"I learned how to have an eating disorder from a made-for-TV movie . . . . I struggled with all three major types of eating disorders from the ages of 12 to 21. They were my worst enemy and my best friend . . . . I wish that one of my teachers had intervened."
Educators and coaches are in a unique and powerful position to recognize the symptoms of eating disorders in students. Recent media attention has focused on childhood obesity, but the incidence of eating disorders is also widespread. According to the National Eating Disorders Association, in the United States as many as 10 million females and 1 million males struggle with the eating disorders anorexia nervosa and bulimia. Millions more wrestle with binge eating disorder.
Eating disorders are serious mental illnesses and can prove fatal. In fact, statistics from the National Eating Disorders Association show that anorexia nervosa has the highest premature mortality rate of any mental illness, and females between the ages of 15 and 24 who suffer from the illness are 12 times more likely to die from it than from any other cause of death.
Not only are eating disorders dangerous, but they are also increasingly prevalent among children. In the United States, for example, the number of diagnosed cases of anorexia nervosa among young women ages 15–19 has increased every decade since 1930, and diagnosed cases of bulimia among females ages 10–39 tripled between 1988 and 1993.
As an educator who interacts with young people every day, there are several important things you can do to help a student with an eating disorder get the appropriate help and counseling he or she needs.
Learn to Recognize the Warning Signs
There are three major types of eating disorders: anorexia nervosa, bulimia, and binge eating. Although the symptoms of each disorder can be unique to every child, according to experts, there are signs to look out for.
- Sudden, rapid weight loss
- Gauntness, paleness, or circles under the eyes
- Thinning hair
- Lots of layering of clothes
- Fasting or skipping lunch
- Exercising excessively or alone, even when ill or injured
- "Chipmunk cheeks" caused by swollen facial glands
- Bloodshot eyes
- Frequent sore throat
- Damaged tooth enamel
- Scarring on knuckles and backs of hands
- Sudden, rapid weight gain
- Food hoarding
- Sullenness and introversion
- Withdrawal from friends, interests, and activities
- Talking frequently about food and dieting
This list is by no means comprehensive. However, "it's very important for educators and school personnel to be familiar with these signs, because they spend so much time with students," says Johanna Kandel, founder and executive director of the Alliance for Eating Disorders Awareness.
According to Laurie Vanderboom, director of programs at the National Eating Disorders Association, the middle and high school years are the critical ones. "Be on the lookout for excellent students, usually perfectionists, who begin losing or gaining weight rapidly," Vanderboom says. "The lunch lady can be your best ally."
Educators should particularly note students who appear to withdraw from friends or display a lack of interest in activities in which they were previously engaged. Because eating disorders are closely related to obsessive-compulsive disorder, one of their hallmarks is that they are all-consuming. Patients report that they think about food 70–90 percent of the day, according to Andrea Vazzana, a clinical psychiatrist at the NYU Child Study Center. Students may also show signs of decreased cognitive function; insufficient nutrition combined with food obsession makes it difficult for sufferers to concentrate and retain information.
Identifying eating disorders in students can be difficult, says Michael Axler, a psychologist with Fairfax County Public Schools in Virginia. "These students are typically highly organized, enthusiastic, and adept at hiding these behaviors. These behaviors do not always signal an eating disorder, but collectively they do constitute strong signs," he says. Plus, positive proof is not necessary for an intervention, he adds.
Doing everything possible to save a child's life is critical in such a situation. Therefore, educators should use their best judgment, taking students' health and safety into account when determining whether an intervention is appropriate.
Eating Disorders Are Not a Choice
Eating disorders are not caused by vanity, and they are not a choice, Kandel says. She notes that recent research indicates that 50–80 percent of eating disorders are actually caused by genetics but that our culture is also to blame.
Adrienne Ressler, president of the board of the International Association of Eating Disorders Professionals, agrees: "Eating disorders exploded in the 1960s, when we adopted this new, ultrathin standard of beauty. However, the elements for a potential disorder have to be present in an individual. Biological predisposition, in the form of brain chemistry, has to be there."
Eating disorders can manifest themselves in children as young as age 7 or 8. "The media has a huge impact on young children and promotes unhealthy body types. Kids get an early message that they have to be thin, if girls, or muscular, if boys," Vanderboom says.
Appropriate Intervention Is Guided by Care and Concern
Teachers are not qualified to diagnose or treat mental illness. However, if you witness warning signs that disturb you, experts advise quick and careful intervention. Ressler recommends approaching the student, expressing concern about behaviors you've witnessed, asking about the student's feelings, and offering to help.
Kandel emphasizes the importance of not being accusatory. Use "I" statements of concern, care, and observation. For example, you could say, "I've noticed that you seem to have lost a lot of weight," "I've noticed that you seem to often complain of being cold," or "I've noticed that you seem to often have a sore throat."
Still, be prepared for the student to deny the problem. Be firm and push the student to get specialized help. If you don't know the student well or would prefer backup, involve a member of the school counseling staff in the conversation. Also, notify the student's parents as soon as you conclude the conversation. You can work with a school counselor to provide parents with a referral to a professional trained in the diagnosis and treatment of eating disorders.
"The more people who are involved and invested, the better you demonstrate both support for the student and the urgency of the situation," Axler says. No matter which approach you take, expediency and action are vital. "Keeping your concerns to yourself creates a conspiracy of silence," he says.
Take a Proactive, Preventive Approach
Don't wait until there is a problem, Kandel advises. Create a plan for what you will do if one of your students begins to exhibit symptoms by familiarizing yourself with campus resources on eating disorders, learning which school counselors are experienced in eating disorders, and staying current on eating disorder information and research.
Keep in mind that although many young people have a genetic predisposition toward eating disorders, students can also learn to have eating disorders, as Kandel notes in her quote. If not carefully implemented, well-intentioned efforts like awareness weeks—especially ones that cite students' lowest weights— can actually provide students with negative goals.
One of the most positive findings about eating disorders is that they can be prevented, and the picture of health begins with you. "Be aware of the environment you're setting up," Vazzana says. "What kinds of comments do you make about yourself and others regarding appearance?"
Do everything possible to promote healthy eating habits, body image, and classroom culture. If you coach or advise a sport that requires weigh-ins, consider conducting them in private rather than posting or announcing students' weights. Also, take a zero-tolerance approach to teasing and bullying on the basis of weight or size. "We must create an atmosphere in our schools where weight is neutral," Ressler says.
You can truly be the key to saving a student's life. "Many warning signs of eating disorders are the symptoms of a host of other mental illnesses and disorders," Axler says. "Involvement by teachers can prevent them from coming to fruition."