Chapter 4Body Image and

Eating Disturbancesin Children and Adolescents

Marilyn Massey-Stokes, EdD, CHES, Marilyn Massey-Stokes, EdD, CHES, FASHAFASHA

Texas Tech UniversityTexas Tech University

Learning Objectives

After completing this chapter, you should After completing this chapter, you should have an understanding of:have an understanding of:

1.1. body image disturbances and their body image disturbances and their prevalence among children and adolescentsprevalence among children and adolescents

2.2. eating disturbances and their prevalence eating disturbances and their prevalence among children and adolescentsamong children and adolescents

3.3. the connection between eating disorders and the connection between eating disorders and other risk behaviors &psychological other risk behaviors &psychological disordersdisorders

Learning Objectives

4.4. risk and protective factors for body image risk and protective factors for body image and eating disturbancesand eating disturbances

5.5. promoting healthy body image and promoting healthy body image and preventing eating disturbances among preventing eating disturbances among youth youth

6.6. the application of Social Development the application of Social Development Strategy in the health promotion and Strategy in the health promotion and prevention processprevention process

Eating Concerns and Weight Issues for Children and Youth

• American children as young as age 6 are American children as young as age 6 are dissatisfied with their body shapes or dissatisfied with their body shapes or weights. weights.

• Children as young as 8 or 9 are dieting.Children as young as 8 or 9 are dieting.• Approximately 9 million American children Approximately 9 million American children

are classified as obese.are classified as obese.

Eating Concerns and Weight Issues for Children and Youth

• Among American HS students, 30% of girls Among American HS students, 30% of girls and 16% of boys engage in disordered and 16% of boys engage in disordered eating behaviors (e.g., bingeing, vomiting, eating behaviors (e.g., bingeing, vomiting, fasting, laxative and diet pill use, and fasting, laxative and diet pill use, and compulsive exercise).compulsive exercise).

• Body image and eating disturbances affect Body image and eating disturbances affect the “whole child” (physically, mentally, the “whole child” (physically, mentally, emotionally, socially, spiritually).emotionally, socially, spiritually).

Continuum of Eating Problems

• The triad of body image difficulties, eating The triad of body image difficulties, eating disorders, and obesity are an interrelated set disorders, and obesity are an interrelated set of body weight and shape disturbances.of body weight and shape disturbances.

• Eating problems are often viewed on a Eating problems are often viewed on a continuum, beginning with body continuum, beginning with body dissatisfaction and weight concerns and dissatisfaction and weight concerns and ending with clinical eating disorders.ending with clinical eating disorders.

Definitions

• ““Eating disorders” refers to anorexia nervosa and Eating disorders” refers to anorexia nervosa and bulimia nervosa.bulimia nervosa.

• ““Eating disturbances” and “disordered eating” are Eating disturbances” and “disordered eating” are broader terms, referring to a range of unhealthy broader terms, referring to a range of unhealthy behaviors such as obsession with body weight and behaviors such as obsession with body weight and shape, excessive restrictive eating, skipping meals, shape, excessive restrictive eating, skipping meals, laxative & diet pill use, cycles of binge eating and laxative & diet pill use, cycles of binge eating and dieting, self-induced vomiting, and excessive dieting, self-induced vomiting, and excessive exercise for purging calories.exercise for purging calories.

Purpose of Chapter

• Present an overview of some of the key Present an overview of some of the key findings concerning body image and eating findings concerning body image and eating disturbances in children and adolescents.disturbances in children and adolescents.

• Discuss viable avenues for promoting Discuss viable avenues for promoting healthy body image and preventing eating healthy body image and preventing eating disturbances among this population. disturbances among this population.

Body Image

• Subjective depiction of physical appearanceSubjective depiction of physical appearance• Comprised of behavioral, perceptual, Comprised of behavioral, perceptual,

cognitive, and affective experiencescognitive, and affective experiences• Numerous studies have shown a connection Numerous studies have shown a connection

between body image disturbances (BID) between body image disturbances (BID) and low self-esteem, psychosocial distress, and low self-esteem, psychosocial distress, and early-onset depression. and early-onset depression.

Body Image

• The relationship between body image The relationship between body image dissatisfaction and BID has been strongly dissatisfaction and BID has been strongly linked to eating disorders such as anorexia linked to eating disorders such as anorexia nervosa and bulimia nervosa.nervosa and bulimia nervosa.

• As age increases, ideal body size generally As age increases, ideal body size generally becomes progressively thinner. becomes progressively thinner.

Body Dissatisfaction

• High numbers of Caucasian American High numbers of Caucasian American children experience body dissatisfaction.children experience body dissatisfaction.

• There is evidence that body dissatisfaction There is evidence that body dissatisfaction may be increasing among girls in minority may be increasing among girls in minority ethnic groups (e.g., African Americans and ethnic groups (e.g., African Americans and Mexican Americans).Mexican Americans).

Developmental Trends

• There are developmental trends in body There are developmental trends in body image and weight concerns, and these image and weight concerns, and these trends vary by gender and across ethnic trends vary by gender and across ethnic groups. groups.

• These trends are important because there is These trends are important because there is evidence that body dissatisfaction in young evidence that body dissatisfaction in young girls can lead to eating problems and early-girls can lead to eating problems and early-onset depression later.onset depression later.

Assessing Body Image

• Most researchers focus on two separate Most researchers focus on two separate components of BID—perceptual body-size components of BID—perceptual body-size distortion and the affective (attitudinal) aspect. distortion and the affective (attitudinal) aspect.

• PerceptualPerceptual body-size distortion is comprised body-size distortion is comprised of inaccurate perceptions of one’s body size of inaccurate perceptions of one’s body size (e.g., individuals with eating disorders often (e.g., individuals with eating disorders often overestimate their actual body size). overestimate their actual body size).

Assessing Body Image

• The The affectiveaffective element relates to element relates to dissatisfaction with one’s body size, shape, dissatisfaction with one’s body size, shape, or some other aspect of physical or some other aspect of physical appearance.appearance.

• Although most studies have focused on the Although most studies have focused on the distortion component, greater consistency distortion component, greater consistency has been found by using attitudinal has been found by using attitudinal measures.measures.

Assessing Body Image

• Body image is considered Body image is considered multidimensional.multidimensional.

• The assessment of BID requires a variety of The assessment of BID requires a variety of methods and techniques. methods and techniques.

• Instrument glossaries can help clarify terms Instrument glossaries can help clarify terms for youth.for youth.

Body Image Instruments

• Instruments should have sound Instruments should have sound psychometric properties (e.g., a test-retest psychometric properties (e.g., a test-retest reliability of a least .70) and be evidence-reliability of a least .70) and be evidence-basedbased

• Video distortion methods and custom Video distortion methods and custom computer software for measuring body size computer software for measuring body size estimations have been successfully used.estimations have been successfully used.

Research Questions

• How body dissatisfaction varies at different How body dissatisfaction varies at different ages for different genders and across ages for different genders and across different ethnic and socioeconomic groupsdifferent ethnic and socioeconomic groups

• The need to develop more accurate The need to develop more accurate measurements of body image, particularly measurements of body image, particularly in young children and adolescents from in young children and adolescents from various ethnic and socioeconomic groupsvarious ethnic and socioeconomic groups

Research Questions

• Developmental trends in body image Developmental trends in body image developmentdevelopment

• Whether childhood body dissatisfaction, Whether childhood body dissatisfaction, high body mass index, and eating high body mass index, and eating disturbances are risk factors for later disturbances are risk factors for later development of eating disorders, obesity, or development of eating disorders, obesity, or depression depression

Eating Disorders in Youth

• Clinically diagnosable eating disorders Clinically diagnosable eating disorders (EDs) are atypical among prepubescent (EDs) are atypical among prepubescent children.children.

• EDs rank as the third most common chronic EDs rank as the third most common chronic illness among adolescent females, with an illness among adolescent females, with an incidence of up to 5%.incidence of up to 5%.

Eating Disorders in Youth

• Eating disorders are related to other risk Eating disorders are related to other risk behaviors (e.g., tobacco use, alcohol and behaviors (e.g., tobacco use, alcohol and other drug abuse, sexual activity, and other drug abuse, sexual activity, and suicide attempts). suicide attempts).

• Eating disorders often lead to multiple Eating disorders often lead to multiple negative outcomes that affect the whole negative outcomes that affect the whole child.child.

Range of Health Consequences for EDs

• Preoccupation with eating that can Preoccupation with eating that can significantly hinder healthy growth and significantly hinder healthy growth and developmentdevelopment

• Severe malnutrition Severe malnutrition • OsteoporosisOsteoporosis• Acute psychiatric emergenciesAcute psychiatric emergencies• Heart and other organ damageHeart and other organ damage• DeathDeath

Death Rates from EDs

• Among the highest for any mental illnessAmong the highest for any mental illness

• For U.S. females ages 15-24, the mortality For U.S. females ages 15-24, the mortality rate among those with anorexia nervosa is rate among those with anorexia nervosa is approximately 12 times higher than the approximately 12 times higher than the death rate from all causes of death.death rate from all causes of death.

Eating Disorder Not Otherwise Specified (EDNOS)

• Patients who do not fully meet the DSM-IV Patients who do not fully meet the DSM-IV criteria for anorexia or bulimia, but criteria for anorexia or bulimia, but experience the same medical and experience the same medical and psychological consequences of these psychological consequences of these disordersdisorders

• The majority of adolescents in ED The majority of adolescents in ED treatment centers meet the EDNOS criteria.treatment centers meet the EDNOS criteria.

Warning Signs of EDNOS

• Unhealthy weight management practicesUnhealthy weight management practices• Obsessive thinking about food, weight, Obsessive thinking about food, weight,

shape, or exerciseshape, or exercise• Failure to maintain a healthy body Failure to maintain a healthy body

weight/composition for gender and ageweight/composition for gender and age

Consequences of Sub-Clinical EDs

• Considerable social and educational Considerable social and educational impairment that may require clinical impairment that may require clinical interventionintervention

• Significant interference with the Significant interference with the developmental needs and resilience of developmental needs and resilience of children and adolescentschildren and adolescents

Co-Existing Disorders

• DepressionDepression• Obsessive-Compulsive DisorderObsessive-Compulsive Disorder• AnxietyAnxiety• Bipolar DisorderBipolar Disorder• Personality DisordersPersonality Disorders• Substance AbuseSubstance Abuse• Self-MutilationSelf-Mutilation

Co-Existing Disorders

• In some cases, the eating disorder is a In some cases, the eating disorder is a secondary symptom to an underlying secondary symptom to an underlying psychological disorder.psychological disorder.

• Or, the psychological disorder may be Or, the psychological disorder may be secondary to the eating disorder. secondary to the eating disorder.

Treatment

• EDs should be addressed by a EDs should be addressed by a multidisciplinary team of medical, multidisciplinary team of medical, nutritional, mental health, and nursing nutritional, mental health, and nursing professionals who have expertise in child-professionals who have expertise in child-adolescent health and are experienced in adolescent health and are experienced in treating BID and EDs.treating BID and EDs.

Treatment

• Numerous barriers to proper care (e.g., Numerous barriers to proper care (e.g., inadequate health insurance benefits and inadequate health insurance benefits and resistance from patient and family)resistance from patient and family)

• Failure to detect an ED in its early stages Failure to detect an ED in its early stages can exacerbate the illness and make it much can exacerbate the illness and make it much more difficult to treat. more difficult to treat.

Risk and Protective Factors

• Risk factorsRisk factors (RF) are those conditions that (RF) are those conditions that increase the likelihood that an individual increase the likelihood that an individual will develop an eating problem.will develop an eating problem.

• Protective factorsProtective factors (PF) are those conditions (PF) are those conditions that mitigate the risk.that mitigate the risk.

4 Primary Categories of RF and PF

• BiologicalBiological• IndividualIndividual• FamilialFamilial• SocioculturalSociocultural

Biological Risk Factors

• Genetic predisposition to eating disordersGenetic predisposition to eating disorders• Mood disordersMood disorders• Neurochemical (e.g., serotonin) imbalancesNeurochemical (e.g., serotonin) imbalances• Early puberty Early puberty

Individual Risk Factors

• Negative body image & body dissatisfactionNegative body image & body dissatisfaction• Temperament (e.g., negative emotionality)Temperament (e.g., negative emotionality)• Personality characteristics (e.g., perfectionism)Personality characteristics (e.g., perfectionism)• Low self-esteemLow self-esteem• Inadequate coping skillsInadequate coping skills• Substance AbuseSubstance Abuse• Overweight/obesityOverweight/obesity

Familial Risk Factors

• EDs in first-degree biological relativesEDs in first-degree biological relatives• Maladaptive parental behaviors and Maladaptive parental behaviors and

dysfunctional family relationsdysfunctional family relations• Family pressure to adhere to the thin idealFamily pressure to adhere to the thin ideal• Alcohol misuseAlcohol misuse• Physical or sexual abuse (controversial)Physical or sexual abuse (controversial)

Sociocultural Risk Factors

• Societal glamorization of the thin idealSocietal glamorization of the thin ideal• Media exposure promoting thinnessMedia exposure promoting thinness• Peer influences promoting dieting and Peer influences promoting dieting and

adherence to the thin standard adherence to the thin standard

Protective Factors

• There is little research about protective There is little research about protective factors and how they may buffer individuals factors and how they may buffer individuals against developing eating disturbances and against developing eating disturbances and clinical EDs. clinical EDs.

• The primary protective factor that has The primary protective factor that has received the most empirical support is received the most empirical support is positive family relationshipspositive family relationships. .

Individual PFs

• High self-esteemHigh self-esteem• Self-directedness and assertivenessSelf-directedness and assertiveness• Ability to effectively cope with life Ability to effectively cope with life

stressorsstressors• Genetic predisposition for slimnessGenetic predisposition for slimness

Familial PFs

• Living in a family that does not Living in a family that does not overemphasize body weight and physical overemphasize body weight and physical attributesattributes

• Living in a family where parents do not Living in a family where parents do not misuse alcoholmisuse alcohol

• Social support from the familySocial support from the family

Sociocultural PFs

• Participation in sports that do not emphasize Participation in sports that do not emphasize thinness for successful performancethinness for successful performance

• Cultural messages that embrace different Cultural messages that embrace different body shapes and sizesbody shapes and sizes

• Close relationships with friends who do not Close relationships with friends who do not overstress body weightoverstress body weight

• Social support from peersSocial support from peers

Primary Prevention

• Primary prevention focuses on keeping body Primary prevention focuses on keeping body image and eating disturbances from developing image and eating disturbances from developing among children and adolescents. among children and adolescents.

• Programs must be age and developmentally Programs must be age and developmentally appropriate.appropriate.

• Programs should address the relevant skills and Programs should address the relevant skills and challenges for each stage of development.challenges for each stage of development.

• Prevention should begin at an early age (e.g., Prevention should begin at an early age (e.g., elementary school years). elementary school years).

Primary Prevention Strategies

• Development of positive self-esteem and Development of positive self-esteem and healthy body imagehealthy body image

• Development of essential life skills, Development of essential life skills, including social-emotional and effective including social-emotional and effective coping skillscoping skills

• Provision of experiences that encourage the Provision of experiences that encourage the development of self-efficacydevelopment of self-efficacy

Primary Prevention Strategies

• Skills training for lifelong balanced Skills training for lifelong balanced nutrition and physical activitynutrition and physical activity

• Opportunities to develop media literacy Opportunities to develop media literacy skills, and learn how to challenge skills, and learn how to challenge sociocultural myths and attitudes regarding sociocultural myths and attitudes regarding body shape and sizebody shape and size

• Positive youth developmentPositive youth development

Development of Positive Self-Esteem

• Self-esteem appears to be a significant Self-esteem appears to be a significant predictor of eating problems.predictor of eating problems.

• Branden defines self-esteem as possessing Branden defines self-esteem as possessing two components – two components – self-respect self-respect and and self-self-efficacy. efficacy.

Self-Respect

• An individual’s assurance of his/her value An individual’s assurance of his/her value and basic right to experience a fulfilling lifeand basic right to experience a fulfilling life

• Comfort in appropriately asserting thoughts, Comfort in appropriately asserting thoughts, wants, and needswants, and needs

• A caring adult can foster a child’s self-A caring adult can foster a child’s self-respect through increasing the individual’s respect through increasing the individual’s sense of sense of positive uniquenesspositive uniqueness..

Self-Efficacy

• A person’s belief or confidence that she/he A person’s belief or confidence that she/he can successfully accomplish a taskcan successfully accomplish a task

• A sense of competence (power) is A sense of competence (power) is foundational for sound mental and foundational for sound mental and emotional health.emotional health.

• It also is preventative against the It also is preventative against the development of negative body image and development of negative body image and eating problems. eating problems.

Fostering Self-Efficacy

Help youth develop Help youth develop health literacyhealth literacy::

• Effective communicationEffective communication• Self-directed learningSelf-directed learning• Critical thinking and problem solvingCritical thinking and problem solving• Responsible, productive citizenshipResponsible, productive citizenship

Fostering Self-Efficacy

• Goal setting (e.g., “baby steps”)Goal setting (e.g., “baby steps”)

• Opportunities for rehearsal of life skillsOpportunities for rehearsal of life skills

• Positive social supportPositive social support

The Family

• Families are a major health and social Families are a major health and social influence in the lives of youth.influence in the lives of youth.

• Family involvement is essential to the Family involvement is essential to the health promotion process.health promotion process.

• Positive, nurturing relationships are integral Positive, nurturing relationships are integral to family health. to family health.

The Family

Children can be taught:Children can be taught:• the value of eating healthy foods and being the value of eating healthy foods and being

physically active for health and wellnessphysically active for health and wellness• the importance of respecting different body the importance of respecting different body

typestypes• how to effectively communicate feelings how to effectively communicate feelings

and needsand needs

The Family

• All children, regardless of their weight and All children, regardless of their weight and size, should feel that they are size, should feel that they are unconditionally loved and accepted by the unconditionally loved and accepted by the family.family.

• If a family suspects that a child is engaging If a family suspects that a child is engaging in restrictive eating and/or other in restrictive eating and/or other maladaptive behaviors, they should seek maladaptive behaviors, they should seek help from a qualified professional.help from a qualified professional.

Family Involvement Through School-Based Health Promotion

• Provide information about puberty and adolescent Provide information about puberty and adolescent development.development.

• Provide information about healthy eating, and Provide information about healthy eating, and include strategies to promote healthy eating at include strategies to promote healthy eating at home.home.

• Address how parents feel about themselves in Address how parents feel about themselves in terms of their own body image, how they may terms of their own body image, how they may impart unhealthy thinking to their children, and impart unhealthy thinking to their children, and how they may be influenced by sociocultural how they may be influenced by sociocultural norms. norms.

Family Involvement Through School-Based Health Promotion

Families and schools can partner to foster Families and schools can partner to foster resilience in youth by:resilience in youth by:

• forming caring, nurturing relationshipsforming caring, nurturing relationships• communicating high expectationscommunicating high expectations• providing meaningful opportunities for providing meaningful opportunities for

youth to participate in pro-social activitiesyouth to participate in pro-social activities

Sociocultural Influences

• SchoolsSchools• PeersPeers• Health Care ProvidersHealth Care Providers• MediaMedia• Larger SocietyLarger Society

Schools

• Of all the factors that influence adolescent Of all the factors that influence adolescent health-risk behavior, the most critical are health-risk behavior, the most critical are the family and schools. the family and schools.

• Schools are logical venues for primary Schools are logical venues for primary prevention programs due to the large prevention programs due to the large number of children they serve.number of children they serve.

• Upper elementary appears to a viable age Upper elementary appears to a viable age with which to target interventions. with which to target interventions.

School-Based Prevention Programs

• Part of an overall CSHPPart of an overall CSHP• Based on lived experiences of participantsBased on lived experiences of participants• Include relational componentsInclude relational components• Coincide with developmental issuesCoincide with developmental issues• Designed for the stages of change for the Designed for the stages of change for the

participantsparticipants• Incorporate active, experiential, and peer-Incorporate active, experiential, and peer-

mediated formats mediated formats

Peers

• Peer groups that model pro-social values Peer groups that model pro-social values can serve as crucial protective factors. can serve as crucial protective factors.

• In a qualitative research study, positive peer In a qualitative research study, positive peer influences (e.g., being dissuaded from influences (e.g., being dissuaded from dieting or purging) protected high school dieting or purging) protected high school girls from excessive weight concerns that girls from excessive weight concerns that can lead to eating disturbances .can lead to eating disturbances .

Healthy Peers

• Do not place overemphasis on body weight Do not place overemphasis on body weight and sizeand size

• Value themselves and others for who they Value themselves and others for who they are on the inside (e.g., their spirit, character, are on the inside (e.g., their spirit, character, talents, and gifts)talents, and gifts)

• Challenge each other’s unrealistic thoughts Challenge each other’s unrealistic thoughts and self-defeating actions concerning body and self-defeating actions concerning body weight and sizeweight and size

Health Care Providers

• The role of health care professionals in The role of health care professionals in recognizing and preventing EDs is recognizing and preventing EDs is paramount. paramount.

• Why?Why?

Role of Health Care Providers

• Communicate important information to Communicate important information to children and their parents, including children and their parents, including strategies for healthy eating and physical strategies for healthy eating and physical activity to enhance health and quality of activity to enhance health and quality of life. life.

• Be careful when talking to families about Be careful when talking to families about childhood obesity.childhood obesity.

Role of Health Care Providers

• Help parents and children understand what to Help parents and children understand what to expect during various developmental stages, expect during various developmental stages, particularly puberty.particularly puberty.

• Contribute to primary prevention through school- Contribute to primary prevention through school- and community-based interventions that deliver and community-based interventions that deliver screenings and education. screenings and education.

• Participate in advocacy efforts aimed at changing Participate in advocacy efforts aimed at changing cultural norms that children and adolescents cultural norms that children and adolescents experience.experience.

Media

• Young people spend an average of nearly Young people spend an average of nearly

6 ½ hours a day with media.6 ½ hours a day with media.• Media literacy education is a valuable Media literacy education is a valuable

weapon against unrealistic body image weapon against unrealistic body image messages.messages.

Media Literacy Education

• Helps girls enhance their sense of self-Helps girls enhance their sense of self-acceptance and empowerment regarding acceptance and empowerment regarding media portrayal of female bodiesmedia portrayal of female bodies

• Teaches girls how to effectively counter Teaches girls how to effectively counter messages that promote unrealistic body messages that promote unrealistic body images and unhealthy eating images and unhealthy eating

Media Literacy Education

• An alarming gap exists in terms of reaching An alarming gap exists in terms of reaching prepubescent and younger girls with media prepubescent and younger girls with media literacy education.literacy education.

• Media literacy education should target Media literacy education should target different age groups of children and different age groups of children and adolescents, and hold relevance in terms of adolescents, and hold relevance in terms of the types of media each group uses. the types of media each group uses.

Pro-Ana and Pro-Mia Websites

• Promote disordered eating as a lifestylePromote disordered eating as a lifestyle• Offer dangerous and negative reinforcement for Offer dangerous and negative reinforcement for

youth who are practicing disordered eating or youth who are practicing disordered eating or thinking about doing sothinking about doing so

• Far outnumber that of professional or recovery Far outnumber that of professional or recovery sitessites

• A need to increase awareness among parents, A need to increase awareness among parents, health care providers, and other caring adultshealth care providers, and other caring adults

Sociocultural Changes

• How females are portrayed in the mediaHow females are portrayed in the media• Expectations regarding gender rolesExpectations regarding gender roles• Acceptance of a wide range of body Acceptance of a wide range of body

weights and shapesweights and shapes• Increased opportunities for healthy eating Increased opportunities for healthy eating

and physical activity, particularly in low-and physical activity, particularly in low-income neighborhoods income neighborhoods

4 “Toxic” Sociocultural Myths

1.1. Valuing image over substance (e.g., marketing Valuing image over substance (e.g., marketing extremely thin models as if they were normal)extremely thin models as if they were normal)

2.2. Denial of biological diversity of body sizes and Denial of biological diversity of body sizes and shapesshapes

3.3. Denial of the harmful effects of restrictive eating Denial of the harmful effects of restrictive eating for weight loss purposesfor weight loss purposes

4.4. Discounting the value of eating well and being Discounting the value of eating well and being physically fit physically fit

Resources

• The Model for Healthy Body Image - The Model for Healthy Body Image - www.BodyImageHealth.org. www.BodyImageHealth.org.

• BodyWiseBodyWise

http://4woman.gov/BodyImage/bodywise.cfmhttp://4woman.gov/BodyImage/bodywise.cfm• The National Eating Disorders Association The National Eating Disorders Association

www.edap.orgwww.edap.org

Positive Youth Development

• The Social Development Research Group The Social Development Research Group emphasizes the importance of a emphasizes the importance of a comprehensive approach to preventing comprehensive approach to preventing youth problem behaviors by addressing youth problem behaviors by addressing both risk and protective factors. both risk and protective factors.

• The framework for guiding the positive The framework for guiding the positive youth development process is Social youth development process is Social Development Strategy (SDS).Development Strategy (SDS).

Social Development Strategy

SDS focuses on the outcome of health-SDS focuses on the outcome of health-enhancing behaviors through exposing enhancing behaviors through exposing children and adolescents to two critical children and adolescents to two critical protective factors: protective factors:

1.1. pro-social bonding to family, school, and pro-social bonding to family, school, and peerspeers

2.2. healthy beliefs and clear standards for healthy beliefs and clear standards for behavioral normsbehavioral norms

Social Development Strategy

Mechanisms that help create these protective Mechanisms that help create these protective factors:factors:

• opportunities for meaningful participation in opportunities for meaningful participation in productive prosocial rolesproductive prosocial roles

• life skills to facilitate participation in these roleslife skills to facilitate participation in these roles• consistent systems of recognition and positive consistent systems of recognition and positive

reinforcement for prosocial involvementreinforcement for prosocial involvement• individual characteristics individual characteristics

Positive Youth Development Programs

• foster resiliencefoster resilience• promote healthy bondingpromote healthy bonding• promote social, emotional, cognitive, promote social, emotional, cognitive,

behavioral, and moral competenciesbehavioral, and moral competencies• foster self-determinationfoster self-determination• foster self-efficacyfoster self-efficacy• foster clear and positive identityfoster clear and positive identity

Positive Youth Development Programs

• cultivate spiritualitycultivate spirituality• foster belief in the futurefoster belief in the future• provide recognition for positive behavior provide recognition for positive behavior • provide opportunities for prosocial provide opportunities for prosocial

involvementinvolvement• foster prosocial norms (healthy standards foster prosocial norms (healthy standards

for behavior)for behavior)

Future Direction

• Which protective factors should be targeted Which protective factors should be targeted and enhanced to reduce the incidence of and enhanced to reduce the incidence of body image and eating disturbances among body image and eating disturbances among children and adolescents from different age children and adolescents from different age and ethnic groups?and ethnic groups?

• Which interventions are more effective – Which interventions are more effective – universal or targeted ones? universal or targeted ones?

Future Direction

• How long should interventions last, and How long should interventions last, and what are the most cost-effective what are the most cost-effective approaches?approaches?

• How can high-risk youth be reached, and How can high-risk youth be reached, and what interventions are most effective with what interventions are most effective with this group?this group?

• Directly compare promising prevention Directly compare promising prevention programs in randomized trials.programs in randomized trials.

Future Direction

• Explore the pathogenesis of early-onset Explore the pathogenesis of early-onset eating disorders.eating disorders.

• Enhance the current diagnostic system to Enhance the current diagnostic system to address the “unique spectrum of early-onset address the “unique spectrum of early-onset eating disorders and the development of eating disorders and the development of effective treatments for adolescent eating effective treatments for adolescent eating disorders.”disorders.”

Future Direction

• Research also is needed to determine Research also is needed to determine whether positive youth development whether positive youth development programs that employ SDS can produce programs that employ SDS can produce positive outcomes in terms of decreasing positive outcomes in terms of decreasing body image and eating disturbances among body image and eating disturbances among children and youth.children and youth.

Summary and Conclusion

• Body image and eating disturbances are highly Body image and eating disturbances are highly complex and wield a harsh blow to our nation in complex and wield a harsh blow to our nation in terms of health care costs, diminished quality of terms of health care costs, diminished quality of life, and tragic loss of life. life, and tragic loss of life.

• Parents, school personnel, health care providers, Parents, school personnel, health care providers, and entire communities can be effective change and entire communities can be effective change agents for the prevention of body image and agents for the prevention of body image and eating disturbances among children and eating disturbances among children and adolescents. adolescents.

Summary and Conclusion

• Health promotion efforts need to be multifaceted Health promotion efforts need to be multifaceted and encompass the whole child.and encompass the whole child.

• Prevention efforts should target interests, skills, Prevention efforts should target interests, skills, and challenges that are distinctive for particular and challenges that are distinctive for particular stages of development.stages of development.

• Even small changes have the capacity to produce a Even small changes have the capacity to produce a powerful ripple effect that can transform society. powerful ripple effect that can transform society.