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A Time for Resolutions: Healthy Body Images
Editorial
www.jpedhc.org
A Time for Resolutions: Healthy Body Images Bobbie Crew Nelms, PhD, RN, CPNP By now we are all settling into the new year. I have always found the beginning of a new year an exciting time— one full of new opportunities, a time to plan new things. For me it’s also a time to clean—to get rid of clutter, both in my mind and physical space. And, of course, it’s a time for resolutions. Unfortunately, by the time you read this, many of us will find we have already broken those resolutions. One I hope we can work on together is helping children, particularly young girls, have positive body images. As we all know from our education and clinical experiences, a positive self-view is one of the most important aspects of positive psychological development. Whether we like it or not, a critical component of positive self-esteem is a positive body image. One of my concerns as we tackle the childhood overweight and obesity issue is that we must be sure we do not go to the opposite extreme, making all chil-
dren think they must be super-thin to be OK. I realize that some of my concerns about this focus on thin-ness come from living in Southern California. Recently I had to spend a day in bed, so I watched lots of television. I counted ads and public service announcements for 2 hours; 1 hour in the morning and 1 in the early evening. I counted three public service announcements about the problems of childhood obesity. I thought they were well done and gave a good message to parents and children. However, during the same time frame, there were five ads for various diets and diet supplements, two for weight-loss surgery, and two for health clubs focusing on the link between exercising and losing weight. During the majority of these ads, the “after,” or successful outcome, of these various products, procedures, or activities was shown to be a very thin man or woman; not an individual of normal weight.
J Pediatr Health Care. (2007). 21, 1-2. 0891-5245/$32.00 Copyright © 2007 by the National Association of Pediatric Nurse Practitioners. doi:10.1016/j.pedhc.2006.09.005
Journal of Pediatric Health Care
This is what concerns me; we need to help children learn what normal healthy bodies look like, not those of the super-thin models on television and in magazines. Making a change in the way bodies are portrayed on television or in the fashion magazines is a major challenge. It will not be easy, but that doesn’t mean we can’t work to modify what is seen as normal or healthy. Another major influence on children’s body image is one on which we have more direct influence: the parents of the children we see. Parents are a major determinant of children’s body image; from birth on, parents are looking and commenting about their child’s body. These looks, comments, and behaviors over time are a powerful influence on the child’s self-view. It is hoped that these parental views will be good ones and that as a result the child will develop a positive body image. Unfortunately, that is not always the case. Many parents today, especially mothers but fathers too, do not like their own bodies, and they transmit this message to their children who then learn not to like their bodies either. In my clinical and personal experience, it seems like we can classify the “problem” body images into two groups. First, there are the obese families in which both parents and their children are obese and for the most part do not see it as a problem. Parents often seem shocked or unconcerned when told their child is obese and that he or she may face current or future health problems as a result. These families, as you all know, are a challenge to counsel because first you need to help them see that the whole family has a problem, and denial can be very strong. One interesting aspect of this type of family is that the children may not have a negative body image. The January/February 2007
1
child usually does not receive negative feedback about his or her body at home, though it may come from other children at school. Thus, one challenge with this type of family is that as we make them aware of the obesity problem, we may also trigger in the child the beginning of a negative body image. We must be careful not to link the concepts of bad and good with high and lower weight or body mass index (BMI). The numbers may be good or bad, but not the child who has them! We must work to protect or develop positive body image as we help such families take on the challenge of overweight or obesity. The second challenging type of family, one I frequently see here in Southern California, is the one with parents who are very focused on their weight and appearance and project this concern onto their children. Unfortunately, parents who do not like their bodies and are constantly on a diet are being role models for their children. The children can learn very unhealthy views about their bodies. They can learn to judge themselves as good or bad based on what the scale says or how they look in a particular pair of jeans. The parents may think they are only focusing on their own body issues, but the child living in that environment learns the message. Parents may comment to themselves making statements like, “Oh, I look fat today,” or, “I’d better skip breakfast to get into that outfit”; they are talking to themselves, but the child is listening and learns to equate weight and self-worth. Thus, the child may learn to copy the parents’ behaviors. In such an envi-
2
Volume 21 • Number 1
ronment, the child may learn how to manage weight by healthy eating, but he or she can also learn binging, purging, or other negative behaviors. Even if the child learns positive eating patterns and activities, it is the message about the self that can be negatively affected, not just now, but forever. The child learns to evaluate his or her sense of self purely by appearance or weight. Families can be well into one of these scenarios when we see them in the clinical setting. Thus, as we focus on the child’s weight, BMI, and overall health, we must also remember to consider psychological state, or how the child feels about his or her body. As we know, tackling the problem of childhood and overweight requires a family approach. Indeed, the National Association of Pediatric Nurse Practitioners’ Healthy Eating and Activity Together (HEAT) Clinical Practice Guideline (2006) fully emphasizes a family approach to prevent overweight in children. Thus, it may be important to explore parents’ attitudes and beliefs about their own health status and weight. Such conversations may need to be done without the child present. Then the clinician can openly discuss parents’ concerns and issues about their own body image as well as the child’s. This can be a time to share with parents how their own views about their body can affect how their child evaluates his or hers. I believe that most parents do not want to hurt their child’s developing self-esteem, but they may not be aware of what negative messages they are communicating. To me, normal weight for a child is
not enough; I want the child to feel good about his or her body too. . .to like the weight achieved or maintained not because of some number, but because of the ability to ride a bike longer or swim faster or play longer without fatigue. I want children to like their bodies, which is an important aspect of liking themselves. Thus, one resolution I have for this year (and future ones) will be to help promote positive body image in children along with working to prevent overweight in children. Just today at my health club’s child activity area, I heard a 3-year-old complain about her “fat butt” while she vigorously ran on a child’s treadmill. I was sure if I looked hard enough I’d find her mother running, trying to improve her derrière as well; probably thinking, if not making, the same statement as her daughter. To me that was sad; I want that little girl to run because it feels good. I want her to like her body and know how to make it work well for her. I believe we can help children and their parents develop more positive views about their bodies, and that will help them be more psychologically healthy in the future. Child overweight and obesity is an epidemic, but we want to be sure we do not harm the sense of self in our efforts to improve physical health. As nurses we have always focused on the total child, and I hope we will continue to do so. REFERENCE The National Association of Pediatric Nurse Practitioners. (2006). Healthy Eating and Activity Together (HEAT) Clinical practice guideline: Identifying and preventing overweight in childhood. Cherry Hill, NJ: author.
Journal of Pediatric Health Care
www.jpedhc.org
A Time for Resolutions: Healthy Body Images Bobbie Crew Nelms, PhD, RN, CPNP By now we are all settling into the new year. I have always found the beginning of a new year an exciting time— one full of new opportunities, a time to plan new things. For me it’s also a time to clean—to get rid of clutter, both in my mind and physical space. And, of course, it’s a time for resolutions. Unfortunately, by the time you read this, many of us will find we have already broken those resolutions. One I hope we can work on together is helping children, particularly young girls, have positive body images. As we all know from our education and clinical experiences, a positive self-view is one of the most important aspects of positive psychological development. Whether we like it or not, a critical component of positive self-esteem is a positive body image. One of my concerns as we tackle the childhood overweight and obesity issue is that we must be sure we do not go to the opposite extreme, making all chil-
dren think they must be super-thin to be OK. I realize that some of my concerns about this focus on thin-ness come from living in Southern California. Recently I had to spend a day in bed, so I watched lots of television. I counted ads and public service announcements for 2 hours; 1 hour in the morning and 1 in the early evening. I counted three public service announcements about the problems of childhood obesity. I thought they were well done and gave a good message to parents and children. However, during the same time frame, there were five ads for various diets and diet supplements, two for weight-loss surgery, and two for health clubs focusing on the link between exercising and losing weight. During the majority of these ads, the “after,” or successful outcome, of these various products, procedures, or activities was shown to be a very thin man or woman; not an individual of normal weight.
J Pediatr Health Care. (2007). 21, 1-2. 0891-5245/$32.00 Copyright © 2007 by the National Association of Pediatric Nurse Practitioners. doi:10.1016/j.pedhc.2006.09.005
Journal of Pediatric Health Care
This is what concerns me; we need to help children learn what normal healthy bodies look like, not those of the super-thin models on television and in magazines. Making a change in the way bodies are portrayed on television or in the fashion magazines is a major challenge. It will not be easy, but that doesn’t mean we can’t work to modify what is seen as normal or healthy. Another major influence on children’s body image is one on which we have more direct influence: the parents of the children we see. Parents are a major determinant of children’s body image; from birth on, parents are looking and commenting about their child’s body. These looks, comments, and behaviors over time are a powerful influence on the child’s self-view. It is hoped that these parental views will be good ones and that as a result the child will develop a positive body image. Unfortunately, that is not always the case. Many parents today, especially mothers but fathers too, do not like their own bodies, and they transmit this message to their children who then learn not to like their bodies either. In my clinical and personal experience, it seems like we can classify the “problem” body images into two groups. First, there are the obese families in which both parents and their children are obese and for the most part do not see it as a problem. Parents often seem shocked or unconcerned when told their child is obese and that he or she may face current or future health problems as a result. These families, as you all know, are a challenge to counsel because first you need to help them see that the whole family has a problem, and denial can be very strong. One interesting aspect of this type of family is that the children may not have a negative body image. The January/February 2007
1
child usually does not receive negative feedback about his or her body at home, though it may come from other children at school. Thus, one challenge with this type of family is that as we make them aware of the obesity problem, we may also trigger in the child the beginning of a negative body image. We must be careful not to link the concepts of bad and good with high and lower weight or body mass index (BMI). The numbers may be good or bad, but not the child who has them! We must work to protect or develop positive body image as we help such families take on the challenge of overweight or obesity. The second challenging type of family, one I frequently see here in Southern California, is the one with parents who are very focused on their weight and appearance and project this concern onto their children. Unfortunately, parents who do not like their bodies and are constantly on a diet are being role models for their children. The children can learn very unhealthy views about their bodies. They can learn to judge themselves as good or bad based on what the scale says or how they look in a particular pair of jeans. The parents may think they are only focusing on their own body issues, but the child living in that environment learns the message. Parents may comment to themselves making statements like, “Oh, I look fat today,” or, “I’d better skip breakfast to get into that outfit”; they are talking to themselves, but the child is listening and learns to equate weight and self-worth. Thus, the child may learn to copy the parents’ behaviors. In such an envi-
2
Volume 21 • Number 1
ronment, the child may learn how to manage weight by healthy eating, but he or she can also learn binging, purging, or other negative behaviors. Even if the child learns positive eating patterns and activities, it is the message about the self that can be negatively affected, not just now, but forever. The child learns to evaluate his or her sense of self purely by appearance or weight. Families can be well into one of these scenarios when we see them in the clinical setting. Thus, as we focus on the child’s weight, BMI, and overall health, we must also remember to consider psychological state, or how the child feels about his or her body. As we know, tackling the problem of childhood and overweight requires a family approach. Indeed, the National Association of Pediatric Nurse Practitioners’ Healthy Eating and Activity Together (HEAT) Clinical Practice Guideline (2006) fully emphasizes a family approach to prevent overweight in children. Thus, it may be important to explore parents’ attitudes and beliefs about their own health status and weight. Such conversations may need to be done without the child present. Then the clinician can openly discuss parents’ concerns and issues about their own body image as well as the child’s. This can be a time to share with parents how their own views about their body can affect how their child evaluates his or hers. I believe that most parents do not want to hurt their child’s developing self-esteem, but they may not be aware of what negative messages they are communicating. To me, normal weight for a child is
not enough; I want the child to feel good about his or her body too. . .to like the weight achieved or maintained not because of some number, but because of the ability to ride a bike longer or swim faster or play longer without fatigue. I want children to like their bodies, which is an important aspect of liking themselves. Thus, one resolution I have for this year (and future ones) will be to help promote positive body image in children along with working to prevent overweight in children. Just today at my health club’s child activity area, I heard a 3-year-old complain about her “fat butt” while she vigorously ran on a child’s treadmill. I was sure if I looked hard enough I’d find her mother running, trying to improve her derrière as well; probably thinking, if not making, the same statement as her daughter. To me that was sad; I want that little girl to run because it feels good. I want her to like her body and know how to make it work well for her. I believe we can help children and their parents develop more positive views about their bodies, and that will help them be more psychologically healthy in the future. Child overweight and obesity is an epidemic, but we want to be sure we do not harm the sense of self in our efforts to improve physical health. As nurses we have always focused on the total child, and I hope we will continue to do so. REFERENCE The National Association of Pediatric Nurse Practitioners. (2006). Healthy Eating and Activity Together (HEAT) Clinical practice guideline: Identifying and preventing overweight in childhood. Cherry Hill, NJ: author.
Journal of Pediatric Health Care