INTERVIEW:Why aren't we comfortable in our skins and why don't we accept that diets don't work? Susie Orbach says we've lost track of the relationship between eating and hunger

SUSIE ORBACH’S PLACE in the history of body-related issues is already assured, first as the best-selling author (in 1978, when barely out of her 20s) of Fat is A Feminist Issue, the title of which alone assured her a place in the pantheon. Second as therapist to Diana Princess of Wales, whom she began treating for bulimia in 1994, and whose weekly treks to Orbach’s north London consulting rooms were zealously monitored by the tabloid press. The following year came the infamous Panoramainterview, and the psychoanalyst was widely credited as the impetus behind her patient’s decision to go public. Although Orbach remains silent on the subject, it’s fair to say that Diana’s testimony was marked by language redolent of therapy-speak. Now, with her uncanny knack of nailing the zeitgeist, we have her new book, Bodies, its forlorn cover depicting a broken mannequin, scarred, shorn, its femininity represented via the slash of red lipstick and Cleopatra eyes.

The timing is spot on, coinciding with the annual smorgasbord of diet and detox regimes offering redemption to the post-Christmas porky, but which – according to Orbach – represent a complete waste of time and money, her clarion call being: Diets Don’t Work. (If they did, she says, you’d only have to do it once.) Not only useless, they’re positively damaging, throwing a spanner into the delicate cogs of the body’s metabolism. With a normally fluctuating food intake, our metabolism slows down or speeds up to keep weight roughly stable. But if the body thinks it’s starving, it’ll lay down fat whenever it can and once thrown out of kilter, it’s very, very hard to put back on track.

The morning we meet, Orbach flutters in like a bird, petite and chic in yellow skirt, yellow heels, black tights and waist-skimming jacket. Her career focus on weight and related issues was not fuelled by personal experience, although as a teenager growing up in 1960s London she did diet, she admits, but because she thought it was “what women did”.

“Like most little girls, I loved watching my mother getting ready to go to a party. The whole ritual was gorgeous, the powder, the smells – it was totally lovely. She represented glamour for me, something about femininity.” And young Susie’s mother routinely dieted twice a year.

“My mum was preoccupied with eating. The fridge was open. It wasn’t like other girls’ houses: I could have whatever I wanted whenever I wanted it. But we didn’t have sweets in our house, we didn’t have potatoes, we didn’t have bread. She was American, from a European background, so I grew up eating really good food, things my friends had never heard of such as garlic and aubergines and artichokes that my dad would bring back from Soho.” But her mother had a secret. “She would eat chocolate in the middle of the night. Because what’s the other side of dieting? You binge.” (Susie’s own parallel secret was wolfing down an entire packet of biscuits at one go, “in order not to leave evidence”.)

“I took her dieting as part of what it was to be a woman, thus creating a problem I didn’t actually have. It was like an imprint. Then, in my 20s when I came to write Fat is A FeministIssue and think about all the ideas around food, I thought, wait a minute, food ain’t bad. There’s no such thing as good foods and bad foods. There’s something called hunger.”

The relationship between eating and hunger is what we have lost, she believes, and is the root cause of all food-related problems, from anorexia through bulimia to the latest headline grabber, obesity. “I suppose obesity for me is just the visible expression of eating problems. It’s visible in the way that anorexia is visible, but it doesn’t really relate to the mass of eating problems, which I see as much more damaging.”

In Bodies, she confronts the assumption that obesity has reached epidemic proportions. “I first got suspicious about the obesity statistics when they changed over night.” BMI is, she says, “a completely stupid whimsical measure”. Based on simplistic height versus weight ratio, George Clooney, Brad Pitt and Linford Christie turn out to be obese. “And I’m sorry, but people are making money out of this. I’m not saying that there aren’t obese people, there are, but it’s not the problem it’s put out to be.”

Far more worrying, she believes, are the general eating/body image problems across the board for girls and women, and increasingly boys. “Girls constraining their eating, not eating during the week, then eating at weekends, or binging and vomiting . . . We have really lost our normal biological relationship to eating – eating with pleasure when you’re hungry, stopping when you’re full.” Not only is this healthier psychologically, but it also makes your body work correctly, she explains.

“Imagine what would happen if people stopped peeing when they needed to pee. Of course, it’s socialised – I mean you don’t go to pee in the middle of something. You go at the end or the beginning – like food. But what if you were only supposed to pee four times a day, and only a certain amount? You would create a kind of frenzy around peeing. Girls would be in clutches, and they’d be saying, ‘Oh God I’ve over-peed today . . . I didn’t pee enough . . .’ As it is, sometimes we have a long pee, sometimes it’s a little – the body regulates itself. But they’d be in competition, and then there’d be kidney problems and the rest of it. They would have mucked with the basic biological process, and I think that’s what has happened with our relationship with food.”

The body is no longer something that is essentially stable. The reasons are twofold, she says. “First there’s the visual culture, that gives the impetus and second there’s a lot of money to be made around mucking about with food.” Not to mention the diets.

Bodiesencompasses more, however, than attitudes to food. As the “post-modern myth of self-invention” takes hold, thanks to the global reach of television, from Brazil, to Iran, Fiji and Nigeria – not to mention the former Soviet republics of eastern Europe – western criteria reign supreme. For each perceived physical “defect” there is a solution: reduction, augmentation, suction. Cosmetic surgery is big business with a global value of $14 billion, and is growing at the rate of a billion dollars a year.

Just as houses – once places where we lived out our lives – have been turned into investments to be improved and traded, so too our bodies are now simply commodities, to make money from. “The poor have always used their bodies to get out of the ghetto – boxers and actresses are the obvious example – but there was always the notion of offering something, of accomplishing something. Now you ask any middle-class kid what they want to do with their life and they say, ‘Be famous’. The paradox is that these boys and girls are increasingly invisible. Their push for fame is about recognition. They have to do brilliantly at whatever they do. They have to produce the right kind of answers. They are cookie-cutter kids, and in that way they need to blend in. So how do they get recognised? Something’s gotten flattened.”

In our post-industrial world, we no longer make anything. Our bodies, which previously would have developed naturally as the result of physical work, need to be honed into shape and health artificially – via the treadmill or the yoga class, or under the surgeon’s knife. “Our bodies themselves have become a form of work,” she writes. Increasingly, the social networking sites favoured by young people use unflattering pictures to “snark” their contemporaries, resulting in what the therapy-industry calls body instability or body shame, and what is the result? More interference with nature and a crippled society, both mentally and physically.

Body distress, she says, is no longer a clinical rarity. “It now constitutes an ordinary part of everyday life for many people and many families. When I wrote Fat is A Feminist Issue, I had barely heard about anorexia. It was happening but you didn’t come across it that much. It was a clinician’s oddity.” So what happened? The 1960s, she explains, saw a fundamental shift from voluptuous to skinny as the body-shape of choice, exemplified by Twiggy.

“It was part of challenging the class structure. In the 1950s you could tell people’s class background by their clothing, just as you could by an accent. Now you no longer can, and Twiggy – a working-class girl – was part of that revolution. What happened was that this generation of women had daughters and the eating problems simply got passed on, but in a huge way. Now you’ve got women in old-age homes who haven’t eaten for years. You have kids of six who already have eating problems.”

While there have always been fads in fashion, until recently they were short-lived, Orbach contends. “You might have wanted to look like a flapper, or whatever the forms of glamour were for those times, but they were episodic. The notion of glamour did not start at the age of six and continue past 60.”

As a psychoanalyst of nearly 40 years’ experience, Orbach illustrates her narrative with desperate cases that defy comprehension. Other themes are familiar to anyone who uses e-mail, the disturbing daily injunction to enlarge breast or penis. This is just the tip of the internet iceberg, however. “Little girls can go on a Miss Bimbo website to create a virtual doll, keep it waif-thin with diet pills and buy it breast implants and facelifts.”

Self-harm, once seen as an aberration, is now standard behaviour in adolescent girls. Sex, for so long a taboo, is discussed (and practised) at ever decreasing ages, for no other reason than the drive for peer affirmation that they are “fit”, which is to say their bodies conform to a perceived norm, long before their emotions are ready.

“When my kids were little, I was vigilant to make sure that they never saw the au pair or babysitter looking in the mirror and saying ‘I hate my body’. I didn’t want my children to absorb that notion. I didn’t want them to be scolded if they didn’t eat this, or did eat that, or ate things in the wrong order. And I really wanted my daughter to have joy in her body rather than be frightened of it. I could see so much terror in girls.” While her own children have emerged unscathed from this damaging adolescent obstacle course, the problem among the young is growing at an exponential rate and it frightens her, as it should frighten all of us, she says.

So where does the answer lie? Is it too late to change? “I wouldn’t do my job if I didn’t think I could change things. Nor would I be writing this book saying, ‘Please could we have new theory and rethink the place of the body because this is serious’.” Yet even in relation to the individual patients that Orbach has treated, they will never be “pristine”, she says. “But they do find a way to live inside of their bodies, which is all they can hope for, really. They would always have a weakness, but they would have different tools to deal with it.”

As for the wider population, she believes that there are public health initiatives that could help, starting with the proper training of midwives and health visitors to help new mothers. “New mums really want to give their kids a good start. They don’t want to pass on their eating anxieties to their babies, but they are anxious, so the health visitor is very well placed to help with that, to help her understand she doesn’t have to emerge with a washboard stomach after a month, as the preoccupation with celebrity culture suggests she should. Health visitors should really help mothers to respond to their baby’s cues about eating, and not the regimented approach of Gina Ford. We need to rethink the body in such a way that we can both take it for granted and enjoy it.”

  • Bodies, by Susie Orbach, is published by Profile Books, £10.99/€12