- The Washington Times - Monday, August 25, 2003

Few high school graduates will start college this fall without hearing about the dreaded “Freshman 15” — extra pounds that creep on from dining-hall food, late-night snacking and beer. And a new study by Cornell University shows the Freshman 15 isn’t a myth. Researchers discovered that students gained an average of 4.2 pounds during the first 12 weeks of school alone.

Students concerned about gaining weight, however, are unlikely to hear much advice from their colleges on losing it.

Wellesley College’s Web site on eating concerns, for instance, warns students that “The billion-dollar diet industry tells us constantly in many ways that we need to lose weight,” but that “in fact, we are OK the way we are.”

Smith College’s health service touts workshops on how to “appreciate our bodies” and “why diets don’t work.”

Across the country, colleges and advisers who work with freshman downplay the risks of weight gain because they don’t want to push freshmen toward a different eating problem: anorexia.

Anorexia nervosa is characterized by intentional, extreme weight loss. It is a serious though relatively rare mental disorder estimated to affect less than 1 percent of young women. College students prone to perfectionism are most at risk.

But given America’s increasing obesity rate, some observers are starting to question whether anorexia deserves the publicity it garners.

“It’s a legitimate medical issue,” says Greg Critser, author of “Fat Land: How Americans Became the Fattest People in the World.” “The question is whether our attention to it far exceeds the attention it deserves.”

Only a handful of women, he says, suffer from anorexia, while more than 60 percent of Americans are overweight or obese.

“If you look at lifelong morbidity, the Freshman 15 — or 20 sometimes these days — will have a more profound impact on a person’s lifelong health than their chances of developing an eating disorder,” Mr. Critser says.

Yet widespread concern about anorexia means few freshmen receive information on the health risks of becoming overweight.

Doctors aren’t sure what causes anorexia, though depression and previous abuse can play a role. Activists often cite cultural factors in the disease, such as body expectations inspired by fashion models.

The National Organization for Women’s “Advertising and Health” fact sheet notes that “The body type portrayed in advertising as the ideal is possessed naturally by less than 5 percent of females.”

Some dispute whether cultural pressures are a cause.

“There’s no shortage of people who develop eating disorders who are not consumers of fashion magazines,” says Dr. David Herzog, professor of psychiatry and pediatrics at Harvard Medical School. “There’s also no shortage of individuals who are exposed to the same pressures and don’t develop eating disorders.”

Regardless, magazines aimed at college women have become more sensitive in recent years. YM magazine banished diet stories in 2002. Glamour magazine has made a concerted effort to photograph larger models.

Some organizations pressure advertisers and magazines to dump images that they say encourage anorexia. The National Eating Disorders Association wrote Kellogg’s in May to protest the Nutri-Grain ads that show women with pastries for hips. “The overall message … is that eating pastries will make you fat, and that being fat is something to feel guilty about,” NEDA’s Tracy Kahlo wrote.

The evidence on whether Americans feel too guilty about being fat, or not guilty enough, is mixed:

• In 1997, Psychology Today found that 24 percent of women and 17 percent of men would trade more than three years of their lives to reach their desired weight. But a 2003 Annals of Internal Medicine study found that people who were overweight at age 40 died about three years earlier than those of a healthy weight. Obese people died five to seven years earlier.

• NEDA reports that Americans spend $40 billion a year on diet products. Surgeon General Richard Carmona pegs the annual cost of obesity at $117 billion.

• At any point, NEDA says, 40 percent to 50 percent of women are trying to lose weight. Yet more than 60 percent of women need to lose weight because they are overweight or obese.

• Researchers estimate that anorexia causes 1,000 deaths a year. The surgeon general says excess weight causes nearly 1,000 deaths a day.

The surgeon general urges overweight and obese Americans to lose weight, but eating-disorder activists and their allies warn that the message can be muddled.

“While it is so important to fight the obesity epidemic, we should not inadvertently send the wrong message by telling our children and adults simply to eat less and exercise,” said Sen. Hillary Rodham Clinton, New York Democrat, in a speech on the Senate floor. “Unfortunately, many adolescents misinterpret this as a message that they should eat to achieve the body of a runway model.”

Many college health programs echo this theme. Students concerned about weight gain at Princeton University, for instance, are told by the health services Web site, “Don’t diet. Diets don’t work.”

The site links to the National Association to Advance Fat Acceptance, whose Web site says “Given that permanent weight loss is elusive for most people, the issue of fat and health is irrelevant.”

Sometimes colleges inadvertently cause weight gain with measures designed to help new students make friends. Bryan Walsh, a former resident adviser to freshmen and sophomores at Princeton says, “We were given money to feed these guys pizza at 1 a.m. We were the reason for the Freshman 15.”

Princeton’s advisers were trained in spotting eating disorders, he says, but not in nutrition.

Colleges worry about anorexia, but not obesity because the acute risk is not so great, says Dr. Herzog. “Someone who gains weight will have a shorter life span and a higher risk of death from heart disease or diabetes, but not tomorrow or two years from now.”

Others assign a more sinister motive. College officials fret about anorexia, says Mr. Critser, “because they’re rich.”

“Anorexia, like obesity, is a disease of class,” he says.

Dr. Herzog says that anorexia commands attention because “it takes our most gifted.” He defends the attention, though, saying, “Anorexia has one of the highest rates of death among psychiatric disorders.”

Colleges should realize that not everyone who diets is going to develop an eating disorder, says Ann Selkowitz Litt, author of “The College Student’s Guide to Eating Well.”

Still, she says, “there are a lot of vulnerable kids out there.” So she advises colleges to be sensitive but still explain that students can avoid the Freshman 15 by:

• Being aware of how many calories they’re drinking in alcohol, soft drinks and coffee drinks.

• Setting mealtime patterns and eating every 3 to 4 hours, including a healthy late-night snack.

• Making exercise a regular part of their schedules.

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