With obesity rates climbing, health experts have been pushing for the past decade for more nutrition education in schools and less fat and sugar in kids' foods. "The problem is, some kids are interpreting the message to be 'food is fattening' or 'food is the enemy,'" says Natenshon. "They'll say they don't need to eat breakfast, or think they can't eat a big meal unless they'll be burning those calories later." She describes an 11-year-old patient whose friends eat a smaller lunch on days when they don't have soccer practice. "These children are mimicking what they're seeing adults do," says Natenshon. "But kids' nutritional needs are different from those of adults. They need enough calories and fats to fuel their body, grow their bones, enter puberty, and create neuronal pathways in their developing brain."
It's hard to know how big a role the anti-obesity movement has played in the rise of eating disorders in younger kids. "The teasing that goes along with early-childhood obesity can become a trigger for food restriction and eating disorders as well," explains Natenshon. "In fact, a child's actual body weight has little or no bearing on the development of an eating disorder. The child's distorted self-perception leads to the sensation of feeling fat, even though she might be painfully thin." But obesity-prevention efforts are almost certainly contributing to delayed diagnoses, says Julie O'Toole, M.D., medical director of Portland, Oregon's Kartini Clinic for pediatric eating disorders. "Many pediatricians are so focused on curbing obesity that they'll miss an eating disorder that's right in front of them. If a child is declining rapidly on the growth chart, even if he was in a too-high percentile before, that's a red flag." Overweight kids are at special risk, because they may -- out of pressure from parents or concerns about teasing -- go on a diet severe enough to cause their heart to fall into a dangerously slow rhythm (a response to extreme caloric restriction, common in anorexia) before they drop enough weight to get the attention of parents and doctors, says Dr. O'Toole.
It doesn't help that celebrities aren't just thinner than ever, but younger too. "When I was a child, most of the big stars were in their late teens or older, so my friends and I didn't really compare ourselves to them," says Susan Deemer, 37, a teacher at an all-girls primary school in San Francisco and mother of a 7-year-old girl. "Now, kids have idols closer to their own age. This makes them concerned about their body at a much younger age."