By Laurie Dunham, MS, RD, LD, CEDRD
I’d like to help empower all parents, educators and healthcare practitioners to take an active role in preventing eating disorders. Right now we are seeing an increase in eating disorders in certain younger age groups. I believe that with proper education of adults, we could help reverse this trend.
On a large scale, it would be helpful if parents and adults who work with and care for children (from age 0-21) were aware of warning signs and risk factors involved in eating disorder development. For example, family members should be aware of whether they have any family history of eating disorders, addiction, depression, OCD and/or anxiety, all of which can be risk factors or co-occur and therefore should be monitored. Healthcare professionals and educators should be aware of the complexity of eating disorders and learn to avoid triggering language and messages when working with children and adolescents.
Pediatricians need to be reminded that Body mass index (BMI) is just a screening tool and that not every body fits nicely into the “recommended” healthy norms. A child/adolescent should be measured against his/her own growth curve. For example, if someone’s BMI has always been at the 90th percentile and a pediatrician recommends the child lose weight to stay within the guidelines of having a BMI within the 15th-85th percentile, this could trigger dietary restriction or over exercise and lead to an eating disorder, when the child may be perfectly healthy. The focus should always be on healthy lifestyle choices, not weight. Health care providers can talk about being physically active and including more fruits and vegetables in the diet. They can also refer to a registered dietitian for further nutrition counseling.
Schools should never take a role in weight education or any form of nutrition counseling with weight loss in mind. School is for educating about various subjects, but we just don’t find that most health teachers are qualified to speak about weight and eating without extra training, and thus can unintentionally contribute to eating disorders. Health teachers can talk in general about healthy practices but don’t need to get specific about “healthy” weights. The size of adolescents differs so much, that you can’t even say what “normal” is.
The classroom and gym are sensitive areas, and many teachers and coaches may not realize the impact of their words. Sure, many kids can hear general comments such as “you shouldn’t eat fast food” and be okay, but if you have just one child in the classroom that tends to be more perfectionistic or has family history of an eating disorder or anxiety, this could be what sends them over the edge into disordered eating behavior. Unless a teacher has been trained in the importance of language monitoring around weight and nutrition, they should avoid discussing both topics.
Parents should be educated about eating disorder prevention in much the same way they are educated about Internet safety, seat belt and bike helmet use, etc. In other words, the parent sets expectations for safety and health, and monitors the child’s behaviors to ensure both.
We know that having family history of mental illness, personality traits of perfectionism, anxiety, OCD, etc. places one at a higher risk for an eating disorder. We also know that the more a parent encourages dieting, the higher the occurrence of disordered eating behaviors. If a child/adolescent has any risk factors, this information should be shared with all parents without any suggestion of shame or blame, just fact. Having family history of certain illnesses or certain personality traits is nothing to be ashamed of or feel guilty about. We need to talk about it more to decrease the stigma.
Children look to their parents as role models. If parents have issues with their own weight or body image, they may need to get help, . Many adults have disordered eating patterns, if not outright eating disorders, and it’s important to get treatment in order to be a parent who can model healthy eating and positive body image.
I recommend talking in non-specific terms about food. For example, instead of saying this food is good or bad, teach kids at an early age that there are foods we should eat every day and there are foods we have occasionally. When I talk to elementary aged kids I use the terminology “every day foods” and “sometimes” foods.
Additional nutritional guidelines to help prevent eating disorders:
- stress that all foods can fit into a healthy style of eating
- don’t comment on calories or weight
- model healthy eating practices such as sitting at the table to eat, eating without distractions, putting food on a plate or in a bowl as opposed to eating out of a bag or box.
- provide regularly scheduled meals so your child knows when to expect food
- associate food with physical growth and development, not weight
- adolescents should be eating more than their parents in most cases as they are going through a period of rapid growth
- keep wholesome foods in the home. If parents purchase fat free, sugar free, low carb varieties of foods, kids learn that they too, should eat diet foods
- teach kids to honor their own hunger and satiety cues
- establish normal, healthy eating practices early on to help an adolescent feel confident in his or her eating abilities later in life
- encourage cooking at home; you don’t need to cook gourmet meals, but try to have 4 food groups (protein, grains, vegetable, dairy & cook with healthy fats).
- try to eat out less
- don’t use food as a reward or punishment
Laurie Dunham, MS, RD, LD, CEDRD, is Registered Dietitian II at the Eating Disorder Program at Cincinnati Children’s. The Eating Disorders Program serves all adolescents, male and female and gender nonconforming, with significantly unhealthy eating behaviors including anorexia nervosa, bulimia nervosa and binge eating / overeating. Cincinnati Children’s provides outpatient treatment to children, adolescents and young adults through age 21. Website