The results of a study published in the September 1989 issue of the journal Pediatrics underscore the problem. Michael Maloney and his colleagues explored eating attitudes among 3rd through 6th graders at two schools in middle-income neighborhoods in Cincinnati. They concluded that “concerns about body fat and dieting are found in a large percentage of 8- to 13-year-old boys and girls.’' For example, among the 6th grade girls, 79 percent said they want to be thinner and 59 percent said that they had already tried to lose weight. The study also noted an increasing preoccupation with dieting as children grow older. (See table.)
Anorexia nervosa and bulimia, the most common eating disorders among adolescent and college-age girls, are still uncommon among younger students, experts say. Patients with anorexia starve themselves in the misguided belief that they are fat; those with bulimia binge and then induce vomiting. The stress of puberty-- especially the exaggerated concern over the normal growth spurt of adolescence--can trigger eating disorders in teenagers.
But some experts now suspect that such disorders diagnosed during adolescence may actually originate at a younger age. Based on the results of an eating-attitude test, the Cincinnati researchers suggest that anorexic eating attitudes may be “already set by the preadolescent years, although not usually acted out until adolescence.’'
Richard Kreipe, a pediatrician who directs the program on adolescent eating disorders at Strong Memorial Hospital in Rochester, N.Y., also expresses concern about the long-term dangers to some young children with unhealthy eating habits. For many children, a preoccupation with food is a passing thing, he says. But the vulnerable child, perhaps slightly overweight and with low self-esteem, may get the message that losing weight is the way to solve problems.
There is little disagreement that society’s preoccupation with slenderness plays a major role in the attitudes of young children. Mickley notes that when nursery school children are shown silhouettes of thin and fat people, they already reveal a negative attitude toward being fat. “The national fetish for thinness is very dramatic, very early on,’' she says.
And, experts say, one reason this generation of children may be more vulnerable to the message is that the obsession with thinness is not coming just from the media--children are also seeing it in their own homes. Sixtynine percent of the students in the Cincinnati study said that their mothers have dieted at some time, but only 13 percent described their mothers as overweight.
“I think there is a strong link with mom always dieting,’' says Virginia Inglese, a dietitian in Arlington, Va. She points to one of her patients, now 13, who “can count calories better than I can.’' The child has been dieting since age 8. When Inglese asked her why, she responded, “Mom went on a diet and I went on it with her.’'
Lubbers says she also sees the influence of parents’ eating habits on her Los Angeles clients. Sometimes, she notes, parents with their own eating problems fail to recognize the problem in their children. Says Lubbers: “One would hope a parent would ask, ‘Why is a 7-year-old so preoccupied with being on a diet?’ But that doesn’t always happen when the mother has eating problems herself.’'
Ironically, some children with eating disorders have restricted their diet because they think it is healthy to do so. These children often pick up nutrition and health messages from the family, media, and school and distort them. “Kids hear that adults should lower cholesterol and dietary fat, and they think that if they eliminate them altogether it will be better,’' Kreipe says.
Mickley points to an instance in which 6th graders were being measured for body fat as part of their gym class. “The kids were all starving for two weeks to prepare for the test,’' she recalls. The school discontinued the practice.
Many of the young children obsessed with their diets “almost have a phobia about eating fat,’' says Kreipe. Typically, he says, they eat almost no red meat, remove the skin from chicken before eating it, and avoid many dairy products because of their fat content. Inglese adds that some of her young patients have restricted their diet to five or six “safe foods.’' They can develop symptoms, experts note, that include cold feet and hands, constipation, and slowed growth; they may grow only a quarter of an inch, instead of a couple of inches, over the course of a year.
Kreipe believes that with all the emphasis on reducing fat, there is too little attention paid to the importance of fat in the diet--especially during the growing years. Healthy bone development and overall growth depend on ample supplies of fat and other nutrients, including the calcium and protein often found in the dairy products the children avoid. “The whole idea of nutrition education is to start healthy eating habits early,’' he says. “But the habits that are good for adults are not always good for children.’'
Although many of Inglese’s young patients say their classmates are also restricting their diets, she gets almost no referrals from schools. One reason for this, experts say, is that teachers generally fail to identify the students most likely to need help because they are often the star pupils--the class leaders and straight-A students. “They are good kids to have around--they don’t give you a hard time,’' says Kreipe. Sometimes, he notes, these students are trying hard to please others because they lack self-esteem, which contributes to their dietary problems. They believe that their peers will like them better if they are thinner.
Inglese says these young dieters often defy the usual stereotype of being at-risk because many come from loving, protective families. But that sense of having everything taken care of can cause trouble. “Often the underlying problem is that the children may feel like they have no control over their lives,’' she says. “They feel like they can control food--nobody else can do that--so that gives them their sense of control.’' That same need for control can also arise in children who suffer a traumatic event--such as a divorce-- that gives them a feeling of helplessness.
School personnel--teachers, administrators, nurses, and counselors-- could be an important referral source, say those who treat the young children. And by helping children understand the dangers of extremes in weight and diet, educators can help prevent the problem. Experts also emphasize the importance of helping young children develop self-esteem that is not tied to their weight. Otherwise, they say, these children could enter the stressful adolescent period with the notion--too often voiced by their teenage patients-- that being thin will cure all ills.
--Renie Schapiro
