Dieting is making teens sick. The Canadian Paediatric Society says it’s time to push back
Bronwyn Black always felt like a happy and confident child — until she turned 13 and, for the first time, started to feel insecure about her body.
“I kind of innocently, I think, started to look into how could I lose a little bit of weight. And it really did start so innocently. You know, what's healthy? What's this recipe swap on Pinterest that has grapes instead of X?” Black, 24, told CBC News.
“That's how it started. And it just snowballed so quickly.”
For the rest of her adolescence, Black struggled with various forms of disordered eating. She was deluged with social media content that equated thinness with health, and drew a hard line between “good” and “bad” food. When she sought help from her family doctor, she was dismissed.
It’s a problem the Canadian Paediatric Society (CPS) says has only gotten worse. That’s why they’ve issued updated guidelines stressing that “dieting during adolescence can have serious and lasting physical and mental health consequences” and urging health-care providers to “move away from weight-focused care.”
‘The message on social media is that thin is ideal’Dr. Alene Toulany, co-author of the new CPS guidance, says there was a time where society seemed to be shifting away from diet culture and towards body positivity.
But that, she says, is no longer the case.
“Young people are using and consuming a lot of social media, and the message on social media is that thin is ideal," she told As It Happens host Nil Köksal. "It's constant messaging."
That messaging, she says, is reinforced at school by peers, at home by parents, and in some cases, in the health-care system by doctors.
Eating disorders among young people in Canada began to spike during the early part of the pandemic, according to the National Eating Disorder Information Centre (NEDIC). At one point, the volume of calls to its health line and chat service increased 100 per cent.
The CPS estimates that one third of Canadian girls aged 10 to 14 have dieted, and that by Grade 8, more than half of young people have attempted to lose weight.
That’s worrying, Toulany says, because dieting is dangerous, especially for adolescents whose brains and bodies are still developing.
Dieting — defined as restricting or modifying food intake with the goal of changing one’s body — can interrupt puberty and growth, and cause nutritional deficiencies, menstrual irregularities, and decreased bone density, she said.
Adolescent dieting is also a major risk factor for developing dangerous eating disorders, and is linked to a greater risk of suicidal behaviour in adulthood, the CPS says.
“When a young person isn't eating enough, it impacts how they feel about themselves and how they show up in the world,” Toulany said.
What is health at every size?Toulany is an adolescent medicine specialist at the Hospital for Sick Children in Toronto who works in the fields of obesity and disordered eating.
In both fields, she says, she takes what’s known as a “health at any size” approach to care. The CPS guidelines urges other health-care providers to do the same.
That means taking a broader view of health that goes beyond the number on the scale.
“A person's [ideal] weight is whatever weight they can achieve by doing safe, sustainable, healthy behaviours and also enjoying life,” Toulany said.
It also means letting go of the idea that there’s good and bad food.
“All foods belong in our diet. And there are some that we have more of, those are the healthy foods that we typically think of, but then the treat foods or unhealthy foods. Those fun foods also have a place in our diets,” she said. “Young people need to hear that message.”
The guidelines urge health-care professionals to routinely screen youth who have shown changes in their eating habits for disordered eating — regardless of their weight — and connect them to the help they need.
The idea, Toulany says, is to stop kids who are struggling from slipping through the cracks because they don’t look a certain way.
Gatekeeping by family physiciansThat’s what happened with Black when, at the urging of her parents, she told her primary care physician about her struggles back when she was 13 and her obsession with regulating her food intake was starting to impact her life.
They put her on a scale and determined her weight wasn’t below a dangerous threshold.
“The feedback that I received was a little bit to the tune of, ‘It's a phase.’ They asked about side effects. I had noted that I had lost my period in this and they kind of said, ‘OK, we’ll give you some iron pills,” she said. “And that was it.”
She wouldn’t seek help again until her early twenties. She now thinks of that experience as a form of medical gatekeeping.
“If you want any level of help or care that could be publicly funded, you have to go through your primary care physician to get that referral, to get that diagnosis, to get those initial assessments,” she said.
“But it takes them being able to recognize this disorder beyond just looking at one number.”
Aryel Maharaj, a psychotherapist and community educator with NEDIC, says primary care doctors are not always well-educated on the signs and dangers of disordered eating.
But they are well aware that weight is a risk factor for several health conditions, including diabetes, high blood pressure and heart disease.
“It’s natural, then, that a health-care provider hearing all this worry about weight potentially [would be] really worried about that, and want to be preventative with that,” he said.
“But what we’ve found, unfortunately, is that the weight focus in health care might mean that a person who’s affected [by disordered eating won’t] feel comfortable taking this to their health care provider … thinking that they’re going to get stigmatized.”
Help is availableBlack says she’s doing a lot better lately. She just finished a master’s degree in public health, and she works with NEDIC to share her story for the next generation.
But she’s not sure if she’ll ever be fully recovered.
“I don't think that voice [in my head] will ever fully go away,” she said.
She worries about kids today, who are exposed to even more anti-fat messaging online than she was.
“Something that's quite damaging about the body talk and diet talk is it can feel like an ocean and sometimes even feel like a tsunami of messages and information,” she said.
“It's too easy to fall down that wormhole. And not only fall down, but I think that more and more of this narrative is being pushed that smaller is better and smaller is healthy.”
She wants young people to know there are alternatives, including the NEDIC hotline.
“I would advise anyone who thinks that they may be struggling in any capacity to know that thinking you're struggling is enough ... and you're worthy of help,” she said.
“There are a myriad of resources out there.”
If you or someone you know is struggling with disordered eating, here's where to look for help:
cbc.ca
