Culture of Dieting and Its Impact on Adolescent Development

Presentation for PEDAW Sept 11, 2012

Culture of Dieting and Its Impact on Adolescent Development

Presentation for PEDAW Sept 11, 2012

Dr. Tara Tandan MD FRCPCCommunity Pediatrics & Adolescent Medicine

Clinical Instructor, UBC Dept. of PediatricsDivision of Adolescent Medicine

Kit Standish RN MA, Aman Dhaliwal BSC RNProvincial Specialized Eating Disorders Program at BCCH

Dr. Tara Tandan MD FRCPCCommunity Pediatrics & Adolescent Medicine

Clinical Instructor, UBC Dept. of PediatricsDivision of Adolescent Medicine

Kit Standish RN MA, Aman Dhaliwal BSC RNProvincial Specialized Eating Disorders Program at BCCH

Introduction & ObjectivesIntroduction & Objectives

We all seem to know the word “Diet”Is this a new phenomenon?

What is the impact of dieting on our youth?Physical, Social, Mental repercussions:Disordered eating, eating disorders, body image dissatisfaction, obesity, bullying

What can we do about it? (youth, parents, teachers, health professionals)

We all seem to know the word “Diet”Is this a new phenomenon?

What is the impact of dieting on our youth?Physical, Social, Mental repercussions:Disordered eating, eating disorders, body image dissatisfaction, obesity, bullying

What can we do about it? (youth, parents, teachers, health professionals)

Our culture rules our waistlineOur culture rules our waistlineWhat was a “Diet” in the 15th century?

Extra weight was a good thing until it impeded your movementIndication of wealth, protection in times of famineBody image has always been important and both women and men over the ages have worked to improve their image with wigs, corsets, make-up, girdles and now SpanxDiets have always been class related … you can never be too rich or too thin is a saying we still hear nowadays

What was a “Diet” in the 15th century?Extra weight was a good thing until it impeded your movementIndication of wealth, protection in times of famineBody image has always been important and both women and men over the ages have worked to improve their image with wigs, corsets, make-up, girdles and now SpanxDiets have always been class related … you can never be too rich or too thin is a saying we still hear nowadays

…history 1930’s…history 1930’s

1930’s the great depression … little emphasis on weight loss. However, Sylvester Graham, a Presbyterian minister started a vegetarianism movement as a path to longevity. Also part of the temperance movement against coffee, alcohol and tobacco.

1930’s the great depression … little emphasis on weight loss. However, Sylvester Graham, a Presbyterian minister started a vegetarianism movement as a path to longevity. Also part of the temperance movement against coffee, alcohol and tobacco.

…history 1940’s…history 1940’sDebates about women staying home vsworking for the war effortPropaganda showed working women as slender, young simple clothes and strong

Women who were not concerned about make-up etc

Debates about women staying home vsworking for the war effortPropaganda showed working women as slender, young simple clothes and strong

Women who were not concerned about make-up etc

History …1950’sHistory …1950’sEra where women were depicted house cleaning in their pretty clothes and new appliancesStill about wealth … no need for the privileged American women to work

Things were different post war in Europe as there were still images of starving refugeesWomen could exercise with Jack Lalanne on TV while the men went out to work

Era where women were depicted house cleaning in their pretty clothes and new appliancesStill about wealth … no need for the privileged American women to work

Things were different post war in Europe as there were still images of starving refugeesWomen could exercise with Jack Lalanne on TV while the men went out to work

History 1960’sHistory 1960’sThe sexual revolution post invention of the pillWomen were taught that they could control their bodyThe ideal woman is no longer portrayed as maternal … she is thin, boyish, empoweredAlso introduction of super slim model, Twiggy… pleasantly plump was no longer OKInception of Weight Watchers in 1961

Based on Dr. Joliffe’s “Prudent diet” for cardiac health

The sexual revolution post invention of the pillWomen were taught that they could control their bodyThe ideal woman is no longer portrayed as maternal … she is thin, boyish, empoweredAlso introduction of super slim model, Twiggy… pleasantly plump was no longer OKInception of Weight Watchers in 1961

Based on Dr. Joliffe’s “Prudent diet” for cardiac health

History 1970-s to 1980’sHistory 1970-s to 1980’sExercise was highly endorsed with the “aerobics”movement which continued with the idea of promoting cardiac health

Idea that if you exercise you can indulge

Women trying to juggle jobs and child-rearing. The word “stress” becoming common languageMen were feeling pressure of women taking more leadership roles

Exercise was highly endorsed with the “aerobics”movement which continued with the idea of promoting cardiac health

Idea that if you exercise you can indulge

Women trying to juggle jobs and child-rearing. The word “stress” becoming common languageMen were feeling pressure of women taking more leadership roles

Diets in the 1990’sDiets in the 1990’sLow protein diets …More wheat, fruit and vegetables … less meat and dairy (males not happy with this)Reversed into a more male friendly diet …high protein Atkins dietAll diets followed with the theme of “crash”diets since the 1920’s meaning instant gratification, however short-lived

Low protein diets …More wheat, fruit and vegetables … less meat and dairy (males not happy with this)Reversed into a more male friendly diet …high protein Atkins dietAll diets followed with the theme of “crash”diets since the 1920’s meaning instant gratification, however short-lived

Dieting Industry TodayDieting Industry TodayWe are more enlightened and told that diets don’t work. We are told to change out lifestyle. However the diet industry continues to boom along with consumerism telling us how to improve our body image.We spend billions on weight loss schemes

Advertising budgets per year Weight Watchers $117 MillionJenny Craig $34 MillionNutri-System $297 Million

We are more enlightened and told that diets don’t work. We are told to change out lifestyle. However the diet industry continues to boom along with consumerism telling us how to improve our body image.We spend billions on weight loss schemes

Advertising budgets per year Weight Watchers $117 MillionJenny Craig $34 MillionNutri-System $297 Million

What our patients in the Day Program Say

What our patients in the Day Program Say

Most young people do not realize that diets don’t workTeaching about the consequences of dieting (e.g. ED’s) in high school is a good thing, not harmful.They want to know the facts to make informed choicesIf not, they will do their own research and come up with websites such as Pro-Ana and not be able to understand the harm of trying to lose weight

Most young people do not realize that diets don’t workTeaching about the consequences of dieting (e.g. ED’s) in high school is a good thing, not harmful.They want to know the facts to make informed choicesIf not, they will do their own research and come up with websites such as Pro-Ana and not be able to understand the harm of trying to lose weight

What our patients in the Day Program Say cont’d….

What our patients in the Day Program Say cont’d….

Teens want to be educated about their bodies and will respond to programs that encourage them to be healthyPresent high school curriculum which has teens keep food diaries, tests BMI and percent body fat is harmful and embarrassing Most important is a nurturing environment that encourages play, fun and stops bullyingStudents need a supportive environment to eat snacks and school lunches including enough time

Teens want to be educated about their bodies and will respond to programs that encourage them to be healthyPresent high school curriculum which has teens keep food diaries, tests BMI and percent body fat is harmful and embarrassing Most important is a nurturing environment that encourages play, fun and stops bullyingStudents need a supportive environment to eat snacks and school lunches including enough time

Working with families teaches us…Working with families teaches us…Parents are not to blame for eating disorders but they are the biggest support for young people to recoverParents need help to understand that dieting does not work but balanced regular eating and moderate exercise with family fun will.

Parents are not to blame for eating disorders but they are the biggest support for young people to recoverParents need help to understand that dieting does not work but balanced regular eating and moderate exercise with family fun will.

BCCH Survey Results & Discussion

BCCH Survey Results & Discussion

We surveyed three groups of people: Youth living with an Eating DisorderYouth who do not have an Eating DisorderGeneral Public (ie., males and females of all ages)

Types of questions asked:What are your beliefs around dieting?What motivates you to go on a diet?Does the media affect how you feel about your body?What do you think has the most impact on how you feel about yourself and your body?

We surveyed three groups of people: Youth living with an Eating DisorderYouth who do not have an Eating DisorderGeneral Public (ie., males and females of all ages)

Types of questions asked:What are your beliefs around dieting?What motivates you to go on a diet?Does the media affect how you feel about your body?What do you think has the most impact on how you feel about yourself and your body?

What did we find?What did we find?

Common ThemesYou have to diet in order to obtain your “ideal” body weight and shapeDieting is normal – everyone does itYou need to diet to be healthyMain influences to go on a diet are:

1) Friends 2) Boy Friend3) Family4) Curriculum at school

Common ThemesYou have to diet in order to obtain your “ideal” body weight and shapeDieting is normal – everyone does itYou need to diet to be healthyMain influences to go on a diet are:

1) Friends 2) Boy Friend3) Family4) Curriculum at school

Common Themes Continued…Common Themes Continued…

Parents feel that their role in how their child views dieting is insignificant compared to the mediaYouth feel that media doesn’t have a huge impact on their body image because “they are not real”Everyone thinks, talks and engages in diets…“food, food, food – the topic of everyone’s conversation”

Parents feel that their role in how their child views dieting is insignificant compared to the mediaYouth feel that media doesn’t have a huge impact on their body image because “they are not real”Everyone thinks, talks and engages in diets…“food, food, food – the topic of everyone’s conversation”

Things to Consider…Things to Consider…

People perceive the media to have a small impact on youth’s decision to go on a diet.Social environment seems to have the largest impact.What are we, as a society, teaching our youth about what is “healthy”?How can we change this culture?

People perceive the media to have a small impact on youth’s decision to go on a diet.Social environment seems to have the largest impact.What are we, as a society, teaching our youth about what is “healthy”?How can we change this culture?

General Pediatrics ScenarioGeneral Pediatrics Scenario12 year old girl with mild ADHD, good grades, already sensitive about her weight (just slightly ‘overweight’)Dad makes fat jokes whenever she’s weighed at Pediatric visitsAt last visit, after dad’s joke, she cried for the rest of the appointment …..

12 year old girl with mild ADHD, good grades, already sensitive about her weight (just slightly ‘overweight’)Dad makes fat jokes whenever she’s weighed at Pediatric visitsAt last visit, after dad’s joke, she cried for the rest of the appointment …..

General Pediatric ScenarioGeneral Pediatric Scenario9 year old girl, larger build than her siblings …again slightly ‘overweight’, but active Very self conscious when trying on back to school clothesWorried that she is too fat; talks to mom about itParents unsure re best approachReferred for “r/o Eating Disorder”No abnormal behaviors, but very distressed by body image dissatisfaction

9 year old girl, larger build than her siblings …again slightly ‘overweight’, but active Very self conscious when trying on back to school clothesWorried that she is too fat; talks to mom about itParents unsure re best approachReferred for “r/o Eating Disorder”No abnormal behaviors, but very distressed by body image dissatisfaction

Community Adolescent Medicine Community Adolescent Medicine 17 year old boy with history of tics and anxiety,A honors studentReferred for poor growth

stopped playing rep sport after 3 yrs; was smaller than the others; hard to keep pace ; wanted to gain weightGained some weight after stopping sportTeased by peers re: body shape; Grandparent called him chubbyBegan to decrease intake (portion sizes & snacks), ignore hunger cues; decreased appetite, not hungry at lunch and minimal dinner unless likes it (picky eater)Pubertal Delay: min. changes at 17 … looked young !

17 year old boy with history of tics and anxiety,A honors studentReferred for poor growth

stopped playing rep sport after 3 yrs; was smaller than the others; hard to keep pace ; wanted to gain weightGained some weight after stopping sportTeased by peers re: body shape; Grandparent called him chubbyBegan to decrease intake (portion sizes & snacks), ignore hunger cues; decreased appetite, not hungry at lunch and minimal dinner unless likes it (picky eater)Pubertal Delay: min. changes at 17 … looked young !

Community Adolescent MedicineCommunity Adolescent Medicine

16 year old male, A studentBrought in for ‘Obesity’ ConsultationDad lost weight after diagnosis of TIIDMPatient is significantly overweight, and dissatisfied with this; parents concerned tooVery sedentary, lots of video games, variable dietAttended a few appointments, then ‘disappeared’At risk for medical complications

Has acanthosis nigricans, abnormal lipid profile

16 year old male, A studentBrought in for ‘Obesity’ ConsultationDad lost weight after diagnosis of TIIDMPatient is significantly overweight, and dissatisfied with this; parents concerned tooVery sedentary, lots of video games, variable dietAttended a few appointments, then ‘disappeared’At risk for medical complications

Has acanthosis nigricans, abnormal lipid profile

Spectrum of Adolescent Relationships with FoodSpectrum of Adolescent Relationships with FoodNormal adolescent eating habits

Snacks, fast foods, energy drinks, pop, skip mealsGenerally eat when hungry, stop when full, normal exercise

Common adolescent dieting techniquesSkipping meals, episodic dieting, diet aids, increased exercise

Sub-clinical Eating DisorderFrequent ‘thoughts’ but inconsistent ‘action’

Eating Disorder - thoughts & actions aligned and activeWarning signs: preoccupation, obsessiveness, excuses, relentless exercise, bathroom trips, mood change, rapid weight change, physical symptoms

Normal adolescent eating habitsSnacks, fast foods, energy drinks, pop, skip mealsGenerally eat when hungry, stop when full, normal exercise

Common adolescent dieting techniquesSkipping meals, episodic dieting, diet aids, increased exercise

Sub-clinical Eating DisorderFrequent ‘thoughts’ but inconsistent ‘action’

Eating Disorder - thoughts & actions aligned and activeWarning signs: preoccupation, obsessiveness, excuses, relentless exercise, bathroom trips, mood change, rapid weight change, physical symptoms

Societal Values, Culture & Assumptions

Societal Values, Culture & Assumptions

High BMI = UnhealthyLow fat diet = Healthy diet

While in most literature, “overweight = unhealthy”, there is literature out there suggesting 1/3-1/2 of obesepeople are metabolically healthy (Shea, Randell & Sun, 2010) * lipids, glucose, insulin, BP, CRP *

Dieting & weight cycling in this group may be more dangerous than maintaining a high but stable weight

High BMI = UnhealthyLow fat diet = Healthy diet

While in most literature, “overweight = unhealthy”, there is literature out there suggesting 1/3-1/2 of obesepeople are metabolically healthy (Shea, Randell & Sun, 2010) * lipids, glucose, insulin, BP, CRP *

Dieting & weight cycling in this group may be more dangerous than maintaining a high but stable weight

Body Image Dissatisfaction - Anecdotes & Thoughts

Body Image Dissatisfaction - Anecdotes & Thoughts

Reactions child weighed at doctors, tries on clothes, goes swimming, plays Wii … are tellingFamily values, practices & health inter-relate with child’s perceptions & actions around food

Healthy eaters; Fit familiesFamilies with high BMI, Type II DM, Cardiovascular Disease

Family, peers, society often support and positively reinforce efforts to ‘get in shape or be more healthy’

Reactions child weighed at doctors, tries on clothes, goes swimming, plays Wii … are tellingFamily values, practices & health inter-relate with child’s perceptions & actions around food

Healthy eaters; Fit familiesFamilies with high BMI, Type II DM, Cardiovascular Disease

Family, peers, society often support and positively reinforce efforts to ‘get in shape or be more healthy’

British Columbia StatisticsBritish Columbia Statistics

The McCreary Center Society : Adolescent Health Survey 2008 : http://www.mcs.bc.ca/pdfstuff/weight.pdfOver 29,000 BC public school students in grades 7-12 completed the survey between February and June 2008Previous surveys were conducted in 1992, 1998 and 2003, next one 2013

The McCreary Center Society : Adolescent Health Survey 2008 : http://www.mcs.bc.ca/pdfstuff/weight.pdfOver 29,000 BC public school students in grades 7-12 completed the survey between February and June 2008Previous surveys were conducted in 1992, 1998 and 2003, next one 2013

BC Statistics; AHS 2008BC Statistics; AHS 200819 % of males and 10 % females rated selves as very satisfied with body image46 % of females & 15 % of males dieted to lose weight in the past year36 % of females & 18 % of males binge ate8% of females and 3 % of males vomited on purpose after eating53 % of healthy weight females & 14 % of healthy weight males are trying to lose weight3% of healthy weight females & 31 % of healthy weight males are trying to gain weight

19 % of males and 10 % females rated selves as very satisfied with body image46 % of females & 15 % of males dieted to lose weight in the past year36 % of females & 18 % of males binge ate8% of females and 3 % of males vomited on purpose after eating53 % of healthy weight females & 14 % of healthy weight males are trying to lose weight3% of healthy weight females & 31 % of healthy weight males are trying to gain weight

Eating Disorders & Obesity Project EAT

(Eating Among Teens - 2007, Neumark-Sztainer et al)

Eating Disorders & Obesity Project EAT

(Eating Among Teens - 2007, Neumark-Sztainer et al)

USA Data collected on 2516 adolescents 1998/99 & 2003/04Weight related problems identified in 44 % of girls and 29 % of boys

Extreme weight control behaviors, Binge eating, Overweight

Extreme weight control behaviors include:laxatives, diuretics, diet pills, purging etcLess extreme unhealthy weight control behaviourslike meal skipping, fasting, smoking for weight control) not included in the above

USA Data collected on 2516 adolescents 1998/99 & 2003/04Weight related problems identified in 44 % of girls and 29 % of boys

Extreme weight control behaviors, Binge eating, Overweight

Extreme weight control behaviors include:laxatives, diuretics, diet pills, purging etcLess extreme unhealthy weight control behaviourslike meal skipping, fasting, smoking for weight control) not included in the above

Eating Disorders (EDs): Lifetime Prevalence

Eating Disorders (EDs): Lifetime Prevalence

EDNOS ( Eating disorder not otherwise specified ) 2.5 - 5 %Includes: Binge eating disorder, food avoidant emotional disorder, others

Anorexia Nervosa1-2 % F, 0.2-.3 % M1: 10-15 M:F ratio

Bulimia Nervosa1.5 - 2.3 % F, 0.5 % M

1: 15-20 M:F ratio

Heads or Tails: 2 Sides of the CoinHeads or Tails: 2 Sides of the CoinAmerican Diabetes Association describes Type 2 DM in young people as a “new epidemic”Dieting in children is being reported at earlier ages (McVey et al, 2004 studied 10-14 yr olds in Southern Ontario)Incidence of restrictive ED is 2 x greater than incidence of T2DMamong all kids < 18 yrs

Evidence that as public health messages about obesity reduction increase, incidence of both ED’s and Disordered Eating (DE) will increase (O’Reilly C, 2011 & Bacon L, 2011)Obesity Reduction is a major health priority featured in new Healthy Families BC strategy - Must be designed to avoid unintentional harm !

American Diabetes Association describes Type 2 DM in young people as a “new epidemic”Dieting in children is being reported at earlier ages (McVey et al, 2004 studied 10-14 yr olds in Southern Ontario)Incidence of restrictive ED is 2 x greater than incidence of T2DMamong all kids < 18 yrs

Evidence that as public health messages about obesity reduction increase, incidence of both ED’s and Disordered Eating (DE) will increase (O’Reilly C, 2011 & Bacon L, 2011)Obesity Reduction is a major health priority featured in new Healthy Families BC strategy - Must be designed to avoid unintentional harm !

Health Impacts of DietingHealth Impacts of DietingWeight loss clinics, camps, programs, & products promise rapid and dramatic results …

But What Really Happens When We Diet ?Skipping Meals / Decreasing Calories

Lowers metabolism, increased fat storage from fewer caloriesRebound munchies (high fat & sugar) due to body demand for fuelPoor attention span, irritability, fatigueLoss of muscle massDehydration / Weight loss = fluid loss

Weight loss clinics, camps, programs, & products promise rapid and dramatic results …

But What Really Happens When We Diet ?Skipping Meals / Decreasing Calories

Lowers metabolism, increased fat storage from fewer caloriesRebound munchies (high fat & sugar) due to body demand for fuelPoor attention span, irritability, fatigueLoss of muscle massDehydration / Weight loss = fluid loss

Health Impacts of DietingHealth Impacts of DietingUnwanted ‘Dramatic results’ can include:

Progression to ED in a subset of dieters (with all the serious associated chronic health problems & increased risk of death)Commencement of bingeing behavior Long term weight instability & wt gain, with loss of appetite regulation mechanismsPhysiologic / cardiovascular instability with rapid weight fluctuations - Low Heart rate & low Blood Pressure CommonMicronutrient deficiencies (eg. Iron, Vit D, Zinc, folate, B12 )Chronic low Body mass index (BMI) leading to eventual osteoporosisChronic low BMI leading to irregular periods & abnormal reproductive hormones & possible fertility problemsGrowth & Pubertal delay in younger population

Unwanted ‘Dramatic results’ can include:Progression to ED in a subset of dieters (with all the serious associated chronic health problems & increased risk of death)Commencement of bingeing behavior Long term weight instability & wt gain, with loss of appetite regulation mechanismsPhysiologic / cardiovascular instability with rapid weight fluctuations - Low Heart rate & low Blood Pressure CommonMicronutrient deficiencies (eg. Iron, Vit D, Zinc, folate, B12 )Chronic low Body mass index (BMI) leading to eventual osteoporosisChronic low BMI leading to irregular periods & abnormal reproductive hormones & possible fertility problemsGrowth & Pubertal delay in younger population

Costs of DietingCosts of DietingDieting can be a precursor to an ED ( Killen, Taylor et al, 1996, J Consult Clin Psychol)

Teens who diet severely are 18x more likely to develop clinical EDTeens who diet moderately are 5x more likely to develop clinical or sub-clinical ED (Patton et al, 1999, BMJ)

Adolescent Eating Disorders = serious with many medical complications, and 1.8 % mortality in AN, 0-6 % in BN

Dieting can increase risk for binge eating and weight gain over time (Neumark-Sztainer et al, 2002)

Shown even in 9-14 yr olds (Field et al, 2003, Pediatrics)

Dieting can be a precursor to an ED ( Killen, Taylor et al, 1996, J Consult Clin Psychol)

Teens who diet severely are 18x more likely to develop clinical EDTeens who diet moderately are 5x more likely to develop clinical or sub-clinical ED (Patton et al, 1999, BMJ)

Adolescent Eating Disorders = serious with many medical complications, and 1.8 % mortality in AN, 0-6 % in BN

Dieting can increase risk for binge eating and weight gain over time (Neumark-Sztainer et al, 2002)

Shown even in 9-14 yr olds (Field et al, 2003, Pediatrics)

Costs of DietingCosts of DietingDieting is associated with weight gain and obesity onset

Project EAT: dieters have 2x likelihood of being overweight 5 years later compared with non-dietersDieters are less likely to engage in protective behaviors such as eating breakfast regularly

Dieting may not be maintained long enough to bring about desired wt changeDieting may not be associated with appropriate changes in eating patterns

Dieting is associated with weight gain and obesity onset

Project EAT: dieters have 2x likelihood of being overweight 5 years later compared with non-dietersDieters are less likely to engage in protective behaviors such as eating breakfast regularly

Dieting may not be maintained long enough to bring about desired wt changeDieting may not be associated with appropriate changes in eating patterns

Costs of DietingCosts of Dieting

Unhealthy weight control behaviors are associated with:Poorer psychological well being, including lower self esteem, higher depressive symptoms, & greater use of alcohol & tobacco (Crow et al, J Adol Health 2006, Ackard et al, J Psychosom Res, 2002, Nowak, J Adolhealth 1998, Rafiroiu et al, Am J Health Behav 2003)Poorer quality of dietary intake, lower fruits, vegetables, grains, calcium rich foods (Neumark-Sztainer 2004)

Unhealthy weight control behaviors are associated with:Poorer psychological well being, including lower self esteem, higher depressive symptoms, & greater use of alcohol & tobacco (Crow et al, J Adol Health 2006, Ackard et al, J Psychosom Res, 2002, Nowak, J Adolhealth 1998, Rafiroiu et al, Am J Health Behav 2003)Poorer quality of dietary intake, lower fruits, vegetables, grains, calcium rich foods (Neumark-Sztainer 2004)

Predictors of Weight Related Problems (Project EAT)

Predictors of Weight Related Problems (Project EAT)Weight specific variables are strongest predictors of weight related problems

Socio-environmental FactorsParental weight concerns / behaviorsWeight teasing by family

Personal Factors - BI dissatisfaction & weightconcernBehavioral Factors - Dieting, unhealthy weightcontrolWeight … weight … weight …..

Weight specific variables are strongest predictors of weight related problems

Socio-environmental FactorsParental weight concerns / behaviorsWeight teasing by family

Personal Factors - BI dissatisfaction & weightconcernBehavioral Factors - Dieting, unhealthy weightcontrolWeight … weight … weight …..

Socio-Environmental FactorsSocio-Environmental FactorsNegative effects of weight related social pressure(McCabe 2005), BI concerns (Stice 1998 & 2002) & dieting (Patton 1999) have been well describedAdolescents teased about weight are 2x more likely to be overweight 5 years later (Project EAT), & increased risk for BI dissatisfaction, depressive symptoms, low self esteem, abnormal eating behaviorsMedia use may increase unhealthy weight controlbehaviors through negative BI effect ( Neumark-Sztaineret al 2003 & 2007) ( ? Not consistent with our survey results re adolescent perceptions)

Negative effects of weight related social pressure(McCabe 2005), BI concerns (Stice 1998 & 2002) & dieting (Patton 1999) have been well describedAdolescents teased about weight are 2x more likely to be overweight 5 years later (Project EAT), & increased risk for BI dissatisfaction, depressive symptoms, low self esteem, abnormal eating behaviorsMedia use may increase unhealthy weight controlbehaviors through negative BI effect ( Neumark-Sztaineret al 2003 & 2007) ( ? Not consistent with our survey results re adolescent perceptions)

Personal Factors & Protective Factors

Personal Factors & Protective Factors

Body image (BI) dissatisfaction a key risk factor for disordered eating and EDs

Actually associated with lower levels of physical activity in girls (Project EAT)Predicts greater use of dieting & unhealthy wt controlOverweight girls with BI dissatisfaction gained the most weight over time

Self esteem protective against problematic weight outcomes in girlsHaving regular meals inconsistently shown as protective

Body image (BI) dissatisfaction a key risk factor for disordered eating and EDs

Actually associated with lower levels of physical activity in girls (Project EAT)Predicts greater use of dieting & unhealthy wt controlOverweight girls with BI dissatisfaction gained the most weight over time

Self esteem protective against problematic weight outcomes in girlsHaving regular meals inconsistently shown as protective

Preventing Eating Disorders & ObesityDianne Neumark-Sztainer 2009 J Adol. Health

Preventing Eating Disorders & ObesityDianne Neumark-Sztainer 2009 J Adol. Health

Five Research Based Recommendations for Health Care Providers (HCP), from Project EAT, that Focus less on weight & more on sustained behavioral change

Discourage unhealthy dieting / encourage eating and physical activity profile that is maintainablePromote positive body imageEncourage more frequent/enjoyable family mealsEncourage less home talk re weight and do more to facilitate healthy eating and physical activityAssume that overweight teens have experienced weight mistreatment, and address this with teens and families

Five Research Based Recommendations for Health Care Providers (HCP), from Project EAT, that Focus less on weight & more on sustained behavioral change

Discourage unhealthy dieting / encourage eating and physical activity profile that is maintainablePromote positive body imageEncourage more frequent/enjoyable family mealsEncourage less home talk re weight and do more to facilitate healthy eating and physical activityAssume that overweight teens have experienced weight mistreatment, and address this with teens and families

Tip: Encourage Healthy Alternatives to Dieting & Promote Positive Body ImageTip: Encourage Healthy Alternatives to

Dieting & Promote Positive Body ImageAim for positive eating and physical activity behaviors fitting into lifestyle that will be maintainableAvoid using body image dissatisfaction as motivator for change Promote BI satisfaction … discuss positive

characteristics before discussing wt as specific health outcomeHelp teens develop positive relationship with

bodies, encourage positive self talk

Aim for positive eating and physical activity behaviors fitting into lifestyle that will be maintainableAvoid using body image dissatisfaction as motivator for change Promote BI satisfaction … discuss positive

characteristics before discussing wt as specific health outcomeHelp teens develop positive relationship with

bodies, encourage positive self talk

Tip: Encourage More Frequent & Enjoyable Family Meals

Tip: Encourage More Frequent & Enjoyable Family Meals Frequent participation in family mealsassociated with

Better dietary intake in teens F&V, grain, Ca rich foods, fiber) (Neumark-Sztainer et al, 2003)Less intake of soft drinks

Frequent family meals with positive family atmosphere protective against binge eating and extreme weight control behaviors in girlsNOT consistently protective against obesity (Fulkerson et al, 2008, Taveras, 2005, Sen, 1997)

Frequent participation in family mealsassociated with

Better dietary intake in teens F&V, grain, Ca rich foods, fiber) (Neumark-Sztainer et al, 2003)Less intake of soft drinks

Frequent family meals with positive family atmosphere protective against binge eating and extreme weight control behaviors in girlsNOT consistently protective against obesity (Fulkerson et al, 2008, Taveras, 2005, Sen, 1997)

Tip: Less Weight Talk at Home & More Efforts to Facilitate Healthy Eating &

Balanced Physical Activity

Tip: Less Weight Talk at Home & More Efforts to Facilitate Healthy Eating &

Balanced Physical ActivityTheme: Talk Less, Do More !

Avoid weight talk (self & others), and encouragement towards weight loss (even for obese kids)

Evidence that too much weight talk at home is counterproductive & may increase risk for both ED & ObesityProject EAT: Parental weight talk, dieting, encouragement to diet predicted incidence of overweight status 5 years laterWeight related comments made directly to a child (teasing or encouragement to lose weight) probably the most harmful (Wertheim et al, 2002)

Disallow weight teasing from home (place weight jokes in same category as ‘race’ jokes … not OK)

Theme: Talk Less, Do More !Avoid weight talk (self & others), and encouragement towards weight loss (even for obese kids)

Evidence that too much weight talk at home is counterproductive & may increase risk for both ED & ObesityProject EAT: Parental weight talk, dieting, encouragement to diet predicted incidence of overweight status 5 years laterWeight related comments made directly to a child (teasing or encouragement to lose weight) probably the most harmful (Wertheim et al, 2002)

Disallow weight teasing from home (place weight jokes in same category as ‘race’ jokes … not OK)

Tip: Health Care Provider Should Discuss Likely History of Weight Maltreatment in

Overweight Teens

Tip: Health Care Provider Should Discuss Likely History of Weight Maltreatment in

Overweight TeensLarge number of overweight teens report extreme wt control & binge eating behaviors

Nearly 25 % of overweight girls report extreme wt control behaviors (Project EAT)Weight maltreatment almost universal (98% of n=50) in overweight girls (Neumark-Sztainer 1998)

HCP should discuss weight maltreatment / stigmatization history (home, school, other places)

Hurtful comments / weight teasing, activity exclusions secondary to weight, negative assumptions re; laziness, cleanliness, overeating can be damaging & lead to problem behaviors

Large number of overweight teens report extreme wt control & binge eating behaviors

Nearly 25 % of overweight girls report extreme wt control behaviors (Project EAT)Weight maltreatment almost universal (98% of n=50) in overweight girls (Neumark-Sztainer 1998)

HCP should discuss weight maltreatment / stigmatization history (home, school, other places)

Hurtful comments / weight teasing, activity exclusions secondary to weight, negative assumptions re; laziness, cleanliness, overeating can be damaging & lead to problem behaviors

Solutions?Solutions?

Public Health shift - use ‘healthy weight’language

Public health policies concerned with ‘obesity reduction’ may inadvertently promote weight stigma

Societal shift re values, definitions of ‘healthy eating’ and ‘healthy body’

Body comments should be off limits

Public Health shift - use ‘healthy weight’language

Public health policies concerned with ‘obesity reduction’ may inadvertently promote weight stigma

Societal shift re values, definitions of ‘healthy eating’ and ‘healthy body’

Body comments should be off limits

Solutions?Solutions?

Media shift ( Dove Campaign )Social marketing re natural diversity in body weights

School curriculum shiftEducation for athletic communityPhysician approach and communicationParent & Child Education

Media shift ( Dove Campaign )Social marketing re natural diversity in body weights

School curriculum shiftEducation for athletic communityPhysician approach and communicationParent & Child Education

Weight Related Problems Prevention Advice

Weight Related Problems Prevention Advice

Avoidance of diet and weight talk at homeNo wt jokes allowed at homeRefrain from magazines focused on wt lossEncourage appreciation of positive aspects of bodySupport lifestyle based around healthful eating and physical activity behaviors (not wt) may help guide people to balance

Avoidance of diet and weight talk at homeNo wt jokes allowed at homeRefrain from magazines focused on wt lossEncourage appreciation of positive aspects of bodySupport lifestyle based around healthful eating and physical activity behaviors (not wt) may help guide people to balance

Weight Related Problems Prevention Advice

Weight Related Problems Prevention Advice

More fruit & vegetable availability (correlates strongly with intake)Role model good eating habits ; Stop dieting !

Mothers who diet may end up with daughters who diet to deal with life stressors

Potential benefits of more frequent , pleasant family meals

Availability of healthier foods Parent modeling for healthy eating patternsIncreased opportunity to connect with teen Monitoring child’s eating behaviors

Don’t raise concern for child’s eating problems during the meal (discuss at non meal time)

More fruit & vegetable availability (correlates strongly with intake)Role model good eating habits ; Stop dieting !

Mothers who diet may end up with daughters who diet to deal with life stressors

Potential benefits of more frequent , pleasant family meals

Availability of healthier foods Parent modeling for healthy eating patternsIncreased opportunity to connect with teen Monitoring child’s eating behaviors

Don’t raise concern for child’s eating problems during the meal (discuss at non meal time)

Weight Related Problems Prevention Advice

Weight Related Problems Prevention Advice

Examine your own beliefs re food, weight & shape - avoid messages teaching kids that only certain bodies are acceptable and only some foods OK to eatExamine your dreams & goal for your own kids

Is it difficult to accept your child if their bodies are larger than the ‘promoted’ ideal ?

Get out family photos and help kids identify who they look like

Focus on relationshipsIntroduce concept of genetics playing into body size

Help put and end to teasing and bullying in & outside school

Examine your own beliefs re food, weight & shape - avoid messages teaching kids that only certain bodies are acceptable and only some foods OK to eatExamine your dreams & goal for your own kids

Is it difficult to accept your child if their bodies are larger than the ‘promoted’ ideal ?

Get out family photos and help kids identify who they look like

Focus on relationshipsIntroduce concept of genetics playing into body size

Help put and end to teasing and bullying in & outside school

Weight Related Problems Prevention Advice

Weight Related Problems Prevention Advice

Communication: Talk with and listen to your kids re experiences, feelings & opinionsHelp them learn to recognize & deal with conflictGive specific daily feedback re skills & processes to build non body based self esteem

Exercise for the joy of feeling your body move and function effectively & integrate it into family life with the same goalsHelp children identify hunger and satisfaction

No good/bad foodsEncourage food for joy, energy & strength

Communication: Talk with and listen to your kids re experiences, feelings & opinionsHelp them learn to recognize & deal with conflictGive specific daily feedback re skills & processes to build non body based self esteem

Exercise for the joy of feeling your body move and function effectively & integrate it into family life with the same goalsHelp children identify hunger and satisfaction

No good/bad foodsEncourage food for joy, energy & strength

ED Prevention ResourcesED Prevention ResourcesJessie’s Legacy

http://familyservices.bc.ca/professionals-a-educators/jessies-legacyA program of Family Services of the North Shore provides eating disorders prevention education resources and support for B.C.

Keltymentalhealth.ca Summer Institute 2011 A list of body image resources are listed

Mission Nutrition (www.missionnutrition.ca)Instills healthy eating habits in school age children, and healthy eating and body image resources for parents

Student Bodies Prevention ProgramNational Association of Anorexia Nervosa & Associated Disorders (ANAD) http://www.anad.org/get-help/online-program/

Jessie’s Legacy http://familyservices.bc.ca/professionals-a-educators/jessies-legacyA program of Family Services of the North Shore provides eating disorders prevention education resources and support for B.C.

Keltymentalhealth.ca Summer Institute 2011 A list of body image resources are listed

Mission Nutrition (www.missionnutrition.ca)Instills healthy eating habits in school age children, and healthy eating and body image resources for parents

Student Bodies Prevention ProgramNational Association of Anorexia Nervosa & Associated Disorders (ANAD) http://www.anad.org/get-help/online-program/

BC’s Emerging Initiatives to Address Eating Disorders & Obesity

Collaboratively

BC’s Emerging Initiatives to Address Eating Disorders & Obesity

Collaboratively

Prevention Subcommittee of Provincial ED Network - work on reducing structural determinants of DEAction Schools! BC “Being Me: Promoting Positive Body Image” Resource - for K-7 teachers; focus on positive BO, resilience and ED preventionFHA Weight Bias training for mental health clinicians and othersFamily FUNdamentals Project (DE Prevention) - North Shore collaboration with BCMHAS for province wide educational program for parents - positive BI, healthy eating, positive parenting strategies

Prevention Subcommittee of Provincial ED Network - work on reducing structural determinants of DEAction Schools! BC “Being Me: Promoting Positive Body Image” Resource - for K-7 teachers; focus on positive BO, resilience and ED preventionFHA Weight Bias training for mental health clinicians and othersFamily FUNdamentals Project (DE Prevention) - North Shore collaboration with BCMHAS for province wide educational program for parents - positive BI, healthy eating, positive parenting strategies

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Thank YouFor contact:Email to keltycentre@bcmhs.bc.ca or Call 604-875-2084 or 1800665-1822

Thank YouFor contact:Email to keltycentre@bcmhs.bc.ca or Call 604-875-2084 or 1800665-1822