While eating disorders (EDs) are most often diagnosed in adolescence, and young adulthood, the foundations for their development begin in childhood, which makes early life ED prevention important.
Nonetheless, few policies have been designed and implemented with the purpose of ED prevention in children.
One reason for this is limited funding for ED prevention. Another is that when funding is allocated for ED prevention programs, the money is usually directed towards childhood obesity prevention programs instead. 5 This is because childhood obesity is perceived as a bigger, more dangerous problem than childhood eating disorders.
This is a misconception, however. EDs are both an individual and societal burden. 6 They reduce the productivity, health, and wellbeing of many individuals, with some cases resulting in death. On a societal level, treatment is expensive and often ineffective. For the 2018-2019 fiscal year alone, it was estimated that EDs cost the US nearly $400 billion in added economic burdens and reduced wellbeing.
We need ED prevention in childhood because the groundwork for disordered eating development begins during this time. Our early life environments help establish our relationships with food and how we think about our bodies.
Children learn acceptable eating behaviors, what foods are good or bad, and which body sizes are valued most through observing and modeling peers and family. 2 These interactions influence brain development and can contribute to ED development.
To better understand how our environments influence brain development, we can think of the brain as a lump of clay. During childhood, the clay is soft; this flexibility allows certain factors, like the environment, to influence how the brain is connected and how it functions. However, with age, the clay becomes less flexible, and we can no longer shape it as freely as we once could.
Like clay, the brain’s neural pathways become less flexible as we age. Consequently, pathways that are repeatedly shaped a specific way during childhood might stay that way in adulthood. 9 This is how psychological disorders can develop.
Recent research shows that parents who routinely and consistently teach and model food behaviors (i.e., discussing food habits) with their children might influence the relationships their children develop with food on a neurological level. 3 For example, overweight children with parents who teach and model food behaviors show higher brain activation in regions associated with reward when looking at food images than overweight children whose parents don’t discuss food behaviors with them. This suggests that neural circuits related to food relationships are flexible in childhood and that parents can influence how these circuits develop.
Brain-environment interactions are not a new finding. For example, studies show that specific maternal behavior patterns (i.e., poor child attachment) can disrupt brain processes (e.g., synaptic formation; dendritic growth) from maturing; this can prevent children from developing resilience to psychological disorders. 8
These environmental influences become especially concerning when children have a parent with a current or previous ED, increasing hereditary and environmental risk factors for ED development. These factors include cognitive and emotion regulation/recognition difficulties. 4
It’s important to acknowledge that environmental factors won’t singularly cause an ED, and however, they do contribute to ED development in at-risk individuals. Consequently, childhood is a crucial time for ED prevention; it is a time when we can identify children who are at-risk for developing an ED and educate all children about ED symptoms and severities.
THE BASICS
Not all children have access to eating disorder preventions, though. This is partly because the public is overwhelmingly uneducated about EDs. 7 Through interviews, we’ve learned that most people deny that EDs are biological, dismiss that these disorders are difficult to treat, and believe that EDs are singularly about food. Consequently, support to increase public funding for ED prevention isn’t there.
Unfortunately, because public misconceptions about EDs are widespread, most interactions children have will be with people (e.g., parents; teachers) who aren’t familiar with ED symptoms, risk factors, or treatment.
This becomes problematic when we consider obesity discussions in the public sphere. Specifically, the way we talk about healthy eating for obesity prevention differs from how we talk about healthy eating for ED prevention.
