Eating Disorders and the School Setting

Eating disorders are serious, potentially life-threatening illnesses that often initially present in adolescence. They may first be identified in the school setting because of the impact they can have on school performance. Some students with disordered eating may struggle with concentration, memory and processing information. In addition, disordered eating may impact behaviors and students may become more anxious, depressed, irritable and socially withdrawn. This can impact their relationships with friends, families and teachers. Many young people can also have anxiety and/or obsessive-compulsive disorder (OCD) that may be contributing to disordered eating. Some may have body dysmorphia, a mental health condition where a person spends a lot of time worrying about perceived flaws in their appearance. Finally, young people with eating disorders may also be at risk for medical complications that need close monitoring and management.

Early identification and treatment are associated with improved outcomes for young people struggling with eating disorders. School staff can play an important role in prevention and identification. For example, school nurses, counselors, psychologists, and/or school-based health centers can provide support, education, and referrals, when necessary. Additionally, coaches and athletic staff, especially in sports that place an emphasis on weight through classifications (eg, wrestling) or perceived performance benefits/ideals (eg, dance, distance running, gymnastics) should be well educated on prevention and identification. Finally, schools can collaborate with pediatric medical homes and community-based care teams in supporting young people that are able to continue to attend school.

In January 2021, the AAP released a clinical report entitled Identification and Management of Eating Disorders in Children and Adolescents which summarizes the diagnostic categories, signs and symptoms, and approach to care for eating disorders for pediatric care providers. The current diagnostic categories for eating disorders include:

1. Anorexia Nervosa
2. Bulimia Nervosa
3. Binge Eating Disorder
4. Avoidant Restrictive Food Intake Disorder
5. Other Specified Feeding or Eating Disorders

Key AAP Recommendations

Prevention Strategies in the School Setting:

• Create a school environment where all students of all body sizes feel safe and welcome.
• Address healthy habits, not weight.
• Discuss media literacy, use of enhanced images.
• Incorporate eating disorder education into health education classes.
• Ensure nutrition education uses sensitive, non-stigmatizing language.

Identification: Young people may exhibit a variety of different emotional, physical and behavioral signs of disordered eating. Some students may not exhibit any of these. Be alert for:

• Sudden weight loss or gain.
• Dizziness, abdominal pain, fatigue.
• Extreme focus on food and/or exercise.

Care Collaboration:

• Create a multidisciplinary collaborative 504 plan to address the need for medical monitoring, nutrition supervision and academic accommodations as needed.
• Schools can collaborate with the medical home, family and other members of the outpatient care team.

Helpful Resources:

AAP Guidance on Identifying and Treating Eating Disorders
This resource provides guidance for pediatricians on how to help families reduce stigma around weight through supportive language and linking them with appropriate services.

AAP Identification and Management of Eating Disorders in Children and Adolescents
This resource is a clinical report that describes common eating disorders.

AAP Preventing Obesity and Eating Disorders in Adolescents: This resource is a clinical report that addresses the interaction between obesity prevention and EDs.

Academy for Eating Disorders
The website includes a variety of resources for professionals and students.

Resources for Schools
Children’s Health School Services School Guide for Student with Anorexia Nervosa or Bulimia Nervosa
This guide provides schools with information about eating disorders, how they impact student’s academic, social/emotional and physical health, as well how schools can help.

Understanding Eating Disorders in BC Schools: A Guide of Trauma Informed Practices for School Professionals
The purpose of this guide is to generate thoughtful discussion about eating disorders in schools.

Eating Disorders Fact Sheet for Educators
The purpose of this fact sheet is to increase educators’ knowledge and awareness of the medical and psychological concerns caused by eating disorders that affect school-age children.

Resources for Parents & Families
Healthychildren.org Identifying and Treating Eating Disorders
This resource is for families and provides information on identifying and treating eating disorders.

National Eating Disorders Association – Parent Toolkit
A toolkit for parents and families to provide help, hope and healing, if they have a child suffering from an eating disorder.