Preventing Eating Disorders in Adolescents

*Just a quick note/trigger warning that the article described uses the word “obesity”. Many people find this word stigmatizing and I personally do not use this word when speaking about clients. When the word “obesity” is used, it’s in a direct quote from someone other than me.

Many professionals have concerns that the “war on obesity” is fueling eating disorders (EDs). Increased focus on weight, dieting, regimented exercise, and shameful body-image messages are usually present in many weight-loss programs. However, when prevention efforts are done with a focus on lifestyle, rather than weight, it may be possible for adolescents to avoid developing disordered eating behaviors. Eating disorder experts jumped for joy when The American Academy of Pediatrics (AAP) released new guidelines, this September, for the “prevention of obesity and eating disorders in adolescents”. These guidelines all contain concepts that many eating disorder professionals have endorsed for a long period of time.

Cross-sectional and longitudinal observational studies have identified the following specific behaviors associated with both obesity and EDs in adolescents:

1. Dieting—Dieting is defined as calorie restriction for weight loss. We know that dieting leads to increased thoughts about food and bingeing. Weight gain almost always happens after the diet is “over”, because dieting can slow metabolism, and alter true hunger and fullness cues. We also know that dieting is a predisposition to eating disorders.
2. Decreased Family Meals—Family meals can be protective against disordered eating because parents may catch eating issues earlier. Having family mealtime is also important for nutrient quality. Eating together as a family, with parents leading the way and serving as role models, is associated with increased fruit and vegetable consumption.
3. Weight Talk—Talking about weight in the household almost always increases disordered eating. It could be talking to the child or adolescent about his or her weight , or it could be a parent talking about his or her own weight issues.
4. Weight Teasing—Teasing may contribute to unhealthy food behaviors and bingeing. Overweight and obese adolescents are much more susceptible to teasing than kids with a “normal” weight.
5. Body Dissatisfaction—1/2 of all teenage girls and 1/4 of all teenage boys are dissatisfied with their body. These statistics are alarming because an unhealthy body image leads to disordered eating and unhealthy behaviors. Adolescents with healthy body image are less likely to report weight concerns and behaviors.

Physicians are encouraged to focus less on weight and more on healthy family-based lifestyle modifications. The following guidelines are appropriate for physicians, but all healthcare professionals may benefit from supporting these ideas.

1. Discourage dieting, skipping meals, and diet pills. Encourage healthy eating and physical activity that can be maintained in the long-run. Focus on healthy living and healthy habits, rather than on weight.
2. Promote a positive body image. Do not encourage body dissatisfaction as a reason for weight-loss or dieting.
3. Encourage frequent family meals
4. Discourage families from talking about weight. Instead discuss healthy eating and being active to stay healthy. Facilitate healthy eating and physical activity at home.
5. Inquire about history of teasing and bullying in overweight and obese teenagers, and address the issue with their parents.
6. Carefully monitor weight loss in an adolescent who needs to lose weight, to ensure that the adolescent does not develop the medical complications of semi-starvation.

Reference:  Golden N, Schneider M, Wood C (2016). Preventing Obesity and Eating Disorders in Adolescents. Pediatrics: published online August 22, 2016.

See the full-text pdf research article here:  http://pediatrics.aappublications.org/content/pediatrics/early/2016/08/18/peds.2016-1649.full.pdf