How children see themselves

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.