Obesity and eating disorders in teenagers can be prevented with a single approach, according to new guidelines from the American Academy of Pediatrics.
The new recommendations show that physicians and parents can ward off problems of obesity and eating disorders by avoiding focusing teen's attention on weight or dieting and instead encouraging a healthy and balanced lifestyle.
‘Parents and physicians should focus teenagers on a healthy lifestyle and balanced diet and avoid focusing teens attention on weight management.’
The guidelines were developed in response to growing concern about teenagers' use of unhealthy methods to lose weight.
Teenagers methods to lose weight may not fit doctors or parents image of eating disorder patients since most are not excessively thin. But, substantial weight loss can trigger medical consequences such as unstable heart rate seen in people with anorexia nervosa.
"This is a dangerous category of the patient because they're often missed by physicians," said Neville Golden, MD, professor of pediatrics at the Stanford University School of Medicine and a lead author of the new guidelines. "At some point, these patients may have had a real need to lose weight, but things got out of control."
Nearly 40 percent of patients who have been admitted to some eating disorder treatment programs fit this easy-to-miss category, said Golden.
Five evidence-based strategies have been included in the new recommendation. The strategies can be used by pediatricians and parents to help teenagers avoid both obesity and eating disorders. These strategies apply to all teens, not just those with weight problems.
Out of the five recommendations, three focus on behaviors to avoid. Parents and doctors should not encourage dieting. They should avoid 'weight talk' such as commenting on their own weight or their child's weight. Never tease teens about their weight.
Two recommendations focus on behaviors to promote. Eat regular meals with family members. Parents should help their children develop a healthy body image by encouraging them to eat a balanced diet. Exercise for fitness, not weight loss.
"Scientific evidence increasingly shows that for teenagers, dieting is bad news," Golden said. Teens who diet in ninth grade are three times more likely than their peers to be overweight in 12th grade, for instance. And calorie-counting diets can deprive growing teenagers of the energy they need and lead to symptoms of anorexia nervosa, which may even become life-threatening. "It's not unusual for us to see young people who have rapidly lost a lot of weight but are not healthy; they end up in the hospital attached to a heart monitor with unstable vital signs," Golden said.
"Negative comments about weight can also be detrimental to a teen's health," Golden said. "Mothers who talk about their own bodies and weights can inadvertently encourage their kids to have body dissatisfaction, which we see in half of teen girls and a quarter of boys," Golden said.
Body dissatisfaction is linked to lower levels of physical activity and with use of vomiting, laxatives and diuretics to control weight.
Family meals protect against weight problems. Teenagers will have an opportunity to see their parents modeling healthy eating. "Pediatricians can encourage families to have family meals as often as possible. It doesn't have to be every night," said Golden.
The rated of childhood obesity have declined. But obesity rates in adolescents have not declined. Helping teens to maintain healthy weights without veering toward obesity or an eating disorder is more challenging than it is for young children.
"Adolescents are also dealing with other issues, such as teasing from peers and body-image concerns. A 3-year-old may not be worried if she's a bit overweight, whereas an adolescent may try unhealthy weight-loss methods like fasting or diet pills and end up in a vicious circle of more weight gain," said Golden.
The new guidelines will be published in Pediatrics