Friday, Nov. 3, 2:30 p.m. ET

Teens and Food

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Dianne Neumark-Sztainer
Author, educator
Friday, November 3, 2006; 2:30 PM

Dianne Neumark-Sztainer , author of, "I'm, Like, SO Fat!: Helping Your Teen Make Healthy Choices about Eating and Exercise in a Weight-Obsessed World," was online Friday, Nov. 3 at 2:30 p.m. to discuss teen eating habits.

A transcript follows.

Neumark-Sztainer is a professor a the University of Minnesota's School of Public Health and a member of the university's Obesity Prevention Center .

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Dianne Neumark-Sztainer: Hi, Just thought I would introduce myself briefly before getting started. I have been researching issues related to eating, weight and body image in teenagers for the past twenty years or so. I am also the mother of four children -- aged 12, 18, 20, and 24 -- so I have been humbled and educated by them (as you can imagine). My mission is to help young people feel so good about themselves and their bodies that they will want to take care of them through healthy eating, physical activity and positive self-talk. But, I admit that I have never done an online chat room before...so bear with me and I'll try to address your questions as best as I can.

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Chicago: My 16-year-old son has both high cholesterol and high blood pressure, but is of normal weight and very physically active. It's basically a bad roll of the genetic dice. I try very hard to encourage healthy eating (low salt and low fat) but honestly, it sometimes feels like a losing battle. He feels angry that he has these issues and the last thing I want is to set up a problematic relationship with food. We met with a nutritionist who was marginally helpful, but seemed out of touch with what real adolescents like to eat. Any suggestions?

Dianne Neumark-Sztainer: You are facing a problem that many parents of teens face...just how much should I say? Based on the research I would recommend "say less and do more." See what you can do at home to make healthy foods more available and accessible. Don't totally eliminate the "less healthy" foods but make foods like fruits and vegetables readily available. Also, try to make your home environment one in which it is easier to be physically active. For example, limit the number of TVs and don't have them in the kitchen or the bedroom if at all possible. Find a nutritionist who works with adolescents - check out the American Dietetics Association for someone in your area. Show your love and support and let someone else give the "advice." Good Luck!

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Washington, D.C.: Hi, Dianne, How can parents help their overweight kids become healthier without making them feel fat and, perhaps, triggering an eating disorder? That's a hard line to walk.

Dianne Neumark-Sztainer: That is the $20 million question and the reason I took a year out of my life to write a book for parents on this topic. In my book I suggest four cornerstones. In brief they are as follows:

1. Model healthy behaviors for your children

2. Provide an environment that makes it easy for your children to make healthy choices

3. Focus less on weight, instead focus on behaviors and overall health

4. Provide a supportive environment with lots of talking and even more listening.

You should know that most overweight kids have been teased or mistreated because of their weight. As parents we need to do what we can to help our kids be more active and make healthier food choices...but also let them know that we love them regardless of their size. If you get the book and find the more detailed explanation of these cornerstones helpful -- let me know.

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Silver Spring, Md.: What is the racial/economic breakdown of girls and women with eating disorders? I am getting the impression that is a disease of white, affluent women and their daughters.

Dianne Neumark-Sztainer: Great question. Actually, we see eating and and weight problems across the spectrum of ethnicity and socio-economic status...although not everyone gets the treatment that they need. In Project EAT, a large survey of teens, we found that girls and boys from different backgrounds reported high levels of body dissatisfaction, unhealthy weight control behaviors, binge eating and overweight. But some groups (such as African-American girls) do seem to place more emphasis on what their bodies can do (and how they can move) rather than how they look, and don't desire to be stick-thin. Seems like a good thing to me!

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Laurel, Md.: Isn't a good self image what we need to promote among the young? If there would be less talk about it being okay to be "a bit on the heavy side," likely by relatives/friends flying off the BMI charts themselves, there would be a stronger motivation to get in shape.

Dianne Neumark-Sztainer: Great question! In our research we have found that teens who feel better about their bodies are more likely to engage in healthier behaviors -- like being more physically active -- and less likely to use unhealthy weight control behaviors. So we need to find a way to help young people appreciate the wonders of their bodies and then take care of them through healthy eating, exercise, and avoiding behaviors such as smoking and substance use and cutting and food restrictions and binge eating....

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Arlington, Va.: Did you decide to narrow your focus to teens because that's when most women "learn" their eating disorder habits. I made it all the way to college only to run right into anorexia/bulimia and I've been running into it ever since. We have to stop treating this like an after-school special topic and address it as the widespread public health crisis that it is. I want T-shirts, bumper stickers, benefit concerts, NIH funding and insurance to cover it.

Adults can't drop out of their lives to take four weeks at a clinic without huge risks right now. Let's get it out in the open -- all the way, beyond the teen scene.

Dianne Neumark-Sztainer: Thanks for the question and the points you raise. We need to be working with pregnant moms, young children and adults -- and basically everyone -- if we want to solve the problems that are facing us! I started working with teens after years of working with adults since I felt like I wanted to help prevent excessive weight gain AND excessive preoccupation with weight. I love teenagers because of where they are at and all they are going through. So I think it is really important to work with teens...but not only with teens.

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Philadelphia: What is the first step to the road of recovery for those who suffer from an eating disorder? Seeing a nutritionist or a psychologist?

Dianne Neumark-Sztainer: It is important to see a professional who understands eating disorders -- and this may be either a nutritionist or a psychologist or a physician. Go to the Web site of the National Eating Disorders Association to find someone in your area. And good luck! This is the first step to getting better.

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Arlington, Va.: Thanks for taking the time to do today's chat. Do you think it's possible to ever fully recover from an eating disorder? How would you define "recovery?"

I had anorexia as a teenager -- I am now living a healthy and fulfilling adult life. I've made my peace with the eating disorder and feel "recovered."

That being said -- I put an emphasis on eating healthy, exercising regularly and am generally aware of my weight. I wonder about the nuances sometimes when I am wandering the grocery store in search of bread made without high-fructose corn syrup. (i.e., I wonder if I am overly aware.)

Dianne Neumark-Sztainer: Congratulations on your recovery! A full recovery from an eating disorder is possible as you have demonstrated. But it is important to be aware of early symptoms/concerns. Your concerns may or may not be "normal" and I certainly can't tell via the computer. If you are at all concerned, talk with a therapist to make sure you stay the course. And stop reading the bread labels!

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Washington, D.C.: Hello:

I feel like sometimes eating recommendations and plans, instead of helping teenagers or people in general, create more tension and could be a trigger for eating disorders. At the same time, I wonder if it would make more sense to bring more focus and create more awareness programs to the psychological underlying aspects that teenagers face and from which eating disorders is only one of the symptoms. What does Dr. Neumark-Sztainer think?

Dianne Neumark-Sztainer: I think this is a great question. In my opinion we need both -- we need to address the underlying problems to ensure that our kids feel good about themselves. But, we also need to address the specific issues regarding weight pressures and opportunities for healthy eating and exercise. The problem seems to come when things just go too far with regard to recommendations for "healthy" eating and weight loss.

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Pennsylvania: My daughter (freshman in college) told me about a food-related problem her roommate is having.

Frequently, the roommate buys junk food, chews it up, and spits it out. She doesn't actually binge and purge, but apparently does this to "enjoy" junk food consequence free. She eats healthy food normally.

This seems bulimia-like, but until a few days ago, I had never heard of such a thing. Is this a recognized eating disorder?

Finally: I know it's not any of my business to intrude in this situation, but should I encourage my daughter to do so? (Report to her resident assistant or counseling service?)

Dianne Neumark-Sztainer: If your daughter is concerned, she could raise the concern with her roommate. In raising concerns it is important to find a good time to talk (when relaxed), express your concern for the person (because you care about the person), discuss specific behaviors that you've seen, and recommend that the person talks with someone (e.g., a counselor) to get some help. This behavior sounds disturbing to me -- but I don't know how intense it is. I always say that it isn't our job (as parents or friends) to make a diagnosis -- but rather to show our concern and get the individual to a professional.

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Charlottesville, Va.: How can parents of grade school-aged girls let their daughters know that all the skinny beauties on Disney Channel and other like-minded programming are the exception to the rule when it comes appearance?

Dianne Neumark-Sztainer: Great question! As parents we can either reinforce such ideas or try to filter them out (at least somewhat). Here are a few ideas that parents can do:

1. Take a look at how you talk about weight -- your own, your daughter's weight, and other people's weight. Avoid talking about weight and make positive comments about people of different shapes and sizes. This will have a bigger impact on your child than the media...and it isn't too hard to do.

2. When your daughter (or son) is watching TV - make a comment about how actors/models don't really look like that - but are manipulated to look better.

3. Limit the types and amounts of negative media that come into your home.

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"reading bread labels": Um -- I'm sure you didn't mean to sounds like people shouldn't be informed about what the ingredients are in the food they're buying.

Dianne Neumark-Sztainer: Everything in moderation -- check if the bread is whole grain -- and leave it at that. Particularly for someone with a history of an eating disorder.

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Baltimore: I still can't bring myself to tell my family and friends, and continue to successfully hide that I am now bulimic. Perhaps it's because I don't want to stop. What can I do?

Dianne Neumark-Sztainer: It is natural to feel how you are feeling and many individuals with eating disorders are in a bind -- they want to get healthy but are afraid of letting go of their eating disorder. A well-trained team can help you get well. PLEASE get the help that you need. Go directly to see your family doctor or talk to an adult that can help you get to a professional. Your family and friends will be relieved that you have brought up the topic. Who knows -- maybe they are aware of the problem and don't know how to bring it up. Do it today. Thank you for reaching out and good luck!

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Ontario, Ore.: Dianne: As parents of a 13-year-old daughter who has been struggling with bulimia since puberty we are very confused (and divided) about two issues. First, whether or not to try and intervene directly when she begins to binge. Some books tell us to not interfere with her (restricting access to the kitchen, following her around the house or implementing consequences when she begins her cycle) but to simply redirect her to something else while reminding her of the physical consequences of binging and purging and assuring her of our love and support. However, this strategy seems very inadequate and has had very limited success. Next, are their any good studies which indicate that anti-depressant medication can help with bulimia -- I would like my daughter to try them but my wife is dead set against it. And yes, my daughter has been visiting a therapist but we have not witnessed very encouraging results since she began the visits around five or six months ago. Sorry for the windiness of this inquiry but we are about at our wits end.

Dianne Neumark-Sztainer: Having a child with an eating disorder can be very hard on families -- so make sure to get the help that you need so that together you can help your daughter. Here are some thoughts:

Talk with your daughter's therapist about your concerns. Have a specific list of questions and see if she/he can address them or send you elsewhere. Anti-depressants can help with bulimia but I don't know your daughter's situation so it is good to discuss with the therapist.

See if there is a parent support group in your area -- go to the Anna Westin Foundation Web site to see if there is a support group in your area. Parents need help also with these difficult problems.

Good luck!

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Reston, Va.: How do you reconcile the widespread concern with childhood obesity and the growing problem of eating disorders in young people? I'm afraid to even talk about food choices and healthy eating anymore, for fear of triggering some poor kid's anorexic tendencies...it just seems like such a minefield.

Dianne Neumark-Sztainer: I'm with you on your concern...it is what I spend most of my time talking and thinking and writing about! The trick is to make it easier for our kids to engage in "normal" eating and activity and feel good about their bodies within a society that works against both. We are surrounded by huge portion sizes of foods high in calories and high technology that makes us sedentary. But we are also surrounded by images of lean and muscular young men and women. No wonder our youth are confused. But we can do a lot within our homes, schools, and communities to make a change. For ideas about what to do in our home see my previous answer regarding the four cornerstones that I wrote about in my book.

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Northern Virginia: What is your opinion on the Maudsley approach in the treatment of eating disorders?

Dianne Neumark-Sztainer: The research suggests that it can be very effective.

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Philadelphia: As someone who suffers from an eating disorder, how can I model healthy behavior so that my children will not themselves develop unhealthy eating habits and attitudes?

Dianne Neumark-Sztainer: Well the fact that you are asking the question shows that you are going in the right direction. I would encourage you to talk with your therapist about this issue. A great motivation to getting well can be setting an example for our children. That said -- we all have our issues -- and can minimize their impact on our children by avoiding certain behaviors in their presence, watching how we talk about things, and being honest about the problems we have had. Good luck!

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Washington, D.C.: I know eating disorders are generally associated with teens and young women -- with the assumption that they eventually "grow out of it" either with or without help. I'm wondering how prevalent middle-age eating disorders are -- with more ability to financially support (and hide) an eating disorder, my guess is that there are a number of women who never let go. I've been bulimic since I was 19 -- I'm 42 now and still binging/purging at least once a day.

Dianne Neumark-Sztainer: Thank you for sharing. Yes there is more and more discussion about the prevalence of eating problems in adults. You are not alone. Can you find a therapist who can help you? Go to the National Eating Disorders Web site to find someone who specializes in adult care.

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Oxon Hill, Md.: Two questions...I've heard that you never fully recover from an eating disorder, especially if you've had it for a very long time. Is this true? I've also heard that anorexia can shoot your metabolism into overdrive. What are the experts saying now? What about former anorexics that have trouble keeping weight on even though they are eating normal amounts...is that common?

Dianne Neumark-Sztainer: Full recovery is difficult -- but it can and does happen. I don't know the answer to your second question.

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D.C.: I am also bulimic and am able to successfully hide it. I know it's a problem and I know it's unhealthy and I am still unable to stop. My question is...If I know I need to stop but can't stop, how is a psychologist or family doctor going to persuade me to stop?

Dianne Neumark-Sztainer: It isn't a matter of persuasion but helping you work through whatever it is you need to do and giving you the skills to overcome the eating problems. PLEASE give it a try. You will be so much happier and the results for bulimia nervosa treatment are very successful.

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Virginia: Normally, I would consider obesity a matter of personal responsibility, but when I see the crazy stuff that even our schools and community do (or do not do) to undermine healthy habits, I am furious. The Post recently reported that Virginia Beach Schools were serving lunch at 9 a.m. to students. Lunches are notoriously unappealing and rushed. PE classes? Those seem to be nearly universally dreaded-would an adult go to a gym to spend a miserably 40 minutes and then yelled at to be dressed and out in five minutes? There are very few sidewalks along streets (you can't even tell your kid to get off their fanny and walk). Silly stuff like this abounds... Are there any advocacy groups out there to pressure for some very basic common sense changes in our schools?

Dianne Neumark-Sztainer: Yes there are a lot of positive changes going on in our schools. Advocacy groups ARE making a difference!

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Dianne Neumark-Sztainer: Looks like my time is up and I see that there are still unanswered questions. I hope that some of my answers to the other questions will be of help to those who didn't get their questions answered. All of us reading the questions can see the pain that eating disorders have caused individuals and families. We NEED to make the prevention of eating disorders a high priority within our homes, schools and communities. We can all do our piece -- the next time you hear a negative comment about weight speak up against it. Take a look at how you talk about weight and make an effort to avoid negative weight comments about yourself or about others. Try to help those around you feel good about who they are! Thanks for your questions and all of your insight.

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