A Tale of Two Epidemics

Monday, January 08, 2007

The irony of two recent New York Times stories, running two days apart, was not lost on me. Today I learned that chunky, and even not so chunky, children are being tormented by weight report cards from their schools. Only Saturday I read that the fashion industry is struggling over the concept of weight requirements for their increasingly cadaverous models. Two sides of the same coin really; these twin epidemics of obesity and anorexia. And lost in the divide between them, any real concept of health.

You can never be too rich...
We have for too long equated "thin" with "healthy." I know far too many ideally thin girls who start their day with coffee and a cigarette, to buy into that notion. I've also known many heavy women who are far more healthy and energetic than their skinny counterparts. Such simplistic shorthand is based far more in lookism than in any real indicators of health and wellness. It does not address the prevalence of say, fitness freaks I've known who stopped menstruating in their twenties because of their lack of body fat. Some of them looked great, though.

This is certainly not to say that obesity is healthy; only that the issue is far more complex and subjective than can be addressed in standardized "report card." Such an approach can only exacerbate the self esteem issues that most girls and an increasing number of boys experience over body image. Just ask the mother of six-year-old Karlind Dunbar, profiled in the New York Times story.

The problem was the letter Karlind discovered, tucked inside her report card, saying that she had a body mass index in the 80th percentile. The first grader did not know what “index” or “percentile” meant, or that children scoring in the 5th through 85th percentiles are considered normal, while those scoring higher are at risk of being or already overweight.

Yet she became convinced that her teachers were chastising her for overeating.

Since the letter arrived, “my 2-year-old eats more than she does,” said Georgeanna Dunbar, Karlind’s mother, who complained to the school and is trying to help her confused child. “She’s afraid she’s going to get in trouble,” Ms. Dunbar said.

Mrs. Dunbar should be concerned as more and more girls succumb to a life-threatening body dysmorphia. The obsession with "thin" has spawned a generation of acolytes of "Ana."

They call her “Ana.” She is a role model to some, a goddess to others — the subject of drawings, prayers and even a creed.

She tells them what to eat and mocks them when they don’t lose weight. And yet, while she is a very real presence in the lives of many of her followers, she exists only in their minds.

Ana is short for anorexia, and — to the alarm of experts — many who suffer from the potentially fatal eating disorder are part of an underground movement that promotes self-starvation and, in some cases, has an almost cult-like appeal.

Followers include young women and teens who wear red Ana bracelets and offer one another encouraging words of “thinspiration” on Web pages and blogs.

Or too thin.
Then, as if conjured by the hallucinations of a thousand starving girls, a real-life Ana died of complications of anorexia. Brazilian model Ana Carolina Reston, died of self-imposed starvation, sending a chill through a fashion industry already under scrutiny for parading skeletons down runways from New York to Milan.

The response from the fashion industry has been unsurprisingly superficial.

According to participants at the meeting, the recommendations are likely to include scheduling fashion-show fittings with younger models during daylight hours, rather than late at night, to help them get more sleep; urging designers to identify models with eating disorders; and introducing more nutritious backstage catering, where a diet of Champagne and cigarettes is the norm.

There are no plans to require models to achieve an objective measure of health like a height-to-weight ratio, which was imposed by Madrid in September, a move that brought much public attention to the issue.

I can't help but wonder if models were packing on the pounds like those at-risk school children around the country, if the response would be as blase. Methinks that in a an industry by whose contemporary standards modeling greats of time of yore -- such as Cindy Crawford -- would be considered real chunkos, the response would be far more draconian than the report cards embraced by public schools.

But here is the real tragedy. At both extremes of this weight dichotomy is the same problem: malnutrition.

Here, in the rural Southern Tioga School District, the schools distribute the state-mandated reports even as they continue to serve funnel cakes and pizza for breakfast. Some students have physical education for only half the school year, even though 34 percent of kindergartners were overweight or at risk for it, according to 2003-4 reports.

Even health authorities who support distributing students’ scores worry about these inconsistent messages, saying they could result in eating disorders and social stigma, misinterpretation of numbers that experts say are confusing, and a sense of helplessness about high scores.

“It would be the height of irony if we successfully identified overweight kids through B.M.I. screening and notification while continuing to feed them atrocious quality meals and snacks, with limited if any opportunities for phys ed in school,” said Dr. David Ludwig, director of the Optimal Weight for Life program at Children’s Hospital Boston.

So let me see if I understand the formula. Evaluate kids and be sure to tell them when they fail to meet the bar, then provide no real means for support or improvement. That sounds about right for the public school system.

None of this even addresses the problems of depleted soil and pesticide laden food that is poisoning overfed Americans and tearing apart our immune systems. We are a nation literally growing fat on deprivation; starving to death in the land of plenty.