Even as childhood obesity rates plateau, eating disorders in kids have been on the rise. And plenty of families still struggle with both.
By Christina Elston
It’s 6 p.m. on a Thursday, and in a small classroom at Children’s Hospital Los Angeles, eight families are taking a quiz.
In what order are things listed on food ingredient labels?
How many teaspoons of sugar should be your maximum for the day?
How do you know if something is a high-fat or low-fat food?
Instructor Emily Millen calls out the questions, and the children seated at the tables with their parents are – for the most part – ready with answers. This is the families’ sixth and final week in the hospital’s Kids N Fitness (the “N” is for “Nutrition”) program, an effort of the type that has become increasingly common over the past decade as our country wages a war against childhood obesity.
But while the sight of children learning about healthy eating and the importance of physical activity is now a familiar one, the picture regarding kids and weight in Southern California is far from simple.
A study released in 2012 by the UCLA Center For Health Policy Research found that Los Angeles County includes the cities with the highest – and the lowest – rates of childhood overweight and obesity in California. Looking at 2010 state department of education data on 5th, 7th and 9th graders, researchers found that upscale Manhattan Beach had overweight and obesity rates of just 11 percent. Less than 20 miles away, in inner-city Huntington Park, the rates jumped to 53 percent.
Manhattan Beach students, according to 2012 statistics from kidsdata.org, are also more likely than those in L.A. Unified – which includes Huntington Park – to meet government physical fitness standards (more than 59 percent of Manhattan Beach kids do, while fewer than 28 percent do in L.A. Unified) and to be at a healthy weight (more than 77 percent in Manhattan Beach are versus less than 49 percent in LAUSD).
Much less data is available on Southern California kids with weight and food issues at the other end of the spectrum – including eating disorders such as anorexia nervosa and bulimia nervosa. L.A. County saw 58 kids ages 18 and younger hospitalized for bulimia and 92 for anorexia 2012, according to the Office of Statewide Health Planning and Development. Case numbers are too few to draw solid conclusions about trends among cities, but Richard MacKenzie, M.D., a specialist in adolescent medicine at Children’s Hospital Los Angeles who has been treating children with eating disorders since 1974, says these are traditionally high-functioning kids from upper socio-economic groups. The landscape, however, is changing.
MacKenzie says that about 10 years ago, as the healthcare community boosted its efforts to combat childhood obesity, he wondered whether we would also see an increase in childhood eating disorders. And we have. Nationally, among kids under age 12, hospitalizations for eating disorders rose 72 percent between 1999 and 2009, according to the U.S. government’s Agency for Healthcare Research and Quality.
And children with eating disorders no longer necessarily fit the classic profile. “This has evolved over time to an epidemic,” says MacKenzie. “It has evolved in both its character and its prevalence.” Eating-disorder patients now come from all parts of the county and all socio-economic groups.
MacKenzie believes the focus on weight is a contributing factor, and illustrates with the story of a 15-year-old patient from South Los Angeles. The boy was being bullied at school, and lost 100 pounds by basically starving himself thin. “He’s no longer bullied,” says MacKenzie. “He’s now admired by his classmates.” But rather than a weight problem, the teen now suffers from anorexia. “He’s afraid that if he does eat, he’ll get fat,” MacKenzie says.
A study by University of Minnesota researchers published in JAMA Pediatrics in June appears to back MacKenzie up. Looking at a large sample of teens and parents, the study found that when parents focused on their children’s weight or size, the children were more likely to go on extreme diets or develop eating disorders.
Family dynamics play an important role in eating disorders and obesity among children.
“We have to talk to parents a lot about what they’re doing and saying in front of their kids,” says Carolyn Costin, who founded Monte Nido Eating Disorder Treatment Center in Malibu and wrote the book Your Dieting Daughter. She describes one 9-year-old patient who developed an eating disorder trying to keep up with her exercise-fanatic father, and another whose overweight mother fixated on the child’s weight until, at age 8, the girl developed bulimia trying to slim down.
Megan Lipton, who has overseen dozens of sessions of Kids N Fitness since the program’s inception in 2000, says that children who are overweight need a good example as well. Lipton found out early on that Kids N Fitness needed to include parents. “They were waiting for their kids [at the end of class] with the value meals they got at the McDonalds downstairs,” Lipton says. Since families tend to share eating and exercise (or not) habits, now Kids N Fitness works to get everyone on board, sharing strategies for healthy cooking, healthier restaurant food, and staying active even if there’s no safe playground nearby.
Parents also have a role to play in helping children take a realistic view of their bodies. With more than one-third of children in the U.S. overweight or obese, overweight children are starting to look like everyone else on the playground to parents – and even some doctors. “It’s a problem of the changing norm of society,” says Steve Mittelman, M.D., Director of the Diabetes and Obesity Program at The Saban Research Institute of Children’s Hospital Los Angeles. “If we decide to accept the new norm, then we have real problems.”
Meanwhile, adolescents have unrestricted access to media that feeds them images – often completely unrealistic images – that shape their ideas about how they should look. “Marilyn Monroe would be considered overweight today,” points out MacKenzie, adding that instead, the ideal is a super-slim body with thin hips and few curves. “Just look at the average fashion model.”
Unless you’re looking in a magazine, where – Costin points out – she will almost certainly be photoshopped.
Getting It Right
So what’s a parent to do? One great example comes from Cris Liquori. About 18 months ago, the mother of twin boys was struggling with health and back problems and lack of energy. “I couldn’t keep up with the boys,” she says. “I was extremely overweight.”
Starting with the mom in the mirror, Liquori changed her eating habits and became more active. Then she tried to motivate the family. “I was trying to convert the family, but my kids were not on board,” she says.
She thought healthy messages might be more appealing coming from someone else, so she enrolled her son Sebastian, the one she believed most likely to be interested, in Kids N Fitness. At first, just Liquori and Sebastian attended, but soon Sebastian was having so much fun that his brother, Michael, wanted to go as well. By the end, her husband, Terry, was even showing up.
The Liquoris went from junk-food-loving couch potatoes to an active family with healthy cupboards. Liquori has lost 60 pounds, and at Sebastian’s physical in October, he had grown two inches without gaining any weight. His doctor was pleased.
What You Can Do
Here are tips to help foster a healthy family approach to weight and food.
Unplug and get moving. Turn off the TV, get outside and do something, suggests Liquori, remembering how tough that was for her at first. “I couldn’t walk more than a block,” she says. In November, she and family walked their first 4.8K. Most kids, given the chance, are active. “In their natural state,” says Mittelman, “kids run around.”
Have the right attitude about food. Costin advises parents to focus on what to eat rather than what not to eat, talk positively about food and your body, and even eat things like pizza and ice cream on occasion to teach moderation instead of elimination.
Keep the kids involved. Lipton reminds parents that healthy eating and activity is a family affair. Involve your kids in shopping and cooking, and keep offering healthy options. Find out about upcoming sessions of Kids N Fitness (a new Junior program for ages 3-7 starts Jan. 11 and a session for ages 8-16 starts in February) at www.CHLA.org/kidsnfitness.
Manage expectations. Overweight kids might not lose weight, and that can be OK. The goal is often just to stabilize their weight and let them grow into it. “That’s a first good, successful step,” says Lipton.
If you are worried, take your child to the doctor. MacKenzie says that most general pediatricians are sensitive to eating and weight issues. If your child is reluctant to see the doctor, he recommends taking advantage of other visits – such as those for immunizations or school sports physicals.
Christina Elston is editor of L.A. Parent.