Despite the Best of Intentions, Healthy Eating Messages Could Have Harmful Consequences

自1980年代以来，儿童肥胖率几乎增加了两倍。¹Since the attitudes of parents, caregivers and physicians can have a lasting impact on children, it is vital that healthy eating messages are communicated in a supportive, non-shaming way. This encourages children to make beneficial food choices while maintaining a positive sense of self.²“Positives are always better than negatives,” says玛莎·莱文（Martha Levine），医学博士, director, intensive outpatient and partial hospitalization programs,宾夕法尼亚州赫尔希青少年医学和饮食失调部门。

幸运的是，学校越来越参与帮助儿童做出更健康的选择。但是，即使有最好的意图，有时这些消息也会产生负面影响。借助年度称重和“ BMI报告卡”，结果可能会造成破坏，甚至对于无法完全理解适当背景或成熟的儿童而感到可耻，甚至可以正确处理它。重点可以转向体重而不专注于健康，这可能导致危险的饮食行为。该地区唯一的专门饮食失调计划宾夕法尼亚州赫尔希的孩子”s Hospital希望抵消这些善意的健康信息的潜在负面影响。

Negative messages aren’t the only challenges.Rollyn奥恩斯坦。, interim chief of the division, describes another concerning condition—avoidant/restrictive food intake disorder—is characterized by restricted eating (as the result of a negative experience with food, such as choking) without weight or shape concerns. This disorder and atypical anorexia were recently classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The latter includes patients who exhibit the signs and symptoms of anorexia without being significantly underweight – in fact, some are at a normal weight or overweight. She continues, “We are definitely seeing the classic eating disorders in younger and younger patients; it’s not unusual to have an 11-or 12-year-old with anorexia nervosa.” Both doctors advise that the earlier the treatment, the better the prognosis, as it’s harder to break the cycle after the same behaviors are acted on day-after-day, year-after-year.

Ornstein博士与8-16岁儿童的部分住院计划共同导演，其中包括州立法的学校组成部分。该计划强调家庭参与所有治疗课程，提供监督的餐点，并要求父母和孩子一起吃早餐。这有助于父母了解如何在家中帮助孩子。Penn State Hershey饮食障碍计划的重点是个人目标，应对应对困难情绪的策略以及为康复的良好框架。尽管宾夕法尼亚州立赫希（Penn State Hershey）专注于数字，但个人的总健康状况至关重要。莱文博士总结说：“没有人是完全一样的，但我们所有人都希望保持健康！”

Points to Remember:

1. Evaluate, don’t congratulate:Especially if a patient has struggled with weight for a long time, sudden, large-scale weight loss may be a sign of disordered eating.
2. Check the growth chart:孩子越来越高但不重吗？这可能是饮食受限的迹象。
3. Watch your language:Focus on health, not a number. The obesity epidemic has made clinicians very aware of overweight, but weight loss is not always positive and should not always be encouraged.
4. Starting weight doesn’t matter:尽管肥胖流行，但重要的是要记住，饮食失调症 - 甚至厌食症 - 都可能以任何起始重量发生。无法解释的体重减轻始终是引起关注的原因。
5. Don’t wait to refer:饮食失调治疗需要时间，初级保健医生通常没有的时间。Penn State Hershey儿童医院的饮食失调计划每周要多次见患者。

---

Martha Peaslee Levine，医学博士
Associate Professor of Pediatrics, Psychiatry and Humanities
Director, Intensive Outpatient and Partial Hospitalization Programs
Division of Adolescent Medicine and Eating Disorders
PHONE:717-531-7235 •电子邮件：mlevine1@hmc.psu.edu
CARE PHILOSOPHY:“My care philosophy is to help individuals appreciate their own unique talents so that they are not always defining themselves by negative messages, but by an appreciation of their own self-worth.”

Rollyn M. Ornstein, M.D.
Associate Professor of Pediatrics
青少年医学司及
Eating Disorders
PHONE:717-531-7235 •电子邮件：rornstein@hmc.psu.edu
CLINICAL INTEREST:“I have a particular interest in the care of younger patients with eating disorders, including those with the new Avoidant/Restrictive Food Intake Disorder.”

---

参考：

1. http://www.cdc.gov/healthyschools/obesity/facts.htm。2015年9月5日访问。
2. Daye CA, Webb JB, Jafari N. Exploring self-compassion as a refuge against recalling the body-related shaming of caregiver eating messages on dimensions of objectified body consciousness in college women.Body Image.2014;11:547–556。