Wellness News 4-26

By Melissa Nishawala, M. D.
     According to the latest government figures, more youngsters than ever (10%) are overweight and between 16 and 33% of them are obese. On the other side of the weight issue, some youngsters become so preoccupied with being thin that they develop eating disorders. (estimated 7 million girls and 1 million boys). It’s easier to prevent problems than to manage them later when they occur. The key to preventing both kinds of eating disturbances is instilling healthy eating and exercise habits at a young age. 
How to Help
Lead by Example
    Research shows that children imitate their parents’ behavior, so lead by example. If you make an effort to maintain a healthy attitude and healthy eating habits your children are more likely to do the same now and for the rest their lives. Here are some tips:
* Come to terms with your own food issues and body image
Take a look at your own food habits and ideas about weight. Your comments and ideas about appearance can influence what your children think is acceptable or desirable. How many times have you heard yourself make a negative comment about how you look in an outfit? “Do I look fat in this?” or “Boy! these jeans make my thighs look fat!” Kids are listening and take in that a person is valued by his or her appearance.
* Give up dieting—it doesn’t work!
What’s a Healthy Weight? 
     Check with your doctor to understand how your child compares to established standards for height and weight.
     How to calculate your BMI (body mass index)
Multiply your weight in pounds by 703; divide by height in inches; divide again by height in inches and the result is your BMI
For example, a 13-year-old boy who weighs 190 lbs. and is 5’5″ tall would have a BMI=190/(65)(65) x 703 = 31.6, indicating that he is obese. A healthy BMI is between 18.5 and 24.9.
Start by making small changes, such as:
    Cutting back on soda and juice; switching to skim milk (kids don’t need as much milk as the dairy industry recommends); substituting fruit for dessert; drinking 8–11 eight-ounce glasses of water daily. Rather than make a particular food taboo, use it in moderation for treats.
   Work towards following the Federal Dietary Guidelines
Healthy Eating—Some Do’s
* Eat breakfast
* Eat 5-6 small meals/snacks daily
* Eat slowly and stop eating when you’re satisfied
* Eat when you’re hungry
* Eat together as a family
* Have plenty of healthy snacks available
* Make fast food only an occasional treat
Healthy Eating—Some Don’ts
* Put your child on a restrictive diet
* Skip meals
* Use food as a reward or a comfort (Substitute a special trip, art or sports supplies, movie etc. as a reward)
* Withhold food as punishment
* Eat in front of the TV
* Force children to eat when they’re not hungry
Get active
* Aim for 30-60 minutes of moderate physical activity daily
* Encourage walking, biking, swimming, skating, ball sports, etc.
* Reduce your child’s total TV screen time to less than 2 hours daily
Body Image
What Is it?
     Body image is how you think and feel about your body. It may have nothing to do with actual appearance. Each person holds an image of the perfect body and evaluates his/her appearance against this ideal. Poor body image can lead to disordered eating, depression and low self-esteem.
Helping Your Child Develop a Healthy Body Image
* Foster a strong sense of identity and self-worth by letting your child know she is loved and appreciated whatever her weight.
* Focus on health and positive qualities, not weight.
* Be involved in your child’s life and praise her for her accomplishments.
* Notice the contradictory messages from the media and help children critique them. Help children understand that the ‘ideals’ portrayed in fashion magazines are unrealistic and absurdly out of line with what a real body looks like. Studies show that by age 17 a child has received over 250,000 commercial messages, and 50% of commercials aimed at girls focused on physical attractiveness.
* Talk openly about ads, articles, websites or window displays that promote either eating disorders or healthy body image.
* Never tease a child about his looks, weight or body shape.
* Encourage expressions of individuality. Teach children to appreciate people for who they are, rather than what they look like.
* Make your child feel he has an important role in the family by assigning age-appropriate household tasks.
* Celebrate diversity.
* Watch for “fat talk,” such as ‘good’ or ‘bad’ foods, among yourself and others. 
Eating Disorders
Eating disorders may occur when a person’s preoccupation with food and weight becomes obsessive and results in starvation, overeating and purging, to a degree that becomes dangerous. Eating disorders can limit other aspects of a person’s life and can seriously affect physical and mental health. Following are the most common types of eating disorders:
Anorexia Nervosa is a serious and life-threatening disorder which is usually due to emotional issues. People with Anorexia Nervosa have an intense fear of getting fat, even when underweight. They are generally obsessed with food, but deny their hunger and starve themselves. Many also limit other aspects of their lives such as relationships, social activities or pleasures. Anorexia can start as a desire to lose weight and a need to maintain control.
Bulimia Nervosa, a related and serious disorder with medical consequences, is harder to detect. It refers to a cycle of out-of-control eating following by some form of purging, such as self-induced vomiting, excessive use of laxatives, or obsessive exercising. Individuals with bulimia may have other out-of-control behaviors, such as spending money, abusing drugs or alcohol, or chaotic relationships. 
Binge Eating Disorder is characterized by episodes of compulsive overeating followed by periods of guilt and depression.
Warning Signs:
Anorexia Nervosa
• Excessive weight loss—15% or more of ideal body weight
• Distorted body image—feels fat even if thin food rituals
• Lack of menstrual cycles
• Fine hair on face, arms and torso
• Wearing baggy clothing 
• Vigorous exercise at odd hours
• Paleness, dizziness, fainting spells
• Repeated attempts at dieting
• Self-conscious or embarrassed about eating
• Perfectionistic
• Eating for emotional comfort
Bulimia Nervosa
• Missing food/secretive eating
• Fluctuating weight (10-15 pounds)
• Cuts/scrapes on back of hand from purging
• Tooth decay
• Uses bathroom after meals
• Diet pills/laxative abuse
• Self disparagement related to food intake
• Swollen glands, puffy cheeks, broken blood vessels under the eyes
• Reacts to emotional stress by eating
Binge Eating
• Eating large amounts of food when not hungry
• Eating very rapidly until the point of feeling uncomfortably full
• Often eating alone due to shame or embarrassment
• Feeling depressed, disgusted or guilty after eating
• Marked weight fluctuations
How Parents Can Help:
A child with an eating disorder may be reluctant to acknowledge the problem. Let her know you care and want to help.
• Be aware of your own reactions and prejudices about people’s weight.
• Realize that you can support your child but you cannot control her eating.
• Do not discuss weight, appearance or food intake.
• Watch for signs that physical and/or emotional health are worsening.
• Don’t compare her to others or make comments about her appearance.
• Contact your pediatrician or family doctor and ask for referrals to a psychiatrist, therapist, and nutritionist.
Helpful Websites
About the Author
Melissa Nishawala, M. D. is Assistant Professor of Psychiatry at the NYU School of Medicine and the Director of the Tisch Young Adult Program at the NYU Child Study Center. Dr. Nishawala’s special interests are in eating disorders and autism spectrum disorders. 
The NYU Child Study Center is dedicated to the understanding, prevention, and treatment of child and mental health problems. For more information visit