Teen Eating Problems: A Live Chat with Kelly Brownell, PhD, Director of the Yale Center for Eating Disorders

Keeping the relationship your kids have with food healthy

WebMD Weight Loss Clinic - Live Events Transcript
Event Date: March 20, 2003

How can you keep your child from establishing an unhealthy relationship with food? And what are the best ways to avoid conditions like anorexia, bulimia, and compulsive eating? The Director of the Yale Center for Eating Disorders, Kelly Brownell, PhD, joined us to talk about it.

The opinions expressed herein are the guest's alone 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.

Member: How do you deal with a teen who wants to eat vegetarian?

Brownell: There is nothing wrong being vegetarian. A vegetarian must be very careful about eating a balanced diet, but it can certainly be done. If being vegetarian is a means of restricting intake, and may be signs of an eating disorder, then perhaps some professional help might be in order. So, the motivation of being vegetarian really is the key here.

Moderator: What are the signs of an eating disorder in teens?

Brownell: There are different eating disorders. It would probably take me too long to list the diagnostic criteria here, but there are some excellent web sites. One excellent site is nationaleatingdisorders.org. I must add, however, that a person may not meet a strict diagnosis, but still have problems that should be addressed. If a person has his or her behavior or his or her psychological well-being affected by desires to be thin and to restrict eating it makes sense to get professional help. The web site I mentioned is a very good place to start, to find both information on what an eating disorder looks like, and what might be done about it.

Member: Do eating disorders only affect teen girls or can boys get them, too?

Brownell: More and more we realize that boys can have eating disorders much the same as girls. In clinics like ours we will see eight or nine female clients to every male we see. This does not mean, though, that males do not get eating disorders. It is generally the case that males are less likely to seek help for problems of any kind, plus most media attention is on eating disorders in females. Thus, males may be unaware that their problem is an eating disorder or may be reluctant to speak about it. In our clinic and others, a good success has been found with males we encounter. Therefore, I encourage any males with such problems to learn more about eating disorders and if needed, to get professional help.

Member: I am a school nurse dealing with about three cases of anorexia, one bad enough to be sent to a hospital. She is returning next week. The kids have asked what to serve if they have a birthday party or special class event; the same thing they are having or make accommodations?

Brownell: There is no reason to treat this young woman differently than any other child. If her friends and the adults around her begin treating her as if she is her disorder, she loses her individuality and identity. In addition, there is not much that outside folks can do that would make the disorder worse or much better, other than to be generally supportive.

With that said, anorexia is a very serious disease. This is especially true for a person who has required time in the hospital. It is essential that follow-up care be provided, but I suspect the hospital program arranged this for the girl.

It can be helpful to watch for signs that the eating disorder is not over, or emerges at a later point. It is perfectly reasonable to keep parents informed about what you observe as a health professional.

Member: How can I as a school nurse encourage those girls that need to maintain a more healthy body weight achieve that without giving them notions that they are "fat"?

Brownell: You raise a very good point. In a high school or middle school, health professionals face this fine line where you want to encourage healthy eating but not exert undue pressure for people to be thin. We typically recommend that for the general student, eating and physical activity placed in the context of improving energy, vigor, and overall well-being and confidence, not weight loss.

For students who appear to be developing eating problems, it is important that they get help. Eating disorders can be serious, and can grow worse with time, so students and parents should be encouraged to pay attention. Particularly for the students who have anorexia, denial is strong. Students may ask you to keep their problems in confidence, but if you suspect that a student truly has an eating disorder, it is important to tell the parents, and perhaps to work with them in getting help for their child.

Member: Wrestling season just ended. I was appalled at the things the boys at our high school went through to make weight, whether they needed to go up or down. Isn't this harmful? Can't this lead to eating disorders?

Brownell: This is an interesting question. My colleagues and I have studied this issue, and typically find that the disturbing behavior that is promoted by the sport of wrestling tends not to be carried on beyond the wrestling season. Stated another way, boys appear to be drawn to wrestling for athletic reasons rather than as a means of dieting in a socially acceptable way.

There may be some boys who do develop a more permanent problem that persists beyond the wrestling season, so parents, coaches, and healthcare professionals should be alert to signs of an eating disorder. But I would certainly not say the majority of wrestlers develop permanent eating problems.

Member: Are moms who talk a lot about their appearance and their daughters' appearances, such as clothing and hairstyles, etc., unknowingly contributing to potential eating disorders as much as obsessing over weight and diets?

Brownell: There are a number of studies on what is called intergenerational transmission of eating disorders. It does appear that mothers who are critical of their own appearance, speak often of how they look, or are constantly dieting in a way that is public to the family have daughters (and perhaps sons) who are at an elevated risk for developing eating disorders.

Children learn from the media and from friends that they are to be evaluated for how they look rather than who they are as people. This is a terribly harmful message, but is a relentless one. Sometimes a child's only buffers are messages delivered by parents. A child must learn that their body is their friend. They should celebrate what their body can do, how it allows them to lead an active and happy life, and not feel that their body betrays them when they fail to meet some social standard.

Parents are in a position to protect their children from these toxic messages, or to make the messages even more powerful than they are already. Parents can either not speak about their own bodies and their physical appearance of their children, or deliver positive messages. Parents can also be good models, healthy, reasonable eating, and regular, but reasonable exercise.

Member: What is "normal" as far as a teen boy's eating habits? My son seems to eat as much as he breathes! He isn't overweight. I am just worried that as he gets older his enormous eating habits will get the best of him. And I am concerned about what it is he eats (way too much pasta; and I was so happy when he learned to cook!).

Brownell: It would probably be a mistake to ask your son to change his eating in order to prevent later weight problems. This would probably focus him on weight when he otherwise may not be worried. It certainly does make sense to work with your son on healthy eating, not in the service of weight, but in the service of his overall health, energy, and happiness. He sounds old enough to understand nutrition on his own. There are some excellent web sites with information that may be helpful both to him and you. A good place to start is nutrition.gov. I hope this is helpful.

Member: Does the "starving kids in China -- clean your plate" argument make for trouble as kids become more independent and make their own food choices more? Does it lead to overeating?

Brownell: The issue has not been studied enough for me to give you a definitive answer. My best guess is that the "clean your plate" philosophy is counterproductive, because it teaches children to ignore their own internal signals of hunger and pay attention instead to what somebody else serves them. Given that portion sizes are so enormous, people are usually served more than they need. It is best, therefore, to let the child decide how much is to be eaten and to learn to follow internal signals rather than external cues.

Member: Both of my teens are athletes. What should they be eating before and after competition? My son plays baseball and football. My daughter is a swimmer.

Brownell: There is some very good information available on sports nutrition. If you go to a web site like Amazon.com and put in the name Nancy Clark in the search field you'll find several fine books on nutrition in both male and female athletes.

Member: What do you think about sports drinks?

Brownell: My own belief that sports drinks are highly overused. For someone who has been quite active, the sports drinks can be very helpful because they replenish electrolytes. The problem in my mind is that many youngsters are drinking these sports drinks in large amounts, not realizing that they are basically sugar water and can add a considerable number of calories to the diet. The other problem is that the serving size of sports drinks, the 20-ounce bottle, whereas when children are drinking other soft drinks, sometimes at least they have smaller servings.

"Our foods tend to look so unlike what comes from the farm that Dr. Frankenstein would be impressed."

Overall, sports drinks should probably be used in moderation and not considered a source of good nutrition other than the impact they have in a person who is being physically active. Stated another way, water may often be just as good, but without the calories.

Member: How can I get my teens to think about what they eat? I don't supply junk food, but they are mobile and have their own money.

Brownell: The problem parents face is that their children live in the real world. No matter how ambitious a parent might be in teaching their children good nutrition, children still watch television, go to friends' houses, and are exposed to all the drive-in windows, convenience markets, and soft drinks and snack foods in schools that affect everyone. A power struggle can begin between parent and child if the parent tries to manage the child's eating too closely. What probably works best is to provide as much nutrition information as possible, and to focus on how healthy eating can enable a child to reach his or her goals in life, because the good food will promote health and happiness.

Member: Now that the kids are in high school, they have so many activities that their schedules are quite busy. We used to always have dinner together as a family. How important is family dinner?

Brownell: Family dinner turns out to be quite important. There is good research showing that children's diets deteriorate when the family does not eat together. There are many potential reasons for this. One is that families who can't eat together may be especially busy or stressed, and therefore have little time for anything other than convenience foods. As you know, the more convenient a food is, the less healthy it tends to be. For example, there are very few places where one can go to a drive-in window and get a good-tasting healthy meal. It makes sense to have family dinner together as much as possible, but when this doesn't work, find ways to eat quickly and conveniently, but with healthy foods.

As I mentioned before, there is very helpful nutrition guidance available on the Internet. A good website is nutrition.gov.

Moderator: I have found that having my teen help shop for groceries and help prepare meals means that they are more likely to be there for family dinners and to eat more healthy.

Brownell: This is an absolutely terrific idea. We as modern human beings are often very distant from our food and from the origins of our food. Our foods tend to look so unlike what comes from the farm that Dr. Frankenstein would be impressed. Having a child involved in the shopping and preparation of food is a very good way for her or him to be in touch with what food is and how important it can be to good health.


Eating Disorders: Anorexia, Bulimia, Binge Eating See Slideshow

Moderator: And if you are lucky enough to have some space to grow some veggies or fruits, get them involved in that, too!

Moderator: Do teens have any special nutritional needs?

Brownell: Teens do have special nutritional needs, because they are growing and developing. But basically, teens should be aware they must eat enough healthy foods to have a vigorous body, but should also avoid too much of foods high in fat and sugar. Nutrition can get very complicated, but it also possible to distill it down to its basic components. If a person eats lots of fruits and vegetables and avoids junk food (most people understand what this means), you may be 80% or 90% of the way to a really good diet.

Member: What age is too young to diet?

Brownell: I am inclined to say that "dieting" is not good at any age. What is good is healthy eating in the service of well-being, and not in pursuit of thinness. Dieting, and the food restriction it connotes, can be especially harmful to young children. It can lead them to a lifetime of unhappiness with their bodies, aspirations to look like the anorexic models and actresses that they see on television, and general unhappiness.

It is best if children can learn that food is their friend, and can focus more on increased amounts of healthy foods rather than restricting the unhealthy foods. The typical American does not like his or her body, no matter how good they look to someone from the outside. This is the background that all children will face. It is important for parents counteract these messages by helping children celebrate their bodies rather than to consider the body bad.

If a child is overweight, parents might consult with a pediatrician and come up with a healthy eating plan, but again, focus more on health than weight.

Member: My daughter seems to go through weird eating phases. One week it's all yogurt. The next week she is vegan. Then it's, "I need to eat proteins." Then it's all salads followed by a week of Oreos and milk. One week she went on a pickled beet binge! Should I be concerned about her weird eating habits or does it all work out in the end?

Brownell: It will be important to learn your daughter's motivation for making these changes. If her diet is so chaotic and she wishes to lose weight, or because she's heard something about food having miracle qualities, she should be educated immediately on having a balanced, reasonable, but good tasting diet. Having pickled beets, yogurt, or any other food exclusively is not healthy because the body is deprived of nutrients that those foods do not provide. Once again, balance is the key concept. If a child can be convinced that in order to provide their body its best fuel you must get a mix of nutrients, that can help her stay away from bad diets.

Moderator: Do you have any advice for helping teens who need to follow a special diet due to health issues (diabetes, celiac disease, etc.)? Teens want to fit in and not be perceived by their peers as different or weird.

Brownell: It can sometimes be very helpful to meet with a registered dietitian. Dietitians are very skilled at helping people figure out how to live with different diets. Such a person can be very helpful in judging what types of common foods a person can eat and still maintain her special diet. Ultimately, it is nice if teenagers' who have special diets know a range of foods they can eat, but also are aware of what can happen if they stray too far from the optimal eating plan.

Member: I'm afraid that bullying about weight will lead my teen niece to crash diet. What can I do to help her feel better about her body image?

Brownell: A very important message that parents can deliver is that social injustice occurs when people are evaluated by how they look. It is obviously the case that our society DOES evaluate people for how they look, so children need to be protected from this so they do not come to believe that their worth as a person is established by their physical appearance.

With that said, obesity can have negative health consequences, and it does represent a social disadvantage. Therefore, parents can be very helpful working with their child to develop a healthy eating plan that focuses on balance and good nutrition, knowing that weight loss will likely follow once a healthy diet is established.

Also, a parent whose child is bullied because of weight has every right to step in and speak with school officials about this behavior. It is not acceptable for children to tease others based on physical attributes. If the bullying becomes a real problem, school officials need to step in and the parents of the bullies should be informed.

Moderator: Dr. Brownell, we are almost out of time. Before we wrap up for today, do you have any final comments for us?

Brownell: I'm pleased to see that so many parents are paying attention to eating and nutrition issues in their children. The environment is so bad that children are blitzed with messages to eat unhealthy food. If there is anyone who can help counteract these negative forces, it is parents. You and your children can benefit tremendously from eating a healthy balanced diet. Anything parents can do to help children develop habits that can last a lifetime could make a big difference over the long term.

Moderator: We are out of time. Our thanks to Kelly Brownell, PhD. For more information and advice about diet and nutrition, visit our WebMD Weight Loss Clinic message boards.

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