Dying to be Thin

Four-year-old girls are refusing to eat cake at birthday parties because they say it contains too many calories. Nine-year-old boys are starving themselves and exercising obsessively in order to be cut and maintain a six-pack. Seven-year-old girls are vomiting up their meals to get ready for bathing suit season.

This is the disturbing picture emerging from hospitals around the country, where progressively younger children are being admitted with eating disorders. Canadian doctors say that as recently as a decade ago, it was extremely rare to see children under 12 with anorexia nervosa or bulimia nervosa, conditions usually associated with females aged between 14 and 25.

While eating disorders are caused by a number of colliding psychological, physiological, and social factors, medical professionals believe marketers, the media, and an image-obsessed culture all play a role in contributing to increased body dissatisfaction among children.

Children are the Losers

Nationwide research undertaken by the Canadian Paediatric Surveillance Program (CPSP) between 2003 and 2005 documented 135 individual cases of early-onset eating disorders in children between the ages of five and 12. The study found 98 percent of these children avoided food, 55 percent exercised excessively, and 73 percent feared gaining weight. A further 11 percent were purging their food, a behaviour previously thought to start only in adolescence.

Of those who had lost weight (75 percent of girls and 93 percent of boys), the average loss was 17 lb (7.8 kg). This figure concerns the study’s researchers, based at Toronto’s Hospital for Sick Children, who say children should be gaining, not losing, weight during these crucial growing years when good nutrition is of vital importance.

Dr. Leora Pinhas, the psychiatric director of the Eating Disorder Program at the Hospital for Sick Children and a principal investigator in the study, says the research findings represent the “tip of the iceberg.” Most children deny their symptoms, and unless doctors and parents are closely monitoring a child’s growth, it can often take years before they pick up a pattern of disordered eating, she explains.

“The tricky thing about restrictive eating disorders in children is sometimes the children are a pretty normal weight; what happens is that they stop growing in height. This is the body’s way of conserving energy. We saw a nine-year-old child who hadn’t grown since she was about seven,” says Pinhas.

Some of the medical complications arising in children with eating disorders include electrolyte disturbance, acid-base and fluid imbalance, vitamin and mineral deficiency, tooth decay, reduced ability to think clearly, bowel dysfunction, cardiac arrhythmia, hypotension, and hypothermia. Pinhas stresses that if caught early and treated aggressively, most of the health consequences of anorexia are reversible. If not caught, long-term health implications may include stunted growth, infertility, osteoporosis, and even death.

The Beauty Myth

In the 10 years she has been working in this area, Pinhas has noted a worrying rise in the number of children (including boys) being admitted to the hospital’s eating disorder unit. While about 30 percent of these children express no dissatisfaction with their bodies (their eating disorders are related to issues of control, anxiety, or stomach disturbances), the remaining 70 percent are very weight conscious.

Canadian findings on anorexia nervosa are consistent with research trends in other Western nations. The Australian Paediatric Surveillance Unit found that the average age of children with anorexia dropped from 14 1/2 years in 2001 to 12 years old now. In 2002, the Australian Medical Association blamed “marketing and advertising” and their “portrayals of physical perfection” for contributing to a rise in body dissatisfaction among children.

US social theorist Jean Kilbourne, creator of the Killing Us Softly film series, claims that in the three decades she has been campaigning on body image issues, marketers have become far more aggressive.

“Advertising places an enormous pressure on girls in particular to achieve an impossible image of beauty, and there’s a widespread belief that somehow this should be possible if they try hard enough,” she says. “That pressure is starting on girls earlier.”

Where it was once teenage (or older) girls who were bombarded with images of thin and flawless women, “now kids as young as seven years old are encouraged to be very thin, beautiful, and sexy,” Kilbourne says, adding that thong panties, padded bras, cosmetics, increasingly sexualized toy dolls, and beauty magazines all compete for the coveted “tween” market.

“If you get people obsessed with their appearance at younger and younger ages and obsessed with the idea that buying products is somehow going to solve their problems for them, then you make an enormous amount of money in the present and you also get customers for life,” Kilbourne explains.

Under the Quebec Consumer Protection Act, advertising to children under the age of 13 is prohibited. Pinhas would like to see this extended Canada-wide. “The sad part is, we’re not letting our children have childhoods anymore. They have been turned into little consumers.”

Doing the Diet Thing

Pinhas worries that messages from the mainstream media about dieting are also filtering down to children. “I’ve seen kids recently who were saying, ‘Summer’s coming so I had to lose weight.’ And when they start doing that they also have no stopping point; they think if losing a little bit of weight is good, then losing more is better,” she says.

But according to Quinn Cashion-Vosburgh, a director of Jessie’s Hope Society, a British Columbia-based organization that works to prevent eating disorders, positive body image starts in the home. “In my research, I surveyed moms–and there wasn’t one mom who liked her body,” Cashion-Vosburgh says. “If that’s a girl’s first role model, what does that say? Parents should be very conscious of how they talk about food and their own bodies.”

Fear of Fat

Society’s hysteria over the so-called “obesity epidemic” is also filtering down to some children through parents, teachers, and peers, with fear of fat often overriding messages of healthy eating.

Pinhas says, “It’s not unusual for us to see, particularly in the 12-and-younger age group, children who have ended up with an eating disorder because they’ve been exposed to obesity prevention programs at school. Twelve-year-old girls are being subjected to class weigh-ins where everyone lines up in the gym and they all have to be weighed publicly. In this culture we have this idea that all fat is bad, everyone who is fat is unhealthy, and you can never be thin enough.”

Still, obesity remains one of the most significant health issues facing Canada. Data collated by Health Canada shows that obesity rates have nearly tripled among children in the past 25 years, with serious long-term health risks including high blood pressure, diabetes, and heart disease. Surely it is important to be fighting fat.

“Obesity is a problem–there is no question about that,” agrees Kilbourne. “But it is frankly moronic for people to think that the solution to obesity is to encourage our daughters to starve themselves.

“I also think [obesity] are two sides of the same coin, because when children start dieting at a very early age it throws their metabolism off; they get into a pattern of deprivation followed by binging, which sets them up for eating disorders and also makes them fat.

“The solution is not for people (including children) to diet but rather to learn to eat healthy good food in moderation.”

Boys and Eating Disorders

Studies show that eating disorders are increasing among men and that young boys are particularly vulnerable. A 2005 study published in the Journal of Applied Developmental Psychology found that boys and girls aged eight to 13 were “equally focused on losing weight,” with boys especially focused on “increasing muscle.” The Canadian Paediatric Surveillance Program study found that the male to female ratio of children with eating disorders was 1:8, higher than the 1:10 ratio found in the older adolescent and adult population.

Pinhas says the main difference between boys and girls who are admitted to the hospital with eating disorders is that boys are “not so worried about getting bigger; they’re just obsessed with not having any fat on their bodies. They all want to be cut or have a six-pack,” she says.

Anorexic Teens

Anorexia nervosa is now the third most common chronic illness affecting teenage girls. A study published in the Canadian Medical Association Journal in May 2004 found that 29.3 percent of Ontario females aged 10 to 14 years were trying to lose weight. A further 3.9 percent of the girls were binge eating and 1.5 percent were engaging in self-induced vomiting.

According to surveys of dieting and body image reviewed by CPSP, between 20 and 42 percent of nine-year-old girls are trying to lose weight, 55 percent of girls between eight and 10 are dissatisfied with their size, and 21 percent of five-year-old girls have weight concerns.