by Wilson, Bee
It wouldn’t be surprising if they did have low self-esteem, given that girls—overweight or otherwise—are often made to feel that their eating is more of a problem than that of their brothers. Mothers who exert weight pressure may be projecting their own body anxieties onto their daughters, which explains why they do it more to girls than boys. (One study showed that bulimic mothers were more likely to exert “controlling feeding practices” on daughters than on sons, regardless of whether the girls were overweight.) Fathers may have the same bias toward children of the same sex. Fathers who were dissatisfied with their bodies, one study found, were more likely to monitor their sons’ but not their daughters’ food intake. But for the most part it is mothers who are in charge of the family’s food, and it is daughters who are given the lion’s share of the weight pressure.
Parents, it seems, find it hard to know quite how to behave around teenagers at the table, whether they are boys or girls. Project “EAT” in Minnesota followed nearly 5,000 adolescents over a five-year period. Of these 5,000, some were younger teenagers (aged twelve to seventeen during the time frame of the study) and some were older (aged fifteen to twenty). Researchers led by Katherine Bauer used interviews with the adolescents to assess any changes over the years in how much parents encouraged them to choose healthy foods, to exercise, and to lose weight. Over time, parents of boys backed off on all three counts. This finding reflected the growing independence of the teenage years. Apparently it feels slightly absurd to be asking someone bigger, stronger, and hairier than you if he has eaten five vegetables yet today. Maybe there’s also a shift of priorities. When you fear that your teenage boy might be into drugs, it can be hard to care so much about the odd fizzy drink. Parents of teenage boys don’t want to be too heavy about family meals for fear of driving them away altogether, which is a pity, because the data suggest that continuing to give them balanced home-cooked meals is one of the best things you can do for your adolescent’s health. Children who eat regular home-cooked meals consume more fruits and vegetables and seem to be happier than those who do not, insofar as this can be measured.
With the teenage girls in the study, however, the picture was different. Like the boys, the girls reported that as they got older, their parents made less strenuous efforts to get them to eat healthy food and to be physically active. But as the older group moved from mid- to late adolescence—from fifteen to twenty—some of the parents actually started to put more pressure on them to go on weight-loss diets. At just the stage of life that we’d expect a girl to be given full independence in matters of food—an age when they are free to drive their own cars, get married, and vote—rising numbers of them were being told by their parents that what they ate was still the family’s business.
Our childhood experiences with food can trap us in destructive patterns for the rest of our lives. This pressure on the girls in some families to lose weight is a case in point. I recently spoke to a professional woman in her late forties who had been on more failed diets than she cared to remember. Every time she phoned home, no matter what else was happening in her life, with her children or her career, her mother’s first question was still, “Have you lost weight?” Her friends cheerily joked that she would only stop the yo-yo dieting once and for all when her mother died. She felt that she had trapped herself in overeating for many years as a form of rebellion against her upbringing, but one that ended up as a form of self-punishment. At last, in her forties, she had found a form of healthy eating that she could maintain—not the diet that her mother wanted her to go on, but a routine of lovely salads, grilled fish, and intensely flavored soups that did not feel like deprivation. It had taken her such a long time getting there, and she felt she could have arrived sooner without the parental voice in her head telling her to eat less.
Like so many of the things parents do out of loving solicitude, putting pressure on girls to lose weight has no good outcomes and a lot of bad ones. It has repeatedly been shown to leave children more at risk of body dissatisfaction, excessive worry about weight, depression, bingeing, and disordered eating. In one study, nearly a third of fifteen-year-old girls whose mothers encouraged them to lose weight engaged in extreme weight-control behaviors—including laxatives, vomiting, skipping meals, smoking as a meal substitute, and taking diet pills—as against just 5 percent of girls whose mothers did not encourage them to diet. There are similar consequences from family “weight teasing” of overweight girls. One study found that girls who were teased “very often” for being chubby by relatives were far more likely to resort to binge eating than those with more courteous families. Even if that fact doesn’t deter you from hinting at your daughter to slim down, consider this: it probably won’t work. Having parents pressure an overweight child to diet left the child with a higher risk of being overweight after five years.
This weight pressure on girls is part of a wider mindset. The sphere of eating can feel like a different place for boys and girls. Regardless of whether we have actual brothers or actual sisters, our culture sends strong hints that we should choose foods appropriate to our sex. “For a boy certain things were off-limits,” wrote food writer Nigel Slater in his memoir Toast. As an eight-year-old boy, Slater felt labeled as effeminate by his choice of treats: “Love Hearts and Fab ice creams were for girls . . . and no one over six would be seen dead with a flying saucer.” There’s still a macho note to much of the food advertising aimed at boys and men. “Man up!” urged KFC’s slogan for its Double Decker Burger, as if there might be something wimpish in a boy who didn’t think he could manage a bun containing two full chicken burgers, bacon strips, cheese, lettuce, and a splodge of mayonnaise.
Girls, too, are given strong messages that some foods are more for them than others. When businesswomen in Japan socialize with the boss, they are “allowed to drink plum wine mixed with plenty of soda instead of beer,” reports The Economist, as if it were impossible for a woman to prefer beer to watered-down plum wine. Such thoughts go all the way back to the playground, where boys are “meant” to want foot-long sandwiches stuffed with meat, while girls are supposed to dream of sugar and spice and all things nice. Before they arrive in junior high, girls learn that certain foods come with a “shouldn’t” attached. They learn that “skinny” is a compliment. They absorb the sense that there would be something slightly odd about a girl who didn’t revere chocolate.
The idea that boys and girls respond to food differently is not all myth: there are definite physiological differences in the way that boys and girls relate to food. For one thing, there’s the vexing fact that—levels of exercise and size being roughly equal—boys need more energy than girls. According to recent guidelines, a seven-year-old boy needs around 100 calories a day more than a girl of the same age (1,630 versus 1,530). By the age of eighteen, the gap jumps to nearly 700 calories (3,155 calories for boys versus 2,462 for girls), the equivalent of a whole extra meal. There’s a difference between pressuring a girl to eat less and simply giving her a different portion. If I fed the same mountainous helping to my average-height twelve-year-old girl that I give to my sixteen-year-old boy (six foot ten), she wouldn’t be able to make a dent in it. That isn’t meanness; it’s math.
A more startling physiological difference is that male and female brains show different activity in response to eating. The sour taste of citric acid, for instance, has been found to produce a more marked response in the insula and thalamus of women than in men. Overall, women have a greater sensitivity to smells and flavors than men and are better at remembering them. This increased sensitivity may make girls pickier. Many studies have shown that women have a greater number of negative attitudes toward foods and are more likely to reject them for not tasting quite right. Marketing expert Bryan Urbick has spent many years working with panels of children doing product development for the food industry, interviewing, on average, 4,000 children a year in Europe, North America, Central America, Asia, and the Middle East. Across these differe
nt cultures, Urbick found “strong, recurring patterns” in the ways that girls and boys responded to food. Boys regularly had lower sensitivity to taste and touch than girls. Urbick found that “if you get the taste right for girls, you have probably got it right for boys as well.” Yet when it came to the branding of food products, the situation was reversed. Urbick advises product developers that when targeting both boys and girls, the packaging and brand should always be skewed to boys. “Girls are more accepting of ‘boy’ products whereas boys are more likely to reject something that is too ‘girly.’”
The idea that there are “girly” foods and “boyish” foods is pretty ridiculous when you think about it. Who gets to decide that Men Love Pies, Girls Love Hummus, the title of a 2013 cookbook by chef Simon Rimmer? Yet even if we insist we are beyond such childish notions, it is very hard not to internalize the idea that some foods belong more to one sex than others and to make our choices accordingly. We tend to automatically associate hearty meat dishes with men, and lighter salads and sweets with women, and these stereotypes are replicated in cultures as different as France and Japan. When American college students were asked to say which foods belonged to which sex, they answered readily: steak, fried potatoes, onions, and hard candy were for men, and cottage cheese, peaches, soufflé, and crepes were womanly. Moreover, it was found that some adolescent boys were wary of eating foods with feminine connotations—above all, when friends were present: real men don’t eat soufflé!
These ideas about boy food and girl food tip over inexorably into our personal preferences. In 2003, one research group used survey data to explore how the concept of “comfort food” differed according to gender. They found that “males preferred warm, hearty, meal-related comfort foods (such as steak, casseroles and soup) while females preferred comfort foods that were more snack related (chocolate and ice cream).” Striking numbers of women also considered vegetables to be a comfort food. The researchers suggested that the fact that men were comforted by full hot meals was likely to be a throwback to childhood, when they became “accustomed to having meals prepared for them.” Another gender difference was that men tended to feel “healthy” after eating their preferred comfort food of steak, whereas women felt “guilty” after their ice cream, cookies, and chocolate. So the women’s comfort food didn’t even comfort them: a waste all round.
This social pressure to eat according to your sex matters more than it seems. For one thing, it undermines our pleasure in eating, which is seldom a good thing. Women often deny themselves the thing they might really want on the menu because they feel it isn’t “appropriate.” Women in Japan reported intense cravings for sushi, but did not eat it as often as they wished, perhaps because it was seen as a filling, masculine sort of food. A survey of how British consumers behave when eating out found that, while women may say that they enjoy steak in restaurants, they do not ultimately choose it as often as men, seeing it as too expensive for them. Overwhelmingly, female diners-out choose white meat, and male diners choose red meat. We see nothing wrong in this because we are so acclimatized to the view that men are the “red-blooded” ones when it comes to food.
But if anyone needs red meat (and some would argue that no one does), it is not men but adolescent girls. What is so damaging about our gendered approach to food is that it encourages both boys and girls to feed themselves in ways that go against what their bodies require. We have got things the wrong way round. It is girls more than boys who need the most hemoglobin-boosting foods. And boys more than girls are lacking in salad and vegetables. “Girl food” and “boy food” are dangerous nonsense that prevent us from seeing the real problems of feeding boys and girls.
Contrary to the impression given by the health pages of newspapers, the greatest single nutritional shortfall in our diets right now is not that we don’t eat enough “superfoods,” whatever those might be. It is the iron deficiency of girls. Across the globe, rich or poor, fat or thin, millions of adolescent girls are anemic because they do not have enough iron-rich foods in their diets to cover the leap in what their bodies need—from 8 milligrams to 15 milligrams daily—when they start to menstruate. Many more have iron depletion, where no iron is stored in the body, which can cause tiredness, headaches, and impaired cognitive function. Iron deficiency affects 2 billion people worldwide, according to the World Health Organization. Plenty of men and boys are anemic, too, but young women are disproportionately affected. Iron-deficiency anemia takes its heaviest toll in developing countries, causing one in five deaths in childbirth (often due to hemorrhage—a pregnant woman needs twice as much iron again as a teenage girl). But it is also remarkably common in countries where you might expect girls to be well nourished, and matters are not helped by the stereotype that girls can survive on lettuce leaves and chocolate.
A European survey from 2001 found that as many as 40 percent of girls aged fifteen to sixteen in Sweden had depleted iron stores (as against 15 percent for boys); in Denmark low iron affected 7 percent of boys aged sixteen and seventeen and 20 percent of girls of the same age. In China, a sample of 1,037 adolescent girls in 2007 found iron deficiency in 40.4 percent and full anemia in 19.5 percent. Short of supplements (which can cause constipation and nausea) and fortified breakfast cereals, it isn’t easy to eat enough iron-rich foods. By far the richest and most “bioavailable” source is liver (a three-ounce serving of chicken liver contains eleven milligrams), followed by red meats (a six-ounce sirloin steak: around six milligrams). Absorption of iron is impaired when tea or coffee is drunk alongside an iron-rich food, whereas vitamin C improves absorption.
A teenage girl who suddenly switches her morning juice for coffee, goes vegetarian, and stops eating eggs for breakfast (eggs are boy food!) may find herself in trouble. Women are far more likely to be vegan or vegetarian than men: out of around 1 million American vegans, 79 percent are women; among vegetarians, 59 percent are female. There are plenty of good vegetarian sources of iron, including pumpkin seeds, nuts, spices, green leafy vegetables, blackstrap molasses, dried fruits, egg yolks, pulses (such as kidney beans), bran, and whole-grain bread. The problem is that a teenager who goes vegetarian on impulse is unlikely to be in the habit of eating the correct balance of these foods. Non-meat sources of iron are also less readily absorbed by the body, so vegetarians may need even more iron than their carnivorous counterparts. The most dangerous group for girls to be in for anemia risk is the one where people are both dieters and vegetarians: in the 1990s, 43 percent of vegetarian British girls aged eleven to fourteen who had tried to lose weight over the past year had low hemoglobin levels in their blood, whereas only 15 percent of non-dieting vegetarians did, and 8 percent of non-dieting meat-eaters.
Surprisingly, the overweight are also at high risk for anemia. The problem is due not to the amount of food they consume, but the quality. A sample of Iranian adolescent girls confirmed this finding: despite taking in more calories than they needed, the overweight girls in the study were actually more likely to be anemic than the normal-weight girls (34.1 percent of the overweight girls were anemic as against 27.8 percent of the normal-weight girls). These girls were not getting enough iron from their carb-heavy, nutritionally imbalanced meals. There’s not much iron in pizza, or in ice cream or chips, all newly popular foods on the streets of Tehran.
It may be that iron deficiency is cause as well as consequence of being overweight. Iron deficiency seems to slow down metabolism because it causes a reduction in levels of carnitine, a compound involved in metabolizing fatty acids. Anemic women have a poor capacity for aerobic exercise, which can be reversed with iron supplements. It’s understandable if teenagers with anemia are not raring to get on a treadmill, given that lack of iron makes you feel faint and woozy, hardly able to put one foot in front of the other (or so I felt when I was anemic and white as a sheet after the birth of my first child).
Too many overweight teenage girls are being pressured by their families to lose weight when what
they in fact need is better nourishment (which would almost certainly help them to lose weight along the way). Iron-deprived girls of every size need to be “built up,” as the reassuring old phrase had it, with soft-boiled eggs and whole-grain toast, with dark leafy greens, griddled flank steak, lamb casserole, grilled sardines, and hearty minestrone or black bean chili. In short, these girls need man food. If they still feel their bodies are crying out for chocolate, they should switch from cheap milk-chocolate bars, which are really mostly sugar and vegetable fat, to real 70 percent cocoa dark chocolate, which might actually do them some good (a small 30-gram bar of dark chocolate: 5 milligrams of iron).
But almost no one speaks of building girls up—these delicate soufflé-nibbling creatures who ought to be able to survive on air and compliments. Instead, great focus is placed on building up their brothers, stoking them with dangerous delusions about how much food they need. In the current food environment, the overfeeding of boys is no more helpful than the underfeeding of girls.
One of the biggest obstacles to any overweight or obese child losing weight is when parents do not see that there is anything wrong. Dr. Laura Stewart runs child obesity clinics in Tayside in Scotland, which has some of the worst child health outcomes in Europe. “A lot of parents do not perceive their child has weight problems,” Stewart told a conference of health professionals I attended in October 2013. The problem, in Stewart’s view, is that the media only shows photographs of “the most exceedingly obese children” when discussing the issue, which leaves people whose children are only mildly obese thinking that they are perfectly fine. If most of the people you see around you are overweight, it starts to seem normal.
Stewart told us of an experiment she did in Tayside in 2010 that was aimed at finding out what it would take to make parents see that their child has a weight problem. Parents were shown photographs of children and asked to group them into “normal” and “overweight.” It was as if they couldn’t grasp what was in front of them. These parents could only recognize a problem with weight when the child in the picture was actually “significantly obese.” All of the photos of children who were overweight, rather than obese, were seen as “normal.” There is a lot of collective denial when it comes to children and weight. It is even there among some of the doctors and nurses whose job it is to deal with it. Around half of those employed by the National Health Service (NHS) in Great Britain are now overweight or obese, making it seem normal for them, too. After Stewart had finished talking, a health worker in the audience put up her hand and criticized Stewart for using the body mass index system in evaluating children. “You could have a fat but fit child! On the BMI system, a body builder could be classified as obese!” Stewart collects herself and smiles. “I’ve never once had a fit muscular child referred to my clinic. You do have to use your eyes.”