Tag Archive | kids

First Days of School and Body Image

For many school-aged kids (preschool through senior year in high school), “back to school” shopping is fun. They love buying new outfits and shoes and backpacks and school supplies. With every item they buy, they get more excited to get back to school. They happily try on their new clothes. They stuff their new backpacks with all the pens, pencils, notebooks, and planners. The night before school starts, they feel a mixture of excitement, anticipation and a little anxiety.  The first days back to school, they put their new outfits on, head out to school, and experience all the first days activities. They may have ups and downs. They may like some teachers, and dislike others. They may have difficulty figuring out where to sit in the classroom, or in the lunch room. They may be a little anxious about finding their classrooms or getting there on time. They also may be excited to reacquaint with friends. This is all normal.

For those school-aged kids with eating disorders, a different experience is felt altogether. Although there are no universal experiences, I’ve seen enough eating disordered kids to know there is an element of difficulty that accompanies the “back to school” transition. They may experience all the same activities as non-disordered kids, but they also may experience a multitude of inner thoughts and heightened anxieties that non-disordered kids don’t experience. Many of these thoughts are negative and distorted. Many of them are body related.

Shopping for clothes to go back to school in can be a very upsetting endeavor. When one’s body has changed, there can be both physical and emotional discomfort. Looking for sizes, trying on multiple articles of clothing in various sizes, experiencing physical sensations associated with the way clothes fit, and standing in front of mirrors in the dressing room can trigger all sorts of thoughts and feelings.  These thoughts and feelings can taint the experience, and can trigger urges to use eating disordered behaviors. It is always best for the individual to shop with a compassionate friend or family member who understands the sensitivity of the individual and can offer support if needed.

If the eating disordered student’s body has changed over the summer, due to recovery related goals or as a result of the eating disorder itself, he/she has tremendous fear that others will comment about his/her body. “Wow! You look so much better than you did last year!” “You gained weight. You look great!” “You lost weight. I wish I was as skinny as you!” “Did you put on a few pounds over the summer?”

Any comments regarding one’s body can trigger someone with an eating disorder. Comments can be well-intentioned but may still be perceived as triggering. I tell my clients over and over that they cannot control the comments made by others. All they can control is their reaction to the comments. Comments about one’s body also exacerbate the body image distortion that the person already feels because they draw unwanted attention to the body. I usually advise my clients to either change the subject or try to walk away from the conversation. Then, they need to talk to a good friend to get the support and distraction they need, in order to move on with their day.

Getting dressed in the morning before school is also challenging. When someone has an eating disorder, he/she is uncomfortable in his/her own body. He/she experiences it in a distorted way. He/she does not necessarily have the ability to see him/herself objectively.

Below is an example of what someone with an eating disorder may experience in the morning, before the school day begins:

Allyson has set out her clothes the night before the school day. She wakes up in the morning already a little anxious for the school day ahead. She’s worried about a test she has to take, and she’s overwhelmed by the amount of school work she faces in her AP classes. She puts on the clothes she had picked out, but they just don’t feel “right”. They feel tight this morning. They didn’t feel tight when she tried them on yesterday. But this morning, she feels like she will burst at the seams. She begins to feel more anxious than she felt when she woke up. She convinces herself that she absolutely cannot wear the outfit. She tears it off and throws it on the floor of her room. She urgently searches through her closet and pulls out another pair of jeans and another top. These jeans feel too tight and the shirt looks “ugly”.   Off they go, onto the pile of clothes that are on the floor. She grabs a skirt, tries it on, and doesn’t like the way her legs look in the mirror. It goes onto the pile. Her anxiety escalates. The amount of time she is taking to pick out something to wear is cutting into the time she needs to devote to the rest of the morning activities, including eating breakfast. Her mother reminds her that she will be late if she doesn’t hurry up. Her anxiety is mounting. She grabs a dress out of her closet. She doesn’t like the way her arms look. She throws a sweater on over it. It just doesn’t feel or look the way she wants it to. She throws it on the top of the heap of clothes. Her time to get ready is significantly dwindling. She digs through the clothes and finds the original pair of jeans. She puts them on, pulls them up, buttons them, and throws a sweatshirt on. She feels “gross” and defeated. She heads to the kitchen where she has to figure out what to eat. Due to her anxiety and subsequent loss of appetite, as well as her “gross feeling”, she has urges to skip breakfast altogether. Her mother is watching though, so she eats part of her breakfast and promises her mother she will make up for it later. The school bus comes and she races out. On the way to school, she can’t get her body off her mind. She still feels “gross” in her body and she’s worried about the test and all the other stresses of the day ahead. From the outside, Allyson appears “fine”. She’s friendly but a little quieter than usual. On the inside, she’s suffering. She’s worried. She’s conflicted. She wants to be “in recovery”, but at the same time, she’s desperate to use eating disordered behaviors to make herself “feel better.”  The best strategy for her to follow to “get out of her head”, is to distract herself with friends or find a friend to voice her struggle to. Communication of her feelings may lessen the power they have over her. Also, if she shares her feelings, her friends may help to “normalize” them. If she has a treatment team, she might want to discuss this with them during her next session to help strategize for these types of situations, as well as to get help gain a more positive perspective on recovery.

The experiences outlined above are only a few examples of the types of situations that may trigger a student with an eating disorder. Situations that intensify negative body image are challenging but do not have to derail recovery!  It is his/her responsibility to work through these difficulties using the coping mechanisms he/she has learned and practiced so that he/she does not use any type of eating disordered behavior. Using his/her voice to express feelings is a key coping mechanism. Having an understanding circle of friends and family is also essential.

It is important to remember that negative or distorted body image is a byproduct of low self-esteem, stress, anxiety, negative feelings, life experiences, messages from others, distorted beliefs that are exacerbated by the media, societal pressures and other personal issues. Distorted body image is NOT about the weight, size, or shape of one’s body.

If you or a loved one experiences distorted negative body image issues, the National Eating Disorders Association says it best when they say “We all may have our days when we feel awkward or uncomfortable in our bodies, but the key to developing positive body image is to recognize and respect our natural shape and learn to overpower those negative thoughts and feelings with positive, affirming, and accepting ones.”  It is also vital for recovery to learn to separate your feelings from your body, and take care of your body as best you can through satisfying balanced eating and the types of pleasurable movement that energize and strengthen your body.

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Back to School: Recovery Focused!

For all of you who are going back to school – middle school, high school, college – there are some challenges that you may face. You want to be “armed” for these challenges and not let them hurt your recovery. For those of you who are parents of children, adolescents, or young adults with eating disorders, the following information will be helpful for you as well.

Summer, for many individuals, is a time of less structure, less pressure, and less exposure to the stress from peers. For students, it may involve a summer job, camp, vacation, a summer class or two, or just relaxing with friends and family.  Then, toward the end of August and the beginning of September, all that swiftly changes. Academic and social pressures begin again. Perhaps there is a change of school entirely, such as the change from middle school to high school, or high school to college. College students may leave home for the first time or begin living in an apartment, dorm, fraternity or sorority house.

Whichever the case is, transition back to school is a time of challenges for many students. It is especially challenging for those with eating disorders.

Structure, on the one hand, is very good for people with eating disorders. Getting back to the structure of a school day where there are specific times for specific academic and extracurricular activities, can be very comforting. The distractions that school provides, as well as the focus on new subjects, sports, and other skills, can also take the focus off the eating disorder and provide the sufferer with some relief.

On the other hand, going back to school can elicit some unforeseen stressors that can exacerbate an existing eating disorder. First and foremost, the anticipation of school (or leaving home to go away to college) will undoubtedly create anxiety. The fear of the unknown is a powerful source of anxiety. Social anxiety can also escalate. Anxiety can also relate to academics, lockers, teachers, making friends, and  living arrangements (at college). And, of course, there is tremendous anxiety related to body image, clothing, and food. I’ll highlight some of the specific stressors in my next few posts, and try to offer some solutions. Ultimately, it is important to be acutely aware that “back to school” time is a transition that individuals with eating disorders may struggle with. The issues are very real and must be handled with care and sensitivity.

The first topic I will discuss is “the lunch table” at school.

A number of my student clients are fearful of the lunch table. If you are a parent, you may be thinking “What types of stress could the lunch table create?”

Stressors that middle school and high school clients experience at the lunch table are:

  1. What should they put their lunch in – paper bag or lunch box (more typical in middle school)? Believe it or not, this decision causes an enormous amount of stress. They fear that if they put their lunch in the “wrong” container, they will get made fun of.
  2. Should they bring lunch, or buy lunch? This decision is stressful because they want to feel comfortable with what they eat for lunch, yet if their friends are buying lunch, they want to fit in. Also, there are usually lines of students waiting to buy lunch. Standing on line may be uncomfortable for the eating disordered student, as well as waiting on line creates a shorter amount of actual eating time. This can be challenging for the student who takes a bit longer to eat.
  3. If they bring lunch, what should it be and how much should they bring? Many individuals in recovery are on a meal plan that requires specific amounts of food that must be eaten at each meal. There is an enormous amount of conversation that occurs at the lunch table regarding what everyone eats. When a student eats anything that appears “different” in the eyes of anyone else at the lunch table, there is the potential for unwelcomed attention on the sufferer and their food choices. This is especially challenging when the sufferer is eating “more” than the others at the table.
  4. For female students especially, there is excessive “diet talk” at the lunch table. Comments such as “I am not eating carbs anymore.” Or “I only eat XX amount of calories a day.” Or “I have to lose XX pounds by Thanksgiving.” Or “I only eat pretzels at lunch.” This talk can trigger someone with an eating disorder, even when they are doing well.
  5. During the first few days of school, one of the biggest stressors my student clients experience regarding the lunch table is “where do I sit?” When an individual with an eating disorder has social anxiety and/or has only a few friends, and there is no comfortable person for him/her to sit with at lunch, he/she may experience an enormous amount of anxiety and may try to skip the lunch room altogether.

What are the ways to cope with these lunch table stressors?

  1. As far as the container you bring your food in, for the first few days, bring it in a paper bag (unless you know that the other students are using lunch boxes). Look around and see what everyone else brings their lunch in, and then you can re-assess whether the bag is the best choice or a lunch box. I’ve never heard of anyone getting teased about bringing lunch in a plain brown bag. Remember though, if you don’t have an ice pack in the bag, you shouldn’t bring anything that is perishable (lunch meats, fish, dairy, etc).
  2. Regarding bringing or buying lunch is concerned, keep your recovery at the top of your priority list when making this decision. If you feel most comfortable bringing lunch in order to meet your recovery goals, then bring lunch. As time goes by, and you can see what is on the school lunch menu, and you have seen how long it takes other students to get their lunch, then you can decide if you want to change your mind and buy lunch.
  3. You need to bring to lunch the amount of food that will carry you through until the next time you can eat (after school snack), or the amount of food that you and your treatment team have deemed necessary for your recovery. If you bring too little, you may struggle later, as you will be too hungry. This is true, no matter what type of eating disorder you have. In terms of what to bring for lunch, you want to bring the types of food that meet your nutritional requirements and foods that you like. If you need a supplement at lunch, you can bring it in a sports-type of bottle so that it appears like a sports drink. Try to bring foods that are “common” so as not to draw attention to your eating. I want to add here, that I understand this advice may cause some controversy. I’d love to say to my student clients to bring whatever they want to the lunch room regardless of what anyone might say, but I also want to protect them from any unwanted attention and comments. I had a male middle school client who brought tuna for lunch once and everyone at the table said “Ewww! That smells!” He threw his lunch away and ate none of it. A female high school client brought stuffed grape leaves to lunch and the others at the table commented on how “gross” they looked. She didn’t eat them and was too uncomfortable to sit at the lunch table again. Instead she ate in the nurse’s office.  You have to bring foods you like, but if there are foods that are pretty common looking, you will go unnoticed. These might be foods like peanut butter and jelly sandwiches or other sandwiches, yogurt, cheese sticks, pretzels, fruit, cookies, salads with chicken and cheese, granola bars, etc.
  4. When other girls start talking about their diets, you can try your best to ignore the conversation, start a separate conversation with the person sitting next to you, or change the topic altogether. Try to sit next to a “safe” person that you can rely on to help you out. If you are being too triggered, find an excuse to leave the lunch table (and take your remaining food with you). Unfortunately, diet talk is a pastime for so many people. You will likely not be able to escape it very easily. Also, many teens “talk” about their latest and greatest diets, but most of them don’t act on them. You must do your best to tune the “diet talk” out. Remember, in recovery, you have to stay focused on your needs, not the behaviors of others.
  5. Get as much information as possible in advance of the first day of school about who you know that will be in your lunch period. Ask them to meet you outside the lunch room before lunch starts so you can walk in together. Ask them to sit next to you as well. If you don’t know who will be in your lunch period, try to find a fairly empty table and bring a book with you. If you have a book to read, you might feel a bit more comfortable. While you are sitting there, try to look around for someone you know and then move to their table if there are empty seats. If there is someone else in the lunch room that seems like they are sitting by him/herself, you could try sitting at that table. He/she might be relieved to have someone sit with him/her. Or, if you are feeling courageous, you might try to use the lunch period to meet new people and sit with people you don’t know.

Remember also to talk to your family, friends, and/or treatment team about the anxiety you might feel about “back to school”. They will surely understand and might offer some great support.

Stay tuned for more posts regarding “back to school.”


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Parents, Kids, Food Fight!

Too often, parents and children get into power struggles over food which NEVER fosters a healthy relationship with food. Also, a parent’s own food issues can often distort their objectivity and sensitivity when it comes to their child’s eating.

The following is a great article on how parents can healthfully and positively approach the topic of eating with their children in order to teach them positive eating skills.

Things Parents And Grandparents Say That Can Cause Eating & Weight Problems

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Kids and “Weight Management”

I will precede my comments in this post by saying that in my practice I see the individuals who are the “casualties” of confrontational combative discussions and treatment of weight issues. I am unquestionably biased about the issue as a result of seeing the emotional pain and scars that result from the mishandling of this issue, especially with children.

In my opinion, there are “right” ways and “wrong” ways to deal with a child who is “overweight”. First of all, when a child is young, especially during the growth and development years, their bodies are supposed to get wider before they get taller. If weight is made in to a big issue at this life stage, and a child is restricted to too few calories and essential nutrients, there could potentially be a stunting of his/her growth and development.

It’s not only the physical complications associated with restricting a child’s intake or putting a child on a diet that are bad enough, but also the psychological ramifications that can leave a child with lifelong emotional scars and weight and disordered eating issues.

I want to share with you a few stories that I have encountered during my years as a nutrition therapist. I am only one person and if I’ve seen a number of cases like the ones I will describe, imagine how many others there are.

Several years ago, a family of four came in as clients. There was a mom, a dad, and twin 9 year old girls. One of the girls was “skinny” and the other one was ‘fat”, according to the parents. The parents wanted to bring all of them in to discuss making changes in their eating but actually the visit was an attempt to make the “fat” daughter lose weight without her feeling singled it. On the first visit, the father called me aside and said he was concerned that his overweight daughter was going to be bullied in school, was going to grow up having no friends and lead a life of misery and loneliness like he did because he was a “fat kid”. So, after hearing his plea for me to “fix” his daughter, I met the four of them and discussed life in their household with the food. The daughters were quiet and the dad did most of the talking. I asked if I could meet with the daughters separately and we agreed. When I got the “fat” daughter alone in the room for a short session, she said “I don’t think my father loves me as much as my sister. He always lets her have anything she wants and he yells at me for my eating. At Easter, she got a big chocolate bunny and I got a small one. It doesn’t seem fair.”

Another little girl was brought in to see me because her father wanted her to lose weight. He was a very intelligent thoracic surgeon. He was so anxious to get her to lose weight, he demanded she go on the treadmill for 45 minutes each day. She was 7 years old. He said it was because he wanted her to be healthy and prevent all types of diseases like heart disease but also so that she looked good and was able to like herself better. She never complained to me that her weight was causing her to dislike herself. She actually seemed pretty secure in her skin.

A mom brought her 13 year old daughter in because she had just come from a pediatrician visit where the doctor berated the mother (in front of the daughter) for “allowing” her daughter to gain 20 pounds in a year. The mother cried when she told me the story. She said she felt like such a terrible mother and said she felt like she should lock her daughter in a closet and starve her until she lost the weight. Obviously this brutal tactic didn’t take place.

A beautiful 12 year old girl came to me to “learn” how to like healthy foods. When I asked her what types of food she liked and didn’t like, and why she was so interested in “learning” how to eat healthy foods, she told me that she liked pop tarts, sugared cereal, cookies and pasta but she wanted her father to stop forcing food (literally) into her mouth. She told me that her father would stuff peas into her mouth and hold her mouth shut until she would chew and swallow them to teach her how to like vegetables. She HATED vegetables as a result.

I could list story after story like these, representative of the “wrong” ways to parent children with food.  I wish I could tell you that stories like this are uncommon. But they are not. In fact, even the most well intentioned parents are apt to make significant mistakes in the treatment of food and weight issues.  Much of the parenting of children in the food arena comes from the parents’ own weight and food issues. Sometimes it comes from a genuine concern about health but that concern is significantly overshadowed by “fat phobia”. When “fat phobia” begins to rear its ugly head, food rules change and parents tend to become more emotional about food and much more controlling and rigid with food.

Children that experience food withholding or restriction or overt dieting at a very young age often become very “resourceful” in getting their food needs met. Restriction is scary because hunger is scary if it cannot be satiated. They will beg for food, whine, and cry, throw tantrums and yell at their parents that they are hungry. If that doesn’t work, they will go to greater lengths to not feel deprived. They will ask peers at school for food and sneak food at home. When they are at friends’ houses they will eat more than their friends because they know they won’t get the food at home. At parties, they will take advantage of the opportunity to drink large amounts of soda and eat excessive sweets and other foods they aren’t allowed at home. They will go to great lengths to not feel deprived.

So, how do early childhood eating/withholding patterns, parental control and overt dissatisfaction affect a child’s eating patterns, their instinctive ability to self-regulate and their overall love for a variety of food? How does it affect their body image and self-image? I think it is easy to see that all these factors can affect a child very negatively in the short-term and in the long term. It can set the child up for a disordered view of food and themselves. It may create aversions for certain foods as well as strong cravings for others. It also can cause weight gain, the very thing that is being focused on so strongly.

Most of the “overweight” children that I have treated have not been overweight because of a thyroid or other medical issue. They have been overweight because of excessive control being exerted over their food by parents, excessive focus placed on the size and shape of their body by others, the unhealthy role modeling of food by their parents, underactivity, because they are using food to cope with their stress, or a combination of these factors.

So what is the answer to the question “how do I parent my ‘overweight’ child with food? “For great detailed solutions, you can read Ellyn Satter’s book called How to Get Your Child to Eat…But Not Too Much. But, the premise of her work is to practice a division of responsibility. The parent is responsible for what is served, when it is served and where it is served. The child is ultimately responsible for how much they eat.

Also, if a child is given access to more variety of foods, with no emotion attached, they will be more apt to choose a wider array of choices. This is by no means a quick process but the more abundant the food choices and the less pressure experienced around food, the more natural the food relationship can become. Keeping the house free of “fun” foods will only cause the child to seek them out elsewhere.

Positive healthy parental role modeling with food and body image is also an essential component in the fostering of a child’s good relationship with food. “Do as I say, not as I do” will not work! Children will imitate their parents. If there is excessive negative talk about food, dieting, or anyone’s body in the house, no matter how innocent it may seem, it can exacerbate negative feelings and unhealthy food behaviors. Using derogatory words as a motivator for healthy eating NEVER works. The focus must always be kept positive.

Fun movement can help a child feel better about him/herself because movement brings pleasure. Movement cannot be tied into weight though because it won’t feel pleasurable or natural and will be short-lived. Getting on a treadmill is not pleasurable for many people, especially not for a child. Ice skating, sledding, and building a snowman are fun winter activities. Other times of the year they can walk, play ball, kayak, swim, hike, dance, jump rope, climb, skip, throw the Frisbee, walk the dog, climb trees, go to the batting cages, go bowling, biking, or skateboarding.

And, lastly, if the child is using food to cope with their feelings because they aren’t able to comfortably express them, or if the household is chaotic or stressful and the child is impacted by the stress, the issues and the child’s feelings need to be directly, openly and honestly addressed and supported. If a child uses food to cope, beginning at an early age, they are more apt to continue to use it rather than look for other healthier coping mechanisms (especially if they are not taught them by their parents).

So, as you can see, the food and weight issues of a child cannot be managed through withholding of food, dieting, negative body talk and “do as I say” tactics. They are complex and need to be treated seriously, compassionately, creatively and ultimately in a positive supportive way. When a child is able to learn how to self-regulate their food, their body will, in turn, become the body that is the healthiest for them, NO MATTER WHAT SIZE IT IS.

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