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In what way is body image dissatisfaction important in understanding disordered eating and in tackling obesity levels in children?

Introduction

Often it is difficult for adults to recognize that a child is experiencing problems related to intake of food and control of weight. It can be even harder for parents to believe that their own child might have such a problem. However, an increasing number of children in the United Kingdom are developing eating disorders, including obesity, which, if left untreated, could lead to serious physical and mental health problems.

According to the National Statistics, given by the Department of Health, the proportion of overweight children in the United Kingdom is on the increase, showing a marked rise from 22.7% in 1995 to 27.7% in 2003. The prevalence of obesity has shown a similar trend, with a rise from 9.9% in 1995 to 13.7% in 2003. This increase is similar for both sexes, with a slightly higher prevalence of boys being overweight and obese (Obesity in children under 11, 2005).

Together with this rise in obese and overweight children, is the increasing pressure, from the pop culture, for children to achieve the somewhat unattainable ‘ideal body’. When the child becomes aware that his or her ‘real body’ does not fit the mould of the ‘ideal body’, this may lead to extreme steps in trying to achieve the ideal as well as creating a distorted self-image.

The following paper provides a description of the relationship between body image dissatisfaction and disordered eating, paying special attention to targeting obesity levels in children.

Body Image vs. Ideal Image

Self-concept, or body image, is flexible in definition and evolves over time in relation to physical, emotional and social development as well as various external and internal influences. Body image is essentially the way we perceive our body as looking or the picture we have of ourselves in our mind. As early as 21 months, the toddler, who is able to recognise themselves from photographs, becomes aware that he/she has distinguishable features. The toddler may display behaviours of embarrassment at this stage, marking the initial stages of self-esteem and establishing the disparity between body image and ideal image. In early years, infants and young children construct an image of themselves in relation to an ideal image, which is outlined by their parents. The young child who watches her mother dressing and applying make-up and accessories, will then value this behaviour and style as the ideal. She will then mimic this behaviour so as to decrease the discrepancy between her body image and the ideal image. Self-esteem is measured by the degree of discrepancy between these two images. The more she is able to achieve likeness to that which she values as ideal, the more confident she will grow in her own body image. It can then be seen that these constructs are highly dependent on culture and religion, and that the ideal image may vary significantly from one group to the next, and even, in the early years, from one family to the next.

However, as children grow older, they do not remain in isolation, on the contrary, young children’s exposure to the secular society is on the increase (Price, 1990: 9). Not excluding general socialisation at school and sporting activities, the influences of television, magazines and the lyrics to popular music greatly define the child’s evolving construct of the ideal image. As in early childhood, the school going child, entering society, will now use this new image as a reference in establishing their body image. However, this image is very often unrealistic and unattainable, and as the discrepancy between the ideal and real images widens, the child becomes vulnerable to disappointment and decreased self-esteem. Salter (1997: 95) recognizes the school going child as learning to classify, and order according to hierarchy. The child is thus able to make a comparison and evaluate their real image to the ideal image, leaving them feeling inadequate. As a result of this body image dissatisfaction, the child may consciously or unconsciously turn to compensatory or behaviours to try and retain the balance between their body image and their established ideal image.

Disordered Eating

Among preschoolers, the most common eating disorders are pica, rumination disorder, and feeding disorder of infancy or early childhood. According to Thomson (2004: 636), Pica can be described as the persistent consumption of inedible substances over an extended period of time. It is typically associated with developmental disorders and exposure to poverty, neglect and lack of supervision may increase the risk of pica in vulnerable children. Rumination is the voluntary regurgitation of food, and is characteristically seen in children with sensory or emotional deprivation and children with attachment disorders. When considering the development of the afore mentioned disorders, against the background of Eriksson’s stage of ‘trust vs mistrust’, it can be seen that infants diagnosed with pica and rumination are not receiving the warmth and affection from their parents and develop mistrust towards their external environment and towards themselves. The failure to negotiate this stage successfully may have a marked impact on the development of a positive self-image in later childhood. If the eating problems are not addressed and resolved in infancy, this could cause later eating problems during childhood, adolescences and adulthood.

It is thus clear that, disordered eating may arise as a result of a number of factors. Children raised in dysfunctional families are at high risk of developing eating disorders. Over eating or self-imposed starvation may be a form of retroflection, whereby the child develops a distorted body image and uses food intake or restriction as a form of self-harm. Other children are at risk of developing an eating disorder if the parents themselves are too preoccupied with appearance and weight, and introject their ideal image onto the child. When these parents are seen as constantly dieting and expressing dislike towards their own bodies, the child will receive the message that appearance is important and the achievement of the ideal image becomes a primary focus in the consumption and restriction of food. In other families, a double standard is established in term of boys and girls, where the family may encourage the boy to eat so that he may become strong, but discourage the girl from eating so that she may maintain a slim figure. Society and media also send the message that being thin is important and necessary to achieve acceptance and success.

The Learning Theories emphasize the role of environmental influences on shaping the way the child constructs his/her body image (Smith & Cowie, 1991: 149). The child’s development of constructs is guided by both deliberate and unintended learning experiences, or introjections, in the home, peer group and community. Therefore, childhood is significantly shaped by the values, goals and expectations of their culture. Thus, it is as a result of these introjections, shaping the child’s body image and self esteem, that the child develops eating disorders.

Children dealing with the emotional distress of low self-esteem and poor body image very often turn to dieting or restricted food intake as a means of containing their depressed feelings about themselves. However, these children very often lack the dietary knowledge on how to approach dieting and simply resort to bouts of limited food intake. Despite this being the child’s intention, most children are naturally unrestrained eaters, who eat freely and are easily triggered by external cues. On the other end of the spectrum, the child may be a restrained eater, who resists eating in most situations, but may become temporarily unrestrained and indulge is overeating (Sarafino, 2002: 248). This ‘yo-yo’ dieting very often results in a paradoxical effect, where the child is seen to gain excess weight instead of losing weight.

The child’s efforts to decrease the discrepancy between his/her body image and ideal image have failed, and have had a rather opposing outcome. The overweight child is subject to gross stigma and social rejection, which again, has a direct impact on the child’s self esteem and body image. The problem now turns to emotional compensatory eating and fixation on food.

Causes of Obesity and Tackling the problem

The preceding discussion on body image provides a compelling argument for the onset of disordered eating and the development of obesity in children. However, there are a number of other factors, which are important in the consideration of obesity. Genetic predisposition plays a significant role in determining the degree of adiposity in an individual (Taitz & Wardley, 1989: 130). Children with obese or overweight parents have been found to be at higher risk of gaining weight. Environmental factors such as physical activity and exposure to unhealthy eating habits, such as ‘fast-foods’ and sugary delights, also play are large part in determining a child’s vulnerability to weight gain. The merging relationship between the environment and gene’s could then result in either healthy or unhealthy dietary behaviours. The child with a genetic predisposition to weight gain, may have parents who encourage healthy eating, and would thus be more likely to maintain a healthy size. Equally, the child without any genetic predisposition may have parents who are constantly encouraging unhealthy eating habits, resulting in weight gain (Taitz & Wardley, 1989: 131).

Nevertheless, regardless of the onset or causes for obesity, the argument remains that body image would then have a continued impact on the developing or already obese child. Physical attractiveness is of high value in society and the overweight or obese child is very often viewed as being lazy, unintelligent, unmotivated and ugly. This negative stigmatisation would very often turn around on the child as a self-fulfilling prophecy. The overweight or obese child is very often seen sitting on the sideline, avoiding physical activity or rejected by his or her peers. During a stage where play is a vital key to successful socialisation and development of a positive self imagine, the isolated or excluded child would, as a result of a poor self image, then be more and more reluctant to initiate interaction with other children. Obese children, as a result of humiliation and shame, often isolate themselves and spend time in front of the television and video games, to avoid further judgement. They also very often turn to comfort eating to compensate or sooth the emotional discomfort of being excluded. They are striving to complete the gestalt. To break the inveterate pattern of the obese child being excluded and thus excluding him or herself rests on the redefining the body or self-image into something positive.
Treating obesity in children with diets is very often ineffective as children typically lack the self-discipline to commit to long term restricted intake and selective eating. Dieting in children reveals a typical pattern of temporary commitment to a limited intake or limited calorie diet, followed by bouts of binge eating. Also, this form of intervention requires strict adherences by the entire family in support for the dieting child. Increasing activity levels has been found to be most effective, but the child is often very unmotivated to attempt such activity for fear of ridicule. Therefore, the author is of the opinion that the crucial area of intervention should focus on the child’s self or body image. In a therapeutic environment, the child should be encouraged to challenge the ideal image presented by the world. On separating this image as something unrealistic and unattainable, the child should then be guided into a process of replacing this ideal body image for the real body image. The child is required to reconstruct his or her body image against a more realistic goal. The obese child would need to work through emotional scaring and reach a point of confidence and willingness to engage socially. A positively reconstructed body image sets the child on a path to recovery. The more positive the child feels about him or herself, the more energy and motivation he or she will have to make a change and commit.

Summary

A poor body image robs the developing child of achieving social integration and self-efficacy. Obese children are reluctant to engage in physical activities for fear of humiliation and ridicule, and compensate for this isolation by comfort eating and self-isolation. By tackling the root of poor body image, the child is freed of his or her feelings of shame and is able to consider realistic goals for the future.

Reference

Price, B. 1990. Body Image, Nursing Concepts and Care. Prentice Hall: London.

Salter, M. 1997. Altered Body Image: the Nurse’s Role, Second Edition. Bailliere Tindall: London.

Sarafino, E.P. 2002. Health Psychology, Biopsychosocial Interactions, Fourth Edition. John Wiley & Sons, INC: New York.

Smith, P.K. & Cowie, H. 1991. Understanding Children’s Development, Second Edition. Basil Blackwell Ltd: UK.

Taitz, L.S. & Wardley, B. 1989. Handbook of Child Nutrition. Oxford University Press: Oxford.

Thomson, K. 2004. Handbook of Eating Disorders and Obesity. John Wiley & Sons, INC: New York.

Obesity in children under 11. 2005. [O]. Available:
http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsStatistics/PublicationsStatisticsArticle/fs/en?CONTENT_ID=4109245&chk=WB/AR1
Accessed on 2005/05/16