Last updated on June 14th, 2020
You’d be shocked how many pupils are obsessing about food and body shape right now
When your school pays attention to disordered eating and body dissatisfaction it is helping a great number of pupils improve their mental wellbeing and nutrition, while also helping the minority of pupils who may develop an eating disorder or who are undergoing treatment. Three birds with one stone. Four, actually, if your school is under pressure to ‘tackle obesity’ and five if it wants to do effective health promotion. I propose a policy that ties all this together.
What to do: an overview
I recommend that your school designate at least one member of staff to learn the essentials from these web pages, to draw up a policy, and to be a central point of contact for parents, clinicians and other school staff.
Your school will make all the difference when it:
- reviews the messages it gives around eating, exercise and body-shape
- knows how to reduce the risk of pupils developing an eating disorder or of suffering from disordered eating
- helps with early identification of eating disorder, so that treatment begins as soon as possible
- supports pupils during eating disorder treatment, cooperating with the family and treatment providers
Disordered eating describes unhealthy or risky behaviours such as:
- Regularly skipping meals, for instance only eating at home after school.
- Being caught up in cycles of denial and bingeing
- Using diet pills, laxatives, diuretics
- Purging (self-induced vomiting)
- Cutting out important food groups
These behaviours are estimated to affect around 55% of girls and 30% of boys so they’re not rare. At least a third of your classrooms have pupils whose brains are not operating at full capacity due to poor nutrition and obsessive thinking. For some, calorie or nutrient deficits affect healthy development (e.g. girls may not get periods).
There is a continuum of disordered eating, from the occasional mild behaviours, to the extreme compulsions of someone with a diagnosable eating disorder.
Many of your pupils will have some form of disordered eating without ever having an eating disorder. For pupils with a combination of risk factors (genetic and environmental), mild disordered eating can be an early sign of an eating disorder.
Body dissatisfaction is feeling bad about the way you look. This matters when it impedes engagement with school life, ambitions, confidence. mood and connections.
Body dissatisfaction may involve a distorted body image which defies objectivity: girls may be certain they are fat, boys may never consider themselves muscular enough.
Around 70% of adolescents are affected by body dissatisfaction. Figures quoted for children and adolescents range from 25 to 75%.
These youngsters attach their self-worth and their self-esteem to the way they look. This affects their confidence and is linked to low mood and depression. It stops them reaching their potential: around the world, 6 out of 10 girls stop doing something they love or that will benefit them because they feel bad about the way they look. A worldwide study of women and girls from 70 countries found that 45% of respondents think girls are held back from taking on leadership positions because of low body confidence. In the UK, 70 to 80% of young girls opt out of activities because of low body confidence. And they put their health at risk: 9 out of every 10 girls with low body esteem skip meals. (For these statistics and more, see here, here and here).
Body dissatisfaction is often linked to disordered eating. It can lead to unhealthy behaviours as pupils strive to be thinner or more toned. Also, body dissatisfaction is one of a complex blend of risk factors in developing an eating disorder (it is not a unique cause). Once someone has an eating disorder, they often (but not always) suffer from body dissatisfaction and a distorted body image. Body dissatisfaction is, in some youngsters, an early sign of an eating disorder.
Your school can promote body confidence by providing an environment without weight stigma and fat-shaming.
An eating disorder is an illness diagnosed from a set of criteria, such as behaviours around food, bingeing, vomiting.
The most common diagnosable eating disorders likely to affect pupils in your school are:
- binge-eating disorder
- Pupils with atypical variations of these may get the OSFED diagnosis (‘other specified feeding or eating disorder’).
- A wide variety of eating issues, which are most often seen in primary school children, come under ARFID (‘avoidant/restrictinve food intake disorder’).
All these diagnosable eating disorders normally require urgent specialised care.
Your school has a vital role to play because eating disorders are highly dangerous illnesses if they are not well treated. They multiply someone’s risk of death by 1.5 to 6 times. You might expect emaciated people hospitalised for anorexia to be particularly at risk, and that is true, but in general all eating disorders are equally lethal and carry major risks to health. Someone may be in danger medically and psychologically even while their weight appears high or normal. They may be at great risk medically if they are restricting food groups, restricting calories, alternating restriction and bingeing, cutting out food groups, over-exercising, vomiting or abusing laxatives, diuretics or diet pills.
Any eating disorder may present an urgent medical risk, depending on the degree of malnutrition. Any eating disorder is dangerous, utterly miserable, prevent pupils from reaching their full potential, and can become chronic.
A person with an eating disorder is 4 to 7 times more likely to commit suicide than someone without an eating disorder. At the very least an eating disorder affects a pupil’s ability to concentrate and engage with school work and with peers.
For every 100 pupils (male and female) in your secondary school, you can expect at least 6 to be suffering from an eating disorder. Out of 100 secondary school girls, the figure might be 8 to 15. One of those, typically, will suffer from anorexia, and the others will have bulimia or binge-eating disorder. If you work in a primary school, you should be ready for around one pupil at any time to have an eating disorder that causes them to be undernourished and terrified.
Don’t imagine that an eating disorder ‘will pass’, that it’s just ‘a phase’ or that the school can, on its own, beat an eating disorder. An eating disorder is serious and requires expert treatment.
In England the health service has to diagnose and begin treatment for an eating disorder promptly. For more details, see https://anorexiafamily.com/nhs-england-commissioning-guide-eating-disorders-access-waiting
The massive payoff for your actions
Current treatment requires partnership between parents, clinicians and school. The task for schools is rarely burdensome and the pay-off is a young person getting well fast.
“I am indebted to my child's school. Their support, including a period of lunchtime supervision enabled my daughter to remain at school and maintain vital links with her friends.”
Forget anything you’ve heard about people developing an eating disorder as a way of coping with emotions, asserting control or autonomy, or even being about vanity. Causation is so complex that the best experts are still investigating. The causes as well as the maintaining factors of the illness have a lot more to do with biology, metabolism and genes than previously thought.
A strong message in this document is to avoid weight-loss diets. For most people, an eating disorder begins with dieting or unintended weight loss. Food restriction perpetuates disordered eating
Genes and environment interact in complex ways. It’s unlikely that you can get an eating disorder just because you’ve had a trauma, been bullied, exposed to images of skinny models or to dieting tips. But these things may contribute to the overall risk, and they certainly make recovery harder.
One thing we now know is that (contrary to earlier theories) parents don’t cause eating disorders. It’s important you know this because parents are the main assets in a young person’s treatment. They will need teamwork with you to help their child.
An eating disorder brings on obsessive and miserable thoughts:
“She was thinking of food and of her body shape every minute of the day. After a meal she’d feel sick and anxious, agonising over the food she’d eaten, running off to self-harm, convinced it was too much and that she was enormous.”
“He was so hungry and weak, yet he had a voice in his head screaming that he was greedy, fat and didn’t need or deserve food. He’d be desperate to go for a run. No way could he concentrate on homework.”
“I found lists where she’d been counting and re-counting calories. She would plan tomorrow’s starvation to compensate for today’s bingeing.”
School provides some welcome relief from the incessant controlling voice in a pupil’s head, and it can, for a few hours, restore self-esteem and a sense of self. But when lessons are hard, when there’s exam pressure or conflicts with peers, school adds to the stress of the illness. Stress reinforces the urge to restrict, binge or purge, so school can inadvertently be part of a vicious cycle.