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As more teens are taking desperate measures to lose weight, an author tells parents how to help their kids change their thinking and their behavior.
A third of teens are overweight or at risk of being overweight. Meanwhile, more than half of teen girls and a third of teen boys skip meals, smoke or use other unhealthy behaviors in an effort to lose weight, according to research by Dianne Neumark-Sztainer, a researcher at the University of Minnesota's School of Public Health.
Based on her landmark study of nearly 5,000 Twin Cities teens, Neumark-Sztainer has a new book, "I'm, Like, SO Fat!" (Guilford Press, 2005) to guide parents in helping their middle- and high-school-age children make healthful choices about eating and exercise. It's no easy task in a culture that, as she says, "pushes fat and rewards thin."
Q: We hear a lot about overweight kids. How much of a problem is it?
A: It's a huge problem. The prevalence has tripled in adolescents in the past couple of decades and doubled in younger children. It's associated with obesity in later life and has an array of physical and behavior consequences.
Q: You say in your book that our culture "pushes fat and rewards thin." How so?
A: Everything in our society makes it easy to be fat. We're surrounded by food, big portions of food. And food tends to be cheap. You go to a movie, and they say, "Do you want a larger size for an extra 20 cents?" Well, why not? Especially if you're a teen.
Meanwhile, we spend much of our time sitting in front of screens. When I was a kid, we were outside playing. Kids don't do that anymore. ... We've become sedentary.
At the same time, there is more of an emphasis on being thin today. You really are penalized in our society for being overweight. So, you have this situation that is very, very difficult to manage, especially for young people.
Q: Your survey found that many teens are trying to lose weight in unhealthy ways. What are they doing?
A: Seventy-five percent of overweight girls said they were using what we classified as unhealthy or extreme weight-control behaviors -- skipping meals, using laxatives, fasting, making themselves vomit, using cigarettes to lose weight or using diet pills. There is all this pressure on these girls to lose weight. And yet, these behaviors are ineffective when you look at them over time. The use of diet pills has also increased greatly over the past few years among teens. I was shocked.
Q: How can parents catch any warning signs their teen might be at risk for unhealthy eating or dieting habits?
A: One of the best ways to catch problems is to have regular family meals. That really gives you an opportunity to see what's going on with your teens. Are they looking for opportunities to skip meals? Are they pushing food around their plates? What are they doing afterward? Could they be getting up to go vomit? It's so easy to lose track of what your teen is doing if you don't eat together.
Q: In your book, you say if eating disorder specialists could offer one piece of advice, it would be this: "Don't diet?" Why?
A: It depends on how they're doing it. Most people talk about a diet as if it's a short-term behavior. "I need to go on a diet to go to prom." That's why dieting doesn't work. People change their habits for a short period of time, and then they regain the weight. I've seen this with hundreds of people.
Q: Why do parents encourage their children to diet?
A: Parents wants to help their child. They don't want their child to be teased about weight, so they encourage the child to diet. The problem is those same kids will often engage in unhealthy dieting behaviors, which ironically will put them at risk for weight gain. So, I think it's very important for parents to avoid encouraging their children to diet.
Q: What can parents do to help their children develop healthful attitudes about weight?
A: Model healthful behaviors for your children. If you talk to anyone who works with families where there are eating disorders, you find out quickly there is a lot of talk in those households about weight and a lot of talk about dieting.
Think about what you say. Consider these two scenarios: One parent who is dieting says, "Oh, I'd love to have that cake. But I'm on that new low-carb diet, so I can't eat it." Another parent says, "I'm full already, so I'm not going to have that cake." Or "I'm going to have a small piece."
Same behavior but different message.
It's hard for parents to change their own body image, but what they can do is talk differently in front of their kids. They don't have to say things like, "Oh my gosh! I look so fat in these pants."
Q: How can parents get their teens to eat more nutritious foods?
A: The teens we survey tell us, "If you put it out, we will eat it." Teens are hungry. So, buy a little bit of the less-desirable food and buy a lot of the desirable food. And, then put that more nutritious food in the front of the refrigerator. And, if you're really into it, wash it and cut it up.
Q: How can parents encourage exercise?
A: As far as physical activity goes, parents do need to be involved -- you need to sign the forms, get the kids to the doctor for a physical, pay the fee and then go watch their games.
You need to think about what you're modeling. If you're going to do something as a family, consider something physically active as opposed to going out to eat. Also, limit the number of televisions in a home. ... There is research showing children with televisions in their rooms watch a lot more TV and are less physically active.
Q: How widespread is teasing about weight?
A: We found it was very common. We interviewed 50 overweight teens for one study, and 48 of them talked about some sort of weight teasing. Much of the teasing that's done, at least the teasing at home, is not done intentionally to hurt a child. It's done playfully. But it can be harmful. Being teased about your weight is associated with more unhealthful dieting, more binge eating and higher suicide rates.
Q: Why should families eat together?
A: Some of the first strong research on family meals was done in our study. We found kids who ate family meals had much better dietary intake in terms of getting more calcium, getting less fat and eating more fruits and vegetables. They were at much lower risk of unhealthy weight control and binge-eating behaviors. They were at lower risk for substance abuse, and they were more likely to achieve academically.
Project EAT (Eating Among Teens) is one of the largest studies looking at eating patterns and weight-related issues in adolescents. Nearly 5,000 student in seventh and 10th grades completed surveys in 1998-99, and 2,500 completed follow-up surveys in 2002-03. About 900 parents were interviewed by phone. For more on the project, visit www.epi.umn.edu/research/eat.
Here are some findings from the project:
12.5 percent: Girls who are overweight, with highest risk among black, Hispanic and American Indian girls.
7 percent: Boys who are overweight, with highest risk among Hispanic and American Indian boys.
56 percent: Girls who skip meals, use diet pills, smoke cigarettes or report other unhealthy dieting behaviors to lose or control weight.
32 percent: Boys who skip meals, use diet pills, smoke cigarettes or report other unhealthy dieting behaviors to lose or control weight.
12 percent: Girls who take laxatives or diuretics, vomit after meals, fast or report other dangerous dieting behaviors.
4 percent: Boys who take laxatives or diuretics, vomit after meals, fast or report other dangerous dieting behaviors.
33 percent: Students who report eating two or fewer family meals over the past week.
40 percent: Students who report eating three to six family meals over the past week.
25 percent: Students who report eating seven or more family meals over the past week.
53 percent: Students who say the television is frequently on during meals.
5 percent: Middle school boys who use steroids.
46 percent: Girls who are encouraged by mothers to diet who are not overweight by federal guidelines.
30 percent: Girls who get the recommended amount of calcium.
43 percent: Boys who get the recommended amount of calcium.
30 percent: Students who eat the recommended five servings a day of fruits and vegetables.
15 percent: Students who never eat breakfast.
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