How to help pupils struggling with an eating disorder

Sarah Salmon

Saturday, 18 May 2019

Whilst an eating disorder can affect someone of any age, many people who experience issues with eating develop them during adolescence or even earlier.

We know that the earlier an eating disorder is identified and treated, the better the chance that individual has of fully recovering.


Teachers and school staff are well placed to spot the early signs of an eating disorder or those who may develop one in the future. By talking about eating disorders within an educational setting, such as a PSHE lesson can help pupils recognise their own behaviours of disordered eating whilst encouraging them to seek further help.

Policies and practices in your curriculum that highlight health and wellbeing risks aim to prevent bullying, establish connections with health and wellbeing services and place appropriate instructions and guidance for teaching staff in schools.

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Whether you know or suspect a pupil to be struggling with an eating disorder, it can create a lot of worry, concern and questions such as, “Is there anything I can be doing to make school easier for her/him?”. 
In honour of Eating Disorder Awareness Week, we’ve put together a range of teacher resources to help you support your students in his/her recovery and enable them to continue their education in a safe and confidential environment.

Whilst this toolkit can’t possibly begin to address the diverse range of issues that are unique to each sufferer or academic setting, we hope that it can give you more of an understanding of what to look for in pupils struggling with eating disorders and where to find resources to help address their unique issues further. 

There are a number of ways you can begin to educate pupils about eating disorders in a safe way for any students who are currently or most at risk of suffering themselves.

To ensure that student wellbeing remains at the forefront of your teaching, here are a few things to be aware of when teaching about eating disorders:

1. Challenging misconceptions that pupils may have
2. Recognising the signs specific to a school setting
3. Assisting a pupil disclosure about an eating disorder
4. Tips for communicating with parents/guardians

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Challenging misconceptions that pupils may have

For most, including professionals who have been working within the industry of mental health for many years, find eating disorders confusing and baffling, so know that you’re not alone. Unfortunately, eating disorders are largely swept up in a number of myths and misconceptions which makes understanding them even more difficult. Below is a list of common myths surrounding eating disorders which may be useful to print out and share with other staff members in the staff room.

1. It’s just an eating disorder. It’s not really a big deal

Eating disorders have the highest mortality rate of any psychiatric illness. Those who suffer from an eating disorder live with a greatly compromised quality of life with up to 20% of individuals with chronic anorexia dying as a consequence of their illness. 

2. Eating disorders are a choice. They simply need to snap out of it and just eat

Eating disorders are a complex psychiatric illness that patients don’t choose nor do their parents' cause. 

3. Only those who are emaciated have an eating disorder

Just like any mental health issue, you simply cannot look at an individual to diagnose them with an eating disorder. Whilst the media portrays eating disorders as someone who is severely thin, this is not the case for the majority of cases. Someone does not have to be underweight to be struggling which is why many cases often remain untreated for many years. 

4. Once a student has gained weight, they’ll be fine

Weight restoration is only the first step in a very long and tough journey of recovery from an eating disorder. Malnutrition comprises the cognitive abilities of an individual which is why only once an individual has restored weight, can their mental restoration begin to catch up. Often, psychological therapy is needed to help address the core reasons for the eating disorder as well as help manage behaviours, thoughts and emotions without resorting to destructive behaviours. 

5. Eating disorders are a fixation on food and weight so the only main symptom I should look out for is weight loss in a student. 

Although eating disorders are often characterized by weight loss, it is not the main cause or reason to suspect that someone is struggling. There are many other physical and behavioural symptoms that you need to look out for. Read on to find out the most common symptoms to be aware of in students. 

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Recognising the signs specific to a school setting

Eating disorders are characterised by a number of different emotional, physical and behavioural changes. Whilst adolescence is a period of time that students are getting used to changes in their bodies and often associated with fad diets and body shaming when the following symptoms are seen together, it can indicate the beginnings or current eating disorder illness.

Emotional

1.) Changes in performance or attitude.

2.) Sending increasing amounts of time alone; isolating themselves from friends.

3.) Overvalues self-sufficiency and very rarely reaches out for help. 

4.) Is reluctant to recognise or cooperate with change.

5.) Emotions are flat or even absent.

6.) When in conversation, often talks incessantly about food, weight, diets, exercise or labels certain foods as ‘good’ or ‘bad’.

7.) Displays obsessive or rigid patterns or routines of doing things.

8.) Strives for academic success and appears intolerant of anything less than perfection.

9.) Appears low, anxious, depressed and is unable to take any compliments – personally or academically – and often resorts to self-disparaging comments about themselves.

Physical

1.) Feeling faint, cold, or tired.

2.) Sudden and apparent weight loss.

3.) Dry, thin hair or blue hands.

4.) Thin baby-like hair across their skin (Lanugo).

5.) Dark circles under their eyes or bloodshot eyes.

6.) Calluses on the knuckles due to purging.

Behavioural

1.) Exercises for long periods of time or has obsessive and rigid ‘rules’ around always being on the go.

2.) Incessant pacing or leg twitching due to an inability to keep still and focus on burning calories.

3.) Makes frequent trips to the bathroom – particularly after periods involving food.

4.) Avoids the school canteen or remains alone or absent during school meal times. 

5.) Wears oversized or baggy clothes to hide their body due to shame or concerns of their body size. E.g. weight loss in anorexia or weight gain in Binge-eating disorder. 

6.) Obvious disengagement with food – either through a limited or low-calorie diet or by avoiding or throwing away uneaten food.

7.) Denies any problems or issues with their food choices or size despite evidence for concern.

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Assisting a student who discloses an eating disorder

• The first step is to consider the environment in which a student is disclosing their issues with disordered eating. It is often very difficult for those who are suffering from eating disorders to speak up and reach out due to the secretive nature of the illness. If a student begins talking during a busy period e.g. in a class or in the school hallway, consider some protective interruptions such as “Thank you for sharing this with me. Let’s pause for now and discuss this together in a more private and quiet space later today”. 

• Accepting that you have an eating disorder is one of the most difficult lessons in recovery, let alone talking to someone else. If a student has reached out to you, it is because they trust you or feel that they can share with you so remember to take that responsibility seriously. Acknowledge that you know it must have been difficult for that student to speak up and that you will hold anything they do say with great confidentiality until you feel further escalation is required. 

• During this conversation, ask the student how they would like you and other teaching staff to support them and how to respond when that student is asked about how they are doing. 

• Be mindful that the full extent of a student’s eating disorder may still remain under wraps. The full extent of their struggles may be more serious than you or the student realises.

• Once the student has opened up about their struggles, contact their legal parents or guardians and invite them in for a meeting to discuss this face to face. Effective communication between parents and teachers is key in such situations so that an appropriate treatment plan – either medical or psychological can be put in place. 

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Tips for communicating with Parents/Guardians

From a teacher’s perspective, eating disorders are one of the most difficult issues to spot amongst students due to the secretive aspect of it. Teachers can often only see a student for short periods of time in lessons so tracking severe behavioural, physical or emotional changes can be difficult to spot. 

Whilst rules may vary between different states, counties and countries, it is important that you educate yourself in terms of your school’s confidentiality and communication policies. Some schools may be regulated by strict policies stating that any concerns for a student’s safety are to be disclosed by contacting parents and guardians about their concerns.

Parents are often grateful and relieved when a teacher communicates their concerns and are generally responsive to the feedback. Like anything, however, there won’t always be the case. 

Whilst some schools will have a confidentiality policy that when a student discloses to a teacher, all information must remain confidential. A student can request you not to talk to anyone else above or their parents.

Eating disorders, however, can be serious life-threatening illnesses and maintaining the overall wellbeing of that student remains at the forefront of the situation. Therefore, it may be that you have to make the decision on what to disclose about that student and to whom.

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Here are a few tips for implementing successful communication between the school, the student and their parents/guardians:

Before approaching the family

• When approaching a family member or guardian, always ensure that it is a convenient time to converse with them. If not then schedule an alternative time when they can concentrate. 

• It’s important to consider any family dynamics, cultural background or religious beliefs of the family which may impact the ability to talk effectively. 

• Prepare yourself for the student to push back and resist you involving their family in the situation. Reassure them that you are involving them because you are concerned for their health and it is your safeguarding duty to involve them.

• Prepare from some resistance from their family. Many parents – who are often unknowing of their child’s problems will feel embarrassed and find it difficult to accept mental health issues in their child. 

• If the parents are resistant but the pupil is willing or vice versa, discuss what type of support they want to progress with e.g. talking privately on a daily basis, eating lunch with the pupil etc.)

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How to begin the conversation

• The most important piece of advice to take with you into a parent-student-teacher meeting is your ears. Listen to what the student is saying, listen to what the family has to say without interrupting, judging or making promises you can’t be sure of.
 
• Ensure that you show empathy for all those in the room and express your concern and compassion for the student’s health with a strong and serious tone. 

• Be mindful that many families may be unaware of any problems with their child and therefore may come across as defensive due to shock or shame. Begin by sharing your concerns and provide concise, factual observations of the student’s behaviour to validate your concerns. 

• Try not to make any subjective judgements or personal diagnoses. 

• Encourage the family to talk and be open with one another and access further support by giving them a list of external agencies who offer support and further treatment.

• Lastly, don’t persist with a conversation that isn’t going to plan as this may compromise any further communication with both the student and their family. 

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Important resources for educators

Many educational resources and external agencies can provide further information, support and treatment plans which can be used as a reference to give to students and their family. Such resources can also be incorporated into school policies as well as health and wellbeing classes in school.

1. Beat

Beat is the UK’s leading charity for eating disorder recovery. Resources include peer support and regional projects to foster community awareness.

Contact: info@b-eat.co.uk

Websitehttps://www.beateatingdisorders.org.uk/

2. The National Centre for Eating Disorders

The NCFED provides training for professionals and resources for those struggling with eating disorders.

Website: https://eating-disorders.org.uk/

3. ABC – Anorexia & Bulimia Care

With over 25 years of experience, ABC provides support and information for the eating disorder community throughout the UK.

Contact: mail@anorexiabulimiacare.org.uk

Website: http://www.anorexiabulimiacare.org.uk/

4. SEED – Eating Disorders Support Services 

 This volunteer organization based out of England aims to bridge the gap between professional care and self-help with regard to eating disorder recovery. Resources include peer support, drop-in sessions, and online materials.

Contact: hello@seedeatingdisorders.org.uk

Website: http://www.seedeatingdisorders.org.uk/

5. Somerset & Wessex Eating Disorder Association

This organization founded the first and only adolescent residential eating disorder facility in Canada and has a host of other resources available to the community.

Contact: support@swedauk.org

Websitehttps://www.swedauk.org/


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Sarah Salmon

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With a background in social media management and editorial writing for jewellery and gemological education, Sarah is the Digital Marketing Executive at Opogo.

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