Health and Physical Activity Institute

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Health and Physical Activity Institute

• Practical Tips for Educators to Help Students
  Dealing with Eating Disorders
• Marilyn Trownsell, R.D.

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What is Disordered Eating?

• When a persons attitude about food, weight, and
  body size lead to very rigid eating and exercise
  habits that put ones health, happiness, ability
  to function, and safety in jeopardy, it is
  identified as an eating disorder.

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Defining Different ED

• Eating disorders are a continuum of symptoms that
  show an individuals issues of self-hatred and
  negative self-esteem
• Anorexia, Bulimia, Binge Eating Disorder, even
  the obsession with eating perfectly healthy are
  forms of ED.

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Why Do Eating Disorders Occur?

• Symptoms of ED occur because the adolescents
  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.

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Anorexia

• Earlier developmental Arrest
• Unworthy-An inability to take things in
• People
• Experiences and opportunities
• Pleasure
• Food
• I dont deserve this I shouldnt have this
• Im not good enough
• Recovery Tips
• Learn how to say Yes
• Learn to take things in
• Risk feeling good, feeling worthy

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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

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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

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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 ones self self-esteem

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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 students
  obsessive attention to food, weight or body image
  concerns.

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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.

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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.

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Helpful Strategies

• Invite the student, the parents and non-school
  professionals involved in the students care to
  be part of the school-based team responsible for
  planning the students 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.

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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.

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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 students health

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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 persons feeling healthy and
  effective functioning, not weight, shape or
  morality
• Do not be a savior, victim or therapist

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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.

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Educator Role Some Donts

• Dont 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

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Educator Role Some Donts

• Dont oversimplify
• Dont imply Bulimia is less serious due to often
  normal appearing weight
• Dont judge- sick or stupid
• Dont advise about weight loss, exercise or image
• Dont confront in a group or in public

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Educator Role Some Donts

• Dont diagnose Focus on IMAD-Inefficiency,
  Misery, Alienation, Disturbance
• Dont become the students therapist, savior or
  victim.
• Dont promise to keep secret.

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Educator Role Some Donts

• Dont argue
• Repeat what you observed, evidence
• Repeat concern for persons 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

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Educator Role Some Donts

• Dont be inactive during an emergency.
  Throwing-up often, passing-out, c/o chest pain,
  suicidal needs professional help immediately.

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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
  athletes health or self-esteem

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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.

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Tips for Coaches Re Athletes

• Emphasize the health risks of low
  weight (esp.-female athletes with amenorrhea)
• Understand a females 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

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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.

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