Is the media responsible for childhood eating disorders?

I really don’t want my children to be overweight. I know this because I see the consequences every day in my practice, consequences like high blood pressure, impending diabetes, or poor self-esteem.

At the same time, I really, really don’t want my children to have an eating disorder. I know this because I had one.

In college, I suffered from anorexia nervosa. I’m a little more than 5 feet 9 inches tall, and when I was in the midst of it, I weighed 112 lbs—and even then, I didn’t feel thin enough. It was a horrible way to live. It took me years to climb out of that hole; hands reached down to help me, but I had to do most of the hard climbing myself. Never, ever do I want one of my children to go through that.

Plan A, therefore, was that my children would always be at a healthy weight, with excellent eating and exercise habits. That way I would never have to intervene. I wouldn’t have to say anything to them that might start them wondering if their bodies were beautiful enough, anything that might make them start skipping meals or exercising out of desperation instead of fun. I liked Plan A.

But then Elsa didn’t lose her baby fat the way her older sister did. So much for Plan A.

I approached Plan B with true trepidation. And, as is usually the case with a Plan B, I made it up as I went along, adapting it to different situations and kids (Elsa wasn’t the only one who strayed into unhealthy territory). But there are two main principles that I have always tried to stick to.

First, I am incredibly consistent with everyone in the family when it comes to diet and exercise, no matter how much anybody weighs. There’s no junk food in the house, no soda and very limited sweets (“There’s no sugar in this house!” has been a common complaint over the years.) Everyone has to eat vegetables. Everyone has to exercise (including me and my husband). It has felt a little weird sometimes saying that the skinniest kid in the house can’t have another cookie, but I didn’t want the overweight kid to feel bad—and I didn’t want the skinny kid to learn bad habits. We have family rules about what and when people eat—and one of the great things about the consistency is that the kids enforce them with each other. I’ve watched Natasha remind Liam that he had chips at Nana’s house and so can’t have an Oreo—and watched Liam put the Oreo back in response.

Second, I have been really careful to never frame anything in terms of appearance. Instead, I’ve framed everything in terms of health. We limit sweets, junk food and fast foods because they aren’t healthy. We eat fruits and vegetables because they are healthy. We exercise to make us strong—and healthy. We want to be at a good weight not to be more beautiful or handsome, but because it’s healthy.

This has been hard sometimes; there were moments when I really struggled with the spin. And I’ve worried that the kids might be hearing it differently, that secretly they’ve been thinking: Mom thinks I’m fat, that’s why she’s saying these things. In preparation for writing this blog, I screwed up my courage and talked to my two older daughters about what they thought we’ve done wrong—or right—when it comes to our family health rules.

Elsa, 13, says she never felt bugged about her weight—and while there were times she resented getting yogurt for snack when her friends had chips, she understands why now. As for why she’s slimming down, she said, “I’m more mature now, so I’m making better choices,” (cracked me up, but I didn’t let on.) Michaela, 20, who communicates with me from college via Skype chat, wrote: I always took it as you being your crazy doctor self. I never took anything personally.

I know better than to pat myself on the back. There’s nothing more humbling than parenthood—and I’ve still got two younger ones to raise (or mess up). One of those younger ones is a thin and pretty 9-year-old girl, a fashionista who plays very close attention to the media, something her older sisters were less interested in.

The media, really, is where the real blame—and danger—lies. Sure, the attention on childhood obesity could have a backlash. But my guess is that the preteens with eating disorders are more affected by the skinny models, not to mention the skimpy, sexy clothing marketed directly at them.

So I’m working on a strategy to help me navigate media messages with Natasha—Plan C, I guess. I’ll get back to you on that one.

Claire McCarthy is a primary care physician and the medical director of Children’s Hospital Boston’s Martha Eliot Health Center.  She blogs at Thrive, the Children’s Hospital Boston blog.

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  • mary

    This sounds like an extremely controlling style of parenting with diet as the main vehicle of control. Sounds like a “how to” on the development of an unhealthy relationship with food.

  • maribel

    Not controlling – responsible. When I was growing up there was maybe one overweight person in the neighborhood. Now it’s the normal sized ones who stand out. My fit and trim daughter thanked me for not keeping junk food around and for going to the gym with her.

  • Taylor

    I don’t know. It’s a difficult call. I grew up in a house where sweets were always around. However, we also had to eat all of our meals and there was always a vegetable and/or fruit included. We were also big on fruits as snacks. We didn’t get dessert every night, but we did most nights if we ate our dinner. I ate LOTS of junk food up through college, but exercised semi-regularly. Then I noticed that I my metabolism wasn’t quite the same! I took a look at my eating habits and stopped eating as much processed stuff and purchased more whole foods. Now I eat extremely healthy and workout 6-7 days a week. I don’t think it’s anything my mom did or didn’t do. I just grew up and realized I needed to be healthier for me.

  • stephen reginald

    I think this approach is quite reasonable. My mother did pretty much the same thing. We ate healthy foods because they were good for us. We avoided too many snacks and sweets because the opposite was true. I think that it’s a parent’s responsibility to monitor what their children are eating so that they grow up to be healthy adults. And part of being a parent is “controlling” and molding certain behaviors. What’s wrong with that?

  • http://www.brightonyourhealth.com Mary Brighton

    I read your post with interest, thank you for the interesting article. I am also a parent of 4 children, the oldest who is 11, 3 girls and 1 boy. I am a registered dietitian and live in France and my work’s focus is on child nutrition.
    I think you are doing a lot of things right for your kid’s nutrition, for your children’s future. But if you don’t mind me adding my two cents (or two centimes :) )
    Living in France we just accept food as is…that means we don’t label it-it is just there. I believe that children and adults can still eat “junk food” as part of a healthy eating plan. Maybe less emphasis on labeling foods at home as healthy and non healthy foods could be beneficial?
    I am also strict with my kids eating, not so much as whether they are eating junk food or not, but for snacking between meals. Snacks are usually not “allowed” except for fruit and water between meals. However, the afternoon snack after school can be the time for a cookie or piece of cake or bread. Main meals are a big production, why cook all this fresh food if klds won’t be hungry to eat it? Of course meals include fresh salads as the first course, fruit after the meal, and a fun yogurt for dessert (here in France the yogurts are full of fat and are yummy!).
    I also am especially aware as a mom of 3 girls to never talk about my weight, never weigh myself, never make comments about a food saying “I cannot eat that because it would make me fat.” Just trying as a mom to eat normally.
    Finally, as you do…just making sure kids are running around and getting enough exercise, nature, downtime. Basically, not living a sedentary lifestyle. I think in America the drinks for kids also need to be restricted…no sugary drinks, only water or milk. This is because of the high fructose corn syrup in the sugared drinks.
    Plus, there is a bit of luck that happens..my kids inherited my high metabolism…and they are all lean.
    As a funny lesson: I learned the delicate balance of restricting too much what type of foods my kids were eating when I found out my daughter was at her friend’s houses and eating 4-5 slices of bread with nutella on it for the gouter (snack time in France). She told me she loved it…so I bought some, she finished the big jar in one week. Bought more nutella…she enjoyed every morning for breakfast for the next 2 weeks. Finally she got sick of it…hasn’t touched it in 3 months and is back to Special K for breakfast. Parenting is hard…! Good luck with your 4 kids.

  • http://freerangecomm.com fran melmed

    been there, doing it. i had bulimia for much of my post-college days and am now raising two girls, worrying about the same thing as you. i also focus on eating and exercise as a means to good health, both physically and mentally. i’ve held conversations around our society’s norms and where they’re healthy and where they’re not. and i’ve valued my kids for who they are and not who i want them to be. for beyond the media’s impact, i didn’t see you address how eating disorders are tied to emotional health…and that starts and ends at home.

    f

    if you’re interested, i wrote about my experience on my blog: http://www.freerangecomm.com/2009/11/how-can-you-eat-only-one-cookie/

  • Finn

    This approach–eating vegetables, limited sweets, rules about what and when people eat–is the way my mom raised us back in the 50s & 60s. The only real difference is that my mom didn’t make us exercise, although most of us were active kids anyway. And we were city kids, not suburban, so when we wanted to go somewhere we walked or rode our bikes. It’s a parent’s job to teach kids what’s good for them; I can’t help thinking that national obesity rates are rising partly because too many parents, for too many years, have not.

  • Morgan

    Here is an important resource for parents going through this with their children – Give Food A Chance by Dr. Julie O’Toole. Dr. O’Toole founded the Kartini Clinic in Portland OR, a treatment facility that specializes in treating teens and children with ED
    http://www.perfscipress.com/give-food-a-chance-julie-otoole-eating-disorder-bulimia-kartini-clinic/

  • gzuckier

    At the same time, the media is trying to sell you the 1200 calorie fast food snack.

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