Children in Weight Crisis
Donna Foster, RD, LD
Kentucky Center for Eating and Weight
Disorders
“If we could give every individual the right
amount of nourishment and exercise, not too
little and not too much, we would have found
the safest way to health.”
Hippocrates,
460-377 B.C.
Health Promotion Model
Current weight and eating crisis
New initiative for prevention and
treatment
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Self-trust, empowerment to follow body
signals and needs
Acceptance, regardless of size, shape or
appearance
Liberation from false, narrow images
based on appearance
Need to accurately evaluate and combat
media stereotypes
A Unified Effort should…
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Address all the problems together
Focusing on weight reduction alone may
increase other problems such as:
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Dysfunctional eating
Dangerous weight loss methods
Eating disorders
Stigmatization of large youngsters
Health professionals, educators and
parents need to...
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Look carefully at all the problems
Be aware of the harm that can be done to
vulnerable children and teens
Find positive ways of working together to
build strengths
Policy makers need to...
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Take a broader look at weight and eating
problems
Change their rigid stance
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U.S. health policy sets the agenda for the
country
U.S. health policy has a profound influence on
media response to health issues
Traditional view of weight and health
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All large persons can and should lose
weight
Anything over a narrow “ideal” is
unhealthy, dangerous and expensive to
national health care
For all large persons, 10-15% weight loss
is recommended
New View needs to address…
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The method of moderate eating, living
more actively and relieving stress
Ways of helping children, not harming
them
Allowing children to eat without fear
The Dieting Cycle
The Dieting Cycle
Eating Disorders
Important Risk Factors
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Dieting*
Genetics
Biological factors
Psychological factors
Sociocultural factors
Family
History of sexual or physical abuse
Changing Ideals
Then
Now
Today’s Male Ideals
The Evolution of Toy Figures
Current statistics
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1 in 5 women struggle with an eating disorder or
disordered eating
There are up to 24 million sufferers in the U.S.
There are up to 70 million sufferers world wide
Eating disorders have the highest mortality rate
of any mental illness
Death rate from anorexia nervosa is 12x higher
than the death rate from ALL other causes for 1524 year old females
10-15% of those with anorexia and bulimia are
male
“Eating Disorders should be called Dieting
Disorders, because it is the dieting process
and not eating that causes the initiation of
both anorexia nervosa and bulimia
nervosa.”
Joy McVoy,
E.D. Specialist
Size Prejudice
Size prejudice
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It can come from classmates, parents and
teachers
The psychological effects can damage
children for a lifetime
Prejudice can keep regular-sized kids
striving to be thin enough so they’ll be
safe
It can affect even very young children
Harshest offenders…other children
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They believe large children deserve scorn
and abuse, that humiliation might drive
them to lose weight
Intense shame can lead victims to believe
they deserve abuse
In adolescence (more so than in
childhood), lifelong negative self-image
can develop
“Obesity is the last socially acceptable
form of prejudice. Obese persons
remain perhaps the only group toward
whom social derogation can be directed
without impunity.”
Albert Stunkard
Jeffery Sobal
Teachers reinforce prejudice
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Teachers and staff often ignore
harassment laws.
Teachers discriminate in their interactions
and grading
Acceptance into prestigious colleges is
lower for large females
In 1993, a National Education Association
investigation found size discrimination in
schools at every level
Self-Esteem Comes in All Sizes
Size prejudice in health care
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Physicians often blame other conditions
on obesity
They name obesity as a cause without
offering a successful, affordable cure
which places blame on the victim
Physicians have been counseling patients
to lose weight for decades with no
positive results
New directive for Health Providers
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Better lifestyle guidance
Understand how social discrimination
affects the care given to large children
Understand that attitude affects an obese
child’s response
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Fear, anxiety and stress can damage the heart
and immune system through continual
increased cortisol exposure
Obesity
Scientists are asking...
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Does it start in childhood through excess
fat cell development, or even in the
womb?
Is it most likely to be triggered at highrisk points during a child’s development?
How powerful are genetic factors?
Scientists know...
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Obesity is a complex condition that resists
intervention
Prevalence has sharply increased in the
last decade for both children and
adolescents
Not only are more children overweight,
they are more severely overweight than in
the past
3rd National Health and Nutrition
Examination Study
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Data gathered from 1988 to 1994
Study looked at a sampling of 8,534
youths ages 6-17
Compared their weight with children
measured in 1963
3rd National Health and Nutrition
Examination Study
• Cutoff point: 95th
percentile of BMI (1960’s)
• 5% of children were
defined as overweight
3rd National Health and Nutrition
Examination Study
• 22% are at 85% level
• Healthy People 2000 goal: 15%
or less overweight
• Greatest increase is at upper end
• Heaviest children are much
heavier than in earlier studies
Fat distribution and health risks
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Apple shape = greater risk of
developing heart disease and
diabetes
Pear shape = lower risk of
heart disease and diabetes
Disease
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Growing incidence of asthma, high blood
pressure, insulin resistance and type 2
diabetes in children
Ten-fold increase in children with type 2
diabetes in the past 5 years
In 1992, 2-4% of childhood diabetes was
type 2
In 1994, 16% of childhood diabetes was
type 2
Balance, Moderation, Variety
Today’s Shifting Diets
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Focusing mostly on a single group
Based largely on grains
 Breads, cereals, baked goods,
crackers
Pulling down foods from the tip
 Desserts, candy, high-fat
snacks, soft drinks
Treating Type 2 Diabetes in children
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Knowledge of calorie and nutrient
composition of foods doesn’t help
Behavior modification has limited
effectiveness
Rigid control produces only short-term
weight loss
Dieting doesn’t work!
Tools for Parents
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Maintain a positive feeding relationship
through the growing up years
Allow kids to feel relaxed and comfortable
about eating and in touch with their
internal cues of hunger, appetite and
satiety
Golden Rule for parenting with food
“Parents are responsible for what is
presented to eat and the manner in
which it is presented. Children are
responsible for how much and even
whether they eat.”
Division of Responsibility
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Parents
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Select and buy
food for the family
Put meals on the
table
Have meals and
snacks at regular
times
Serve food in a
positive and
supportive fashion
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Children
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Decide which
foods and how
much of each to
eat
Make decisions
about food
Respond to
internal cues of
hunger and satiety
Healthy Choices
What Can we do About it that Works
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Treat the parents
Eat out less
Change the food environment
Limit TV watching and video games
Encourage physical activity, finding
something they enjoy doing
Healthy Lifestyle choices include…
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Nourishing the mind, body and spirit
Eating well
Living actively
Having a positive attitude toward life
Families
Schools
Health professionals
Communities
Canada’s Vitality Program
“Feeling good about yourself starts by accepting who you
are and how you look. Healthy, good-looking bodies come
in a variety of shapes and sizes. A good weight is a healthy
weight, not necessarily a low weight, so don’t let your selfworth be determined by the bathroom scales. Think
positive thoughts. Laugh a lot. Spend time with people
who have a positive attitude – the type who look at the cup
as being half full, not half empty. Feel good about yourself.
Have fun with family and friends, and you’ll feel on top of
the world.”
How is the Healthcare Industry
responding to the crisis
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AMA is recommending fundamental
changes aimed at prevention
Developed the Guidelines for Adolescent
Preventive Services (GAPS)
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Phase 1: Doctors will screen teenage patients
each year for health, weight and eating
problems
Phase 2: Specific recommendations on
prevention and treatment
Unified Health Approach
Health Promotion Approach
5 Areas for Change
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Attitude
Lifestyle
Prevention
Healthcare
Knowledge
Let’s start making changes by…
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Practicing normal eating
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Eat at regular times
Rediscover hunger, appetite and satiety
Trust our instincts
Promote zero tolerance for size bias
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Size discrimination means no one is ever thin
enough to be “safe”
Everyone deserves respect
With some work…