Disordered eating issues are on the rise, and younger children are being diagnosed at conerning rates. Current research shows that up to forty percent of 9 year-olds have been on a diet, and eating disorder hospitalizations for children younger than 12 increase by one hundred and nineteen percent between 1999 – 2006. The sharpest increase in treatment was seen in boys and minority youths. Anorexia in a young child is more dangerous than in an older teen, mostly because the body is developing at a rapid rate, and both brain and bone development are affected very quickly when calories are restricted.
Treatment for such young children can be difficult as lengthy hospitalization stays can be traumatic when the child is away from their parents and the comforts of home. Plus, children are often not mature enough for traditional talk therapy. For these cases, a medical and family approach can be extremely beneficial: using food as “medicine” to re-nourish the brain and allow the child to think more clearly, while also addressing any family issues that might be contributing to the child using food as a means to cope. Setting boundaries in the family system to not collude with disordered behaviors, as well as having the parents involved and plate out meals to help re-feed their child, sets the expectation that the eating disorder will be defeated.
Currently, there are several emerging and continuing trends that parents should be aware of, and that their child may be exposed to on a daily basis. Keeping these influences in mind may help to protect your child from unhealthy influences, as well as open up a dialogue around curiosities and social stimuli.
1. Internet and Social Media Influences: The Internet is filled with an innumerable amount of unhealthy resources. Facebook provides a platform for a life that isn’t reflective of reality, where kids post the best pictures of themselves and provide embellished status updates. Many spend endless hours stalking their “friends” profile pictures leaving them with a strong desire to achieve a look or body that can never be imitated. “Fakebook” creates a false sense of reality, and depression or anxiety when the comparisons to others create insecurities.
“Pro-Ana” websites (those that encourage a low body weight and restrictive behaviors) provide tricks and tips that promote dangerous, disordered behaviors, under the guise of a sense of belonging to such an elite group (i.e. no one else has discipline to achieve an ideal body other than those who are most dedicated to the disorder). Even scarier are the sites such as Omegle or ChatRoulette, where pedophiles and predators try and seduce minors into taking their clothes off, all under the promise of being anonymous. No age requirement or registration necessary, and those that aren’t getting enough attention easily fall victim to such sites.
As much as there are negative influences that are surrounding your children, there are positive ones as well. There are new movements in place (i.e. peer counseling groups in school or church) to help support and prevent disordered eating issues. These groups utilize positive role models as a way to counter negative messages through the media or in their community, and help to develop a healthy self-esteem. Further, the National Eating Disorders recently launched their website www.Proud2BMe.org, to promote healthy attitudes about food, weight and body image, targeting tween, teens and young adults. WebMD also has their own site geared towards children and tweens, atwww.fit.webmd.com/kids.
2. Bullying and Body Image: A recent study shows that almost 50% of those diagnosed, attributes bullying as a main contributor to the development of an eating disorder. Starting in elementary school, bullies target those people who are most sensitive, the same type of people with the temperament to develop eating disorders. This group tends to over-personalize when others talk about them, and they generally have less confidence to stand up for themselves and fight back. When bullying takes the form of making fun of a person’s weight or teasing about body shape, it contributes to the development of an eating disorder. As a result, the victim develops extreme anxiety at the possibility of future attacks, and turns to food as a means to cope. To complicate the experience, disordered behaviors then create an inner bully, a relentless critic that mirrors what they are experiencing in the outside world.
Setting boundaries and developing empathy are two core ways to battle both the inner and outer bully. Stand up for yourself and others with a no tolerance policy for the mistreatment. Create empathy for yourself and commit to recovery from the disordered behaviors. Seek help from adults, authority figures and professionals when needed.
3. Eating Disorders in Boys: Even though 5-10% of those with diagnosable eating disorders are boys, it may in fact be higher due to underreporting rates and current diagnostic criteria (current criteria includes amenorrhea, or lack of menstrual cycle). Boys are often socially isolated because of their disorder, more easily bullied by others, and less supported because they are not expected to be affected by food/body image issues. Boys are vulnerable to the development of an eating disorder due to opportunities to engage in unhealthy behaviors outside of the home (gym/athletics). Boys encourage each other to “work out hard,” and often ridicule those who are “weaklings.” Sadly, this type of bullying behavior is usually dismissed as “guy talk.”
Start a dialogue with your sons at an early age around food and body image issues. Don’t assume just because they are boys that they will not be affected or be challenged with issues of self-esteem. Work with them to develop a strong, authentic sense of themselves, and if you see signs of any emerging disordered eating issues, intervene with concern as soon as possible.
4. Athletics and Performance Pressures: According to the Clinical Journal of Sports Medicine, an estimated 13-42% of athletes are affected by an eating disorder, depending on the sport and the gender of the participant. Athletes face an even greater physical risk to themselves compared to non-athletes due to the stress that they place on their bodies on a daily basis. Those most vulnerable are involved in appearance sports (i.e. gymnastics, swim, figure skating and dance), but eating disorders are also common in endurance sports (i.e. running or cycling) and sports that have weight classifications (i.e. wrestling). Many cases of eating disorders are not reported or handled in secret, due to the pressures on athletes to perform and encouragement of coaches for achievement.
Coaches, teammates and parents should be aware of the traditional physical warning signs of eating disorders, which if left untreated can have serious health risks, including cardiac failure. These consist of:
• Menstrual irregularities or amenorrhea
• Low blood pressure or dizziness
• Decreased stamina in performance
• Weight loss
• Bradycardia or heart arrythmias
• Fine hair on the body
• Swollen or puffy cheeks
• Frequent complaints of feeling cold
• Hair loss
Parents whose children participate in athletics should make an effort to closely monitor their child for any warning signs of disordered eating. Consistent communication with the coach can help to ensure that the child is being appropriately monitored, and creating an open dialogue about any concerns will also allow the child to be accountable for their actions as they build their talents and strengths. If you notice that your child is becoming extremely competitive, exhibiting a severe preoccupation with their ability level or feeling pressure to perform, intervention may be necessary. Further, consult with your child’s physician to ensure that they are medically stable to perform.
5. Academic Achievement: Expectations New pressures to be accepted into college are creating added pressure for children starting in elementary school. Those tweens with already high expectations for themselves will establish perfectionistic standards that are near impossible to reach. Success of their peers will increase competitiveness, and despite any achievements, there is still some sense of inadequacy. Self- esteem is strongly tied to success, and any real or perceived “failure” produces guilt, shame and a sense of worthlessness. Those with any predisposition to eating issues will try and “control” their environment through food in effort to increase sense of power when feeling helpless in other areas.
Work with your children to attain balance between working hard and setting realistic, achievable goals for themselves. Place importance on having fun, and encourage them to take breaks from any pressures that they place on themselves. If you notice that their anxiety or perfectionism is affecting how they eat, begin a dialogue around how you can be helpful to prevent further issues from developing.
6. Plastic Surgery: With the influence of media sources on a daily basis, a strong emphasis is placed on children starting from birth. We are raised to believe that physical attractiveness and being thin is associated with success. With role models who endorse cosmetic enhancements, the probability that your tween may be curious about how to improve their appearance increases dramatically. The “teen toxing trend,” represents 12,000 procedures done for children 13-19 in 2008, up 2% from previous year. A total of 36,800 cosmetic surgery procedures were performed among teens in 2009, and breast implants or rhinoplasty is being given for sweet sixteen or high school graduation presents.
These procedures send messages to kids that happiness only comes from the outside, and if you are allowing your older children to have cosmetic procedures performed, chances are your tween will be asking for them soon too. Encourage your child to examine what emotions/experiences are driving their desire to change themselves, and you will likely reveal any areas that can be addressed to help enhance their self-esteem.
Hopefully, the information around these trends in food and body image issues with your tweens will allow you to become prepared for the more dangerous and risky influences that your children may be exposed to as teenagers. Setting the expectation that such issues will be addressed, and addressed early in a continued open dialogue enhances the relationship that you can have with your child, as well as sets the expectation that you will continue to be involved with them as they grow up and more independent. After all, establishing a strong, healthy sense of self is one of the most important gifts you can give to your child!