Healthy populations and the unwell

I tend to find the Huffington Post more annoying than it’s worth to read, but every so often I’ll scan through in a weaker moment, mainly to see what new inanity the popular culture has birthed. In so doing this morning, I came across this story:

Yoplait has agreed to pull a yogurt commercial that the National Eating Disorders Association (NEDA) believes could trigger dangerous behavior in those suffering from eating disorders.

The ad in question addresses a common dilemma: to dessert, or not to dessert? An already slim woman is frozen in front of her office’s refrigerator, an inner monologue belying a complex barter system that could justify a piece of raspberry cheesecake.

She could have a small slice, she rationalizes; she has been “good.” Or maybe a medium slice with some celery sticks. Or what if she were to jog in place while eating a big slice of cake followed by some celery sticks – that would cancel everything out, right?

This spiral of obsession and restriction ends when a skinnier coworker grabs Raspberry Cheesecake Yoplait Lite. The first woman’s decision has been made.

“[For those with eating disorders], opening a refrigerator is like walking off a bridge,” said Lynn Grefe, president of NEDA. “And to see this behavior in a commercial tells people with eating disorders, see, it’s even on TV. It’s ok and normal for my head to go through all these mental exercises.”


“I was shocked by how they really nailed it on the head–that’s exactly what I thought every time I opened a refrigerator door,” said Jenni Schaefer, who remembers experiencing negatives feelings towards food as young as 4 years old. Scheafer battled anorexia in high school and bulimia in college; she began treatment for her disease when she was 22 years old. Now 35, she considers herself fully recovered and has written two books on recovering from eating disorders.

“When you live with an eating disorder, you divide all foods into “good” and “bad” categories, like the yogurt versus the cheesecake [in the commercial],” Schaefer said. “Pretty soon everything moves into the bad category.”

Grefe says that NEDA “applauds” Yoplait and parent company General Mills for agreeing to pull the commercial days after the group voiced concerns.

“We had no idea,” Tom Forsythe, VP of Corporate Communications for General Mills, said to the Huffington Post. “The thought had never occurred to anyone, and no one raised the point. We aren’t sure that everyone saw the ad that way, but if anyone did, that was not our intent and is cause for concern. We thought it best to take it down.”

I can understand why General Mills decided to pull the ad. It’s far too easy for controversy to spin out of control, and I can’t blame a large corporation for being chary of creating the appearance of indifference to the plight of sick people.

I actually saw the ad in question before it was pulled, and didn’t think a thing of it. The Better Half commented on the ridiculousness of the premise that anyone seriously craving cheesecake would find that yen met by lite yogurt, but it was an otherwise unremarkable commercial. It seemed no different from any of the other commercials that revolve around the conceit that people (women, almost always) are concerned with their weights and physical attractiveness, and analyze which foods and drinks will help them look as svelte as possible. (Cf. every other ad for diet, lite, low-fat, “smart,” “healthy,” etc. foods and beverages on the market.)

I do not think that General Mills should have been made to pull this spot. As a specialist in adolescent medicine, I’ve managed the care of several patients with eating disorders, and know colleagues whose work is focused exclusively on treating such patients. Any honest medical provider who takes care of patients with eating disorders will concede that they are among the most challenging, frustrating patients to treat. Anorexic or bulemic patients are often very, very resistant to treatment, and the disorders are often refractory to intensive therapy. It takes a lot of patience and a multidisciplinary approach to care for patients with these disorders, a feature of which is the tendency of those who suffer from them to obfuscate, stymie or sabotage their own care.

It’s probably true that a patient with an eating disorder has thoughts very similar to those depicted in the commercial.  But the joke of the ad relies on those thoughts being common to a great many viewers (myself included).  In a patient with a certain pathology, they may serve to reinforce an unhealthy behavior, but the thoughts portrayed are normal for most of us, or at least so commonplace and non-problematic as to be innocuous.  Whose experience bears more consideration — that of the vast majority of viewers, or that of a small population of patients?

Further, patients with eating disorders have their dysmorphic body images and pathological attitudes toward eating reinforced by all manner of images and messages in popular culture.  As I said above, the thoughts depicted in the Yoplait commercial are hardly unique.  One might argue that our society has a warped and unhealthy view of what women should weigh and look like, and I’d be inclined to agree.  I think the fashion and entertainment industries do reinforce a very dangerous standard of what is attractive, and there should be efforts to address and rectify this.  But if a relatively anodyne depiction of common thoughts about what foods to choose are a trigger for disordered behaviors, then so is a lot of our otherwise acceptable popular culture.  Defining what is permissible by the experience of an unhealthy few, particularly for a patient population as sensitive as this one, sets the bar too low.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. Also, that’s sort of a healthy way to think, isn’t it? I mean, we encourage people to eat in moderation. If I’ve had three slices of pizza, I SHOULD think twice about getting a mochaccino, whereas if I’ve eaten basically healthily it might okay to indulge.

  2. Great post. I agree that the Huffington Post is inane, but disagree with NEDA that those with eating disorders running through a series of decision making thoughts is either abnormal or unhealthy. Every decision that we make is based on such reasoning, albeit usually a little quicker than in the commercial. Would NEDA rather we all just jump to a decision without thinking of the consequences?

    Oh, and the commercial in question just aired about a minute ago on TNT.

  3. Of course GM should pull the commercial, God forbid anyone be even slightly offended. Next time the NEDA should call on the fed government to investigate.

  4. “Russell Saunders is a pediatrician in New England. He has a husband, son, cat and dog, though not in that order. He enjoys reading, running and cooking. He would have warned the Academy of Motion Picture Arts and Sciences that James Franco was a bad idea, if only someone had asked” It’s posted at the top right of this page.

    This is Dr. Saunders bio. Have any of you read it carefully?

    I didn’t think so. While you’re at it you may want to read the some of the excellent articles written by folks who have actually done their homework regarding eating disorders. Pediatrician’s aren’t required to take any specialized training in eating disorders even though there is a very strong body of research as well as some credible organizations such as the Acadamy for Eating Disorders. These people are experts in this specialty field. Dr Russell Saunders is likely a very competent pediatrician, but his opinion about ED’s is not based on the wealth of research available. It’s just shooting from the hip. Quaint, but not well informed.

          • The problem with you young people is that it’s all about novelty.

            Sometimes it’s good to go back to stuff that you know is good. Why? Because you know it’s good. This whole “but this thing that I don’t know about might be 10 times better! 100 times!!! THE SKY IS THE LIMIT!!!!” thing never, ever pans out.

        • It Franco is going to try and rock a drag look a la Marilyn Monroe, the very least he could do is do a full-on performance of “Diamonds Are a Girl’s Best Friend.” Just strolling out on stage in the dress? Meh. Weaksauce.

    • Always glad to have another reader, Joe.

      I must say, I’m not entirely sure what a close reading of my glib little bio is meant to reveal. Do feel free to elaborate.

      And no, pediatricians aren’t required to get any specialized training in eating disorders. However, as a board-certified sub-specialist in adolescent medicine (as I mention above), I did actually get specialized training in that area, and I’ve taken care of a great many patients with those diagnoses.

      I’m not clear what your specific qualms with my post are, as you haven’t bothered to state them. I suspect I was a bit more honest about the experience of treating patients with eating disorders than you like. Which is fair enough, but hardly an indication that I don’t know what I’m talking about.

      • Perhaps you would like to speak with sufferers from eating disorders who are all to familiar with the painfully obsessive thought processes that are reflected so accurately in that commercial, and the others who believe it’s normal as they are dieting themselves into oblivion, and maybe talk to some of the countless individuals who are seeking thinness for thinness sake because both overweight and obesity have become stigmatized states that only get worse with stigma and yes dieting. Dieting doesn’t work. All the available research points to higher weights after dieting within a period of 3-5 years.
        The problem with the commercial is that it is just promoting another quick fix to a systemic problem and impressionable people are believing that that character’s processes are harmless. They are not! They are classic eating disorder obessesions! Talk to the pros who have dedicated decades to working with these patients. It is not just another harmless commercial, or maybe it’s more accurate to say it’s another harmful commercial. I suggest reading this article
        You will find it far more articulate that I and you will better understand where i’m coming from.

        And btw thank you, it is clear that you are respectfully inviting further conversation. Sincerely, Joe

        • Joe, you are perfectly welcome to a contrary opinion. However, you are not going to get me to agree that the commercial in question is sufficiently consistent with a pathological behavior to warrant its being withdrawn. Sure, sufferers from eating disorders have obsessional thoughts along those lines. But I aver that the overwhelming majority of people who have thoughts along those lines keep them healthily in check. You think the bar should be set in consideration of an unhealthy few. I disagree.

          We don’t ban alcohol commercials out of concern that they will trigger relapses among alcoholics. Rather, recovery programs teach alcoholics that they are going have to live in the world on the world’s terms. Again, you clearly feel that patients with eating disorders deserve a particular kind of deference, but I do not believe you have made a sufficiently strong case for your argument.

  5. No, you are right we don’t ban ALL commercials for alcohol. We continue to teach young people how to be alcoholics at an early age. And we all know that abolition was a failure. It’s important to remember that eating disorders aren’t addictions, they’re well, eating disorders.
    Either way, we can choose to let culture play out and see what damage is done, and not demand any wisdom permeate popular culture. Some might want to do so in the name of free enterprise. But others choose to talk back to commercials in a way that brings insight to those who may be vulnerable to give them strength and insight to resist those who would prey on them. Obesity & disordered eating is a very complex area of inquiry today, and many are offering solutions with little or no empirical support other than the affect on their profits. But EDs & Obesity are a field that cannot be easily addressed by another diet yogurt option or bromides about personal responsibility. The vulnerable viewers of the commercial we are debating number in the range of 24 million according to the NIMH, and if you include the overweight and obese the number is staggering. The two aren’t separate competing populations. There is much overlap and crossover in these patient populations.
    I believe the National Eating Disorders Association is choosing to talk back to the commercial. Factually all they have done is request something of Yoplait, and Yoplait has graciously and respectfully accepted the feedback because they are willing to honor and defer to the experts. One might argue this is setting the bar low, because they are asking Yoplait to remove a commercial that is targeted at everyone who watches TV. I believe their goal is making it known that what is depicted in the commercial is not healthy, mindful, natural eating. It’s not a healthy solution. It’s another problem—a quick fix with consequences. It is eating that is being ruled by obsessions and deprivation. This “solution” is as much a problem for the overweight and the overeater as it is for the under-eater or the binge/purge. The solution to our out of balance relationship to food and our bodies is not to go on the next fad diet. You may have heard of this one
    The solution is to eat regularly, eat balanced whole foods and practice listening to what are bodies are hungry for, not what the waif at the office says is best. Underweight people suffer too from health problems. (It’s healthy nutrition and activity that determine health not simply weight.) It takes practice, but overweight, obese, normal weight and underweight people are all vulnerable to the message that obsessing, strategizing and dieting to lose weight will bring happiness and health. Formerly overweight and obese individuals are overrepresented among eating disorders patients and many of them arrived there by starting with a restrictive diet. Many of them return to health and happiness by letting go of the idea that health comes from a diet and embracing the bell curve reality of BMI. For all of those who don’t fall on the low end of the BMI scale naturally, the best, healthiest lifestyle is balanced nutrition, healthy activity and accepting variation in the human form. Dieting to lose weight leads to eating disorders in many people and return to pre-dieting weight in 95% of dieters!!! I challenge you to find evidence to the contrary that has long term follow-up of at least 5 years.

    I’m guessing that NEDA, knowing this, because this is their area of expertise, would like to get people talking about this stuff so we can get beyond the simple quick fix solution to overweight and obesity.
    (We don’t even have terms that make sense—oveweight and obesity?!? Why don’t we use a term that is appropriately opaque for Anorexia. Let’s just call it the “skinniness disease.” Seems absurd to me. Then again it might remind us that skinniness does not equal health and that there is something under the surface that needs explaining, which can lead us back to talking about overweight and obesity in meaningful terms.)

    Yoplait and many other companies would love to capitalize on our concerns about our weight. In fact it probably doesn’t sound conspiratorial at all to most people these days to suggest that companies like Yoplait use insecurity so that we are more concerned about something for which their product provides an easy solution. (Just because they’re selling yogart doesn’t mean that their marketing department cares about what’s best for us. They care about selling.) The media watchdogs’ role in society is to help us see beyond this lie and find a balanced truth. AA helped those with alcoholism. Before AA, we just locked alcoholics up when they completely lost control of their lives. What are we going to offer those who suffer from eating and weight problems? A moral lesson in personal responsibility?! The only question we need to ask is, will that lead to positive results for humanity in this area. Will preaching about responsibility alone bring about balance while we continue to inundate our young people with misinformation?

    Of course medicine in concerned about treating problems. I respect that approach, but other approaches are important too. Media watchdogs are interested in preventing problems, and educating the public about concepts such as normal healthy variation in BMI, and the risks of a diet-quick-fix is a preventative approach to EDs and obesity.

    I’m grateful to organizations like NEDA for taking complex issues like obesity and eating disorders and challenging us to ask questions, such as why does that commercial concern them? Why would a leading organization committed to helping those with eating, weight and activity disorders object to this commercial? I think it’s important to ask that question, not just respond from a position of authority with easy answers that blame or abandon the individuals who are suffering. If that would help I’d be all for it, but I have seen no evidence that it does. We also believe shaming “fat” people helps. It does not. It only causes greater dysfunction and isolation.
    So for now I’m going to thank NEDA and other organizations that challenge me to think, ask questions, and go beyond what seems obvious to me. We’d all like to believe that our intuitions would be supported by the research. But in a society where the thin ideal is greater today then ever and both obesity and eating disorders are more prevalent than anywhere or any time, I think we need to rethink rather than just reiterate.

    again, thank you Dr. Saunders.

  6. here’s another article that does a nice job of highlighting the difference between obsessing and carefully thinking & choosing.

    anyway, enough from me.

    I’ll check back to read response, but I’ve said what I have to say.

    best wishes,

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