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Fear of Fat, Disregulated-Restrained Eating, and Body-Esteem: Prevalence and Gender Differences AmongEight- to Ten-Year-Old ChildrenSusan Shapiro , Michael Newcomb & Tamra Burns LoebPublished online: 07 Jun 2010.

To cite this article: Susan Shapiro , Michael Newcomb & Tamra Burns Loeb (1997) Fear of Fat, Disregulated-RestrainedEating, and Body-Esteem: Prevalence and Gender Differences Among Eight- to Ten-Year-Old Children, Journal of Clinical ChildPsychology, 26:4, 358-365, DOI: 10.1207/s15374424jccp2604_4

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Journal of Clinical Child PsychoIogy 1997, Vol. 26, NO. 4,358-365

Copyright O 1997 by Lawrence Erlbaum Associates, Inc.

Fear of Fat, Disregulated-Restrained Eating, and Body-Esteem: Prevalence and Gender Differences Among

Eight- to Ten-Year-Old Children

Susan Shapiro Los Angeles, California

Michael Newcomb Division of Counseling Psychology, University of Southern California

Tamra Burns Loeb Neuropsychiatric Institute, University of California, Los Angeles

Examined whether: (a) societal directives to be thin are perceived among children, (b) discontent with body and attitudes and behaviors associated with eating disorders begin before adolescence, and (c) these differ by sex. These issues were assessed in 239 Grade 3 students. Scales of eating and weight attitudes and behaviors for this under-studied population were either created or modified from existing instruments. These 8- to 10-year-old children expressed weight, dieting, and physique concerns that reflect Western sociocultural values and preoccupation with body weight and dieting. Sex dzrerences were examined and revealed several but not very reliable distinctions at this young age. These findings appear to be consistent with research on adolescents. The components that may lead to the development of an eating disorder or disregulated-restrained eating in a vulnerable adolescent may be both internalized and expressed at a very early age.

The fear of obesity appears ubiquitous in society today, and this preoccupation may affect children as well. Research has shown that many adolescents diet and believe they are fat (Greenfeld, Quinlan, Harding, Glass, & Bliss, 1987; Gross & Rosen, 1988; Williams, Schaefer, Shisslak, Gronwaldt, & Commeric, 1986), even though their weight to height ratio is normal (Feldman, McGrath, & O'Shaughnessy, 1986; Rosen & Gross, 1987; Williams et al., 1986). Girls signifi- cantly outnumber boys in dieting behaviors (Dwyer, Feldman, & Mayer, 1967; Nylander, 1971) and report using drastic measures to attain a slim body (Crowther, Post, & Zaynor, 1985; Kelley & Patten, 1985; Rosen & Gross, 1987). Although 26% to 80% of adolescent girls are disturbed about being overweight, 8% to 27% of adolescent boys worry about their weight and their bodies (Greenfeld et al., 1987; Rosen & Gross, 1987; Wardle -& Beales, 1986).

At one time, researchers doubted that dieting oc- curred before age 14 (Nylander, 1971). Now there is suspicion that it begins substantially earlier (Feldman,

This research was supported by National Institute on Drug Abuse Grant DA 01070.

Requests for reprints should be sent to Susan Shapiro, 1010North Kings Road, Suite 206, Los Angeles, CA 900694381,

Feldman, & Goodman, 1988; Killen et al., 1986; Olsen, 1984). Research has shown that even young children are engaging in dieting behavior (Mellin, Scully, & Irwin, 1986; Stein, 1986; Terwilliger, 1987). There are two major concerns associated with dieting. The first involves deleterious physical, psychological, and social consequences and sequelae (Lifshitz, 1985; Nelson, 1979; Pugliese, Lifshitz, Grad, Fort, & Marks-Katz, 1983; Pugliese, Weyman-Daum, Moses, & Lifshitz, 1987). Second, there is a belief that dieting leads to an inability to regulate food intake that results in purging (Polivy & Herman, 1985; Ruderman, 1985) or the development of eating disorders (Johnson, Lewis, Love, Lewis, & Stuckey, 1984; Killen et al., 1986; Striegel-Moore, Silberstein, & Rodin, 1986).

Children as young as 5 have expressed fears about becoming fat and concerns about their body image (Feldman et al., 1988; Terwilliger, 1987). Children have also been found to have negative attitudes regard- ing obese individuals (Harris & Smith, 1982; Strauss, Smith, Frame, & Forehand, 1985), dislike an obese body build (Kirkpatrick & Sanders, 1978; Lerner & Gellert, 1969; Stager & Burke, 1982), express a fear of becoming obese (Feldman et al., 1988; Stein, 1986; Terwilliger, 1987), and do not like to play with fat children (Strauss et al., 1985). Children also avoid

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FEAR OF FAT IN CHILDREN

selecting photographs of their peers and of themselves if they appeared fat or stocky, preferring pictures of slim children with good posture (Gellert, Girgos, & Cohen, 1971). Of major concern is the finding that unhealthy dieting and disregulated-restrained patterns of eating behaviors are now being detected in children as young as age 8 (Mellin et al., 1986). In this study, the term disregulated-re,strained eating (Striegel-Moore et al., 1986) is used to describe weight concerns; attitudes about foods and dieting that result in a variety of behav- iors, including skipping meals to reduce weight; avoid- ance of foods resulting in weight gain; episodic binge eating; vomiting; and use of laxatives, diet pills, or any oral agent to control or reduce weight.

This Study

Research is needed to investigate the prevalence and gender diflerences involved in the fear of obesity, body

8r u2b . concerns, perceived social influences, han81$ietmg be- <, & < b w * a " hglajer4w pmng s,&ml-aged children (~oll'ms, 1991 ;

rr. Maloney, IMcGuire, Daniels, & Specker, 1989; Thelen, Powell, Lawrence, & Kuhnert, 1992). The primary focus of this investigation is to develop sca be used to evaluate the incidence and sex involved in a number of behaviors and have been implicated in the development of eating disorders in young children. To do this, we assessed the prevalence and intensity of a fear of becoming fat, body esteem, and attitudes and behaviors associated with eating disorders in 8- to 10-year-old boys and girls. In particular, we tested for sex differences in these atti- tudes, bdwvi~rs, and pes&pions to determine whether such difhences found among @dolescents and adults also occur among young prepubesclent children.

The following hypotheses were formulated for this study: Firsit, 8- to 10-year-old children will express a fear Of becoming Eat, at least s o m degree of poor body esteejn, and dill engage in disregulated-restrained eat ing attitudes and diedng behaviors. Second, these con cerns and behaviors will occur mlore frequently in girls than boys. It is also hypothesized that socibcultural influsnces will be perceived by these, childken regarding the fqar Of becoming fat, and these pekceived environ- rne~thl pressures will be greater for girls than for boys.

Metbod

Participam~ts

student of the purpose and the procedures of the study. Teachers were given written instructions regarding the distribution of the consent forms. Only tholse: children who had parental consent and agreed to participate were tested, weighed, and measured for height. The final sample contained 239 out of a total of 393 students. Seventeen students were eliminated after the data were collected because they did not meet criteri,a for inclu- sion (able to comprehend English and younger than 1 1 years of age). The sample consisted of 105 boys and 134 girls, including African American (5.9%), Hispanic (7.9%), Caucasian (73.3%), and AsianIPacific islander (13%) children. The mean age of the children was 8.78 for boys and 8.74 for girls (range = 7.20 to 9.94; SD = .45). Socioeconomic status, although not assessed di- rectly, appeared to be more representative of an upper socioeconomlc population.

Boys and girls did not differ significantly in weight percentiles (66.30 and 62.07, respectively), with arange of 5.0 to 95.00 and SD = 25.24. Hecausb this is a general sample of nonclinical children, most responidents fell within no~rmd weight ranges for boys and girls. Suffi- cient numbers of children that could be considered obese, or seriously underweight are not included in the sample for separate analyses. Therefore, this; study is limited to the attitudes and behaviors of a normal sam- ple of children, iwhich should provide more reliable tests of sex differences and scale construction.

Measures

The survey used in this investigation was a two-part 20-page questionnaire that contained 58 items. This questionnaire, combined new and existing items and was designed to meet the cognitive abilities of X-year- olds.

The Perceived Origins of Attitudes About Thinness and Obesity (POAATO) was developed for this study. The POAATO was constructed because no1 scales ex- isted that measured the perceived origins of attitudes relating to thinness and dieting. Research has indicated a need to determine the influence of peers, family, and the media on the: development of these attitudes (Thelen et al., 1992). The items originated from the Beliefs About Attractiveness Questionnaire (Striegel-Moore, Silberstein, & Rodin, 1985), pilot study interviews with youn8 children, and expert opinions. In addition, sev- eral existing instruments were modified for this inves- tigation, indudlng the Eating Attitudes Test (EAT; Garner & Garrfinkel, 1979) and the Body-Esteiem Scale (BE; Mendelson & White, 1982). The modlified EAT consisted of 16 items with three forced-choice response options ("all the time," "half the time," and "none of the time"). The modified BE consisted of 22 de:ms with yeslno and three forced-choice response scoring. Modi- fications af the EAT and BE were achieved through simplifying the wording of some questions so that they

The study utilized a community school sample of 239 Grade 3 students that were not selected because of problems with weight. Participants were drawn from five schoolls within three school districts in the Los Angeles arlea. Consent forms, which requested volun- tary participation, informed both the parent and the

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could be easily read and understood by young children, and eliminating several items due to redundancy.

The wording of the questionnaire was based on the opinions of child specialists and educators, as well as the pilot test responses of 10 diverse 8- and 10-year- olds. Psychometric guideli isting questionnaires,

people are happy peopls," and "I believe that fat pe~ple have very few friends." The second question iri each grouping contained a 20-item checklist that required the selection of as many options as were applicable. These questions included "Who believes that it is bad to be fat," "Who believes that it is important for women to be thin," 'Who believes that it is important for men to be thin," 'Who believes that thin people are happy peo- ple," and 'Who believes that fat people have very few friends." The 20 possible responses in each of the five checklists included: magazines, newspapers, radio, television, my dad, my mom, my brother, my sister, my grandparents, my aunt, my uncle, my cousins, girls who are my age, boys who are my age, girls who are older than me, boys who are older than me, adults I see after school, my doctor, my teacher, and my physical educa- tion teacher. Children were instructed tu place a circle around the words that applied.

Part two of the questionnaire consisted of modified EAT and BE items that had Likert-type 3-point attitu- dinal response scale formats. Examples of these items and their development are presented in the Results seoqm.

Pwcledure

All participants at each site were tested on the same day and received the same 58-item questionnaire. The

360

testing session lasted approximately 30 min. A written outline was followed to ensure that each group of children received the same instructions.

Results

Fear of Becoming Fat Scale

Scale development. There was no test available to directly assess the construct pf Sear of Becoming Fat (FOF). This construct was hypothesized to be reflected in four items from the EAT, three items from the BE, and four items from the POAATO. An example from each instrument includes 'T am very scared about being fat" (EAT), "My weight! makes me unhappy" (BE), and "I believe it is bad to be fatw (POAATO). All items were chosen because they awareid to capture conceptually the construct of FOF more so than their respective instruments. geveral factor and reliability analyses were conducted on these 11 it~ms. An exploratory prisaipal components factor analysis was conducted using an oblique rotation to ascertain whether the items repre sented a unidim~nsianal coxrstmct. Using Cattall's scree test, two di~tinat factors were identified. TWO items that did nnot load highly (5 .40) on either factor were eliminated.

Analysis of item content repulted in two factors designated Faas af Becorrlixrb Pat-Pe~gonal (POW) and Fear of Bmorning Fa+Saoial (FO&S), Examples of FOF-P (a = ,741 indude "I wish I wqre thinner" 6nd "I think about being thin.yWxamples Of F O P S (a = 52) are "It is very impastamt far proqen ta be @in" and "It is very inlpartmt for map to be thin? The corrdation between these two scales was .17 @ c .01).

Response analyses. Most of the children in this investigation expressed some fear of beooming fat. Response breakdowns and chi-square difference tests are provided in Table 1. Eighty-three percent of the children had scores graater than 4 (4 = no concern on any item; lowel' end of scqle) on the FOF-S scale and 85% had scores greater than 5 (5 = no concern on any item; lower end of scale) on the FOF-P scale. Seventy- eight percent of the boys and 75% of the girls agreed with the statement "It is bad to be fat." Mare than one fourth of the children thought it was important for adults to be thin; 38% of the bays and 45% of the girls thought it was importmt for women to be thin, whereas; 3 3 8 of the boys and 35% of the &'Is falt it was important for men to be *in. nirty pewent of the boys and 31 % of the girls answer4 that they arr: "a1ways"scar~d about being fat; whereag 30% af the boys pnd 36~% of the girls reported being scared only ""hial,P' the time,. In addition, 10% of the girls and 7% of tha boys reported that their weight makes them unhappy. Bighteen pmcemt of the

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FEAR OF FAT IN CHILDREN

Table 1. Percentage Responses of Participants (BoydGirls) to Items on Fear of Becoming Fat and Disregulated Restrained Eating Scales

Fear of Becoming ~ a t - S o c i d Yes No -

It is bad to be fat 78/75 22/25 It is important for women to be thin 38/45 62/55

It is important for men to be thin 33/35 67/65 Fat people have very few friends 24/24 75/76 -

Fear of Becoming b at-person& Always Half - Never

I am very scared about being fat 30131 30136 41/33' My weight makes me unhappy 07/10 30136 68/55;

I wish I were thinner 18/23 24/37 58/46'*

I think about being thin 2 1/27 36/43 43/30* I think about the fat on my body 05/08 24/32 71/60

Disregulatedl Restrained Eating-~ehaviors~ I skip meals to lose weight, even . . . hungry 05/03 24/21 68/76 I eat fooda that will help me stay thin 29/41 65/54 07/Q4* I throw up on purpose after I eat 04/00 0711 1 89/89 I exercise to lose weight 22/22 43/54 35/25 I take medicine to lose weight 03/01 08/04 90195 I try to lose weight by going on a diet 10113 20125 70162

Disregulatedl Restrained Eating-~ttitudes~ I fkel I have to eat a lot of food . . . no stopping 08107 24/17 69/76 I eat fooda that will make me fat 05/01 66/60 30139' I feel like a bad person after I eat food 05/02 12/18 83/80 I feel sad after I eat sweets 06/07 27/48 68/46'* I love to eat sweets 23/14 57/68 20118 I like the way my tummy feels when it's empty - 10113 29/23 - 62/64

Note: n = 10.5 for male participants. n = 134 for female participants. bichotomous items tested with chi-square. b~ategorical items tested with t test.

boys and 23% of the girls answered that they "always" wish they were thinner.

Girls were more likely to be scared about becoming fat Ip < .D5) and reported greater unhappiness about their weight (p < .05) than boys. In addition, girls reported tlhinking about being thin and wishing they were thinner significantly more than boys (p < .05 and p < .01, respectively).

Mean .malyses. As it was hypothesized that boys and girls iwould respond differently, one-tailed t tests were conducted to test for sex on scale means. A sig- nificant sex difference on means was found for the FOF-P scale but not for the FOF-S scale. Female scores were significantly higher than male scores on this scale (p < .008).

Disregulated-Restrained Eating Attitudes and Behaviors

Originally, the investigation utilized Methods of Weight Reduction (MWR) and Disregulated-Re- strained Eating (DRE) scales of the EAT. However, reliability analyses suggested that the internal consis- tencies of both scales were poor (MWR a = .36; DRE a = .29). The correlation between the scales was .44 (p < .0001). As it was impossible to summarize the struc-

ture of the individual items to reflect either the original dqfinitions of the scales or coherent independent fac- t ~ r s , both an exploratory factor analysis and analysis of item content were used to create scales. These analyses indicated that the items represented either attitudes or behaviors, and a decision was made to strive for con- ceptual integrity rather than empirical clarity. One item from DRE was added to MWR and the scale was renamed Disregulated-Restrained Eating Behaviors (QRE-B). DRE was renamed Disregulated-Restrained Eating Attitudes (DRE-A). Examples of DEW-B are "I skip meals to lose weight even though I am huingry" and "I eat foods that will help me to stay thin." Examples of DRE-A include "I feel sad after I eat sweets" and "I like the way my tummy feels when it is empty ." As one goal of this investigation was to explore the relation between a fear of becoming fat and the development of attitudes and behaviors related to eating disorders, the reconceptualization of these scales seemed appropriate.

Reliability and correlation analyses were conducted on these scales and indicated that these were sound changes. The coefficient alpha of DRE-B iincreased to .52 (from .36) and the correlation between the two scales dropped to .35 07 < .0001). Despite the reduction in the coefficient alpha of DRE-A to .22 ( h m 0.29), the improvements in the other indices (concep~tual clar- ity, coefficient alpha of DRE-B, and correlation) sug-

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SHAPIRO, NEWCOMB, & LOEB

gested that the two scales should be retained for analysis in the study.

The results indicate that a clustering of these atti- tudes and behaviors has not occurred at this age. How- ever, a simple sum of these attitudes and behaviors may be an important index of disregulated eating attitudes and behaviors. Research with older children and adults indicates that these attitudes and behaviors do converge and appear to become more consistent with age.

Reliability analyses and c tests of the six scales and six combined groupings of the 20 individual POAATO scales by sex are presented in Table 2. Scores of six on the D R E A and DRE-B scales (created with simple sum scores) indicated the absence of disregulated eating attitudes and behaviors (six reflects no endorsemept of any item; lower end of scale). Ninety-seven percent of the children in this sample had scores greater than 6 on the DRE-A scale and 98% obtained scores greater than 6 on the DRE-B scale. Despite large means and broad ranges, the variability uim small, as were the standard deviations @RE-A = 1.61 and DRE-B = 1.83). Chil- dren in the sample reporttsd engaging in a variety of dieting behaviors; 7% of tFe boys and 11% of the girls reported the occurrence d t h ~ w i r z g up on purpose after eating. More than half of the Grade 3 students exercise "always" or "half" the time to lase weight. In addition, 10% of the boys and 13% of the girls reported 'Wways" trying to lose weight by going an a diet. Ten percent of the boys and 13% of the girls responded "always" to the statement "I like the way my tummy feels when it's empty." Tr was neoessary to adopt a three-choice re- spbhsu: P~mat FOP Chis age gmYIp, which may have inflated these results to some extent. However, these children we& indi&iting the: presence of these attitudes an4 bhwiors.

Several sex differences on DRE-A and DRE-B items were noted. Girls were significantly more likely to report eating foods that would help them stay thin (p < .05). In addition, girls reported being less likely to eat foods that would make them fat (p < .05) and more likely to feel sad after eating sweets (p < .01) than boys.

One-tailed t tests were conducted on each scale to test the hypothesis that boys and girls would respond differently. The only diffmenae was noted om the DRE-A scale. Girls reported significantly more dis- regulated-restrained eating attitudes than boys (p < .05).

Body Esteem

The BE scale has established reliability and was utilized, for the most part, in its original format. Reli- ability analyses of the BE produced a coefficient alpha of 36. As these results were similar to those previously reported, the internal consistency of the BE was cor- roborated in this investigation of a young sample. One- tailed t tests indicated that boys and girls did not differ significantly with regard to the personal evaluations they made about their bodies.

POAATO

The POAATO assesses 20 sociocultural influences or agents often implicated in promulgating attitudes related to obesity and thinness. The data for the 20 scales came from a checklist of option responses to questions regarding attitudes about thinness and obe- sity. The reliability analyses indicated that the internal consistencies of the 20 individud scales were good (a

Table 2. Reliability Analyses andMean Dif3'erence Tests of SinScales andsix Combined Groupings of the 20Zndividud Perceived Origins of Attitudes About Thinness and Obesity Scales by Sex

Boys Girls

Reliability Total M SD M SD --

Fear of Becoming Fat Personal .74 8.44 7.99 2.53 8.80** 2.52 Social .62 7.53 7.49 2.39 7.57 2.60

Disregulated-Restrained Eating-Attitudes .22 9.88 9.69 1.69 10.04' 1.52 Disregulated-Restrained Eating-Behaviors .53 9.21 9.12 1.89 9.28 1.78 Body Esteem scale 3 6 47.16 48.07 6.28 46.45 6.94 POAATO

Extended Family .86 3.81 3.90 4.33 3.70 3.89 Media .86 4.46 4.20 3.99 4.66 4.40 Nuclear Family 3 2 5.37 5.40 4.22 5.30 3.88 Other Relations .87 5.49 5.67 5.73 5.35 4.99 Peers .85 3.32 3.10 3.65 3.50 3.84 Significant Others .85 3.03 2.90 3.42 3.13 3.70

Note: N7?39. n = 105 for male participants; n = 134 for female participants. *p < .05. p < .Ol; based on r tests.

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FEAR OF FAT IN CHILDREN

ranged from .60 to .77). Despite the fact that these scales could be represented by one general factor (eigenvalue of 6.52), due to the nature of the study a decision was made to analyze six smaller groupings of five items each. These six groupings included extended family, media, nuclear family, other relations, peers, and sig- nificant others. The face validity and conceptual clarity of these scales, along with the reliability analyses (a ranged from .74 to .87), suggested that these groupings were both viable and appropriate for investigation.

Results revealed that for the total sample of boys and girls, the most influential sources of social influence were, in order of importance, Other Relations (con- sisted of siblings, cousins, aunts, uncles and grandpar- ents), Nuclear Family (consisted of mom, dad, brother, and sister), and the Media (consisted of newspapers, television, radio, and magazines), Among the Media, the largest sources of influence were television, maga- zines, and the newspaper, respectively.

One-tailed t tests were conductad to test the hypothe- sis that ba~ys and girls would perceive sociocultural agents differently. Results indicated that boys and girls had similar perceptions of sociocultural influences re- garding thinness and obesity.

Discussion

A central aim of this investigation was to modify existing instruments and create measures to assess eat- ing and weight attitudes and behaviors in young chil- dren. The DRE-A and DRE-B scales were created for this investigation. The items were taken from estab- lished, reliable instruments that assess the existence of these attitudes and behaviors in adolescents and adults and were modified for children. Although thereliability of each of these scales was less than expected, this may actually reflect the developmental acquisition of these attitudes and behaviors, as these are not typically seen in 8- to 10-year-old children.

The reliability of the D R E A was particularly low, although the scale demonstrated good face validity. For the age group examined, this type of scale is not inter- nally consistent. However, results obtained fram the D R E A suggest that these attitudes do exist qnd indi- cated ageneral tendency toward the construct. For these reasons, the DWE-A may best be considered a risk index for eating, disordered attitudes at this point in time.

Arralyses suggested that these children were engag- ing in some dieting behavior and expressing disregu- lated-restrained eating attitudes. However, analyses also indicated that these behaviors do not occur in clusters at this young age, as the items were not highly intercorrelated. Other research indicates that these atti- tudes and behaviors do become more internally consis-

tent at older developmental ages (Dwyer et id., 1967; Nylander, 1971). However, the reliability of each of the combined POAATO scales suggest that these scales consistently assessed the sociocultural influences re- garding thinness and obesity. In addition, the data veri- fied the reliability of the BE scale, the modiification of the items, and the appropriateness of this scale for the age group tested.

The reliability analyses and meaningful sax differ- ences suggest that the scales used were generally reli- able, meaningful, and valid and that this m~ethod of examining children effectively gathered data from chil- dren regarding attitudes, beliefs, and vduies that are important to them. However, as this was an e:xlploratory study, further research (i.e., assessing stability over time) is requird to provide information regarding the reliabilities of the scales developed.

These 8- to 10-year-old children reported being afraid of becoming fat on both measures of FOF. The scores on the FOP-S scale and POAATO suggest that children are aware of the sociocultural prefeirence for thinness, especially from extended family members, the nuclear family, and the media (in paticudar, tele- vision). The real tragedy lies in their FC)F'-IP scores, which indicate that these children have internalized this sociocultural vdue on a personal lev~el as well. Boys and girls reported very similar perce~vied social pressures.

Girls were more distressed about becoming fat than boys, as girls had significantly higher FOIZ-P scores than boys. Although boys and girls expresss~d similar awarqness of the socioaultwal preference for thinness and reported similar feelings concerning their body image, girls were more personally concerned about becoming fat. This contrasts with Thelen et aL's (1992) finding that although sex differences in eating-related problems were noted among fourth and sixth graders, no sex differences were found among second graders. Girls in Grade 3 in this sample wese sc;msc:d about becoming fat, unhappy because of their weight, wished they were thinner, and thought about baing thin signifi- cantly more often than Grade 3 boys. Because a strong sociocultural emphasis exists for girls to be thin (Johnson & Gonnors, 1987; Rodin, 1987; Schwartz, 19861, this finding for girls may reflect the internaliza- tion of this expectation.

These children also derhonstrkted an ability to re- duce their anxiely about becoming fat by implementing early weight control behaviors. Ten to 29% of boys and 13% to 41% of girls reported using dieting, diet foods, or exercise: to lalse weight. Ten percent of all children in the study expressed attittides that are assoc:iated with eating disorders, with girls scoring significant] y higher than boys.

The implementation of these behaviors at such a young age causes concern on at least two bevels. The

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first is that these types of behaviors could place children at risk for malnutrition and stunted growth at important developmental stages throughout their lives. The sec- ond, which highlights the first, involves the possibility of using more extreme measures, such as vomiting or using medication, if the earlier measures fail or the pressure to be thin intensifies.

Attitudes develop early and are forged by a complex interplay of social, cultural, family, and media influ- ences. 1t seems dear that without intervention, these children will peroeive society's mandate for thinness even more acutely with the passage of time. The prob- lem is that with gmowth and development, &ttitudes and behaviors are extremely difficult, if not impossible, to change. Thi$ rafraotivenesslrecidivisrn has b&n quite evident with eating disorder6 (Johnson & Connors, 1987; Rodin, 1482; Wilson, 19815). Early identification of children at risk could reducethe likelihood of devel- oping a life disabling/thrmtenidg disorder.

Although not a true rmdbm sample, the results of this investigation srre similar td those found with ado- lesaenm. However, gmemlimbility tp other 8- to 10- yea-olda await$ furthe?: irlviestigation, as only 25% of the population was repr$senbd by ethnic mhorities and the sooiwononic statw, althobgh: not assessed di- rstly, appear& to be aiare mpr@Mm%tivs of an upper- socioecloaiomio prrpulatiod. El)leY&p,pit@ thiese limitations, the data seem to support the spsculation that with these scales, we cam rrebognizp tb eidy bsginnings and sources of the$$ rrt&~~dm isund b@haviors, particularly mong young g i r l ~ ~ b W also evYdm! in young boys, and can evdwtt& ~ ~ s ~ ~ d # i l l l ~ ~ nnd dev&Icrp policiies and ptograrrrs to rerJuCal &a qady dev@lopment of strong attitudere that $ m y ffrrdve tb ;bnlllak@d 20 Illness,

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Received September 6,1996 Final revision received July 21, 1997

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