By Eloïse Jones
The day I went to the hospital, it was winter. Pathetic fallacy at its finest. I sat on a hospital bed feeling cold and numb. Earlier that day, I had been diagnosed with Anorexia Nervosa, which I had been suffering with alone for a year. But in a matter of a few hours, my world had changed very suddenly: I was an in-patient at my local hospital under 24-hour watch. It wasn’t long before I realised that this would be the beginning of a very long, very intrusive and at the same time very lonely journey.
What I couldn’t realise that day –because I hadn’t the capacity – was how lucky I was to simply still be alive. Anorexia Nervosa has the “highest mortality rate of any psychiatric disorder”: I see now that I was only a few breaths and a couple more missed meals away from vanishing completely.
But even if you are ‘lucky’ enough to not be killed by your anorexia, it will break you down into a very lonely half existence incomprehensible to those who do not know what it is like to grieve yourself.
I write to you about that cold day in hospital because for those who have not experienced an eating disorder (I am not referring solely to Anorexia here), you may catch a glimpse of the pain inflicted on those suffering. I write to you about that cold day in hospital so that when I argue that the upcoming reintroduction of primary school weigh-ins will lead to a rise in eating disorders, you will understand the severity of my statement.
This September, the UK government plan to reintroduce regular weigh-ins for primary school students. This is part of a wider ‘Better Health’ government strategy to assess the level of child obesity within the country and as a move toward an apparently healthier nation. However, these regular weigh-ins will teach children an overly narrow, weight-focussed view of health. The programme will involve teachers calculating the body mass index (BMI) of their students by regularly measuring their weight and height. This data will then be collected and analysed by the National Child Measurement Programme (NCMP), whose focus is on assessing the “excess weight” of children. The issue with a “nationally mandated health programme” that focuses specifically on excess weight is that it shows that our government’s idea of health is one that is intent on keeping children under a certain weight.
The BMI grew into more mainstream use in the UK over the 1970s to 1990s and has been instrumental in recognising the obesity epidemic we have become more aware of in recent years. However, despite its uses in highlighting the obesity epidemic we face, it is not a useful nor a necessarily accurate tool to measure excess weight more generally. The downfall of BMI is that it cannot “differentiate between excess fat, muscle, or bone mass”, nor can it analyse how fat is distributed around the body. This makes it a dangerous tool to be used as a national measurement for health, especially when used with children, whose bodies are developing at different rates. And though as Fletcher argues, BMI has been useful in our understanding of the obesity epidemic, this could also be in part due to a more general hyper-focus on obesity research, and a lack of focus on other factors of ill health, such as malnourishment.
It appears ironic that there is such insufficient attention given to malnutrition of children since, as Cole states, child malnourishment “poses a considerably larger public health problem internationally”. I am not arguing that the only problem with the government weigh-in scheme is its focus on excess weight; I argue that the programme should not be focussing on weight at all. It is too narrow a measurement for such a broad concept such as health and teaches children to obsess over weight in the name of ‘health’.
Teaching children that excess weight is unhealthy, whilst not giving sufficient attention to the effects of malnutrition is a dangerous lesson to teach, and one that will not create a healthier nation.
When the government’s “nationally mandated health programme” educates children that this is what health is, what we are doing is cementing our social idealisation of thinness into their minds, whilst simultaneously telling them that this is healthy – this is normal. Diet culture and the thin ideal seek to punish those who do not fit into the category of ‘thin enough’, whilst placing on a pedestal those who do. This will not lead to a healthier nation, but a rise in the development of eating disorders and disordered eating.
Though there are many factors that contribute to the development of eating disorders, such as biology, personality and family history, research shows that “sociocultural factors are central to this development”. The focus on weight in the UK government’s new health programme will reinforce the thin ideal, and, as Suisman writes, “[i]t is through the development of [this] thin-ideal internalization and social comparison that body dissatisfaction, disordered eating, and eating disorders are thought to emerge”. As with all lessons we learn at school, we bring them with us into adulthood, so internalising and normalising the thin ideal is the government paving a future in which children are weight-obsessed. It will lead to the normalisation of diet culture and of the consequential eating disorders, which “in the developed world […] is [already] the third most common chronic condition of adolescence”.
It is easy when writing this to focus on Anorexia Nervosa, as it is arguably the most recognised eating disorder, however, to synonymise ‘eating disorder’ with Anorexia is to take away the experiences and pain that people with other eating disorders face. And it would be inaccurate to say that the thin ideal internalisation would only lead to Anorexia because it could lead to any. Even – perhaps counter-intuitively – Binge Eating Disorder, which typically characterises itself with excessive obsessive eating and often leads to physical symptoms such as weight gain. The idealisation of thinness is already leading to an increase in eating disorders, hence the huge growth in cases in the past few decades when diet culture has become the accepted norm.
If we are to reinforce this ideal in the name of health, we will not see a healthier nation, but one that in the next few years will be plagued with eating disorders.
With a health programme that focuses on weight and teaches children that excess weight is an indicator of ill health, we will teach children an inaccurate measurement of health and we will see a future with more and more cases of eating disorders. Unfortunately, it is not just at school that children (and the nation at large) will be barraged with messages perpetuating diet culture in the name of health. One of the aims of the UK government’s Better Health campaign is that restaurants, cafés and takeaways will be required to publish calorie content on their menus. Surrounded by messages of health that only perpetuate the thin ideal, children will normalise diet culture and normalise eating disorders.
When I sat on that hospital bed all those years ago, I found myself there because nobody considered my severe malnourishment dangerous – had I been severely overweight I would immediately have been labelled unhealthy.
The reintroduction of primary school weigh-in this September will see more and more children sitting on hospital beds feeling cold and feeling numb. Scarier still is the children who will not even get that far. But who cares? It’s all in the name of “improving the nation’s health”, after all.