Recently in Media Category

I was on Womans Hour on Radio 4 today. The programme was dedicated to the discussion of eating disorders and obesity today. Other contributors included Julia Buckroyd, Susan Ringwood from bEAT (formally the Eating Disorders Association) plus writers Candida Crewe and Susannah Jowitt.
It was a very enjoyable experience being on the programme and discussing my views with like-minded people. I have always wondered whether the discussion goes on after the programme goes off air and I can confirm that this does happen! I only wish that the health minister Caroline Flint had actually been in the studio with us rather than just on the phone as it would have spiced up the debate even more. I felt that she wasn't particularly engaged with the issues, and ducked the problem of the parlous state of the NHS in relation to access to psychological therapies. The suggestion that the upcoming review of the 2004 NICE guidelines for eating disorders would enable an assesment of how well they were being met was also quite at odds with what anyone with an eating disorder could tell you. The Layard report (commisioned by this same government) makes the point that we need to train 10,000 more therapists to even begin to cover the need for talking therapies in the NHS. Waiting lists are currently 6 months - 2 years; in the meantime people with eating disorders (as well as other conditions) are deteriorating and are often unable to work or contribute to society.

As always with such things, I was left wishing I'd had more time, or else been more succinct so that I could have fitted more points into the time I had on air. For example, I would have liked to spend more time describing new treatment approaches which myself and other colleagues are developing for anorexia nervosa, as well as mentioning the ambivalence about treatment which is a major aspect of the disorder.

Hopefully there will be another opportunity.

Womans Hour this wednesday will have a discussion on obesity and size zero. Could be interesting....

The Academy of Eating Disorders (AED), an international organisation for eating disorders professionals, have just released guidelines for the fashion industry regarding health and wellbeing amongst fashion models.

They seem sensible and well thought out guidelines and hopefully will have a positive influence. I just wonder whether they will be applied sensitively by the industry in such a way that models who are suffering from eating problems are encouraged to come forward for treatment. I think, sadly, that it is more likely that they will be in fear of losing their livelihood and will become even more secretive than before. I am also aware that the guidelines will not help those with bulimia nervosa, who may not be underweight, to gain access to supportive treatment. But a good start has been made and hopefully this will encourage further debate.

AED Guidelines for the Fashion Industry (available to download from the AED website.

* Adoption of an age threshold requiring that models be at least 16 years of age so as to reduce the pressure that adolescent girls feel to conform to the ultra-thin standard of female beauty.

* For women and men over the age of 18, adoption of a minimum body mass index threshold of 18.5 kg/m2, (e.g., a female model who is 5' 9" [1.75m] must weigh more than 126 pounds [56.6 kg]) which recognizes that weight below this is considered underweight by the World Health Organization.

* For female and male models between the ages of 16 and 18, adoption of a minimum body mass index for age and sex equivalent to the 10th BMI percentile for age and sex (weight below this is considered underweight by the Centers for Disease Control). For example, applying this criterion to a 16 year old female model, the minimum required body mass index would be 17.4 kg/m2, for a male model 17.7 kg/m2. A 16 year old female model who is 5' 9" [1.75 m] must weigh more than 118 pounds [53.3 kg].

* Adoption of an independent medical certification affirming that students who are aspiring models do not suffer from an eating disorder and/or related medical complications (see below).

* Development of action steps to identify models in need of intervention and appropriate and sensitive procedures for detection and referral.

* Discouragement of all non-healthy weight control behaviors throughout the industry (e.g., self-induced vomiting, use of laxatives, diuretics and diet pills). Increased educational initiatives aimed at student models and professional models, their agents and employers to reduce the multiple health risks of various unhealthy weight control behaviors.

* Provision of educational initiatives aimed at aspiring and working student models, professional models, their agents and employers to raise awareness of the multiple health risks of low weight and restricted nutritional intake. These health risks include irregularity or cessation of menses, bradycardia (low heart rate)/irregular heart beat, electrolyte imbalances, dizziness/fainting spells, sudden cardiac death and long term health complications including osteoporosis, depression, and reproductive complications.

* Increased communication with advertising agencies to encourage the use of age-appropriate, realistic models in ad campaigns and reduction of unrealistic computer enhancement in pre-teen and adolescent advertising campaigns.

* An overall ban of the use of photographic manipulation techniques that artificially slim images of fashion models throughout the entire fashion industry.

* Inclusion of models of varying weights and body types on both the catwalk and in fashion magazines so that these images - and the message that women and men of differing body types can look good in a variety of fashions become part of our collective view of what constitutes beauty.

* Promotion of awareness in students, models, and the general public about advertising industry tactics, such as computer enhancement, used to falsify the appearance and actual size of models used in advertising.

* Collaboration with politicians, stakeholders, and eating disorder organizations to develop ethical self-regulatory codes for the fashion industry.

* Collaboration with politicians, stakeholders, and eating disorder organizations in widening the availability and affordability of effective eating disorders treatment, which must be made readily available to people in the fashion industry.

The winner of the annual Grierson Award, given to the best feature-length documentary at the London Film Festival, has just been announced. Lauren Greenfield's Thin, about a Florida eating disorder treatment centre, has been given this honour. The Grierson Award will be presented at Thursday's screening of the film, for which you can still buy tickets.

There has been considerable controversy recently following the decision by the Madrid Fashion Week to ban models below a certain size (BMI) from their catwalks. (This was followed more recently by a similar decision by the Clothes Show in Birmingham)

As far as I understand the beliefs behind this are twofold
(1) Such models have anorexia nervosa (may have anorexia nervosa?) and thus should not be working
(2) Such models, even if they don't have an eating disorder, set a bad example to impressionable young women who might go on to develop eating disorders

Now don't get me wrong. I think that the decision, in that it raises the profile of eating disorders and encourages debate, was probably a good one (although a naive one, as I'll go on to explain). But I would question both of the aims above. Firstly, it is not clear that all 'underweight' women have anorexia (or any other eating disorder). Some women are truly, naturally extremely thin. Weight, like other characteristic of humans, varies a great deal between individuals and it is as bad to automatically assume someone has an eating disorder because they are thin as it is to assume they do not have one because they are normal weight or overweight.
Of course, women can be underweight for other reasons, such as illness or drug misuse. Similarly, women who are not underweight may also have eating disorders (particularly bulimia nervosa, which is quite a bit more common than anorexia). Ignoring those women because their eating disorder is less easy to detect seems rather unbalanced.

I have spent many years attempting to 'diagnose' eating disorders, as part of my research and clinical practice, using various tools to help in this. Many, such as the Eating Disorders Examination, developed by Chris Fairburn and colleagues, are complex and time consuming to administer even after specialist training. The suggestion that one can 'diagnose' an eating problem simply by weighing someone is laughably naive.

The second supposed aim of the move, to reduce eating disorders in impressionable young women by stopping them from seeing emaciated models and trying to imitate them is also quite flawed. There is very limited evidence that exposure to to such models causes eating disorders (although it is possible that it may prove the 'last straw' in some particularly vulnerable women). What we do know is that exposure to such models reduces self esteem amongst young women, which may not lead to eating disorders, but is likely to just increase the amount of misery in the world. Most would agree that this is a bad thing, so from that point of view the move makes sense.

Finally, the idea that any model below the specified BMI will be 'given medical treatment' is another enormously naive idea. We know that people with eating disorders often have very mixed feelings about their condition and about recovery. The most conflicted amongst them are likely to be those who, despite the negatives of their condition (weakness, sensitivity to cold, osteoporosis, heart problems etc etc) are promised the highly valued rewards of money and celebrity status through their work as models. Are these women likely to accept the medical treatment offered, especially when it may compromise their career.

I'd like to see a whole range of body shapes and size represented in catwalk and magazine models, as well as different ethnicities and ages. Campaigns like Dove's Campaign for Real Beauty are very much along the right lines.

An interesting article in the BMJ discusses a proposed change to childhood obesity guidelines in the USA. Currently, children above the 95th percentile for body mass index (those who are heavier than 95% of children of their weight and height) are classified as 'overweight' and
children above the 85th percentile for BMI norms are classified as 'at risk
for overweight.' The proposed change would include all those above the 85th
percentile in the 'overweight' category. This would mean that around 25-40% of
children in the U.S. would be classified as overweight.

As mentioned in a discussion article on the Food Consumer website, one side effect of the changes would be that many more children would be 'diagnosed' as obese and therefore potentially eligible to be prescribed weight loss drugs. This has led to suggestions of pharmaceutical company pressure, especially as the International Obesity Task Force, one of the major organisations behind the proposal receives much of its funding from drug companies.

Thanks to Francie Berg via the AED mailing list for drawing my attention to this proposal.

Travis Matthews is a trainee psychotherapist and film-maker based in San Francisco. He has recently finished a film, entitled 'Do I look Fat' dealing with issues of weight and eating amongst gay men.

Travis says:
'Do I Look Fat? is a feature-length documentary with fat on the brain -fat that we feel, fat that we think and all sorts of fat problems that manifest from fat-phobic thinking inside the fat-wary gay community. As one person puts it, "fat is the little word with big meaning." '

Through interviews with a number of gay men as well as several professionals, Travis tries to unpick some of the issues which might lead to eating problems in this group.

I haven't yet managed to see the film, but it sounds like a great project. You can find out more about the film and the filmmaker at the film website.

I've been reviewing the literature about men, eating disorders and body image for a presentation at work. I'll hopefully get a summary of the literature with some references up on the site in the next few weeks, time allowing.

But in the meantime, I came across an interesting article in In Touch, the magazine of the Australian Psychological Society about body image issues in men (thanks Graham!). Well worth a read for a quick overview of the area.

Woman's Hour on BBC Radio 4 had a special programme on body shape last Monday (31st Jan 05). It was followed by a phone in on Tuesday, where women gave their views about their bodies and pressure to conform to a thin ideal.

You can listen again to the programmes until 1 week later via the Woman's Hour homepage