When I was in fourth grade, Bible history class at St Andrew's Parochial School, Sr Mary Frances told us students a compelling story about a female saint who lived for years eating only the consecrated host and drinking only water. With great devotion and fervor, the nun explained to us that such deprivation was apparently commanded by God and constituted a miracle. I think that today the saint's unconventional dietary pattern would be seen as an eating disorder and diagnosed as anorexia nervosa. This mystifying behavioral aberration traces its roots at least as far back as the Middle Ages. Today, however, the behavior (if not exactly living on the consecrated host and water) is the same. It is the context that is different. Our culture is the modifier. Today, many individuals, mostly females but an increasing number of males are depriving themselves of food in search of some perceived ideal body image, not to be holy, but because they believe that our culture demands it. They will do anything imaginable to avoid gaining weight. To be obese in our society is to be laughed at, made fun of, and discriminated against. Even our current surgeon general has been criticized by some for not having a perfect body. Elementary school children have reported that being obese is worse than being handicapped. Half of American women are dissatisfied with their physical appearance. We are seeing more of a new disorder, orthorexia nervosa, an eating disorder in which individuals have an unhealthy obsession with eating only what they perceive to be healthy, usually only food that is organic, fresh, whole, raw or sprouted, seasonal, and local, avoiding most carbohydrates, milk, and milk products. Obsession with food is oftentimes the norm.
Jeanne Martin's excellent article in this issue traces a number of influences affecting our continuing obsession with attempting to achieve some perceived ideal body image. She points out that as our perception of the idealized female body has become thinner and thinner, the body mass index (BMI) of females has become heavier and heavier. With males, the ideal body size is perceived as increased muscle mass, and the disorder muscle dysmorphia has risen as has the number of males experiencing eating disorders, with many using products that supposedly boost exercise capacity and physical performance.
Our society's obsession with attempting to attain the unattainable is not limited to the Western culture. The second article on idealized body images in this issue summarizes a symposium held in Japan on the topic. The insightful papers presented at that symposium illustrate clearly that the desire for thinness is prevalent in many countries throughout the world and that the greater the desire for thinness, the more likely is the occurrence of disordered eating and eating disorders. In young Japanese females, for example, the BMI begins decreasing at age 18 years. The incidence of eating disorders in Japanese women has increased 10-fold in the past 20 years.
In her article, Martin argues convincingly that the globalization of today's marketplace heightens the popularity of selected role models and hastens the pursuit of the elusive ideal body image. The 2008 Miss America, a recovering anorexic, had a BMI of 16.29 (BMIs <18.5 are considered underweight) when elected. The Brazilian model Ana Carolina Reston had a BMI of 13.4 when she died at age 21 years. The entertainment media, oftentimes portraying extremely thin women as the ideal body type, influence the perceptions of many individuals, especially vulnerable youth. These distorted perceptions of an elusive idealized body image versus a realistic one can lead to dissatisfaction with one's body, depression, disordered eating, and, for some, an eating disorder.
It is troubling to me that some nutrition professionals do not appear to be aware of the potential dangers of focusing only on dieting behaviors and neglecting to address body image and related lifestyle issues. I think that we must always be vigilant in our interactions with clients, the public, and media to help raise awareness of the fallacy of pursuing the idealized body image. Our focus must be on education, especially with the young. Martin's article presents some insightful strategies for accomplishing this goal and a number of helpful Web links. Nutritional professionals are on the front line. They can have a significant positive effect by focusing on the development of positive body images and the related nutritional and lifestyle issues to achieve them.
Ritva Butrum Named International Congress of Nutrition Living Legend
Ritva Butrum, PhD, was named a living legend by the International Union of Nutritional Sciences, to recognize her extraordinary contributions in the field. Ritva is an internationally recognized authority in the field of diet, nutrition, and cancer prevention. She is also an innovator in the study of bioactives in food other than nutrients. For many years, she was vice president for research at the American Institute for Cancer Research in Washington, District of Columbia. She currently serves as a senior science advisor at the American Institute for Cancer Research. In 1983, Dr Butrum initiated the Diet and Cancer Branch (DCB) within the Division of Cancer Prevention and control of the National Cancer Institute, National Institutes of Health. As DCB branch chief, her key responsibility was the largest nutrition program at the National Cancer Institute, which encompassed clinical intervention trials in diet, nutrition, and cancer prevention. She also oversaw the planning and development of agendas for many workshops and scientific conferences related to diet, nutrition, and cancer prevention. Under the leadership of Dr Butrum, the DCB developed material for the National Institutes of Health Nutrition Objectives for the Year 2000 Goals for the Nation, the Dietary Guidelines for Americans, and the National Nutrition Monitoring and Related Research Act. Dr Butrum received her PhD in food science from the University of Maryland at College Park, MS degree in nutrition biochemistry from the University of California at Los Angeles (Fulbright Fellowship), and her BS degree in foods and nutrition from the University of Helsinki, Finland. Best wishes, Ritva!
Koonin Awarded Lyn Howard Advocacy Award
The American. Society of Parentral and Enteral Nutrition awarded the 2010 Lyn Howard Award posthumously to Lee Koonin. Unfortunately, she passed away recently, and her husband and daughter accepted it on her behalf during Clinical Nutrition Week 2010 in Las Vegas. This recognition acknowledges a patient, family member, and/or a caregiver who works tirelessly for regulatory change and/or to increase funding and research for clinical nutrition.
The award was named in honor of Dr Lyn Howard, cofounder of the Oley Foundation, which provides information and support to consumers of home intravenous and tube-feeding nutrition. Home parenteral nutrition (PN) was not common in 1977 when Ms Koonin first started on this therapy. She founded the Lifeline Foundation, a consumer advocacy organization, and opened her life and medical history to others to help advance this therapy.
Ms Koonin was a guest on numerous TV shows including Good Morning America, where she discussed the value of PN and established herself as a role model. She also addressed medical societies including ASPEN, and when Catastrophic Insurance was being considered by Congress in 1981, she testified in front of the House Health Subcommittee. Her speech impacted the future of employment by addressing that people who were forced to be declared "disabled" to finance the substantial cost of home PN were actually "enabled" as a result of the nutrition. Ms Koonin encouraged legislation to protect these differently abled individuals by allowing them to work while retaining benefits under catastrophic insurance.