Is the Fight Against Childhood Obesity Creating Eating Disorders?

Why the new national focus on weight and food choices may promote needless anxiety among healthy teens and kids

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As a father to three young girls, I have been particularly struck over the past several months by the flurry of public activity related to childhood obesity. Like most parents, I have been aware of our country’s epidemic for a number of years, but I haven’t seen this kind of concentrated attention since the early 2000s. While the efforts are well-intentioned, it’s worrisome to watch the movement gain logarithmic momentum when we still don’t really know whether what we’re doing is actually working — nor do we really know if there will be any downsides to the anti-obesity initiative.

The most recent major move in the fight against childhood obesity came on Jan. 25 when First Lady Michelle Obama and Agriculture Secretary Tom Vilsack announced that school meal options were going to get a lot healthier. This represented the first major shift in school nutrition policy in 15 years. It is, undoubtedly, a good idea to make school lunches more nutritious, although some research suggests that by the time a child gets to school, his or her tastes for high calorie or otherwise unhealthy food is already in place and that changing lunch doesn’t make them eat healthier at home. In other words, school-based initiatives may be too little too late for those children who may be predisposed, whether through genetics or environment or both, towards obesity. Which brings us to another problem with the “fight”—it doesn’t target those most at risk.

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According to the Centers for Disease Control, 17% of all children and adolescents in the U.S. are obese. Yet the majority of obesity programming, especially in our schools, is applied to the child and adolescent populations as a whole. Sure, promoting healthy eating, regardless of one’s weight or age, seems like a positive thing on the surface. But here’s the potential downside: We know kids and teens react differently than adults to external pressures like persistent messaging. Sometimes these pressures can translate into incredible waves of anxiety and fear. At the extreme, a healthy-weight youth could be pushed to monitor his weight more frequently or even begin an unsupervised diet — behaviors that might represent an impending eating disorder.

So the real question is what are children saying and how are they behaving in light of our anti-obesity effort? A nationally representative survey, conducted last September by the C.S. Mott Children’s Hospital National Poll on Children’s Health, attempted to answer this question. The results, released in January, showed that 30% of parents of children age 6-14 report worrisome eating behaviors and physical activity in their children; 17% of parents report that their children are worried about their weight; 7% say their children have been made to feel bad at school about what or how much they were eating; and 3% of parents report their children had a sudden interest in vegetarianism. Certainly these data do not directly link the anti-obesity effort and eating disorders. They also do not offer any insight into whether obese children are actually losing weight. They do, however, serve as a reminder of how vulnerable these “worried” children already are to disordered eating and that everything we do, no matter how well-placed our intent, carries risk.

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Some programs have already come under criticism for being too harsh. Strong4Life.com, an Atlanta-based childhood-antiobesity organization, recently launched an advertising campaign that has attracted national and international attention because of its stark images of obese children. Critics said that the images might serve more to ostracize overweight kids than to help them. And, there’s no telling how kids with already-fragile body-images, whether they are overweight or at a healthy weight, might be affected by such a campaign.

With that said, we shouldn’t stop promoting healthy eating habits in our children. And we shouldn’t necessarily downplay our anti-obesity efforts for fear of increasing the rate of childhood eating disorders. Instead, we should just be mindful — as parents and as organizations — of a potentially evolving, complex situation. At the most basic action level, this might mean making the warning signs of an impending eating disorder more accessible to all of us. A simple notation, for example, on a childhood obesity website (like Let’s Move or Strong4Life) of what parents should look for takes little effort and could have a significant impact. And, on a more advanced level, striving to tailor and target our efforts to those kids who need it most should be a priority.

In the end, this is about health and food. But, more importantly, it’s about our children. With their wonderful and special abilities as well as their unpredictabilities, they surely deserve an approach and awareness that is as well-thought out and balanced as the meals we’d like them to eat.

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