Information for teachers

Contents of this page
What are eating disorders?
Why should this matter to teachers?
Risk factors
Signs and symptoms that teachers may notice
How you can help a student with an eating disorder
How to teach children about eating disorders

What are eating disorders?

Anorexia nervosa is often characterized by low self-esteem and a need for control. People with anorexia use starvation and restriction to control not only their weight, but also their emotions. Bulimia nervosa involves the use of binging and purging (not always by vomiting) as a means of control or of self-punishment. People with compulsive overeating disorder can be described as having an addiction to food, which they often use to fill a void that they feel inside and to cope with difficult emotions. People with binge eating disorder suffer from symptoms of compulsive eating disorder and of bulimia; their symptoms involve binge eating that is not followed by purging. Reasons for this disorder are similar to those for compulsive eating. Eating disorders not otherwise specified (known as EDNOS) are exactly that: eating disorders that do not fit into the above categories. People with EDNOS suffer from a combination of symptoms, and do not fit the clinical criteria for other eating disorders, but their condition is often just as serious.

Eating disorders are complex illnesses with a variety of causes, including genetic predisposition, psychological characteristics, and social and cultural influences. They can affect people of any race, ethnicity, income level, age, gender, or sexual orientation.

Why should this matter to teachers?

The incidence of eating disorders among adolescents is increasing while the average age of onset is decreasing. One study found that “individuals who report binge eating before ever dieting also report that their first binge eating episode occurred at 11–13 years old.”¹ At one eating disorder treatment centre in the UK, nearly 20% of adolescent patients reported the onset of their disorder as being before age thirteen. Also, when children develop eating disorders, there is a high risk of them suffering serious medical complications.² Some experts suggest that eating disorder risk factors and associated behaviours may emerge as early as nine years of age.³

Fortunately, teachers are in a special position to identify those at risk of eating disorders, and to provide a positive environment that builds resilience and strong self-esteem, helping to protect students against mental illness.”⁴ As one researcher noted, children would be most likely to discussion eating disorder-related concerns with their teachers if they “could guarantee that their teachers would be well-informed.”⁵

Risk factors

A student who possesses one or more of the following characteristics may be at increased risk for developing an eating disorder.

·      Female gender

·      Early puberty

·      Participation in appearance-focused sports and activities including dance, gymnastics, figure skating, modeling, and cheerleading

·      Participation in speed-oriented sports such as track and field, distance running, and cycling

·      Participation in sports with weight classes such as weight lifting, judo, or wrestling

·      Perfectionism – many children and adolescents with eating disorders excel in school and can be obsessive about their grades or schoolwork

·      Concurrent mental disorders such as anxiety or obsessive compulsive disorder (OCD)

·      Emotional sensitivity

·      Identification as lesbian, gay, homosexual, or transgendered

·      History of physical, sexual, or emotional abuse

Signs and symptoms that teachers may notice

 Unlike medical professionals, teachers may not notice many of the "classic" indicators of disordered eating behaviour. However, you spend many hours a day with your students, often more time than they spend with their parents. If you notice a student who exhibits any of the following indicators, please alert appropriate staff members at your school and/or the student's parent(s).

·      Weight changes (preadolescent children may not lose weight; instead they may fail to gain weight despite growing taller or may not grow taller as expected)

·      Wearing oversized clothing

·      Repeatedly touching or pinching parts of body, such as stomach or arms

·      Expressing concern over weight or shape

·      Skipping school meals and/or scheduling classes or activities during lunch break

·      Excessive gum chewing and/or excessive consumption of water or diet beverages

·      Excessive exercising

·      Leaving eating settings to purge immediately after eating

How you can help a student with an eating disorder

-Remember that you are not the student’s parent, doctor, or therapist. It is not your job to provide counseling – though if you are comfortable, be available for your student if she or he needs to talk to somebody. Many adolescents are more comfortable talking with adults who are not their parents.

-Do not give nutritional advice to your student – this is usually more harmful than helpful.

-Do not force your student to eat.

-Encourage your student to talk to his or her parents or doctor and to seek treatment if he or she has not already done so.

-Many people with eating disorders become anxious when required to eat either alone, in crowded places, or both. You can allow your student and a few of his or her close friends to eat lunch in your classroom rather than in the lunchroom or cafeteria, or you can offer to be a “lunch buddy” for a student who needs support from a trusted adult while eating.

-Be a positive role model for all of your students. Do not make disparaging comments about your body in front of your students. Model eating a variety of nutritious food as well as treats, and never tell students that a particular food is unhealthy or fattening.

-Do not comment on your student’s weight, size, or eating habits, even if your comment is intended as a compliment. Praising your student for completing a meal or complimenting her or him for gaining weight may be extremely triggering.

-Learn about eating disorders so that you can empathize with your student.

How can I accommodate a student with an eating disorder in my classroom?

-Communicate with the student, the student’s parents, and his or her treatment team if possible about how to support and accommodate him or her at school.

-A student with an eating disorder may be prohibited from physical activity while in treatment and will therefore need alternative activities/assignments for physical education class.

-Most students with an eating disorder may need to miss classes for frequent medical appointments and should be excused from class for these appointments without penalty.

-A student with an eating disorder may need flexible deadlines for tests and assignments in order to reduce his or her anxiety and stress and because the effects of malnutrition may make concentration on schoolwork particularly difficult.

-Many people in recovery from eating disorders are required to follow strict meal plans. Your student may need to eat meals and snacks at specific times of day. You can help by allowing this student to eat during class or by providing breaks during tests and exams.

-You may need to develop an Individual Education Plan (IEP) for your student.

What do I do if my student is hospitalized?

-Maintain contact if possible. Encourage your other students to write letters, cards, or emails to their hospitalized classmate. This will make the transition easier when this student returns to school.

-Most hospital units and day treatment programs for children or adolescents have teachers on staff. Communicate with this teacher about your student’s schoolwork so that he or she can stay up-to-date with assignments and classroom activities.

-You may have to explain to your other students about the cause of their classmate’s hospitalization. 

How do I recognize an eating disorder-related emergency?

The following situations should always be treated as an emergency:

-fainting or collapsing

-complaints of dizziness or of severe weakness

-student reports seeing blood in his or her vomit

-suicide attempts or threats

-seizures (unless your student has an unrelated seizure disorder)

How to teach children about eating disorders

My story of what NOT to do

When I (the founder, Emily) was in middle school, my teachers did what they thought was appropriate to prevent their students from developing eating disorders. Several weeks in health class were devoted to the subject, and the health teacher told us almost everything that there was to know about anorexia, bulimia, and compulsive over-eating. We were given a long list of the medical signs and symptoms of eating disorders, and we were then shown several television clips and documentaries, each of them featuring an anorexic woman (here I must note that every time, the woman featured was white and in her twenties or late teens, and was severely ill). Many of these clips were from daytime television shows such as Oprah or Dr. Phil. In each instance, the woman on the video talked extensively about her eating disordered behaviour. We learned which foods she ate and which she avoided, how many calories she consumed, how she avoided eating, how she hid her disorder from her family and friends, and how much weight she lost.

For many topics in school, the more information the children learn, the better it is for them. This is not true with eating disorders. For myself and several of my adolescent classmates, our well-meaning teacher was inadvertently giving us classes on how to have an eating disorder. Many of us copied the behaviours that we saw in these videos, or "competed" with the women on the videos to try to lose more weight or eat less calories. These cautionary tales did nothing to prevent eating disorders - in fact, they may have made the problem worse.

Our teacher would then have some media literacy lessons; she'd explain over and over again how images in magazines were airbrushed and that real women didn't look like supermodels. Once she had determined that we all understood this, the topic of eating disorders was over - perhaps the teacher even considered us immune. The problem with this is that there is far more to eating disorders than wanting to look like fashion models or celebrities. While some adolescents develop disordered eating behaviours or clinical eating disorders because they want to look like the celebrities that they idolize, more widely accepted theories state that eating disorders are coping mechanisms and/or biological, brain-based illnesses. Children who understand that magazine images are airbrushed may still develop eating disorders.

I'm not saying to stop teaching media literacy. The "magazines are airbrushed" lesson is still important. The problem, however, is that people who learn that eating disorders come from copying celebrities tend to trivialize these life-threatening disorders and to think of people with eating disorders as being superficial or shallow. To make matters worse, the belief that eating disorders are all about fashion and appearances may prevent some people who are suffering from getting treatment.

That was how it happened with me. I had learned in school that people with eating disorders wanted to look like Hollywood icons, to fit into skinny jeans. At age fourteen, newly diagnosed with anorexia, I was ashamed to have my friends find out about my disorder because I was afraid that they would think I was stupid. I was not a fashionista; I was a perfectionistic high-achiever who wrote poetry and sang opera! I watched TV rarely, had never read a teen magazine, and pretty much boycotted all forms of popular culture. But I had learned that eating disorders were all about vanity. Recovery was a lonely experience because for the first few years I never reached out to my friends. I believe that I could have recovered sooner if I'd had the support of my peers - but I didn't tell them what I was going through, because I was afraid of being judged. Unfortunately, too many people believe that eating disorders are what happens when spoiled little girls go on diets - such ideas create stigma, and stigma makes recovery more difficult.

Teachers, please remember two things:
a) Don't give your students too much information about eating disorders! Adolescents who learn all about disordered behaviour may use this knowledge against themselves.
b) Don't focus on the outdated idea that eating disorders involve superficial girls who took their diets too far - this grossly misrepresents why people develop eating disorders, and it increases the stigma surrounding eating disorders.

So, what should you do? I'll write about what you actually SHOULD do soon!



More information

More information for educators, including several convenient pamphlets and an e-book, will be available on this page shortly - please stay tuned. 

References

Manley, R.S., Rickson, H., and Standeven, B. (2000). Children and adolescents with eating disorders: strategies for teachers and school counselors. Intervention in School and Clinic, 35:4, 228-231.

¹ Shapiro, J.R., Woolson, S.L., Hamer, R.M., Kalarchian, M.A., Marcus, M.D., & Bulik, C.M. (2007). Evaluating Binge Eating Disorder in Children: Development of the Children’s Binge Eating Disorder Scale (C-BEDS). International Journal of Eating Disorders, 40(1), 82-89.

² Hamilton, Jan D. (2007). Eating disorders in preadolescent children. The Nurse Practitioner, 32(3), 44-48.

³ Cook-Cottone, C. (2009). Eating disorders in childhood: Prevention and Treatment Supports. Childhood Education, 85(5), 300-305.

⁴ Jeremiejczyk, N. (2007). Eating disorders and effective exercise. Issues, 84, 15-17.

⁵ Bloom, A. (2012). You can’t trust teachers not to blab. Times Educational Supplement, pp. 14

⁶ Manley, R.S., Rickson, H., and Standeven, B. (2000). Children and adolescents with eating disorders: strategies for teachers and school counselors. Intervention in School and Clinic, 35(4), 228-231.