RedOrbit Exclusive Interview: Martina M. Cartwright, Ph.D., R.D., University of Arizona, Department of Nutritional Sciences

Jedidiah Becker for redOrbit.com — Your Universe Online
The child beauty pageant is a uniquely American cultural phenomenon that has been catapulted into the media spotlight in recent years. Popular reality television shows like Toddlers & Tiaras and Here Comes Honey Boo Boo as well as films like Little Miss Sunshine and Living Dolls: The Making of a Child Beauty Queen have raised public awareness and debate about these pageants to an unprecedented level.
In a recently published study, registered dietician and adjunct professor at the University of Arizona Dr. Martina M. Cartwright suggested that these high-glitz child pageants are often more about the parents and their needs, and have little to do with the children at all. Her study also scrutinizes several common pageant practices and she draws on her clinical expertise to predict that these can have harmful effects on both the physical and mental health of the young participants. Dr. Cartwright recently talked with redOrbit about these controversial pageants and how we as a society can start to counteract their negative effects.
Read the original article “Pageant Parents Exhibit Signs of Princess By Proxy” first.
Interview
RO: Dr. Cartwright, while child beauty pageants have gained increasing public attention (and scrutiny) in the past few years through news headlines, TV reality shows and even documentary films, your research is the first that we´ve encountered that has actually brought this bizarre cultural phenomenon under the scrutinizing gaze of science. What prompted you to tackle this controversial issue as a topic of research?
Cartwright: As a registered dietitian, I have worked with child athletes and performers for several years, many of whom develop abnormal relationships with food including eating disorders like anorexia and bulimia. As a result of my experiences, many people have asked for my professional opinion about what “happens” to young girls who participate in appearance driven pursuits like glitz pageants? For example, do they develop eating disorders etc.? I found that little research has been published on this issue and wrote an opinion piece for Psychology Today Online about child pageants. The piece was based on what I saw on TV. Thinking that the edited TV shows might not be a true reflection of what occurs in “reality,” I decided to see for myself. Hence the research article in JAACAP (Journal of the American Academy of Child and Adolescent Psychiatry) which was based on my direct observations of two live filmings of Toddlers and Tiaras.
RO: Much of the discussion surrounding these pageants tends to focus on the negative psychological effects that they can have on the impressionable young girls that compete in them, and your work specifically addresses topics like self-esteem, body dissatisfaction and the very early sexualization of these girls. However, as an expert in developmental biology and nutritional science, you also shine the spotlight on some common pageant practices that you believe could lead to real health problems for the young contestants. You mention, for instance, that many of the girls consumed large amounts of sugar (“pageant crack”) and caffeine, and that many had highly irregular sleep schedules. Did you observe any other potential health threats for these young girls? And what do you see as the potential short- and long-term health consequences of all this?
Cartwright: I did not observe any additional health threats at the pageants. The main issues were overt consumption of large amounts of sugar and caffeine. Short term sugar consumption can lead to issues with tooth decay if not properly addressed. Short term sugar intake does temporarily raise blood sugar but doesn´t cause diabetes. The bigger concern is long term, not from a calorie standpoint, but from an emotional-food connection. Adult stress and emotional eaters learn to associate certain foods with comfort and relief of stress and possibly reward if the behavior is done repeatedly. For example, repeatedly giving a child sugar for performing well might cause the child to associate the sugar with good feelings. The chemistry in the brain might actually change such that a “high” is achieved each time the award is provided. Long-term overuse of high sugar drinks and candy may lead to poor dietary choices and possibly obesity. I didn´t see overconsumption of calories just overuse of sugar, there is a difference. For example, on TV I saw Honey Boo Boo eat two large pieces of sugary cake“¦too much sugar and too many calories. At the pageants, sugar was used as an energy booster and again may produce a temporary “high” that can become addictive.
Regarding the caffeine, my concern was about kidney function. Large amounts of caffeine can tax growing kidneys and result in dehydration since caffeine pulls water out of the body. Energy drinks are a problem too as they have high levels of B vitamins, in excess of what children need. B vitamin toxicity is relatively rare but a concern. Energy drinks and sugary caffeine laden sodas were omnipresent at the pageants I attended.
If the lack of regular meals and poor dietary choices continue outside the pageant, this may be a recipe for disaster later in these children´s lives. Moms who put their kids in pageants are often diet or body image (appearance) oriented and this can have a profound influence on the child´s relationship with their body and with food. As a result of my article in Psychology Today On-line, I was contacted by Karen Kataline, a 1960s tot beauty queen. She recently wrote a book called “FatLash” (I wrote the forward) and confirmed what many have thought about what “happens” to former tot beauty queens who have pushy moms that control the child´s appearance and food intake. Disordered eating patterns and poor self-image can be lifelong struggles for some of these former pageant participants. I recently became aware that a former colleague who had been a model throughout her childhood and college years passed [away] from complications from an eating disorder. She was only 37 but had suffered with anorexia and bulimia for years. It has been my experience, and research supports, that young children develop dietary habits early in life and that these habits are influenced by their closest relationships and activities.
RO: The American public seems to have an ambivalent attitude toward these child pageants. While I couldn´t find any public opinion surveys, I would guess that most people would say that they disapprove of them and probably even believe them to be unhealthy for the young participants on some level. On the other hand, however, millions of people tune in each week to watch The Learning Channel´s show “Toddlers and Tierras.” Add to this consideration the popularity of shows like “Freaky Eaters,” “Hoarders” or even outlandish talk-shows like Jerry Springer, and it starts to seem like Americans have some sort of obsession with the bizarre and dysfunctional. You mentioned, however, that you think the public might start paying less attention to these pageants once they start to understand why these parents subject their children to this. Why is that?
Cartwright: Viewership drives ratings and the ratings occur because the public can´t look away. Banning the show isn´t the answer, but I believe ignoring it is. I believe if people understand that extreme pageant parents are “fed” by the attention, they will choose to stop watching. Low ratings lead to cancellations and this might drive the show off the air without a ban.
It is curious why people watch and why they are fascinated. I´ve had people tell me how they get sucked into watching and are aghast at the behaviors but keep watching anyway. According to the APA´s report on the Sexualization of Girls, repeated viewing of TV shows and media that sexualize girls can lead to self esteem and body dissatisfaction. I think if adults understand the consequences such shows have on girl´s self-esteem, they would be less likely to watch, which would tank the ratings. As it stands now, shows like T & T [Toddlers and Tiaras] provide entertainment without consequences.
RO: Your study uses the term “achievement by proxy distortion” [ABPD]–or, more specifically, “princess by proxy”–to describe the parents who push their children through these pageants for more or less self-centered reasons. What´s the difference between this phenomenon and those parents that everyone knows who push their kids really hard to succeed in football, ballet or even academics? Is it simply a difference of degrees or is there something fundamentally different about what these pageant-obsessed parents are doing?
Cartwright: Benign ABP [achievement by proxy] is when the child gets healthy support from the adults involved (coaches, parents, etc.)  Cheering a child on at a sport or pageant; listening to the child when they have concerns about losing or winning are examples of this. However, ABPD is when the parent loses sight of the child´s needs and abilities in favor of their own desires. ABPD occurs in stages and it can occur in sports, dance and academics. I´ve seen it in all of these areas.
I named the pageant behaviors PBP [princess by proxy] to describe behaviors specific to pageant parents who go too far“¦.PBP is a type of ABPD specific to pageants. The pageant parents are not fundamentally different from extreme sports parents as the behaviors are similar. My article points out the behaviors specific to pageant parents.
To help clarify this point, overzealous sports parents, some of the moms on [the television show] Dance Moms and some extremely academically-focused parents can all exhibit characteristics of ABPD. The first stage of ABPD is risky sacrifice, which I describe in PBP as the pageant financial investment exceeding possible winnings. In football or sports, this might manifest as spending a lot of money on coaches and special out-of-town clinics to improve a child´s ability.
The next stage, Objectification occurs when the adult no longer differentiates their needs and goals for success from their child´s: winning at all costs is the mantra and excessive focus on the prize-winning activity is a must. A child may be forced to train beyond their abilities, such as in a sport or academics or, in the case of pageants, don an unrealistic physical appearance.
The last stage is potential abuse and is a severe or complete loss of the adult´s ability to differentiate their needs and goals from the child´s. At this level, the child is at risk for exploitation and is often forced to continue the sport or activity despite potential physical or emotional harm; this is often done in an effort to provide financial or material gain for the adult. Kids who are forced to perform despite injuries (football, gymnastics) or in the case of pageants, keeping intense schedules are examples. So to sum up, extreme pageant parents are on the ABPD spectrum just like other extreme parents (sports, etc), I just gave the phenomenon a name.
RO: Do you see any similarities between the “achievement by proxy distortion” that you witnessed at these pageants and the so-called ℠Tiger Mother´ controversy that has also been in the media quite a bit in the last year?
Cartwright: Yes I do see similarities. I think that the “Tiger Mother” is an example of some ABPD behaviors, particularly objectification and potential abuse. For example, I recall the mom in Tiger Mother forced her young child to learn a difficult piano piece by foregoing meals, breaks, etc., calling the child names (“garbage,” I think?) and threatening the child with the removal of favorite toys. The question is why? Was the motivation for the parent´s sake, which would be ABPD. Or was the motivation to discipline the child? If so, then this would not be ABPD. For Tiger Mother to “fit” ABPD, the motivation would have to be for parental gain.
RO: You mentioned that you don´t necessarily think that an outright banning of these types of child beauty pageants is the correct way to approach this problem. What kind of concrete measures do you think would prove most effective in curbing some of the potentially unhealthy and dangerous aspects of these pageants that you´ve highlighted in your work?
Cartwright: The Learning Channel has received dozens of complaints about T & T and refuses to change or cancel the program. T & T and Here Comes Honey Boo Boo are two of the top-rated shows on television. For the shows to be cancelled, people need to stop watching so the ratings will fall and they will no longer be lucrative programs. For that to happen, adults and viewers need to be aware that such programs exist because we “feed” them through viewership. So, stop watching.
However, this is easier said than done. Viewership might be discouraged if people understood the potential long-term consequences on girls. Sexual images and sexualization of young girls is linked to poor self esteem and body image. Further, constant exposure to such images may make society desensitized to images of young girls in adult outfits etc. So, educate the public about the consequences to discourage them from watching.
Lastly, educate young girls about media images and realistic body image. I give a presentation to young girls that helps them understand the differences between what they see in media vs. reality. I also talk to coaches, parents, teachers and other adults involved with performers and athletes about signs of ABPD and what can be done about it. Education is the key to curbing behaviors that can lead to a lifetime of body dissatisfaction and disordered eating behaviors.
RO: Dr. Cartwright, thanks very much for taking the time have a chat with us. On behalf of the redOrbit team and our readership, we wish you the best of luck on your future research and look forward to reading about your next project.
Biography
Martina M. Cartwright is a registered dietitian (R.D.) with a Ph.D. in Nutritional Science and Biomolecular Chemistry from the University of Wisconsin-Madison. She has more than 16 years experience in medical education, scientific research and clinical practice in both the academic and pharmaceutical settings. Martina has conducted research on child beauty pageants, the use of Facebook for weight management and the impact of child teasing on adult self-esteem. Her nutrition education and clinical interests include intensive care medicine/surgery/trauma, eating disorders and cardiovascular/wellness. However, she has published in peer-reviewed medical journals on topics such as developmental biology, genetics, sepsis, eating disorders and immunonutrition therapy. Dr. Cartwright’s landmark November 2012 article in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) was the first to describe “Princess by Proxy”, or why parents put their children in tot pageants.
Earlier in her career, Martina served as a nutrition consultant to the Cirque Du Soleil in Las Vegas and was a nutritionist for the Las Vegas Canyon Ranch Spa. A contributor to articles featured in Redbook, MORE and Health, Martina continues to be a featured presenter at scientific-medical conferences and symposia. Among her passions are teaching, public speaking and writing. She is the author/publisher of a children´s book entitled The Angel Academy: A Tale of Heavenly Spirits in Training. Dr. Cartwright is an adjunct faculty member within the Department of Nutritional Sciences at the University of Arizona and she works as an independent biomedical consultant and author in Scottsdale Arizona.