Perceptions of Overweight: Parallels Between Obesity and Eating Disorders

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Antwan Jones
Antwan Jones Antwan Jones is Assistant Professor of Sociology and of Africana Studies at The George Washington University. Receiving degrees from Duke University and Bowling Green State University, he has published research on various health outcomes. However, he focuses his research on the residential and neighborhood context in which individuals live as a way to understand health disparities among marginalized populations. Engaged in national and international research, Jones has firmly located himself in the field of urban sociology by revealing how residential processes (such as housing instability) and neighborhood contexts (such as food deserts and concentrated poverty) are essential to the study of adult cardiovascular disease, child obesity and disability among the elderly. Jones is currently a board member of the Capital City Area Health Education Center as well as the Society for the Study of Social Problems, and he has been named lead faculty in obesity research on Webmed Central.

At a family reunion that I recently attended, I was approached by one of my distant cousins with a revelation that immediately stopped me in my tracks: “I need to lose weight.” What was troubling about the statement is that these words were spoken by a self-doubting, weight-appropriate, eight-year-old child. While the health consequences of being obese – heart diseasestrokediabetes – are dire, a recent journal article in Pediatrics suggests that overweight children who have lost a considerable amount of weight are at an increased risk of developing eating disorders such as anorexia and bulimia later in life.

In addition, some research has suggested that these eating disorders are also used as a mechanism for weight loss among individuals who are obese. It is this direct tie between obesity and eating disorders that gives me greatest concern, particularly among children. The fact that my young relative had a distorted view of her weight places her in an enhanced risk of adopting behaviors consistent with eating disorders. 

To combat this situation so that it does not become a more pervasive problem in the future, I believe that two things must occur. First, we as informed citizens, researchers and concerned family members need to be more aware of the messaging of the problem of obesity. Obesity is often seen as a body imperfection and is messaged as something that needs to change because it is not socially ideal. This idea varies across racial/ethnic groups, gender, age, sexual orientation and other demographics. It is mentioned only afterwards that excess weight is also a health risk. I believe that when talking to children and adults about weight problems, the only thing that should be mentioned should be these potentially bad health outcomes. In addition, these assessments of how much weight is “extra” weight should be done in conversation with a primary health provider or a family physician. 

Second psychological and nutritional interventions should be at the forefront of any person who is overweight or at-risk of becoming overweight.  These interventions are also related to eating disorders as well and thus could help in combating them. For some, obesity becomes a psychological barrier – research suggests that the stigma associated with obesity, as well as discriminatory behavior from others against those who are obese, is related to low self-esteem and low feelings of self-worth. As a consequence, individuals may be less likely to have and maintain a positive sense of self, and may be less likely to engage with or have close, personal friends. A psychological intervention could help in elevating self-esteem. If combined with psychiatric evaluations to assess the potential emergence of eating disorders, this intervention could also lead to a reduction in the adoption of behaviors (such as starvation) that are associated with these disorders. Nutritional interventions are also instrumental in establishing healthy eating, both for individuals who are obese and individuals who have an eating disorder. 

Thus, as we enter into the world of post-ACA (Affordable Care Act), it is imperative that mental and nutritional services remain a key part in expanding health care for all individuals. ACA already creates provisions for mental health services – it requires that depression screening and other preventive services be included in all health plans with no additional cost. In addition, behavioral assessments for children, such as screening tools for eating disorders, are also requires at no additional cost. However, in order to ensure that there is no obesity-to-anorexia pipeline, these screening tools should also be supplemented by conversations about healthy weight for all children and adults, individualized referrals of children to nutritionists, and regular visits to a mental health provider, in addition to a physician. This way, children in this country, including my eight-year-old cousin, will grow up with real and healthy perceptions of their body and diet, and if necessary, be able to locate and utilize nutritional and psychological resources in the case that excess weight ever becomes a problem later on in life.

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