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children and eating disorders

Posted by on Aug 28, 2012 in Blog Posts, Uncategorized | 16 comments

Watch the video. Please. And pass this link along.

This CNN article on kids and eating disorders may be shocking to some of you, but is no surprise to those of us working in the field.

My one complaint is again that the focus is on restrictive ED’s like anorexia and implies that weight loss is the indication of an ED. Children with EDs can be any size. In fact, the most common behaviors I am seeing in very young children, many of whom I would consider to have feeding disorders, are more in the lines of bingeing behaviors. See my post on kids and bingeing.

Take home points:

1) eat with your kids, take any changes seriously
2) don’t weigh your kids (and remember, behavior and attitudes that are unhealthy, even with “normal” weight shouldn’t be ignored)
3) focus on health, not on weight
4) seemingly “healthy” eating, like the girl in the video who eats only low-fat Greek yogurt and strawberries for lunch, may be signs of disordered eating
5) if you suspect a problem, don’t blow it off. Early treatment is critical. Find resources (here is a great list) and get help.
5) ask your schools to address size in diversity and anti-bullying curriculum. Teasing about weight doesn’t make kids healthier, it makes them miserable, more likely to diet, practice disordered eating, and gain weight…
6) Avoid fat is bad, junk food is bad, anti-obesity language

Note, eating disorders are complex disorders with many factors from biological, genetic and environmental playing a role. The above list may help you raise a competent eater. What else can you think of to help raise children to feel good about food and their bodies?

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16 Comments

Join the conversation and post a comment.

  1. Amy

    Hey, Katja. I don’t have a lot of time to comment, but I want to point you to two articles that I think are relavant to this issue. That CNN piece, like your post here, is well meaning, but I think it does a disservice to just about everyone – disordered eaters as well as eating-disorder suffers – to conflate “restrictive habits” (in the words of the article) or an unhealthy family culture around food with a genuine, biological eating disorder. Your points 2, 3, 5, and 6 are absolutely good practice for everyone, but they probably won’t prevent the onset of an eating disorder in a child who is genetically predisposed.

    • katja

      Thanks for your comment. There are so many different experiences with disordered eating and eating disorders, and they are complex processes, and not the same, so thanks for the link. Many millions of people with disordered eating are just plain miserable, though functioning, and not in the grips of an eating disorder. From my adult readers who comment, from my clients, and discussions with folks in the field (I’ve had a nice correspondence with Laura and admire her work immensely) I’ve come to understand that many clients/readers struggle withe BED, some with selective eating, others with restrictive eating, dieting casualties etc. many do share traumatic histories around weight and dieting as children. I think that when someone tells me they were weighed every day by their father starting in first grade, with their weight written on the wall and discussed at dinner, and the dieting and shame cycle started before puberty, that makes it pretty hard to grow up feeling good about food and your body.(Horrid grammar, but I’m running out the door.)
      You are right, there are children who are genetically predisposed, and even if parents do everything “right” will still get the ED. I don’t claim to “prevent” eating disorders, but I do think there are things we can do to increase the chances of raising competent eaters. You’ll note I did not title the post, “preventing eating disorders.” Does that make sense?

  2. Erika

    Thank you so much for this! Do you know of good resources for kids (books, videos?) that discuss the diversity of size? I know my kids are already getting the subtle message from school that fat = unhealthy or bad, and that certain foods are bad, and I’d love for them to see a more neutral view. I try to combat that myself but I get a feeling they’re tired of hearing me talk!!

    • katja

      So very, very few I’m afraid. Here is an old post. Caillou for little kids, Lilo and Stitch, a book called I Like Me (can’t remember author right now.) But alas, very, very few… Check out Hardy Girls online, they might have some. I will check them out too when I have more time :) My book due out this month!!
      Follow lots of great discussion and links on my FB page. The Feeding Doctor

  3. Kim

    As the sister of a sibling that is suffering with an ED, this brought tears to my eyes. I will definitely pass this along. I am learning much about EDs with attending group therapy sessions with my sister. Thank you for posting tips in such an accessible way. Looking forward to reading more of your posts.

    • katja

      Oh Kim, I am so sorry you are all going through this. I wish you all the best with your sister’s recovery. So hard on families and loved-ones as well. Becky Henry, The Hope Network focuses on helping family and loved ones, she might be a great resource on this journey. Feel free to browse posts tagged with eating disorder or body image… I’ve written lots here and there. Also, in my book I talk a lot about having a healthy relationship with food and our bodies…

  4. DC

    I like your advice, but it does give me flashbacks to elementary school when every year each kid was weighed in front of the whole class (along with height measurements, etc). They tried to keep it “confidential” but you could just look at the piece of paper and see what you and other kids weighed. It was definitely a walk of shame. I agree that being weighed should not be done in a way that seems like you are policing the kids – it sends messages to them, intentionally or not.

    Also, it frustrates me that psychiatrists still, by definition, don’t include overweight/obese individuals as having eating disorders, especially anorexia, because low BMI is a DSM requirement for diagnosis. You can have severe physiological effects from EDs regardless of your BMI category. Any efforts to get this changed in the next DSM out soon?

    • katja

      Never, ever should children be weighed in school. I too remember having one of the highest skin-fold thicknesses and weight, and at the time I was swimming on a swim team, and was one of the few kids in the class to get the presidential medal for physical fitness… Yes, you are right on the last paragraph. Weight is seen as an easy proxy for a system that needs a number to “diagnose” and measure “success.” So not helpful. I do think there are going to be changes on the weight front with the next DSM, but I’m not the expert to ask on that one… Yes, those in the field are trying hard to get this addressed. Thanks for writing, and please keep in touch! Follow lots of great discussion and links on my FB page. The Feeding Doctor

  5. Alicia

    I think it’s important to mention that sometimes eating disorders are not about food, abuse can make a person develop an eating disorder, especially sexual abuse but other kinds too and children are not immune to that. I know many adults that developed an eating disorder because of abuse and not so much because of food and weight.

    • katja

      Yes, EDs are complex, multi-factorial afflictions. Thanks for the reminder. Thank you for writing in! I think I mean my tips and advice as ways that we can avoid harm and triggering issues in children who may be genetically or otherwise susceptible.

  6. Twistie

    To the excellent points you make around food, I would also suggest regularly talking with kids about the good things their bodies do for them, like breathing, getting them from point A to point B by whatever means, laughing, blinking, etc. without focusing on whether or not they would generally be considered physically attractive. Reminding them that bodies are good without reinforcing beauty standards helps them find value other than ‘pretty’ or ‘handsome’ in themselves. It also makes it that much more likely that they’ll value something more than ‘pretty’ in others.

    In general, I believe that taking the focus off waistlines and the concept of a specific beauty ideal takes pressure off kids so they can appreciate themselves more easily, leading to a better, easier relationship with everything from food to school to future bosses to, well, themselves.

    I really liked the mantra from The Help where the maid told the little girl every day ‘you is smart, you is kind, you is important.’ More kids need similar mantras that focus on their personal strengths and general value to the world rather than fitting in a tiny box of acceptable appearance.

    • katja

      Thank you, and yes… M talked about her “fat” legs the other day, and I almost freaked out, then she said it’s because all the muscle, and how her strong legs help her ride fast on her bike and swim fast… I think all those little hints are sinking in, and that loving and appreciaiing our bodies should be a natural part of growing up :)

  7. Kate

    I was reading the last Ellyn Satter newsletter and it mentioned that kids who eat with their parents are less likely to be obese and it just filled me with such shame because we always had family meals, but I’m still quite fat. Of course, my parents used meal time to body shame me and tell me I was eating to much and to calculate how much exercise I’d have to do work off dinner, so I don’t think they were doing family meal time right.

    I’m not sure my thought is really on topic, but I’ve just been completely overwhelmed with shame since the last Ellyn Satter newsletter came out and I just can’t seem to shake it off.

    • katja

      Oh man, I’m so sorry that happened. I hope you will take some cleansing breaths, or a shout or two, and recognize that “family meals” means, pleasant family meals, and that all that baggage that happened to you at the table made it a bad place to be, rather than a good place… It is not your fault that you were treated so poorly, that your parents so nicely shamed you and buried your natural skills with self-regulation. I tell parents, we can feed children in a way that supports their inborn skills of self-regulation, or we can feed them in ways that bury and suppress those skills. Sounds like the latter was done to you, even if it was done at the *family table*. PLEASE let go of the guilt and shame. I also bristle at some of the general language around “obesity prevention.” Even if parents to everything “right,” there will always still be fat children and adults, it’s simply biology. Are there fat people who weigh more than they might have because of a difficult relationship with food? Sure, as there are people who weigh less than their set-point because of a difficult relationship with food. I hope you will be able to be kind to yourself, and know that none of itis your fault. Extend that kindness to the little girl you were. Also, the data on family meals and weight from my understanding does show that children who eat with their families tend to have a more stable weight, a few show lower BMI, others show no difference. It’s not at all a given, and perhaps it’s more correlation than causation, that there is something else going on. Maybe it’s the structure, the lack of grazing, the sense of connection. Whatever it is, it’s not what you experienced. Hope that helps. You can always message Ellyn on facebook and give her some feedback. Hang in there. I know from past comments that you have done amazing healing around food, and hope you will see this as a hiccup in that process and nothing more, that this triggered all that negative energy and voices from the past, and you’ve moved on, and get back on that feel-good horse.

  8. Becky Henry

    Glad to see you addressing concerns with this article Dr. Rowell. Given that Binge Eating Disorder is the most common of all the eating disorders I too get frustrated that the focus is often on Anorexia which is in fact the least common of all eating disorders.

    Children (BOYS and girls) can be ANY size and have an eating disorder. Same with adults. When our providers and families don’t know this we have people who are going undiagnosed and untreated.

    I love your point #6 and would love to see a whole blog post addressing that issue alone. I’m sure you have done that in the past but it is SO very important and many may have missed it. Would you consider reposting and/or having a discussion on what is dangerous about saying: “Fat is bad. Junk food is bad.” And what damage is being done by using anti-obesity language? This is a tough sell to a lot of health providers as well as the general public who go right to the argument, “But what about the people with heart disease and diabetes?”
    Thank you,
    Becky Henry
    Hope Network, LLC

    • katja

      Yes, I’ve written about this over the last several months. Check out the tags that say “childhood obesity” for some ideas. With slow internet access right now I can’t do a quick post with links…