Eating disorders are being seen in children as young as 5. It's up to parents to promote a positive body image.
Washington - A friend’s eight-year-old daughter packs her own lunch for school. One day her dad noticed that lunch consisted of a single cherry tomato, one slice of apple and one spoonful of yoghurt. When asked, the child replied that she didn’t think she’d be hungry at school.

My friend wondered whether this was the beginning of problem eating.

Eating disorders most commonly emerge during the adolescent years, says Claire Mysko, the chief executive of the National Eating Disorders Association. “But we’re hearing about younger and younger cases.”

How young? As young as five, according to the American Academy of Paediatrics (AAP), which updated its guidelines on preventing eating disorders and obesity in teenagers last year. About half of teenage girls and a quarter of teenage boys are dissatisfied with their bodies, according to the AAP.

“The stereotype is of a young white thin girl. It’s a common misperception,” Mysko says. “These illnesses occur in all sizes, all races, all genders, all ages.”

If you see signs that concern you, don’t dismiss them, Mysko says. Signs might include a child who cuts out an entire food group or one who seems anxious during meals. Talk to your paediatrician about your concerns.

Paediatricians will look at kids’ growth curves, measuring height and weight to ascertain whether growth is on track. “It’s normal to expect picky-eating episodes,” says Lynne Lillie, a family physician.

“Kids can seem hungry one day, but not at all the next.”

My friend did not dismiss the signs. She talked to a friend with some expertise, she watched her child eat at home, and she kept an eye on lunch content. A visit to the doctor was already scheduled.

My friend said she felt that she and her husband were doing many things right. They offer a variety of fresh foods and let their kids decide how much to eat. They don’t promote a particular body size or talk about dieting.

This aligns with current advice. Through their actions, parents should be modelling messages of healthy eating and positive body image.

What else can families do to encourage healthy eating?

Avoid putting emphasis on weight. This is a key recommendation of the AAP guidelines.

Losing weight should not be a goal. Nor should “losing a few pounds” or “getting thinner” be associated with hopes for greater happiness or popularity. A parent who talks about weight – their own or their child’s – is a risk factor for eating disorders.

Teasing a child about his or her weight is not good. This may seem obvious, but remember that such teasing might come from any source – parents, siblings or schoolmates.

Statistics reported in the AAP document indicate that 40% of 13-year-old girls have experienced this. Such teasing puts boys and girls at risk for becoming overweight, and it increases a girl’s chances of disorders like binge eating and extreme weight-control behaviours.

“The focus on weight,” Mysko says, even when it is well intentioned, “can backfire.”

Indeed, she says that dieting is a major risk factor for developing an eating disorder. “Not everyone who goes on a diet will get an eating disorder, but the restrictive mindset is linked to eating disorders.”

One of the most important things parents can do is eat with their kids. A 2007 study of 1 710 high school students found that those who ate most often with their families consumed more fruit and vegetables and fewer soft drinks than other students. These healthy eating trends were maintained into young adulthood.