I don't know about you, but as a school counselor, I receive a lot of remarks, from both teachers and parents, about student weight loss. And, frankly for this age group of students, it is something to be on our radar. Face it, we live in an Instagram world full of selfies, filtering tools for pictures, and unrealistic physical goals (remember thigh gap?). Many adults can escape this barrage of pressure, but our teens, um, not so much. Now, I am not blaming the current climate for the onset of eating disorders. In fact, eating disorders have been around for a long time and it seems the media is now focusing more attention on this illness. I applaud celebrities like Demi Lovato, Lady Gaga, and Zayn Malik who are willing to share their struggles with the public. So, if our current climate is the not causation of this disorder, what is the true culprit?
Eating Disorders and the School Counselor
As a school counselor, you are not always an expert on certain disorders or illnesses. Often, we are a part of a 504 Plan or involved in a re-entry plan, but sometimes we really don't know the whole story about a disorder. The purpose of this post is to give you some information about eating disorders and help you advocate for your students.
So, when should you be concerned about a student? We always have well-meaning teachers who express their concerns about a student's weight loss, but when is it a real issue? The Child Mind Insititute details the difference between normal child development and disordered thinking.
- Disordered body image perception - the student is obsessed by weight, a particular part of the body (i.e thigh gap) or achieving an unrealistic goal.
- Fixation on appearance - the student may spend hours filtering selfies.
- Extreme dieting - the student loses an unhealthy amount of weight in a short period of time.
- Purging/binging behaviors - the student eats high amounts of calories and then participates in a purge (vomiting, excessive exercising, laxatives, etc.)
Second, know the signs of an eating disorder. Let's review the definition and types of disordered eating.
According to Amen Clinics, eating disorders are a brain disease that impairs a person's image of self. People who suffer with an eating disorder are at elevated risk for physical problems, suicide, and death. So basically, eating disorders are a mental illness that can have a high mortality rate. Again, something we should be concerned about as professional school counselors.
There are five categories of eating disorders:
1. Anorexia Nervosa
Eating disorder in which the person has a distortion of the body, usually viewing self as overweight, even when the person is underweight, and have an intense fear of gaining weight.
Red Flags:
Student talks about weight or parts of the body more than the average teen.
Student severely limits intake of food or refuses to eat.
The student is extremely underweight.
The student obsessively worries about gaining weight.
2. Bulimia Nervosa
Eating disorder in which the person experiences a loss of control while eating and consumes large amounts of food. After the consumption, the person routinely purges by engaging in vomiting, taking laxatives, excessively exercising, or fasting.
Student is afraid of gaining weight.
Student consumes extreme amounts of food in one sitting.
Student repeatedly forces self to vomit.
Student excessively exercises after eating.
Student takes weight loss supplements to lose weight.
Student fasts to make up for large meals.
3. Binge Eating Disorders
The most common eating disorder in the United States where the person has no control over the amount of food consumed. Although the person may feel guilty about the amount of food consumed, the person does not compensate for the number of calories. Because of their high consumption, they are typically overweight.
Red Flags:
Student consumes large amounts of food in one sitting.
Student feels a loss of control while eating.
Student eats when he/she/they are not hungry.
Student eats alone.
Student stashes food.
Student feels remorse or guilt for eating.
4. Orthorexia
Although a healthy diet is important, this person has a fixation on healthy eating. This person is obsessed about eating nutritious foods and has an intense worry about eating the wrong diet.
Red Flags:
Student cuts out whole categories of foods.
Student severely limits food consumption to a small group.
Student compulsively checks labels.
Student obsesses over what can be eaten at a restaurant or event.
Student expresses distress or anger when a food category is not available.
5. Other Eating Disorders
Additional disorders include:
Avoidant Restrictive Food Intake (ARFID) - limiting specific foods or amounts of food due to concerns about body weight.
Other Specific Feeding or Eating Disorders (OSFED) - eating disorder that does not meet the criteria for Anorexia or Bulimia.
Pica - non-food substances including dirt, hair, paper, detergent, clay, glue, starch.
Rumination Disorder - constantly regurgitating food.
Compulsive Exercise - exercise that interferes with everyday life activities. Person exercises to the point of exhaustion.
Diabulima - neglect of diabetes management due to the fear that insulin will make you gain weight.
Third, educate yourself about eating disorders and provide information and resources to students, parents, and staff.
Julen Buser, Assistant Professor at Ryder University, gives some tips on how school counselors can address eating disorders effectively in their schools.
Buser found that dissonance-based prevention
programs are effective with students. A dissonance-based program encourages personal application and group sharing. Buser gives an example of a program in her article for school counselors of a dissonance-based prevention program. In this program, students talked about the thin-ideal. After the discussion, the teens completed homework assignments
about this concept, like writing an essay arguing against the thin-ideal. Next, the students were asked to share about a
personal experience regarding feeling pressured to be thin. From these discussions, students were also asked to challenge themselves to change thoughts and behaviors.
Another strategy, Buser discusses in her article, advocates for encouraging health teachers to include prevention strategies in their health and PE curriculums.
Another great prevention strategy was created by colleges and the National Eating Disorders Association to raise awareness to girls both young and old called the "Real -Life Barbie Doll. I totally believe this campaign could be used with high school students. The point of the campaign is to get the message out that the image of Barbie is a myth, and no one can become Barbie (unless you spend over $100,000 in plastic surgery and take out 3 ribs). Attached is a handout to use for this campaign and a photo of Barbie as a real person for a point of reference.
The National Eating Disorders Association (NEDA) has provided an Educators' Toolkit that can provide additional guidance for school counselors. Here are some suggestions for NEDA:
School counselors can assist in creating protocols for parents, teachers, and other students to report their concerns about a student who may be experiencing disordered eating.
School counselors can update school anti-harassment and antidiscrimination policies to ensure they include
provisions about physical appearance and
body shape.
School counselors can adopt checklists of typical physical, social,
behavioral, and psychological signs and
symptoms of eating disorders to facilitate
monitoring changes that could signal
progression to a more serious condition so that
a student can be referred to specialist support
as warranted.
School counselors can assist in speaking to coaching staff about the elimination of student
weighing and BMI measurements in health,
PE, and other classes. If you can’t, make it a
policy not to weigh students publicly or in
close proximity to fellow students.
School counselors can advocate for a wide range of tasty and
nutritious foods in school cafeterias, and
vending machines with a variety of snacks and
beverages.
School counselors can suggest that a broad variety of body
shapes, sizes, and ethnicities included in posters, books, and materials.
School counselors can encourage students of all sizes are encouraged
to participate in school activities such as band,
cheerleading, student government, theater
groups, etc.
Fourth, school counselors can support students with disordered eating and help their peers support them at school. The National Eating Disorders Association has laid out some strategies in their Educators' Toolkit that may be helpful.
How to assist the student:
- Talk to the student in a confidential space.
- Acknowledge to the student how difficult disclosing personal concerns can be.
- If the student is returning from hospitalization, ask the student how he/she would like teachers (and others) to respond when asked about how the student is doing.
- Contact the student’s parents or guardians to assure appropriate medical and psychological follow-up.
- Protect confidentiality and privacy by providing generic information about how to be supportive to a friend.
- Remind friends that they are not responsible for their friend’s eating disorder or recovery.
- Encourage the students’ friends to continue usual activities with the person.
- Be mindful of other students’ reactions to the eating disorder; for example, provide age appropriate, selected information.
- Encourage classmates and friends to discuss their concerns with you, a fellow teacher, or another adult.
In addition to the Educators' Toolkit, ANAD provides a great school resource for helping staff support students with disordered eating. Their guide goes into detail about communication with students and parents, assessing students, supporting students returning to school, and much more!
Fifth, provide staff in-service and information, if you are up for the challenge.
Again, the National Eating Disorders Association and ANAD hasve provided information for schools about eating disorders. One great additional toolkit to share is the Coaches' Toolkit from NEDA. Many experts in the field have contributed to this toolkit and it provides the
information and resources coaches need to face disordered eating or an eating
disorder in school sports.
Sixth, provide advocacy for students who are facing disordered eating and body image. Again, not to sound a broken record, but the National Eating Disorders Association provides many avenues to provide advocacy from supporting legislation to promoting Eating Disorder Awareness in schools.
Eating Disorder Events
Eating Disorder Awareness Week - February 21st-27th - #BetheChange
No Diet Day - May 6th
NEDA Pride Week - June
Body Acceptance Week - November
Some Additional Considerations
Talking about or assisting those who may have an eating disorder can be very difficult, so consider educating yourself. The International Association of Eating Disorders Professionals has numerous webinars for professionals that may be a great starting point. In addition, ASCA has copious articles for school counselors, ethical considerations, and much more. Check out the ASCA webinar on Ethical Considerations When Working With Minors.
When speaking about eating disorders, it is important to consider how you will deliver this information. The National Eating Disorders Association has provided some guidance for presenters to follow in their Giving Safe Presentations on Eating Disorders.
Also, consider giving out resources to students and parents who may have questions regarding body image, dieting, body positivity and much more.
Resource from TPT
If you are desperate and need a presentation, consider checking out my TPT store for a staff Inservice.
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