Health and Physical
Activity Institute
Practical Tips for Educators to
Help Students Dealing with
Eating Disorders
Marilyn Trownsell, R.D.
What is Disordered Eating?

When a person’s attitude about food,
weight, and body size lead to very rigid
eating and exercise habits that put one’s
health, happiness, ability to function, and
safety in jeopardy, it is identified as an
eating disorder.
Defining Different ED
Eating disorders are a continuum of
symptoms that show an individual’s issues
of self-hatred and negative self-esteem
 Anorexia, Bulimia, Binge Eating Disorder,
even the obsession with eating perfectly
“healthy” are forms of ED.

Why Do Eating Disorders Occur?

Symptoms of ED occur because the
adolescent’s psychic structure cannot tolerate
the demands of the developmental tasks that are
specific to that time in their life.
Reference-Levy-Warren, M.H. (1996) The Adolescent Journey: Development,
Identity, Formation and Psychotherapy, Northvale, New Jersey: Jason
Aronson.
Anorexia

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Earlier developmental Arrest
Unworthy-An inability to take things in:

People
 Experiences and opportunities
 Pleasure
 Food
“I don’t deserve this” “I shouldn’t have this”
“I’m not good enough”
Recovery Tips:
Learn how to say “Yes”
Learn to take things in
Risk feeling good, feeling worthy
Bulimia

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Socially more advanced
Inability to take things in
Unable to take in, keep or maintain
-Jobs
-Focus
-Relationships
-Food
Feels guilty/shameful about taking things in and needs to rid oneself of them
Impulsiveness with associated behaviors of self mutilation, sexual activity,
drug and alcohol abuse
Recovery Tips:
Learn to take things in and keep them
Lessen impulsive responses
Binge Eating Disorder


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Never gets enough
Feels empty or hollow inside
People pleaser-caretaker
Avoids/fears confrontation-difficulty saying ”No” or risking being
disliked
Difficult to say “No” to people, experiences, food
Feel they do not get enough love, recognition, care understanding,
food
Recovery Tips:
Learn to say “No”, set limits and boundaries with people, oneself and
food
Recovery from ED
Requires one to:
 Identify and be aware of feelings
 Express needs and communicate feelings
 Meet needs more often than not
 Tolerate and deal with uncomfortable feelings
 Increase care for self and develop empathy and
love for one’s self = self-esteem
Teaching Students with ED


While educators need to be sensitive to the issues and
needs of students with ED these students do not usually
pose a classroom management concern.
Many students with ED especially ones with anorexia
nervosa, are generally quiet, hardworking, even driven.
The real challenge is to provide a supportive and safe
learning environment, that does not add to the student’s
obsessive attention to food, weight or body image
concerns.
Helpful Strategies

Coping Strategies to support students
-Identify people on the school staff or in the district as
resources for advice e.g.: school counselors
-Share advice/insights you have gathered from colleagues and
health professionals with other educators. It is important that no
educator faces this challenge alone.
-Meet regularly with support professionals such as school
administrators, counselors and school nurses, to update progress
and reaffirm the commitment of the team in addressing the
educational needs of students with ED.
Helpful Strategies
Planning Strategies to Build a Support Network in the School

It is helpful to have a system in place to ensure coordination with other
professionals and parents.

Designate a key staff member as the school “case manager” who
communicates regularly with the medical treatment team of a student with
an ED for passing on support strategies to school staff and for staying in
contact with parents i.e.: medical treatment may recommend a student with
anorexia be excused from gym class or take a test at a different time.

The case manager should pass this information to appropriate teachers who
than adjust the education program to meet the needs of the student. Case
managers often are school counselors or administrators.
Helpful Strategies


Invite the student, the parents and non-school
professionals involved in the student’s care to be part of
the school-based team responsible for planning the
student’s ongoing educational program.
In complex cases the school may establish an
Individual Educational Plan (IEP) even if
hospitalization occurs. Collaboration between educators
and other service providers is necessary to achieve
consistency and coordinate support for these students.
The Role of the Educator
Guidelines for Meeting and Referring Students
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First speak privately with the student.
Select a person with the best rapport with the
student.
Directly and non-punitively indicate observations
with the student and listen empathetically.
Do not diagnose or give therapy. Communicate
care, concern and desire to talk.
The Role of the Educator

If the info is compelling, tell the student:
-you sense that he or she might have
an ED
-you sense that evaluation is needed
-your understanding that school
aspects will not be jeopardized unless
it is dangerous to the student’s health
The Role of the Educator
Avoid arguments. End the talk if it is
unproductive or either of you are
getting upset. An impasse suggests
a professional consultation is needed.
 Focus on the person’s feeling healthy and
effective functioning, not weight, shape
or morality
 Do not be a savior, victim or therapist

The Role of the Educator
Know community resources available to
the student.
 Emphasize that it is hard to overcome ED
alone and may require repeated attempts
before it is effective (if frustration from past
attempts are mentioned)
 Arrange follow-up with the student.

Educator Role: Some Don’ts

Don’t cast “awe” -focus on reality that ED may
result in:

Inefficiency in achieving academic, familial,
occupational etc. goals
 Misery in obsession, anxiety ,mood swings
 Alienation with social anxiety, withdrawal, secrecy
and self-absorption
 Disturbance of self and others through loss of control
over diet, body image, eating, emotions and decisions
Educator Role: Some Don’ts
Don’t oversimplify
 Don’t imply Bulimia is less serious due to
often normal appearing weight
 Don’t judge- “ sick” or “stupid”
 Don’t advise about weight loss, exercise or
image
 Don’t confront in a group or in public

Educator Role: Some Don’ts
Don’t diagnose; Focus on IMADInefficiency, Misery, Alienation,
Disturbance
 Don’t become the student’s therapist,
savior or victim.
 Don’t promise to keep secret.

Educator Role: Some Don’ts
 Don’t argue:
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Repeat what you observed, evidence
Repeat concern for person’s well-being
Repeat conviction for need for evaluation by expert
End conversation if an impasse occurs
Take actions to carry out your responsibilities and
self-protection
 Leave the door open for further talk
Educator Role: Some Don’ts
 Don’t be inactive during an emergency.
Throwing-up often, passing-out, c/o chest
pain, suicidal needs professional help
immediately.
Tips for Coaches Re: Athletes

Preventing ED in Athletes
 Take warning signs and ED behavior seriously.
Cardiac arrest and suicide are the leading cause of
death for ED sufferers
 Early detection helps success. Chronic dieting or mild
abnormal eating habits may benefit from referral to an
ED health professional.
 De-emphasize weight in action and comments
 Focus on physical condition and performance
 Performance should not be at the expense of the
athlete’s health or self-esteem
Tips for Coaches Re: Athletes
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Instruct Coaches/Trainers to recognize
symptoms of ED. i.e.: skip meals, absorbed
with calories/carbs/weight, over exercise
beyond fatigue or injury, binging,
preoccupation with body size, throwing up
often (often symptoms are hidden)
Provide athletes with accurate information of
weight, weight loss, body composition,
nutrition, and sport performance.
Tips for Coaches Re: Athletes
 Emphasize the health risks of low weight
(esp.-female athletes with amenorrhea)
 Understand a female’s sensitivity about weight avoid thoughtless or derogatory comments or
behaviors toward weight
 If there is a concern, refer the athlete for
assessment from appropriate professional
Tips for Coaches Re: Athletes
 Do not automatically curtail athletic
participation if an athlete is found to have
ED, unless needed by a medical condition.
 Explore your own values and attitudes
concerning weight, dieting and body image
and how that affects your athlete.
 Promote positive image and self-esteem in
athletes.
Help but most of all do not do harm
while charting through rough
waters…