Excerpts

Children and Teens Afraid to Eat
Helping Youth in Today’s Weight-Obsessed
World

Part I: Children
and teens in weight crisis

Part II: Helping
youth in a weight-obsessed world

Part I: Children and teens in
weight crisis

Chapter
1

Growing up afraid to
eat

 America’s children are afraid to eat.
It’s a fear that consumes them, shatters lives, even kills. It’s an
obsession that dims their joy, their curiosity, their energy and their
sense of what’s normal. It’s taking the fun from their teenage years. . .
. Our daughters and sons are caught � and they need our help . . . 

Today’s crisis consists of six major eating and weight
problems: 
1. Dysfunctional eating.
Disturbed, chaotic, disordered eating has become the norm for kids. They
are dieting, fasting, bingeing, skipping meals, undereating and
overeating. 
2. Undernourishment of teenage
girls.
Teen girls have the poorest nutrition of any group in America.
Yet their widespread undernourishment and malnourishment go largely
unnoticed, ignored by the policy makers who should care the most. 

3. Hazardous weight loss. The methods kids use to
lose weight can be very dangerous � vomiting, smoking, fasting, and taking
laxatives, diuretics, diet pills. They can have lasting harmful effects,
and even kill. 
4. Eating disorders.
Extremely difficult to treat, eating disorders devastate families and
claim many lives, a significant number from suicide. But their prevention
and treatment is largely ignored in U.S. health policy. “The public is
silent when young women die,” charges Naomi Wolf, author of The Beauty
Myth

5. Size prejudice. Large kids are
easy targets for cruel and isolating taunts from their peers and others.
Yet the harassment and stigma of size prejudice hurts youth of all sizes �
in today’s milieu no one is thin enough or perfectly shaped enough to feel
safe. And some, especially boys, are stigmatized because of small stature
or thinness. 
6. Overweight. More kids are
overweight today than ever before, yet we seemingly have no means to help
them. Prevention efforts other than scare tactics have not moved forward,
perhaps because most people still believe weight loss is fairly easy and
safe. Research proves otherwise. 
These six problems
are interrelated and are intensifying. What affects one, affects others.
For 16 years, I’ve been editing Healthy Weight Journal reviewing
the latest worldwide research on these issues, and have seen all six
problems growing worse year by year, yet little is being done to solve
these problems in an integrated way. 

Chapter
2

Our culture fails to
nurture its youth

   Modern culture is
youth-centered, yet in many ways it does not provide an environment that
is nurturing or supportive for the healthy growth and development of our
children. In fact, it nurtures serious problems. . . . 

Appearance and, above all, thinness are the criteria by
which girls are being judged. Magazines for teenage girls give training in
lookism where the emphasis is on makeup, fashion, weight and how to
attract boys, with almost no space given to sports, hobbies, careers or
healthy body image attitudes. Young readers are being sold to advertisers
through articles and editorial copy linked to the ads. Boys, too, are
being taught body dissatisfaction through advertising and the many new
“muscle” magazines. . . . 
The increasing pressures
to be thin are vividly illustrated by a survey of Miss America winners
from 1922 to 1999. These cultural icons dropped weight steadily from the
1920s, when it was in the range considered normal — to as low as a body
mass index of 16.9. Nearly all winners since the mid 1960s have had a body
mass index below 18.5, defined as undernourished by the World Health
Organization. Worse, it is likely that every local and state pageant up
through the national contest promotes this same ideal of female gauntness
and hunger. 

Chapter
3

Dysfunctional eating
disrupts normal life

   We are seeing
great changes in the way kids eat today, changes in what they eat, how
they eat, and when they eat. 
You may recognize the
eating patterns. The fourth grader who eats only a small amount of each
food on her plate, never feeling really satisfied, because she’s afraid of
getting fat. The 12-year-old who comes home to an empty house and eats
continuously on snack foods, crackers, cookies and chips. The teenager who
skips breakfast and lunch, grabs a candy bar and Diet Coke after school,
finds a way to skip the evening meal with her family � and then goes on an
eating binge in the evening. The wrestler who fasts and spits for two days
before his match to make weight, then binges a day or two before
restricting again. 
Dysfunctional eating describes
these types of disordered and disturbed eating behaviors which disrupt
normal life, sometimes up to the level of clinical eating disorders.
Dysfunctional eating hasn’t been investigated in much detail. Today
there’s such concern, almost an obsession, with what to eat, that how and
when to eat are being largely ignored. Yet, when kids eat in normal ways,
good nutrition is likely to take care of itself. 

Chapter
4

Undernourishment of
teenage girls

   Teenage girls have the
poorest nutrition of any group in America. Taken as a whole, their diets
are deficient in many important nutrients and in total calories. Yet this
is a time in their lives when they have critical needs for growth and body
development. . . . 
The appalling truth is that over
half of teenage girls do not eat enough for health, energy and strength.
They do not eat enough to feel or look their best. But it is the lower 25
percent of girls � the hungry one-fourth � who are at most risk. . .

Looking at iron intake, girls at the 25th
percentile get less than half the iron they need, and at the 10th only
one-third . . . In London, investigators recently found that one in four
girls age 11 to 18 may be damaging their intelligence by dieting and
depriving themselves of iron. “We were surprised that a very small drop in
iron levels caused a fall in IQ,” said Michael Nelson, PhD, study author
and senior lecturer in nutrition at King’s College, London. “We conclude
that poor iron status is common among British adolescent girls and that
diet and iron status play an important role in determining IQ.”. . . Iron
is not easily absorbed by the body. In fact, experts say 80 to 98 percent
of iron may be wasted unless some heme iron from animal products is
consumed. . . . 
The calcium situation is even
worse. Girls at the 25th percentile, are getting only about one-third of
what they need  . . . 
The effects can be
physical, mental, emotional, social and spiritual. And they can be long-
lasting. 

Chapter
5

Hazardous weight
loss

   There are a hundred and more ways
to lose weight. This alone should tell us something:none work. If even one
method worked in a safe way, the others would speedily disappear. 

Worse, many of today’s quick fixes are outright
dangerous, causing serious injury and sometimes death. Yet kids and adults
are trying them all, often with a terrible sense of desperation that if
they only try hard enough, they’ll hit on the miracle cure. 

But is the cure for obesity worse than the condition?
This is the question asked by the distinguished editors of the New England
Journal of Medicine in their 1998 New Year’s Day editorial. The editorial
said flatly that weight loss is not effective, that it involves serious
health risks, and that it is untrue that the risks of obesity are so high
this kind of treatment is justified. It was a breath of fresh air,
indeed. 
The answer is, yes, in many cases the cure
is worse. 
Americans spend $30 to $50 billion
annually on weight loss schemes. And this figure doesn’t even include
smoking for weight control, that unacknowledged and highly lucrative
windfall for tobacco companies. 
If this industry
made cars, no one would buy them, and if they did, consumer groups would
force a recall. If the diet industry promised any other health service, it
would be required to prove safety and effectiveness. It would be held
accountable for the harm it does. Instead, the weight loss industry’s
unproven experiments are prescribed to millions of unsuspecting consumers
� as were both the disastrous very low calorie diets and the fen-phen and
dexfen diet pills in the last decade. 

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Chapter
6

Eating disorders
shatter young lives

   An eating disorder
is an unpleasant full-time occupation, terrifying in the way it takes over
a child’s life and that of her or his family. Yet we have reached a point
in modern society where young women eye the skeletal forms of anorexEating
disordersic students hovering at the edges of their classes and murmur in
envy, “Wish I could control my eating like she does. Wish I could be that
thin!” 
While eating disorders may carry a certain
aura of glamour for some, highlighted by the veil of “heroin chic,” in
truth they offer not sophistication, but the deadening opposite. They
expose the raw state of advanced starvation, a human being at her lowest
survival level, losing even her sense of humanity, compassion and love.
How can this be called attractive or desirable? 
. .
. “I have many regrets. I lost a number of friends, hurt a lot of people I
care about,” laments one young woman. 

Chapter
7

Size prejudice punishes
large children

   Large children and
teens often live with vicious prejudice from classmates, parents and
teachers, which can interfere with their ability to grow into
self-assured, successful adults. Disrespect for their size can be painful
for youth who are taller, shorter, or thinner than most, but it is
especially cruel and abusive to larger kids. 
Echoes
from his youth, writes Dan D, are the shouts: “I don’t want you on my
team. You’re too fat to run.” “Look at the fat tub.” “Your belly looks
like a watermelon.” Today he says, “My stomach still knots when I
remember . . . I’ll carry the scars to my grave � [but] today’s kids have
it worse.
” 
For some children, fat oppression,
teasing and ridicule comes from inside the family circle, so there is no
escape from tormentors. . . . Pat, 34, describes her father’s disdain of
her size in Real Women Don’t Diet. “My experience of prejudice for
being fat started at a very young age. The sadness and teasing I went
through then was not from individuals outside my family; it was from
within my family, by the people who are supposed to most love you.” 

Chapter
8

Weights continue to
rise

   What alarms public health
officials is that rates of overweight and obesity were fairly stable
during the 1960s and 1970s, but since the early 1980s, both children and
adults have gained weight, particularly at the upper end. The heaviest
children are now heavier than children in earlier studies � and more of
them have moved above the cutoff point. But at the other levels,
percentages have remained fairly constant for the past three decades. . .

Poor family communication can also contribute to
overweight. If children are isolated in a disinterested or disengaged
family, they may be at a higher risk of overweight, reports Laurel Mellin,
MA, RD, San Francisco. Her study of 254 obese adolescents found that four
factors accounted for most of the weight differences: family cohesion,
adolescent communication, age of obesity onset and the mother’s weight . .

Lowering fat intake by itself has not been a
successful weight loss method. For instance, women lost weight the first
year when reducing their fat intake from 38 percent to an extremely low 20
percent in the Women’s Health Trial, a treatment study of women with
breast cancer. However, by the end of the second year, they had regained
it all and weighed about the same as the control group, even though they
had carefully followed the low-fat diet. 

Chapter
9

Lifestyle choices
increase problems

   Compared with 20
years ago, young people are eating twice as much food like crackers,
popcorn, pretzels and chips, and more pasta, rice dishes, tacos, burritos
and pizza, the all time favorite � more grain-based foods from the bread
and cereals group. They are drinking three times as much soda pop and
consuming more desserts and candy. 
What’s missing?
All of the other four food groups � fruits, vegetables, milk and meat.
Teens are coming up short in four out of five. . . . 

Young children are the most active and physically fit of
all Americans, averaging one to two hours of moderate or vigorous physical
activity each day. But they’re less active than their parents were as
children � and are developing habits that could turn them into inactive,
unhealthy, overweight adults. And the less active they are, even at age 3
or 4, the less active they will be later on. Most kids become less active
each year . . . 
At the other extreme from sedentary
living are young people who exercise obsessively, and develop an activity
disorder that takes over their lives. 

Part II:
Helping youth in a weight-obsessed world

Chapter
10

Health at Any
Size

   As these problems claim more and
more children, it’s time for a new approach. It is time to move ahead with
vision and direction, to focus on more positive ways of living. The
traditional ways of dealing with weight and eating must be replaced by a
new paradigm, a new philosophy that helps children and does not harm them.
. . . 
Health at Any Size affirms that beauty,
health and strength come in all sizes, that good health is not defined by
body weight, but by a state of physical, mental, and social well-being, by
wellness and wholeness. It recognizes that people are healthiest at the
weight that results from a healthy lifestyle . . . 
This new approach asks: How can we gradually shift to healthier habits
that will last a lifetime? How can we prevent the onset of eating and
weight problems? 
Following these three principles
will help us make this shift: 
1. Eat well. Think of food
as a friend � celebrate, enjoy, taste, savor . . . 
2. Live
actively.
Help children celebrate activity as a natural and joyful
part of their lives. . . . 
3. Feel good about yourself and
others.
Celebrate and enjoy every child’s special traits and talents .
. . 
Instead of struggling against a child’s
natural weight, parents and health professionals need to recognize and
work with it. 

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Chapter
11

In the
family

   The family is a critical,
positive force in defusing this public health crisis. . . . 

It’s important that families talk to each other � the
small talk, the praise and reassurances . . . Talking about feelings is
not always easy, but it helps if moms and dads will ask, “How do you feel
about that?” and then listen, without offering advice. Helpful parents
will listen quietly when kids want to talk, giving their undivided
attention. Acknowledge their feelings in a noncommittal way, “Oh . . .
Hmmm . . . I see . . .” Give the feeling a name, “That sounds
frustrating.” Encourage and trust the child to explore solutions, without
taking over. 
. . . Restoring normal eating is a
priority for those who have restricted their eating, or who habitually
overeat. Unfortunately, today many parents are so confused and fearful of
their own eating, weight and health, that their fears are multiplied in
their children. They need to stop dieting, stop talking about hips and
stomachs and thighs, and realize that their own attitudes and behaviors
may contribute to their children’s eating and weight problems. Giving
oneself a year to normalize eating will make a great difference . .

Satter is adamant about family meals. “Meals are
as essential for nurturing as they are for nutrition . . . Without meals,
a home is just a place to stay.” . . . It is when parents don’t live up to
their feeding responsibilities or intrude on the child’s prerogatives that
feeding difficulties and disturbances of food regulation occur. Parents
may fail to get a meal on the table, then try to control what and how much
their child eats . . . 
The large child needs lots
of love and attention, as do all children, and to be reassured of parental
love regardless of weight. Diets and weight loss programs are not an
option, since they disrupt normal eating, will likely fail, and may set up
a lifelong pattern of excessive weight gain following weight loss. 

Chapter
12

Prevention in
schools

   Teachers tell me that they see
girl after girl in the lunchroom choosing the salad bar over main-course
meals, and coming out with only a small plate of lettuce. “I hope they are
making up for it with healthy meals at home,” one teacher said. Then she
sighed � we both knew it wasn’t happening at home, either . . . 

Many schools are well on their way to shifting physical
education emphasis toward keeping all youngsters active in ways that last
a lifetime. These schools focus on getting all kids involved, less on
winning games, grooming star athletes, and showcasing spectator sports.
They don’t excuse youngsters with special needs from PE, but broaden
programs to include them. . . . 
Schools reflect
society’s obsession with thinness and scorn for large people. The
pressure, the harassment is all there � between students, between
teachers, between students and teachers, in the classrooms and in the
halls. . . . 
There is a great need to support teen
girls by increasing social support and mentoring, reducing environmental
stressors like sexual harassment and teasing, transforming girls’ lives by
reducing the importance of appearance, and changing institutions such as
the mass media that disempower them. 
Preventive
programs are most promising when they have first assessed the need and
timing for prevention, then deliver the program about one year before the
age when the behavior starts. . . . Levine and Piran advocate prevention
programs that include these components: 
l Media literacy and ways of
analyzing the culture 
l Student discussion of the
impact of culture 
l Nutrition education that promotes healthy eating
and challenges dieting 
l Techniques for developing
personal competencies 

Chapter
13

Healthy
choices

   Healthy lifestyle choices
nourish the mind, body and spirit. They include nutritious eating, active
living, and having a positive attitude toward life. It’s important to
teach children how to make healthy choices to prevent the weight and
eating problems that dampen the spirits of so many kids today. 

So how do we create an atmosphere that makes healthy
choices for youngsters easy and fun, and show them it’s the natural way to
live? It involves families, teachers, schools, health professionals and
communities. 
“Feeling good about yourself starts by
accepting who you are and how you look,” the Canadian Vitality program
reminds us. “Think positive thoughts. Laugh a lot. Spend some time with
people who have a positive attitude � the type who look at the cup as
being half full, not half empty. Positive vibes are contagious. Enjoy
eating well and being active. Feel good about yourself. Have fun with
family and friends, and you’ll feel on top of the world!” 

Chapter
14

Changing to a
child-friendly culture

   Changing
culture is a monumental task, but it is possible. Strong forces and
powerful commercial interests have molded today’s society, and change
won’t be easy, nor will it happen overnight. But each of us can make a
difference, starting now . . . People are ready for a change. They are
hungry for messages of body acceptance, self-trust, normalized eating,
freedom from dieting, balance, and getting on with life . . . 

Letters, phone calls, faxes, email and Internet campaigns
are effective in combating these destructive images. . . . On a more
impulsive note, vigilantes are striking at offensive displays on
billboards and buses by scrawling graffiti over thin women’s bodies. “I’m
So Hungry,” lamented the caption on one gaunt model. “Please Give Me a
Cheeseburger,” another pleaded. . . . 
Official
recognition of eating disorders is, I believe, the key to bringing about
needed change in federal policy. In the U.S. we have about 16 million
girls between the ages of 13 and 20, according to the last census. If 10
percent of these girls have clinical eating disorders, and one-fourth are
severely undernourished, what are the numbers here? Are they enough to
gain a politician’s attention? 
When eating
disorders and related problems get the attention they need, policy makers
will be forced to change their approach to obesity, so as not to
exacerbate eating problems. A health-centered approach is the most logical
when one looks at the big picture. 
The time has come to
move forward. . . . If we work together, it will happen. 

Chapter
15

Call to
action

   We need to deal with the
current weight and eating crisis in healthy ways � ways that don’t repeat
the mistakes of the past. . . . How can we reach a shared vision and
effectively communicate that vision? How can we promote wellness and
wholeness in positive ways for children of all sizes? 

Encouraging health at any size challenges us to make
changes in these five areas: attitude, lifestyle, prevention, health care
and knowledge. 

APPENDIX INCLUDES:
Body mass index chart 
Median daily
intake 
Eating disorders test 
Vegetarian self-test 
How to help a friend with
eating issues 
Letter of protest to Red Robin 

A doctor’s weight loss education 
Teens & Diets: No Weigh 
Child-centered
resources (7 pages) 
References 

Index 
Biography 
A
personal note 

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