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Childhood Risk
Factors for Preoccupation with Thinness:
What Your Father
Thinks Counts
Stanford researchers recently identified several risk factors for developing a preoccupation
with thinness as well as disordered eating, which can begin in childhood and emerge
during adolescence and young adulthood.
One risk pathway involved parents’ attitudes about their daughter’s body size and
weight.
W. Stewart Agras, MD and co-workers at Stanford University designed a study of body
image that started literally at birth, when they recruited 216 newborns and their
parents at several hospitals in the San Francisco Bay area (Am
Child Adolesc Psychiatry 2007; 46:171).
After screening more than 1,000 families, 134 infants and their parents entered
the study; 22 were minorities (13 Asians, 6 Hispanics, 2 blacks, and 1 American
Indian). The children were followed
from birth to 11 years of age.
The study recorded infant feeding behaviors including sucking, length of breast
and bottle feeding and difficulty weaning, then evaluated eating behaviors as the
infant grew older, such as tantrums over food, over-interest in food, “picky eating,”
hiding food, and binge eating and vomiting (parents’ questionnaire). During middle
and late childhood, the researchers asked about instances of weight teasing, emotional
eating, and the child’s weight and dieting concerns.
Activity levels were measured with an accelerometer, which the children wore
for 24 hours when they were 3 and 5 years of age, and hours of watching television
were recorded by parents and questionnaire.
Parents were studied, too
The parents themselves were interviewed by a psychiatrist at the beginning of the
study to document any eating disorder symptoms and/or any histories of diagnoses
of eating disorders. Beginning when
the child was 2 years of age, parents filled out questionnaires each year about
their concerns about their child’s weight, any disagreements between parents about
weight food and feeding, and the use of food limits, for example.
Both parents filled out the Eating Disorders Inventory, and the Parental
Authority Questionnaire was used to measure parenting style.
Later in the study, other questionnaires assessed controlling the child’s weight,
commenting on the child’s eating habits, or restricting the child’s eating. Parents’ concern about their own weight
was recorded. After 11 years 134 (62%)
of the participants were still available for assessment.
Results:
Two pathways led to over concern about body size and image
Two major moderators emerged, outlining two different pathways to body dissatisfaction
and preoccupation with having a thin body.
The first group at greater-than-normal risk of body image disorders had fathers
who had a high degree of dissatisfaction about their own bodies.
The largest group at risk was females who had fathers who were concerned
about their child’s weight and who intervened in some way to regulate the child’s
eating and weight. Other risk factors
included being teased about their weight by their friends and peers.
Hours of watching television emerged as another risk factor (media influences
on weight and shape). Independent risk
factors included higher scores on drive for thinness and body dissatisfaction for
fathers and a higher child activity level at age 5.
Picky eating was negatively correlated with thin body preoccupation.
Children with higher BMIs were also at risk
A second group at risk, smaller than the first, was characterized by low parental
dissatisfaction and a child with a body mass index (BMI) higher than the 85th
percentile at 5 years of age. This
subgroup included only 13% of the children in the study.
Other independent risk factors were low activity level in early childhood
and high eating speed in later childhood, and early parental control of their child’s
eating through discouraging comments about food.
By late childhood, the independent risk factors, including rapid eating and
teasing by parents and peers about weight and shape, predicted over-concern with
a thin body shape.
More concern about girls’ shapes and weight
Actions taken by parents to control their child’s weight and shape appear to be
focused specifically on their daughters, according to the authors.
The higher prevalence of bulimic symptoms in girls may be partly due to the
girls’ concerns and interventions to change their weight as a result of their parents’
attitudes and actions. Although media
images ordinarily receive al lot of attention as a possible cause of disordered
eating, in the authors’ study, the parental effects were far more powerful than
any effect from media. However, vulnerable
girls, already concerned about their weight and shape, had increased concerns when
exposed to media in one study (Stice et al, 2001).
Early intervention is warranted
Dr. Agras and his colleagues note that very early intervention may be helpful for
preventing the development of an unhealthy body image because concerns about weight
and shape emerge as early as the third grade.
Early intervention may be more helpful for changing harmful behaviors than
waiting until adolescence, when such behaviors can be more difficult to change.
In addition, the results of this study showed that fathers are an important factor
in the development of their daughter’s views about their weight and shape.
Thus, both parents should be assessed because the father’s role in the development
of a child’s eating disorder is easily overlooked.
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