Body Image at Age Nine

I have a 9-year-old-daughter who is extremely body conscious and thinks she has a fat stomach. I emphasize thinks because she is incredibly slender and doesn't have a bit of fat on her. She's in third grade and is only in the tenth percentile for weight in her age group. I'm worried about her not growing, and she's worried about being fat, which is so ludicrous I can't wrap my mind around it. Let me assure you, she isn't getting this from me. She looks at other kids' stomachs and thinks they are flatter and therefore skinnier, then she looks at her stomach and thinks it is "sticking out" and wants to hide it under a shirt when she's at the pool or beach. I'm at my wit's end. We went through this "fat" thing last year, and I showed her pictures of what fat really looks like. I also enlarged a picture of her and a friend in bathing suits to highlight how thin she is. Now we're back at square one. What can I do to get through to her?

Girls and young women today experience body image disorders in growing numbers. That is, they view themselves as fat or unattractive, when they are objectively quite thin or beautiful.

While this is troubling for any parent to behold, in your case there are two reassuring points to keep in mind. First, your daughter is slender but still within a normal body weight range. In addition, the earlier the onset, the better the prognosis. Research has found that young children who display excess concern about body weight may be more likely to outgrow it. At the age of nine, your daughter is more likely reacting to peer pressure and self-consciousness than suffering from true body dysmorphic disorder. Younger children may pick up concerns from friends or from the media, and while this is troubling, the fact is that they are less likely to fully internalize harmful messages than are adolescents, who are generally more disturbance-prone than are pre-teens.

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So the question is how to support your daughter and prevent this behavior from intensifying or morphing into an eating disorder. It sounds as if you are on the right track in terms of that objective. I don't know what tone the conversations with your daughter take, but I assume that you express concern but also show your daughter that she is misperceiving reality. You can reinforce this message calmly, consistently, and non-confrontationally. It is important that you convey your concerns in a non-hostile and non-pushy manner. Accept that she will disagree with you for now. You want to avoid breeding secrecy and mistrust in your daughter, as this will only render your message less effective. Unless a doctor says that your daughter is physically endangering herself, you need not become confrontational.

Your daughter seems to be operating under an assumption of negative comparison: "She's perfect, while I'm too fat." With that kind of self-talk, she will focus on other kids' shapes, and feel badly about her own body. This thinking is cumulative—she will collect "evidence" over time that she is fat. Your long-term goal is to build a sense of self-acceptance in your daughter and to challenge idealized body images.

As her mother, you're better off not upsetting yourself as you prepare to deal with this situation for what could conceivably be many years to come. Don't go to your "wit's end." No doubt you are frustrated, but please stay on message: Tell your daughter that she looks beautiful and that she'll be fine as long as she stays healthy. Also, monitor the peers around her, and what their messages seem to be.

Your focus can be on making sure your daughter eats sufficiently and healthfully. Gently distinguish a "fat tummy" from a growing girl who is not yet formed; remind her that her real goal is to be healthy and fit—and that comes only with proper nutrition.

If she is later diagnosed with anorexia nervosa (which too can sometimes remit) continue to nurture your relationship; don't foster a test of wills—anorexia is partly about willpower. People diagnosed as anorectic get biologically and emotionally reinforced by starving themselves. Your daughter does not seem to exhibit this behavior.

You're right not to blame yourself—genetic factors, peer culture, and the media all conspire to make girls want to be thin. Monitor your daughter's health, and again, unless a physician believes that she is harming herself, there is no reason for you to radically intervene. Hopefully your daughter, like many girls today, will endure this phase of excessive body awareness and self-criticism, and will find her way through it.

If, however, her eating and body image do not improve as she approaches adolescence, it is important to find a psychologist with whom your daughter feels comfortable to work on more tailored treatments.

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