Eating Disorders in Children

Recently, the government has declared war on obesity with the main goal to reduce the health risks of school-age children being overweight. This focus is well placed and will be extremely beneficial to millions of overweight children.

There is a caveat, however, in that we can become too focused on weight and lose sight of the health concerns which really drive the obesity issue. The danger is that in focusing on children becoming thinner, we inadvertently support stereotypes about being overweight and fuel the increase in eating disorders in children.

Research as far back as the1980s reveal that children are fearful of becoming “fat.” A study in 1983 of 201 children from 9 to 17 years-old found that children had an intake of from 32 to 91% of the recommended caloric intake for their age group because of fears of becoming fat. Unfortunately, these children did not have adequate diets and were at high risks for nutritional related diseases.

The fear of becoming overweight has more to do with the stigma of being overweight than health reasons. Overweight children are stigmatized by their peers and are at high risk for depression, low self-esteem, and isolation. The craze to be thinner at all costs becomes an overpowering motivation for many preadolescents, especially girls.

Studies have found that girls desire to be thinner even thought their weight falls within normal limits. Negative body image and the fear of being overweight are major factors in the development of eating disorders. Negative body image in preadolescent girls is related to lower self-esteem, general dissatisfaction, and psychological problems.

The most common eating disorders are anorexia nervosa and bulimia nervosa. Anorexia nervosa is defined as a willful refusal to maintain adequate body weight for age and height by restricting food intake. Bulimia nervosa is defined as binge eating followed by self-induced vomiting or purging to prevent weight gain.

Researchers estimate that roughly 1 to 3 % of middle and high school girls develop bulimia, 1% develops anorexia, and another 10% have significant symptoms of one of the disorders.

An eating disorder has long-term heath risks for children. Proper nutrition is needed for building bones and the growth spurt in puberty where 25% of height and 50% of adult weight occur. Preadolescent girls with eating disorders will have menstrual abnormalities and greater risks for low bone density and osteoporosis. For example, girls with anorexia will have a suppression of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) resulting in low level of estrogen, which will interfere with ovulation.

Even adolescents can develop osteoporosis and anorexic girls who participate in sports are susceptible to stress fractures after even a brief bout with the disorder.

The underlying issue is that most children do not have healthy lifestyles. They get far too little exercise and about one fourth of their caloric intake comes from foods with little or no nutritional value. When this basic lack of nutrition is combined with the fear of being overweight, a recipe for disaster is in the making.

Take the following scenario:

Helen explains the process and course of her 11 year-old daughter Mary’s anorexia. “I’m not sure when it started. I became aware that she wasn’t eating at times and I became concerned that she appeared to have lost weight. I talked to her doctor about it, but he didn’t think there was a problem and said her eating would change when puberty got underway. But soon her personality seemed to change. It was like you were communicating with a different person. She would also lie about it. She would look you in the eye and say that she had already eaten, when I knew that she had not. She would lie about other things too. I felt like something had just taken control of my child.”

Family life becomes disrupted by an eating disorder. Children become much less compliant, more rebellious and need more supervision at a time when parents should be giving more responsibility to them. Mealtimes become stressful and exhausting, more like on-going confrontations, than a time to interact and share the events of the day.

Researchers have shown the importance of parents taking control of the eating disorder. Parents must become diligent in managing mealtimes, how much and what their child eats. Parents must be on the same page so that they can support each other’s efforts. Otherwise they can be easily split and undermined by the child.

What parents can do to address concerns about eating disorders:
• Discussion about weight should be in the context of healthy foods rather than the context of weight. Parents want to be cautious about reinforcing negative body image stereotypes.
• Listen to children’s concerns about their body image and strengthen and support positive feelings.
• Parents should be cautious about encouraging dieting, which may support the binging and purging dynamic. Rather they should focus on providing a healthy selection according to the food pyramid.
• If an eating disorder seems to be developing, seek medical advice early. Eating disorders can be life threatening and can cause life-long medical complications. The sooner eating disorders in children are diagnosed, the less impact it will have on physical and psychological health.
• Family therapy sessions may be suggested to help parents understand eating disorders and learn how to take control. It takes parents’ involvement and support for children to overcome eating disorders.

About Dr. Roberts

Dr. Roberts has worked for the past 25 years in the field of Child and Family Development. He has a PhD in Child and Family Development with an Emphasis in Marriage and Family Therapy. He also has an EdS degree in Counseling and the MDiv degree in Theology. He directed the Marriage and Family Therapy program at Appalachian State University, Chaired the Department of Family and Consumer Sciences at Long Beach State, and chaired the Department of Child and Family Development at San Diego State University. Dr. Roberts is a licensed Marriage and Family Therapist in the state of Georgia and had his own practice before starting his long career in higher education. Dr. Roberts also holds the title of Elder in the United Methodist Church.
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