Chapter 4 Body Image and Eating Disturbances in Children and Adolescents

1. Chapter 4Body Image and Eating Disturbancesin Children and Adolescents Marilyn Massey-Stokes, EdD, CHES, FASHA Texas Tech University

2. Learning Objectives After completing this chapter, you should have an understanding of: • body image disturbances and their prevalence among children and adolescents • eating disturbances and their prevalence among children and adolescents • the connection between eating disorders and other risk behaviors &psychological disorders

3. Learning Objectives • risk and protective factors for body image and eating disturbances • promoting healthy body image and preventing eating disturbances among youth • the application of Social Development Strategy in the health promotion and prevention process

4. Eating Concerns and Weight Issues for Children and Youth • American children as young as age 6 are dissatisfied with their body shapes or weights. • Children as young as 8 or 9 are dieting. • Approximately 9 million American children are classified as obese.

5. Eating Concerns and Weight Issues for Children and Youth • Among American HS students, 30% of girls and 16% of boys engage in disordered eating behaviors (e.g., bingeing, vomiting, fasting, laxative and diet pill use, and compulsive exercise). • Body image and eating disturbances affect the “whole child” (physically, mentally, emotionally, socially, spiritually).

6. Continuum of Eating Problems • The triad of body image difficulties, eating disorders, and obesity are an interrelated set of body weight and shape disturbances. • Eating problems are often viewed on a continuum, beginning with body dissatisfaction and weight concerns and ending with clinical eating disorders.

7. Definitions • “Eating disorders” refers to anorexia nervosa and bulimia nervosa. • “Eating disturbances” and “disordered eating” are broader terms, referring to a range of unhealthy behaviors such as obsession with body weight and shape, excessive restrictive eating, skipping meals, laxative & diet pill use, cycles of binge eating and dieting, self-induced vomiting, and excessive exercise for purging calories.

8. Purpose of Chapter • Present an overview of some of the key findings concerning body image and eating disturbances in children and adolescents. • Discuss viable avenues for promoting healthy body image and preventing eating disturbances among this population.

9. Body Image • Subjective depiction of physical appearance • Comprised of behavioral, perceptual, cognitive, and affective experiences • Numerous studies have shown a connection between body image disturbances (BID) and low self-esteem, psychosocial distress, and early-onset depression.

10. Body Image • The relationship between body image dissatisfaction and BID has been strongly linked to eating disorders such as anorexia nervosa and bulimia nervosa. • As age increases, ideal body size generally becomes progressively thinner.

11. Body Dissatisfaction • High numbers of Caucasian American children experience body dissatisfaction. • There is evidence that body dissatisfaction may be increasing among girls in minority ethnic groups (e.g., African Americans and Mexican Americans).

12. Developmental Trends • There are developmental trends in body image and weight concerns, and these trends vary by gender and across ethnic groups. • These trends are important because there is evidence that body dissatisfaction in young girls can lead to eating problems and early-onset depression later.

13. Assessing Body Image • Most researchers focus on two separate components of BID—perceptual body-size distortion and the affective (attitudinal) aspect. • Perceptual body-size distortion is comprised of inaccurate perceptions of one’s body size (e.g., individuals with eating disorders often overestimate their actual body size).

14. Assessing Body Image • The affective element relates to dissatisfaction with one’s body size, shape, or some other aspect of physical appearance. • Although most studies have focused on the distortion component, greater consistency has been found by using attitudinal measures.

15. Assessing Body Image • Body image is considered multidimensional. • The assessment of BID requires a variety of methods and techniques. • Instrument glossaries can help clarify terms for youth.

16. Body Image Instruments • Instruments should have sound psychometric properties (e.g., a test-retest reliability of a least .70) and be evidence-based • Video distortion methods and custom computer software for measuring body size estimations have been successfully used.

17. Research Questions • How body dissatisfaction varies at different ages for different genders and across different ethnic and socioeconomic groups • The need to develop more accurate measurements of body image, particularly in young children and adolescents from various ethnic and socioeconomic groups

18. Research Questions • Developmental trends in body image development • Whether childhood body dissatisfaction, high body mass index, and eating disturbances are risk factors for later development of eating disorders, obesity, or depression

19. Eating Disorders in Youth • Clinically diagnosable eating disorders (EDs) are atypical among prepubescent children. • EDs rank as the third most common chronic illness among adolescent females, with an incidence of up to 5%.

20. Eating Disorders in Youth • Eating disorders are related to other risk behaviors (e.g., tobacco use, alcohol and other drug abuse, sexual activity, and suicide attempts). • Eating disorders often lead to multiple negative outcomes that affect the whole child.

21. Range of Health Consequences for EDs • Preoccupation with eating that can significantly hinder healthy growth and development • Severe malnutrition • Osteoporosis • Acute psychiatric emergencies • Heart and other organ damage • Death

22. Death Rates from EDs • Among the highest for any mental illness • For U.S. females ages 15-24, the mortality rate among those with anorexia nervosa is approximately 12 times higher than the death rate from all causes of death.

23. Eating Disorder Not Otherwise Specified (EDNOS) • Patients who do not fully meet the DSM-IV criteria for anorexia or bulimia, but experience the same medical and psychological consequences of these disorders • The majority of adolescents in ED treatment centers meet the EDNOS criteria.

24. Warning Signs of EDNOS • Unhealthy weight management practices • Obsessive thinking about food, weight, shape, or exercise • Failure to maintain a healthy body weight/composition for gender and age

25. Consequences of Sub-Clinical EDs • Considerable social and educational impairment that may require clinical intervention • Significant interference with the developmental needs and resilience of children and adolescents

26. Co-Existing Disorders • Depression • Obsessive-Compulsive Disorder • Anxiety • Bipolar Disorder • Personality Disorders • Substance Abuse • Self-Mutilation

27. Co-Existing Disorders • In some cases, the eating disorder is a secondary symptom to an underlying psychological disorder. • Or, the psychological disorder may be secondary to the eating disorder.

28. Treatment • EDs should be addressed by a multidisciplinary team of medical, nutritional, mental health, and nursing professionals who have expertise in child-adolescent health and are experienced in treating BID and EDs.

29. Treatment • Numerous barriers to proper care (e.g., inadequate health insurance benefits and resistance from patient and family) • Failure to detect an ED in its early stages can exacerbate the illness and make it much more difficult to treat.

30. Risk and Protective Factors • Risk factors (RF) are those conditions that increase the likelihood that an individual will develop an eating problem. • Protective factors (PF) are those conditions that mitigate the risk.

31. 4 Primary Categories of RF and PF • Biological • Individual • Familial • Sociocultural

32. Biological Risk Factors • Genetic predisposition to eating disorders • Mood disorders • Neurochemical (e.g., serotonin) imbalances • Early puberty

33. Individual Risk Factors • Negative body image & body dissatisfaction • Temperament (e.g., negative emotionality) • Personality characteristics (e.g., perfectionism) • Low self-esteem • Inadequate coping skills • Substance Abuse • Overweight/obesity

34. Familial Risk Factors • EDs in first-degree biological relatives • Maladaptive parental behaviors and dysfunctional family relations • Family pressure to adhere to the thin ideal • Alcohol misuse • Physical or sexual abuse (controversial)

35. Sociocultural Risk Factors • Societal glamorization of the thin ideal • Media exposure promoting thinness • Peer influences promoting dieting and adherence to the thin standard

36. Protective Factors • There is little research about protective factors and how they may buffer individuals against developing eating disturbances and clinical EDs. • The primary protective factor that has received the most empirical support is positive family relationships.

37. Individual PFs • High self-esteem • Self-directedness and assertiveness • Ability to effectively cope with life stressors • Genetic predisposition for slimness

38. Familial PFs • Living in a family that does not overemphasize body weight and physical attributes • Living in a family where parents do not misuse alcohol • Social support from the family

39. Sociocultural PFs • Participation in sports that do not emphasize thinness for successful performance • Cultural messages that embrace different body shapes and sizes • Close relationships with friends who do not overstress body weight • Social support from peers

40. Primary Prevention • Primary prevention focuses on keeping body image and eating disturbances from developing among children and adolescents. • Programs must be age and developmentally appropriate. • Programs should address the relevant skills and challenges for each stage of development. • Prevention should begin at an early age (e.g., elementary school years).

41. Primary Prevention Strategies • Development of positive self-esteem and healthy body image • Development of essential life skills, including social-emotional and effective coping skills • Provision of experiences that encourage the development of self-efficacy

42. Primary Prevention Strategies • Skills training for lifelong balanced nutrition and physical activity • Opportunities to develop media literacy skills, and learn how to challenge sociocultural myths and attitudes regarding body shape and size • Positive youth development

43. Development of Positive Self-Esteem • Self-esteem appears to be a significant predictor of eating problems. • Branden defines self-esteem as possessing two components – self-respect and self-efficacy.

44. Self-Respect • An individual’s assurance of his/her value and basic right to experience a fulfilling life • Comfort in appropriately asserting thoughts, wants, and needs • A caring adult can foster a child’s self-respect through increasing the individual’s sense of positive uniqueness.

45. Self-Efficacy • A person’s belief or confidence that she/he can successfully accomplish a task • A sense of competence (power) is foundational for sound mental and emotional health. • It also is preventative against the development of negative body image and eating problems.

46. Fostering Self-Efficacy Help youth develop health literacy: • Effective communication • Self-directed learning • Critical thinking and problem solving • Responsible, productive citizenship

47. Fostering Self-Efficacy • Goal setting (e.g., “baby steps”) • Opportunities for rehearsal of life skills • Positive social support

48. The Family • Families are a major health and social influence in the lives of youth. • Family involvement is essential to the health promotion process. • Positive, nurturing relationships are integral to family health.

49. The Family Children can be taught: • the value of eating healthy foods and being physically active for health and wellness • the importance of respecting different body types • how to effectively communicate feelings and needs

50. The Family • All children, regardless of their weight and size, should feel that they are unconditionally loved and accepted by the family. • If a family suspects that a child is engaging in restrictive eating and/or other maladaptive behaviors, they should seek help from a qualified professional.