Doctors’ Notes: Teens’ weight struggles can damage mental health | Toronto Star

Being a teenager is hard enough. For teens struggling with weight issues, the toll on their mental health can be devastating.

As a pediatric psychologist, I often see patients who are made to feel weak and inadequate because of their size. They feel excluded and even targeted. For instance, a patient once told me that while eating a granola bar on the subway, a stranger asked, “Do you really need that?”

In fact, recent research has shown body weight is one of the most common reasons people are bullied, and this bullying is often overt. I’ve had patients who have been pushed down stairs and even broken bones. And many of my patients blame themselves. Society tells them that unlike other medical conditions, their challenge with weight is their fault. This, of course, grossly underestimates the complexity of eating, physical activity and weight issues.

The pressure these teens face to achieve an acceptable body size can propel them into various states of anxiety, depression, disordered eating, binge eating, and thoughts of suicide.

To further complicate the situation, some necessary medications prescribed to treat mental health issues can lead to unstable eating behaviour. In fact, obesity and mental illness are so frequently combined that they constitute an epidemic within an epidemic.

These teens need support to address not only their diet and lifestyle habits, but also their mental well-being. As health-care providers, we are always looking at new and better ways to support these kids and their families. Thankfully, mental health providers are now becoming more integrated into thoughtful weight-management programs around the world.

In the most comprehensive of these programs, physicians, nurses, mental health providers, dietitians and exercise specialists work collaboratively with patients and their families to develop a treatment plan in support of healthy eating, active living, and overall improved quality of life.

Some teens require intensive treatment. Through the Medical Psychiatry Alliance, a collaborative partnership aiming to integrate mental and physical health care, several programs at The Hospital for Sick Children (SickKids) are joining forces on a new pilot day treatment program for teens struggling with both debilitating mental health issues and disordered eating. We hope this new program will reach those vulnerable teens who might otherwise be lost in the system.

If you want to support a teen facing similar challenges, here are some tips on how to look out for both physical and mental health.

Listen to your teen. Try to really understand their experiences and emotions. Listening is more important than trying to solve their issues. Let your children know that you love them unconditionally regardless of their size or appearance. If they can’t open up to you, suggest they talk to another trusted adult — another parent, an aunt, uncle or a favourite teacher.

Work together to address issues at home and at school. If your teen would like to problem solve with you, help them define each issue and then brainstorm together all kinds of ways to address it. No idea is too crazy at this stage — be creative. Make a list of all the ideas and then identify the ones each of you agree is worth trying. Select one or two strategies that you are both open to and make a plan to implement them. Schedule a time to review whether the plan is working so that you can revise it as needed.

Watch for bullying. Bullying and weight discrimination comes in many forms. When kids are younger, they may make offensive verbal comments or physically hurt someone. In teens, you may see more social exclusion. Let your teen know that you are open to talking about feelings of being left out or targeted. If they feel like they do not have a solid peer group, help them find one. Help them explore additional resources, like clubs, sports teams, community centres or youth groups, where they can develop a sense of belonging. Having even one good friend is immensely protective against depression and feelings of hopelessness.

Set a positive example. Engage the entire family in physical activity; this could include taking the stairs instead of the elevator, or taking evening walks as a family. Take a stand against unrealistic body ideals portrayed in the media, and avoid frequent comments about your own weight, or the weight of friends and family. Frequent weight talk from parents about others can suggest to kids that physical size is what matters most.

Foster balanced regular eating: This means three meals and two to three snacks per day, three to four hours apart, for the entire family. This type of eating helps regulate our metabolism and our experience of hunger. Many teens skip breakfast because they are tired in the morning and eat nothing or very little at lunch, which sets them up for bingeing from the afternoon until they go to sleep at night. This pattern over time can set them up for disordered eating and weight gain. Another way to encourage healthy eating is to have meals together as a family.

Focus on healthy food and activity. Fight against the diet industry and severe exercise plans. Instead think of realistic, sustainable changes. Encourage the whole family to increase vegetable and fruit intake by using the plate method. This means that half the plate is filled with vegetables and fruits, one quarter with whole grain carbohydrates, and the last quarter with lean protein. Make sure healthy snacks are readily available and easier to get to than less nutritious foods. Plan fun family activities that get everyone moving together.

Get professional help sooner rather than later. Do not hesitate to ask for help, especially if mental health issues are persistent, problematic and pervasive. Sometimes one session with a professional to help explore and problem solve is all it takes. Sometimes more intense treatment is needed. A specialist can help you decide how serious a problem is. Wait lists can be long — it is better to add your name to the list and then withdraw it than to procrastinate until you and/or your teen is in crisis.

Dr. Elizabeth Dettmer is a staff psychologist and the mental health lead with the SickKids Team Obesity Management Program (STOMP) and a project lead with the Medical Psychiatry Alliance. She is also a project Investigator at SickKids Research Institute, and an assistant professor of Paediatrics at the University of Toronto. Doctors’ Notes is a weekly column by members of the U of T Faculty of Medicine. Email doctorsnotes@thestar.ca .

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