January 17, 2012 by Deanna James, LPC, CEDS in Castlewood In the News A recent magazine article featuring plus sized models has stirred quite the controversy in the fashion world. The article claims that most runway models meet the BMI criteria for Anorexia. This article also features provocative images of plus sized models and challenges the fashion industries preference for stick thin models. Obviously we could not agree more that it would serve all of us if fashion magazines and society in general accepted diverse body types, and welcomed this diversity into the media and culture. The magazine spread itself is interesting, but not what is most interesting to us. What is most interesting to us are the comments and discussion that has resulted. It brings to light a common debate in our field- health versus weight.
For many who treat Eating Disorders and for insurance companies- the measure of health is weight. At Castlewood, we find this limiting and for some shaming. Now, let me be clear, weight is a measure of health, it is just not the only measure. Those who struggle with anorexia need to get to a healthy BMI in order to restore cognitive function, proper body function, normalize lab work, and in order to start to listen to hunger/fullness cues. And for many who struggle with binge eating disorder, weight loss is a part of the process of stopping binge behaviors, reducing cholesterol levels, risk of diabetes, etc. The problem emerges when we as a field say that once someone with Anorexia is weight restored they are healthy, or once someone with BED loses the weight they are healthy, or that someone with Bulimia is healthy because they may have a normal body weight. Another problem with weight as the measure of health is if we have a prescribed idea that everyone on the planet should be at 100% ideal body weight. We must take into account that some people will naturally fall outside of these parameters on either side. Their must be adjustments made for body type, family history, and other factors when determining someones goal weight.
The measure of health must be more complex. We have to take into account weight, cognitive function, lab and other medical data and whether the person can maintain this weight while following a normal healthy balanced diet. This debate in the fashion world brings to light the debate that I often hear about weight stigma and the childhood obesity campaigns. There has to be a way to encourage healthy eating, healthy activity without stigmatizing those whose weight is naturally higher. There has to be a way for us as a country to teach our youth to be healthy without encouraging Eating Disorder behaviors. If you are medically healthy, if you eat normal amounts of food without ED behaviors, have an active lifestyle, and if most importantly you are happy, then isn't that the measure of health? Isn't that what we should all be moving towards?