An 11-year-old boy – let’s call him Enrico – had a tough day at school. He’d done poorly on a math test – again – and some boys picked on him during gym because he’d missed an important free throw. Enrico walked home from the bus, let himself into the house and grabbed an unopened extra-large package of chips. He took one, then another; he ended up methodically eating the entire package, even though he’d even felt a little sick half way through. He simply couldn’t stop himself. It wasn’t the first time it had happened; in fact, it had gone on long enough that Enrico had started to become overweight.
A hypothetical story, but not an unusual one. Loss of control (LOC) eating is the most common disordered eating behavior in overweight kids, even pre-adolescents. A mental disorder that causes people to lose control of the amount or type of food they ingest, binge eating is also the most common eating disorder in the United States. Up to half of adults who seek weight loss treatment may suffer from it – and those who do often report that they began having weight problems at a younger age. In some cases, binge eating promotes excess weight gain and obesity.
Marian Tanofsky-Kraff, an Associate Professor at the Uniformed Services University of the Health Sciences, says many of the issues that predict obesity are also linked to eating disorders. It’s an evolving field; binge eating was only last year classified as a disorder by the American Psychiatric Association. Like the obesity epidemic itself, the causes of binge eating in kids are varied and complex, from anxiety to environmental triggers.
“Our obesogenic environment promotes loss of control. When we were in school, there weren’t birthday cupcakes every day of the month. We weren’t surrounded by junk food. I’ll hear about kids in a Saturday morning dance class whose moms make a list of who’s bringing brownies for the next class,” she says.
Eating disorders in children have been associated with depression and anxiety, yet younger kids have a harder time pinpointing emotions or realizing triggers, Tanofsky-Kraff says. She conducts interpersonal therapy with children to help them express their experiences, as it’s often upon reflection that they realize the trigger of an unhappy experience like Enrico’s.
Primary care clinicians could help, too, by asking about eating patterns rather than just noting height and weight, which could help pinpoint LOC eating.
“We can focus on that excessive intake instead of saying, well, just jog an extra mile and eat healthier, which is quite difficult to do. We don’t live in a society that promotes moderation. We live in a society of extremes,” Tanofsky-Kraff says.
Super Heroes: Role Models Help Keep Kids on Track
The best places to begin to teach moderation and healthy eating are in homes and schools, says Lynn James, a Senior Extension Educator at Penn State Extension in Sunbury, PA.
“Children are not going to make good connections or changes if they don’t see the adults around them walking the walk themselves. If healthy food’s not in the home, there’s no chance they’re going to eat it at home,” she says.
The Extension, part of Penn State’s College of Agricultural Sciences, runs many group education programs, including Family Fitness, in which parents attend classes on how to make healthy food choices right along with their kids. Another called Cook Smart, Eat Smart teaches basic food prep and planning to young adults and parents of teens, and Nutrition Links helps low-income families eat well on a budget.
Proud2BMe is a youth outreach project of the National Eating Disorders Association (NEDA) that tackles another big influence on what kids see and hear: the media. Claire Mesko, who runs the project, says that uphill battle is only compounded by social media, which means kids can be bombarded virtually 24/7 by airbrushed images that convey the ideal that only a certain kind of face and body is attractive and only perfection will do. Boys hear about extreme workouts and bulking up.
“There are lot of mixed messages about food body weight and health, and its very difficult to intuitively know how to eat healthfully. Phrases like ‘sinfully delicious’ promote the idea that there are good and bad foods and things to avoid, and that if we indulge we are slipping up,” she says.
Proud2BMe counters with stories and webinars explaining just how images and messages are manipulated, and provides a forum for a lively online community of bloggers and boards where kids can share thoughts or stories of their own struggles with disordered eating. NEDA is also working on public policy to expand mental health coverage for eating disorders.
“We have several states now that have made eating disorders information mandatory for parents, and we would like them to conduct eating disorder screenings right along with BMI tests,” Mesko says.
Join a Great Challenges Google + Hangout Tuesday, May 6 at 12pm ET to talk about disordered eating in children and ways to help keep them healthy through empowerment and effective role modeling.