BodyVVise

HOW ARE EATING DISORDER

Eating disorders and obesity are part_ e • s.

These problems include anorexia nervosa,bulimia nervosa, anorexic and bulimic behaviors,unhealthy dieting practices, binge eating disorder,and obesity. Adolescent girls may suffer frommore than one disorder or may progress from oneproblem to another at varying degrees of severity.It is important to understand this range of weight-related problems in order to avoid causing onedisorder, such as bulimia, while trying to preventanother, such as obesity. 1

Body dissatisfaction and unhealthy dietingpractices are linked to the developmentof eatin I e

High numbers of adolescent girls arereporting that they are dissatisfied with theirbodies and are trying to lose weight in unhealthyways, including skipping meals, fasting, andusing tobacco. A smaller number of girls areeven resorting to more extreme methods such asself-induced vomiting, diet pills, and laxative use.?

These attitudes and behaviors place girls at agreater risk for eating disorders, obesity, poornutrition, growth impairments, and emotionalproblems such as depression.3 Research shows,For example, that overweight girls are moreconcerned about their weight, more dissatisFiedwith their bodies, and more likely to diet thantheir normal-weight peers.s

Binge eating is common among peoplewith <>'1 If ~ c r ae - <> n

People with bulimia binge eat and thenpurge by vomiting, using laxatives, or other means.Binge eating that is not followed by purging mayalso be considered an eating disorder and canlead to weight gain. More than one-third of obeseindividuals in weight-loss treatment programs reportdifficulties with binge eating.5 This type of eatingbehavior contributes to feelings of shame, loneliness,poor self-esteem, and depression.6 Conversely, thesekinds of feelings can couse binge eating problems."A person may binge or overeat for emotionalreasons, including stress, depression, and anxiety.8

AND OBESITY RELATED?

Depression, anxiety, and other mooddisorders are associ '" '"

rCJe .. Adolescents who aredepressed may be at an increased risk of becomingobese. One recent study found that depressedadolescents were two times more likely to becomeobese at the one year follow up than teens whodid not suffer from depression.? In addition, manypeople with eating disorders suffer from clinicaldepression, anxiety, personality or substance abusedisorders, or in some cases obsessive compulsivedisorder.Iv Therefore, a mental health professionalmay need to be involved in treating on adolescentwho is obese or suffers from on eating disorder orother weight-related problem.

The environment may contributeThe

moss media, family, and peers may be sendingchildren and adolescents mixed messages aboutfood and weight that encourage disorderedeating.ll Today's society idealizes thinness andstigmatizes fatness, yet high-calorie foods arewidely available and heavily odvertised.t? At thesame time, levels of physical activity are atrecord lows as television and computers replacemore active leisure activities, travel by automobilehas replaced walking, and many communities lackspace for walking and recreation.13

HEALTH RISKSMost teens don It suffer from

either anorexia or obesity.

Eating disorders may lead to

behaviors such as bingeing,

• Stu nted growth

• Delayed menstruation

• Damage to vital organs such as the

heart and brain

• Nutritional deficiencies, includingstarvation

They are more likely to

engage in disordered eating

purging, and dieting. These

behaviors are associated

• Cardiac arrest

• Emotional problems such as depressionand anxiety

with serious physical and

emotional health problems.

We've got to get back to

three square meals a day,

Obesity increases the risk for

nutritious snacks, and

• High blood pressure

• Stroke

• Cardiovascular disease

• Gallbladder disease

• Diabetes

• Respiratory problems

• Arthritis

• Cancer

healthy meal planning,

regular physical activity. 14 • Emotional problems suchas depression and anxiety

- RICHARD KREIPE, M.D., CHIEF, DIVISION OF ADOLESCENT

MEDICINE, UNIVERSITY OF ROCHESTER MEDICAL CENTER

1

Changing habits is never easy, but switching to a healthier diet and

regular physical activity will bring children and their families

many benefits, including improved health, more energy, and a better

quality of life. 15

- JONELLE C. ROWE, M.D., OFFICE ON WOMEN'S HEALTH

HELP ADOLESCENTS DEVELOP HEALTHY EATINGATTITUDES AND BEHAVIORS

Be a positive role model. Children look to parentsand other adult caregivers as they develop theirown attitudes and behaviors toward eating andweight. For example, children of overweight parentsare more likely to be overweight than their peers.Also, daughters of mothers who diet are morelikely to diet than other girlS.16 Teach young peoplehow to eat healthily through your own actions. Avoidunhealthy habits such as skipping meals to loseweight, complaining about your body, or using foodas a reward.

Help children learn to control their owneating. Parents and other adults can help children getin touch with their feelings of hunger and fullness. Forexample, encourage young people to stop eating whensatisfied. Avoid forcing children to eat certain foods,requiring that they "clean their plates," or forbiddingparticular foods, as it may even increase theirpreference for and intake of those foods.17 Studiesshow that when mothers try to restrict their children'sfood, the children actually tend to eat more when theyare not being supervised. IS

Offer young people a variety of healthy foodsat meal and snack times. Plan meals in advance,and make sure they include vegetables, whole grains,protein, and other foods that are low in sugar andsaturated fat. Pack a healthy school lunch for yourchild. Keep plenty of healthy snacks such as nuts andfruit available at home.

Eat dinner together as a family most daysof the week. Meals are an important social activity,and help parents and caregivers keep track of whatyoung people are eating, as well as their activitiesand moods. Make mealtime a relaxed and enjoyableoccasion.

Be aware of your child'semotional health.Depression, anxiety, and other mood disorders areassociated with obesity, eating disorders, and otherweight-related problems. Consult a mental healthprofessional if you think your child may be sufferingfrom a more serious emotional problem than typicaladolescent mood swings.

Provide opportunities for children toparticipate in sports, dance, swimming, orother physical activities. Take your child regularlyto parks, beaches, and other places where he or shecan be physically active. Take walks, hikes, or bikerides as a family. Keep exercise clothing and equipmentavailable. limit and monitor time spent watchingtelevision, which encourages sedentary behavior andexposes children to junk food advertisements. Removetelevisions from kids' bedrooms.

Counteract harmful media messagesaboutbody image. Watch television with children andtalk about messages regarding body image. Discusshow advertisers use thin models to market productsand manipulate photos and other images to makebodies look perfect. Praise the child for his or hertalents and abilities, and encourage a focus on healthrather than on appearance.

Don't be afraid to seek help. Take your child to afamily doctor if you think he or she has a weight-relatedproblem. A doctor can suggest ways to maintain ahealthy weight, assess your child for any underlyingemotional problems, or recommend a program thatpromotes healthy food choices and exercise. Many ofthese programs include family members, so you maybenefit personally from it too.

Did you know ...

• In American high schools,30 percent of girls and16 percent of boys schoolssuffer From disorderedeating, including bingeing,vomiting, fasting, laxativeand diet pill use, andcompulsive exercise 19

DEFINITIONSBody image is how you see yourself when you look in the mirroror picture yourself in your mind.

• Childhood obesity has morethan tripled in the last 30years. By the year 2000,15 percent of children andadolescents ages 6 to 19were obese.20

Obesity means having an abnormally high proportion of bodyfat. A person is considered obese if he or she has a body massindex (BMI) of 30 or greater. BMI is calculated by dividing aperson's weight in kilograms by height in meters squared. Youcan also calculate your BMI by going to an online BMI calculatorat www.fns.usda.gov/tnrockyrun/diff.htm .

• A personal or familyhistory of obesity is a riskfactor for later developmentof bulimia.22

Overweight refers to an excess of body weight compared toset standards. The excess weight may come from muscle, bone, fat,and/or body water. A person can be overweight without beingobese (for example, athletes who have a lot of muscle). However,many people who are overweight are considered obese due toexcess fat on their bodies. A person may be considered overweightif he or she has a BMI of 25-29.9.

• Studies suggest that about70 percent of overweightadolescents will becomeobese cdults.?'

• The overage child in theU.S. watches 10,000television advertisements forfood each year, 95% ofwhich are for foods in oneof four categories: sugaredcereals, candy, fast foods,and soft drinks.23

Anorexia nervosa is self-starvation. People with this disordereat very little even though they are thin. They have on intense andoverpowering fear of body fat and weight gain.

Bulimia nervosa is characterized by cycles of binge eatingand purging, either by vomiting or taking laxatives or diuretics(water pills). People with bulimia have a fear of body fat eventhough their size and weight may be normal.

Binge eating disorder means eating large amounts of food ina short period of time, usually alone, without being able to stopwhen full. The overeating and bingeing are often accompaniedby feeling out of control and followed by feelings of depression,guilt, or disgust.

Disordered eating refers to troublesome eating behaviors,such as restrictive dieting, bingeing, or purging, which occur lessfrequently or are less severe than those required to meet the fullcriteria for the diagnosis of an eating disorder.

!

THE DIET TRAP• The risk for obesity may be 324 percent

greater for adolescent girls who describe

themselves as dieters than girls who do

not diet.24 ... the potential consequences

of body dissatisfaction and

unhealthy weight control

behaviors are of considerable

public health significance,

because these negative

cognitions and behaviors

are associated with the

• Up to one in four ll-year-old girls have

already tried to diet at least once.25

• Children who diet may actually end

up gaining more weight in the long term

than children who do not diet. This is

because dieting may cause a cycle of

restrictive eating, followed by overeating

or binge eating.26

• People who are obese or at risk of

becoming obese are more likely to use

unhealthy weight loss practices, such as

vomiting and using diet pills or laxatives.27 development of both eating

disorders and obesity. 29• Disordered eating and dieting have been

linked to serious risk-taking behaviors

such as drug, alcohol and tobacco use,

delinquency, unprotected sexual activity,

dating violence, and suicide otternpts.»

- DIANNE NEUMARK,SZTAINER, PH.D., M.P.H., R.D.,

DIVISION OF EPIDEMIOLOGY, UNIVERSITY OF

MINNESOTA SCHOOl OF PUBLIC HEALTH

RESOURCES

The National Women's HealthInformation Center (NWHIC)Telephone: (800) 994·9662TDD: (888) 220·5446Web site: www.4womon.gov

www.4girls.gov

NWHIC is a federal government Website and toll-free call center that providesfree, reliable women's health information.Sponsored by the Department of Healthand Humon Services' Office on Women'sHealth, NWHIC features special sectionson body image and girls' heolth. The4girls.gov Web site gives girls betweenthe ages of 10 and 16 reliable, currenthealth information designed to motivatethem to choose healthy behaviors.

National Institute of Diabetesand Digestive and Kidney Disease(NIDDK)Telephone: (877) 946·4627Web site: www.niddh.nih.gov

NIDDK offers stotistics, research, andeducational information on its Website and manages The Weight·controlInformation Network (WIN), whichprovides resources on obesity, eatingdisorders and other weight.related issues.

The National Heart, Lung, andBlood Institute (NHLBI)Telephone: (301) 592·8573Web site: www.nhlbi.nih.govE·mail: NHLBinfo@rover.nhlbi.nih.gov

The NHLBI Information Center andthe Obesity Education Initiative prOVideinformation obout weight control, includingtools such as an online BMI calculatorfor adults and a menu planner. The NHLBIalso operates 0 program called HeartsN'Parks, a partnership with the NotionalRecreation and Parks Association, whichhelps provide activities for kids andadults that encourage healthy lifestylechoices to reduce the risk of obesity andheart disease.

American Dietetic AssociationNutrition hotline: (900) 225·5267Publications: (800) 877·1600 ext. 5000Web site: www.eatright.org

The American Dietetic Associationoperates a nutrition hotline thot providesthe public with nutrition information fora small fee. The association also offerspublications and other resources to thegeneral public, health core providers andother professionals, teachers, and parents.

National Eating DisordersAssociation (NEDA)Telephone: (206) 382·3587Information and Referral Helpline:(800) 931·2237Web site: www.nationaleatingdisorders.org

NEDA is the largest eating disordersprevention and advocacy organizationin the world. The association providestreatment referrals to those suffering fromonorexia, bulimia, binge eoting disorderand to those concerned with body imageand weight issues. NEDA also developsprevention programs for a wide rangeof audiences, publishes and distributeseducational materials, conducts an annualconference, and operates a tall·freeeating disorders helpline.

The Body PositiveTelephone: (510) 548·0101Web site: www.thebodypositive.orgE·mail: Info@thebodypositive.org

The Body Positive is a non.profitorganizotion that educates peopleto think about self·esteem, health andbody image in a new way. Theirresources include a gUidebook on howto creote comprehensive, youth·ledeating disorders prevention programsin schools and youth organizations,as well as videos on body image andself·esteem for girls, families, healthcare providers and educators.

BodyWise ond BodyWorks are initiotives of the U.S. Deportment of Health and Human ServicesOffice on Women's Health. BodyWise provides school personnel and other adults who interact withstudents ages 9 to 12 with information to help prevent disordered eating and eating disorders.BodyWorks is a toolkit on physical activity and nutrition for porents and other adult caregivers ofgirls ages II to 13. Print copies of BodyWise and BodyWorks are available at www.4woman.gov.

g Office on Women's Health B@>~,*,WO~KSA rorHlci1 'tl, H •• /t", (iI", • $tro"9 Women

Elld Notes

1 Neumoric,sztoinor, D. -0be5ity end Eating DilOt'dot Preventi.on; An Inlugrol1:JdApprooch~" Ado/esconf MfKlfclne, Feb;l.:S(ll: I 59·73 IRovlowt. 2003.

:2 NCLJJnork,S2k1irmr, D., Story, M, Hennen, PJ., or 01. "'Woight.Reklled Concerns

and Behavior! Among Overweight end Non-Ovorweisht AdoleSCents:Impllcotions for Prcvonfing VVeight-Reiated Disorders." Archi'IeJ of PecJj'oIriC$ondMalesan,!kd;ano, Feb;156121:171-8, 2002.

3 Neutnati:-Smioor, O. ·Obesity and Eeting Disorder Prevention: An IntegratedApp<oach?" 2003.

4 Burrows, A., Cooper, M. ~Pouible Risk Foctors In me Dcw!topmenl of EatingDi:sorden in CNorwoightProAdobcent Girls.~ Inlf.trnoliOflOI.1cumo1 of Obesityand Fleloted A-1cl"boIic DiMJfOou., Sopt;26(9): 1268.1 273, 2002; Davison, K.K.,Markey, CN., Birch,LL "Etio$ogy 0( Body Dissati.fodlon and Welehl CcocemsAmong .$.yeor--oJdGIrl,." Appoflle, 0cJ;35(2): 143-151, 2000; Vandor Wal,J.S., Thelen, M.H. ·Eoftng and Body Image Concern. Among Obese and

AVMoge-We+ght Children." AJJIctNe 8elxmor. Sep-Oct;25(5):77'>778, 2000,

5 Vonovs.ki, S.l. '"Bingo Ealing in Oteee Persons.· In Foifbom, e.G., 8Jownell,K.O. lads), fallng DjJOl'Clersand Obesity. 2nd 00, Now York: Guilford Press,403.407, 2002.

6 Wallor, G, 'The P5yChoIogy of Binge EDling." In FaIrburn, e.G., Brownoll,

K.D. (em) EatinS Ofsord"tl and Obesity, 2nd ed. New York: Guilford Press.9(1.102.2002.7 Fairburn, C., O\t-efcomlng Bmge fating. New York: The Guilford Press, 1995,pp.8().99.

8 Goodmon, E, Whitakor, R. ~A Pro5p8divo Study 01 tho Role of Depression inthe Development ond Peni$tence of Adolescent Obesity." Pcdlatria. 2002Sep;110I3J:497..504. Lumeng JC, Gannon K. Cobral HJ, Fronk OA, ZuckermanB. "A5.WCiatlon between clinically meaningful behavior problems cnd overweightin chjld!en.~ PecJlalrK;s. 2003 Nov;11215J:1138-45.9 Goodman, E.• Whitaker, R.C. "A Prospective Study of the R~ af Depressionin the Developmenr and Porsbtence 01 Adote.scent Obesity." Pec/,afriQ.

Sep;IIOI3):497.5Q4,2002.10 Notional Mentol Health Auodation. 'Teen Eating Disorders.- 1997.11 Irving, LM .• Neumori.:-Sztainer, D. -Inlegrohng tho Prevention of EatingDisorder:s Dnd Obolity: Feo~ible or Fuli~· Pr~1ivo Meclicin", 34:299-309,2002. Stice, E, "SocioculturallnAuencei on Body Imago and EatingDisturbance.· II) Fairburn, e.G .• Brownell. K.D. (ods) Eollng Di.sorders andObeJily, 2nd 00. Now V",., Gu;lI",d P,.... , 103-107. 2002.12 601'l1e,EX, Brownell, K.O. ~Confronting oRbing rtdo of Eating DiJordouand Obesity. Treatment YS. Preventioo and Policy.· Addidive BcJ,crvior,21:75S.()5IRev;ew),1996.13 Frencn, S.A. Story, M., Jeffery, R. "ErrvironmenkJ!lnfluonc;:es 00 Eating andl'hysicQ! Activity. Annl}Qi RtJVIew of Pvblic Heal,h. 22:309-35 IReview), 2OOl.14 Krcipe, R. Personal communication. November 9, 2003,IS Rowe. J.e. Porsonol communication. Octobftr 31. 2003.16 SIc-Inberg, A.B .• Phore., V. -Family functioning, 80dy Image, and EatingDi,hHbooce •. • In ThomP"'", J,K" Smolak, l. Icds), 8cxft Imoge, fo#ng{);JOfden, anti Obesity to YOCIfhWommgtQn, DC: Amerkan PsychologicalA..oc.mon, 127·147,2001.17 Fimer. J.O., Birch, LL "Eor~ o:porience WI.n Food o~ Eeting: Implkohonslor the Dcvdopmont of Eallng Oisorden. In Thotnpwn, J.K., Smolak. L lodsl.Body ImQge, Earing D/sore/en. and Obcsily in you,h. Washington, DC: .AmericcnP~ychologicol AS5OCiotioo, 23-39, 2001.HI Birch, L. "kquisitiOfl ot Food Prelcrences and Eeting Patterns in Children, Infairburn, C.G., Brownell, K.D. (adsJ. EDhng Duorders oncJ Obesity. 2nd rtd.New Yoe'k:Guilford Prcu, 75-79,2002.19 Austin. S" Z,yodch, N., lei ... , A. Zocbwy, A. & Fannon, S. ·50 .... ;09High School Studonts lor Eati~ DiKX'ders: Rc:uulls01 a Not)onollnitiotivc.·Jou,"o/ 01 Male",,,,,, Heolth, 28121, 96, 2001.20 Ogden, C,l.. Flegal. K.M., Carroll, M.D .• JohntOf'l,C.L "Pr6ll'Olence andTrendll in Overweight Among US Children and Adolesconts, 1999.2000,"lAMA 2002;288:1728·1732.21 Dietz., W.H. ".v.edicol Coosequel'lCM of Obesity in Chi'dren ond Adolc!oCcnh.

In Fo;dxm" C.G., Brownell, K.D., (odsl, EatingD'""d." arC 0bes;1y, 2nd 00.New Ycrlc Guilford Press, 47~76, 2002.22 fohbum, c.G" Slke, E., Cooper, Z., Doll, HA, Norman, P.A., O'Conn""M.E. "Undemanding Persl~lonco it1 Bulimia NervOloO: A ,S.yoor J\IoturolislicStudy. Journal 01 Consu/llna and Clinical PsychoJooy, Fob;7111); 103·9, 2003.23 Brownell, K.O. 'rho Environment and Obosily: In Falrbum. e.G., Brownoll,K.D. (ods) faring Disordtl($ and Oh.a.5ily.2rtd ad Now York; Guilford PrIm.403-407, 2002.2. Stice, E., CGrneroo. R.P.. Killen, J.D., et 01. -NoturoliUic Weight-RechdionEffort, Prospectively Prodid Growth in Rekmve Weight and OniOt of Obesityamong female Adoiesc:enIS. Joorncl of Consulting and Clml(!ol PsydJology.Dec;6716j:967.JA, 1999.25 Hili, AJ. ~Prevolftnco and Demographics of Olatlng,~ In FQlrborn, e.G .•Srownefl. K,D. (edtl Eating Diwrders and Obesity. 2nd E!d. New YOft.:GuilfordPress. 80-83, 2002.

•• Field, AE., Au,';n, S.B .• Taylor, C.8., MoIspei •• S" R"",er, B" Rock .. , H.R"Gmmon. M.w., Cold .. , G.A. ·RoIon"" Beiwoon D"~ng arC We;ght ChangeAmong P'eodole""",,, and AdoIeocen"." Podiatries, Oct;11114)~, 2003.27 Neumorit-Sztorner, D., Story. M.. folkner, N.H., et al ~Socicdemogfaphicand Per$Qnol Chorodcristies 01Ado!e~nb Engaged in "Nelghl Loss andWclght/Musde Gain Behaviors: Who i~Doing Whot;~ Preventive Medicill~,28:40, 1999. Neumork.sz.lainer, D., Story, M .• Fronch, S., Hannon, P., Rrasknid:,M., Stum, R.W. "Plycho$OC\ol Concerns and Health-Compromising BehavIorsamong CNerweight ond ~ighf AdoIeKen~.· Obesity Research"Moy:5131:237"9, 1997.2.8 Neumort.szkuner, 0 .. Story, M., French, S.A. "Covoriotiolu 01 on UnhealthyWeight lns:s Bohovlors and Other High-Risk Behaviors among AdolescentsArchives of p"ai",,.c AcIoleKHtt MediCine. 15013), 304.308, 1996.

29 Neumonc·Szlainor, 0 ~Obt.t.\ity nnd Ealing Disordor Provcntion: An IntegratedApproach?" 2003

Eating DUarders and Obesity Companion Pie<.