Health and Physical Activity Institute

1. Health and Physical Activity Institute Practical Tips for Educators to Help Students Dealing with Eating Disorders Marilyn Trownsell, R.D.

2. 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.

3. 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.

4. 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.

5. Anorexia • 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

6. Bulimia • 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

7. Binge Eating Disorder • 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

8. 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

9. 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.

10. 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.

11. 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.

12. 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.

13. The Role of the EducatorGuidelines for Meeting and Referring Students • 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.

14. 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

15. 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

16. 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.

17. 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

18. 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

19. Educator Role: Some Don’ts • Don’t diagnose; Focus on IMAD-Inefficiency, Misery, Alienation, Disturbance • Don’t become the student’s therapist, savior or victim. • Don’t promise to keep secret.

20. Educator Role: Some Don’ts • Don’t argue: • 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

21. 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.

22. 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

23. Tips for Coaches Re: Athletes • 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.

24. 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

25. 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.

26. Help but most of all do not do harmwhile charting through rough waters…