WHEN MARY PABST visits a Towson classroom as a guest speaker this week, she'll be talking about self-esteem and positive body image -- not unusual subjects in a discussion designed to deter students from eating disorders like anorexia nervosa and bulimia.
But in this case, the students she'll be lecturing are preschoolers.
"We know now that the seeds for dissatisfaction, dieting and a drive for thinness are planted in the very young child," says Ms. Pabst, president of the Maryland Association for Anorexia Nervosa and Bulimia. Very often the eating disorders that reveal themselves in a teen-age girl have been growing quietly and steadily for years, she says.
A psychiatric social worker at Sheppard Pratt Hospital, Ms. Pabst routinely counsels young women -- and the overwhelming majority of people with eating disorders are female -- with emotional and physical problems related to abusive eating habits. Anorexia nervosa -- characterized by self-starvation and excessive weight loss -- and bulimia nervosa -- a secretive cycle of binge eating followed by purging -- are the most critical eating disorders because of their life-threatening consequences. But lesser conditions arising from chronic dieting, compulsive overeating and obsessive behavior related to weight control also have become common.
Ms. Pabst is a founding member of Eating Disorders Awareness and Prevention Inc., a four-year-old national, non-profit organization concerned with the growing number of problems associated with Americans' preoccupation with food, weight and striving for thinness. This week, the group is sponsoring Eating Disorders Awareness Week by targeting young children and their mothers, in particular, in a nationwide effort aimed at prevention.
Through a series of grass-roots efforts in 33 states, EDAP members are going into their communities this week -- to parent groups, schools, birthing classes, hospital groups and anywhere else that they can reach mothers of the very young or the youngsters themselves. Their message in essence: It's what's inside a person that counts, not what he or she looks like on the outside.
Ms. Pabst will visit her son's class of 4- to 6-year-olds at the Montessori School of Central Maryland in Towson on Thursday. There she'll talk informally with the kids about the variety of body shapes and sizes they see when they look at themselves and their friends. She'll remind them that their body sizes "have nothing to do with being good, smart or a valuable person" and distribute a fact sheet and letter to be taken home to their parents.
In Florida's Dade County, Paula Levine, a psychologist specializing in eating disorders and vice president of EDAP, has lined up visits with a couple of hospital support groups for expectant parents. And she'll be attending PTA meetings to talk to parents of children in kindergarten through third grade.
"This is a way to get directly to families of young children," says Dr. Levine, who is director of the Anorexia and Bulimia Resource Center in Coral Gables, Fla., and a staff member of the nearby Renfrew Center, an in-patient facility devoted exclusively to women with eating disorders.
"Everyone today wants to raise kids with a healthy self-esteem. But you can't have positive self-esteem with a negative body image. And the kid who doesn't like herself at age 4 or 5 is already dieting by age 8 or 9," says Dr. Levine, whose clients include adolescents and pre-adolescents who have abused themselves to the point of needing hospitalization as well as counseling.
Dr. Levine, who emphasizes that no two eating disorder cases are alike, says there are a variety of conditions that predispose a girl -- and the overwhelming majority of people with eating disorders are female -- to anorexia or bulimia. There is often an underlying psychological need that's being addressed with food; but biological and genetic factors, social conditions and family background also play a part.
And the surrounding culture, with its unrelenting emphasis on the "perfect body," feeds their obsession.
"They are getting it from dieting and exercise-conscious families, from advertising, from Barbie dolls, from TV . . ." says Dr. Levine. "This stuff is not subliminal. It's all right out there in front of them."
While there might seem to be an inherent danger in introducing discussions related to eating disorders with children in the primary grades, those who have counseled victims of the illnesses say the risks of not talking are greater. Research, they say, supports their fears that young minds are fertile ground for weight-consciousness to thrive.
Take the study published in the International Journal of Eating Disorders in 1991 in which 1,100 Indiana youngsters were surveyed on their idea of attractiveness. The results showed that 42 percent of girls in the first through third grades preferred body shapes different and thinner from their own, indicating that dissatisfaction with their bodies may start as early as 6 and 7 years of age," says Ms. Pabst.
In another recent study by the National Dairy Council, 34 percent of 9-year-old girls reported they were afraid of getting fat, had experienced bingeing and had already tried dieting.
That doesn't surprise Andrea McDonough, a registered dietitian and EDAP volunteer who has led group discussions in classrooms in Concord, Mass., as well as in private schools in Baltimore.
"When I go into schools, only a handful of 8- to 10-year-olds have never heard the words 'anorexia' and 'bulimia.' And when I ask them how many live in a home where there's never been dieting, very few raise their hands," says Ms. McDonough, who was an eating disorders specialist at Children's Hospital in Boston before moving to Baltimore last year. Her "Growing into Your Own Size" program addresses small groups of students in several visits over about a five-week period.
Ms. McDonough says girls 10 to 12 are at highest risk for eating disorders because they are at an age when a very important growth spurt is about to take place and when their anticipation of growth can create severe anxiety.
"It's a critical period in which to get the message across that the size you are now is not final, that you need to get nutrients now and that dieting would be dangerous to your health."
Eating Disorders Awareness Week will culminate Sunday with a guest appearance at Goucher College by Susan Kano, author of "Making Peace With Food." Ms. Kano's lecture/mini-concert, titled "Never Diet Again," begins at 4 p.m. in Merrick Lecture Hall. Admission is $6.