Both obesity and eating disorders are major problems for our youth.  Making matters more complicated is the worry that talking about obesity with a child or adolescent might actually trigger eating disorder symptoms.  This concern can feel somewhat paralyzing both for parents and medical professionals alike to the point that both topics get ignored.

Is there a solution to this mental health Scylla and Charybdis?  New data from the Eating and Activity in Teens Study, recently published in the journal JAMA Pediatrics, suggests that there is.  In the study, over 2000 teens from 20 public schools around the Minneapolis/St Paul area were assessed using school based surveys.  Parents were also surveyed about the home environment.

Most parents reported having some kind of discussion with their children related to eating behavior.  Among nonoverweight teens, these conversations were directly about weight in about one-third of families while in families of overweight teens, the rate rose to 60%. Compared to conversations about that centered around “healthy eating,” maternal discussions that focused on weight were significantly more likely to be associated with dieting and unhealthy weight control behaviors for both overweight (64% versus 40%) and nonoverweight teens (39% versus 30%). However, when it came to more “extreme” weight loss behaviors, reported by about 9% of adolescents, the association with specific content of family conversations was less apparent.  

The authors concluded that parental discussions to prevent or address obesity should happen but be focused on healthy eating habits and not the child’s weight or size.  To do otherwise, they warn, could raise the risk of the child engaging in unhealthy weight loss tactics such as those present in eating disorders.

While this is a useful study that offers data about a common dilemma, it is important not to go overboard with the conclusions.  For one, the study was cross sectional (i.e. it collected data only at one point in time) and consequently cannot really address questions of causality.  In addition, the survey asked the parents and not the kids about the content of these eating behavior conversations, so parents may have been tempted to answer in a more socially desirable way.  The findings also seemed to get weaker as the adolescent behaviors became more extreme, not to mention the fact that no actual eating disorder diagnoses were made.   Finally, it is worth noting that eating disorder symptoms were quite common among teens whose parents focused their discussions on healthy eating too.

Nonetheless, the study does offer some empirical support to a practice that many parents and clinicians already advocate, namely to make weight a secondary issue and instead focus discussions on healthy eating and good choices.

David Rettew is author of Child Temperament: New Thinking About the Boundary Between Traits and Illness and a child psychiatrist in the psychiatry and pediatrics departments at the University of Vermont College of Medicine.

Follow him at @PediPsych and like PediPsych on Facebook.

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