How Childhood Obesity and Eating Disorders Are Linked

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On the surface, they may seem like two entirely different problems but childhood obesity and eating disorders have a fair amount in common. Both conditions involve unhealthy eating patterns, too little or too much exercise, and underlying psychological issues such as low self-esteem or poor body image. It isn’t known exactly how many obese kids also suffer from an eating disorder in the U.S., but a study from Germany found that 43 percent of obese adolescents participating in a lifestyle intervention for weight loss met the criteria for an eating disorder.

Who’s at Risk and Why

By itself, obesity is now viewed as a risk factor for eating disorders, including binge-eating disorder (which could also be a cause of obesity) as well as anorexia nervosa and bulimia. A pair of studies found that overweight adolescents have a 2 1/2 to 5 times higher risk of developing eating disorders than teens whose weight is in the healthy range. This same pair of studies also found that teens with low levels of physical activity have a 2 to 4 times greater risk of developing eating disorders.

Meanwhile, obese kids who lose weight are considered at risk for developing eating disorders such as anorexia nervosa and bulimia. Here’s why: When they begin restricting their eating or they start exercising vigorously in order to slim down, these efforts can become a major preoccupation, leading the kids to lose a lot of weight and become driven to continue these new behaviors, often to extreme lengths, according to researchers at the Mayo Clinic in Rochester, Minnesota.

Kids with eating disorders often have low self-esteem and low self-efficacy. With eating disorders, the effort to exert control over eating behavior is often a manifestation of underlying psychological issues, perhaps feeling out of control in other areas of their lives. Obesity may compound these underlying issues, thus placing obese kids with eating disorders in a state of double jeopardy.

Social factors can contribute to this vulnerability. A study involving 130 overweight teens found that those who experienced frequent teasing by family members and peers had a greater likelihood of having disordered eating thoughts and behaviors, as well as depression, anxiety, and low self-esteem. The more these kids were teased about their weight and the more they were bothered by the teasing, the greater the odds were that they’d develop severe levels of binge eating, in particular.

Protective Measures

Sharing meals together as a family can help foster healthy eating habits in kids and decrease their chances of developing disordered eating habits (such as bingeing and purging, self-induced vomiting, fasting, eating very little food, and using diuretics), according to a review of studies by researchers at the University of Illinois Urbana-Champaign. So can shifting the focus away from thinness. A study from the University of South Florida found that obese undergrads who received more positive comments about their body shapes tended to have less body dissatisfaction. Presumably, this could help protect them from going to extreme lengths to lose weight and developing an eating disorder in the process.

Shifting the focus at home can also help. Parents who frequently engage in weight-related conversations are likely to have adolescents who diet, use unhealthy weight-control behaviors, and engage in binge eating, according to research from the University of Minnesota Medical School. By contrast, obese teens whose mothers, in particular, focus their conversations on healthful eating are less likely to diet and use unhealthy weight-control behaviors.

A Wake-Up Call

Because their weight tends to be on the high side, the symptoms of eating disorders in obese kids often go unrecognized and untreated. That’s alarming because these disorders can have serious consequences for a child’s health and development. Parents and primary-care physicians should be on the lookout for signs that a child may be developing an eating disorder. These include rapid weight loss, being driven to exercise, extreme dietary restriction, binge-eating, compensatory behaviors (such as purging), having an unhealthy preoccupation with body weight and shape, a negative body image, social withdrawal, irritability, and rigidity.

If you see your overweight child losing weight suddenly or inexplicably, ask about her eating habits and whether she is skipping meals, starving herself, or exercising to excess. While it may seem beneficial for an obese kid to lose weight, if the methods are extreme, the ends don’t justify the means—and the child or teen may need to be treated for an eating disorder. Whether it involves an inpatient program, an outpatient treatment, cognitive behavioral therapy or individual therapy, the sooner treatment is begun, the better the chances are that a child will recover from an eating disorder.

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