Our failure to deal with the scourge of eating disorders has created a public health emergency, Susie Orbach tells Reva Klein

Forget condoms, vaccines and gas masks. The public health crisis we’re in the midst of is virulent and has no quick fixes. This is the belief of Susie Orbach, arguably the most high-profile shrink on the planet: she treated Princess Diana and, more importantly, in 1978 she wrote Fat Is A Feminist Issue (FIFI to its fans), changing the way a generation of women saw their relationship with food.

The crisis she’s now concerned about is based on numerous studies that show that girls and women of all ages in this country, throughout the West and beyond, believe they’re overweight and adopt self-destructive strategies to lose weight. A pre-Christmas MORI phone survey carried out by Penguin Books asked 500 British women whether they would take a magic pill that would give them the body they wanted, even if it meant endangering their health. One in four said yes. Two-thirds of young women said they would swap their bodies with someone else.

Anorexia and bulimia represent the extremes, but there are many more females who from an early age get caught up in a cycle of constant dieting. The cruel irony of this cycle of self-denial is that it not only makes you miserable and preoccupied with food, it makes you fat because of the havoc it wreaks on your metabolism.

Orbach is girlishly slender and, as if to prove the point of her latest book On Eating: change your eating, change your life, she munches on a brownie in the Hampstead cafe where we meet to demonstrate how rational she is about food. The central point of the book is that eating is a metaphor for the way we feel. And, more often than not, we feel terrible about our bodies because they don’t conform to the oppressively idealised images of thinness that are impossible to avoid and as impossible to attain.

This has led to the situation we have today where girls - and to a lesser but growing extent boys - are learning from primary school that their bodies aren’t like models’ and actors’ and that they have to do something about it. So they diet, they binge, they become obsessed with what they can and can’t eat, when they can eat it and in what quantities.

And with this comes an ingrained, hard-to-shift dissatisfaction with who they are and what they look like that can stay with them for the rest of their lives. Victoria Beckham and Uma Thurman have both recently revealed that they have had body dysmorphia, which means that when they look in the mirror they perceive themselves to be fat. If these glamorous women can hold on to those insecurities, what hope is there for pubescent and adolescent girls who are constantly comparing themselves to such celebrities?

Orbach is appalled at the scale of the problem. “In this country nearly half of 25 to 35-year-olds are on some kind of diet and 20 per cent of young women say they diet all or most of the time. And two-thirds of a sample of 14 to 16-year-old Australian girls think of themselves as fat and use crash diets, smoking and other methods to lose weight,” she says. It doesn’t all come right once you get older, either. “There are 70 and 80-year-old women in old age homes who are anorexic,” says Orbach.

Eating disorders are no longer confined to the West. She tells me about the Saudi women with eating disorders coming to the London Women’s Therapy Centre, which she co-founded in 1976. And then there’s the recent study from Fiji showing how graphic the cause and effect of the media can be. “Three years after the introduction of American TV in Fiji, 15 per cent of girls have been diagnosed with bulimia. It didn’t exist before they were exposed to programmes such as Friends.”

Orbach believes that the book’s message - if you understand how you think about and use food, you’ll conquer it - should be introduced into primary as well as secondary schools: by the time girls finish Year 6 they may be set on a lifelong treadmill of dieting.

Providing a mix of thought-provoking insights into why we over-eat and offering practical strategies for dealing with it, the book is eminently user-friendly for young people and adults, though some of the advice could create momentary ripples.

For example, parents may be bemused, if not alarmed, when their daughter demands a tub of ice cream as a main course, but if they’re told the advice comes from Susie Orbach and is predicated on the belief that it’s only by conquering our fear of binge-triggering “indulgent” foods that we can move on, they may be less averse to running to the freezer.

To tie in with the book, Orbach is planning to run workshops in schools later this year for teachers and pupils. “If teachers are helped to understand their own relationships with food and how it’s a metaphor for things in their life, it would enable them to interrogate their own prejudices about eating and size. There’s no doubt that they have the same issues as everyone else.”

She would like the book to be used as part of the curriculum once teachers have gone through their own “exploration” of the issues. She cites the example of Frankfurt, where she has run groups for young people on body image as part of the curriculum, tied into nutrition theory and fashion. “There are a number of ways you could bring this into the national curriculum. Instead of sticking it into PSHE, you could put it into science or design and technology.” Her publisher Penguin is planning to set up a website on the book which will put people in touch with each other to discuss related issues. She hopes to make a weekly visit to a chat room on the site.

Despite the fact that “I’ve written 10 books and only four of them are on eating problems”, Orbach has a missionary zeal to purge, if you’ll excuse the expression, the world of this scourge. On Eating was written as a result of the frustration that followed the summit on body image that Downing Street hosted in 2000. “We got magazine editors and clothing manufacturers together to talk about changing the visual imagery surrounding fashion for the first time. But then the Government dropped the campaign when some of the papers lambasted the nanny state for ‘intruding’. Now we have a public health emergency that the Government has failed to take on. Someone’s got to do it.”

For more information about ‘On Eating’ and the issues it raises, see Penguin’s website: www.penguin.com