DON'T put your daughter on a diet
Not even if she’s overweight. And not even a 'moderate' diet. Unless you want to increase her risk of developing an eating disorder.
According to a study published recently (20 March) in the British Medical Journal, adolescent girls who diet even 'moderately' are five times more likely to become anorexic or bulimic than those who do not diet. Those on strict ('severe') diets are eighteen times more likely to develop an eating disorder.
While it is always unwise to over-react to the results of a single study (see Health Stories: Reading Between the Lines), and other psychological and social factors are clearly involved in the development of eating disorders, these findings are nonetheless worrying, and it is therefore surprising that only two major media sources reported this story (the Health section of the BBC News website and The Guardian). Even those who did give it a brief mention emphasised the value of exercise as much as the dangers of dieting.
This uncharacteristic squeamishness (imagine the banner headlines if, say, GM foods had been similarly 'linked' to anorexia) could be due to the fact that the BMJ study is 'off-message' in terms of the current health orthodoxy, in which obesity and overweight are regarded as the main public health problems, and low-fat, 'healthy' diets as the miracle cure. Monitoring the media, one cannot help noticing that current 'health promotion' messages disseminated by government agencies and health charities are often virtually indistinguishable from the propaganda of the multi-million pound slimming/diet industry. Both make the basic (mistaken) assumption that slim=healthy (for an excellent review of the evidence that plump females are healthier, see Dr Tom Sanders' You Don't Have To Diet), and both often adopt the same scare-tactics and moralistic tones.
Rather than expressing concern about the ways in which the slimming industry exploits and preys on the anxieties of vulnerable adolescent girls, persuading them that the perfectly natural and healthy weight and fat gains of puberty are a 'problem', the health establishment, by focusing campaigns exclusively on the dangers of overweight and dietary fat, is tacitly condoning this message.
Pick up any slimming or diet magazine (almost all of which are produced by slimming-club chains), and you will find the word 'health' or 'healthy' on every other page. Those advertising diet products and slimming aids are also jumping on the health bandwagon. While the health educators continue to tout the simplistic message that any degree of overweight is unhealthy, and imply that losing weight is automatically a healthy thing to do, they can hardly object to the cynical slimming industry joining them on the moral high-ground.
Health professionals should take note, however, of the growing body of research evidence showing that the majority of normal-weight and even underweight adolescent girls already believe that they are too fat, and that increasing numbers are dieting (see Mirror, Mirror), to the detriment of both their physical and mental health.
We are of course by no means the first scientists to express concern about over-zealous promotion of weight loss by the health establishment. In January 1998, to take just one prominent example, the editors of the New England Journal of Medicine asked: "Given the ambiguous benefits of weight loss, why are physicians and public health officials joining in the general enthusiasm for losing weight?" They suggested that "the medical campaign against obesity may have to do with a tendency to medicalize behavior we do not approve of" and accused health professionals of "overstating the dangers of obesity and the redemptive powers of weight loss."
The NEJM urged health professionals to speak out against the public's excessive infatuation with being thin and help the public regain a sense of proportion. This advice, it seems, has been ignored.
(Note: The Social Issues Research Centre is conducting a review of the research literature on dieting and eating disorders. This study is currently in the early stages, but an overview will be published on this website when the research is completed.)