How to Support Your Patients with Eating Disorders Going Back to School
The back-to-school season can trigger unique stressors and anxieties for students, especially those struggling with their relationship with food and their bodies. It’s important to remain on the lookout for signs of an eating disorder in your adolescent patients during this busy time of year.
Your role in supporting your patients with eating disorders cannot be overstated. By remaining compassionate and committed to your patients’ well-being, you have the ability to intervene early when you notice signs of an eating disorder, thereby improving treatment outcomes and reducing the risk of long-term harm.
Read on to learn why the back-to-school season can be a catalyst for eating disorders and what you can do to help your patients.
Student Mental Health
The general well-being of today’s children and adolescents is significantly impacted by the stressors they face. Recent research has shown increasing rates of depression and anxiety among young people, with the aftermath of the pandemic playing a significant role. Child and adolescent depression has skyrocketed from 8.5% in 2017 to 23.8% in 2021, while anxiety has risen from 11.6% in 2012 to 19% in 2021 (Benton, Boyd, & Njoroge, 2021).
This decrease in mental well-being can be attributed to a number of factors, including the influence of social media, increased school work, the tensions of our social and political environments, and the enduring impact of the pandemic. The combination of these and similar factors can contribute to depression and anxiety, which may in turn increase the likelihood of an eating disorder. In students who are entrenched in a school culture fixated on high achievement and perfectionism, these pressures may be even more significant.
Contributing Factors To Eating Disorders In Students
As a provider who works with adolescent patients, it is essential to understand the difficulties that going back to school may bring for a student at risk of developing an eating disorder. Learning what can influence the development of these illnesses can help you better monitor your patients for disordered behaviors and distorted thoughts.
Navigating transitions, including changes in routine or environment, can be challenging for people healing from eating disorders. Recovery is often strengthened by plans and routines (e.g., meal plans, consistent therapy sessions) for the structure and support they provide. A change to a well-established routine can throw a person with one of these illnesses off their axis. For example, it may be difficult for a student to go from being home in the summer surrounded by supportive loved ones to being at school with peers and teachers who may not fully understand what they are going through.
Fitting in during middle, high school, and even college can be exhausting. Certain social cliques may choose to relate to each other by focusing on negative feelings about themselves and others. Other groups may promote disordered eating behaviors such as dieting and emphasize the importance of appearance. In an attempt to fit in with certain social groups, some of your young patients may succumb to dieting, which can be a precursor to an eating disorder in those susceptible.
Bullying is unfortunately common in elementary through high school and can contribute to eating disorders in those biologically susceptible to these illnesses. Bullying, body discrimination, and negative appearance-related comments can lead middle school students to increased levels of emotional distress. This body judgment can spark disordered behavior in students as young as eight.
Scattered mealtimes and eating in public
School lunch periods can fall anywhere from 10:30 AM to 1:30 PM, and in some schools, students may only be given 20 minutes to eat. This schedule can make it more challenging for students to eat mindfully and tune in to their body signals of hunger and fullness. In addition, individuals with eating disorders or those in recovery may have negative feelings, including guilt and shame, about eating in public. This can further perpetuate food restriction, as eating meals with peers in school cafeterias can be overwhelming.
Eating disorders are typically associated with sports that place an extreme emphasis on body size, weight, or shape. These sports include gymnastics, figure skating, dancing, and wrestling. However, eating disorders can be present in all sports. Some signs and symptoms include generally increased training time, frequently talking about food, weight, and body size, an aversion to refueling, and eating in secret. If an athlete is exhibiting any of these symptoms, it is possible that they could be struggling with an eating disorder.
For students struggling with eating disorders, perfectionism is a common trait that is often celebrated and reinforced in a school setting. With an emphasis on academic achievements like flawless grades and impressive college acceptances, less-than-perfect ratings or the feeling of being academically monitored can trigger or exacerbate disordered eating.
How Providers Can Support Students With Eating Disorders
Now that you understand the specific challenges school can bring for your young patients at risk of or experiencing an eating disorder, you may be wondering what you can do to help. Here are some ways you can support your patients at risk of developing or currently experiencing an eating disorder when going back to school.
- Help your patients develop coping strategies. With the transition back to the school year comes potential triggers and obstacles. One way to help your patients prepare is to make a plan. For example, if your patient is worried about classmates asking about their past or current treatment experience, perhaps you could prepare some responses they feel comfortable saying. If eating in the cafeteria is a stressor for them, you might discuss who might be a good friend to sit near when they are feeling anxious.
- Promote open communication. Whether your patient is in recovery or at risk of an eating disorder, promoting open communication during this seasonal transition is essential. With recovery, there is a possibility of relapse, so creating an environment where your patient feels they can come to you if that happens is incredibly important. For your patients at risk of an eating disorder, having open communication means there’s a better chance they may open up to you if they start to have disordered thoughts about food and their bodies.
- Provide education. It is essential that providers do not reinforce the damaging messages of diet culture. Instead, be a positive force in your young patients’ lives. Teach them that every body is worthy and “all foods fit” in a balanced diet. You may be the first person who has taught them these things in our diet-obsessed culture.
Warning Signs Of An Eating Disorder
You may be wondering, “How do I know if my patient needs support?” or “How do I know if they are experiencing an eating disorder?” Knowing the common warning signs of an eating disorder is the first step in helping your patients with these illnesses. Signs of an eating disorder in children and adolescents include:
- Withdrawal from friends
- Preoccupation with food
- Fear of vomiting or choking
- Distorted body image or excessive worry about weight and shape
- Sudden significant changes to diet
- Purging by self-induced vomiting or abusing laxatives, diuretics, or diet pills
- Hiding or hoarding food, or eating in secret
- Avoidance of social situations involving food
- Obsessive exercise
- Aversion to tastes, smells, or textures
Adolescents with eating disorders may decline events that revolve around food to keep their eating disorders hidden. This may cause them to feel isolated and excluded, which could drive them to more severe disordered eating behaviors.
In college students who suffer from eating disorders, those around them may notice social withdrawal, missed meals, or excessive exercise. Those suffering in college may also attempt to hide their disordered eating by hiding food and wrappers, refusing to eat in common spaces, making up excuses to skip meals, running late at night or engaging in other secretive exercise, and other disordered behaviors.
Take Action If You Spot The Signs
If you suspect one of your young patients is struggling with an eating disorder or disordered eating, it’s essential that you open the conversation. We suggest administering our Eating Disorder Assessment Quiz—a very simple, straightforward questionnaire that covers all eating disorder diagnoses. You may want to read through the assessment questions and make them your own. If a patient answers two or more questions with “yes,” a further assessment may be needed.
If you are concerned, the best thing you can do for the patient is refer them to an eating disorder treatment program for a comprehensive assessment. You play an essential role in getting your adolescent patients with eating disorders the care they need. Your commitment and collaboration during this back-to-school season can have a lasting impact on their lives.
If you have spotted the signs of an eating disorder in one of your young patients, The Emily Program’s eating disorder experts can help. Refer your patient to us by calling 888-364-5977 or by filling out our online form.