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Children seem to be in a precarious position in the contemporary global dieting culture. Threatened with rising rates of obesity and related diseases (Wilfley and Saelens 2002), young people, from toddlers to teens, must wrestle with body image in a culture that worships slender-ness. Much is being done in schools and homes to reduce obesity numbers in children (Goldfield and Epstein 1995: 573-7); however, the preoccupation with preventing overweight may distract parents and doctors from the equally important problems of body-image disturbance and dieting behaviors in children and adolescents.

While dieting and disordered eating are generally thought to emerge during adolescence, studies show the onset of dieting behaviors can be found in preadolescent children (Truby and Paxton 2002). A study in 2000 of body dissatisfaction amongst third- to sixth-grade children using interviews and questionnaires found that 50 percent of them wanted to lose weight (Schur et al. 2000: 74).

In addition, interviews with eight-year-old girls have revealed a concern about weight gain and a desire to be thin, while similar interviews with five-year-old boys revealed that they were aware of body size and desired a muscular body type (Grogan 1999: 119-20; Harris 1997: 15). Finally, studies reveal that even second-grade boys and girls report preoccupation with food and dieting (Cherene et al. 1999). Taken together, the results from these body-image satisfaction studies show that, without a doubt, awareness of (gendered) expectations for body size develops early and frequently results in dissatisfaction.

Children do not, however, only internalize adult body standards. They also develop a fairly sophisticated awareness of the imperative to diet and methods of losing weight prior to adolescence. Schur et al. (2000) found that, out of sixty-two elementary school students surveyed, 16 percent reported having attempted to lose weight. Perhaps even more surprisingly, the study indicated that 42 percent of boys surveyed had attempted to either lose or gain weight through dieting methods. Clearly, onset of dieting and eating disordered behavior may precede adolescence and affect young children.

In the study by Schur et al., children who dieted in order to lose or gain weight expressed diverse motivations, including being teased, feeling pressure from family, feeling embarrassed about their weight, and having a desire to look "better," improve sports abilities, and "be healthier" (Schur et al. 2000). However, popular culture, specifically diet commercials and diet-related teen magazines, have also been implicated in dieting and eating disordered behavior in adolescents. In the Schur study, 55 percent of children reported learning about dieting from the media, and several children actually cited specific commercials for weight-loss products, like Jenny Craig and Slim Fast. A 2003 study also found that "girls who read magazine articles about dieting and weight loss are more likely to engage in weight control behaviors" (Field 2003: 906).

Adult-like body dissatisfaction and dieting behaviors can be measured in children as young as five to seven, and the methods that children use to diet may also resemble adult dieting practices. Schur et al. also found that, while children do not generally conceive of dieting in terms of caloric restriction, they did define dieting as "eating less" and exercising more, and some even mentioned the use of diet pills as a method of weight loss (Schur et al. 2000).

The early onset of dieting in school-age children has various consequences, including unanticipated weight gain and the development of eating disorders. A 2003 study published in the classic journal of childhood medicine Pediatrics demonstrated that dieting in childhood may be predictive of weight gain during three years of follow-up. Reasons for potential weight gain were cited as changes in metabolic rate and dietary attrition (Field 2003).

While weight gain in children is certainly a concern in the context of a growing obesity epidemic, perhaps of more concern is the possible link between the early onset of dieting and the development of eating disorders in children and adolescents. A 1987 study of bulimia and binge-eating behavior in school-age populations found that, of 126 school children surveyed, 53 percent reported engaging in some form of binge behavior. While not directly linked to dieting behaviors, the prevalence of binge-eating was found to be closely associated with "unwanted thoughts about food" (Lakin and McClellan 1987). The "predominance of young people at risk for bulimic behavior" was also found to be high in a 1999 study of unhealthy eating behaviors in adolescents (Martin 1999). Studies have also shown that rates of anorexia amongst preadolescent girls have been increasing every decade since the 1950s (Inoko 2005; Emans 2000; American Academy of Pediatrics 2003). These studies and others demonstrate that even young children in a dieting culture are susceptible to eating disorders, such as anorexia, bulimia, and binge-eating disorder.

Children have become one of the main focuses of diet culture, yet they are often the main targets of "junk-food" marketing. Foods such as Kraft's Macaroni and Cheese, Dunkaroos, Gushers, Fruit by the Foot, and Chex Mix have little if any nutritional benefits, yet are nevertheless marketed to children, who need proper nutrients in order to grow. Because "junk-food" marketing has made these specific foods so exciting and appealing to children, there is no wonder that children are one of the groups who are subjected to the diet culture.

Pressures of the dieting culture have extended and heightened for children in recent years as obesity has come to be seen as a growing problem for children. One of the main concerns about obesity in children is that obese children are at substantial risk for remaining obese throughout their lives (Kolata 1986). At the National Institute of Child Health and Human Development, participants advocated that physicians should "intervene," and attempt to control this problem among their patients. In the past, it has been argued that fat children outgrow their obesity, but due to the rising rate of obesity in children and adults, this idea has recently been countered. Leonard Epstein of the Western Psychiatric Institute and Clinic in Pittsburgh notes that 40 percent of children who are obese at age seven become obese adults (Goldfield and Epstein 1995: 577), and 70 percent of obese adolescents become obese adults. There have been various hypotheses as to why the childhood obesity rate has been rising. William Dietz of the New England Medical Center Hospitals in Boston feels that, "Children eat more while they are watching TV and they eat more of the foods advertised on TV. The message that TV conveys is that you will be thin no matter what you eat. Nearly everyone on television is thin" (Dietz 2002). This message is obviously false. In addition to the marketing effects of television, it also causes inactivity among children, as they give up outside activity for inside sitting.

Obesity among children is by no means random. Fat parents tend to have fat children, not only because they set an example of poor eating habits to their children but also because of genetic predisposition. Focusing more on the behavioral aspect of obesity, more research has been suggesting that children are also strongly influenced by their parents' attitudes to being overweight and their approaches to dieting (McAllister 2006). Many health authorities recommend that parents, teachers, and other influential adults set a pattern and example for healthy eating habits during childhood. With increasing independence, older children eat more meals out of the home, therefore reducing the effect of the household on the child. In order to positively affect health and nutrition of children, nutritional education should be targeted toward mothers with young children and toward school-age children who make their own eating choices (Variyam et al. 1999).

The obesity problem among children is being examined outside of the U.S.A. In the U.K., in particular in Hull, which is the country's most obese city, a slimming club has started for children. The club, Slimming World, invites children from eleven and up to attend weekly classes which will help them lose weight. Director Clare White stated, "It's not about dieting, it's about healthy eating and education" (Bingham 2005). Schoolchildren in Hull are given one piece of free fruit each day to help promote a healthy diet and to contend obesity.

Schools around the world are making changes in their lunch programs and vending machines in the hope of promoting healthier eating habits among their student body. While this movement within schools is quite recent, there has been speculation for years that healthy diet leads to better performance in school. A study of the diet and health of schoolchildren in South Carolina over fifty years ago showed those with better diets to be superior in health, in posture, and in scholastic progress (Everitt 1952). While posture is no longer a main concern in the twenty-first century, health and scholastic progress certainly are.

For this reason, celebrity chef Jamie Oliver began something of a revolution in various London schools in 2004. Oliver had taken on the challenge of going into schools and swapping the usual unhealthy foods with healthful, and tasty foods. His ideas, struggles, and successes have created another successful television show for Oliver. Oliver's campaign, Feed Me Better, was launched on the Internet. Within weeks of the television airings and site creation, people all over England were sharing Oliver's disgust with the lack of quality and nutrition in the food being served at schools for lunch and dinner. The revolution Oliver started became the talk of the nation. Unlike earlier Europeanwide attempts to change the politics of school lunches, Oliver's approach paid off, as British Prime Minister, Tony Blair, announced that the Government would take immediate action over school meals by upping the per pupil cost from 37 pence (70 cents) to 50 pence (95 cents) (Young 2003).

An analogous approach to reform the eating habits of children was undertaken by Arthur Agatson, the creator of the "South Beach Diet," a version of the low-carbohydrate diet, in 2004. Using the Osceola County (Florida) school district as his "laboratory," he created HOPS (Healthier Options for Public School Children). Working on the assumption that a change in diet would impact the short- and long-term health of the child, Agatson created gardens to show children how food was grown and to encourage them to eat "fresh." They included nutritional information in other classes, such as math or social sciences, so that it became a general topic of conversation. Most importantly, HOPS provided the cost difference between the school district's food budget and the increased budget for healthier foods. Thus, white bread was replaced by whole-grain bread; "Tater tots" by sweet-potato fries. While the program was successful in changing the eating patterns of most children, there seems to be little evidence that such changes actually reduce "obesity," which was the public health rationale for such undertaking (Belkin 2006).

Children's nutrition has become a concern all over the world. While it is important not to place weight pressures on children, because they can lead to several psychological and emotional problems, it is just as important at the same time for healthful eating to be part of a child's daily routine. In order to change the obesity and weight-related health problems, changes need to be made among children. Overweight children today may well lead to overweight adults tomorrow.

SLG/C. Melissa Anderson/Laura K. Goldstein

See also Advertising; Anorexia; Binge-eating; Craig; Epidemic; Genetics; Media; Men

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Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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