What is the potential for doing damage?

1. Children & Weight:First, Do No HarmJoanne Ikeda, MA, RDNutritionist EmeritusDepartment of Nutritional SciencesUniversity of California, Berkeley

2. What is the potential for doing damage?

3. Parental health beliefs as a cause of nonorganic failure to thrivePugliese et al, Pediatrics. 1987

4. Nonorganic Failure to Thrive and Parental Health BeliefsMcCann et al, Arch Dis Child. 1994 Mar • Mothers had high levels of dietary restraint • 50% restricted their infant's intake of 'sweet' foods • a further 30% restricted foods they considered 'fattening' or 'unhealthy'

5.  Growth Stunting in Older Children Due to Fear of ObesityPugliese, N Engl J Med. 1983

6. Children are Worried About Obesity

7. Fear of Obesity Among Adolescent GirlsMoses, Pediatrics, 1989 As many as 51% (n = 60) of the underweight adolescents described themselves as extremely fearful of being overweight and 36% (n = 43) were preoccupied with body fat.

8. KidsPoll* Survey of 9-13 Year Olds About Weight Issues • Survey of 1,100 children • 52% believe there is a problem with kids being overweight • 59% said they’ve tried to lose weight • 43% who classify themselves as slight or very underweight, have tried to lose weight • 67% of girls worry about their weight versus 41% of boys

9. When kids were asked cause of overweight? • 29% not enough exercise • 25% not eating right • 19% fast food

10. When asked best way to control body weight? • 69% eating healthy and exercising • 17% going on a diet * Website: www.KidsHealth.org

11. How Common is Dieting Among Children in US?National Study of 10,000 youngsters • 41% of Caucasian children • 40% of Asian children • 33% of Hispanic children • 22% of Black children

12. Does Dieting Contribute to Weight Loss?Stice et al, J Consult Clin Psychol,1999 • A Stanford study that followed 692 females from 9th through 12th grade found that increased dieting and radical weight loss efforts predicted greater subsequent growth in relative weight and increased risk of obesity.

13. “Frequent Dieting Among Youth May Increase Future Obesity Risk”Field et al, Pediatrics, 2003 • Study by Harvard Medical School assessed weight change of frequent dieters compared to those who never dieted. • Over 10,000 youngsters ages 9 to 14 followed for 2 years. • Regardless of their calories, fat, CHO, or their physical activity or inactivity, the frequent dieters were more likely to become overweight than those who never dieted.

14. Impacts of Dieting on Children’s HealthPhysical well being • Risk of stunting growth in height • Lower bone density • Delayed puberty • Poor quality diet • Fatigue • Obesity

15. Impact of Dieting on Children’s HealthPsychological well being • Preoccupation with food and eating • Sneaking and hiding food • Body dissatisfaction, poor self-esteem • Eating disorders

16. Impact of Being Large on Children’s HealthSocial well being • Subject to size discrimination by adults • Teased, harassed, and rejected by peers • Apt to become socially isolated

17. Dieting is considered one indication of body dissatisfaction in children.

18. Body Dissatisfaction Discontent or disappointment with various aspects of one’s body.

19. How Common is Body Dissatisfaction Among US Children?Maloney, Pediatrics, 1989 • 318 boys & girls grades 3-6 • 28 to 55% of girls want to be thinner • 17 to 30% of boys want to be thinner • 13% to 48% of boys want to be larger/broader

20. “Body dissatisfaction is the most consistent predictor of the onset of eating disturbances.” (Thompson, Exacting Beauty, APA, 2002)

21. PROMOTION OF EATING DISORDERS

22. Prevalence of Eating Disorders in the United States • 0.5-1% of adolescents have anorexia nervosa • 2-3% of adolescents have bulimia nervosa • 10% of late adolescent and adult women have symptoms

23. Incidence of Eating Disorders • Doubled since 1960s • Increasing in younger age groups • Occurring increasingly in diverse ethnic and sociocultural groups • 13% of high school girls purge Source: Journal of the American Academy of Child and Adolescent Psychiatry

24. Eating disorder hospitalization for children younger than 12 years has increased by 119% from 1999 to 2006 Federal Agency for Healthcare Research and Policy

25.  Promoting Body Dissatisfaction and Dieting

26. Skip to content Enter Now! Promoting Body Dissatisfaction and Dieting

27.  Size Discrimination

28. What is Size Discrimination? • a difference in treatment or favor made on a basis other than individual merit • prejudiced or prejudicial outlook, action, or treatment

29. Stigmatization of Fat Children Has Increased by 40% in the last 40 Years! Latner & Stunkard, Obesity Research, 2003 “The results of this study suggest that in addition to efforts at treating obesity in children, there is a need for education, prevention and intervention aimed at increasing acceptance and decreasing negative attitudes and behaviors directed at obese children.”

30. Social Marginalization of Overweight ChildrenStrauss & Pollack, Arch PediatrAdolesc Med, 2003 • More likely to be social isolated • Significantly fewer friendship nominations by others • More friendship nominations associated with: • decreased TV time • Increased sports participation • Increased participation in school clubs

31. “few problems in childhood have as significant an impact on emotional well-being as being overweight.” Strauss & Pollack, Arch Pediatr Adolesc Med, 2003

32. Negative Impact on Self-EsteemVeugelers, Health Reports/Statistics Canada,2011 • For each BMI unit increase, self-esteem scores decreased by 5% ● Could lead to an upward trend of mental health problems

33. Negative Impact on Self-EsteemVeugelers, Health Reports/Statistics Canada,2011 • For each BMI unit increase, self-esteem scores decreased by 5% ● Could lead to an upward trend of mental health problems

34. Media Stigmatization * ► 72% of photographs paired with online news stories about obesity are stigmatizing toward obese ► 65% of videos paired with online news stories about obesity stigmatize overweight/obese ►77% of videos stigmatize overweight/obese youth. *http://www.yaleruddcenter.org/press/image_gallery_intro.aspx

35. Georgia Stop Childhood Obesity Campaign

43. How can we avoid doing harm?

44. Society for Nutrition EducationPosition PaperJNEB, February, 2003 ● Programs should help ALL children adopt healthier lifestyles. ● Set goals for health, not weight ● Provide a nurturing environment ● Set goals for healthy eating & physical activity .

45. SNE Do No Harm • Teaching children that theirs is a good body will encourage them to keep it healthy. ●Avoid stigmatization and humiliation in all aspects of the program ● Go beyond BMI in assessment

46. What is Normal?Oregon Dairy Council Poster & Lesson Plans $5.

47. Win the Rockies:Community Nutrition Programshttp://www.uwyo.edu/wintherockies/ Where We Were

48. WIN Overall Goals ►to enhance the well-being of individuals by improving their attitudes and behaviors related to food, physical activity, and body image; and ►to help build communities' capacities to foster and sustain these changes.

49. WIN Principles of Body-size Differences and size-acceptance • Accept and value every body, whatever size or shape. • Help people feel good about their bodies and about who they are. • Recognize that people of all sizes and shapes can reduce their risk of poor health by adopting a healthy lifestyle. • Challenge your own size-prejudice beliefs.

50. WIN Principles of Positive Self-acceptance ● Value yourself regardless of your size or shape. ●Identify your strengths and abilities and build on your assets. ●Be critical of messages that focus on unrealistic body images as symbols of success and happiness.