Disordered Eating Behavior in Middle Childhood

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Toward the end of middle childhood, individuals experience increased awareness of body image, or how they think and feel about their bodies. A preoccupation with body image and size may be further exacerbated by school transitions and the simultaneous occurrence of puberty and associated social and academic pressures (Levine, Smolak, Moodey, Shuman, & Hessen, 1994). Research illustrates that body and weight dissatisfaction occurs as early as third grade; is greater in European American than in African American children, females than males, and those with a heterosexual orientation; and increases over time, peaking around eighth or ninth grade (Thompson, Rafiroiu, & Sargent, 2003). These patterns of body dissatisfaction also tend to occur in other affluent countries, such as Hong Kong, Australia, and Sweden (Lam et al., 2002; Lunner et al., 2000).

Body dissatisfaction and weight concerns can lead to unhealthy dieting behaviors, which in turn may promote the development of disordered eating in school-age children and adolescents (Killen et al., 1996). Studies of middle-school students have reported that between 30 and 55% have dieted at some time (Shisslack et al., 1998) and that, among females, about one-third of normal dieters progress to other problem dieting behaviors (Shisslack, Crago, & Estes, 1995). Problem dieting behavior includes fasting or skipping meals, the use of diet pills, vomiting or using laxatives, smoking cigarettes, or binge eating (Croll, Neumark-Sztainer, Story, & Ireland, 2002; Neumark-Sztainer, Story, Falkner, Beuhring, & Resnick, 1999). These unhealthy dieting behaviors are far more prevalent among adolescents than children in middle childhood and often go unaddressed because of the varied unmonitored settings within which teenagers consume food. In addition, most unhealthy dieting patterns fall below the criteria for diagnosable eating disorders and may not be viewed as problematic.

Health consequences result from both disturbed eating patterns and eating disorders. Health problems associated with disturbed eating patterns are delayed sexual maturation, menstrual irregularity, constipation, weakness, irritability, sleep problems, and poor concentration (Story & Alton, 1996).