How children see themselves

In their recent research letter, Gail McVey and associates1 suggest that fear of being overweight and the desire to be thinner lead to behaviours such as “dieting and other extreme weight control methods.” Their proposed solution is to increase the education of key individuals, including primary care physicians.

In designing a prevention program, it is important to realize that teenagers' fear of becoming overweight is reasonable. Given the significant social discrimination against obese individuals in areas such as marriage, income, health care and education,2^,3 as well as the rise in obesity among children and teens,4^,5it is not surprising that some teens go to great lengths to prevent weight gain.

It would have been useful if the authors had reported how many respondents in their sample were aware that their eating behaviour was inappropriate. Such awareness has a great bearing on what preventive measures will be effective. In particular, it would be helpful to determine how a physician should manage care for a girl at serious risk of obesity if dieting is not an option.

In most people, dieting and disordered eating are symptoms of the underlying issue of body dissatisfaction. It is not clear how effective educational prevention programs will be in addressing this problem. However, it seems advisable to determine the overall impact of such interventions (including any possible adverse outcomes) before recommending this approach to primary care physicians.

Jacqueline Quail PhD Candidate McGill University Montréal, Que. J.A. Chris Delaney Statistician Royal Victoria Hospital Montréal, Que. Bruce Oddson Postdoctoral Fellow University of Toronto Toronto, Ont.