Children see, children do.
A little girl watches her mother every morning as she stands before the full-length mirror, pulling her clothing this way and that while critiquing her body shape and size. One day, the mother catches her daughter posing before the mirror, shaking her finger at her reflection and saying, "Fat, fat, you are just too fat. No more cookies for you!"
Isn't that funny ... a person might think ... that sprite of a girl pretending she's fat!
The girl's behavior might seem amusing, even cute, but it could be a harbinger of a weight obsession. It could be an early warning that the child is at risk for developing a full-blown eating disorder that could stunt her growth, delay the onset of puberty and cause a host of medical issues including heart problems and osteoporosis.
Experts on eating disorders -- disorders that typically affect teen-age and college-age females -- have noticed in the last seven or eight years that children under age 12 are joining the ranks of those who endanger their health in the quest for thinness, beauty, perfection. Most of the known cases involve girls, but experts caution the number of boys concerned about their weight is steadily climbing.
A 1991 study revealed that 42 percent of girls in first through third grades want to be thinner, according to information on the Eating Disorders Awareness and Prevention Inc. Web site www.edap.org
The nonprofit organization also cites studies showing that 81 percent of 10-year-olds are afraid of being fat; 51 percent of 9- and 10-year-old girls feel better about themselves if they are dieting; and 46 percent of 9- to 11-year-olds are "sometimes" or "very often" on diets.
"I've definitely noticed an increase in children being worried about their weight," says Beth Wilson, chairman of the Department of Family and Consumer Sciences at Harding University, Searcy. Wilson is a volunteer community resource person for Eating Disorders Awareness and Prevention. "Even preschoolers see themselves as too fat or too thin. There are even children exhibiting some disordered eating patterns by age 4, by refusal to eat or being afraid to eat certain foods for fear of being fat."
The National Association of Anorexia Nervosa and Associated Disorders estimates that 7 million women and 1 million men, including children, have eating disorders. Other organizations devoted to preventing eating disorders report similar figures.
Alarming figures were reported in the early '90s by the Medical University of South Carolina after a study of more than 3,000 middle-class fifth- through eighth-graders. The university found that 40 percent of the children surveyed felt fat or wished they could lose weight; 30 percent had already dieted; 8 percent had fasted; 30 percent had taken a parent's diet pills or diuretics; and almost 5 percent had forced themselves to throw up after eating.
"Weight issues have become an obsessive concern for American children of all ages," wrote nutritionist Francie M. Berg in her 1997 book Afraid to Eat: Children and Teens in Weight Crisis. "Clearly it is a national crisis when harmful attempts at dieting are common in the third grade and before."
Why would young children be worried about their weight?
Children see, children do.
Many experts theorize that children who restrict what they eat, engage in excessive exercise and purge after eating are copying behavior they've seen in adults or reacting to society's obsession with weight and media messages that equate thinness with beauty.
"When you have a 4-year-old girl practicing bulimic [purging] behavior, she would have had to see that somewhere," Wilson says.
"Children listen and hear everything that's being said whether we're aware of it or not. They're taking in a lot of what they hear adults say when commenting on their body shape or body size," she says. "By the time they are 6 or 7, they are dissatisfied with body size, which leads to wanting to do something about it."
No one really knows what causes a young child to start worrying about weight, says Dr. Maria Portilla, medical director of the Eating Disorder Clinic in the Department of Pediatrics at Arkansas Children's Hospital, Little Rock. Teens with eating disorders such as anorexia nervosa (restricting food intake or refusing to eat), bulimia (bingeing, then purging by using laxatives or vomiting) or a combination of the two are primarily motivated by body image. They become obsessed with being thin: No matter how much weight they lose, they still see themselves as being fat.
"Young children might not have much of an issue with body image," Portilla says, "because kids under 12 don't have that abstract thinking [that teens have] and ... they have different things going on psychologically. It's hard to come up with the why."
Portilla theorizes that children who restrict how much they eat, count calories or fat grams, exercise excessively or purge after eating are probably imitating the behavior of an older family member. She noted the case of a 4-year-old girl whose parents brought her to the Eating Disorder Clinic because she was throwing up after every meal.
"After hours of interviewing the parents, we discovered that Mom was vomiting after eating," as were two other adult family members, Portilla says.
Children not only imitate "disordered" behavior such as purging, but also go overboard when responding to the "positive" messages they get from health-conscious parents. For instance, Portilla says, a mother and father may believe dairy products are unhealthy or they may cut all fat from their diet. "That gets out of hand," she says. "The child may refuse to eat anything but fruits and vegetables," which isn't a balanced diet. "It's a compulsion and kids think that is what they are supposed to do because they've seen Mom do it."
Eliminating all fat from one's diet is unhealthy, Portilla explains. "Even a patient with a heart problem needs at least 20 percent fat in his diet."
Besides imitating behavior of the adults in their lives, what else would cause children to worry about weight?
Children see, children do.
They respond to images they see in the world around them.
"We're living in a culture that has embraced thinness as the way to be," says Kathy Kater, a licensed independent clinical social worker in St. Paul, Minn. "From the time kids are able to even read, they begin to read the covers of magazines as they go through checkout counters with their parents. They see billboards exclaiming you can lose weight fast and diet ads on TV. A lot of times those advertisements don't qualify that their targets are overweight people. Even children as young as 5 or 6 are growing up believing that part of life is losing weight."
Kater counsels teens and adults with eating disorders. About five years ago, she became frustrated by what she saw as the medical community's lack of progress in preventing eating disorders.
She developed a curriculum for fourth-, fifth- and sixth-grade children to give them knowledge about nutrition and their bodies so they would not be vulnerable to the constant barrage of images and messages promoting thinness as an ideal. Her program is called "Healthy Body Image." (See accompanying story.)
Portilla agrees that the value society places on physical appearance can cause a child to worry overmuch about weight.
"Without even mentioning the word 'thin,' our society is so appearance-oriented," Portilla says. "We change our eye color with contact lenses, we go to tanning booths to change our skin color, we color our hair.
"We're always worried about how we look."
What can be done to help children develop healthy attitudes toward eating, their bodies and weight?
Children see, children do.
"Your behavior as a parent may help your child to avoid eating disorders," according to an article on the Eating Disorders Awareness and Prevention Web site. The article warns parents that their body image affects their child's body image. "If you constantly say 'I'm fat,' complain about exercise and practice 'yo-yo' dieting, your son or daughter may feel that it is normal and acceptable to have a distorted body image."
EDAP encourages parents to let children help them cook nutritious meals, convey to them that exercise can be fun and let children know that they are valued for who they are, not how much they weigh.
Parents are often the key in effectively treating the children she sees at the Eating Disorder Clinic, Portilla says. "With children under 11, you try to do therapy with the children, but you really have to include the parent -- either with the parent and the child, or with the parent alone. It depends on the child."
It's difficult to do the type of counseling that works with teens and adults, she says, because a child may not realize why she's worried about weight and sometimes isn't even aware her behavior is abnormal. "It's hard to sit down with a 6-year-old and engage in any meaningful therapeutic discussion," Portilla says. "A child is not going to talk about issues of control and self-esteem on the same level as a teen-ager."
Despite that, she says, a younger child has a better chance for recovering from an eating problem because "she's not as sophisticated in her thinking ... you can set her structure." The clinic's therapists and doctors work with the parents to understand how much influence they have on a child's attitude toward food, eating and weight. They teach parents about the child's nutritional needs and help them determine what kinds of changes they need to make in their household to meet those needs.
"As adults, we have to be more responsible about comments we make about food, about how we look. We have to watch what we say to kids about their weight," Portilla says. "It's important to be an appropriate role model and practice appropriate nutrition."
Children see, children do
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