Dr. Joan Bushwell's Chimpanzee Refuge

America is obsessed with dieting, and it's taking a toll. The country that invented the fast-food greaseburger has now seen the rate of eating disorders double since the 1960s, according to the Journal of the American Academy of Child and Adolescent Psychiatry. Up to 60 percent of high school girls diet, and even more worry about their weight.

There are a couple of subtexts here. One is that Barto apparently sees the association between America's preponderance of high-calorie foods and its high incidence of eating disorders as ironic. Let's see: Affluent, appearance-driven culture plus lots and lots of grub equals a fair number of eating disorders. I fail to see how this equation isn't balanced.

In addition, Barto seems to think that "dieting" (a euphemism for anything aimed at weight loss) is categorically bad. Obviously this is something that needs to be evaluated on a case-by-case basis, and considering how many overweight kids there are floating around now, there are defensible reasons for why so many girls are concerned. Let me restate that more clearly: Not everyone who wants to lose weight is anorexic.

The problem is the prevailing attitude that equates thinness with good health and happiness. Combine this with a grossly distorted view of what is normal, and it's no wonder that so many people hate their bodies.

In reality, a wide variety of body types are normal, depending on one's bone structure, metabolism and genetics. It is fruitless and misleading to expect everyone to conform to the same weight. Whether you are naturally muscular, chunky, twiggy, curvy or tiny, trying to change your body can be frustrating and even dangerous.

Okay, so Barto is now running with the idea that weight loss is motivated solely by a desire to look better and thus feel better on the basis of perceived appearance alone. In regard to the population she's focusing on (teenage and pre-teen girls), she's largely correct. But "fat activists" can also be charged with having a "grossly distorted view of what is normal," given their aim to have obesity seen as one more healthy biological variant, just as malignant tumors might be said to represent nothing more than an especially avid brand of healthy cell division.

With eating disorders and obesity both on the rise, this is just not an area in which it is meaningful to generalize in the manner Barto and so many others do.

Ninety-eight percent of dieters regain all the weight they manage to lose, plus about 10 extra pounds, within five years.

The editors of the New England Journal of Medicine concluded in 1998 that, "(s)ince many people cannot lose much weight no matter how hard they try and promptly regain whatever they do lose, the vast amount of money spent on diet clubs, special foods and over-the-counter remedies, estimated to be on the order of $30 billion to $50 billion yearly, is wasted."

This is important. The implicit conclusion here is that because mass-marketed diet programs fail, weight loss is not only unhealthy but unattainable. And these programs are indeed a waste of money for most. But the premise -- people regain weight they lose because their bodies dictate as much -- is unsupported, and the NEJM editors are not claiming that weight loss itself is neither attainable nor healthful. I can state that the amount of money spent on "natural male enhancement" products is a colossal, scandalous waste without linking this to the notion that satisfying one's sexual urges is trivial.

Yes, we're all "programmed" to maintain different levels of fat and muscle, and frame sizes vary widely between individuals and ethnic groups. But when someone who loses weight regains it and then some, this is hardly circumstantial evidence for an exaggerated "set point" at work. In fact, most people will tell you what happened without considering the implications of their own words: "I was doing so well, but then I quit my walking when I got too busy and kind of backslid food-wise, and soon enough I'd gained 30 pounds..." How different is this than the longtime problem drinker we've all known who intersperses periods of abstinence with ever-worsening benders? Do these people have an "ethanol set point" or are they simply falling victim to their own human tendencies?

The issue here is that "bad" habits are hard to change and good ones correspondingly difficult to maintain. This is hardly an assault on anyone's character, personality or appearance. Unless I'm badly mistaken in terms of the medical literature, the idea that so many Americans are noticeably heavy because of a non-negotiable "set point" is a pipe dream, especially given that this "set point" has mysteriously risen in concert with more and richer fast and not-so-fast food and bigger "Big Gulps" in just 20 or 30 years.

What a paradox, that dieting should be such a lucrative industry in a country with such high obesity rates.

How is this paradoxical? Would Barto expect purveyors of weight-loss plans to do better in Chad or Ethiopia than in the United States? Even if the slimming industry isn't correcting the problem, it's addressing a genuine medical and psychological need. Same goes for hypnotists who can make you quit smoking, psychics who can assure you your dead uncle buried a million dollars somewhere on his property, and hucksters who tell men they can be hung like Enzyte Bob if only they ingest the correct herbs.

Couldn't those billions of dollars be better spent? Instead of trying to buy happiness, think of all the good that money could do if diverted to cancer research or stamping out hunger.

I imagine there's a name for this logical fallacy: "Because problem X exists, problem Y isn't really a problem." Red herring, I guess.

Rather than focusing on weight loss at any cost, we should aim for good health at any size. Too many dieters harm their bodies and psyches by skipping meals, purging and popping pills in the quest for skinniness. We should eat for nutrition and well-being, not solely to lose weight. Amidst all the deprivation and guilt associated with eating, we often forget that fresh, simple food is a joy in itself.

Another well-executed blend of fact and fiction. The idea that you can be healthy at "any size" is attractive for obvious reasons, but it's childishly wishful thinking. The rest of the passage -- which implores people to steer clear of deranged eating patterns -- is true but unrelated.

Likewise, our use of language reinforces the idea of exercise as a punishment for the body. Instead of saying "feel the burn" or "no pain, no gain," try "feel good."

Exercising releases serotonin, the brain chemical that causes you to feel happy. Find an activity that you enjoy, be it swimming, cycling or salsa dancing -- it doesn't have to be a torture session on the Stairmaster.

This I can swallow, but I cringe a little at the implication that vigorous exercise is necessarily "torture." But I recognize that everyone has to begin somewhere, and many people whose bodies and minds could use a surge in physical activity would be well served by doing anything about what their current schedule includes, be this walking to the mailbox instead of driving or deciding to be ready to enter a "century ride" in six months.

The unfortunate thing is that a lot of "health at any size" advocates have constructed a world view in which posts like this one are ascribed to "fat hatred" and nothing more. It's as if people feel free to tune out basic facts when they're not offered by someone not overtly empathetic. I've seen a lot of "fat advocates" claim variously that among critics of HAAS, once-fat people who lose and keep off weight are smug, never-heavy people don't get it (or are threatened by "alternate notions" of beauty), and fat people who want to lose weight but can't are brainwashed and resentful. This leaves fat people who want to be fat as the only objective observers, and many people will forever and annoyingly browbeat anyone who writes what I just did with cries of "Why do you hate fat people so much?" and "What difference does it make to you?" Oh well. People can be healthy at any level of irrelevancy.

Former 410-pounder Jimmy Moore at "Livin' La Vida Lo-Carb" has also weighed in on Barto's article.