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Wasting away, Katie died weighing only 58 pounds. And she was sixteen. That just doesn't seem possible to me when I look at my seven-year-old daughter who weighs in at about 55 pounds. Anorexia is a medical enigma. Although there is little concrete evidence of what actually causes anorexia, most experts agree that there are several contributing risk factors. We believe that awareness of these risk factors can reduce the odds that they will be triggered so we are hopeful that this information will save lives. If you're a parent or a teacher, you need to read on'

Word has it around town that Katie had been told by a high school teacher that "she needed to go on a diet." So she did. Certainly this one comment didn't cause this young lady to spin out of control with dieting but it might have been the straw that broke the camel's back. Negative comments about body type and size from authority figures, teachers, coaches and parents, can have a big impact on an adolescent child's self-esteem and are implicated as possible triggers in studies on anorexia. Never underestimate the power of the spoken word to heal' or kill'

Eating disorders (bulimia and anorexia) have historically been considered a girl problem but the pendulum is swinging. Anorexia is being diagnosed more frequently in boys, too. Young boys are becoming more body image conscious than in previous generations. Case in point: my nine-year-old son has come home from school upset on several occasions because kids have called him fat. He is far from fat; in fact, he has cystic fibrosis so we are grateful for any extra padding he has and work very hard to keep his weight as high as possible. His diet is exactly the opposite of what everyone else is eating, filled with high fat, high calorie foods. Jacob understands the importance of complying with his dietary requirements but it can be hard for him to go against the norm.

With the emphasis on childhood obesity and diabetes, children are thankfully becoming more aware of the necessity of good nutrition and weight control. But I wonder if there is a price to be paid by children who are predisposed to eating disorders. With the media, parents, doctors, schools and peers emphasizing being thin and high achieving, it will be unfortunate if the numbers of children diagnosed with anorexia accelerates.

The difficulty lies in knowing which children are predisposed to eating disorders. As our society addresses the obesity issue, are we unknowingly putting some children at risk for eating disorders? How can we address the very real, very troublesome problems associated with the alarmingly increasing body mass index of our young children without triggering other children's potential for becoming anorexic?

This is a problem every parent of every child should consider. Research shows that about 6% of young people suffer from an eating disorder and this figure is thought to be low. The next time you are at a school assembly, look around. There are likely to be at least 10 kids there who have an eating disorder. One of them may even be your own. It is thought that the "anorexic mentality" is in place long before there is physical evidence of the disease. Has your thirteen -year-old been on a diet lately? Stats say that there is an 80% likelihood that she has been. Dieting at a young age puts children at risk for anorexia.

The cause of an eating disorder in any one child is unclear because multiple factors appear to play a role. Genetic factors, family interaction patterns, and the individual's own character and personality have all been implicated. But to summarize the problem in a single sentence, it appears that the illness is a response to coping with stress in genetically predisposed children who are filled with denial about their feelings and weight. There! Quick, short, concise, and anything but simple. This single sentence has many implications for parents and parenting. Let's take a brief look at each of these contributing factors individually and provide parenting responses that might be helpful in combating eating disorders.

1. The Genetic Factor in Eating Disorders

Eating disorders, like many other behavioral illnesses, appear to run in families. Not only does the illness itself run in families but the predisposing temperament seems to as well. The one good thing about illnesses that run in families is the fact that children can be prepared to recognize warning factors prior to the onset of the problem. When children are forewarned, they are forearmed. This forewarning is best carried out in a heart-to-heart discussion about possible future problems. A loving parent, relative, or counselor can initiate dialogue before the child is an adolescent, in an informative, non-hand-wringing and factual manner that indicates a hopeful outlook for a healthy future.

2. Anorexia and Bulimia as a Way of Coping with Stress

Food and emotions are closely linked. Over- and under-eating change brain chemicals that affect anxiety and depression. They are both often unhappy and ineffective ways of coping with stress. An authority on anorexia recently noted that a child's inherent vulnerabilities "load the gun," and environmental stresses "pull the trigger." So, assuming inherent vulnerabilities like genetics are unchangeable, how can we avoid pulling the trigger? Is it possible that we can use parenting techniques that will reduce the odds of pulling the trigger?

We believe the answer is yes. We can easily use parenting techniques that excel at raising children who effectively learn to cope with stress in healthy ways. Such techniques include guiding children to solve their own problems rather than solving them for them, allowing children to experience the consequences of their decisions, and responding to children's mistakes with empathy and understanding rather than anger, frustration, and criticism. These are great immunizations against the use of food as a dysfunctional coping response. The experience of coping and overcoming difficulties with good problem-solving skills leads to the ability to confront feelings and issues in a healthy manner, rather than displacing them with changes in food intake. Also, the child's history of successfully coping with painful outcomes of poor choices makes denial much less likely. And, when a child's mistakes are met with empathy and understanding rather than anger and frustration, a child feels supported and understood rather than criticized, demeaned and alone.

3. Psychological Factors in Eating Disorders

Two personality factors have often been reported to be present in eating disorders: perfectionism and high, unrealistic expectations of self. Even when anorexic adults have achieved success, deep down they report feeling insecure and inadequate. There is a tendency to see things only in extremes without shades of gray:

"I'm good or I'm bad."
"I'm pretty or I'm ugly."
"I'm successful or a complete failure."
"I'm perfect or defective."
"I'm fat or I'm thin."

Healthy parenting techniques discourage this type of thinking. Parents: don't over-reassure your children. Over-reassurance actually validates the child's negative thinking and may lead to unhealthy "either/or" black-and-white thinking. Responding with, "Gee, honey, I see it differently, but tell me how you are no good," allows for less manipulation, more acceptance of responsibility, and a child's far more accurate self-examination. Using encouragement rather than praise is also an important parenting technique to increase children's self-awareness. Encouragement gives them experience in viewing themselves, their responses, and their creations realistically, rather than simply trying to please an authority figure. With this simple tool, parents can easily help children learn how to feel good from the inside out rather than looking for approval and self-worth from authority figures.

4. The Role of the Family

There are a number of family factors that are thought to play a role in eating disorders. As we look at some of these interaction factors, it is safe to say that while healthy parenting patterns certainly will not cause or aggravate the problem, they may not be able to alleviate the problem either. Loving, effective parents are known to have had children suffering depression, suicide, and eating disorders. Also, this discussion on parenting styles should not be used as a source of parental guilt but instead provide motivation for change if change is needed. Parents do the best they can, under the circumstances they experience, to raise their children with the love they are able to show. The problem in examining family patterns lies with the fact that all sorts of dysfunctional patterns have been reported. These form a long list:

- Smothering and over-protective families
- Controlling and critical parents
- A chronic feeling of being abandoned and misunderstood
- Having parents or a family that overemphasize appearance and achievement
- Having rigid parents who don't model good conflict resolution skills

The effect of unintentional, yet unhealthy, parental responses cannot be ignored. Again, good parenting techniques do not guarantee success, but at least they are unlikely to contribute to the problem. So rather than focusing on what is speculatively wrong, it is more effective to focus on doing what is right by using healthy parenting skills rather than the unhealthy ones that contribute to dysfunctional family patterns. Whether or not an eating disorder is present, or may be present in the future, it will never hurt for parents to show healthy responses and good parenting techniques.

5. Societal Influences

Finally, there are possible societal factors that influence eating disorders. Big drinks and big burgers have enticed the population into a diabetic frenzy. While most of the population is downright overweight, the females that populate the media (those who model prettiness and good looks) are generally thin to the point of appearing anorexic themselves. Talk about image confusion! On the male side of the equation, we have the same issue with buff men cavorting playfully with thin, pretty women.

With so much emphasis in our culture on athletic performance and good looks, it is not too surprising that some predisposed children take things too far. And, although on the surface it seems reasonable enough to blame society for the self-destructive choices of an individual, this is ultimately self-defeating when dealing with individual situations. Blaming society or others simply removes individual responsibility and accountability and actually increases the likelihood of the negative behavior.

In conclusion, when all is said and done, nobody, at this point, can say with any certainty the exact cause of an eating disorder in any one particular child. But we can say with absolute certainty that all the speculation, studies, reports, and conjecture do not implicate the healthy family interaction patterns taught by Love and Logic. It would appear the personality of the anorexic person is not that of children who have grown up in a home advocating honest acceptance of personal responsibility and where children are:

- Lovingly supported by parents who view mistakes as learning experiences,
- Allowed to make choices and share control,
- And encouraged to cope with the stresses of life in healthy ways.

An ounce of prevention is worth a pound of cure particularly where eating disorders are concerned. At this time, there is no cure for anorexia. And America's children are dying to lose weight.