Media Health Hazards? Beauty Image, Obesity, and Eating Disorders Can popular culture make people both obese and anorexic? This seems like a contradiction, but critics charge that both are effects of media culture. In particular, television, food advertisements, and video games are often blamed for contributing to child obesity (but rarely adult obesity). A Boston Globe article cites two prime causes, inactivity and overeating, and notes that “TV watching is linked to both of them.” “The simplest way to reduce obesity risk is to cut TV time,” an expert quoted in the article explains. Does television really make kids fat? The American Academy of Pediatrics thinks so and in 1999 suggested that doctors ask about children’s media use during checkups. One observer blames ads for junk food and watching television for creating “an obesity machine.”1 Yet at the same time, many people blame images on television for encouraging young girls to diet. “Look at Beyoncé and Hilary Duff and all the stars you see on TV and in magazines. They’re thin and they have flat stomachs and perfect everything,” a seventh-grade student told a Toronto newspaper, also noting that she had two classmates with anorexia.2 Fashion models and the magazines that feature them are also charged with contributing to body dissatisfaction. Additionally, online communities of people with anorexia and bulimia sometimes encourage and support each other in their quest to get even thinner. Although images in popular culture reinforce often impossible standards of beauty, the roots of these messages run deeper than popular culture. Likewise, spending more time in front of a screen and less in more rigorous activities can lead to weight gain. As we will see in this chapter, obesity has strong connections with race, ethnicity, and poverty; screen time is a part of the equation, but not the central underlying factor. In this chapter we will critically examine both the complaints and the research to better understand the relationship between eating, health, and popular culture. More centrally, we will consider why popular culture once again finds itself in the center of focus and what structural causes we overlook in the meantime. Poverty, the continued continued objectification of women, and lack of access to quality health care seem less important when the more exciting explanations of television, advertising, video games, and fashion command our attention and interest. Obesity By now you have likely heard about the trend in weight gain for children and adolescents. Between 1980 and 2000, the number of children classified as overweight doubled for those aged two through eleven and tripled for adolescents twelve to nineteen.3 To some the reason is clear and the solution simple: turn off the TV. Whether ads for sugary, fattening foods, or just the act of watching itself is blamed, many public health advocates, such as the Kaiser Family Foundation, believe that popular culture is the key to the problem. Here’s the crux of their argument: the long-term increase in weight gain comes from the intensified marketing of low-nutrient, high-calorie foods to children, which encourages snacking while watching television. “Our children are spending more time than ever in front of the television,” writes Steven Gortmaker of the Harvard School of Public Health. He adds that because today children’s programming is on around the clock, “devoted to entertaining them all day,” that “kids are being taught to lead unhealthy lives from a very young age.”4 This sounds very reasonable on first glance. After all, sitting and eating in front of the television for long periods of time is a good way to gain weight. Spending a lot of time watching television means you are likely not doing something physically active like exercising. Problem solved? Not so fast. Let’s consider some other factors in play here. First, those who blame television advertising presume that there are more ads today for kids than in the past. But a Federal Trade Commission (FTC) study from 2005 found that kids see fewer ads today than they did in the 1970s, when children weighed considerably less.5 I was a kid then and remember ads for cereals like Super Sugar Crisp and Sugar Smacks featuring fun cartoon characters that appeared regularly during Saturday-morning cartoons. Once upon a time, advertising that cereal had sugar was a plus not just for kids but for parents, too. After World War II, cereal makers developed the technology to make sure added sugar stayed on cereal so parents wouldn’t have to take the time to add sugar themselves. It stayed on the flakes better, and most of it didn’t sink to the bottom of the bowl. At a time when parents were less concerned about obesity, a sweetened cereal meant their child would likely finish their breakfast. Advertising sugary foods to children also doesn’t help us understand why adults are more likely to be overweight and obese than children or teens and why their rates rose even faster. Four times as many men over sixty were considered overweight in 2000 than in 1960, and three times as many women twenty to thirty-four have become overweight in this same time period. In a 2009–2010 study, nearly 36 percent of American adults were classified as obese (defined as having a body mass index [BMI] of thirty or higher). By contrast, 17 percent of twoto nineteen-year-olds were deemed obese (weight above the ninetyfifth percentile for their age), with older teens more likely to be obese than young children. Yet critics use only the television explanation for children and adolescents, implying that young children are the most vulnerable to advertising. These explanations ignore the more serious problem of adults who are overweight and obese, the population more vulnerable to serious and immediate health risks of cardiovascular disease, type 2 diabetes, and many forms of cancer. Certainly, public health officials are paying serious attention to overweight adults, but the television explanation is curiously applied only to children. While adults who sit and eat in front of the TV for long stretches aren’t doing themselves any favors, the existing research linking childhood obesity and television is actually much weaker than we are often told. As with other reports that locate popular culture as a source of significant problems, the New York Times and other major newspapers tell us that advertising is a major culprit. A 2005 Times article describes “compelling evidence linking food advertising on television and the increase in obesity” based on a study by a federally appointed advisory group. The author of the study describes their research as “the nail in the coffin” in spite of the fact that we cannot definitely make a cause-effect connection between advertising and children’s weight. Tom Harkin, the senator who requested the study, told the Times that advertising must be effective in getting kids to buy their products; otherwise, advertisers wouldn’t spend the billions that they do.7 This claim that advertising must work because industries do it is based on circular logic: in effect, it is saying that something must be because it is. Industries do spend a great deal of money on advertising, but this doesn’t mean it necessarily has the outcome advertisers intend. A 2007 New York Times article, “Study Says Junk Food Still Dominates Youth TV,” also focuses on food ads as a central contributor to child obesity, after a Kaiser Family Foundation study observed that 50 percent of the advertising during children’s programming are for food ads, mostly snacks and fast food. “TV Helped Create the Child Obesity Problem,” a Washington Post headline asserts.8 Stories like these make it seem as though television is a major cause of child obesity. A closer examination of the research reveals that the connection is not so simple. Researchers have been studying the possible link between television and obesity since at least 1985, when a large study found a correlation between television viewing and obesity.9 A correlation indicates an association, but not causation. Some studies found similar connections, yet others did not. A study published in 2004 found that television was not related to weight, but that video game playing had a complex relationship with children’s weight: those whose weights were higher played moderate levels of video games, whereas thinner kids played both low and high amounts. The authors found an equally complicated relationship with computer usage—those who were heavy used the computer very little or a lot, with lower weight associated with moderate levels of use.10 Both short-term and long-term studies have been mixed in their findings. This doesn’t mean that watching television for long periods of time with a lot of snacking and little exercise is a good idea, just that the causes of obesity are more complex than media use. Nonetheless, experimental interventions, where one group is encouraged to watch less or no television or video games, have found declines in weight in the group that is supposed to watch less television.11 But these studies ignore one major question: what factors lead to more television watching and other sedentary activities in the first place? Rather than just a bad choice, watching more television and staying indoors have causes themselves. For one, children in low-income urban areas often have few safe places to play outdoors. Parents’ work schedules often require these kids to have many hours with little supervision, and while watching television or playing video games inside may not be good for their waistlines, they keep them safe from potential harm on dangerous city streets. Steven Gortmaker, of Harvard’s School of Public Health, barely acknowledges the significance of these issues in his Boston Globe op-ed. “Parents of various socio-economic backgrounds and ethnicities are reluctant to acknowledge the problem because they often feel that their parenting skills are being called into question,” Gortmaker notes, suggesting that an attitude adjustment is all that these parents really need.12 This is about more than stubborn, prideful parents, but rather large-scale structural patterns. The Centers for Disease Control and Prevention’s data on Americans and weight have found that African American and Latino children and adolescents are more likely to be overweight than their white counterparts. In data collected from 2009 to 2010, six- to eleven-year-old African Americans were more than twice as likely to be in the ninety-seventh weight percentile as white children in this age group, while Latino children were more than 50 percent more likely to be in this percentile than white kids were. For twelve- to nineteen-year-olds, the difference is most pronounced media use. Nonetheless, experimental interventions, where one group is encouraged to watch less or no television or video games, have found declines in weight in the group that is supposed to watch less television.11 But these studies ignore one major question: what factors lead to more television watching and other sedentary activities in the first place? Rather than just a bad choice, watching more television and staying indoors have causes themselves. For one, children in low-income urban areas often have few safe places to play outdoors. Parents’ work schedules often require these kids to have many hours with little supervision, and while watching television or playing video games inside may not be good for their waistlines, they keep them safe from potential harm on dangerous city streets. Steven Gortmaker, of Harvard’s School of Public Health, barely acknowledges the significance of these issues in his Boston Globe op-ed. “Parents of various socio-economic backgrounds and ethnicities are reluctant to acknowledge the problem because they often feel that their parenting skills are being called into question,” Gortmaker notes, suggesting that an attitude adjustment is all that these parents really need.12 This is about more than stubborn, prideful parents, but rather large-scale structural patterns. The Centers for Disease Control and Prevention’s data on Americans and weight have found that African American and Latino children and adolescents are more likely to be overweight than their white counterparts. In data collected from 2009 to 2010, six- to eleven-year-old African Americans were more than twice as likely to be in the ninety-seventh weight percentile as white children in this age group, while Latino children were more than 50 percent more likely to be in this percentile than white kids were. For twelve- to nineteen-year-olds, the difference is most pronounced among girls, as African Americans are nearly twice as likely to be in the ninety-seventh percentile than white girls are, whereas the differences for boys are less dramatic, paralleling adult patterns, where significant ethnic disparities are found only in women.13 African Americans and Latinos are also significantly more likely to be poor than whites. According to 2010 US Census data, 27 percent of African Americans and Latinos live in poverty, compared with 10 percent of whites and 12 percent of Asian Americans.14 Poor people of color are more likely to live in areas of concentrated poverty in urban areas with fewer playgrounds and safe spaces.15 These neighborhoods also have fewer grocery chains and little affordable highquality fresh produce, but instead have an abundance of low-cost fast-food restaurants. When public health officials ignore the very real challenges parents in lower-income communities face, they fail to fully address the causes of obesity. Beyond socioeconomic status, obesity itself may be a causal factor for watching more television. Low self-esteem and social rejection, which many overweight children experience, may keep them inside and perpetuate the weight-gain cycle. And where are adults in this equation? Parents who lead sedentary lives are likely to be a major determinant here. As anyone who has tried to lose weight knows, changes that may seem simple to others might not be as easy for people for whom weight is a deep-seated issue. If it were as simple as watching less television, eating healthier, and exercising more, there would be no need for the weight-loss industry. From the unregulated products hawked on infomercials to mainstream pharmaceuticals and bariatric surgery, obesity is, excuse the pun, a growth industry. While turning off the TV seems like an easy solution, it fails to take into account the complex realities of today’s health care needs and the economic realities of many families dependent on cheap, high-fat food living in neighborhoods with few safe spaces for children to play. Whereas poverty ironically now is a predictor of obesity, when starvation happens in the United States and other industrialized nations, it is often the result of an eating disorder. Anorexia and Bulimia Just as critics blame television and other forms of popular culture for weight gain, they also blame celebrities, magazines, websites, the fashion industry, and even Facebook for contributing to eating disorders. How can watching images of mostly underweight people on television make viewers want to eat both more and less at the same time? We might carry this contradiction out by suggesting that some people respond differently to the same images, or that popular culture makes people both heavier and hate their bodies more, but no research supports this idea. Nonetheless, stories about “thinspiration” websites with pictures of participants and celebrities seemingly starving to death next to advice about how to continue eating disorders are unnerving. It is very compelling to think that seeing super-skinny models and other celebrities in magazines, movies, and fashion-show runways causes people—especially young girls—to develop eating disorders. If this is the case, it is the extreme minority of people who are impacted in this way. It’s hard to know for certain, but estimates of the number of Americans with anorexia or bulimia or both range from 7 to 9 million.16 Focusing only on females, the National Institute of Mental Health notes that 0.5 percent to 3.7 percent of females will develop anorexia, and 1.1 percent to 4.2 percent will suffer from bulimia at some point in their lives. Though rare, these are serious disorders that can lead to major health complications and death. Although the conventional wisdom has been that this is a female problem, a 2007 Harvard University study found that a quarter of their sample with eating disorders were male.17 Even if very few people develop eating disorders, the fashion industry seems to employ many of them. Researchers who interviewed young women found that many used modeling and other activities like gymnastics as a cover for anorexia, which suggests that rather than creating eating disorders, the fashion industry may draw some who are already anorexic and validate their behavior. In 2006 two young models in Brazil and Uruguay died, apparently due to the effects of starvation. This led to calls for change within the fashion industry. That same year, Spain declared that all runway models must have a body mass index of at least 18; for instance, a five-foot-ten model needs to weigh at least 126 pounds to meet this threshold.18 Rather than change models’ body size, critics argue, this is likely to simply decrease the amount of runway work in Spain. Italy’s Milanbased Chamber of Fashion proposed that models hold a license, obtainable after a panel of health experts evaluates their mental health status and verifies that they have a BMI of at least 18.5 to be certified healthy. The Australian Medical Association called for a similar restriction for models in Australia. Going a step further, Buenos Aires province in Argentina passed a “law of sizes,” which requires that clothing shops carry larger sizes or face a fine or even be forced to close. In 2008 France’s National Assembly passed a bill making it illegal to publicly “incite extreme thinness.” This means that creators of websites like the pro-anorexia and pro-bulimia sites as well as magazines could be fined up to the equivalent of forty-seven thousand dollars and even jailed if they appear to be providing advice and encouragement for people to become dangerously underweight. Specifically, any attempt to “provoke a person to seek excessive weight loss by encouraging nutritional deprivation that would have the effect of exposing them to risk of death or endangering health” would become illegal, although perhaps difficult to prove.20 As of this writing, the bill is pending in the French senate. Similar restrictions would violate the First Amendment in the United States, but the fashion industry here has faced pressure to make changes nonetheless. In 2007 the Council of Fashion Designers of America created a list of recommendations, including scheduling fittings for younger models earlier in the day to ensure proper sleep patterns, asking designers to “identify models with eating disorders,” and providing “more nutritious backstage catering.”21 But to paraphrase the cliché, you can bring a model to food, but you cannot make her eat, and the American industry has made it clear that they will not impose a minimum BMI for models. However, in 2012 Vogue publicly stated that it would not use models younger than sixteen or who appeared to have an eating disorder.22 Clearly, many of the young women—and teen girls—who walk the runways and whose images appear in fashion magazines are extremely thin and perhaps have eating disorders. Likewise, gossip magazines are quick to point out when celebrities lose (and gain) a great deal of weight, and producers are notorious for suggesting that stars lose weight. Working in the entertainment industry and living in the limelight can certainly promote unhealthy weight loss. But what about everybody else? It may seem like a logical extension that people—especially young girls—who see these teens and young women glorified may themselves develop eating disorders. But the connection is not so simple. Psychologists who research eating disorders in all their complexity are typically reluctant to site popular culture as a key causal factor. Michael Levine, a professor of psychology at Kenyon College who studies eating disorders, told the New York Times in response to the proposed French law that “you’re going to be hard pressed to demonstrate in a very clear way that [Web] sites have a direct negative effect” in causing eating disorders. Michael Strober, director of UCLA’s Eating Disorders Program told the Los Angeles Times that changes in the fashion industry would not necessarily reduce the incidence of eating disorders. “I don’t think you can assume that there will be a dramatic protective effect if the fashion industry alters its standard of body aesthetic,” he told the Times, but added that the attention to the problem of eating disorders was in itself positive, despite the lack of any proven causal link between popular culture and eating disorders. Ian Frampton, a psychologist at Exeter University, told the Times of London, “We need to move away from this idea that supermodels are to blame. It is probably not good for them to look as they do. But for anorexics, the desire not to eat and to be thin seems to be already in them and not something they can pick up by looking at a magazine. There were, after all, anorexics before super-thin models.”23 Rather than a “virus” spread through media images, anorexia and bulimia’s roots are much more tangled. While several studies have demonstrated a relationship between reading fashion magazines and symptoms of eating disorders (but not necessarily the actual development of a diagnosable disorder), it is very likely that those highly focused on their appearance would be drawn to such magazines.24 So we cannot conclude from these studies that magazine reading causes eating disorders. Several studies have found little relationship between television and symptoms of eating disorders.25 Respondents who report wanting to look like celebrities are more likely to increase their physical activity level, which is not necessarily a negative thing, but they are also more likely to use diet supplements. Other research has pointed to family and peers as a more central influence in body image and symptoms of eating disorders. A study published in the Journal of Marriage and Family found that a critical family environment and having domineering parents are key factors in adolescents with eating disorders.26 Another study of girls aged eight to eleven found that peer body dissatisfaction is the strongest predictor of a girl’s own dissatisfaction with her body (the study found that the more children’s television programming the girl watched, the less dieting awareness she had). Watching more music videos and reading teen magazines were positively correlated with more dieting awareness, but these relationships are not as strong as peer influence.27 Media images of young women in particular do merit our attention, but only considering a cause-effect relationship with eating does not go far enough. Images of unrealistically thin young women reflect a very narrow version of beauty and the way in which women are routinely valued based on their appearance in popular culture and, in many cases, everyday life. As I discussed in Chapter 6, these images reflect the contradictions of gender and power. While women have accomplished a great deal over the past several decades, the plethora of images of thin, young, and often white women regarded as beautiful serves as a reminder that their self-worth should not be severed from their appearance. From television shows based on weight loss and makeovers to the endless number of infomercials promising to offer self-improvement, there are numerous ways in which women are encouraged to spend their money to meet a narrow ideal. There is nothing wrong with feeling good and looking good, yet it is often characterized as an imperative rather than an option. As cultural critic Susan J. Douglas writes, deriding a woman’s appearance is often used to minimize any critiques she might have about gender in society. The much-maligned “ugly feminist” is a prime example: her ideas are dismissed because she fails to meet—or even strive for—narrow beauty ideals. Her condemnation serves as a warning to others that it is dangerous to challenge accepted gender and beauty regimes.28 Men also face pressure to live up to often unrealistic physical ideals of being tall, muscular, and strong, rooted in notions of hegemonic masculinity, which emphasizes the need for men to physically dominate others. In addition to magazines, actors, and athletes promoting this image, coaches for even the youngest participants in sports can also provide added pressure, leading some to use steroids. While glamorizing super-thin models and celebrities is problematic on a number of levels, body dissatisfaction and eating disorders have social and environmental roots beyond the media.

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