The best tactic for parents concerned about their overweight teens will be to just relax and cook a healthy Sunday dinner.
Pushing diets probably won't help. Neither will teasing about weight. Instead parents should focus on having frequent family meals, creating a positive atmosphere at mealtimes, promoting physical activity and building self-esteem, the researchers recommend.
The study of more than 2,500 adolescents over five years reinforced several things that doctors have found among their patients - particularly that destructive behaviors such as vomiting or abusing laxatives are prevalent among overweight teens as well as their too-thin peers, and that body attitudes and perceptions can play a big role in future weight problems.
"This is obviously of concern," Dianne Neumark-Sztainer, lead author of the study at the University of Minnesota, said of the risky behaviors. "We know that these behaviors tend to actually increase weight gain over time. It points to a need to address these behaviors with ... overweight kids."
The research will be published in the November issue of American Journal of Preventive Medicine.
The study found that 44 percent of the girls and 20 percent of the boys were either overweight, engaged in binge eating or had used extreme weight-control measures - such as purging or abusing laxatives, diet pills or diuretics.
Of the overweight adolescents, about one fourth of the girls reported using extreme measures, while 10 percent reported using extreme measures as well as binge eating. Only about 12 percent of overweight boys used extreme measures.
Neumark-Sztainer, who is also author of the book "I'm, Like, So Fat!," said she has long been interested in the intersection between eating disorders and obesity, and how both can be prevented. This study shows that problems on both ends of the weight spectrum can stem from the same issues of low self-esteem, body dissatisfaction and risky eating behaviors, she said.
The medical director of the Eating Disorder Center of Denver said the study was well-constructed - using a large number of kids over an extended period. Dr. Carolyn Ross said she was interested in the way the study linked teasing and pressure to lose weight to an increased risk in obesity and binge eating five years later.
The study found that girls who reported being teased about their weight were about twice as likely to be overweight five years later when compared with other girls in the study.
They were also about 1.5 times more likely to binge eat and use extreme weight-control behaviors, the study said.
Ross said the focus on obesity in children has prompted some negative approaches. For example, a physical education teacher who weighs students in front of their peers.
"This study shows us that we are really going in the wrong direction to put more attention and more pressure on kids to lose weight, which further stigmatizes them," she said.
Dr. Joel Jahraus, medical director of the Park Nicollet Methodist Hospital Eating Disorders Institute in Minneapolis, said parents need to send the right message. Jahraus said kids should not be told to "diet, diet, diet."
"The message should be one of balance," he said.