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How to help kids be healthy without shaming, damaging self-esteem
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Gillian Brown's parents don't like her body.

Starting when she was 7 years old, they urged her to change it, setting up meetings with dietitians and offering opinions on why the number on the scale only seemed to rise.

"There was a constant feeling of not being good enough," said Brown, now 26. "That was quite difficult to live with as a teen, especially because I didn't understand why I was failing."

Her parents steered her toward weight loss with good intentions, she said, but all she felt was shame.

Over the last 35 years, the percentage of U.S. adolescents ages 12 to 19 who are obese has jumped more than 15 points, from 5 percent in 1980 to nearly 21 percent in 2012, according to the Centers for Disease Control and Prevention. In light of this alarming trend, health officials and medical professionals are targeting parents, urging them to feed their kids fruits and vegetables and keep them active and noting that healthy habits begin at home.

However, the push for parents to monitor their teen's weight can damage young people's self-esteem, especially when coupled with the media's focus on shedding pounds. Few parents know how to make lifestyle changes without harming a young person's body image, and many unknowingly cause the kind of pain Brown experienced in pursuit of weight loss goals.

Emotional health needs to be prioritized in conversations about a teenager's diet and exercise routines, even though it's hard for parents to find the right balance, according to researchers focused on adolescent weight and health.

"On the one hand, you want your child to be physically healthy. But, on the other, you want him or her to know that they will be beautiful or handsome in your eyes at any size, that you'll love them even if they're heavy," said Deborah Carr, chairwoman of the sociology department at Rutgers University.

Outside influences from magazine covers to instagram photos to peers all make teens worry about how they look, but experts say parents can nurture a home environment in which both healthy habits and self-love can thrive.

The family and health

As Brown's experience illustrates, parents have a strong influence on their teenager's body image. Comments adults make about weight and food set the tone for the household, said Carr, whose sociological research focuses on how family roles and relationships affect health.

"Some studies show the most common source of ill-feeling (about our bodies) is our own families," she said.

One 2013 survey, published in JAMA Pediatrics, found that weight-focused conversations, defined as talks in which parents criticized their teen's weight or emphasized eating less to lose weight, were associated with increased risk for disordered eating.

Nearly 40 percent of non-overweight adolescents and 64 percent of overweight adolescents who participated in a conversation with their mother about their weight practiced unhealthy weight-control behaviors like fasting, compared to 30 percent and 41 percent, respectively, of those who spoke about healthy eating with their moms, the study reported.

Marla Eisenberg, one of the study's co-authors and director of research in the division of general pediatrics and adolescent health at the University of Minnesota, said that even hearing their parents comment about other people's weight can add to a teenager's insecurities.

"Honing in on someone's appearance gives it undue importance, and sets young people up to make constant comparisons and be dissatisfied with themselves," she wrote in an email.

Eisenberg's findings emphasize the consequences of failing to consider teens' emotional health when expressing concerns about their eating habits or exercise routines. And yet many parents continue to make awkward observations about their child's body, assuming it's better to call attention to a few extra pounds than stay quiet, Carr said.

"Parents are under a lot of pressure," she noted. Doctors, teachers and friends often blame them for allowing a teen to develop unhealthy habits.

Additionally, parents are aware that the world can be unkind to overweight people. In a new study published in July by the journal Pediatric Obesity, (paywall) adult respondents from the United States, Canada, Iceland and Australia cited weight-based bullying as the most prevalent form of bullying affecting young people.

"It's rational to want your kids to be thin and attractive, because the world provides all kinds of rewards for that," Carr said. "But parents have to keep the needs of their child first."

Body image as a teen

Some researchers believe nurturing a healthy body image in a teen means treating "diet" like a dirty word.

Christine Logel, an assistant professor of social psychology at the University of Waterloo, said parents should avoid the topic of weight loss with young people, and instead focus on raising kids who are caring, honest and funny.

"It sends a mixed message to tell a teenager that, on the one hand, you love them unconditionally and appearance isn't as important as they think, but, on the other hand, you want them to lose weight and you are going to put time and energy into making that happen," she wrote in an email. "No matter what you say explicitly, the teenager is likely to hear, 'I don't think you are good enough the way you are.'"

Teenagers are sensitive to commentary on their appearance because their body image is still being formed, Logel noted. The way they interpret other people's views on their weight will affect the way they feel about themselves for years to come.

"Most teenagers who struggle with their weight are already getting very negative messages from their peers, from the media and even from strangers on the street," she said. "They don't need them even with the best of helpful intentions from their own parents."

However, parents can still encourage a healthy lifestyle, using more subtle strategies than blurting out a comment about clothes not fitting as well as they used to, Logel said, noting they "can quietly set up the young person's environment so that, without even trying, they are eating more healthful food and smaller portions."

Jean Walker, a mom of six kids who range from age 10 to 21, stocks her refrigerator with family favorites like grapes and tangerines. She also leads informal family dance parties or walks to keep everyone moving.

"I try to keep different fruits and vegetables" on hand to keep dinners interesting, said Walker, 37. "And I'll make dessert but find healthy ways" to adjust the recipe.

Parents make it easier for kids to make healthy choices when they remove tempting junk food from the house, keep snacks like chopped veggies easily accessible and model healthy behaviors themselves, Logel said.

Tips for raising a confident teen

Parents can start to prioritize emotional well-being by being honest with themselves about their own body image issues and addressing the ways their own parents might have unintentionally (or intentionally) affected their emotional health, Logel said.

She emphasized the importance of being positive and loving a teenager extra on the days they have a hard time loving themselves.

"Spend most of your time focusing on things that have nothing to do with weight and eating, that bring meaning to your teenager's life and your own," like art, music, politics, comedy, sports, pets and friends, Logel said.

Parents should be proactive and intentional in efforts to instill self-confidence, Carr said, noting that body image "is one of those topics parents need to talk about early and often."

"Parents have to be mindful not just when they're talking about their own kids, but about other kids, too," she added.

Similarly, Eisenberg said parents should communicate openly about the many things that matter more than weight.

"Parents can talk about bodies being healthy, energetic, strong, flexible and able to do a cartwheel or run a mile," she said. "Things that aren't focused on looks can be a wonderful source of body pride."

And if teens express concerns about their body in spite of these positive messages, parents can help them be healthier without reinforcing negative thoughts, Walker said.

"I don't encourage those thoughts. I ask, 'What was it that made you want to explore how to lose weight?' and then feel my way through it," she noted. "It's tough. You can't control what your kids are going to think about. But you can try to give them some balance."

Over the last few years, Brown has gotten involved with body-image activism, building friendships with other people who struggle with self-confidence and writing about her experiences. She's learning to love her body and asks parents to help their kids do the same.

"Don't imply (that your kids) aren't worthy of your love because of their body," Brown said. Parents should encourage young people of all sizes to "be interested in eating well and exercising for reasons other than losing weight."

As Brown looks forward to having kids of her own someday, she reflects on her difficult relationship with her body and how more empowering messages from her parents would have helped.

"I would have valued the idea of diversity, the idea that people come in all shapes and sizes," she said. "If I had had those lessons as a child, I think I wouldn't have had as many body image struggles because I would have (realized) this is just me and everyone is different."