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Today’s topic: The Culture of Weight

Promoting Health and Preventing Eating Disorders

Speaker: Dr. Clare Roscoe

child & youth

Ment ental al Hea ealth lth Series eries

Date: May 17, 2018

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Declaration

• f conflict

Speaker has nothing to disclose with regard to commercial support. Speaker does not plan to discuss unlabeled/ investigational uses of commercial product.

Promoting Health and Preventing Eating Disorders

• Dr. Clare Roscoe

Child & Adolescent Psychiatrist Children’s Hospital of Eastern Ontario

Case 1 – Libby

14 year old female referred for an Eating Disorder assessment by family MD for severe restriction and rapid weight loss (50lbs):

 Six month history of progressive food restriction

down to 500 – 600 calories/day

 Food rituals: eating every 2 hours, drinking green

tea 30 minutes after eating; taking cold showers, putting ice packs on her stomach to ‘shrink her fat cells’

 Further history – likely 2 – 3 years of cutting out

food types (carbs, becoming pescatarian)

 Physical symptoms: cold intolerance, dizzyness,

decreased concentration, constipation, premenarchal, bradycardia

Further history...

 Co-morbidities:

 Severe bullying due to weight since grade 4, limited

social circle

 Undiagnosed Obsessive Compulsive Disorder,

starting around grade 3

 History of major depressive episode in grade 6  School avoidance in the last year due to anxiety,

involved with a Robert Smart worker

 Family history:

 Mother with previous Anorexia Nervosa then Binge

Eating disorder; 12 year old sister with obesity

 Significant depression/anxiety

Treatment

 Admission

 Medically stabilized, meal plan  Request to leave unit – profound fear of

being “fat again”

 Quick decompensation, showing

extreme rigidity and OCD symptoms

 Kicking people out of kitchen for 30–45 min.

to make her meals; has fear of calories ‘travelling through the air’

 Not eating anything mother makes as ‘afraid to catch

her fat’

 Started skipping outpatient appointments  Eventual readmission

What is a healthy weight for her? A.c.t. patient: She is too big

Reinforced by culture Reinforced by medicine

What is our culture and what are

the facts?

Outline

1.

Look at our culture – history and present day

• 2. What are the facts
• 3. What messages should be sending to all our

children and youth about weight and health?

We live in a culture where…

• 80% of 10 year old girls are afraid to be fat
• The number one “magic wish”, of girls between the

ages

• f 10-14 is to

lose weight.

We live in a culture where..

 50% of Ontario teenagers feel unhappy about their

weight

 Fasting, skipping meals, crash diets are frequent  (22-46%)  Vomiting: 5-12% adolescent girls  Diet pill use 3-10%  Smoking to loose weight: 12-18%

THIN, THIN, THIN

We live in a culture where…

We live in a culture where…

 We as a health care providers are not immune to these

messages

Twiggy – Why now?

 1967- baby boomers as teenagers  30 million teenage girls eager to spend their

allowance

 Beginning of the “billion dollar brainwash”:

 Industries use an ideal person that is unachievable to

society to maintain profits

 Create a culture where women are insecure about their

bodies, and they will be more likely to buy beauty product, new clothes and diet aids

Women’s liberation movement

 Second wave feminism  Bra burning, abortion, gay rights, equal pay

Impact on youth

 Encourages young people to focus on the immediate

and the superficial rather than the personal and the

• profound. – what is important is how we look

 From an early age, we must spend time and energy to

achieve this look

 We must feel guilty and ashamed if we fail  Failure is inevitable….

 Obesity simplified - eating too much  Culture of vigilance in schools:

 good and bad foods  shaming for a cookie in the lunch  calorie counting in health class  Public weighing and feedback

 Profound shaming

Direct or Implied messages

 Any one who is overweight is:

 Lazy  Eats poorly  Unhealthy / going to die  Should be on a

diet

Dieting / Disordered Eating Hazardous weight loss Severe Body Dissatisfaction Weight Pre-

• ccupation

Impact of these messages

 Paralyses women and girls  Culture of self-deprication and self-hatred  Leads to high levels of:

 Size discrimination  Anxiety and stress  Depression

Impact on Youth

 Severe bullying and teasing  This is sanctioned

Risk Factors for Anorexia Nervosa

Cultural Family Individual

Idealization of thinness, “normative discontent” for female body image Family History of ED / Anxiety / Mood disorder / OCPD Female Gender Gay males Early life “overprotective / high concern parenting” Perfectionism / Obsessionality Activity where thinness = success e.g. modeling / acting Low self-esteem / Sense of ineffectiveness Competitive sports with emphasis on thinness: e.g.. gymnastics / ballet Eagerness to please / High sensitivity Puberty

Canary in the Mines

 Sensitive to the world  perfectionistic, anxious, does

things “110%”, compulsive by nature

Facts

1.

Causes for obesity are complex

• 2. There is limited correlation

between weight & health

• 3. Dieting should never be prescribed

Impact of Genetics

 50 – 90% of our risk for obesity comes from our

genes

Some people are at greater risk for developing obesity

and some are at less risk

 Biologic influences:

Gut microbiome/exposure to antibiotics

Obesity

 Poverty, low SES  Trauma  Intra-uterine malnutrition  High levels of parental control

• ver eating

Facts

1.

Causes for obesity are complex

• 2. There is limited correlation

between weight and health

• 3. Dieting should never be prescribed

Set Point

 BMI 18.5 – 25  Body Mass Index kg/m²

Health and Weight

 Limited direct correlation between health and weight  Weight associated with lowest mortality:  Health is much more predicted by genetics and

activity level

All ages >55 yr Caucasian 24.5 26.5 African American 27 29.8

Olympic athletes with 3 different body types

Dieting:

 95% of those who diet to

lose weight regain the weight lost within one year

 What other product or

strategy would we keep using if it had a 95% failure rate?

Effects of dieting

 Increase weight over time

Statistics on Weight Behaviours in Youth...

 95% of all dieters regain their lost

weight within one to five years

 Adolescent girls who diet are at

324% greater risk of becoming

• verweight or obese

 So if weight does not tell us about health…  Obesity is a complex process  And dieting should never be recommended….

They are the same for

• besity as well as the

prevention of Eating Disorders

+ Body image ↑ Physical activity Normalized Eating ↑ Health

Young people who feel better about their bodies, are more likely to engage in healthier behaviours, e.g. Physical activity and normalized eating, and thus have better mental and physical outcomes

Teach that healthy, strong and happy bodies come in all shapes and sizes

 Our shoe size is genetically

predetermined….as is our body height, size, shape and weight

 Encourage youth to

accept all body sizes, Just as we accept all races and colours

Help a child focus on what their body can do well!

How to have exercise improve body image…

 Exercise for the joy of feeling your

body move and be strong

 Exercise to enjoy the social time

with friends and family (skating, skiing, swimming)

 Separate exercise from weight

loss; we don’t want our kids to think of exercise as a way to make up for eating a piece of cake..

In the Office: Fostering Positive Body Image

 Refrain from criticizing your own appearance or clothes in

front of youth

 Help make home and office ‘appearance safe’ zones

• No glossy diet fitness and fashion magazines
• No diet foods

Focus on Healthy Behaviours

(not #’s or BMI)

 How you move

(Physical activity)

 How you cope

(Emotional health)

 What and how you eat

(Nutrition)

How to help: Build SELF-ESTEEM

 Involvement in activities with sense of

accomplishment

 Learning to see own strengths  Communication skills  Skills to cope with stress  Celebrate mistakes  Help with bullying, teasing

Healthy behaviours…

 Enough sleep…  Limits on screen time and increased social

interactions

 Promote a sense of belonging within families, schools,

and communities

 Provide Media awareness

Nutrition

 First and foremost – no dieting  Eating Hygiene

 Regular eating throughout the

day

 Eat when hungry, stop when

full

Nutrition :

 All foods fit - there are no “bad” foods! (kids

can be concrete and think in terms of black and white)

 Moderation is the key, rather than

deprivation

Nutrition Education:

 Food as fun, food as fuel  Teach & model portions, mood and

pace of a meal

 Get kids cooking  Family meals

Normal Eater

 Eats when hungry, stops when full  Enjoys what she/he eats without fear of uncontrolled

weight gain

 Eats for a variety of reasons

 hunger, celebration, comfort

 Stops eating for a variety of reasons

 satisfied, finished

Libby continued….

 Able to engage as an inpatient and re-

establish nutrition requirements

 With weight gain, medically stable, and

significant reduction in obsessive thinking

 Mother and patient struggled ++ with

• ngoing need for weight gain for
• health. Discharged AMA

 Pt terrified of being socially ostracized.

Will this always be the world for Libby?

Thank you!

Thanks to PREDO Team!!

Pediatric Research on Eating disorder and Obesity

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