Panel on Teen Fashion and Eating Disorders

April 30, 2003 Moderator: Dr. William Licamele, Child Psychiatrist in McLean Panelists: Laura Sessions Stepp, columnist for the Washington Post and recipient of a Pulitzer Prize Erin Mackay, student at UVA and graduate of McLean High School Dr. Adrian Brown, director of the Eating Disorder Clinic at Georgetown University Kathy Camisa-Goetz, President, New Faces Modeling Laura Sessions Stepp     Ms. Stepp titled an article she had written on teen fashion as "Naked Fashion—Nothing to Wear." She said the popular style today is low-slung jeans, tiny camisoles, and slip dresses with contrasting-color bras. Abercrombie marketed prominently in their store thong underwear for seven-year-olds until there was such an outcry from parents that they moved the merchandise to the back of the store—but it was still available. Teen fashion is a big business. Girls aged 12-18 spend $38 billion a year on clothes. Over 100 magazines are aimed at teenaged girls.     The issue of suggestive fashion is not new. In 1989 Madonna grabbed her private parts while appearing on MTV to sing "Express Yourself." Jennifer Lopez and Britney Spears are following Madonna’s lead. Naked fashion is an unintended outcome of women’s liberation. As girls feel more empowered, they believe they can wear whatever they want to. Children are told that can be or do anything, but they can’t. Parents have to help teens realize there are limitations. Teen girls dress they way they do to outrage their parents and to impress other girls. Parents need to be careful not to overreact since clothing is part of a natural rebellion. What is new and of increasing concern is that younger and younger girls are wearing suggestive clothes. Her advice to parents included the following: 1) help kids find clothes that fit in with the group and are in good taste (this may take some shopping!), 2) recognize (and teach) that some clothes that look right at a party do not look right at school, church, or Grandmother's house, and 3) realize that the long-range goal is to raise kids who are confident and make good decisions on their own. More important than how they dress is how they feel about what they do – in school, on the sports field or in the music hall. Stepp also reminded parents to set a good example and urged parents to make sure their children have other adults they feel comfortable talking to.     Adults should not underestimate the amount of self-confidence some modern teenaged girls possess. Even overweight girls are wearing revealing clothes. Guys think that girls who dress in hot fashion want to hook up, even though many girls who dress that way don’t think or talk that way. Boys still want to have meaningful relationships with girls who dress more conservatively. Erin Mackay     Erin developed anorexia during her junior year at McLean High School during a stressful period. She felt afraid to grow up, was terrified of failure, and believed that she needed to be beautiful to be successful. As she first began to lose weight, she felt happy. (Dr. Licamele noted that anorexics are often outgoing and popular. They feel happy because they are losing weight.) Gradually, she began to feel that she lost her impact on the world around her and the world lost interest for her. She noted that the brain cannot function normally with fewer than 150 grams of carbohydrates a day.     Two years elapsed between onset and initiation of therapy. The nature of the disease is inherently secretive. She said you cannot tell whether someone has an eating disorder by what they eat in public. She lied about her behavior to her parents, who at one point suspected a problem but relaxed when a gynecologist asked Erin a few questions and concluded she was fine. She wished someone had confronted her earlier so that she might have begun treatment earlier.     Therapy involved a nutritionist and psychiatrist. Her initial experience was not totally positive. She relapsed after two years. She advised other patients to change therapists until you find one you can relate to. She always knew what she should do based on all her reading about the subject but it has taken four years to really get on the right track. While the team helped and it is crucial to have someone else to talk to, it was really a personal decision to work toward a healthy lifestyle that became her turning point. She noted that when people base their self-esteem on more than one area, they have something to fall back on if one area goes bad.     She noted that high school girls dress fashionably to go to school. College girls wear loose, comfortable clothing to go to class but dress fashionably to go to the library or out on a date. Dr. Adrian Brown     Eating disorders affect all ethnic groups. The 20th century was the first in which more food was produced than was needed for consumption. Now the world produces 4000 calories of food per person per day, whereas the average person consumes 2000 calories per day. As food gets more plentiful, our culture stresses the attractiveness of thinness. Gone are the plump models of Rubens; models in Playboy centerfolds in 1995 weighed on average 20 pounds less than the models in centerfolds twenty years earlier. Conditioning to think that thin is beautiful begins very early; a study of three-year-olds showed that they applied bad attributes to persons who were fat.     Biological risk factors include a family history of depression or of eating disorder, obesity, and diabetes. Psychological risk factors include low self-esteem, need to please, fear of rejection, need to be in control, and distorted body image. About 10 times as many women suffer from eating disorders as do men. Anorexia affects about 0.5% of the population; bulimia affects about 3% and is especially prevalent in adolescent girls and young women. Onset is typically in teen and early adult years. Eating disorders lead to death more frequently than most other mental conditions. A study at Georgetown University showed that about 15% of women students suffered from an eating disorder.     The age of puberty has decreased. Some girls move into anorexia to delay puberty and sexual activity. Parents should look for changes in eating habits, signs of vomiting, and presence of diuretics or diet pills. If parents suspect a problem, they should raise the possibility in a neutral way in case their child is looking for help. If that approach does not yield adequate answers, consult a pediatrician or a psychiatrist.     Treatment of anorexia nervosa involves an interdisciplinary team of individual and family therapists, nutritionist, and pediatrician, with the goal of restoration of weight to within 5-10% of the ideal body weight. Bulimia treatment also includes some prescription drugs (Prozac). Kathy Camisa-Goetz     Her modeling agency looks for professional, healthy, well-rounded individuals. Her models wear light makeup, little jewelry, one earring per ear, no tattoos, and no false fingernails or toenails. Hair color is natural; hair is pulled back to show the face. Models wear black skirts to their knee, a high-neck black top, and platform shoes. Models are encouraged to eat nutritiously and exercise. The preppy look is back in. Fuller, looser dresses are fashionable. Girls can find fashionable, conservative, inexpensive clothes at stores like Target and stores carrying labels such as Liz Claiborne and Jones New York.