A common issue that comes up as parents and clinicians try to help adolescents avoid both eating disorders and obesity is the concern that a conversation about obesity with a child might trigger eating disorder behaviors. The dilemma leads to a lot of discomfort as to the best way to have this conversation, if at all.
Directly addressing this question are some new survey data from the Eating and Activity in Teens Study and the Project Families and Eating and Activities in Teens Project. Over 2000 teens from 20 public schools around the Minneapolis/St Paul area were assessed using school based surveys while parents also completed questionnaires. The mean age of the adolescents was 14.4 years and the sample was ethnically diverse with 81% from an ethnic minority and most coming from lower income households.
Most parents reported engaging in some kind of conversation with their children about eating behaviors. For one-third of parents of nonoverweight teens, these discussions were focused on weight. For parents of overweight teens, the rate rose to 60%. Compared to conversations about healthy eating, maternal discussions focused on weight were significantly more likely to be associated with dieting and unhealthy weight control behaviors for both overweight (64% versus 40%) and nonoverweight teens (39% versus 30%). However, the difference in rate of extreme unhealthy weight control behaviors was not different among adolescents whose mothers discussed healthy eating (8.5%) versus weight (9.5%). Similar but not identical trends emerged for fathers.
The authors concluded that parents should have conversations related to healthy eating rather than weight, particularly with adolescents who are overweight.
While this is an interesting study that offers data about a common clinical dilemma, one needs to be mindful not to overinterpret these findings. While much of the attention for this article relates to eating disorders per se, significant associations were not generally found between the content of parental eating discussions and more extreme weight loss behavior, and eating disorders were not diagnosed directly in this sample. Furthermore, eating disorder symptoms were quite common among teens whose parents focused their discussions on healthy eating too. Parents may also have under-reported the amount of weight focus of their conversations.
That said, the study does offer some empirical support to a practice that many clinicians already advocate, namely to make weight a secondary issue and instead focus on more healthy eating.
Berge J, et al., Parent Conversations About Healthful Eating and Weight: Associations With Adolescent Disordered Eating Behaviors. JAMA Pediatrics 2013;167(8):746-753.