About 40 percent of 9- and 10-year-old girls are trying to lose weight, according to a study in Pediatrics, the journal of the American Academy of Pediatrics. What frightens some researchers is that many of these girls aren't even overweight to begin with.
Concerns about body image are surfacing much earlier than in past generations, says Laurie Humphries, MD, director of the Eating Disorders Program at the University of Kentucky Chandler Medical Center in Lexington.
"By age 9," she says, "many young girls are starting to show preoccupation with shape and weight."
She blames this preoccupation on continual exposure to very thin women in the media. Just look at the actresses who star in TV shows popular with preteens. In between the storylines and ad copy is the message that if you want to be happy and successful, you need to be thin.
Children also take cues from health-conscious parents who may give them the message that junk food must be avoided at all costs or that all fat is bad. Even some 7-year-olds have obsessive attitudes toward food, similar to those of older girls with clinically diagnosed eating disorders, says Dr. Humphries. They religiously track calories and shun high-fat treats most grade-school students love.
Martha, who lives outside Washington, D.C., is concerned about her 9-year-old daughter, Emily. (Her last name is being withheld to protect her daughter's privacy.) During the past year, Emily has complained about her legs being "too big." At times, she rejects foods she knows are high in calories. Emily is muscular, but definitely not fat. Martha thinks Emily is being teased about her body shape by another girl at school. That girl is very thin.
"It certainly has been worrying me," says Martha. "It just seems odd to me that a young child would be trying to lose weight."
What will the long-term effects be for such children? Research is underway, but it's still not known if any of the girls are on a collision course with a full-blown eating disorder, such as anorexia nervosa or bulimia.
Adolescents. Anorexia nervosa, in which dieting is carried to a dangerous extreme, is rare before puberty. It typically strikes girls between 12 and 17. The most telltale symptom is dramatic weight loss. Anorexics complain of feeling fat, even as the pounds melt away. Eventually, menstruation ceases and there may be growth of fine body hair. They often are compulsive exercisers. Work, school, and social obligations are structured around workouts.
Bulimia usually appears in the late teens and early 20s. It's more difficult to recognize because bulimics often have a normal weight and may eat regular meals. They try to control their weight through a vicious cycle of binge eating, vomiting (often called purging), or overuse of laxatives. It's estimated that 3 percent of college-age women are bulimic.
Girls. Girls and women represent about 90 percent of patients at eating disorder clinics. No one can fully explain this gender imbalance, but it probably stems from cultural pressure for girls to be thin, says Dr. Humphries. Girls who hear negative comments or teasing remarks about their weight are at particularly high risk for developing an eating disorder.
Whites. Cultural differences may also account for differing attitudes and experiences among African-American and white girls. Although all girls at 10 have an equal desire to lose weight, a lower percentage of African-American girls suffer eating disorders as teenagers when compared with white girls. George Schreiber, of Westat, Inc., a research firm in Rockville, Maryland, thinks it's because they don't strive to be impossibly thin and are more tolerant of being heavier.
"Black girls always choose a heavier-designed body image than white girls," he says. "And at every level, white girls are more dissatisfied with their bodies than black girls."
Dieters. Going on a diet is often what starts an eating disorder, says Victor Fornari, MD, director of the Center for Eating Disorders at North Shore University Hospital in Manhasset, New York. "We often hear patients say, 'I began to diet to lose 5 or 10 pounds, and then the diet controlled me,'" he says.
At least one prominent researcher, though, cautions against assuming this preoccupation will lead to an epidemic of anorexia. "Lots of people diet, but not everybody gets an eating disorder," argues Walter H. Kaye, MD, director of the Eating Disorders Module at the University of Pittsburgh Medical Center.
Children of heavy parents. New research strongly suggests heredity may be involved in the development of some eating disorders. Identical twins are much more likely to share the problem than fraternal twins.
"There's pretty compelling evidence for genetics," says Dr. Kaye. "It's possible that eating disorders are an interaction of both genetics and culture."
Your daughter is bombarded with messages to be thin. Countering this cultural pressure is a daunting task, especially if your child is already unhappy with her weight. Here's how you can help:
Kristina Copeland believes her experience with bulimia was caused by a variety of circumstances. Now 29, she claims her genes made her prone to "addictive behavior." Her biological father is a recovering alcoholic. Having an alcoholic parent may raise a person's risk of becoming anorexic or bulimic, says Dr. Fornari.
As an adolescent, Kristina was acutely aware of her weight. "When I was 10 to 13, I was a little pudgy," she recalls. Then, in eighth grade, her family moved. Leaving her friends and entering a new school caused her self-esteem to plummet.
When she was 15, her best friend started purging after mealtimes. She showed Kristina how to vomit after gorging herself. "At school, we were known as the girls who threw up."
Kristina's problem intensified as she started modeling. She'd starve herself for days prior to a shoot, just to feel super-thin. Bingeing, purging, and fasting was a way of life for nine years. Recovery came about slowly, following a conscious decision to curb her dangerous behavior.
Today Kristina is an actress in New York City. She talks about her experience to high school students. "I'm very grateful I was able to stop," she says. "Food has become my fuel -- it's no longer an issue."
Dr. Fornari hears stories similar to Kristina's every day. He knows countless girls are falling into the same trap, partly because of current fashion whims. Many models are 10 to 20 percent below their ideal weight, he says. Full-figured women have started to appear in some ads, but those are targeted mostly at older women. The emaciated look remains the norm.
Photos of super-slim celebrities should come with a warning label, says Dr. Humphries, only half-jokingly. "It should read: 'These people are very unhealthy.' "