| |
| |
 |
|
| |
| |
Ira Sacker, M.D.
Director, Adolescent and Young Adult Medicine, and Founder, Helping to End Eating Disorders (HEED), Brookdale University Hospital and Medical Center, Brooklyn, N.Y.
|
|
| |
| |
YES
The number of reported cases of anorexia and bulimia is now eight million, up from three million in 1994. Actual cases are probably much higher, because private patients are not reported. The average age, recently 14 to 18, is down to 11 to 12, and we are seeing children as young as 5 or 6 become preoccupied with the fat content of their diet, and bingeing and purging. Males with eating disorders, recently one in 19, now number one in 10.
I have patients who weigh 60 to 70 pounds who tell me they want to lose weight to look like the media models. Some have told me the guidelines justify their emaciation.
In its focus on improving health through weight loss alone the report ignores many competent studies that demonstrate that lifestyle changes alone can deal with many of the health problems caused by obesity. For example, a study in the New England Journal last year reported that subjects’ blood pressure fell within two weeks following improvements in diet, with no weight loss.
Some people are naturally heavier than others, and will fall outside the guidelines even if they eat wisely and exercise. I think the guidelines are inaccurate for people with heavy bones who are naturally mesomorphic or endomorphic.
Health is a complex interplay of many factors. In their one-dimensionality, the new guidelines play into the media’s obsession with painfully thin models and the public’s desire for magic bullets. More people will strive for anorexic figures through quick-fix fad diets and OTC medications that just initially decrease appetite. Look for continued rising rates of eating disorders.
|
|
| |
|
| |
| |
 |
|
| |
| |
Stanley Feld, M.D., FACP, MACE
Past President, American Association of Clinical Endocrinologists, Dallas
|
|
| |
| |
NO
People have eating disorders because they have personality disorders, and not as a result of guidelines issued by government scientific agencies. The standard of the new guidelines is a body-mass index of 25, or 170 pounds for a person 5'10". For bona fide anorexia, BMI is close to 20, or less. One would have to have a strongly distorted body image to diet from a BMI of 25 down to 20.
We are bombarded by stimuli that encourage overeating. In a restaurant it is practically impossible to eat fewer than 1,000 calories. When traveling, it is almost impossible to burn more than you eat.
Still, there might be some increase in dangerous diets. The American psyche has been programmed for quick fixes. But the media, with their obsession with thinness, and the purveyors of quick-fix diets are the ones who would be causing dangerous dieting, not the government’s guidelines.
Furthermore, obesity represents by far the greater threat to public health. Only eight million Americans have eating disorders, while 100 million are overweight. Obesity leads to increasing diabetes, hypertension, and heart disease. The risk of these diseases in obese people is three to five times that in the general population.
The prevalence of diabetes, now 5%, is expected to double in 15 years. Diabetes consumes 15% of the health-care dollar, and 80% of those costs are secondary to complications resulting from high blood sugar. High blood sugars and complications could be avoided if people used dietary means and exercise to avoid diabetes.
In this era of promoting personal responsibility, the American Association of Clinical Endocrinologists recommends that physicians teach people how to eat appropriately and exercise responsibly.
|
|
| |
|
