National Eating Disorders Association

Educators During adolescence, young people often experience sudden variations in height and weight. Eating disorders are marked by a variety of emotional, physical, and behavioral changes. While some of the behaviors may appear to be little more than teenage dieting and body dissatisfaction, taken together they can indicate a serious, life-threatening eating disorder. 

The points outlined below are not necessarily definitive signs or symptoms of an eating disorder — only an expert can make that diagnosis. Although many individuals with eating disorders are perfectionistic and appear to be “perfect” students, it’s not a universal trait. Also, be aware that perfectionism can be expressed by what looks like apathy — if a student can’t reach the impossibly high standards they set for themselves, they may opt not to try. Perfectionistic individuals might feel that disappointing themselves or others would be too upsetting, so they opt to avoid the possibility instead.

If a student consistently shows one or more of the signs or symptoms listed below, it is cause for concern.

EDUCATOR TOOLKIT

Educator ToolkitThe NEDA Educator Toolkit is a resource for educators, staff who work in a school setting or those who work with youth outside of school. If you want to understand more about eating disorders, if you’d like to know how to support students and young people who may be affected, this information will help you. 

 Download Educator Toolkit

 

 

WARNING SIGNS & SYMPTOMS IN A SCHOOL SETTING

Emotional

  • Changes in attitude/performance 
  • Expresses body image concerns: weight concerns; unable to accept compliments; mood affected by thoughts about appearance; constantly compares self to others; self-disparaging; refers to self as fat, gross, ugly; overestimates body size; strives to create a “perfect” image; seeks constant outside reassurance about looks 
  • Incessant talk about food, weight, shape, exercise, cooking, etc. 
  • Displays rigid or obsessive thinking about food, eating, exercise: labels foods as good/ bad; on/off limits for no actual reason; appears uncomfortable or unwilling to share food; inflexible about diet without reason 
  • Appears sad/depressed/anxious/ashamed/ embarrassed/expresses feelings of worthlessness 
  • Emotions are flat or absent 
  • Intolerance for imperfections in academics, eating, social life, etc. 
  • Is target of body or weight bullying currently or in the past 
  • Spends increasing amounts of time alone; pulls back from friends 
  • Is obsessed with maintaining unhealthy eating habits to enhance performance in sports, dance, acting, or modeling 
  • Overvalues self-sufficiency; reluctant to ask for help 
  • Unable or unwilling to acknowledge recent changes

Physical

  • Sudden weight loss, gain, or fluctuation in short time 
  • Complaints of abdominal pain 
  • Feeling full or “bloated” 
  • Feeling faint, cold, or tired 
  • Dark circles under the eyes or bloodshot eyes/ burst capillaries around eyes 
  • Calluses on the knuckles from self-induced vomiting 
  • Dry hair or skin, dehydration, blue hands/feet 
  • Lanugo hair (fine body hair) 
  • Fainting or dizziness upon standing; frequent fatigue 
  • Thinning, dry hair

Behavioral

  • Diets or chaotic food intake; pretends to eat, then throws away food; skips meals 
  • Creates rigid dietary rules or observes strict diet without medical or religious reason 
  • Exercises for long periods and with obsessional attitude; exercises excessively every day (can’t miss a day) 
  • Constantly talks about food; unwilling to share food; hoards food; refuses to eat food prepared by others or without knowing exact ingredients 
  • Difficulty sitting still: hovers over chair instead of sitting, constantly jiggles legs, gets up from desk at every opportunity, offers to run errands 
  • Makes frequent trips to the bathroom 
  • Makes lists of foods and calories eaten 
  • Wears very baggy clothes to hide a very thin body (anorexia) or weight gain (binge eating disorder) or to hide a “normal” body because of concerns about body shape/size 
  • Avoids cafeteria, works through lunch, eats alone 
  • Shows some type of compulsive behavior (e.g., compulsive hand washing; hoarding; repetitive movements/speech; need for constant reassurance) 
  • Denies difficulty with food or body image despite evidence that it is an area of concern

 MEETING WITH AND REFERRING STUDENTS WHO MAY HAVE EATING DISORDERS

  • No matter how strong your suspicion that a student has an eating disorder, do not make a decision without first speaking privately with the student. If possible, select a time to talk when you will not feel rushed. Ensure sufficient time and try to prevent interruptions.
  • Roommates or friends should select the person who has the best rapport with the student to do the talking. Unless the situation is an emergency or otherwise very negative for many people, confrontation by a critical group without professional guidance should be avoided.
  • In a direct and non-punitive manner, indicate to the student all the specific observations that have aroused your concern. Allow the student to respond. If the student discloses information about problems, listen carefully, with empathy, and non-judgmentally.
  • Throughout the conversation, communicate care, concern, and a desire to talk about problems. Your responsibility is not diagnosis or therapy; it is the development of a compassionate and forthright conversation that ultimately helps a student in trouble find understanding, support, and the proper therapeutic resources.
  • If the information you receive is compelling, communicate to the student:
    • Your tentative sense that they might have an eating disorder.
    • Your conviction that the matter clearly needs to be evaluated.
    • Your understanding that participation in school, sports, or other activities will not be jeopardized unless health has been compromised to the point where such participation is dangerous.
  • Avoid an argument or battle of wills. Repeat the evidence, your concern, and if warranted, your conviction that something must be done. Terminate the conversation if it is going nowhere or if either party becomes too upset. This impasse suggests the need for consultation from a professional.
  • Throughout the process of detection, referral, and recovery, the focus should be on the person feeling healthy and functioning effectively—not weight, shape, or morality.
  • Do not intentionally or unintentionally become the student’s therapist, savior, or victim. Attempts to “moralize,” develop therapeutic plans, closely monitor the person’s eating, adjust one’s life around the eating disorder, or cover for the person are not helpful.
  • Be knowledgeable about community resources to which the student can be referred.  In discussing the utility of these resources, emphasize to the student that, since eating problems are very hard to overcome on one’s own, past unsuccessful attempts are not indicative of lack of effort or moral failure.
  • Faculty should arrange for some type of follow-up contact with the student.  If you are often involved with students with eating disorders, consultation with a professional who specializes in eating disorders may be needed.

GUIDANCE FOR SCHOOLS ON AN EDUCATION PLAN FOR A STUDENT IN TREATMENT

  • Recovering from an eating disorder is a long-term process. Students may miss significant amounts of time from school due to treatment and ongoing appointments. Here are some suggested strategies for helping students during and after treatment.
  • Meet with the student and parents before the student returns to school to discuss the support needed 
  • Work with treatment team and school to ensure the reintegration plan takes the student’s medical, psychological, and academic needs into account (upon re-entry, student may need supportive counseling, medical monitoring, release from physical education classes, meal monitoring, and ongoing communication between treatment team and family) 
  • Be aware of the effects of eating disorders on cognitive abilities, so your expectations are realistic 
  • Be flexible while balancing realistic workloads, deadlines, and the need to fulfill important learning goals 
  • Consider the timing of potentially stressful decisions (i.e., discussing if the student needs to repeat the grade) 
  • Try to minimize the long-term impact on the student’s career choice 
  • When making decisions about workload, consider the student’s medical, psychological, academic, and developmental needs 
  • Stay up to date on the latest changes to the students 504 plan or IEP 
  • Reduce homework load and alter deadlines where appropriate 
  • Recognize that the student’s reconnecting with friends may be difficult and stressful 
  • Provide extra academic support, especially after a long absence 
  • Work with the student and the parents to successfully re-integrate the child into full-time schooling 
  • Understand the potential long-term need for missed school for medical and therapeutic appointments and management of ongoing eating disorder symptoms 
  • Refrain from discussing food, weight, exercise, and dieting in the classroom 
  • Help school devise reduced workload for student, alternative assignments for physical education requirements, extended time on assignments/tests, peer tutoring, copies of class notes from missed days, and access to a quiet study location, as needed 
  • Advocate for the student (e.g., help student and/or his/her parents negotiate scheduling conflicts between school and doctor appointments) 
  • Work with administrators to create a healthy school environment (e.g., zero-tolerance of appearance-based teasing and bullying, adequate time to eat lunch, reducing or eliminating in-school weighing and BMI measurements) 
  • Promote alternatives to class activities that may trigger eating disorder behaviors (e.g., weigh-ins, co-education swim class, calorie counting in nutrition class) 
  • Facilitate a manageable reintegration into extracurricular and social activities, which may have become marginalized during the illness
  • Please note that your professional rights and responsibilities may vary by state and school system; please consult your school administration as well as any relevant local and professional organizations for information on regional guidelines.