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Prevention of Eating Disorders in Children: The Role of the Counselor

Niva Piran

This chapter equips counselors with the background knowledge and tools to help prevent negative body image and disordered eating patterns among children through age 14.1 begin by describing the importance of engaging in the prevention of negative body image and disordered eating patterns in children and continue by delineating social factors that shape the development of negative body image and discuss their expression in a child's environment. A description of early identification and intervention follows. I conclude the chapter by delineating several prevention programs a counselor may want to examine and use and by highlighting key points related to the prevention of eating disorders with children in school and community settings.

Prevalence and Phenomenology of Body Weight and Shape Preoccupation, Disordered Eating Patterns, and Eating Disorders Among Children

For many girls, the experience of the body as being a personal site of deficiency, limitations, and low self-worth starts in childhood, is accentuated during puberty, and continues to be a burden throughout their lives. This experience is present, although less common, among some boys and men. More important, during the childhood phase, research has documented a progression from attitudinal disruptions, such as body dissatisfaction or preoccupation with thinness, to engagement in disordered eating behaviors and then to full-blown eating disorders (EDs). For example, by age

Note. This work was supported by the Social Sciences and Humanities Research Council of Canada.

5, girls are already more concerned with being thin than boys (Lowes & Tiggemann, 2003). By ages 10-12, about 40% of girls worry about their weight and are aware of dieting and purging methods (Hill, Weaver, & Blundell, 1990; Murnen, Smolak, Mills, & Good, 2003). By ages 13-14, after the onset of puberty, 40% to 44% of girls engage in dieting attempts, a rate 2 to 3 times higher than that of boys (e.g., Field et al., 1999; French et al., 1997). In a recent study with a nationally representative sample of adolescents (ages 13-18) in the United States, Swanson, Crow, Le Grange, Swendsen, and Merikangas (2011) reported a prevalence of anorexia and subthreshold anorexia of 1.8% in girls and 0.4% in boys. Similarly, the prevalences of bulimia nervosa and subthreshold bulimia and of binge eating disorder are 3.6% and 2.3%, respectively, among girls and 3.1% and 0.8%, respectively, among boys. Not only do these numbers translate to a very large number of affected children in the United States, but Swanson et al. found that the age of onset of these disorders was younger than in other studies that have often relied on retrospective recall. In particular, Swanson et al. reported that the median age of onset ranged between 12.3 and 12.6 for the different types of EDs. The high rates of EDs and the young age of onset clearly suggest the urgency of implementing prevention interventions with children.

A second reason that prevention interventions are important is that if children develop body dissatisfaction by the time they are in middle school (ages 13-14), they are at risk for a variety of psychological and health challenges. First, body dissatisfaction in middle school predicts the development of dieting and eating difficulties, including clinical- level EDs, that are associated with a high rate of health complications (Wertheim, Paxton, & Blaney, 2009). Second, body dissatisfaction predicts the development of consumption of substances aimed at weight control, such as tobacco smoking (Neumark-Stzainer, Paxton, Hannan, Haines, & Story, 2006). Third, body dissatisfaction and dieting in middle school leads to weight gain and reduced engagement in physical activities (Neumark-Stzainer et al., 2006; Stice, Cameron, Hayward, Taylor, & Killen, 1999). Fourth, body dissatisfaction in middle school predicts the development of depression (Stice & Bearman, 2001). Moreover, Bearman and Stice (2008) suggested that the well-documented lifelong higher rates of depression among women than men are also predicted by body dissatisfaction among middle school girls.

Overall, then, research has suggested that during childhood and early adolescence, children, and girls in particular, commonly acquire negative attitudes about their bodies, followed by engagement in disordered eating patterns, as well as the occurrence of full-blown clinical EDs among a sizable minority of young adolescents. The whole range of disruption, from body dissatisfaction to EDs, is associated with considerable impairment and morbidity. All significant adults in childrens lives, and counselors in particular, need to keep the goal of prevention of negative body image, disordered eating patterns, and EDs a priority.

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