Eating Disorders

Q&A with Dr. Rudy Nydegger, Clinical psychologist, Officer in the New York State Psychological Association

HEALTHY BITES

Q: We hear about eating disorders like anorexia and bulimia all the time - are obese kids considered to have eating disorders, too?

A: Diagnostically, obesity is not the same as anorexia or bulimia. However, it is clearly a physical and psychological disorder because of the child's inability to maintain a healthy weight, and this, of course, includes their eating habits.

Q: How prevalent is obesity in kids? Is New York worse than other states?

A: Yes, I think it is a large problem in New York State. In fact, in my opinion, it's an epidemic one and on the increase. More than ever before, we're seeing "husky" sizes for kids on the racks in the stores, and "super-sized" kids' meals at fast food restaurants. That's a bad sign.

Q: What are some of the long term effects of eating disorders?

A: The most unfortunate long term effect of childhood obesity is the "fat" kids will become "fat" adults. That's in addition to all the health problems being overweight brings - like cardiovascular problems, orthopedic problems and diabetes to name a few. And these medical conditions are happening earlier and earlier in children's lives. Also, being an overweight child sets the stage for a life of sedentary behavior, because obese kids are less likely to participate in sports or other physically challenging behavior and will continue this pattern through adulthood.

Q: Besides health, is there an impact in the classroom?

A: You bet. Kids who are obese are rarely treated the same way that other kids are. Some of the reasons are they are too overweight to participate in activities. They are often targeted as objects os ridicule and teasing, and set apart from the other kids in the classroom. This brings with it a risk for both physical and psychological abuse. It's a real social problem and can lead to conditions such as depression and anxiety.

Q: How can you identify eating disorders?

A: Admittedly, sometimes being overweight early on is "hardwired in" - the genetic predisposition causes some children to process and store fats differently at a very early age. However, that doesn't mean there's nothing we can do about it. Again, overweight kids are more likely to become overweight adults. The main thing to look at is patterns. If you have a child who has an overweight body mass index, chances are they are on the road to obesity. Another sign is when kids use food for comfort. One of the things we see is that kids pick up on the foods that are well-marketed, tasty and contain white sugars and other bad or non-nutritional ingredients.

Q: What are the main signs parents and educators should look for in children who are headed for obesity?

A: One of the first and most important signs is that the child's weight is noticeably outside the norm for the reference group. Also, does the child self-select our of activities because of weight? Is the child the object of ridicule or teasing because of size? Does the child seem to consistently make poor choices in terms of dietary options? Does the child seem to be overly concerned and preoccupied with food? Some kids even have stashes of food to protect their "supply" - like a few extra doughnuts in their backpacks.

Q: What should parents and educators do?

A: The most important thing parents and educators can do is be good role models. What schools can do is provide substantial education about nutrition, healthy diets, exercise and provide decent lunches. Many schools are already offering healthy choices for lunch and taking a stronger leadership position on nutrition. Yet we need all schools to become more proactive in educating parents - be it through newsletters on how to determine a child's body mass index and what constitutes a healthy lifestyle. Parents need to know about the medical repercussions and diminished life expectancies of overweight people. They also need tips on how to plan better meals and change the way the entire family is eating and getting exercise.

Q: Should we force kids to eat or not to eat?

A: First of all, parents have to supervise what food is available in the home. If junk food is there after school, kids will eat it. If apples and peanut butter are available, they'll eat that instead. Even though power struggles often backfire, there's nothing wrong in saying if you don't eat your broccoli, you don't get ice cream. Don't make it punitive, but by example make it a good thing to do. Control the options and make them realistic. Restrict choices; don't let the kids eat ad lib.

Q: What kind of language do you use with your children?

A: Be frank, but don't use pejorative words. Make learning how to eat properly and keeping your weight healthy a family thing. Give choices without deprivation, and commit as a family to healthy eating.

Q: If you suspect your child has a weight problem, who should you tell or talk to?

A: The first line of defense, of course, is consulting with your pediatrician or family doctor. They can identify kids who need help and refer them to nutritionists. Other referrals may be to mental health professionals to help children manage behavior more effectively. Again, the best way to battle this epidemic is to work together as a family and a community to diminish the factors that encourage obesity.