(+++) TOO THIN, TOO TROUBLED

Just a Little Too Thin: How to Pull Your Child Back from the Brink of an Eating Disorder. By Michael Strober, Ph.D. and Meg Schneider, M.A., L.M.S.W. Da Capo. $25.

     Teenage girls – they are almost always girls – sometimes find themselves in an uncontrolled spiral, heading for a serious eating disorder and major health consequences.  Half or more of normal-weight teens consider themselves too heavy – media images tell them so – and up to 60% of teens diet regularly.  But there are innocent diets and not-so-innocent ones, and this book is designed to help parents learn the difference in time to intervene when intervention is necessary.

     According to Michael Strober, a leading expert on eating disorders, and Meg Schneider, a therapist who frequently writes about family issues, eating disorders progress through three stages.  First a girl diets innocently enough, but with a certain rigidity and compulsiveness – checking the scale every day, exercising daily as well, thinking about how good she is looking.  This stage is not negative by itself, but it can lead to the second, in which she becomes preoccupied with dieting, food in general, exercise and persistent feelings of hunger (which she is sure she can overcome for the greater good of improving her body).  Then comes the third stage, in which the whole day is spent strategizing about what and when to eat, how and when to do more (and more intense) exercise, and how to take care of “problem areas” she sees in the mirror.  Her reactions to food veer from cravings to nausea.

     This is a scary scenario.  Strober and Schneider explain to parents what to expect at each stage, what a daughter may say and do, and how to know when your child needs professional help.  There are a few remarks about boys – who diet more to try to sculpt their bodies than to lose weight per se – but this is mostly a book for parents of teenage girls.  It is also a book requiring a great deal of parental insight, both into one’s child and into one’s own upbringing and body image.  The book is full of things for parents to do – things that would surely be beneficial if parents had time to do them.  Example: List statements your mother or father made that criticized your appearance; reflect on how each statement made you feel; list alternative statements you wish your parents had made but did not; remember how you felt if your parents ever did compliment your appearance; figure out how to compliment your daughter’s looks without making her preoccupied with them; etc.  This sort of thing is a very, very tall order for most hyper-busy parents today.  So are the suggestions for managing a diet-related crisis – for example, interview lots of therapists and other potential helpers to find the right one, seeing each two or three times if necessary (with your daughter).  This seems to assume at least one non-working parent, plenty of time to take a child out of school, and no insurance hassles – three naïve assumptions.  Strober and Schneider provide excellent diagnostic information about eating disorders, but lack a sense of reality when it comes to treatment.  Their approaches would be just right in a world of ideal circumstances, but very few people live there.  More down-to-earth help would be more useful.