Department of Public Health Sciences, Karlinska
Carolyn Costin is the author of the book Your Dieting Daughter. She has now updated the first edition, which was published in 1997. The author comes from the United States and she has worked as a therapist for many years specializing in disordered eating and body image. She begins by telling her own story, her personal struggle with anorexia nervosa, describing how she was dying to be thin.
The book is written with the hope that parents will be able to help their own daughters and other dieting daughters. The author wants to help parents prepare them for having daughters in the “thin is in society” and to prepare them for a battle against the cultural pressure to be thin at all costs. I believe that this book contributes with new knowledge and takes a different and interesting angle since it is about disordered eating and not solely about eating disorders.
We learn that in the USA, 83 percent of college-aged women are on a diet no matter what they weigh and are wasting billions of dollars every year doing it. Even though more and more people are dieting, the prevalence of obesity has increased. The author claims that dieting is not working and proves that by showing many good examples. Already in 1959, a review of literature showed that 95 percent of people who lost weight regained it, and later studies confirm that between 75 to 95 percent of people who go on a diet will regain their weight loss.
Now dieting is happening at younger and younger ages. In the USA, 13 to 41 percent of girls between 8 to 10 years of age report that they have tried to lose weight by some form of dieting behavior. Worryingly, the average age for the onset of anorexia nervosa is between 9 and 12 and children as young as 7 have been diagnosed.
For parents it is a difficult and complex dilemma when and how to intervene when a daughter has a problem with weight or eating. I believe that dilemma is well illustrated in the following quote taken from the book:
Everyone has a different idea about what I should do regarding my daughter’s weight. If I leave her alone she might end up getting fatter and having health problems. If I try to help her I might cause her to become overly self-conscious or push her into an eating disorder.
A major strength with the book is that it is intended to help parents with practical information and useful advice of what to do when a daughter wants to diet. The author uses her expertise and illustrates various scenarios with girls trying to lose weight and gives advice on how parents can respond. There are many interesting and compassionate real-world examples describing girls and families that have come to her for help.
The author tries to help parents to communicate, respond to questions, understand their daughter better, get her help, set limits and deal with own emotions. She also wants to get the parents to understand the dieting girls better by providing a glimpse inside their inner worlds.
The book is mainly written for mothers but there is one specific chapter intended for fathers. There are many cultural differences which make the arguments feel very American. Sometimes the book feels irrelevant when distinguishing between mothers and fathers. The author assumes that fathers are not primarily responsible for daughters’ day-to-day caretaking, nor are they included in the daily decisions regarding their lives. Also, the author states that fathers are often left out of many things that mothers and daughters do, e.g. shopping, baking and cooking. This would not be the case in Sweden where in many cases both parents are involved in family life and often share an equal responsibility at home. There are quite a few pages filled with advice from fathers on how to understand and help dieting daughters. Personally, I like the fact that the author illustrates insights from the other side, from the parents’ point of view.
The book highlights the importance of building girls’ self-esteem and body esteem. The author stresses the importance of body image since body dissatisfaction is a risk factor for the development of eating disorders. She breaks body image down into three areas: perception, attitude and behavior. Perception is what girls compare themselves to, often based on unrealistic standards so they may never perceive themselves to be good enough. The focus on appearance is happening at younger and younger ages and young girls have become advertising targets. Toys marketed to girls have changed dramatically in the last years where for example “Troll Toys” that used to be short and stubby are now skinny and sexy and Disney characters have been “thinnised”. The prevailing culture puts an unhealthy emphasis on being thin. There are many examples in the book of how society contributes to the obsessiveness of thinness. It is no wonder that little girls are picking up questionable ideals and behaviors regarding food, bodies and weight. Interestingly, the book provides positive antidotes, things you can do to help counteract the current cultural climate.
I was a bit disappointed with the chapter about physical activity. It is quite obvious that the author’s expertise is within the food area, and a colleague has co-authored this chapter with her. Hence, physical activity plays a minor part in this book. The chapter is mainly about the problems that some girls have with physical activity, since some become fanatic and addicted and so do too much exercise in order to burn calories. For this reason the focus of physical activity should be on health and not on weight. There are questions for parents to answer in case they are worried that their daughters have a problem with exercise.
Subsequently, the author intends to help the parents understand if their daughters have progressed from dieting to a disorder. She helps them understand their daughters better if that is the case. Then she discusses certain risk factors that make some individuals more vulnerable to developing eating disorders (biological, environmental, psychological and cultural). In addition, criteria for eating disorders are shown so parents can recognise certain warning signs.
In my opinion, the most interesting parts of the book are when the author is sharing her experiences that she has come across over many years as a therapist. She gives guidelines from working with thousands of parents and dieting daughters over the years. In addition, parents share what guidelines they have found useful, which should be valuable for other parents in the same situation.
There is also a chapter written intended for a dieting daughter. In the last chapter Costin succeeds in touching my feelings by publishing emotional letters written by daughters and people who love them.
Copyright @ Gisela Nyberg 2013