Face food issues before it's too late

For a parent whose child is ultimately diagnosed with an eating disorder, there is typically an uh-oh moment of realization: ''My child is way too fat/thin. What's going on here?" Too often, that moment comes too late. The child's relationship with food is already an obsession. Intervention is painful and difficult, and recovery isn't a sure thing.

Here's the good news: Eating disorders almost always start with disordered eating, but disordered eating does not automatically lead to an eating disorder. ''This is not a runaway process," says psychologist Michael Strober, director of the Eating Disorder Program at UCLA. and author of ''just a little too thin" (DaCapo).

While each of the three major eating disorders -- anorexia nervosa, bulimia nervosa, and overeating -- can be dangerous in the extreme, each has a tipping point. ''It is possible to pull a child back from the brink," Strober says.

The trick is for parents to recognize the brink when they see it:

With anorexia, it's when a child, typically a 13- to 17-year-old girl, loses sight of her weight-loss goal and becomes exhilarated by her ability to not eat. You're at the tipping point when you say to her, ''Honey, you look wonderful, you've reached a good weight, now you just need to maintain it," and she says, ''Oh, just a little more. I feel so good." Or you notice that she hardly ever eats with the family; she's too busy studying to take a break. What further stymies parents is that weight gain often precedes puberty. Some self-consciousness about changing body shape, including wanting to be slimmer, is part of the territory. But is she intent on doing it by not eating, or is she open to other ideas, like exercise?

Bulimia tends to surface between 15 and 17 and involves cycles of bingeing -- eating an unusual amount at one sitting and purging, which is typically self-induced vomiting. Weight may fluctuate but because a girl continues to enjoy eating and there is no dramatic loss, it's harder to come to an uh-oh moment.

''It's almost always because a friend says something or because a parent happens to overhear her vomiting in the bathroom," says Cleveland psychologist Sylvia Rimm. Parents who wait, ''just to be sure," typically miss the tip-off. This is increasingly a problem with parents who have grown up in the same culture.

''They don't have the perspective to earmark this [as] a problem," says psychologist Sharna Olfman.

The definition of an overeater is a child who is ''always grazing," says Strober. ''There's no pattern or structure to the eating. It's continuous." If that's the norm in the family, and especially if other family members are also overweight, it may not even get noticed. When parents do notice, they may keep quiet, hoping a child will grow out of it, or nag or tease a child, unwittingly pushing him to eat more.

If these parents have an uh-oh moment, it's often because their child complains of being teased at school, or because there are changes in behaviors other than eating, for instance withdrawal from an activity. More likely, says Rimm, the pediatrician notices, or a visiting relative. Rimm is author of ''Rescuing the Emotional Lives of Overweight Children" (Rodale).

Only 25 to 40 percent of obesity is genetic. ''That means that more than 60 percent is environmental," such as the result of commercials that pitch fast food directly to children, says psychologist Katherine Horgen. ''The typical child sees 10,000 of them a year."

Even if there is no TV at home, ''If a child goes to school where there's Channel One, there's 2 minutes of commercials for every 10 minutes of news," Horgen says. ''Without fail, those ads are about unhealthy food." The message: ''Eat this and you'll have fun and be popular.' "

A specialist in public health and obesity, Horgen and her family moved six months ago to her hometown in Alabama. You could also say she moved to the belly of the beast: Alabama is one of only nine states in the country where more than 25 percent of the population is obese. One of the first things she noticed was that schools, elementary included, promote unhealthy eating habits with what insiders call ''pouring rights contracts": They agree to place junk food and soda machines in schools. In return, the food manufacturers fund programs the school district can't afford. Horgen wasted no time getting involved in efforts to educate parents and to eliminate the contracts.

''One way around it," she says, ''is to go to local merchants and ask for, say, $1,000 each, so that we can bypass the junk food companies, and put local names on a plaque that says they contributed to a healthy school."

At the first sign of disordered eating, a parent's instinct may be to restrain food or punish unhealthy eating. Horgen says that doesn't work: ''There's an underlying emotional component that pushes a child to turn to food as a coping mechanism." The future anorexic, for instance, may decide, ''I can't control who will be my friend, but I can control what I put in my mouth."

''As parents, it's better to figure out with a girl what is making her feel out of control," Horgen says. Just knowing she can talk about it can be enough to pull her back from the brink.

''The culture sends mixed messages that put girls in turmoil," says Olfman, who is editor of ''Childhood Lost, How America's Culture is Failing Our Kids" (Praeger), which includes an essay by Horgen. At the same time children see all those commercials about junk food, they also absorb a cultural value that glamorizes and idealizes thinness. Think Bratz and Barbie dolls, the female body shapes in any Disney film, or the images of women on magazine covers at the grocery check-out.

''On the one hand, a girl wants to be skinny to be popular," says Olfman. ''On the other hand, what's for lunch at the school cafeteria? What are all her friends eating?"

Psychiatrist David Herzog, director of the eating disorders unit at Massachusetts General Hospital, says 9 and 10 are ages when eating habits begin to solidify. Parents need to pay close attention. Olfman, the mother of a third-grader, already sees some preoccupation with eating and body shape among her daughter's classmates. Whether a girl is overweight or just thinks she is, that's the time to talk to her.

''But not about how she looks," says Olfman. ''About how healthy she is."

The message she wants parents to send is that if you have a good balance now between healthy eating and exercise, you're more likely to have a healthy body the rest of your life. Figure out together what you can do to make that happen. ''Help them to focus on the body for what it can do -- run, swim, skate -- rather than for what it looks like, and on what it takes to fuel it to do those things well," she says.

Horgen's daughter is only 3 1/2 but Horgen is already helping her to think about food in terms of what it can do to her body.

''I often ask her, 'What feels good in your tummy?' " she says.

Last week, after a party with cake and chips, her daughter's tummy didn't feel good. ''Cake and chips are fun to eat," Horgen told her. ''But tummies don't like to eat a lot of them. That's why they are once-in-a-while foods."