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Eating disorders can start in early childhood

Children today are more concerned than ever about their bodies, and many are developing unhealthy relationships with food that could become life-threatening.

Jack is a vegetarian. "I don't want to kill animals to eat," he told his parents one night.

Soon, however, his ban on red meat was extended to chicken, fish and anything with the smallest amount of fat. He also placed himself on a strict exercise program, doing sit-ups and calisthenics every day and running around the school track every afternoon for an hour.

"At first, we thought it was great that Jack was into being fit," his mother explains.

But over the course of six months, not only did Jack not gain weight, he lost more than 20 pounds.

Caitlin, star of the school play, goes to the girls' bathroom two or three times a week, puts two fingers down her throat and throws up before going onstage to rehearse. Her best friends know what she does but are sworn to secrecy.

Sounds like typical teenage angst about body image, right? Not exactly: Jack is 8 years old. Caitlin is 9.

According to experts, these children's stories are becoming increasingly common. Youngsters today are more concerned than ever about their bodies. Many are developing unhealthy eating habits that can become full-blown disorders with potentially life-threatening consequences.

At age 3, children already show a dislike for those who are fat, rating drawings of fat children more harshly than those of youngsters with disabilities, according to a series of studies conducted by Ohio State University psychologist Susan C. Wooley. They also attribute negative qualities to fat people, labeling them mean, lazy, cheating and dirty.

By early grade school, some children are not only counting calories, they're using laxatives and diet pills and forcing themselves to vomit in an attempt to drop pounds.

A study of more than 3,000 middle-class, fifth- through eighth-graders by researchers at the Medical University of South Carolina, in Charleston, found that 40 percent felt fat and/or wished they could lose weight; 30 percent had already dieted; 8 percent had fasted; 30 percent had pilfered a parent's diet pills or diuretics; and almost 5 percent had forced themselves to vomit.

"At the time of the study, most of us thought that eating disorders were pretty much limited to college-age women. To hear kids as young as 10 years old confess to taking laxatives to lose weight was eye-opening," says Dr. Timothy Brewerton, director of the Eating Disorders Program at the Medical University of South Carolina and the study's lead author.

Eating disorders in teens and adults are notoriously difficult to recognize, and those in children even more so. As a result, such disorders are often misdiagnosed or missed entirely.

"Young children may be brought to a pediatrician because they're overeating, refusing to eat or chewing food and then spitting it out," says Dr. Susan Sherkow, a New York City psychiatrist who directs a therapeutic and preventative nursery for mothers and children with eating disorders. "But instead of considering the possibility of an eating disorder, doctors assume these kids are merely picky eaters."

Third- and fourth-grade girls are fearful of getting fat, says Dr. Catherine Steiner-Adair, a clinical psychologist and director of education prevention and outreach at the Harvard Eating Disorders Center.

What Steiner-Adair dubs "fat talk" starts early. By age 6 or 7, it's not unusual for a girl to ask her mom, "Am I too fat?" Around age 9 or 10, girls often begin to appraise their own and each other's appearance and compare themselves with one another.

Early grade school is also a time when children begin to link their self-worth to the concept of good and bad.

"I've heard preteens turn to each other and repeat comments like: "I'm so fat; I hate myself.' . . . "Let's be really bad today, let's eat dessert!' . . . or "I was so good, I just had a salad' that they may have overheard from their parents," Steiner-Adair says.

Boys are by no means immune. Steiner-Adair recalls when a boy in her neighborhood came home from camp and announced that he wanted "a six-pack."

"He'd learned from the older guys that "having a six-pack' means you're so buff, so muscular, that your lower three ribs on each side show," she says. "I realized that "fat talk' was becoming part of a boy's experience, too. They're becoming just as vigilant about their bodies as girls are."

Indeed, 28 percent of normal-weight boys in Brewerton's study reported being dissatisfied with their weight.

And just when fitting in and looking "right" becomes the Holy Grail, the unpredictable pacing of puberty means that growth rates and body shapes become as varied as fad diets. There are girls who are so distraught by their new womanly curves that they believe starvation is their only option. Unchecked, such erroneous beliefs and hazardous habits can develop into a diagnosable eating disorder, putting a child at risk for serious, sometimes irreversible, medical problems, including stunted growth, the cessation of menstruation and heart problems.

Certainly, our cultural preoccupation with thinness presents an unreasonable and, for most, forever unattainable ideal. We may tell our kids that real beauty is found on the inside, but just about everything from Hollywood to Madison Avenue, magazines to music videos, rewards the outside.

Today's kids are the first generation to be raised by parents who target their heart rates, analyze their body fat and purchase fat-free cookies. If Mommy moans that she can no longer zip her jeans, berates herself for having eaten that whole corn muffin or precisely monitors every last morsel that her child puts in her mouth, she's not teaching healthy attitudes about food and moderation.

"I see many mothers who struggled with weight issues when they were young and are so worried that their kids will, too, that they begin talking about counting calories when their child is in preschool," says Dr. Melanie Katzman, assistant professor of psychology at Weill Cornell Medical College in New York City. "That's wrong."

So is eliminating fat from the diet of toddlers and preschoolers, Sherkow says. "Kids need a certain amount of fat in their diet to develop normally," she says. "Fat is not a dirty word."

Temperament also plays a key role. "There is a high correlation between kids who have eating disorders and kids who have trouble coping in social situations," Brewerton says. "Someone who is inflexible, withdrawn, perfectionistic and obsessional may be at greater risk."

Susceptible kids often come from families in which one or both parents are overachieving, overcritical or rejecting, Katzman says. "When a child feels powerless or helpless, eating, or refusing to eat, is the only way she can exert some measure of control over her life."

Clearly, parents play a huge role in shaping their child's self-image and confidence, at least partly through their attitudes toward food.

"The best way to help your child avoid an eating disorder is to stop it before it starts," Brewerton says. "The youngster who has open communication with his parents, who feels loved regardless of her achievements, mistakes or looks, will stand strong against peer and media pressure."

Margery D. Rosen is a contributing editor at "Child" magazine.