Disarming Eating Disorders -- Your Child's Food Attitude -- Kelly Brownell, PhD.
Food problems such as obesity and eating disorders affect more and younger children each year. How can you keep your child from establishing an unhealthy relationship with food? WebMD's expert, Kelly Brownell, PhD, joined us to talk about it.
By Kelly Brownell
The opinions expressed in this transcript are those of the health professional and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Welcome to The WebMD University Student Lounge, and to our "Let's Eat!" course, sponsored by Blue Cross Blue Shield of Massachusetts. Today's lounge guest is our expert on eating disorders, obesity, and body-weight regulation -- Kelly Brownell, PhD.
Member: What are the warning signs that a child has an eating disorder? I'm concerned about my 12-year-old daughter. She seems overly concerned about her body. She looks fine to me. What is normal self-absorption of a girl going through puberty and when does it cross the line?
Brownell: Whether or not it crosses the line, it will help if you and others encourage your daughter to accept her body for what it is, rather than what she fantasizes it to be. Children can be taught to enjoy their bodies and appreciate what the body can do, but it takes some work. The social messages are so toxic and pressure to be thin so severe, that most children dislike their bodies, as is the case with most adults.
Warning signs for eating disorder might be:
It helps to have an honest conversation with children, but if you expect a disorder, it makes sense to see somebody for help. Good luck!
Moderator: What kind of expert should you consult if you suspect your child has an eating disorder?
Brownell: It depends on whether there are medical concerns, in which case seeing a physician and having them do a medical screening may help. This is always a good, safe thing to do. Help for the eating disorder itself is likely to come from a counselor experienced in treating eating disorders. Look for the web site of the National Eating Disorders Organization, which has advice on this matter.
Moderator: Speaking of web sites, there has been disturbing news about pro-eating disorder web sites. Can you comment?
Brownell: This is disturbing to me, as well. Some of these sites are absolutely horrendous because people with an eating disorder give advice to others as to how to perfect their disorder. It's really too bad that this sort of thing can't be controlled, because I see it as a major problem. About the best we can do is to alert our children to the dangers of these sites, and to explain that the advice one sees in some chat rooms can be very dangerous. Parents can also find information on eating disorders on the web that's trustworthy and can provide this to some children as a means of counteracting the negative messages. I am glad you alerted people to this major problem.
Member: By how much are eating disorders on the rise in children?
Brownell: We do not have numbers from good studies to say for certain whether rates of eating disorders are changing. However, the factors that predispose a person to eating disorders, namely pressures to be thin, the need to succeed, and general life stress, all seem to be on the increase. I would be surprised if the rates are not increasing. This makes it even more important for parents to deliver positive body image messages to their children, and to protect their children from the bad environment. Engaging children in discussion of advertisements they see with models and actresses, and avoiding negative self-talk about your body can be very helpful things for parents to do.
Member: Are boys affected, too?
Brownell: Yes, boys are affected but without better science we do not know how much. In my own clinic, we are seeing more boys than ever, and they are experiencing many of the same problems that girls have. The pressure to have a perfect body is intensifying in both boys and girls. In both cases there is a need to be trim and for boys to be overly muscular. Just like most girls cannot attain the female ideal, few boys can attain the male ideal. A parent should be on the lookout for problems in both boys and girls.
Moderator: At what age do these disorders usually start in girls and boys?
Brownell: The peak age of onset for bulimia is generally the late teen years or early 20s, although people can develop the problem much later in life. For anorexia, the onset typically occurs earlier, usually in the middle to late teenage years. In some cases, though, children even as young as 11 and 12 can start to develop eating problems. Anorexia especially is a potentially dangerous disorder. Parents seeing the signs of this should get help for their children, and not sit by hoping the child will "grow out of it."
Member: I am anorexic. I started around age 10 and still struggle.
Brownell: As I just said, some begin these disorders quite early. The fact you still struggle with the problem is a sign these disorders should be taken seriously, even in young children. If you would like information yourself that might be helpful you can go to the National Eating Disorders Association web site.
Member: My daughter is 11 going on 12 and has not yet begun to menstruate. Her weight is not out of range for her height and age, but she has an "inner tube" around her midsection, and refuses to try to hold her abdominals in. Sometimes it looks as if she is expecting. She does get plenty of regular exercise. I have a history of weight problems, and her father and I are very conscientious about exercising and eating appropriately to keep the pounds at bay. The problem is that although I try to limit her exposure to treats and sweets, she would eat junk at every opportunity. How can I tell her how this will/is affecting her weight, without creating a child with eating disorders?
Brownell: Very good question. Most children will eat junk food without limit given the opportunity. The best home environment is one in which eating is not made into a big issue. Rather, healthy foods are available and eating is done in the service of health and vitality, not weight. There is nothing wrong with eating junk food once in a while but if the home environment provides healthy foods for the most part and the rest of the family is eating in a healthy manner, the environment is about as good as it can be.
Outside the home is a different matter. Children are exposed to bad food everywhere along with persistent messages to be thin. My advice is to not focus on thinness or even the prevention of being overweight, because kids get these messages in abundance, anyway. It also makes food an enemy rather than a friend. If your daughter can be convinced that in order for her to lead the fullest life she must eat in a healthy manner, food then becomes an ally and eating not so much of a struggle.
But again, the emphasis should be on vitality, energy, optimal performance in school and sports, and the ability to do just about everything better, rather than on being thin. I hope this is helpful.
Member: I have a 7-year-old daughter who has been underweight according to the doctors and their charts. How do I know if she is really too thin or not?
Brownell: Your doctor is the best guide to whether the thinness is unhealthy. Some children don't eat enough to thrive physically and need to increase eating. However, there are large variations as to how much children can weigh and still be healthy. Hence, I would speak to the doctor to find out whether my child is dangerously below a reasonable weight or whether the weight is on the low side, but still acceptable. Some children are just naturally thin. This may be true especially if you and your spouse are thin.
Member: Can you explain body dysmorphic disorder? Is it separate from anorexia, or does it lead to anorexia?
Brownell: Body dysmorphic disorder is relatively new on the scene. It refers to excessive concern with particular parts of the body. A person, for example, may have excessive concern over facial features and get repeated plastic surgeries. This is separate from anorexia but there are some common issues. Overall, if a person spends a great deal of time thinking about their body and feeling dissatisfied with their shape, weight, or other features, some sort of counseling would be in order. For people unhappy with their bodies, there are some excellent materials that have been developed by Thomas Cash. One can find his Body Image Workbooks at places like Amazon.com.
Member: My 11-year-old son is somewhat overweight. He's definitely a hefty size. He will get up after we've gone to bed, sneak out to the kitchen, and pig out. He takes food into his bedroom and tries to hide the evidence. This is so sad. He has a good dinner. How can I get him to get in better shape and to eat properly without giving him emotional problems?
Brownell: This can be a tricky path to follow, because as you said, you would like to improve your son's eating habits without making him crazed about weight issues. If he has emotional reasons that are driving him to eat, which may be the case, if you feel he is eating excessively, some sort of counseling may be helpful. But prior to this you may want to consider just having healthy foods in the house. This may be a hardship for others in the family, but if your son learns to eat healthy foods when hungry, he could be establishing habits that can help him for many years.
For some children, imploring them to eat better because of weight and health falls on deaf ears. The immediate pleasure of food prevails over long-term consequences. This is why it can sometimes be helpful to convince children that eating more good foods will help them in any area of their life. You could talk to your son about things that are important to him; let's say music, playing with friends, or doing well in school, and say that he will do better at basically anything if his diet improves. Physical activity is also a major feature of being healthy and maintaining a normal body weight. But again, exercise should be done in the service of vitality and having fun, rather than losing weight. Good luck to your son.
Moderator: Just at the age when boys need to "exercise in the service of vitality," there is a separation of boys into jocks and non-jocks. How do we encourage the boy who isn't a serious athlete?
Brownell: It is a tragedy that we equate being physically active with being an athlete. Moving about and enjoying your body while being active is something everyone should be able to enjoy. The problem, however, is our culture is organized around sports and kids who are not superior athletes or don't like competitive sports can find it difficult to have an organized way to be active. There are, however, ways that such children can be active. Parents can often do things with the children that both enjoy. Bicycling, hiking, or other activities such as canoeing, playing tennis, and even just walking to a store, can increase physical activity and provide time for parents and children to be together. Some teenagers will join health clubs, which is perfectly fine, but others simply get into a habit of walking or biking or doing active games with friends. Any movement at all is beneficial, so a child is not required to be in a sport to benefit from physical activity. Even small amounts done repeatedly can help. I hope this is helpful.
Member: I see many overweight parents with overweight children (and vice versa). How much of this is genetic and how much is environment?
Brownell: Both are important. It's difficult to know in any individual how much genetics and how much environment contribute. Parents pass along to children not only genes, but also eating habits. If parents struggle with weight, it's more important than ever to create a healthy food environment for their children at home. It's also helpful to discuss with children the fact that the environment seduces them with inducements to eat. All children, especially those prone to weight problems, need help from parents in how to deal with this bad environment.
Member: My toddler seems to want to graze all day long rather than eating regular meals. Is this a good thing or should I steer him toward the traditional three meals a day?
Brownell: What's most important is that the overall diet is good. If your child is maintaining a healthy weight and is eating a balanced diet of healthy foods, I would not worry so much about the pattern of eating. If your child is grazing because there are tempting treats around the house then there would be more of a problem. But grazing on good food is a good thing.
Member: My 15-year-old seems too focused on being "skinny." How can I communicate to her that she's perfectly fine just the way she is?
Brownell: It's very important, given her concern with being skinny, that she hears positive messages from you. Delivering messages about accepting variations in body shape is very important. You can tell her that our culture accepts differences in skin color, eye color, facial features, and other physical characteristics, so it's simply not fair to expect everybody to have the same shape and weight. It can also help to point out that even the models in the magazines have had their images doctored by the computer. Basically this means that no one is good enough -- not even the most highly paid models. To give in to this arbitrary pressure is to yield control rather than achieve control. Children can come to love their bodies, but it takes some work due to the difficult environment. You may also wish to go to the Internet and find some materials that would be helpful on improving body image. Good luck with everything.
Member: Already it has started. My daughter is in third grade and not one of the skinny ones. She's not fat either. But now she's moaning about being fat because the popular girls are so thin. Help!
Brownell: It's very sad to hear these stories. Children her age should be carefree and enjoying themselves rather than being critical. Your daughter's vulnerability to peer influences will only increase with time. This is why it's terribly important for parents to actively engage children in discussion about body image. It's important to emphasize that a person's self worth should not be driven by how they look. Good luck to you and your daughter.
Member: I have struggled with compulsive overeating my entire life. How can I help my children when I can't stop myself?
Brownell: Compulsive overeating can be a real problem. There is an excellent book on the topic I suggest you consider. It's called Overcoming Binge Eating, by Christopher Fairburn. Fairburn is one of the world's experts on this issue and has written an excellent book. Some need additional help, in which case you may see a counselor. You are correct in feeling that if you improve your own eating habits, you will have a positive impact on your children.
Member: My parents are obese and it made me want to stay thin, probably causing my obsession with staying thin. I saw everything they went through being overweight, and I take extreme measures to assure that doesn't happen to me.
Brownell: Having overweight parents can have many effects on children. Some respond as you do, developing the aversion to even the idea of being fat. One can react excessively to this and go overboard when an eating disorder develops. Some middle ground would be nice, where one is concerned with being overweight but engages in moderate and healthy behavior in its pursuit. I'm glad you raised the issue.
Member: I worry about eating too much, so I take ephedrine to curb my hunger. Can that do more damage than not eating?
Brownell: There are many diet products available, but very few of them have been tested for safety and effectiveness. There is special concern with products that have ephedra. The FDA has issued warnings about this substance and has reported a number of deaths associated with diet products. Still, the government regulates these products poorly. Just about any slimy person can sell these products and get away with it. My advice is to stay away from any product you see advertised on the Internet, television, in magazines, or in newspapers. If you see something you think might be credible, speak to your doctor first. The healthiest way to lose weight is to follow a reasonable diet and have an exercise plan. A good place to find information at no cost is www.nutrition.gov. I hope this helps.
Member: If a parent has or had an eating disorder, is it more likely that a child will develop an eating disorder?
Brownell: The research on this topic is not clear yet, but the answer is probably yes. This does not at all mean that a child in this situation is destined to have an eating disorder, just that their risk may be increased. It is very important for parents to be sensitive to ways they behave that can help or hurt a child's body image. Parents should avoid talking about their own bodies in front of children, unless to say positive things about being vigorous and energetic, and in good condition, because of optimal diet. Being critical of oneself can be hurtful to children. So when you are trying on clothes or looking at yourself in front of the mirror, watch out for negative self-talk. It's also important to focus on food as a means of increasing vitality and overall well-being rather than as a means for losing weight.
Moderator: Before we wrap up for today, do you have any final comments for us, Dr. Brownell?
Brownell: A number of you asked questions about how to help your children with eating concerns. Never doubt for a minute your potential to have a positive impact on your children. Children do need your help because they are hearing so many bad messages otherwise. Living in a home where food is a friend and where people accept their bodies can be a big help for children. Children deserve to feel good about their bodies, to respect their bodies, and to appreciate the positive things their bodies can do. Delivering this upbeat and optimistic message can help children feel good about themselves no matter what they weigh. Good luck to you all!
Moderator: Unfortunately, we are out of time. Thanks for joining us, members, and thanks to Kelly Brownell, PhD, for being our guest.
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