BodyVVise
HOW ARE EATING DISORDER AND OBESITY RELATED?
Eating disorders and obesity are part Depression, anxiety, and other mood _ e • s. disorders are associ '" '" These problems include anorexia nervosa, rCJe .. Adolescents who are bulimia nervosa, anorexic and bulimic behaviors, depressed may be at an increased risk of becoming unhealthy dieting practices, binge eating disorder, obese. One recent study found that depressed and obesity. Adolescent girls may suffer from adolescents were two times more likely to become more than one disorder or may progress from one obese at the one year follow up than teens who problem to another at varying degrees of severity. did not suffer from depression.? In addition, many It is important to understand this range of weight- people with eating disorders suffer from clinical related problems in order to avoid causing one depression, anxiety, personality or substance abuse disorder, such as bulimia, while trying to prevent disorders, or in some cases obsessive compulsive another, such as obesity. 1 disorder.Iv Therefore, a mental health professional may need to be involved in treating on adolescent Body dissatisfaction and unhealthy dieting who is obese or suffers from on eating disorder or practices are linked to the development other weight-related problem.
of eatin I e High numbers of adolescent girls are The environment may contribute reporting that they are dissatisfied with their The bodies and are trying to lose weight in unhealthy moss media, family, and peers may be sending ways, including skipping meals, fasting, and children and adolescents mixed messages about using tobacco. A smaller number of girls are food and weight that encourage disordered even resorting to more extreme methods such as eating.ll Today's society idealizes thinness and self-induced vomiting, diet pills, and laxative use.? stigmatizes fatness, yet high-calorie foods are widely available and heavily odvertised.t? At the These attitudes and behaviors place girls at a same time, levels of physical activity are at greater risk for eating disorders, obesity, poor record lows as television and computers replace nutrition, growth impairments, and emotional more active leisure activities, travel by automobile problems such as depression.3 Research shows, has replaced walking, and many communities lack For example, that overweight girls are more space for walking and recreation.13 concerned about their weight, more dissatisFied with their bodies, and more likely to diet than their normal-weight peers.s
Binge eating is common among people
with <>'1 If ~ c r ae - <> n People with bulimia binge eat and then purge by vomiting, using laxatives, or other means. Binge eating that is not followed by purging may also be considered an eating disorder and can lead to weight gain. More than one-third of obese individuals in weight-loss treatment programs report difficulties with binge eating.5 This type of eating behavior contributes to feelings of shame, loneliness, poor self-esteem, and depression.6 Conversely, these kinds of feelings can couse binge eating problems." A person may binge or overeat for emotional reasons, including stress, depression, and anxiety.8 HEALTH RISKS
Most teens don It suffer from Eating disorders may lead to either anorexia or obesity. • Stu nted growth
• Delayed menstruation They are more likely to • Damage to vital organs such as the engage in disordered eating heart and brain • Nutritional deficiencies, including behaviors such as bingeing, starvation purging, and dieting. These • Cardiac arrest • Emotional problems such as depression behaviors are associated and anxiety with serious physical and Obesity increases the risk for emotional health problems. • High blood pressure • Stroke We've got to get back to • Cardiovascular disease three square meals a day, • Gallbladder disease • Diabetes healthy meal planning, • Respiratory problems nutritious snacks, and • Arthritis • Cancer regular physical activity. 14 • Emotional problems such as 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 EATING ATTITUDES AND BEHAVIORS
Be a positive role model. Children look to parents Be aware of your child's emotional health. and other adult caregivers as they develop their Depression, anxiety, and other mood disorders are own attitudes and behaviors toward eating and associated with obesity, eating disorders, and other weight. For example, children of overweight parents weight-related problems. Consult a mental health are more likely to be overweight than their peers. professional if you think your child may be suffering Also, daughters of mothers who diet are more from a more serious emotional problem than typical likely to diet than other girlS.16 Teach young people adolescent mood swings. how to eat healthily through your own actions. Avoid unhealthy habits such as skipping meals to lose Provide opportunities for children to weight, complaining about your body, or using food participate in sports, dance, swimming, or as a reward. other physical activities. Take your child regularly to parks, beaches, and other places where he or she Help children learn to control their own can be physically active. Take walks, hikes, or bike eating. Parents and other adults can help children get rides as a family. Keep exercise clothing and equipment in touch with their feelings of hunger and fullness. For available. limit and monitor time spent watching example, encourage young people to stop eating when television, which encourages sedentary behavior and satisfied. Avoid forcing children to eat certain foods, exposes children to junk food advertisements. Remove requiring that they "clean their plates," or forbidding televisions from kids' bedrooms. particular foods, as it may even increase their preference for and intake of those foods.17 Studies Counteract harmful media messages about show that when mothers try to restrict their children's body image. Watch television with children and food, the children actually tend to eat more when they talk about messages regarding body image. Discuss are not being supervised. IS how advertisers use thin models to market products and manipulate photos and other images to make Offer young people a variety of healthy foods bodies look perfect. Praise the child for his or her at meal and snack times. Plan meals in advance, talents and abilities, and encourage a focus on health and make sure they include vegetables, whole grains, rather than on appearance. protein, and other foods that are low in sugar and saturated fat. Pack a healthy school lunch for your Don't be afraid to seek help. Take your child to a child. Keep plenty of healthy snacks such as nuts and family doctor if you think he or she has a weight-related fruit available at home. problem. A doctor can suggest ways to maintain a healthy weight, assess your child for any underlying Eat dinner together as a family most days emotional problems, or recommend a program that of the week. Meals are an important social activity, promotes healthy food choices and exercise. Many of and help parents and caregivers keep track of what these programs include family members, so you may young people are eating, as well as their activities benefit personally from it too. and moods. Make mealtime a relaxed and enjoyable occasion. Did you know ...
• In American high schools, 30 percent of girls and 16 percent of boys schools DEFINITIONS suffer From disordered eating, including bingeing, Body image is how you see yourself when you look in the mirror vomiting, fasting, laxative or picture yourself in your mind. and diet pill use, and
compulsive exercise 19 Obesity means having an abnormally high proportion of body fat. A person is considered obese if he or she has a body mass • Childhood obesity has more index (BMI) of 30 or greater. BMI is calculated by dividing a than tripled in the last 30 person's weight in kilograms by height in meters squared. You years. By the year 2000, can also calculate your BMI by going to an online BMI calculator 15 percent of children and at www.fns.usda.gov/tnrockyrun/diff.htm . adolescents ages 6 to 19 were obese.20 Overweight refers to an excess of body weight compared to
• Studies suggest that about set standards. The excess weight may come from muscle, bone, fat, 70 percent of overweight and/or body water. A person can be overweight without being adolescents will become obese (for example, athletes who have a lot of muscle). However, obese cdults.?' many people who are overweight are considered obese due to excess fat on their bodies. A person may be considered overweight • A personal or family if he or she has a BMI of 25-29.9. history of obesity is a risk factor for later development Anorexia nervosa is self-starvation. People with this disorder of bulimia.22 eat very little even though they are thin. They have on intense and overpowering fear of body fat and weight gain. • The overage child in the U.S. watches 10,000 Bulimia nervosa is characterized by cycles of binge eating television advertisements for and purging, either by vomiting or taking laxatives or diuretics food each year, 95% of (water pills). People with bulimia have a fear of body fat even which are for foods in one though their size and weight may be normal. of four categories: sugared cereals, candy, fast foods, and soft drinks.23 Binge eating disorder means eating large amounts of food in a short period of time, usually alone, without being able to stop when full. The overeating and bingeing are often accompanied by 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 less frequently or are less severe than those required to meet the full criteria 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
• Up to one in four ll-year-old girls have of body dissatisfaction and already tried to diet at least once.25 unhealthy weight control • Children who diet may actually end up gaining more weight in the long term behaviors are of considerable than children who do not diet. This is because dieting may cause a cycle of public health significance, restrictive eating, followed by overeating because these negative or binge eating.26 cognitions and behaviors • People who are obese or at risk of becoming obese are more likely to use are associated with the unhealthy weight loss practices, such as vomiting and using diet pills or laxatives.27 development of both eating
• Disordered eating and dieting have been disorders and obesity. 29 linked to serious risk-taking behaviors such as drug, alcohol and tobacco use, delinquency, unprotected sexual activity, - DIANNE NEUMARK,SZTAINER, PH.D., M.P.H., R.D., DIVISION OF EPIDEMIOLOGY, UNIVERSITY OF dating violence, and suicide otternpts.» MINNESOTA SCHOOl OF PUBLIC HEALTH Elld Notes
1 Neumoric,sztoinor, D. -0be5ity end Eating DilOt'dot Preventi.on; An Inlugrol1:Jd Approoch~" Ado/esconf MfKlfclne, Feb;l.:S(ll: I 59·73 IRovlowt. 2003. RESOURCES :2 NCLJJnork,S2k1irmr, D., Story, M, Hennen, PJ., or 01. "'Woight.Reklled Concerns and Behavior! Among Overweight end Non-Ovorweisht AdoleSCents: The National Women's Health American Dietetic Association Impllcotions for Prcvonfing VVeight-Reiated Disorders." Archi'IeJ of PecJj'oIriC$ond Malesan,!kd;ano, Feb;156121:171-8, 2002. Information Center (NWHIC) Nutrition hotline: (900) 225·5267 3 Neutnati:-Smioor, O. ·Obesity and Eeting Disorder Prevention: An Integrated Telephone: (800) 994·9662 Publications: (800) 877·1600 ext. 5000 App
Effort, Prospectively Prodid Growth in Rekmve Weight and OniOt of Obesity among female Adoiesc:enIS. Joorncl of Consulting and Clml(!ol PsydJology. Dec;6716j:967.JA, 1999. 25 Hili, AJ. ~Prevolftnco and Demographics of Olatlng,~ In FQlrborn, e.G .• Srownefl. K,D. (edtl Eating Diwrders and Obesity. 2nd E!d. New YOft.:Guilford Press. 80-83, 2002. BodyWise ond BodyWorks are initiotives of the U.S. Deportment of Health and Human Services •• Field, AE., Au,';n, S.B .• Taylor, C.8., MoIspei •• S" R"",er, B" Rock .. , H.R" Office on Women's Health. BodyWise provides school personnel and other adults who interact with Gmmon. M.w., Cold .. , G.A. ·RoIon"" Beiwoon D"~ng arC We;ght Change Among P'eodole""",,, and AdoIeocen"." Podiatries, Oct;11114)~, 2003. students ages 9 to 12 with information to help prevent disordered eating and eating disorders. 27 Neumorit-Sztorner, D., Story. M.. folkner, N.H., et al ~Socicdemogfaphic BodyWorks is a toolkit on physical activity and nutrition for porents and other adult caregivers of and Per$Qnol Chorodcristies 01Ado!e~nb Engaged in "Nelghl Loss and girls ages II to 13. Print copies of BodyWise and BodyWorks are available at www.4woman.gov. Wclght/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 BehavIors among CNerweight ond ~ighf AdoIeKen~.· Obesity Research" Moy:5131:237"9, 1997. 2.8 Neumort.szkuner, 0 .. Story, M., French, S.A. "Covoriotiolu 01 on Unhealthy Weight lns:s Bohovlors and Other High-Risk Behaviors among Adolescents Archives of p"ai",,.c AcIoleKHtt MediCine. 15013), 304.308, 1996. Office on Women's Health 29 Neumonc·Szlainor, 0 ~Obt.t.\ity nnd Ealing Disordor Provcntion: An Integrated g B@>~,*,WO~KS Approach?" 2003 A rorHlci1 'tl, H •• /t", (iI", • $tro"9 Women Eating DUarders and Obesity Companion Pie<.