Talking Fat and Thin with your Kids, Part I

Although body shape and weight have long been a human preoccupation, things have changed since today's current parents were children. Yes, kids back then knew about thin and fat, but only when they saw it right in front of their eyes: a bullied peer or a body image-obsessed parent. These days, the abundance of processed food, the adoration of thinness and the explosion of eating disorders have created a world in which kids are aware of the many meanings of thin and fat at much younger ages.

The chasm between parents' memories of blissful ignorance and a child's premature exposure to the idea of weight creates a confusing scenario for families with young kids. Scared and perplexed parents seek out my advice when their young daughter starts to talk about feeling fat. Although children routinely mimic the adults in their lives, and the result is often amusing, this example stirs fear in any parent.

Sadly, there is nowhere to turn for reliable guidance. Most reassurance from friends or a pediatrician blends platitudes with unfounded opinion. Often, the advice given to parents is to put the kid on a diet, or at least restrict certain foods. I can't  count the number of patients I've seen who say that it was the first diet that started their eating disorder.

In order to guide these parents, I have found that the best approach is to place their worries within the wider public health problem of eating disorders. This step acknowledges the fears are real while pointing out that one comment doesn't constitute an eating disorder.

Their child is just playing with the adult concept of weight, something innocuous on its own, when taken out of context. And a child won't really understand the context. Once familiar with the scope of eating disorders, parents can return to their own child's behavior with some perspective and, consequentially, develop concrete, practical ideas to steer their child clear of a worrisome illness.

When I describe my practice, to clinicians and laypeople alike, the choice to treat adults with eating disorders, but not adolescents, perplexes even the most knowledgeable and open-minded. The first eating disorder image that comes to everyone's mind is the emaciated teenager, lost and alone. Surely, that's who I must be treating. The existence of a practice treating exclusively adults with these illnesses implies a much larger problem than most people could imagine.

Binging, restricting and purging remain a by product of adolescence to most adults, symptoms of a bygone age of inner turmoil and impulsivity, quickly outgrown with the maturity of early adulthood. The few who aware of an eating disorder's wider reach have generally been touched by the illnesses directly. The rest, without cause to understand further, just see the chronically ill as a group of misguided women without the will or desire to eat.

A new subspecialty, which has emerged only in the past decade, further reveals how widespread the problem has become. The incidence of children ten and younger diagnosed with eating disorders has skyrocketed, now at about ten percent of all cases. Hospital units designed for eating disorder treatment report rising numbers of young children as patients, and the clinical community is scrambling to provide adequate services.

This phenomenon generates sympathy and horror, but, from a clinical vantage point, these are new illnesses which clinicians are only starting to learn how to treat.

As I have written, the longer the course of the illness, the more difficult the recovery. The behavioral eating symptoms, the most obvious and most disturbing, are the mainstay of diagnosis and priority of treatment. All children must start the road to recovery with weight restoration and normal eating.

But the path after that is unclear. What precipitates a young child to develop an eating disorder? How is relapse prevented? These are the obvious first questions to ask and the ones critical to parents wondering what to do about the young child who feels fat. 

Any clinician would agree that protecting these children vulnerable to an early diagnosis of an eating disorder is a priority. Exposure to our culture's weight obsession is unavoidable. Objectification of even a young child's body begins with idle adult comments or a first wearing of Gap skinny jeans, even for pre-pubescent kids. This is the world we live in.

Every child will grapple to make sense of the miasma of information and feedback that comes their way, but where is the line between normal psychological development and a problem? Keeping the broader context of eating disorders in mind, I'll try to answer that question in the next post, part two of talking fat and thin with your kids.