In recent years physicians and popular commentators have drawn attention to a growing population—both in the United States and around the world—of obese adults. Many have referred to this Page 65  |  Top of Articlechange as an “obesity epidemic.” Generally speaking, anyone who weighs more than 10 percent of their healthy weight is overweight; anyone who weighs over 30 percent of their healthy weight is considered obese. A number of researchers add another category called morbid obesity, signifying those who weigh 50 percent to 100 percent over their healthy weight. According to the World Health Organization, over 1 billion adults in the world are overweight, 300 million of whom qualify as obese.

The number of children who are overweight and obese has also grown. The World Health Organization estimates that worldwide, 22 million children are overweight, and the U.S. surgeon general has estimated that the number of overweight children in the United States has tripled since 1980. In the United States, at least 15 percent of those under eighteen are considered overweight. Likewise, the occurrence of obesity in children has continued to grow around the world, including China and Thailand.

A number of reasons has been given for these changes. For many people around the world, access to food, including foods rich in fats and sugars, is more readily available than at any time in human history. The availability of food is further complicated by less physically active lifestyles. As opposed to working all day on a farm as many Americans did during the 1800s, many work in an office behind a desk. “Moves towards less physical activity,” notes the World Health Organization, “are also found in the increasing use of automated transport, technology in the home, and more passive leisure pursuits.”⁷⁰

The obesity epidemic has also had an important impact on body image. One recent study by the Columbia University Mailman School of Public Health notes the relation between body image ideas and the growing obesity epidemic. Says Peter Muennig, assistant professor of health policy and management at Mailman, “Our data suggest that some of the obesity epidemic may be partially attributable to social constructs that surround ideal body types. Younger persons, whites, and women are disproportionately affected by negative body image concerns, and these groups unduly suffer from BMI [body mass index]-associated morbidity and mortality.”⁷¹ Other research suggests that psychological disorders such as depression potentially contribute to obesity. Because Page 66  |  Top of Articleof this epidemic and because of the health-related problems including heart trouble and diabetes, the increase in obesity has also focused greater attention on bodies and as a result, more attention on body image.

An increase in dieting has mirrored the rise in obesity. Dieting is a widespread phenomenon in contemporary culture and is perhaps the most widely used method of controlling body weight and shape. “Keeping to a diet is a serious component of modern culture,”⁷² notes author Peter N. Stearns. Dieting is also very popular in Western cultures. One British study reported that 86 percent

Pictured are various types of diets, including the Zone diet and the Atkins diet. The number of people dieting has increased dramatically worldwide.

of all English women have dieted and other studies suggest that as many as 80 percent of girls under the age of thirteen have also dieted. Men also diet but in fewer numbers. In one survey reported by the BBC, it was noted “Almost two in five (37%) women were dieting most of the time, compared to around just one in six (18%) of men.”⁷³

In the most basic sense, dieting is regulating the intake of food and calories but may also include supplemental vitamins, diet pills, and laxatives. For some people, a diet may consist of no more than skipping meals or limiting fatty foods and desserts. Others may limit proteins or carbohydrates or substitute a diet product like Slim-Fast for one or more regular meals. In extreme cases, dieters reduce calorie intake to a thousand calories or less per day.

Because dieting has become both popular and common, diet aids, books, and supplements have grown into a multibillion-dollar industry. Rebecca Reisner, an editor at BusinessWeek, noted in 2008, “Americans spend $40 billion a year on weight-loss programs and products.”⁷⁴ The names of diets themselves, such as Atkins and South Beach, are familiar and research suggests that the diet industry is one of the fastest-growing industries in the United States. Unfortunately, few dieters seem to obtain the slim body style promised by the weight-loss industry and diets are seldom successful. For obese dieters, success rates have been measured as high as 25 percent; for non-obese dieters, however, success rates are as low as 5 percent.

Worse, dieting can become problematic. Many men and women return to old eating habits after losing weight; then after regaining the weight they diet again. The diet, non-diet routine becomes circular and has been popularly referred to as yo-yo dieting. Another problem is that low-calorie and what is referred to as fad diets may excessively limit calories, depriving the dieter of needed nutrition. These diets may even be counterproductive to losing weight. “Fad diets generally rely on some trick to give the readers the appearance of novelty,”⁷⁵ note researchers Dana K. Cassell and David H. Gleaves. Commonly, a person’s metabolism will slow down, causing one’s body to react as though the dieter were starving. In this state, the body burns fewer calories and will

Weight Loss Methods Used by Underweight and Normal Weight Individuals - Taken from: CDC’s National Center for Health Statistics, 2001-2006. Available online at www.cdc.gov.

frequently burn both fat and muscle. When the person quits dieting, he or she frequently gains weight more quickly as the body seeks to replenish what it has lost during starvation mode. In the worst case scenario, dieting may even lead to eating disorders.

Eating disorders are potential side effects of dieting, especially with yo-yo and other unhealthy fad diets. Many sociologists and researchers believe that these disorders often are associated with concern over body image, especially for children and young adults. “At a time when they should feel secure in their body’s growth, too many American children become anxious about size and weight and begin to eat in ways that contribute to the very problems they hope to avoid,” notes psychotherapist Kathy Kater. “Obesity, negative body image, and eating disorders are extremely difficult to reverse once established, and can be devastating to the self-esteem of developing bodies and egos.”⁷⁶

Poor body image can lead to eating disorders such as bulimia, binge eating, and anorexia (seen here).

While doctors have been familiar with eating disorders since the end of the 1800s, the broader public did not become aware of the wide range of eating disorders, including binge eating, anorexia nervosa, and bulimia, until the 1970s and 1980s. Public recognition of eating disorders followed the death of Karen Carpenter, the popular singing member of the Carpenters duo. She died of heart failure brought on by anorexia in 1983. “Because of her popularity,” write Cassell and Gleaves, “her death brought more attention to eating disorders than anything before or since.”⁷⁷ While the underlying causes of eating disorders are varied, ranging from low self-esteem to social anxiety, all feature a hyperconcern for body shape and image. According to the National Institutes of Health, anorexia, bulimia, and binge eating are considered mental disorders.

Substantiating statistics on eating disorders is difficult, primarily because most people who suffer from eating disorders wish to keep this information private. In the case of anorexia, the severe weight loss eventually becomes obvious. Still, it is unclear

if everyone who suffers the symptoms of anorexia can technically be referred to as anorexic: As many as one-third of anorexics have been described by researchers as me-too anorexics, meaning that these individuals are simply copying the behavior of friends or classmates.

Binge eating may seem easier to identify because of weight gain, but this physical change is misleading: Not all obese people are binge eaters. Finally, bulimia may be the most difficult eating disorder of all to detect. While bulimia most often begins in a person’s teens or early twenties, it is seldom discovered until the bulimic is in her thirties or forties. Since bulimia is so difficult to detect, and because bulimia is much more common than anorexia, overall statistics on eating disorders remain difficult to validate. Author Joan Jacobs Bromberg nonetheless argues that these eating disorders should be taken seriously: “The annual incidence of the disorder [anorexia nervosa] has never been estimated at more than 1.6 per 100,000 population. Still, among adolescent girls and young women there is an increasing and disturbing amount of anorexia nervosa and bulimia.”⁷⁸

Translated literally, anorexia means “not hungry” or “without an appetite.” The literal definition, however, is misleading, because anorexics are frequently hungry. Anorexics fear gaining weight and limit their calorie intake to as little as possible to maintain thinness. Helpguide.org defines anorexia as:

Even when anorexics appear thin to others, they frequently continue to see themselves as heavier. Even when anorexics become emaciated, they are often proud of this accomplishment. Traditionally, incidences of anorexia were limited to primarily

white, affluent teenagers, though this has changed recently. Statistics estimate between 1 percent and 2 percent of adolescent and young adult women suffer from anorexia, though the estimate rises to as high as one in ten for female college students. “Many anorexics go through periods of bingeing and purging as well, which puts additional stress on their bodies,”⁸⁰ writes Yancey.

In reducing calorie intake, anorexics frequently damage their health, leading to as many as fifteen deaths per hundred patients treated for the disease. While treatment is often successful, as many as half of anorexics suffer relapses.

Binge eating disorder (BED) is defined as people who eat massive portions of food at least twice a week and typically do not Page 73  |  Top of Articlecompensate for this behavior by purging (or vomiting) or using laxatives. Frequently binge eaters become overweight. “Compulsive overeaters are also overweight,” writes Yancey, “but they may overeat all the time rather than binge.”⁸¹

Bulimia may almost seem like the opposite of anorexia, but the desired result—a lower body weight and a more desired body image—is the same. While bulimics also binge, they compensate by vomiting or taking laxatives to expunge calories from their bodies. Like anorexia, bulimia frequently begins during the teenage years and is highlighted by a hyper-concern over body shape and size.

Binge eating disorder (BED) is when people eat massive portions of food but do not purge as bulimics do.

The disorder often begins with experimental, self-induced vomiting to get rid of unwanted calories,” writes Yancey, “then quickly becomes a terrible compulsion.”⁸² Statistics point to the fact that bulimia is much more common than anorexia, affecting as many as 4 percent or 5 percent of the adolescent/young adult female population.

Broadly speaking, exercise covers a wide range of activities designed to improve health and fitness through physical activity. Because exercise and sports help burn fat calories, many people also exercise to lose weight or maintain a healthy weight. Likewise, exercise helps tone and shape the body, leading men and women to exercise for an enhanced body image. Because bodies process calories more slowly as people grow older, exercise also balances the gradual weight gain that sometimes occurs as they reach middle age.

While the benefits of exercise are generally thought of as positive and healthy, it can become an obsession. Exercise obsession equals overexercising and is often pursued to achieve a desired body shape and to enhance a body part (muscular arms, a flat stomach, and so forth). Men and women who jog excessively, for instance, may damage knees or other body parts. “Too much exercise and the body breaks down physically,” writes author Michelle Biton. “Bones suffer, as do tendons, ligaments, even muscles.”⁸³ Exercise obsession is also common in people who Page 75  |  Top of Articlehave eating disorders: Exercise is used to burn off unwanted calories. “Breaking an exercise addiction can be as difficult as overcoming an eating disorder,”⁸⁴ note Cassell and Gleaves.

Bodybuilding is a type of exercise that involves lifting weights at home, school, or at a health club. As with general exercise, bodybuilding is used to enhance body shape and self-esteem. Bodybuilding has generally been seen as a male-oriented sport, promoting more muscular body types. “Bodybuilding is becoming more and more popular worldwide as a way for men to attain the culturally valued slender, muscular body,”⁸⁵ writes Grogan. Over time, however, bodybuilding has also become more popular with women, though women bodybuilders may face social obstacles by attempting to achieve a body style that is less socially acceptable. “Bodybuilding is not generally seen as appropriate for women, and women who engage in this sport may face discrimination,”⁸⁶ writes Grogan. As with men, women have their own bodybuilding competitions.

Bodybuilding, like exercise in general, has a number of health benefits if practiced responsibly. When taken to extremes, however, bodybuilding may result in a number of unhealthy side effects. One particular danger has been the use of anabolic steroids to help build greater muscle mass. The use of steroids can have serious side effects, including liver damage, hypertension (high blood pressure), and kidney damage; and the hypodermic needles that are frequently used by athletes to inject steroids may possibly spread infectious diseases such as AIDS. Many of the side effects of steroids affect men and women differently. In women, steroids may cause baldness, breast reduction, the growth of body hair, and the deepening of voice; in men, steroids may cause infertility and the growth of breasts. For adolescents, the use of steroids may stunt the development of bone structure, especially if taken before a growth spurt.

While excessive dieting and exercise may represent a desire to alter one’s overall body image, body dysmorphic disorder focuses on an obsession with an imagined or mentally magnified body

Bodybuilding has a number of health benefits but can have dangerous side effects if practiced irresponsibly.

defect. The Mayo Clinic notes that body dysmorphic disease has also been called “imagined ugliness.” It is common for those with BDD to focus on one or more body parts as unsatisfactory, typically the face, body hair, skin blemishes, thighs, breasts, and buttocks. A person suffering from BDD may be distressed and normal functioning may be impaired. BDD is estimated to occur in 1 percent to 2 percent of the world’s population and is equally common in women and men. The Mayo Clinic lists a number of symptoms:

Like eating disorders, BDD is most often developed in adolescence or young adulthood and may be accompanied by depression and social phobia and in some cases may include the symptoms of suicidal tendencies. It is commonly believed that people suffering from BDD are self-centered or vain, though the opposite is often true: People with BDD obsess about their appearance because they believe they are ugly.

The Adonis Complex, also referred to as reverse anorexia and muscle dysmorphia, is a specific type of body dysmorphic disorder. “Nowadays, it seems, increasing numbers of boys and men . . . have become fixated on achieving a perfect, Adonis-like body,”⁸⁸ notes researchers Harrison G. Pope Jr., Katherine A. Phillips, and Roberto Olivardia. With the Adonis Complex, boys and men (primarily) become obsessed with whether they are muscular enough, and this may lead to excessive exercise and other obsessive behavior. “Research from the USA shows that Page 78  |  Top of Articlemany body-builders think they are puny,” notes writer David Batty. “At its most extreme, this is known as muscle dysmorphia or ‘bigorexia’ (reverse anorexia).”⁸⁹

Many with the Adonis complex rely on diet supplements along with anabolic steroids to improve muscle mass. “For many of the muscle-bound men and women identified as having the disorder,” notes Doctor’s Guide, “preoccupation with their bodies was so intense they routinely gave up desirable jobs, careers and social engagements to spend hours in a gym each day.”⁹⁰