CMAJ • October 26, 2004; 171 (9). doi:10.1503/cmaj.1041129.
© 2004 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters
Correspondance

How children see themselves

Gail McVey, Stacey Tweed and Elizabeth Blackmore

Community Health Systems Resource Group, The Hospital for Sick Children, Toronto, Ont.

Although the issue raised by Jacqueline Quail and associates is valid, teaching children and families to have tolerance for diversity, including diversity in size and shape, is paramount to decreasing body dissatisfaction and reversing social discrimination against overweight and obese individuals. Developing such tolerance is especially important given the link between weight-based teasing and depression or suicide in youth.1 Certainly, efforts to promote healthy eating and active living should not be ignored, but dieting in youth has been linked to weight gain.1,2 Similarly, weight loss programs targeting obese children have been associated with only minimal weight loss.3,4 Furthermore, pressures to lose weight can create a cycle of dieting and low self-esteem.3,5

Because of the link between dieting and body dissatisfaction, extensive school-based research has been conducted on ways to increase body satisfaction and encourage healthy lifestyles. This universal prevention approach has led to improvements in healthy eating, global self-esteem and body satisfaction among children in the upper grades of elementary school.6,7 Although this student-directed intervention has shown promise, it is equally important to sensitize adults to their role in the promotion of children's body image and healthy lifestyles, without focusing solely on weight.

Effective ways for schools to deliver these health promotion messages are available.6,7 Physicians can help to engage families in the following ways: educate patients about natural increases in weight and body fat experienced during puberty, encourage family-wide healthy eating and active living practices,8,9discourage restrictive dieting, model respect for diversity in weight and shape, teach the emotional and physical benefits of physical activity, help families to recognize the impact of weight-based teasing and suggest that families encourage these messages in school communities.10

It may not be surprising that children are dieting to prevent weight gain. However, taking steps to promote health and fitness in all youth, without increasing weight and shape preoccupation, can help to decrease unhealthy weight loss behaviours such as those that we reported.11

Gail McVey Stacey Tweed Elizabeth Blackmore Community Health Systems Resource Group The Hospital for Sick Children Toronto, Ont.

References

  1. Field AE, Austin SB, Taylor CB, Malspeis S, Rosner B, Rockett HR, et al. Relation between dieting and weight change among preadolescents and adolescents. Pediatrics 2003;112(4):900-6.[Abstract/Free Full Text]
  2. Shunk JA, Birch LL. Girls at risk for overweight at age 5 are at risk for dietary restraint, disinhibited overeating, weight concerns, and greater weight gain from 5 to 9 years. J Am Diet Assoc 2004; 104:1120-6.[CrossRef][Medline]
  3. Cameron JW. Self-esteem changes in children enrolled in weight management programs. Issues Compr Pediatr Nurs 1999;22:75-85.[CrossRef][Medline]
  4. Douketis JD, Feightner JW, Attia J, Feldman WF. Periodic health examination, 1999 update: 1. Detection, prevention and treatment of obesity. CMAJ 1999;160(4):513-25.[Abstract]
  5. Pesa JA, Syre TR, Jones E. Psychosocial differences associated with body weight among female adolescents: the importance of body image. J Adolesc Health 2000;26:330-7.[CrossRef][Medline]
  6. McVey GL, Lieberman M, Voorberg N, Wardrope D, Blackmore E. School-based peer support groups: a new approach to the prevention of disordered eating. Eat Disord J Treat Prevent 2003;11(3):169-86.
  7. McVey GL, Davis R, Tweed S, Shaw BF. Evaluation of a school-based program designed to improve body image satisfaction, global self-esteem, and eating attitudes and behaviors: a replication study.Int J Eat Disord 2004;36:1-11.[CrossRef][Medline]
  8. Canada's food guide to healthy eating. Ottawa: Health Canada; updated 2002 Oct 1. Available: http://www.hc-sc.gc.ca/hpfb-dgpsa/onpp-bppn/food_guide_rainbow_e.html (accessed 2004 Jul 9).
  9. Canada's physical activity guides for children and youth. Ottawa: Health Canada; updated 2002 Nov 22. Available: http://www.hc-sc.gc.ca/hppb/paguide/child_youth/resources.html#1 (accessed 2004 Jul 9).
  10. Quality school health: the QSH checklist [online]. Ottawa: Canadian Association for Health, Physical Education, Recreation and Dance; [date unknown]. Available: www.cahperd.ca/e/PDFs/FINALQSHPoster2003.pdf (accessed 2004 Sep 1).
  11. McVey GL, Tweed S, Blackmore E. Dieting among preadolescent and young adolescent females. CMAJ 2004;170(10):1559-61.[Abstract/Free Full Text]




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