Last updated on June 14th, 2020
A school policy on eating disorders, disordered eating and body confidence
Secondary schools and primary schools are likely to have a great many pupils who diet, purge or use diet pills, who misuse exercise, and who suffer from body dissatisfaction. A significant number suffer from a diagnosable eating disorder, requiring urgent, specialised treatment with intense parental input. Schools are also under pressure to take action on obesity.
This document suggests that you designate at least one member of staff to learn the essentials, to shape this policy, and to be a central point of contact for parents, clinicians and other school staff.
The tasks with the greatest pay-off are also the simplest: raising the alarm when a pupil shows signs of a possible eating disorder, and for those pupils who are getting treatment for an eating disorder, liaising with parents and clinicians to hear what specific support the pupil requires.
Longer-term tasks are to set up a culture and use a well-tested program to promote a helpful attitude to food, exercise and body shape. This document will guide you so you avoid the common trap where health promotion or anti-obesity messages backfire.
This document is intended to help your school draw up its own policy and procedures.
Note: the following applies to any country. Some of the more detailed pages I link to may refer to aspects of the health service in the UK.
Why does it matter that pupils have difficulties with eating or body dissatisfaction?
A significant number of your pupils will have a diagnosable eating disorder – even in primary school. These are extremely dangerous illnesses with a high mortality rate if poorly treated. You will also have a large number of pupils who are secretly struggling with risky efforts to control their eating, exercise and body shape. This affects their ability to study, socialise and develop to their full potential.
Your school can make a huge difference to the treatment of those with an eating disorder. Many pupils have been helped this way, and have gone on to be top pupils who make their school very proud. Your school can also promote a balanced attitude to food and body, and healthy behaviours. It can avoid making things worse, in particular around health promotion or obesity initiatives.
Now begins the template for your policy.
Our school’s stance towards disordered eating and eating disorders
A great many young people suffer from disordered eating and from body dissatisfaction. We want our school’s culture to nurture a balanced, healthy attitude to food, exercise and body shape.
Regarding eating disorders, we recognise that they are serious illnesses, that there is a strong likelihood that a number of our pupils are affected at any time, and that the school has a crucial role to play in detection and treatment, in partnership with parents and clinicians.
To the best of our abilities we want to:
- support pupils who are undergoing treatment, in partnership with the family and treatment providers, aiming at rapid and full recovery
- flag up concerns around a pupil so that he or she can get diagnosis and treatment as soon as possible
- play our part in reducing the risk of pupils developing an eating disorder or of suffering from disordered eating
- take care with the messages we give around eating, exercise and body-shape
A central point of contact in the school
The school has one or more designated staff members who shape policy, disseminate information and coordinate action on eating disorders, disordered eating, body confidence and obesity.
They set up or attend meetings with parents and clinicians and keep records.
They liaise with other members of staff and monitor that agreed actions are carried out.
All other teaching staff have basic awareness – enough to recognise the more obvious signs and to then consult the designated members of staff.
We will work out with parents how they can quickly and easily communicate news or requests to the designated staff members. The Head is also available for meetings should this be helpful.
Teamwork around pupils with an eating disorder
Eating disorders are serious medical conditions that require expert treatment. We will take our lead from
- the parents
- the health service
We value teamwork with parents. We appreciate they are experts on their child and are the main asset in a young person’s eating disorder treatment. We are conscious that they may be under tremendous stress and need empathy.
A non-judgemental stance
We intend to have a respectful, non-judgemental stance towards pupils, whether they have difficulties with body confidence or eating. The same applies to their siblings and parents.
We recognise an eating disorder is an illness, not a choice, and that it is not caused by parents. The illness affects all sexes, irrespective of social class and of family environment.
We will treat all signs of an eating disorder seriously.
We will give all staff basic information to help them detect disordered eating or an eating disorder and know how to proceed.
Below: the basic information staff need
Eating disorder versus disordered eating
Your pupils will display behaviours along a continuum, with balanced eating at one end, some signs of disordered eating along the way, and at the far end of the continuum, the signs are serious and frequent enough to indicate a diagnosable eating disorder. There will also be a continuum on body dissatisfaction.
You don’t need the expertise to tell where any particular pupils is on any spectrum. Your role is to spot signs that may indicate either disordered eating or an eating disorder, and to raise this with the parents.
The further along the continuum, the sooner you should act, and the more insistent you should be on the pupil getting referred to a specialist health professional.
Pupils who require the most urgent and specialised attention
Diagnosable eating disorders (like binge-eating disorder, bulimia, anorexia, OSFED and ARFID) normally require urgent specialised care.
Even without a diagnosable eating disorder, some of your pupils may need urgent attention due to malnutrition.
For instance there is a growing number of boys (it’s more often boys than girls) whose health is at risk from an obsession with muscle-building.
Likewise, many of your pupils may be restricting entire food groups in a drive to eat ‘healthy’ or ‘clean’. You will need to raise the alarm urgently with any who seem to have cut out major food groups.
What signs should staff be aware of?
As a school you don’t need expertise in the various types of eating disorder and you don’t need to differentiate an eating disorder from disordered eating. You just need to raise the alarm when:
- a pupil appears to be missing meals, or eating reduced quantities, or avoiding particular types of food
- you suspect the pupil is exercising obsessively
- you suspect the pupil is vomiting after eating
- you suspect the pupil is bingeing – eating unusually large quantities in an out-of-control (and usually secretive) way
- the pupil is intensely interested in the topics of food, cooking, fitness, diet
- the pupil seems to have lost or gained weight
You should be concerned about any child or adolescent having lost weight even if (especially if) they previously seemed overweight. Youngsters need a regular input of energy to grow and develop. Flag up the apparent weight loss with parents (if it was gradual they many not have noticed). Never praise weight loss or slimness in a growing young person.
Another sign is a marked change in mood. People often become withdrawn, depressed and anxious-looking while they’re affected by an eating disorder (though this may only show up at home, and at school this person may be a star student).
The misery of an eating disorder can be combined with self-harm or obsessive-compulsive disorder (OCD).
Note that pupils on the autistic spectrum are at greater risk of suffering from an eating disorder.
Educating pupils to disclose problems
We will encourage pupils to speak up if they suspect that they or a peer has an eating disorder. To this end we will give all pupils a minimum of information about eating disorders.
If a friend of the pupil suspects an eating disorder, staff should record what they say in detail and pass the information on to a designated member of staff.
If a pupil confides difficulties with eating to a staff member, we will explain that we have to inform parents, as we don’t have the expertise to gauge the level of risk, and confidentiality doesn’t apply when a pupil is at risk.
Alerting parents and securing prompt treatment
If we detect signs of an eating disorder or of disordered eating, we will alert the parents. If we suspect that the pupil is at the more severe end of the disordered eating spectrum, or if we suspect an eating disorder, we will call the parents within 24 hours.
Depending on the pupil’s age we may first talk with him or her to tell them we are planning to contact their parents.
We appreciate that it may be a great shock to the parents to discover their child may have an eating disorder. We will strive to build a supportive relationship so that the pupil can get expert help fast.
We will advise parents to consult a specialist service promptly.
Practical support to pupils in treatment for an eating disorder
We will discuss with parents what support a pupil needs with lunch and snacks. We are ready to:
- Make it easy for a pupil to get meal support from their parents in a quiet room.
- Organise a quiet room and rota of staff to supervise a pupil’s meals. The pupil could be joined by a couple of friends. The staff’s role will be clarified – it will be to supervise, not to help the child manage eating. We can inform the parents by text whether each meal was successful or whether some food was uneaten.
- We can also provide lower level supervision in the dining room, and inform parents of any behaviours we spot that would indicate food is not getting eaten.
School staff should not be expected to coax a pupil to eat.
We can provide parents with menus ahead of time, if this helps them prepare their child.
We can give parents printouts from electronic records of purchases made in the dining hall.
We will find out from parents and clinicians what else we can do to help the pupil in school.
Pupils who cannot attend school or need extra support with studies
We appreciate that pupils may need time in hospital, while for others there could be a phase of treatment at home, during which attending school would be counter-productive and studies need to be put on hold.
We will take advice from the parents and the clinical staff. We can provide learning materials or arrange visits from teachers.
We will support the pupil with a phased return to school if that is useful.
Meeting the pupil’s academic needs with flexibility
We understand that studies may have to take a back seat in order to prioritise treatment.
We will help reduce unnecessary stresses on the pupil. For instance we may allow them to hand in homework late and we may stretch deadlines. We may arrange for them to have a teacher they are relaxed with rather than one that they feel anxious about. We may change the class group they are in so that they are with friends. We may adjust our expectations of their academic progress. We may be flexible about their punctuality.
Health promotion work and prevention programs
With regards to:
- health promotion
- body confidence / body image
- obesity prevention
- disordered eating prevention
- eating disorder prevention
we will only use programs that have been validated as safe and effective.
In particular we will not ask pupils to keep a food or exercise diary, or to keep a log of calorie or fat intake, or to read food labels. We will not weigh pupils or comment on their weight or shape.
We will make our school a no-diet zone.
We will discourage fasting. For anyone with an eating disorder, we would expect them to have a dispensation from religious fasts on medical grounds.
We strive to make the school a judgement-free place where the whole person is valued, not their looks. We do not comment on people’s weight or shape or appearance. We discourage ‘fat talk’ or ‘body talk’. We want to create an ethos of body confidence and reduce stigma. We will not tolerate appearance or weight-based taunting or teasing.
We will review teaching materials so that wherever possible they are food-neutral and body-shape-neutral.
We will take care to have a food-neutral stance. In other words we do not refer to any foods as good or bad, clean, healthy or unhealthy, junk or naughty. Food in the dining room will not be labelled as ‘healthy’ and during lessons we will strive to use neutral language.
Our attitude to exercise is devoid of value-judgements. We consider that exercise is a human need, a source of wellbeing and that it serves a social purpose. We do not endorse any messages that exercise be used to change one’s body shape or weight, or to compensate for eating, or that people who exercise are more virtuous. We are aware that with eating disorders and disordered eating, exercise is often just as much a problem as food.
This policy template was produced in 2018 by Eva Musby, parent and author of: ‘Anorexia and other eating disorders – How to help your child eat well and be well’.
Please get in touch to flag up any errors or omissions, and I welcome suggestions to improve this.
I encourage you to use and amend this template to suit your school.
Please acknowledge the source e.g. "Based on template from Eva Musby at anorexiafamily.com"
NICE guideline for the recognition and treatment of eating disorders: https://www.nice.org.uk/guidance/ng69 I wrote a summary relating to under-18s here: https://anorexiafamily.com/nice-guidelines-adolescent-eating-disorder-ng69
FEAST: an international community of parents, with a team of specialist advisers. The site is rich in up to date, evidence-based information and advice. A good site for staff to learn. Do refer parents to it: http://www.feast-ed.org
Eva Musby: my book, audios, videos and website are frequently recommended to parents by NHS specialists. Do point parents to them and use them yourself to learn more about the treatment of an eating disorder: https://anorexiafamily.com
Lock, Le Grange: ‘Help your teenager beat an eating disorder’, and 'Treating bulimia in adolescents': these books describes treatment within the family. Most of your pupils should be getting treatment along those lines.
For an accurate video on eating disorders, watch documentary on http://www.parents-to-parents.org
For well-presented information for schools, see http://www.foodforthought.org.au/ and https://www.nationaleatingdisorders.org/parent-toolkit