By Christopher Scanlan
Knight Ridder Newspapers
Feb. 19, 1994
Worried about her weight, Sarah swore off dessert and cut back on meal portions. Eventually, she began skipping breakfast and was just nibbling at lunch and dinner. Within six months, she dropped 13 pounds.
A weight-loss success story? Not at all. Sarah is only 10 years old. Her diet cost her 20 percent of her weight.
Children such as Sarah, a Philadelphia 4th-grader who’s too embarrassed to let her real name be used, are at the forefront of a disturbing new trend affecting the health of U.S. children: dieting.
Around the country, children as young as 6 are shedding pounds, afraid of being fat and increasingly being treated for eating disorders that threaten their health and growth, health specialists report.
In trying to correct one problem — one in five children is now overweight — doctors, parents, schools, and the media have unwittingly caused another.
‘This whole pressure to be thin has backfired on children,” said Joanne Ikeda, a dietitian at the University of California at Berkeley who counsels parents and health professionals about children and weight issues.
“It’s a national crisis,” said Frances Berg, editor of Obesity and Health, a North Dakota journal that reports the latest scientific research on obesity.
No one denies that many American children, like adults, have a problem with weight. American children are fatter than ever before, experts agree. Among children 6 to 11, obesity increased 54 percent in the past two decades, according to a 1987 review of four national nutrition and health surveys. The number of obese youths rose 39 percent in the 12-17 group.
Obesity a Health Risk
Obesity poses serious health risks for children. The condition is linked with high blood pressure and future problems with diabetes, heart disease and colon and breast cancer, said Dr. Gilman Grave of the National Institute of Child Health and Development.
In recent years, public health officials, doctors, and the nation’s schools have preached the importance of reduced fat and cholesterol and more exercise for children as well as adults.
But now many health professionals are sounding a new warning: Children should never diet.
Dieting can lead to anorexia nervosa, bulimia, and other eating disorders that cause death, serious illness, stunted growth and other health problems at a vulnerable stage when extra protein is needed for a child’s healthy development.
It can also affect a child’s learning, ability to concentrate, and performance in school.
“Even with fat children you can stunt their growth so that instead of ending up with a slender child you end up with a short fat child,” dietitian Ikeda said.
Children go through stages when they are heavier, especially during puberty, and often grow into their weight, dietitians say.
Children, whatever their size, need a healthy beyond diet low in fats and sugars and high in fiber and an active life, health professionals say. Exercise is the key to preventing and controlling obesity, experts agree.
But that message apparently has not reached many children, recent surveys show.
Pre-Teen Dieting
In a study published last summer, researchers at the Medical University of South Carolina reported dramatic evidence about the problem of pre-teen dieting. In the largest study of middle school children to date, they surveyed 3,175 boys and girls between 10 and 13. More than half the girls in the fifth to eighth grades who were surveyed felt they looked fat and wanted to lose weight.
One-fourth of the boys had similar attitudes. Among all the students, one out of three had dieted, and almost 5 percent said they had vomited to lose weight.
“The heavier the kids were, the more anxiety they expressed about their weight,” said Elizabeth Hodges, who treats children with eating disorders and is one of the study’s authors. “But even normal weight kids were dieting.”
Unhealthy dieting is even more widespread among teen-agers. More than two-thirds of high school girls are dieting, one in five has taken diet pills, and many girls as well as boys are using laxatives, diuretics, fasting and vomiting in a desperate effort to become slim, according to a 1992 study of students in 10 Cleveland high schools.
“If you want to look pretty, if you want to be popular, if you want to stand out, you have to be thin,” said Katie, 13, who lives in a Chicago suburb.
Katie’s ordeal began at 7 when she looked at the girl sitting next to her on the school bus. “I just thought my thighs were a lot bigger than hers. I was shocked because I thought I was fat.” Her parents were dieting, and Katie said she was “afraid I was going to be like my mom.”
What followed was a typical pattern, experts say. The 75-pound third-grader cut out fat from her diet and began refusing food. She began spending hours exercising to lose weight, often waking at 4:30 a.m. to jog in place in her bedroom.
42 Pounds at 11
By 11, when she was admitted to a psychiatric hospital for treatment of anorexia nervosa, she weighed 42 pounds.
Today’s children face a cruel dilemma. They are growing up in a society that condones eating too much of the wrong foods and exercising too little, while at the same time clinging to unreasonable ideals of thinness and beauty. Fat children are often shunned and taunted by their classmates, who reflect society’s prejudice against obesity.
Children today are merely reflecting a national obsession about diet and weight among adults, Hodges said. They are, in effect, the post-Weight Watcher generation.
“These children have always been exposed to the diet culture,” said Hodges.
“It’s a fact of life. Everyone’s running and exercising and doing Nordic Track and step machines and watching their weight and what they eat. Kids get the message that to be thin is what’s most important.”
That message is so overpowering, doctors say, that even children of normal size, like Sarah, who weighed 66 pounds when she began dieting, are driven to lose weight. “I couldn’t control it,” she said.
Sarah’s mother recalls her daughter “starting to read labels, counting the calories, reading about the fat content. I thought it was a stage.”
But her daughter quickly moved from avoiding snacks to skipping entire meals.
“She was beginning to look like a concentration camp victim. You could see her ribs. She had lost so much on her thighs there was a big gap between her legs.
“It was heartbreaking,” her mother said.
Under therapy, Sarah and Katie both regained weight.
Therapist Ellyn Satter, author of “How to Get Your Kid to Eat … But Not Too Much,” advises “carefully indirect” methods of weight control that divide responsibility for eating between parent and child.
Parents are responsible for what, where and when [the child eats]; the child is responsible for how much and whether,” she said. She advises against allowing children to “panhandle” for food between mealtimes and recommends drinking water, rather than juice or soda, between meals.
Besides fostering good eating and exercising habits, what’s needed most is acceptance of a child’s weight, experts say.
The emphasis on being thin “sets up a dilemma for kids who are normally heavier to try to diet themselves down to a biologically impossible state,” Hodges said.
“The question should not be how do we make fat kids thin. It should be how do we make fat kids healthy,” said Sally Smith, executive director of the National Association to Advance Fat Acceptance in Sacramento, Calif.
Attitudes that parents hold about obesity must change, Berg said. “They’re conveying the message: There’s something wrong with your body, and we’ve got to fix it. They need to give the message that you’re great the way you are, and we love you.”
