The Lies We Buy: Defining Health at Women’s Expense
In June 2012, the U.S. Preventative Services Task Force renewed a call for physicians to screen all adult patients for obesity by calculating the patient’s BMI, or body mass index. If the patient is obese, doctors are urged to refer those patients to intense nutrition and fitness programs. Over the next two decades, experts expect a significant increase in the percentage of obese Americans.
Problem: The BMI is NOT a reliable indicator of health or even obesity. After years of researching perceptions of women’s health, I became interested in the Body Mass Index (BMI) and how it came to be the standard scale for judging a healthy weight. What I learned was shocking.
Though accepted definitions of physical health should have remained relatively stable throughout the past several decades, public perceptions of female health have shifted dramatically toward a focus on thinness over the past 25 years, as evidenced by media’s almost exclusive depiction of healthy bodies as extremely thin, toned and free of any unsightly “blemishes” like cellulite. By the early ‘90s, the vast majority of magazine health content focused on weight loss (framed as a means to improve appearance), though overweight and obesity had not yet become national health concerns.
While science tells us that current beauty ideals of extreme thinness and tall, shapely perfection have little to no correlation with actual indicators of health and wellness, we still see tons of evidence that people believe this myth to be true:
- The vast majority of girls and women now perceive underweight bodies and extremely low body weights as being ideally healthy
- Even underweight and average-weight females are striving for weight loss using dangerous and unhealthy means, such as disordered eating and abuse of laxatives or excessive exercise
- According to studies done in the last five years, 66 percent of adolescent girls wish they were thinner, though only 16 are actually overweight
Furthermore, in the last decade, there was a 446 percent increase in the number of cosmetic procedures in the U.S., with women undergoing 92 percent of those – the majority being liposuction. Add the cost of those voluntary surgeries to the $7 billion per year U.S. women spend on beauty products, and we have a population that spends $19 billion per year trying to achieve “beauty.” On top of that, with the relatively recent conflation of beauty ideals with health ideals, the weight loss and diet industries have begun to flourish unlike ever before, with an estimated $61 billion spent on the quest for thinness in 2010 – more than twice as much as Americans spent on all types of diet programs and products in 1992.
Through mass media, Americans are delivered a constant stream of messages telling us idealized beauty and health is attainable for any woman willing to devote enough time, money and effort – whether in the gym, at the mall or on the operating table. In case we need a harder push toward these ideals, we’re constantly reminded that the sacrifice is well worth it, based on ever-present media narratives telling women how to fix their flaws in order to find love, happiness, success and – perhaps most the most dangerous lie of all – health.
100 Years and 100 Lbs
Because women’s magazines are second only to physicians as sources of health information, I critically analyzed depictions and discussion of women’s bodies/health in magazines from 1900-2010, hoping to better understand how women’s body ideals have become so unrealistic. Here, I’ll describe just two stunning beauty ideals from this time period – 100 years and 100 lbs apart.
Perhaps the most well-known U.S. beauty icon at the turn of the 20th century was Lillian Russel, a stage actress and singer born in 1861. Her New York Times obituary (1922) repeatedly references her beauty, noting that “for more than 20 years, she had been known as one of the most beautiful women on the American stage.” At the peak of her fame, Russel weighed approximately 200 pounds and was celebrated for her curvaceous figure, as demonstrated in another NYT article about her (1902), in which the author extols her “superior beauty.” The way she was described genuinely caught me off guard: “[Russel] is a particularly robust and healthy creature, who takes good care to remain so.” Russel’s weight, which would be considered “obese” by today’s standard (the BMI), was actually considered a sign of her health and desirability.
Today’s most prominent fashion and beauty ideals represent the opposite end of the spectrum. British “anti-supermodel” Kate Moss’s gaunt, androgynous frame has been lauded by the fashion industry and earned her more than 50 women’s magazine covers and high-profile advertising campaigns. Her much-celebrated “waif” look dominated the fashion industry throughout the ‘90s and well into the next decade, as she ranked 2nd on Forbes’ top-earning model list in 2007 with an estimated $9 million salary. Her much-publicized 2009 statement to elite fashion magazine Women’s Wear Daily that “nothing tastes as good as skinny feels” reflects a dangerous sentiment underlying today’s beauty ideals, as well as the fears of medical experts, as the quote soon appeared across “thinspiration,” or pro-eating disorder websites, worldwide.
Defining Health at Women’s Expense
A standardized table of average weights and heights for women was developed for the first time in 1908, when life insurance companies began looking for ways to charge higher premiums to applicants based on pre-screening by their own medical examiners. Though previous weight tables allowed for increasing weight with age (which naturally occurs), this new table was the first to deem an increase in weight after age 25 as undesirable and unhealthy. Thus, by setting the thresholds for “ideal weight” and “overweight” lower than what mortality data showed as the actual healthy weight ranges, they were able to collect more money for those they deemed “overweight.”
Though it would have been much more accurate to compare death rates with actual assessments of body fat, such as skinfold thickness or even simple waist circumference measures, these data were much more difficult and expensive for both the medical and life insurance industries to obtain than basic height and weight. In the 1800s, an equation was formulated to potentially predict body fat percentage (weight divided by height squared), and the life insurance industries and medical community latched on to it in the 1970s. This equation, which scientists warned was only meant to be used for large diagnostic studies on general populations and was not accurate for individuals, was named the Body Mass Index (BMI).
By 1985, the National Institutes of Health began defining obesity according to BMI, which defined “obese” according to the profit-driven standard set by the 1983 Metropolitan Life Insurance Company mortality tables. It is important to note that these standards did not take into account body frame or build, which were included in the previous tables after physicians demanded “small,” “medium” or “large frame” be factored in to avoid serious miscalculations of body fat.
In the first mention I could find of weight as a national issue, it was reported at a 1993 conference for the National Institutes of Health that 24% of men and 27% of women were overweight, according to the BMI. But by June 1998, those numbers skyrocketed while Americans’ weights stayed the same. Millions of people considered to be of ideal weight according to the BMI were suddenly categorized as “overweight” without gaining a pound when the NIH suddenly changed the rules. The BMI thresholds for what was considered “overweight” and “obese” were lowered and the standards for men and women were consolidated — despite the relationship between BMI and body fat being different for both genders.
- On June 16, 1998, the “average” woman was 5 feet, 4 inches tall and weighed 155 pounds.
- On June 17, a woman of that same height and weight was considered “overweight.”
- The requirement for “average” dropped 10 pounds to 145, and a person of the same height who weighed 175 pounds was considered “obese.”
These standards are still in effect today, and individuals are encouraged to easily diagnose their own BMI status through the NIH website-hosted BMI calculator.
Dr. David Haslam, the clinical director of Britain’s National Obesity Forum, told the Daily Telegraph newspaper: “It is now widely accepted that the BMI is useless for assessing the healthy weight of individuals.” Despite extensive evidence proving the BMI lacks accuracy for calculating an individual’s body fat or healthy weight, the government defends it as the national standard due to the fact that it is “inexpensive and easy for clinicians and for the general public” (CDC, 2010). Thus, the financial interests of those who diagnose, define and profit from the definition of “health” in this country were prioritized over individuals’ accurate understandings of their own health. By upholding and enforcing a faulty measure, the insurance industry, medical industry and federal health agencies save a significant amount of money that could otherwise be spent on diagnostic tools and procedures that are reliable indicators of health.
To further prove the difference between the BMI and actual health, the National Cancer Institute and CDC reported that individuals who are overweight but not obese have a lower risk of death than those of the BMI’s “normal weight” category. Accordingly, a report from the International Journal of Obesity states: “BMI may lead to misclassification of persons with normal levels of fat as being overweight, a fact that could cause unnecessary distress and prompt unnecessary and costly interventions.”
From lost self-esteem, lost money and time spent fixing “flaws” and a well-documented preoccupation with thinness, the effects of profit-driven health information involve serious loss for women, while too many industries see huge economic gains. From the life insurance industry collecting higher premiums for those they deem “overweight” based on a standard they set themselves, to major financial savings for medical experts and the government using the profit-driven BMI, to the diet and weight loss industry raking in an estimated $61 billion on Americans’ quest for thinness in 2010, those who make money off the discourse surrounding women’s health are thriving unlike ever before.
When Women Hate Their Bodies, Their Health Takes the Hit
While representations of women’s bodies across all media have shrunk dramatically in the last 30 years, rates of eating disorders have skyrocketed – tripling for college-age women from the late ‘80s to 1993 and rising since then to 4% suffering with bulimia. Maybe even scarier is the 119% increase from ’99-’06 in the number of children under 12 hospitalized due to an eating disorder, the vast majority of whom were girls. Though the Department of Health reports that “no exact cause of eating disorders have yet been found,” they do admit some characteristics have been linked to their development, such low self-esteem, fear of becoming fat and being in an environment where weight and thinness are emphasized – all of which are shown to be related to media exposure of idealized bodies, which is all but inescapable.
Since the early 1900s, medical experts have agreed on the health dangers of extremes in body weight – both underweight and obesity. The anxieties incited by unrealistic thinness ideals perpetuated by mass media are contributing to two dangerous extremes in disordered eating: women turning to anorexia and bulimia, including exercise bulimia, as an attempt to fit the ideal on one end of the spectrum, and on the other end, women surrendering to unhealthy overeating and sedentary lifestyles in response to their perception that they are too far from the ideal to ever achieve an average or healthy weight.
A rich body of research that shows health and fitness often has very little correlation to body weight or even an individual’s BMI, as evidenced by a meta-analysis of medical studies since the 1970s that concluded overweight and active people may be healthier than those who are thin and sedentary (Macias Aguayo et al., 2005; Heimpel, 2009). Therefore, understanding that activity level is a much more reliable indicator of a person’s health than their body weight is key to promoting real, effective health goals that can lead people away from extremes like disordered eating and obesity.
With so many power holders with serious financial interests at stake in maintaining the disgust and anxiety females feel about their bodies, it is unlikely that the dominant portrayals/descriptions of women’s health will change anytime soon. Therefore, dismantling and revealing for-profit health myths must become the responsibility of everyone who recognizes their existence.
WHO CAN HELP:
- health educators and practitioners who know the difference between thin ideals and indicators of physical fitness
- parents, teachers, friends and other influential individuals who see signs of low self-esteem, distorted body perceptions and disordered eating in girls
- media consumers who recognize negative feelings about their own or others’ bodies after reading or viewing media that represents ideals as normal or “healthy”
- media decision-makers who can disrupt the steady stream of idealized bodies with positive representations of more normative shapes and sizes
- Potential activists who are willing to visibly resist messages that repackage women’s health in objectified terms in any way possible, whether through volunteering to speak out against harmful ideals for any audience who will listen, or by attracting media attention toward the dangerous link between beauty ideals, low self-esteem and serious health consequences
- medical experts, researchers and physicians who have influence over patients’ and colleagues’ perceptions of body fat measures and diagnostic tools
WHAT YOU CAN DO:
Revealing the unrealistic nature of the “beauty ideals=health” myth and its influence on the way girls and women view and treat their bodies is a promising step toward improving women’s health. This can be done in simple ways, such as by:
- pointing out the difference between media representations of women’s bodies and real-life women’s bodies while watching TV or flipping through a magazine with friends or family
- gaining better understanding of realistic and healthy standards of body weight and physical fitness for ourselves and others over whom we have influence, such as by talking with your doctor and researching signs of optimal health for yourself
- posting links or starting discussions on blogs and social networking sites (our FB page is a great place to start) to continuously spark conversation about dangerous thin ideals and those who profit from our belief in them
- reminding ourselves and encouraging others to engage in physical activity as a means for improving physical and mental health, rather than a strategy for achieving unattainable beauty ideals
- developing and helping to implement accurate and reliable measures of healthy weight, whether that means developing new algorithms that can better predict individual body fat or (if you’re a medical expert or practitioner) steering clear of the BMI in favor of other financially feasible measures that are more accurate, such as waist circumference measurement or skinfold thickness — or, more importantly, taking the focus off of body size or fat altogether in favor of a focus on physical activity
For an even more condensed and updated version of this research, please read our important two-part series “Healthy Redefined.”
Kite, Lindsay. (2011). The Lies We Buy: Defining Health at Women’s Expense. Conference paper presented at the National Communication Association, Nov. 18, 2011.
(For a complete list of references, the full PDF of this paper is available here: Kite, Lindsay – NCA Paper, Defining Health at Women’s Expense)