School-based ‘healthy living’ programs triggering eating disorders in some children: Canadian study

School-based, obesity-prevention programs that push “healthy eating” are triggering disordered eating in some children, creating sudden neuroses around food in children who never before worried about their weight, Canadian researchers report.

In one case, a 14-year-old boy who was normal weight lost 11.5 kilograms over seven months after he began severely restricting food, cutting out “bad foods and junk foods” and limiting his intake of cheese, milk and meat in response to a “healthy living” program at his school.

“Healthy eating and weight initiatives have been incorporated into many schools to combat the growing obesity problem,” researchers from Toronto’s Hospital for Sick Children in Toronto and the Children’s Hospital of Eastern Ontario in Ottawa report.

“There is little research, however, on the effectiveness of these programs or any inadvertent harmful effects on children’s mental health.”

The researchers describe the cases of four children referred to hospital-based eating disorders programs after being exposed to “healthy eating curricula.”

“They were all affected by the idea of trying to adopt a more healthy lifestyle in the absence of significant pre-existing notions, beliefs or concerns regarding their own weight, shape or eating habits prior to the intervention,” the authors write in the journal, Eating Disorders.

In one case, a 13-year-old girl’s “progressive food restriction” began after a visiting dietitian talked to her class at length about what foods students should and should not be eating.

After class, the girl was determined to “eat healthier.” She began restricting fats and exercising compulsively. She lost so much weight she had to be hospitalized to stabilize her vital signs.

In another case, a 14-year-old, A-grade student with perfectionist tendencies decided he was going to be “the best” at following the healthy living program at school. He signed up for track and field and soccer and began exercising compulsively. He ate only chicken, fruit and vegetables in ever-shrinking portions and began reading food labels. He became so emaciated his worried parents took him to an emergency room. He was admitted to hospital with a diagnosis of “eating disorder not otherwise specified” — an eating disorder that doesn’t meet the official criteria for anorexia or bulimia.

“Often these are the kids who want to do good, who want to succeed at everything,” says first author Dr. Leora Pinhas, a child psychiatrist at Sick Kids and co-chair of the Growing Healthy Bodies working group of The Sandbox Project, a national think tank on child health.

“I’ve seen kids who had been the best student in their class and they were going to be ‘the best’ at this healthy lifestyle thing and so they did everything, and took it to the extreme.”

But equally vulnerable are children going through the normal, tumultuous transition of the early teen years, when girls especially tend to accumulate more body fat.

“They may be kids who feel badly about their bodies because they’re changing in ways that may not be completely ideal according to our cultural norms, and now they have motivation, or a ‘how-to’ for losing weight,” Pinhas says.

Children are being taught how to read and count calories and cut fat from their diets. “The programs present this idea that weight loss is good, that only thin is healthy,” Pinhas says.

“We live in a culture that stigmatizes fat people, and we’ve turned it into this kind of moralistic health thing.” Many schools now have “healthy food” rules, she said —”all these things you can’t bring to school anymore because they’re unhealthy,” including, in some cases, granola bars with chocolate chips.

“These are elementary schools. They tell parents, ‘If your child brings a granola bar with chocolate chips to school for their snack, they will be asked to put it away,’ ” Pinhas says. “Imagine a child in Grade 1. What are we saying to that child? We’re telling that child that it’s better to go hungry than to have a chocolate chip.”

“The teacher is giving the child the message that their parents have got it wrong in terms of how they’re feeding their child. And we’ve potentially embarrassed and humiliated that child in front of their peers,” she said. “We don’t know if that family is poor and that’s all the mom had in her cupboard to give her child. We don’t know if the child is a picky eater.”

While healthy-weight programs are intended to promote health, she’s not convinced they have a place in schools and has had her own children excused from them. “I think the intentions are good. But what do kids actually have control over, and when are we introducing these things? We’re talking to kids about buying food when it’s their parents who buy food,” she said.

“If we want schools to do something to improve the health of children, why don’t we have a national lunch program that provides every single child in the school with a healthy breakfast and a healthy lunch?”

There is no proof of cause and effect, Pinhas said. But, “these programs certainly were an important ingredient in the development of an eating disorder.”