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Group Counseling Interventions For Overweight Kids

By Julia Taylor for American School Counselor Association

Some parents in Florida and Pennsylvania received an alarming letter from their child's school district a few years ago. The letter had nothing to do with their academic performance or behavior problems; it was informing them that their child had a weight problem. These particular school districts now mail home a letter when the child is overweight, underweight, or at risk for becoming overweight –- suggesting they take their child to a doctor to rule out medical conditions and/or seek advice about nutrition and exercise. While some parents were outraged and believed the letter was doing nothing more than harming their self-image; Galley (2002) reported "The biggest boost for their self-image would be to get them to a healthier weight and a more active lifestyle."

The Centers for Disease Control and Prevention (2003) refers to adolescent obesity as "a public health epidemic." The percent of overweight children has risen to approximately 15%; nearly triple the rate from the 1970's. Being overweight refers to an increase in body weight in relation to height when compared to the average standard. Obesity is defined as an excessive amount of body fat or adipose tissue in relation to lean body mass.

The Surgeon General (2003) suggests that adults be good role models to children by making healthy food choices and exercising regularly. At the same time, it was noted that 61% of the American adult population is overweight. The Surgeon General listed three major health consequences associated with childhood obesity.

• Risk factors for heart disease, such as high cholesterol and high blood pressure, occur with increased frequency in overweight children and adolescents compared to those with a healthy weight.
• Type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents. Overweight and obesity are closely linked to type II diabetes.
• Overweight adolescents have a 70% chance of becoming overweight or obese adults. This increases to 80% if one or more parent is overweight or obese.

The Surgeon General also noted that the most immediate consequence of overweight, as perceived by children themselves, is social discrimination.

The average public school student spends more waking hours at school than in the home. The Action for Healthy Kids (2002) believe that the school system has a responsibility to "promote knowledge, attitudes, and behaviors among our children that help develop eating and fitness patterns that can improve health, intellectual development, and overall quality of life." Accordingly, teachers, counselors, school officials, and parents play a vital role in shaping a healthy future by providing students with a healthy school environment.

Emotional Factors

For overweight adolescents, the biggest concern of excess weight is not health problems, but emotional problems. To live in a society that values thinness often promotes feelings of guilt, depression, and anxiety in children who differ from societal norms. Leach & Morrill (1991) report that being overweight is a "nightmare" for children living in a culture purely obsessed with being thin. Strauss (2000) simply states, "Society does not tolerate excess weight."

Children are often intolerant of differences amongst one another. Barlow, et al, (2002) found that young people are taught the value of attractiveness at an early age. Children who grow up thinking they are different from other children often don't like themselves. In addition, Bartlow indicated that overweight children are at a significantly greater risk for becoming severely depressed, being bullied, developing an eating disorder, and having marked low self-esteem. Leach & Morrill added that feelings of alienation, anger, embarrassment, school avoidance, lower grades, and extreme social difficulties were also common emotional side effects of being overweight.

Successful Strategies in Group

The American School Counselor Association (2003) states that "groups and group counseling make it possible for students to achieve healthier personal adjustment in the face of rapid change and to learn to work and live with others." Overweight children face ridicule every day and are victimized because of their size. Students need to have a safe place to go to when they are feeling threatened. The collaboration, cohesiveness, and sense of belonging children experience in group counseling may help them to feel understood (Lowey, 1998).

Overweight children benefit by learning how to deal with emotional and social issues that often coincide with being viewed as different. Leach & Morrill (1991) provide many suggestions for helping overweight children cope in school. In a group setting, children can help each other identify locations where they have suffered abuse. The children can learn other routes and brainstorm ideas to reduce their vulnerability at locations that cannot be avoided. Discussions among overweight students with valuable information that can be used in many situations (Leach & Morrill).

Goal-setting is a common practice in group counseling sessions. Research shows that overweight children who have clear goals that are non-weight related have a more positive attitude and realistic outlook on life (Barlow, et al, 2002). In a group setting, children can discuss social goals and realistic strategies to obtain their goals without feeling threatened. Research by Strauss (2000) indicated that goal-setting may help children identify people whom they can trust to help carry out their goals.

Idealistic role-models help children to strive for excellence and to overcome negative feelings about themselves. Strauss (2000) believes that it is important for overweight students to have someone to admire for characteristics other than weight and appearance. In addition, children should feel comfortable talking about role models with other students to create a network of "positive people." Lowey (1998) believes that our society is filled with negative images that portray unachievable standards. Children who look up to and admire others for their non-physical achievements seem to be self-tolerant.

Perhaps the most important components of counseling groups of overweight students are the counselor's general knowledge about obesity and the level of empathy that is felt for the children. There seems to be mass confusion about the entire realm of obesity. Leach & Morrill (1991) believe that by not understanding the spectrum of obesity, school counselors often resort to using weight-loss, nutrition, and self-esteem programs to help overweight children. "These methods have been attempted by well-meaning school personnel, but evidence of success is lacking." A school counselor should be seen as someone who can provide support for children and make them feel competent about themselves both in and out of the educational environment (Hubbard & Rhyne-Winkler, 1994). In understanding the entire spectrum of obesity, Lowey (1998) assumes that counselors will come to the realization that "fat children need to be nurtured, not changed."

Unsuccessful Strategies in Group

If it were simple to lose weight perhaps obesity would not be our nation's second largest preventable health threat. School groups that focus on the physical aspects of obesity are doomed for failure. In attempts to intervene, Loewy (1998) found that overweight children are typically subjected to commercial weight-loss programs during group counseling sessions. These programs include, but are not limited to calorie restriction, weigh-ins, behavior modification, and torturous exercise programs. Some of these methods may prove short-term success, but are highly ineffective for long-term results. Lowey found these methods also result in metabolic dysfunction, which can lead to increased weight gain. "It is a vicious cycle -- weight loss, weight gain, social acceptance, social rejection -- overall, children just report increased frustration and lower self-esteem."

Self-esteem programs have not been proven effective in group counseling situations. Kaplan (1995) believes that our country is obsessed with self-esteem and that we are providing children with a disservice by focusing solely on techniques to raise it. Kaplan states that, "The media has oversold self-esteem as a national cure-all." Self-esteem is cyclic and goes through many phases, phases that cannot be taught in one particular setting. Leach & Morrill (1991) found that overweight children tend to bond with each other and show their authentic selves, leaving them isolated from other students. Many of these children do have a lot of self-esteem. By targeting obese children for self-esteem groups, school counselors are running the risk of children feeling further misunderstood.

How To Help

Nutrition and weight-loss programs need to be closely monitored by a medical doctor. Lowey (1998) feels that while dieting and weight control advice can be helpful to parents, it is often shrugged off by children because they typically do not want to feel "criticized or singled out." Leach & Morrill (1991) found that children may be going through a growth spurt and weight loss may be detrimental to future development. In addition, proper nutrition should be emphasized to everyone and should definitely not target overweight children. Group counseling that focuses on these factors has no evidence for success and long-term maintenance of weight loss. Therefore, Lowey suggests that counselor's just "steer clear" from anything not associated with the children's feelings.

School counselors have a responsibility to promote optimal mental health to help children function in the academic setting, but they should not be the one to assist in weight loss. Young people suffering from a physical or mental ailment may maintain a feeling of helplessness that needs to be addressed. A group setting is ideal for children who are overweight, children who harass overweight children, and children who may be at risk for becoming overweight to help children increase awareness and promote a positive sense of self. Such groups provide opportunities for social skill development, realistic goal-setting and providing children with the opportunity to explore their feelings in a non-judgmental, safe environment.

School counseling groups should focus on the emotional piece, school counselors have ample opportunities to provide teachers, administrators, and parent's information that can help to promote more physical success. A team approach can be used to help everyone become more aware of what is occurring in the academic setting. Before this can happen, everyone should be educated about the realm of obesity, take a look at their feelings towards obesity, and try to be empathic towards the children who are struggling. Everywhere I go (literally) I hear somebody talking about food or weight. Unfortunately, our society is obsessed with it. School counselors can help to increase the level of awareness teachers have about this sensitive subject. Parenting groups can be conducted to educate how to develop healthy lifestyles regardless of time and/or income. In addition, school counselors can provide parents with information that can lead to a more supportive environment both socially and academically. The bottom line is when school counselors learn to appreciate the value of each individual child, they may begin to truly advocate.

REFERENCES

Action for Healthy Kids (2003). Fact Sheet: The Healthy Schools Summit. Retrieved March 6th, 2003 from www.ActionForHealthyKids.org

American School Counselor Association (2003). The Role of the Professional School Counselor. Retrieved March 14th, 2003 from www.schoolcounselor.org

Bartlow, S.E., Buschbacher, V., & Jonides, L. (2002). Management of child and adolescent obesity: Psychological, emotional, and behavioral assessment. Pediatrics, 110(1), 215-222.

Galley, M. (2002). School Letters on Students' Obesity Outrage Some Parents. Education Week, 21(29), 11-12.

Hubbard, G.T., & Rhyne-Winkler, M.C. (1994). Eating attitudes and behavior: A school counseling program. School Counselor, 41(3) 195-199.

Kaplan, L.S. (1995). Self-esteem is not our national wonder drug. School Counselor, 42(5), 341-346.

Leach, J.N. & Morrill, C.M. (1991). Adolescent obesity: Rethinking traditional approaches. School Counselor, 38(5), 347-351.

Loewy, M.I. (1998). Suggestions for working with fat children in the schools. School Counselor, 1(4), 18-22.

Strauss, R.B.(2000). Self-esteem related to childhood obesity. Brown University Child & Adolescent Behavior, 16(3), 3-6.

The Center for Disease Control and Statistics (2003). Obesity Trends Among Children and Adolescents. Retrieved March 24th, 2003 from www.cdc.gov

The Office of the Surgeon General (2003). The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity. Retrieved March 6th, 2003 from www.surgeongeneral.gov

ABOUT JULIA TAYLOR

Julia Taylor works as a high school counselor for Loudoun County Public Schools in Virginia and is the Regional Conference Chairperson for the Virginia School Counselor Association (VSCA).If you've found The Counselor's Classroom useful and informative, you may also be interested in subscribing to some of our other newsletters. Dr. Playwell's Newsletter is a unique newsletter full of play therapy techniques to help you address the social and emotional needs of children and young adolescents. FYI From Wellness offers practical tips and suggestions for use in the clinic or classroom written by professionals from a variety of disciplines. The Guidance Channel Zine is a monthly online magazine that includes interviews, website reviews, statistics and articles by many national organizations such as the National Association of School Psychologists, the American School Counselor Association and National S.A.V.E. (Students Against Violence Everywhere).

Media Literacy: Saving Children From Self-Hate and Destructive Behavior

By Dr. Peter DeBenedittis for The Bureau For At-Risk Youth

In mid-March, my friend and I sat in the front row of a minor league ballpark in Tucson, Arizona, watching a spring training game between the Diamondbacks and the Rockies. A woman in her early twenties sat next to us. She asked my friend if he liked her shoes, a pair of bright orange suede Adidas with nifty white stripes. He told her they were all right. Even though he affirmed her, she replied, "I know, but at least my socks are Nike."

By age 18 the average child in America has seen 100,000 commercials on TV. Counting logos, signs, promotions, and all the other mass mediums, this figure soars to nearly twenty million. Behind each ad exposure is a simple message that every child internalizes - you're a loser because you don't own this. No advertising tells us we're okay and don't need to buy anything. Advertising tells us we're uncool, missing what's in style, too fat, too bored, or too boring.

Although our political leaders choose to ignore it, over 4,000 scholarly studies have found that mass media causes societal violence. The Surgeon General wrote in 1972, that "the debate is over." Recent research has found that higher amounts of television viewing is correlated with underage drinking. Teens that see R-rated movies are three times more likely to drink and smoke. And despite all the blame that alcohol and tobacco companies put on parents they depict as not doing enough in their so-called prevention spots, advertising influences children to smoke twice as much as does peer pressure. The same holds true with alcohol. Grube & Wallach (1994) found that children who are more aware of beer advertisements have more favorable attitudes toward drinking, and are more likely to report an intention to drink beer once they are adults.

Media literacy is a powerful tool to inoculate youth against the destructive values being sold to them. The National Office on Drug Control Policy (June 2001) reported that "because the(ir) Campaign's entire strategy acknowledges the power and influence of media on America's youth, it is important and appropriate for the initiative to help young people develop their critical thinking skills by further investing in media literacy."

Media literacy is the ability to "read" television and mass media. Media literacy education teaches people to access, analyze, evaluate, and produce media. Children who understand the motivations and production techniques of media are less likely to adopt the unhealthy attitudes or behaviors that mass media depict.

What makes media literacy a powerful prevention tool is that it takes children's natural tendency to rebel, and redirects it towards those selling them addictive lifestyles. Media education represents a new and exciting approach to protecting youth from the unhealthy effects of media -- an approach that is not dependent on Hollywood's or Madison Avenue's willingness to accept responsibility for its programming and advertising.

In conversations with some of the 50,000 students I give presentations to each year, I continually hear about the impact media literacy education can have. I've had young girls break into tears after seeing me show how actresses and models are computer enhanced in such ridiculously fake ways. I've gotten letters from ex-smokers expressing their gratitude for saving their lives by showing how tobacco ads can manipulate teens into addiction. The impact of media literacy on prevention is more than anecdotal. Post-tests from tobacco prevention talks I gave show that a third of teen smokers attending make an immediate attempt to quit their habit.

At the 2000 Alcohol Policy XII Conference, I presented the results of a study that found a single 45-minute presentation deconstructing alcohol advertising led to significant changes in the social expectancies middle school students had about drinking. Several peer reviewed studies have been published that found similar results with children as young as the third grade. While at Washington State University, Erica Austin (1997) published two studies showing a change in children's intention to drink alcohol after a media education program. Participating students were less likely to rate alcohol ads positively, were less attracted to alcohol promotional material, and showed greater disdain for alcohol commercials

As with alcohol prevention, researchers are beginning to find that media literacy is an effective tool in helping prevent and treat eating disorders. Stormer & Thompson (1995) found that very brief instruction in media literacy given to women in college produced significant pre-to-post program reductions in appearance- and weight-related anxiety. The students were less likely to idealize the slenderness embodied by fashion models and actresses. Irving, DuPen, & Berel (1998) found that high school girls viewing a media literacy film on body image and discussing it reported less internalization of a "thin" beauty standard and lower perceived realism of media images than did their comparison group.

Media literacy education can also reduce children's susceptibility to violence. A study conducted with English 8- and 9-year-olds demonstrated changes in children's comprehension and awareness of media violence. In 1983, Huesmann, et al., found statistically significant changes in children's attitudes about media violence using media literacy. Their treatment simply consisted of two training sessions within a 2-week period where third graders wrote essays for a video about how harmful television violence can be.

Parents and teachers can take back control of the values being taught to our children. It doesn't take a lot of effort either to teach a child to be media literate. One study found that parents who talk back to their TV sets had children who were less likely to drink in their teens. The American Academy of Pediatrics has a wonderful website with tips for teachers and parents called Media Matters.

The beauty of teaching media literacy for prevention is that students love learning about media. Schools also embrace media literacy because, ultimately, students are being taught critical thinking skills. And if these are not reasons enough, the preventive value of media literacy is not substance or behavior specific. The media literacy skills used to deconstruct and build resistance to tobacco advertising are the same ones used to prevent underage drinking, violence, eating disorders and other risky behaviors. I encourage you to become a cultural revolutionary and begin to learn and promote media literacy.

Healthy Bodies And A Healthy Body Image: Opportunities For Wellness

By Peggy Wouts R.N, B.N, M.N, Calgary Eating Disorder Program at Alberta Children’s Hospital

The cultural climate today, predominantly within North America, is one which harbors a "fear of fat." A variety of factors influence this climate and have implications for our population’s mental and physical health. For example, our cultural idealization of thinness has created a standard of female beauty and worth. This idealization not only encourages but also normalizes dieting as a strategy to achieve this standard (Austin, 2000). The diet industry is a multi-billion dollar industry because its profitability resides in the predominant belief that our bodies must change in size and form in order to succeed and achieve. Further, the media and fashion industries form feminine and masculine standards, which are unrealistic and predominantly unattainable. These factors are highly associated with body dissatisfaction, unhealthy eating behaviors, unhealthy weight control behaviors, and eating disorders (Austin, 2000).

Dieting, fear of fatness and unhealthy eating behaviors have been reported in girls as young as nine years old (Mellin, Scully, & Irwin, 1992). Thirty to forty percent of 9-year-old girls and eighty percent of 10 to 11-year-old girls have dieted. Young girls have indicated in surveys that they are more afraid of becoming fat than they are of cancer, nuclear war, or losing their parents (Berzins, 1999; National Eating Disorder Information Center [NEDIC], 1999). While females attempt to reduce their body size, males more often report an obsessive preoccupation with their muscularity to the point where they spend more time at the gym or take steroids and other performance-enhancing drugs in the face of serious side-effects (Pope, Olivardia, Gruber, & Borowiecki, 1999).

Eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder, rank as the third most common chronic illness among adolescent females in the United States (Neumark-Sztainer, 1996). Common features of these disorders include abnormal eating and an over-concern with weight and shape (Russell & Ryder, 2001). According to the American Psychiatric Association (2000), prevalence rates of Anorexia Nervosa are between 1-3.7% of the population and the rates for Bulimia Nervosa are between 1.1-4.2%. What is most concerning is that eating disorders have the highest mortality rates of all psychiatric illnesses, with 10-20% eventually dying, approximately half by suicide and half by physiological breakdown (Garner, Vitousel, & Pike, 1997).

While a large percentage of the population is dissatisfied with their bodies and engage in unhealthy weight control behaviors, childhood obesity is also becoming alarmingly prevalent. The prevalence of overweight youth in the United States has more than doubled over the past two to three decades. It has increased by 54% among 6 to 11-year-old children and 39% among 12 to 17-year-olds (Kendall & Wilken, 1998). Approximately 18% to 25% of all adolescents are overweight (Hill & Townbridge, 1998). It is also reported in the Youth Risk Behavior Survey that more than 25% of students felt they were overweight and used dangerous methods such as pills, laxatives, and vomiting to lose weight (Illuzi & Cinelli, 2000).

The prevention of obesity is currently at the top of the public health agendas of North America and much of Europe (Study Group, European Atheroschlerosis Society, 1987; USDHHS, 1990, 1996; Aggett et al. 1994; CDC, 1996; Seidell, 1999). Prevention programs to date have predominantly focused on nutrition and physical activity for children, however those factors associated with eating disorders have not been integrated into these programs. Further, there is concern with regard to the potential impact on disordered eating when the ultimate goal is to reduce the incidence of obesity and losing weight becomes the only focus and weight is recognized as the only indicator of health.

It is important to acknowledge the relationship between eating disorders, unhealthy eating behaviors, weight control behaviors, and unhealthy attitudes towards our bodies. Dieting for weight loss and a preoccupation with weight is associated with the later development of eating disorders (Neumark-Sztainer, 1996). Dieting may be associated with eating behaviors such as meal skipping, binge eating, and lower intake of those nutrients, which are essential to the healthy growth of adolescents. Obesity involves physical consequences and may influence social and economic development within a society which values “thinness” (Neumark-Sztainer, 1996). The similarities between those who struggle with eating disorders and obesity and those who engage in dangerous weight control behaviors, and unhealthy eating behaviors highlight the potential for collaborative promotion and prevention programs. Attentiveness and intervention is needed throughout a wide a range of unhealthy attitudes and behaviors associated with weight preoccupation.

Preventing illness, such as eating disorders and chronic disease associated with obesity, must incorporate the promotion of healthy body image and the prevention of eating disturbances. The high cost and relatively low success rates of treatment for these disturbances justify investment of time and resources in prevention efforts (Neumark-Sztainer, 1996). Further, most experts agree that for every $1 spent on promotion and prevention programming, approximately $7 is saved in later health care costs (Steinhauer, 1999).

Effective prevention and promotion programs foster the participation and collaboration of professionals, parents, and youth. For example, school programs, which are targeted towards changing individual perceptions and the social environment, create the potential for healthier behaviors. Programs that address eating disorders through didactic teaching of signs and symptoms have been shown to be minimally effective in behavioral change and may even do more harm (Roesen & Newmark-Sztainer, 1998). It is imperative therefore that the emphasis be placed on positive body image and the dangers of unhealthy eating behaviors -- not on specific eating disorders or their causes (Russell & Ryder, 2001).

While it is important to educate the public about nutrition and healthy active living, it is also important to consider our cultural climate. Unhealthy eating behaviors associated with weight disturbances are unlikely to change with the delivery of information focusing only on nutrition and active living. Programs must provide the opportunity for youth, parents, and professionals to critically think about their own attitudes related to their bodies in relation to peer groups, communities, and culture. Devoting time for discussion about these influences is a valuable way for individuals to learn from one another and learn about one’s own perception of reality. The underlying issue of bullying and put-downs about bodies is important to address as a form of harassment and must be addressed as part of creating a healthy environment for youth. The development of acceptance of all body sizes and shapes and the acknowledgement that there is more than appearance contributes to healthy environments and healthy behaviors. Overall it is imperative that prevention and promotion initiatives shift the focus from only weight to wellness with an emphasis on maximizing health (Russell & Ryder, 2001).

While it may appear that obesity and eating disorders exist at opposite ends of the health-care spectrum, the prevention of both share significant commonalties. Issues such as unhealthy body image, disordered eating, and unhealthy and dangerous weight reduction behaviors are prevalent in both obesity and eating disorders. Integrating these commonalties into the prevention of both obesity and eating disorders involves a wellness approach. This approach considers the development of self-esteem, resiliency in children and youth, and resiliency within our communities. To date the prevention of obesity and eating disorders have remained as separate fields of practice, however there is clearly opportunity for collaboration. To remain as separate practices neglects valuable approaches which would only enhance health.

REFERENCES

Aggett, T.J., Haschke, F., Heine, W., Hernell, O., Koletzko, B., Lafeber, H., Ormission, A., Rey, J. & Tormo, R. (1994). Committee Report: Childhood Diet And Prevention of Coronary Heart Disease. ESPGAN Committee on Nutrition. European Society of Pediatric Gastroenterology and Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 19, 261-269.

American Psychiatric Association (2000). Practice Guideline for the Treatment of Patients with Eating Disorders. (2end edition). APA: Washington, DC.

Austin, S.B.(2000). Prevention Research In Eating Disorders: Theory And New Directions. Psychological Medicine, 2000, 30, 1249-1262.

Berzins, L. (1999). A Congressional Briefing: Dying To Be Thin: The Prevention Of Eating Disorders And The Role Of Federal Policy. Washington, DC: American Psychological Association: Public Policy Office.

Centers for Disease Control (1996). Guidelines For School Health Programs To Promote Lifelong Healthy Eating, Morbidity and Mortality Weekly Report 45(RR-9), 1-41.

Garner, D.M, Vitousek, K.M, & Pike, K.M (1997). Cognitive-behavioral Therapy For Anorexia Nervosa. In D.M Garner, & P.E. Garfinkel (eds.), Handbook of Treatment For Eating Disorders. New York: The Guilford Press

Hill, J.O. & Townbridge, F.L. (1998). Childhood Obesity: Future Directions And Research Priorities. The Causes And Health Consequences Of Obesity In Children And Adolescents. Pediatrics, 101(3), 554-571.

Illuzzi, S. (2000). A Coordinated School Health Program Approach To Adolescent Obesity. Journal of School Nursing, 16(1), 12-18.

Kendall, R.D & Wilken, K. (1998, May 8). Childhood Obesity No.9.317. Colorado State University Cooperative Extension c Colorado State University Cooperative Extension. 1995-1999. Contact Cooperative Extension Web Manager online at www.colostate.edu/Depts/CoopExt.

Mellin, L.M., Scully, S., & Irwin, C.E. (1992). Prevalence Of Disordered Eating In Girls: A Survey Of Middle Class Children. Journal of the American Dietetic Association, 92, 851-853.

National Eating Disorder Information Center. (1999). National Eating Disorder Awareness Week Campaign. Toronto.

Neumark-Sztainer, D. (1996). School-based Programs For Preventing Eating Disturbances. Journal of School Health, 66(2), 64-70.

Pope, H.G., Olivardia, R., Gruber, A., & Borowiecki, J. (1999). Evolving Ideals Of Male Body Image As Seen Through Action Toys. International Journal of Eating Disorders, 26, 65-72.

Rosen, D.S., & Neumark-Sztainer, D. (1998). Review Of Options For Primary Prevention Of Eating Disturbances Among Adolescents. Journal of Adolescent Health, 23(6), 354-363.

Russell, S. & Ryder, S. (2001). BRIDGE (Building The Relationship Between Body Image And Disordered Eating Graph And Explanation): A Tool For Parents And Professionals. Eating Disorders, 9, 1-14.

Seidell, J.C (1999). Obesity: A Growing Problem. Acta Paediatrica 88(suppl.428), 46-50.

Steinhauer, P.D. (1999). Review Of The Organization And Delivery Of Children’s Mental Health Services In Edmonton And Calgary: Prepared For The Alberta Mental Health Board, The Capital Health Authority and the Calgary Regional Health Authority. Unpublished manucript.

Study Group, European Atherosclerosis Society (1987). Strategies For The Prevention Of Coronary Heart Disease: A Policy Statement Of The European Atherosclerosis Society. European Heart Journal 8, 77-88.

US Department of Health and Human Services (1990). Healthy People 2000: National Health Promotion and Disease Prevention Objectives. USDHHS: Washington, DC.

US Department of Health and Human Services (1996). Physical Activity and Health: A Report of the Surgeon General. US Department of Health and Human Services, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion: Atlanta, Georgia.

Size Matters: Addressing Negative Treatment of Overweight Children

By Barbara Blackburn, MA, LPC for American School Counselor Association Charlene dreaded going to school today, but she knew she had to. She wanted to make her grandparents happy and proud of her. After all, they were the ones who always treated her with dignity and respect, and above all else, she knew they loved her. She wished that her childhood had been different, that she was more like her classmates, but she wasn’t. She had faced a lot of pain, but she worked hard not to remember all of it. Sometimes, she just couldn’t forget all the teasing and the way she was treated, and her report card was not as good as she wished it was. Her grandparents had been the only constant in her life. Her mother had additional issues and disappeared when she was just a toddler. Then two years ago, her father had been arrested for grand larceny. How she wished he was still around to see her report card to tell her he was proud of her and that he loved her. Some days, like today, Charlene had a particularly hard time going to school. Yesterday, she had been called into the principal’s office again and was yelled at by the principal for “stirring up trouble”-- only Charlene did not do anything--she was the real victim. A teacher’s aide at her school, Mrs. Lincoln, who lived in her neighborhood would continuously say nasty things to Charlene and kept telling her to stay away from her daughter. Charlene tried really hard to be on her very best behavior, but she didn’t understand why she was treated this way. Perhaps it was because Mrs. Lincoln did not want her “normal” daughter to play with Charlene because of Charlene’s size. You see, Charlene was a 10-year-old fourth grader who weighed 175 lbs and was 5’ 3 “ tall. After months of abuse, Charlene finally broke down in tears at home and told her grandmother that she did not want to go to that school anymore because she was tired of Mrs. Lincoln picking on her. Charlene’s grandmother called the school principal, told him what Charlene had reported to her, and asked the principal to keep Mrs. Lincoln away from her daughter. The school principal responded by calling Charlene into his office and yelling at her for “stirring up trouble.” Charlene has repeatedly been teased, picked on, rejected, and treated like she was a troublemaker just because of her size. Even the principal and teachers who didn’t know her were always suspicious of her and treated her differently than the rest of the students. Unfortunately, stories similar to this can be duplicated as more and more of our youth become overweight and even obese. According to the American Obesity Association, 30.3 percent of children (ages 6 to 11) are overweight and 15.3 percent are obese; and 30.4 percent of adolescents (ages 12 to 19) are overweight and 15.5 percent are obese. Overweight and obesity for children and adolescents are defined respectively as being at or above the 85th and 95th percentile of Body Mass Index (BMI). For years, we have known the adverse psychological affects of obesity as outlined in this research article: “In general, size and/or bulk were positively related to teachers` attributions of competence, grades, and achievement test scores for boys, especially for the older boys. Heaviness was negatively related to teachers` ratings of females` competence -- especially athletic competence and especially for older girls.” (Journal of Sex Roles, Behavioral Science, Springer Netherlands, Vol. 15 No 11-12, 1986) In more recent studies, the American Obesity Association substantiates that “Overweight children and adolescents report negative assumptions made about them by others, including being inactive or lazy, being strong and tougher than others, not having feelings, and being unclean.” Recently, much attention has been paid to childhood obesity in schools with the focus being predominately on the physical health concerns, which are many. The focus has been on prevention and weight reduction programs, which is important of course. However, while it is important to support healthy initiatives in the schools, it is also paramount that we address the psychological effects of obesity on youth. Little has been done to address the psychological effects of being overweight and to challenge the social stigma related to obesity. We need to do more to educate school staff and families about how to provide better psychological support to these students. What school staff should know? Remember a ten year old is a ten year old. Although a student may look different, he or she is emotionally the same as other ten year olds in the class. Obese children may be more emotionally fragile than “normal size” students in their peer group. Obesity is sometimes the result of childhood pain. Children may turn to food for comfort and refuge from this pain. It is important to have the same, not less, nor more expectations from obese youth. What should school staff do? 1. Be aware of your own biases. Ask yourself: Do I expect more from larger students than smaller ones? Do I expect less from obese students? Do I make certain assumptions about obese students such as: they are lazy, tougher physically, are natural bullies and trouble makers, don’t have feelings? Do I treat these students like they are developmentally older? 2. Create an emotionally safe classroom and playground environment. 3. Get to know each student as an individual. Provide necessary support and understanding. 4. Give students an opportunity to get to know each other as individuals and to eliminate biases. Provide diversity programs such as: Don’t Laugh as Me (free on ASCA’s website) and MiddleSchool High School “Challenge Day” Programs (available at www.challengeday.com). 5. Try bibliotherapy by having students read books that address this issue. 6.Ensure that these students are included in peer helper/leadership programs such as: natural Helpers; conflict Mediators; student Government; or a “Be the Change” Club. 7.Encourage these students to participate in extracurricular activities and rigorous curricula. 8.Make referrals when necessary to appropriate resources. 9.Work closely with the parent and counselor to address student’s emotional issues. What can parents, grandparents, and guardians can do? Give your child unconditional positive regard and support. Let the child know you are his/her biggest fan. Educate yourself about obesity. Go to:http://www.cdc.gov/growthcharts to determine what the “normal” weight and height are for your child. Be aware that only 1% of child obesity results from medical conditions Work with your child to understand obesity issues and how to change habits that contribute to obesity.http://www.obesity.org/subs/childhood/prevention.shtml is a great website to gain knowledge about changing diet and behaviors. Be aware of school law that relates to staff treatment of your child. Share your concerns about treatment of your child with the school’s administrators and counselors. If your concerns are not addressed, have child psychologists go with you to educate the principal and staff. Ask that you be present when principal addresses your child, particularly if past practice has been to treat your child improperly. Work with the school counselor and other school staff to implement schoolwide programs that address diversity. Go with your child to family counseling to address psychological concerns. Work with school nurse to address medical concerns. In conclusion, parents, teachers, counselors, and administrators must work together to change the school environment to be more supportive of overweight and obese students. When left unaddressed, long term effects include: lower education attainment, depression and other psychological issues, and work place and job retention problems. Schools must do more to address the negative treatment and expectations of obese youth. Resources

• American Obesity Association.com
• Kids Growth.com
• National Center for Health Statistics