Today, I would recognize the signs: the 11 year old girl in the sixth grade class spending her entire recess and lunch-break running in the schoolyard and doing circuits in the gym; every day, exercising more; the same girl continuing to get top marks with her school work, always punctual, eager to please, but becoming withdrawn; her bubbly personality disappearing; she is not eating her lunch – she offers it to her playmates. She keeps only the apple and eats this very, very slowly, one nibble at a time. Today I would recognize these signs as symptoms of anorexia nervosa, for this child was me.

Teachers are in a prime position to be among the first people to notice a child is developing an eating disorder. I certainly wish my teacher had recognized the symptoms and intervened.  But that was 50 years ago. Today, I like to think that all teachers are aware of the signs of anorexia nervosa, and that they know how to respond. Sometimes, friends of the child will notice the symptoms, and confide in the teacher. Or perhaps the coach or dance instructor may notice behavioral changes.

Teachers often want to help when they suspect a child is suffering symptoms of anorexia nervosa, but don’t know when to say something, what to say or how to say it. They might even decide that it is better to say nothing than say the wrong thing. This just goes to show how important it is for school staff to be educated and informed about eating disorders – so that they feel confident and more able to help. A teacher’s attitude and response can greatly influence whether the illness is ‘nipped in the bud’ and stopped in its tracks or gathers pace and becomes entrenched.

School staff are well placed to spot the early signs of anorexia nervosa, enabling early diagnosis, early intervention and a far better prognosis. A child may feel more comfortable talking about food difficulties with a teacher rather than someone in their immediate family. The school can provide a bridge between the child, their family and other care providers to ensure the best possible outcome.

How the teacher responds – how they offer support - can greatly influence what happens next. The clues below on what to say, and when to say it, are drawn from my latest book with Professor Janet Treasure: Anorexia Nervosa: A Recovery Guide for Sufferers, Families and Friends. This updated version includes information for teachers and others whose daily work involves the care of children.

School-specific warning signs
Some anorexia nervosa warning signs are more easily noticed at school. Observing me at age 11, the teacher would have ticked a box in each of the following:

• Weight loss (not because I did not want to eat, but was afraid to eat)
• Avoidance of PE or swimming (because it involved undressing)
• Excessive exercise (I felt driven to do more each day)
• Busy during lunch breaks (to avoid questions like ‘why aren’t you eating?’)
• Wearing extra clothing (to keep warm and hide the body)
• Perfectionism (important to get everything right to avoid anxiety)
• Inability to focus in class (when the brain is starved, concentration is more difficult)
• Loss of friends (because food thoughts increasingly dominate thinking time)

When a child is causing concern
When a teacher suspects a child may be suffering from anorexia nervosa, they should tell the person responsible for pastoral care within the school. They may already be aware of the problem, or they may enlist your help.

Creating opportunities for confiding
A child feels more comfortable when they ‘make the first move’ with regards to talking about their eating disorder as this helps them to feel in control of the situation. To facilitate this, a teacher can create situations for one on one time such as suggesting they stay after class to discuss their homework. Often, a child with an eating disorder feels scared and alone, and during the early stages may welcome the chance to offload to someone.

Remain calm and don’t judge. Encourage the child to share their fears with questions such as: ‘You don’t seem quite yourself lately, how can I help you?’ Avoid talking about food or weight directly as this is likely to frighten the child. Take this first meeting gently and accept that you are unlikely to get to the crux of the issue immediately. Focus on listening to the child. Work on building a trusting relationship and ensure that they know when and where they can talk to you further about what’s on their mind.

* For more information, see Anorexia Nervosa: A Recovery Guide for Sufferers, Families and Friends. Pooky Knightsmith writes the chapter ‘Guidelines for School Staff’.