Estimates of the number of overweight children range from a low of 13% to a high of 25-30%. This means 6 million children could be at risk for current and future self-esteem and health problems. On the other side of the weight issue, an estimated 7 million girls and 1 million boys have an eating disorder. The age of onset of these potentially life threatening eating disorders is getting lower - with children as young as seven being diagnosed.

What causes eating problems?

Weight is determined by a variety of factors: genetics, environment, activity, and emotions. With respect to the psychology of eating problems, some of the same feelings can both lead to and result from unhealthy eating behaviors. For example, it is unclear if such feelings such as loneliness, sadness, anger, anxiety, lack of control, worthlessness, low self-esteem, disordered body image are the cause or the effect of eating problems.

What can parents do?

Know what's appropriate

Check with your child's doctor to understand how your child compares to established standards for height and weight. Also learn about proper nutrition and appropriate expectations for food intake. The risk of weight problems varies with the age and growth of the child. For example, only 20% of overweight 4 to 5-year-olds go on to be overweight adults (Begley, 2000). Therefore it may not be necessary to worry or institute big changes at a young age, but it would be useful to get a doctor's advice. Parents must also pay attention to the warning signs of both overweight/obesity and of eating disorders.

Help children develop individual controls and styles

Parents should pay attention to their children's cues when they indicate they have eaten enough or when they are still hungry - differentiating real cues from stalling or playing. Don't dwell on a picky eater. Food preference takes time to develop. Make an effort to include children in meal choice and preparation to encourage a child's exposure to variety.

Focus on the whole child

Avoid calling attention to a child's weight. Nagging is unsuccessful when you're trying to change behavior. To a child, pressure to lose weight can feel like crushing criticism and ultimately backfire. Children with some type of disordered eating can get caught in a vicious, unhealthy cycle. They can feel badly about their weight and thus develop a negative self-image and low self-esteem. They may try to control their world through food or turn to food out of anger or to find comfort. The inappropriate relationship with food can then lead to further feelings of guilt and upset. Praising and encouraging children in other areas will go farther with respect to improving their self-esteem.

Motivate at the child's level

It is difficult to motivate anyone, children especially, with the threat of long term health risks. Although obese children are at risk for illnesses such as diabetes and heart disease, the consequence is so far into the future they easily ignore and deny these risks. Better to focus on benefits based on feeling healthier, stronger, more active, and more social.

Apply nutrition decisions to the whole family

Good nutrition is good for everyone. Singling out the child with a weight problem can lead to his or her feeling ashamed and blamed. Help your children understand about good nutrition and good food choices - you want them to make the right decisions when they are eating outside the home too.

Avoid using food as a punishment or reward

It is unhealthy to use food as a battleground; it should never be used as either a punishment or reward. Resist the temptation to soothe or bribe with food or threaten to withhold certain favored foods.

Emphasize mealtime, not just the meal

Work towards having meals be a pleasant experience and make time for the family to eat together, even if it's only a few dinners a week. This may also mean sticking to no t.v. and no phone rules during meals, however brief that time may be.

Set appropriate limits

Be mindful of children's attempts to manipulate with food. But don't succumb to operating a restaurant. Going to bed without a full dinner one night will not ruin a child's growth but one evening with a growling stomach should get the point across about proper expectations and behavior.

Monitor your athletes

Exercise is a key component to any weight management program. But children involved in sports may need special attention in order to insure that they are getting enough of the right kind of nutrition and, in the case of eating disorders and that they are not using exercise inappropriately.

Be alert media consumers

While individuals may have a physiological predisposition to weight problems and eating disorders, there's no question that unrealistic media images, unrealistic athletic standards, peer competition, and parental preoccupation with their own outward appearance can all exacerbate the potential for problems. It's better to educate children about their changing bodies, to be mindful of wide fluctuations in a child's weight, discuss healthy physical images and unnatural ones, and stress inner qualities of beauty and skill.

Check your lifestyle

Get everyone in the family moving and avoid those grab and go meals. Not only are t.v. and computers passive activities, but a high percentage (over 50%) of the commercials aired during children's programs are food related. Limit t.v. and computer time, get exercise.

Be a role model

Children learn by experience - look at your own food habits and ideas about weight. Your own comments about appearance can have tremendous influence on what your children think is acceptable or desirable. The goal is to be at a healthy weight and have a positive self-image, based on more than a number on a scale.

About the Authors

Robin F. Goodman, Ph.D. ATR-BC, is a clinical psychologist specializing in bereavement issues.

References and Related Books

Begley, S (July 3, 2000). What parents should do. Newsweek, p. 45

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About the NYU Child Study Center

The New York University Child Study Center is dedicated to increasing the awareness of child and adolescent psychiatric disorders and improving the research necessary to advance the prevention, identification, and treatment of these disorders on a national scale. The Center offers expert psychiatric services for children, adolescents, young adults, and families with emphasis on early diagnosis and intervention. The Center's mission is to bridge the gap between science and practice, integrating the finest research with patient care and state-of-the-art training utilizing the resources of the New York University School of Medicine. The Child Study Center was founded in 1997 and established as the Department of Child and Adolescent Psychiatry within the NYU School of Medicine in 2006. For more information, please call us at (212) 263-6622 or visit us at