Will Your Child Get an Eating Disorder?
	When a preschooler believes thin is in, there may be trouble ahead. by Stephanie Dolgoff

Self-starvation. Bingeing and purging. Compulsive overeating. It may be impossible to imagine your three, four, or five year old touched in any way by such grown-up disorders. Yet a variety of experts believe that the potential for eating-related illnesses can develop very early in life.

What are the roots of the problem? Children, particularly girls, may start to equate attractiveness with thinness when they are still in preschool. "In our culture, children are indoctrinated in the belief that thin is in, especially if you're female," says Paula Levine, Ph.D., director of the Anorexia and Bulimia Resource Center in Coral Gables, Florida. From Barbie to Belle and Ariel, kids get that message with some of their first playthings.

"For boys in our culture, the physical standard is to be big, strong, and muscular; for girls, it's to be slim and beautiful," says Adrienne Ressler, a body image specialist at the Renfrew Center, an eating disorders treatment center in Coconut Creek, Florida. Preschoolers are vulnerable to these attitudes because they are busy learning how they fit into the larger picture. They seek acceptance and can't help but be influenced by a culture that places such a heavy premium on a slender physique.

So a child who doesn't perceive herself as thin is more likely to develop a negative body image and suffer a loss of self-esteem. "If she doesn't like herself at age four or five, she may already be dieting by age eight or nine," Dr. Levine says. She adds that an early negative self-image in young children may set the stage for the development of an eating disorder, such as anorexia or bulimia, by age 11 or 12. Parents have a tough task: They must protect their children's mental and physical health and at the same time communicate to their kids that it's best to maintain a healthy weight. Yet you can help your child develop a healthy relationship with food.

When Eating Becomes an Illness
Some 7 million women and 1 million men in the United States suffer from one of three major eating disorders, according to the National Association of Anorexia Nervosa and Associated Disorders in Highland Park, Illinois. These include anorexia nervosa, a potentially fatal syndrome of self-starvation; bulimia nervosa, a binge-and-purge syndrome; and compulsive overeating.

Beside being bombarded with media messages that thinness is the optimal state, girls also get influential messages at home. "Young mothers today are now the second or third generation of weight- watching women," says Dr. Levine. "Children hear a lot of diet talk, such as 'I can't eat that' or 'It's much too fattening.'"

Fathers also affect how children feel about their bodies. "Some men are weight conscious, if not for themselves, then for their wives and daughters," says Dr. Levine. Fathers may communicate that thinness matters by praising daughters more for their appearance than for their other attributes.

Children of both sexes, according to several studies, express clear preferences for thin physiques, and associate a laundry list of negative attributes, such as laziness, stupidity, and dishonesty, with heavier bodies.

Indeed, the fact that children have become preoccupied with weight and dieting has been well documented over the past five years: Of 1,118 children in first- through third-grade surveyed in Indiana in 1991, 42 percent of the girls preferred body shapes different from and thinner than their own. Of 3,175 fifth- through eighth-graders in a 1993 South Carolina study, more than 50 percent of the girls wanted to lose weight, regardless of whether they were heavy. Twenty-five percent of the boys felt similarly.

What Parents Can Do
Considering the social ostracism overweight kids face in school and elsewhere, it's no surprise that well-meaning parents encourage thinness early on, according to Kathleen Pike, Ph.D., chief psychologist at the Eating Disorders Unit at Columbia-Presbyterian Medical Center in New York City. "But promoting dieting only creates more of a problem, and may lead to eating disorders in the future," Dr. Pike says.

There's a lot that parents can do to help their kids develop a healthy relationship to food and a feeling of satisfaction with their bodies, Dr. Pike claims. The first step, she says, is to ask yourself if you're passing along any potentially harmful attitudes about food and weight to your kids. By keeping a realistic perspective on weight and body shape, she adds, you can prevent your children from developing harmful attitudes.

Adrienne Ressler agrees. "Think about whether you are constantly dieting or preoccupied with weight or appearance," she says. "Ultimately, you need to make peace with your body, so that your child doesn't feel she has to achieve a body standard that you weren't able to reach."

Experts also suggest the following:

Take the emphasis off weight gain. "When talking to your kids about weight and food, steer away from comments like, 'If you eat that whole bowl of whipped cream, you'll get fat,'" advises Ressler. "Little kids shouldn't be worried about fat grams," she adds. "At the same time, you do need to help them understand that eating too much of any one food—even a healthy food—isn't a good thing, either."

There are ways to explain the disadvantages of eating excessive amounts of junk food without harping on weight. Say, for example, "If you eat too much whipped cream, you may get a stomachache," or "These pineapple chunks and raisins are better for you, and they also taste good. Would you like to try some?"

Make a habit of exercise and healthy eating. "We advocate that parents introduce an approach to life that includes exercise and the enjoyment of a wide range of nutritious, flavorful foods," says Dr. Pike. Provide snacks that are low in fat and sugar, but don't make a big deal about it, adds Ressler. "It's OK to have a few sweets around, but provide other foods, too."

Tell your kids that moderate exercise—whether it's swimming or hiking—makes them fit and strong (not thin), and is also fun for the family to share.

Don't make disparaging comments about your children's or your own appearance. In one study coauthored by Dr. Pike, mothers of girls with eating disturbances were far more critical of their daughters' appearance than mothers of healthy girls. Even comments delivered in jest ("Your hips are getting to be almost as big as mine!") or as advice ("You look slimmer in dark colors") can be damaging. "Parents need to realize how powerful an impact they have," emphasizes Ressler.

Praise attributes besides appearance. "Compliment children on their qualities," says Dr. Levine. "Single out a child's honesty, reliability, or sense of humor."

If you think your child is overweight, consult your pediatrician. Seek professional advice before putting your child on a diet, because restricting a child's food intake can harm healthy growth and development, notes Dr. Pike. Your child's doctor may simply tell you that he will grow into his weight, and not to make it an issue. If a weight problem persists, she may encourage more exercise and tell you ways that you can safely reduce the overall amount of fat and calories in the youngster's diet. To prevent a serious eating problem from developing, begin to pay attention to how your child regards her appearance.

Is Your Preschooler at Risk?
There are ways to tell if a preschooler is susceptible to an eating disorder, according to Dr. Levine. "If a child goes to a lot of birthday parties and never takes a piece of cake, or worries about putting butter on her bagel, I'd be concerned," she says. Parents should listen for value-laden comments about weight. "A youngster with an overdeveloped awareness of weight and body shape may make comments like 'I have a fat tummy' or 'I don't like fat people.'"

To tackle this problem, Ressler recommends telling your child that people come in all shapes and sizes. "Mention overweight people whom she knows and loves. Or you might say, 'Can you imagine if Santa Claus were skinny?'"

Finally, try to avoid power struggles over food with your child. A youngster who feels she lacks control over what she is permitted to eat, or who is forced to eat foods she doesn't like, can easily grow up with negative feelings about food and eating—leaving her vulnerable to an eating disorder.

Give your child a good start by allowing her to follow her natural feelings of hunger and by gently encouraging nutritious food choices, says Dr. Pike. By doing so, you are laying the foundation for a life- long healthy attitude toward food.

Stephanie Dolgoff writes frequently on eating and body-image issues.

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