Childhood Risk Factors for Thin Body Preoccupation and Social Pressure to Be Thin

ABSTRACTObjectiveThin body preoccupation and social pressure to be thin (TBPSP) in adolescence are risk factors for the development of full and partial bulimia nervosa and binge eating disorder. This study examined precursors of these potent risk factors.MethodA prospective study followed 134 children from birth to 11.0 years and their parents. Recruitment began in January 1990 and ended in March 1991. The study was completed in December 2002.ResultsTwo moderators identified different groups at risk for the development of TBPSP. A father with high body dissatisfaction characterized the largest group in which TBPSP was elevated for girls who were concerned about and attempted to modify their weight and for children with fathers who had a high drive for thinness. A child at risk for overweight characterized the second smaller group. Parental behaviors such as overcontrol of their child's eating, together with later pressure from parents and peers to be thin, were related to higher levels of TBPSP.ConclusionsDifferent pathways lead to the development of eating disorder psychopathology. These results suggest that prevention programs for eating disorders should begin in early childhood, possibly involving parental education and behavior change, and that different prevention programs may be required for different pathways. J. Am. Acad. Child Adolesc. Psychiatry, 2007;46(2):171-178.