Weight of worry

Gentleness is the best way to help kids resist an obsession with pounds, experts say

Cheyenne Eagle knew she was fat; the kids at school seldom failed to remind her.

By age 12, concluding that being thin was all-important, she’d begun a regimen of dieting (often with the help of pills), binging and purging. A year later, her weight had dropped from 195 to 100 pounds. She was anorexic and in danger of dying.

"I thought that since I had already been overweight, it was not possible for me to become too thin," says the San Diego woman, now 21.

Such stories help explain why some parents shy away from talking to children — especially daughters — about their weight. Calling attention to a child’s size, they fear, could make her overly self-conscious, trigger an obsession with appearance and, possibly, lead to an eating disorder.

Failing to intervene is equally unacceptable, doctors and eating-disorder experts now realize. Facing a daughter’s weight problem may be one of those supremely no-win moments of parenthood, but it has to be done.

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"It’s an absolute tightrope walk," says Dr. Ellen Rome, head of adolescent medicine at the Cleveland Clinic. "Parents have it harder than ever, especially with the rise in obesity. But a parent’s negative comments can be the final straw that pushes a kid toward an eating disorder."

No one understands precisely how and why eating disorders develop. But experts say risk factors include an unstable environment, major life changes, feelings of inadequacy or a lack of control, depression, difficulty expressing emotions and being teased about one’s weight.

More than half of teen girls are on diets or think they should be, according to Anorexia Nervosa and Related Eating Disorders, a nonprofit group that provides information about food and weight problems. An estimated 3 percent of these girls develop eating disorders, which are much more common in girls and women than in boys and men.

At the same time, 1 in 3 kids in the United States is overweight.

Although parents may love and accept their child no matter how he or she looks, obesity’s health risks are so serious that they should intervene if their child gains weight, says Eric Stice, a research professor of psychology at the University of Texas at Austin.

Mothers and fathers often struggle with how to broach the topic. In a recent survey of 304 families, parents admitted they would have at least some level of discomfort in talking to their child about a weight problem.

"Parents are sitting in the most powerful position to turn the tide back on childhood obesity," says survey author Carolyn Will, a graduate student at the University of St. Thomas in St. Paul, Minn. "But there seems to be a need for some sort of guidance or materials for parents. The DARE program, for example, gives parents words on how to bring up drugs. It’s like it’s a taboo subject to bring up weight."

Recent research offers some insight on how to help an overweight child slim down in a healthful way. One approach is to emphasize the entire family’s diet and exercise habits, even if just one member has a weight problem. Another tactic is to encourage healthful choices — not appearance.

"If weight loss is focused on getting on a scale or the view in the mirror, that will produce lower self-esteem and it will be much more difficult to lose weight," says Dr. Howard Taras, a professor of pediatrics at the University of California-San Diego School of Medicine and a spokesman for the American Academy of Pediatrics.

Parents should also highlight their child’s many attributes — what a good student she is or how well she plays her clarinet. Positive words could make the difference between a child who addresses her weight problem in a healthful way and one who veers into an eating disorder.

"It’s best to stay away from body and appearance comments," Rome says. "But praise often. Think of a behavior or action or character trait so the child values all these other aspects of themselves."

Some experts recommend that pediatricians, not parents, bring up a weight problem so that the child won’t feel as if her parents are being critical or are disappointed.

The importance of health, not appearance, may be more obvious to the child when the doctor is doing the talking. And, without proper guidance, teenage girls may be especially prone to using unhealthful tactics to lose weight, Stice says.

Girls typically think "what is the quick fix so I can look like a supermodel?" he says. "They don’t care about health. They just care about the end result."

Mothers need to be particularly conscious of how they communicate their attitudes about weight and appearance to their daughters, says Susan Bartell, a Port Washington, N.Y., psychologist who runs workshops for mothers of overweight girls. Women can project their own anxieties about weight gain onto their daughters.

Overweight girls also may worry that their mother is disappointed in them. Further, relationship problems can emerge, says Bartell, when the daughter is overweight but the mother is slim and trim. These girls can feel embarrassed and inferior compared with their mothers and may resent a parent’s efforts to help.

Ivy Woolf Turk knew she had to tread carefully when her daughter Kelly, now 18, began gaining weight in early adolescence. Turk’s stepdaughter, now 28, had been treated for anorexia in college just a few years before that.

"It was horrible on a lot of levels," Turk says of her daughter’s emerging weight problem. "Not just the fear of ‘here we go again with an eating disorder,’ but I have also struggled with my weight throughout my life."

Gently noting that Kelly seemed unhappy, Turk suggested that she speak to Bartell. She also made an appointment for Kelly with a nutritionist. She tried not to say much, even when Kelly gained and lost weight repeatedly during her teenage years.

"One of the most important parts of it was to take Kelly’s lead," she says. "I knew it was her thing. The last thing I wanted to do was make her feel bad. I just loved her up and told her how beautiful she was."

An overweight child needs praise and support at home and at school. Parents should speak to school authorities if their child is being teased excessively about her weight by classmates, says Carolyn Costin, founder and director of the Eating Disorder Center of California and the Monte Nido Treatment Center in Malibu, Calif., and author of the book "Your Dieting Daughter."

Eagle, who has recovered from anorexia after a seven-year battle, says that overweight kids need extra praise, love and acceptance.

"To me, food equaled weight gain, which equaled fat, which equaled unloved," she says. "Mothers need to talk to their children and express how beautiful they are on the inside and set an example for healthy eating."

How to offer your child positive support

To help a girl lose weight in a healthful manner, experts offer these suggestions: