a recent study that I conducted of 54 large sized women, the median immediate weight loss for those enrolled in diet programs was 75 lbs. But after one year, the median amount maintained was 0. The average amount spent was $7,700 with a range of $0 to $50,000. Virtually all participants weighed more than prior to starting their first diet. Weight loss methods included... surgery to close off part of the stomach, wiring shut the jaw to prevent eating, and injection of female horse urine... 88% of the participants suffered taunts from peers and family members and many reported unsatisfactory experiences with health care professionals. One woman who suffered the loss of her baby was told that it was because she was too fat. Another was told that she would have to live with the pain of an ovarian cyst because she was too fat to operate on. One year later, a more sympathetic doctor removed the grapefruit-sized cyst. Many shared the experience of being admonished to lose weight when seeking help for headaches, colds, and sore throats. It is an unfortunate fact that heavy women often incur health risks by avoiding the humiliation they associate with seeking medical help.

The myth is that overweight can be cured by dieting. The truth is that treating overweight by dieting most commonly results in eventual weight gain. Bodies cannot be shaped at will. Weight is a complex result of heredity, culture, and lifestyle. It is not cured by a pill or a product. Some large-sized people maintain a healthy lifestyle yet remain at above-average weight. It is quite possible to be both fit and heavy despite popular beliefs to the contrary. The health risks of being fat have been oversold whereas, the consequences of dieting have been minimized. Not only has yo-yo dieting been associated with higher mortality rates than maintaining an above average but stable weight, recent studies indicate that dieting and weight loss itself can increase the risk of death.

Dieting is clearly a risk factor for the development of an eating disorder among those who are more vulnerable, and is associated with dysfunctional eating patterns, either undereating or overeating, preoccupation with shape, weight, and food, increased irritability, and risk for depression. For predisposed individuals, dieting may contribute to obesity by altering metabolism. Without a comprehensive health promotion... the public is often faced with confusing or contradictory information. Experts concerned with the prevention of eating disorders decry the excessive emphasis on dieting, an obsession with an unattainable ideals of thinness. Those who focus on the treatment of obesity warn of the dangers of excess weight and point to poor eating habits, a high-fat diet, and lack of exercise. Such polarizing positions are divisive and myopic. They do little more than blame either society or the individual. It is time to shift the focus from weight to wellness with a positive emphasis on maximizing health for people of all sizes.

What can we implement on a national policy level? First, promote healthy eating, healthy living, and respect for a wide range of body sizes and shapes in contrast to rigid meal plans, prescriptive exercise routines and an emphasis on slenderness. The focus on the benefits of health-enhancing behaviors with the recognition that bodies cannot be shaped at will. For example, from Canada, has an innovative Vitality approach which provides an excellent model. Both as a concept and a program, it was launched with a national public awareness campaign with the slogan, 'Enjoy eating well, being active, and feeling good about yourself.' Vitality's focus on health instead of weight advocates stopping the obsession with weight, being healthy with the weight one happens to have, and getting on with life. P.L.E.A.S.E is the organization that I founded is now also called Vitality Wellness for All Shapes and Sizes and there's information describing it; it's very similar in its approach.

Finally, challenge sizeism. Emphasize a respect for a variety of sizes and shapes and the concept of diversity. Increased tolerance and reduced stigmatization, bullying and teasing, beginning in elementary school. A unique approach that I have used with audiences of all ages involves my wearing a padded suit which makes me look twice my size. After I shed it during an intermission during my presentation, people have been able to voice their prejudicial attitudes toward me that were based on my supposedly large sized appearance. People confessed that they disregarded my arguments until I shed my clothes and became thin. I call it challenging fattitudes.

Third, increasing media literacy. Girls who are strongly identified with and who wish to emulate the ideal portrayed in the mass media are most vulnerable to developing eating disorders, poor body image, and low self esteem. Becoming a savvy consumer and differentiating self from image, can be fostered by efforts to emphasizing that advertisers in the dieting and cosmetics industry target and create insecurities about appearance so as to sell their products. Also, encourage families to provide support for their childrens' healthy growth and development. Provide education and reassurance about diversity of size and shape and the importance of challenging media messages that glorify thinness and equate appearance with self worth.

The Girl Power campaign that was launched by the Department of Health and Human Services fosters self esteem and self confidence in girls by encouraging them to pursue their interests while providing skill building opportunities in mathematics, science, and other academics, athletics, and the arts. Encourage diverse, realistic, and representative role models.

In terms of health care and consumer protections. One, increase regulation of advertising that target children as consumers for weight loss products, cosmetics, and apparel. I'm very proud to say that we have succeeded in Connecticut. Connecticut is the first state in the country to enact legislation that requires the diet industry to disclose accurate information regarding average amounts of weight loss maintained based on scientific data that's drawn from representative samples from customers that use their products. And if they don't do that, they have to have a statement that for many dieters, weight loss is temporary. We had a signing ceremony for a second law requiring full disclosure of cost, estimated duration of services, the credentials of program staff, and a 3-day cancellation period without liability. For those interested in information about both of those, there is information out there as well. We would very much like to see this happen on a federal level. The Center for Science in the Public Interest which is based in Washington has petitioned the FCC to adopt similar rulings... We really need Congress to put pressure on the FCC about that.

Ensure that a prescription weight loss drug such as Phen-Fen are prescribed as directed and not exploited for cosmetic or economic reason. Monitor the weight loss industry and hold it responsible for its results in the same way that other health care providers and health care products must be accountable. Include eating disorders awareness in the Healthy People 2000 campaign. This campaign focuses on increasing physical fitness in association with weight control. The campaign needs to highlight the risks associated with dieting and prevention of eating disorders. Eating disorders is mentioned nowhere in the campaign. Finally, reduce size prejudice in health care. Eliminate the use of the traditional height-weight tables, they are based on averages in the general population and have little bearing on individuals than would be determining the desired height based on given weight. Many large women avoid seeking health care because of the treatment they often receive. Require integrated training for providers on eating disorders, nutrition, and obesity. And finally, in terms of research, study the relationship between weight loss and gain, dieting and yo-yo dieting to physical and psychological health, especially self esteem, and determine which overweight persons have risks factors enough to warrant dieting. Thank you.

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