Body Image Concerns in Kids

By Abigail Natenshon, MA, LCSW, GCFP

Childhood Fears Take New Form

From his recliner, a father criticizes a television personality for how fat she looks in her evening gown...

A brother speaks disparagingly about his girlfriend's hip size, claiming she needs a "license for the wide load"...

The mother of a 5-year-old tells her jokingly that she will develop a "Buddha belly" if she puts butter on her bread...

A child states that more important than getting A's in school is being accepted by the "popular group." Her parents make no comment...

Message received!

A vulnerable child is quick to take in and personalize what are otherwise meant to be benign "throwaway" comments. Harmful messages get transmitted to children unintentionally and may result in body image disturbances -- the precursor to eating disorders.

As early as the first grade, children are reporting concerns and preoccupation with weight and body shape; some will even begin to restrict food. Camp counselors report 6- and 7-year-olds studying nutritional labels on food items as they empty their lunch sacks.

A U.S. Dept. of Health and Human Services task force reports that 80% of girls in grades 3 - 6 have bad feelings about their bodies -- an issue diverting attention from schoolwork and friendships. Preteen boys, inspired by the world of sports and television, fret about the inadequacy of their builds, believing that the strength in their muscles or the girth in their chests is more important than intelligence, compassion, or emotional well-being.

Believing that outward appearance is a reflection of inner quality, children with body image concerns develop a sense of who they are (physically and emotionally) and how they should behave by internalizing messages about themselves from others. Children who are lacking in self-esteem and who seek acceptance and approval are particularly sensitive and susceptible to the perceptions of parents, family, peers, and the media.

While body image concerns do not always lead to the clinical disease of an eating disorder, these concerns need to be recognized and addressed so that children can learn to enjoy a healthful relationship with food.

Signals from parents

Parents may inadvertently and unwittingly contribute to their child's body image issues. Disparaging or critical parental messages sent to a child about his or her appearance create or reinforce body image concerns, as well as a lack of self-acceptance, poor self-esteem, and food fears and obsessions. When parents harbor unresolved weight-related and body image issues of their own, these issues may be passed down to children as a legacy, from generation to generation. One study showed that anorexic mothers raised children who by age 5 whined more, demonstrated eating problems, and manifested signs of depression.

Children learn best by example, and overhearing their parents complain about their own weight and need to diet, watching them restrict food or exercise excessively are poor examples. Kids are quick to pick up on the signals of parents who skip meals, purchase and eat only lite or fat-free foods, or who do not consider it a priority to prepare and provide three meals a day and to sit down to eat them together with their family.

Poignant messages are also communicated by what parents choose not to do and to say. When parents do not actively refute poor values or misconceptions in their children, they may find that they are perpetuating and reinforcing them; if they fail to actively negate the child's belief that popularity and peer acceptance is as important as learning and academic achievement, the child's own worst fears and misconceptions are realized and validated. If not part of the solution, parents are in danger of becoming part of the problem.

Predisposing factors

Bombarded by conflicting media messages about how to stay fit and live long, parents have become increasingly food-phobic and, in many instances, as confused as their children.

Many parents have forgotten what healthy eating and living is -- and is not. They assume that fat-free eating is healthy eating and that skipping meals is a shortcut to being trim. They do not realize that an eating or exercise lifestyle that works well for a parent, when taken out of the context of age and health requirements, does not necessarily apply to children -- and in fact may harm them. As an example, children need fat in their diets to complete their neurological development throughout the childhood and adolescent years.

When parents fear that by communicating honestly with their children about uncomfortable subjects they could create more problems or lose their child's love, they may be inclined to pretend not to notice when their child is in trouble. A problem cannot be resolved unless and until it is identified and confronted.

Too many or too few parental limits imposed during the growing-up years deprive children of the opportunity to internalize appropriate controls through which they can ultimately regulate themselves. The overly controlled child who feels victimized and helpless, as well as the overly controlling child who feels overwhelmed and frightened by her own power, may experience an emerging internal image of herself as destructive and without limits. This child may eventually feel the need to turn to an eating disorder to compensate for her lack of external and internal controls ... nature abhors a vacuum.

A tantruming 3-year-old who refuses to put on her snowsuit in a subfreezing Chicago winter won't allow her mother to belt her into her car seat and ultimately refuses to sleep in her own bed, wandering into her parents' room every night. With a legacy of adult obesity and addiction in her family's genetic pool, this child is a prime candidate to develop an eating disorder in the future.

What parents can do:

• Model a healthy relationship with food.
• Educate children, teaching them to regard the body as a wise and predictable machine requiring fuel and maintenance, rather than as an object of beauty; food as a life-sustaining fuel, rather than as the enemy; healthy eating as a balanced and moderated lifestyle, rather than as an exercise in food restriction.
• Listen to "know" their child, and to help their child understand herself. When the child makes negative comments about her shape or size, do not dismiss them, even if they seem irrational; rather, a parent should initiate discussion about how the child thinks she could look better and why.
• Help the child develop immunity to the steady stream of media messages that distort her perspective by teaching her to become a more critical consumer of the media, and by canceling subscriptions to fashion magazines.
• Become aware of their own body image concerns and attitudes that may stimulate their child's fears, distortions, and misconceptions. Parents must be careful not to complain about their own weight.

Psychotherapist Abigail H. Natenshon has specialized in the treatment of eating disorders with individuals, families, and groups for the past 28 years. She is the author of "When Your Child Has An Eating Disorder, A Step-by-Step Workbook For Parents And Other Caregivers," Jossey-Bass, 1999. Based on hundreds of successful outcomes, this book shepherds concerned parents step-by-step through the processes of eating disorder recognition, confronting the child, finding the most effective treatment for patient and family, and evaluating and insuring a timely recovery. Her work can be reviewed further at www.empoweredparents.com.