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Recognising the signs of eating disorders
An eating disorder is a serious and potentially fatal illness. Fiona Parsons and Tracy Preston explore emerging eating disorders and developing a whole school approach to supporting pupils
- Collaboration is key.
- Be aware of how weight and bodies are discussed around the school. Pupils may pick up on negative behaviour and attitudes towards food.
- Watch your language and try to avoid labelling i.e. do you have an eating disorder? Try instead: is there an issue about eating lunch?
- Offer peer mentoring and coaching that specifically aims to develop the student’s internal locus of evaluation.
- Remember those with an eating disorder will do their best to keep it secret; there are visible and invisible symptoms to be aware of.
Eating disorders are serious mental illnesses that involve disordered eating behaviour. This might mean limiting the amount of food eaten, eating very large quantities of food at once, getting rid of food eaten through unhealthy means (e.g. purging, laxative misuse, fasting, or excessive exercise), or a combination of these behaviours.
Eating disorders are not just about food, but about feelings. The way the person interacts with food may make them feel more able to cope or may make them feel in control.
Stereotypes about who gets eating disorders might make them harder to spot among older people, men and boys, and ethnic and cultural minority groups. Boys are often less likely to seek help because it is stereotyped as a female problem.
Types of eating disorders
Anorexia nervosa, bulimia and binge eating are well-known eating disorders.
Individuals may also be diagnosed with other specified feeding or eating disorder (OSFED). This is not a less serious type of eating disorder – it just means that the person’s eating disorder doesn’t exactly match the list of symptoms a specialist will check to diagnose them with anorexia, bulimia, or binge eating disorder.
It’s also possible for someone to move between diagnoses if their symptoms change – there is often a lot of overlap between different eating disorders.
Orthorexia refers to an unhealthy obsession with eating ‘pure' food. Food considered ‘pure’ or ‘impure’ can vary from person to person. This doesn’t mean that anyone who subscribes to a healthy eating plan or diet is suffering from orthorexia.
As with other eating disorders, the eating behaviour involved is used to cope with negative thoughts and feelings, or to feel in control. Someone using food in this way might feel extremely anxious or guilty if they eat food they feel is unhealthy.
Wannarexia (or 'anorexia yearning') is a label applied to someone who claims to have anorexia or wishes they did but does not. These individuals are also called ‘wanna-be-ana’ or ‘anorexic wannabe’.
Individuals will promote their eating disorder and tell everyone how little they’ve eaten. They’ll talk about how fat they think they are whereas someone who has anorexia would not promote this. Anorexics commonly try to sit under the radar and avoid being noticed.
Wannarexia is an attempt at seeking attention which is an issue in itself. Wannarexia is contagious.
Individuals may post on social media (like Snapchat which disappears) their behaviours and share this information with others. There is a risk that students will watch a perceived anorexic and copy their symptoms and behaviours around food.
Identifying wannarexic behaviours is crucial so that PSHE, group chats and individual support can be put in place before a pattern occurs among pupils and the issue escalates.
Bigorexia is understood as a muscle dysmorphia-preoccupation. It occurs when someone believes they are not muscly enough. They may excessively look in the mirror and abuse steroids and protein shakes.
Steroids are used to build up muscle and when taken excessively can affect libido and sex drive due to the abnormally high levels of testosterone. This creates high blood pressure, high cholesterol, liver damage, acne, heart failure and often aggressive and violent behaviour.
Indicators of bigorexia or excessive steroid use include:
- rapid muscle / weight gain
- enlarged breasts (in men)
- facial hair-growth
- aggression or mood swings.
Anorexia athletica (or hyper-gymnasia)
This is an eating disorder characterised by obsessive and compulsive exercise.
The sufferer tends to over-exercise to give themselves a sense of having control over their bodies.
If you’re worried about a pupil, there are some warning signs to look out for.
1. Constantly talking or thinking about food
Those suffering with an eating disorder have an obsession with food. An eating disorder isn’t always obvious as it’s often a very secretive disorder. If someone is drastically yo-yoing with their dieting habits or appear to have very strict regimes it might be cause for concern.
2. Cutting out entire food groups
Eliminating foods from a diet isn’t always cause for alarm but if there’s no apparent health, religious or moral reason behind the change, it might be a sign something more serious is going on.
3. Extreme fitness or eating habits
This could mean changes in activity level (like over-exercising) or excessively counting calories. This also might come with a noticeable weight fluctuation.
Mood changes include expressing feelings of anger, disgust, shame or guilt after eating, or a sense of not being good enough or doing enough with regards to exercising.
4. Changes in physical appearance
Aside from weight changes, eating disorders can cause nail brittleness, skin rashes, tooth erosion and hair thinning. A person living with an eating disorder might also bruise easily, tire quickly and get cold easily.
5. Laxative abuse
Someone living with an eating disorder might overuse laxatives or diuretics to get rid of food that may have been consumed during a binge episode.
6. Being anti-social
Someone with an eating disorder will likely try and avoid socialising when they think that food will be involved. They’ll worry that their eating will be questioned or scrutinised.
7. Displaying signs of other mental health issues
Eating disorders may occur in conjunction with other illnesses like depression or anxiety, both of which have physical and mental symptoms on their own.
Whole school approach
Those suffering from an eating disorder will try their hardest to keep it hidden, making it harder to spot. Recognising an eating disorder sufferer requires all staff to be aware of the signs and collaborate to put in place support for pupils.
Within our annual safeguarding training, we discuss how, by close collaboration with the nurse, canteen and teaching staff, we can spot the signs of eating disorders well in advance.
For example, a canteen helper will tell the safeguarding team if they have noticed that a child is limiting what they are eating, and PE staff are well placed to notice any changes in physical appearance.
The pastoral team will then discuss the child and monitor them closely for at least two weeks. Key staff will be alerted to discreetly observe the eating patterns of the child. PSHE lessons maybe adapted to include eating disorders and keeping each other safe in lessons.
After the two weeks have passed, another discussion takes place about next steps. This could include discussing with the child staff observations, calling parents, offering counselling, making an outside referral (i.e. CAMHS), allocating a ‘go-to’ person for the student etc.
This joined-up approach with all professionals, students, parents and peers may result in a ‘team around the child meeting’ where we are able to offer resources that can be put in place to support the student. We could also offer to work with outside agencies on how best to support this particular eating disorder.
How to help
Don’t ignore any glaring signs that show someone is dealing with an eating disorder. Address what’s going on with a conversation outside of a meal time.
Let them know you care and make some gentle inquires such as, ‘I’ve noticed that you’ve changed your eating habits, what’s prompted the change?’
The best way to support someone who may be experiencing an eating disorder is by talking with them, but when and how you do it matters.
Where and when do eating disorders feature in your curriculum? School-based interventions alone do not work, collaboration with the family is critical.
PSHE can be used to challenge the idealised (and often distorted) body images in the media. Topics may cover:
- healthy coping strategies
- benefits of healthy eating and exercise
- case studies to help pupils identify difficulties with others.
Last Updated:15 May 2019