Healthy eating curriculum may contribute to eating disorders in kids

August 21, 2023 10:39 AM

"Healthy eating education was a trigger for 14 percent of the patients, and ... early adolescents were especially vulnerable." The Washington Post describes how childhood education about "healthy" eating can actually cause eating disorders like anorexia nervosa. (archive.org link)
posted by splitpeasoup (36 comments total)

Personal opinion: as is the case with so many other things, the (real) dangers of ultra-processed food need to be handled at the policy level rather than at the "individual responsibility" level.
posted by splitpeasoup at 10:45 AM on August 21, 2023 [66 favorites]

It's literally the same issue as we see with sex education, and it has the same results.
posted by NoxAeternum at 10:45 AM on August 21, 2023 [3 favorites]

False equivalence. Last I checked, sex education only causes a momentary bump in sexual curiosity and is still a long term positive. Equating that effect with EDs and the horrific damage they inflict is really bad.
posted by splitpeasoup at 10:52 AM on August 21, 2023 [35 favorites]

Last I checked, sex education only causes a momentary bump in sexual curiosity and is still a long term positive.

Comprehensive sex education, yes. The abstinence focused bullshit that kids in the US get subjected to is in the same vein and does the same sort of damage. Sorry if I didn't make that clear.
posted by NoxAeternum at 10:56 AM on August 21, 2023 [37 favorites]

Much as sex education curriculum varies from abstinence based “education” programs that do more harm than good to programs that include instruction on communication, navigating relationships, and body positivity for all bodies (with the majority falling solidly in the middle and including a fair amount of fear-based instruction about pregnancy and STIs), I’m sure “healthy” eating curricula can vary quite a bit as well, from equating thinness with health to ones that focus more on body awareness and include helpful instructions on meal planning, planning a grocery shopping list, etc. Now to read the actual link….
posted by eviemath at 10:59 AM on August 21, 2023 [7 favorites]

I actually wondered about this type of "healthy eating education" as well. It seems to be a profoundly American way of educating - very black and white with no joy or happiness. I have a 5 year old and have been looking at the Japanese way of food education which is embedded in Japanese schools and periodically revised by the government. I really like the way they teach kids about food and wish the Americans could look to other countries to get a sense of how to do healthy eating education in a gentle and joyful way.

Shokiuku
School Lunch in Japan
posted by ichimunki at 11:27 AM on August 21, 2023 [21 favorites]

agree with splitpeasoup - this totally false equivalence bordering on maga level ridiculousness
posted by specialk420 at 11:38 AM on August 21, 2023

There's not really much of a story here. 14 percent of people at a hospital, between 2015-2020, find that healthy eating curricula triggered their eating disorders.

It's pretty circular -- people with eating disorders are people for whom daily normal stimuli triggers disordered eating! That's why there's treatment, right?

The end of the article is concerning. Some food **is** unhealthy.
posted by matjus at 11:52 AM on August 21, 2023 [10 favorites]

That’s because “healthy eating education” almost always teaches kids that restriction is normal and healthy, and that the worst thing you can be is fat. It’s like the way many people learn to associate physical activity with torture and shaming in gym class, only to have to unlearn it as adults to have a healthy relationship with their bodies, except more dangerous.

This is not like sex ed, because there isn’t universal agreement that teens having sex with each other is a bad thing, whereas anorexia, which kills something like 1/5 of its sufferers, is pretty much universally understood to be damaging..
posted by vim876 at 11:52 AM on August 21, 2023 [22 favorites]

Three quick thoughts:

1. This echoes a right-wing talking-point that has been around for years. 'Liberal parents make their kids eat tofu and quiche, triggering eating disorders in later life.'

2. Blaming this on schools, rather than on cultural and peer pressures around diet and appearance, seems a curiously selective explanation.

3. If we're talking triggers, the single piece of research cited in the article suggests that health education is a long way down the list. "Triggers included environmental stressors (reported by 30%), external pressures of the thin/fit ideal (29%), internalized thin/fit ideal (29%), weight-related teasing (19%), and receiving health education (14%)."
posted by verstegan at 11:57 AM on August 21, 2023 [23 favorites]

Well, that's only useful if the health education does not contain external pressures of the thin/fit ideal, which I suspect is seldom true.
posted by restless_nomad at 12:04 PM on August 21, 2023 [3 favorites]

way down the list

Wait, what? It's fifth on the list, and is 14% of patients - a significant percentage. Yes, there are other triggers that are higher on the list, but the number of patients for whom this was a trigger is not negligible and would very much be worth considering even if these programs were effective, which they are usually not.
posted by Kutsuwamushi at 12:04 PM on August 21, 2023 [1 favorite]

In adults, weight management interventions reduce the rate of eating disorders:

Overall, behavioral weight management interventions do not increase eating disorder symptoms for most adults; indeed, a modest reduction is seen post-intervention and follow-up. A small subset of participants may experience disordered eating; therefore, monitoring for the emergence of symptoms is important.

It might be different in children or teens of course, but there's a lot of "mays" and "coulds" in that article. Being a trigger in some cases doesn't mean it's a net cause overall.
posted by TheophileEscargot at 12:13 PM on August 21, 2023 [9 favorites]

It seems to be a profoundly American way of educating - very black and white with no joy or happiness

Pleasure, in any form, is always suspect unless you are already very rich and very thin, in which case, it is your reward for being a good person. Which you are, obviously, because you are very rich and very thin.

I mean, that's in the Constitution right?

/snark
posted by thivaia at 12:47 PM on August 21, 2023 [29 favorites]

It surprises me a little that these students took what they were told in classes seriously enough for it to trigger anything.

I did not think of myself as a rebel, a revolutionary, or even a non-conformist, but in order for me to believe something, I had to have at least a nascent or provisional understanding of how and why it was true.

My parents' approach to getting me to do something was to explain why it was morally the right thing to do in terms of its impact on other people (or animals!), or the best course of action in terms of cause and effects. I don’t remember them resorting to asserting authority except on very rare occasions.

I expected very similar things from school, and thought a lot of what was taught was nonsense — including any number of things that were actually true, in retrospect.
posted by jamjam at 12:52 PM on August 21, 2023 [5 favorites]

The nutritional education obsession when I was a kid was in having a "balanced breakfast" every day. Apparently, the thought was that, by having each kid report what they had for breakfast that day, the kids would be shamed into trying to convince their parent or guardian to feed them the equivalent of a Denny's Grand Slam every morning. That wasn't going to fly with my guardians , so I was ashamed every morning, until one of my peers drily informed me that, as far as they knew, everyone else in class was lying and had the same cereal or toast and glass of milk that I did, and lied about it, because, what, was the teacher ever going to come 'round everyone's house at 7 AM for a spot check? I learned an important lesson that day.
posted by Halloween Jack at 12:56 PM on August 21, 2023 [29 favorites]

Kids have so little control over what they eat. I know I basically didn't have any - what my parents made was what I got to eat. If we went out, I could possibly lobby for a specific place? But it isn't like I could go vegetarian, or pick healthier (or less healthy) options. Do kids these days have more choices somehow? If not, what is the point of this?
posted by Garm at 1:05 PM on August 21, 2023 [11 favorites]

This angle does ring true with a family experience, as my little sister did go through anorexia as a teen. Basically we were all skinny after puberty because my parents were not great cooks and (since we were latchkey kids) not great at providing consistently plentiful food. (Also, no school lunch program in our town, thanks guys.)

But anyway, my sister apparently did have a particularly hard time with all of this because all of the available options seemed like "bad" food, and my family remedied it by subscribing to Cooking Light and letting her browse for meals that (a) she would eat and (b) my mom could make. Not sure it makes sense to blame nutritional education for that, as the result was objectively better afterwards.
posted by anhedonic at 1:07 PM on August 21, 2023 [2 favorites]

In adults, weight management interventions reduce the rate of eating disorders:

Cool, so the analysis you linked shows that in adults, a completely different treatment done by trained medical professionals doesn't cause eating disorders -- in general, although it does for up to one in 15 people -- therefore overstressed school teachers doing completely different interventions, with a completely different population are probably fine?

It might be different in children or teens of course, but there's a lot of "mays" and "coulds" in that article.

I wonder if the person who wrote the first half of the sentence could get in touch with the person who wrote the second half of that sentence.
posted by Superilla at 1:15 PM on August 21, 2023 [6 favorites]

I wonder if she looked at this study from 2020?. Association of the Healthy, Hunger-Free Kids Act With Dietary Quality Among Children in the US National School Lunch Program.
posted by Ideefixe at 1:18 PM on August 21, 2023

3. If we're talking triggers, the single piece of research cited in the article suggests that health education is a long way down the list. "Triggers included environmental stressors (reported by 30%), external pressures of the thin/fit ideal (29%), internalized thin/fit ideal (29%), weight-related teasing (19%), and receiving health education (14%)."

Sure, but the school system is deliberately doing only one of these five things. (Probably two, as restless_nomad notes, I'd be shocked if health education didn't increase external pressures of the thin/fit ideal). Like, if they started teaching bull riding in phys ed, you wouldn't look at the data that shows that the top 5 causes of bone fractures overall are osteoporosis, car crashes, and whatever else, and then shrug that bull riding is only the #6 cause, may as well keep teaching it.
posted by Superilla at 1:21 PM on August 21, 2023 [4 favorites]

Kids have so little control over what they eat. I know I basically didn't have any - what my parents made was what I got to eat.

I'm surprised this hasn't run into the same types of problems that sex ed has because meal choice and eating habits are so connected to culture, class, lifestyle, tradition and religion and healthy eating prescriptions strip a lot of that context.
posted by Selena777 at 1:25 PM on August 21, 2023 [13 favorites]

Do kids these days have more choices somehow?
I think a lot of kids had more choice than you did then then. I'm a young gen X'er who as a kid had several choices for breakfast and lunch, and at least a vote about dinner. Anecdotally, I know a kid whose parents support her eating vegetarian, and have since she wanted to do it at age 8 or so. I also know parents who cook nearly complete separate dinners for their kids who don't want to eat what the others are eating. I can't speak directly to any actual general trend one way or the other over time, but it seems to me there are as many food cultures and rules for what kids eat as there are families. I do think "there is no unhealthy food" is pretty new as a rallying cry, but even as a kid I knew other families who ate tons of junkfood, they just didn't have a smug slogan to support it.
posted by SaltySalticid at 1:30 PM on August 21, 2023 [1 favorite]

Cool, so the analysis you linked shows that in adults, a completely different treatment done by trained medical professionals doesn't cause eating disorders

The comparison to sex ed seems applicable again. There’s probably a good way to approach the subject, and it’s important enough to invest in finding a good way to approach it, but it is often approached in a bad and counterproductive way!
posted by atoxyl at 1:44 PM on August 21, 2023 [3 favorites]

I think a very major part of the issue here has to do with what is a very substantial difference in healthy eating for the different sizes and bodies of the people who populate American middle and high schools.

As someone over 6'3" at the beginning of high school (and who is still 6'4"+), but who took classes with others under 5' and who were literally half my weight, there is an almost ridiculous difference between nutritional needs within any given middle or high school class.

As someone who has never been "athletic" but still is tall and has substantial lean body mass - even though at times I've been "fat" - general nutritional advice has never applied to my situation. I've found over the years that a high protein, low carb, high fiber diet was my best choice, and I'm still ticking today in middle age. But when I was in school, the food pyramid indicated that the foundation of my diet should be grains, which... did not go well. Similarly, I've always been so far away from getting the bulk of my calorie intake from fruits and vegetables that it seems bizarrely absurd to recommend that.

But would that be the right advice for the other people in my classes who were literally half of my weight, and over a foot and a half shorter than me? Almost certainly no.

So the question is, when you have a mixed group of people of radically different builds, what do you recommend? One size does not fit all, and a unified approach is not going to address the nutritional needs of everyone in that class. Almost all of us can agree on "maybe have less added sugar," but at some point, we just need different advice which I certainly didn't get.
posted by I EAT TAPAS at 2:17 PM on August 21, 2023 [6 favorites]

Healthy eating education was a trigger for 14 percent of the patients

Actually, the study abstract says one of the reported triggers was "receiving health education (14%)". The study itself is paywalled, but to me that sure looks like a much more general category than specifically healthy eating education. Seems like some pretty poor journalistic practice here, unless there is something very different in the study itself.
posted by ssg at 2:27 PM on August 21, 2023 [9 favorites]

If you have or had an eating disorder, diet talk can absolutely trigger it. And most "healthy eating education" is just diet talk. Restrict food A, eat more of food B, exercise more.

After sitting through so many repetitions of this mantra, I started to envy the women in the 60s who didn't get lectured on health and just got prescribed speed to be skinny. It felt more honest.

(What actually helped was therapy, diagnosed ADD, and living somewhere where walking outside didn't automatically mean death by car or heatstroke. I still don't eat lettuce.)
posted by emjaybee at 2:41 PM on August 21, 2023 [13 favorites]

Yeah, that's a good catch, ssg. Getting the article, I see that "19 [subjects] (14%) said they received education about healthy food, exercise, or lifestyle habits (e.g., from health class, a coach, or a physician). " So it's not all nutrition, the category also includes gym class and sports - basically any input from teachers.

Really, the focus of the essay and the actual article are very different, so you can see that the author is cherry picking this one detail to write a "all food is heathy food" piece.
posted by anhedonic at 2:45 PM on August 21, 2023 [13 favorites]

Kids have so little control over what they eat. I know I basically didn't have any - what my parents made was what I got to eat.

I have a horrifying story from the time I visited family friends in Singapore maybe 20 years ago that really cemented it as some kind of science fiction dystopia that I didn't want to live in...

Both mom and dad were overweight, daughter was 9 years old and also slightly overweight. We had a meal together and she looked unhappy and didn't do more than pick at her food.

The story was, apparently, if you exceeded the "normal" BMI threshold, you were banned from eating with the rest of the school in the canteen during recess. You were instead made to run laps in the field, in full view of the rest of the school having recess.

I can't think of a more effective way of giving an entire generation an eating disorder! Maybe their logic was that the social stigma and damage of being shamed and forced to exercise to "prevent" being overweight was far less than the social stigma and damage of "actually" being overweight. Or that there's a solidarity and even some strange comfort in having everyone have to undergo this together and being oppressed by the evil "system" rather than it being a lonely struggle where you deal with your own private demons.
posted by xdvesper at 5:00 PM on August 21, 2023 [6 favorites]

I'm surprised this hasn't run into the same types of problems that sex ed has because meal choice and eating habits are so connected to culture, class, lifestyle, tradition and religion and healthy eating prescriptions strip a lot of that context.
posted by Selena777

Totally. Coming from a seafood based state, the USDA directives don't make much sense, compared to how people harvest and prepare food, which is based on Corn and the California Valley.

These messages would be most effective if delivered within a cultural context, but from my time at UGA I imagine that that is not how food science / nutrition is generally done. Is it?
posted by eustatic at 6:13 PM on August 21, 2023

Our society's entire approach to food, nutrition, and weight are so very puritanical. Which makes sense, given the wild dearth of any true understanding of mechanism - almost all we have is religious belief in the stories we pass on to each other as gospel.

Of course it leads to disordered thinking. I can't see how it would be any other way.
posted by Dashy at 6:42 PM on August 21, 2023 [10 favorites]

Personal opinion: as is the case with so many other things, the (real) dangers of ultra-processed food need to be handled at the policy level rather than at the "individual responsibility" level.

The end of the article is concerning. Some food **is** unhealthy.

This is two interesting comments by different posters here that seem to be at odds with the gist of the article. I get the sense that people are very driven to want to place blame for eating disorders somewhere, and the general instinct it to place blame on particular foods. I find lots of people are driven to cling to the notion, which itself I think is suspect. My sense is that if you're ensconced in these beliefs, you're predisposed to having food become an unhealthy issue.

Focusing on labeling food healthy or unhealthy just isn't terribly helpful when it comes down to actual consumption of food. Every food is unhealthy at some point. Plenty of foods that are normally considered healthy are, at best, not particularly nutritional. But putting foods in column A or column B provides a path to unhealthy/unhelpful food policing in spite of good intentions. Once you're keeping a tally, be aware why you're keeping a tally. I'm sure many of us know of, or personally experience, the kinds of pathologies that are dredged up once we've come to that point.
posted by 2N2222 at 6:47 PM on August 21, 2023 [9 favorites]

> Focusing on labeling food healthy or unhealthy just isn't terribly helpful when it comes down to actual consumption of food. Every food is unhealthy at some point.

I can see that when it's time to decide what to eat, it could be pathologizing to feel compelled to beat yourself up when "unhealthy" seems to fit the bill.

On the other side, the worst unhealthy foods, like highly processed frozen chicken nuggets, should make us all much more angry than we are. They're not made with love, they're symptomatic of a huge and evil machine and should not be consumed.

Children should have the tools to discern the difference between items like those and fresh, preservative free food.

We should also equipping them with enough self-esteem to tolerate mild amounts of normal guilt. The insistence that everything must be good or bad is infantilizing.
posted by matjus at 7:05 AM on August 22, 2023

look to other countries to get a sense of how to do healthy eating education in a gentle and joyful way.

But what if that makes people masturbate?!?!
posted by aspersioncast at 9:50 AM on August 22, 2023 [3 favorites]

The thing is that eating disorders aren't just about food. One of the key elements is that of control:

Psychologically, an eating disorder like anorexia can provide a sense of mastery over your body. Rigid rules and rituals around eating create a feeling of structure, predictability and security. You may feel that you are handling life well because you’re able to make the changes you want to see in your body, even if those changes aren’t healthy.

posted by TheophileEscargot at 12:32 PM on August 22, 2023 [3 favorites]

But what if that makes people masturbate?!?!

Then it's corn flakes for you.
posted by Halloween Jack at 8:34 AM on August 23, 2023 [3 favorites]