The ABCs of Eating Disorders

My 12-year-old told me the other day about a girl in her class with a problem. She skips breakfast, eats only half a bag of Goldfish crackers for lunch, refuses brownies offered by  the teacher (she cites a peanut allergy as her excuse even though the teacher assures her that his home-baked brownies have no nuts), and she is very, very thin. “We all know she is, like, anorexic, mom,” my daughter says.

 If the kids know, why don’t the teachers?

 Some just aren’t aware.

 “Everybody is now monitoring for obesity and body mass index,” says nurse practitioner Ann Derouin, who runs a school-based health clinic at Durham Southern High School in North Carolina. “So the eating disorders piece has been pushed to the background.”

Indeed. With eating disorders such as anorexia and bulimia nervosa, the media hands us a myth: eating disorders are about teens who starve or make themselves throw up in order to look like fashion models. Therefore, many teachers believe that seventh  graders are too young to be at risk. (The truth is that doctors are diagnosing children as young as six years of age.) Other educators figure that if a student isn’t emaciated, she has no problem. But those with bulimia are often of normal body weight. And children can have binge eating disorders in which they binge but do not purge, and hence are overweight or obese. By the way, boys get them, too – and their ranks are currently growing.

 According to Derouin, the most common scenario is that the friends of the student in trouble, such as my daughter, get so worried that they eventually approach an adult in the school system. And then what?

 It depends upon the school and educator. Teachers, school nurses, and even cafeteria staff sit on the front lines of eating disorder prevention, as they see our kids in action every day. And yet, many of them do not know how to discuss and handle these complex issues. Even the school administrators themselves may not understand what structures need to be in place to deal with children at risk or their parents, who are often in high denial. Privacy issues complicate matters further. For this reason, the National Eating Disorders Association (NEDA) has put together a user-friendly “toolkit” for educators. It’s a cornucopia of information and resources for everyone involved in the education system.

 •For teachers, there is a general description of what eating disorders are and how to spot them, especially in a school setting. Beyond the obvious weight fluxuations, the guide mentions cognitive changes and ties to parallel problems like anxiety and depression. NEDA makes sure to dispel the notion of weight as the only warning sign on a page entitled, “Common myths about eating disorders.”

 •For administrators, there is a series of pages that discuss setting up a strategic plan, replete with a team who will handle cases as they come up. For the difficult task of approaching parents, there are sample scripts of possible discussions and talking points.

 •For school psychologists, there is a series of tips about how to help students as well their friends and classmates. There is also a template “Student Assistance Program” form, to be filled out in order to set the intervention process in motion.

 •For school nurses, there is information about the risks of weighing students in school, especially in front of other students. Many eating disorders start when an overweight child gets teased or bullied and then fad diets to get thinner.

 •For coaches, particularly those in weight-related sports such as gymnastics or wrestling, there is advice about emphasizing performance rather than size, as well as awareness of problems such as young girls who participate in elite athletics but are also dieting. These girls often lose their ability to menstruate and put themselves at risk for osteoporosis and eating disorders.

 The most important action, says Laurie Vanderboom, director of programs at NEDA, is that schools put in place a strategic plan for dealing with students at risk. Prevention is key. If eating disorders are caught and treated early, prospects for recovery are much better.

 “An eating disorder is like a tiger in a jungle,” Vanderboom says. “Because the tiger is so well hidden and stalking you, when it finally emerges, it is too late.”

 The warning signs are there, and educated educators are there to spot them. They just need to be looking.

Comments

[Spudberry]

Do you know how many people die every year from trusting adults who say there can't be any peanuts in their home baked goodies. I know you are talking about an eating disorder here - and this girl may actually have that too - but people don't take life threatening food allergies seriously enough either.

Don't try to kill the girl with peanuts just because you think she needs to eat more. My children (both allergic to peanuts) aren't allowed to eat ANYTHING from any one's kitchen - this girl probably needs to follow the same rule to keep herself safe.

[Hypnow]

I think the post had very important information for all of us that tend to ignore the obvious because it's not screaming at us through the media. The pre-teen years are the more vulnerable ones for eating disorders and we cannot forget that. However, Spudberry has an excellent point. Food allergies can be life threatening and the girl may just be avoiding a serious attack from unknown ingredients.

Where the author fails here is to not mention the education for the parents of an ED child. They are the ones providing primary nutrition and security in the home (so we assume). Eating disorders are not about food. It's about the child's basic psychological need for safety, security and self-expression in a loving environment. Schools may just be wasting a lot of time trying to figure it out in any other way.