Trisha Gura holds a Ph.D. in molecular biology, is a science writer and a medical journalist. Recovering from anorexia and a mother, Ms. Gura and her daughter reside in the Boston area. She is the author of Lying In Weight: the Hidden Epidemic of Eating Disorders in Adult Women (Harper Collins, 2007).

Trisha Gura--

The ABCs of Eating Disorders

My 12-year-old told me the other day about a girl in her class with a problem. She skips breakfast, eats only half a bag of Goldfish crackers for lunch, refuses brownies offered by the teacher (she cites a peanut allergy as her excuse even though the teacher assures her that his home-baked brownies have no nuts), and she is very, very thin. “We all know she is, like, anorexic, mom,” my daughter says.

If the kids know, why don’t the teachers?

Some just aren’t aware.

“Everybody is now monitoring for obesity and body mass index,” says nurse practitioner Ann Derouin, who runs a school-based health clinic at Durham Southern High School in North Carolina. “So the eating disorders piece has been pushed to the background.”

Indeed. With eating disorders such as anorexia and bulimia nervosa, the media hands us a myth: eating disorders are about teens who starve or make themselves throw up in order to look like fashion models. Therefore, many teachers believe that seventh graders are too young to be at risk. (The truth is that doctors are diagnosing children as young as six years of age.) Other educators figure that if a student isn’t emaciated, she has no problem. But those with bulimia are often of normal body weight. And children can have binge eating disorders in which they binge but do not purge, and hence are overweight or obese. By the way, boys get them, too – and their ranks are currently growing.

According to Derouin, the most common scenario is that the friends of the student in trouble, such as my daughter, get so worried that they eventually approach an adult in the school system. And then what?

It depends upon the school and educator. Teachers, school nurses, and even cafeteria staff sit on the front lines of eating  disorder prevention, as they see our kids in action every day. And yet, many of them do not know how to discuss and handle these complex issues. Even the school administrators themselves may not understand what structures need to be in place to deal with children at risk or their parents, who are often in high denial. Privacy issues complicate matters further. For this reason, the National Eating Disorders Association (NEDA) has put together a user-friendly “toolkit” for educators. It’s a cornucopia of information and resources for everyone involved in the education system.

•For teachers, there is a general description of what eating disorders are and how to spot them, especially in a school setting. Beyond the obvious weight fluxuations, the guide mentions cognitive changes and ties to parallel problems like anxiety and depression. NEDA makes sure to dispel the notion of weight as the only warning sign on a page entitled, “Common myths about eating disorders.”

•For administrators, there is a series of pages that discuss setting up a strategic plan, replete with a team who will handle cases as they come up. For the difficult task of approaching parents, there are sample scripts of possible discussions and talking points.

•For school psychologists, there is a series of tips about how to help students as well their friends and classmates. There is also a template “Student Assistance Program” form, to be filled out in order to set the intervention process in motion.

•For school nurses, there is information about the risks of weighing students in school, especially in front of other students. Many eating disorders start when an overweight child gets teased or bullied and then fad diets to get thinner.

•For coaches, particularly those in weight-related sports such as gymnastics or wrestling, there is advice about emphasizing performance rather than size, as well as awareness of problems such as young girls who participate in elite athletics but are also dieting. These girls often lose their ability to menstruate and put themselves at risk for osteoporosis and eating disorders.

The most important action, says Laurie Vanderboom, director of programs at NEDA, is that schools put in place a strategic plan for dealing with students at risk. Prevention is key. If eating disorders are caught and treated early, prospects for recovery are much better.

“An eating disorder is like a tiger in a jungle,” Vanderboom says. “Because the tiger is so well hidden and stalking you, when it finally emerges, it is too late.”

The warning signs are there, and educated educators are there to spot them. They just need to be looking.

Author’s note: For all those who deal with food allergies, this blog piece is in no way advocating the casual dismissal of those special needs. Food allergies are serious and potentially fatal medical problems. However, experts do note that a person with an eating disorder can use a food allergy to hide their reluctance to eat. After speaking with the 7^th grade girl’s mother, I learned that the girl’s allergies are minor and that her mother is concerned at the extreme to which her daughter is taking the problem. 

More on Eating Disorders From Trisha Gura:

Update on Oct 21, 2008 by At Basil & Spice

Newsweek Link!

Reuters!

Inform!

Chicago Sun-Times!