Dr. Mary Flynn:

I want to address the concern about fear of fatness, tackling obesity and making sure we do not stimulate eating disorders. I concur with my colleague, Professor Donal O'Shea, that eating disorders are at the very severe end of a spectrum but there is a huge problem with fear of fatness, particularly among teenage girls and women. Professor O'Shea will take diet histories but they will be heavily influenced by under-reporting because we make people so uncomfortable about the whole issue of overweight and obesity they do not tell the truth about what they eat.

I have a concern about the focus on obesity. We must be careful and take people to task in this regard. When there is anything in the media about obesity the most unflattering photographs of women and children they can find are made public. They should be called to task over that because that stigmatisation is a prejudice against the very people who need to take action. When we call for, say, the promotion of healthy eating guidelines we should not have the skinniest people in those campaigns but a mix of people, which reflects the reality. Before we go forward with any campaign we should ask overweight men, women and children if it would encourage them to take action because if it makes them feel like hiding under a rock or burying their heads in the sand it will not do any good. There should be a call to action about the fear of fatness. We need to include the body image and be aware that we make people feel ashamed. Parents are terrified that somebody will say their child is obese or overweight because of what it says about them. We need to understand that psychological aspect to it.

We did research from the mid-1990s up to the early 2000s in which 19% of our transition year students said they would smoke to keep down their weight. They said they had started smoking and would continue to smoke to keep down their weight. That is how terrified they are of putting on weight, and that is not within the eating disorders group. We were surprised that 15% said they induced vomiting as a weight loss strategy. Also, with regard to the use of drugs such as ecstasy, it is a reality that people lose weight. We think of their vulnerability but adolescents do not think about what will happen when they are 30, 40 or 50. They are thinking of tomorrow or next week. They under a lot of pressure, and we must be very careful, when we talk about weighing people, that we do it in a manner that does not exacerbate those issues.