Professionals

The below guide has been written by Charlotte, a patient of the Community Eating Disorders Service. It includes tips, support, and information on how to help someone you know that may have an eating disorder. 

What is an eating disorder?

Eating disorders have a multi-faceted impact on the sufferer, impacting both their mind and their body.  Some of the impacts will be long-term and, as with anorexia, can be fatal if not diagnosed and treated in time.

For more information visit the NHS choices website. 

Why do some students not eat lunch?

Staff often report students saying they don’t like eating at school. Fear or anxiety about eating in public is called Deipnophobia. It is not something solely experienced by those with eating problems. The reasons for this can include:

Pressure from Peers

Young teens want to be like their friends - they don’t want to stand out from the rest.  If others aren’t eating, they may fear being judged if they do eat or for what/how much/how they eat.

Socializing with Friends

Lunch is a social time for seeing friends, and being seen. Especially when you’re in class all day, and those classes may not be with your friends.  There isn’t a lot of time, or focus, spent on eating.

Teen Development

Teens are always changing and there are different reasons for their wants and desires.  These changes require change by their parents/carers.  If we don’t adapt to a teens change in food preferences and development, some undesirable behaviours may form in response, like throwing away food, eating friends’ lunches, or not eating at all.

Body Dissatisfaction/Dysmorphia

Some teens stop eating because they’re unhappy with the way they look. In an attempt to lose weight or change their shape, some teens will restrict their eating, or diet. This may be an early warning sign of an ED and should be closely monitored.

 

What can educators do to help young people?
 

A listening ear

Often, eating disorders can cause family relations to become strained. I know in my case that was definitely true; my family’s main priority (rightly so) was getting me to eat a healthy amount, so I wasn’t in physical danger. Having people at school that I could open up to without eating coming into it as much was really valuable as I could talk about the ‘eating disorder voice’ and what it was saying to me with someone who was able to step back and look at it more objectively than my family could. Building trust was key to this, which took a while. Of course, everyone I spoke to wanted me to eat and would tell me so, but they would do it in a way that didn’t make me feel like I was always doing something wrong, which made me more willing to be honest about what behaviors I engaged in​.

​Eating Disorders affect families

As someone who has a younger brother, I know that my ED affected him too. We’re lucky that my family is an incredibly strong one which supports each other, and my brother also had great friends that he could turn to, but that didn’t mean that he wasn’t worried. I once asked him what the worst thing was about living with someone with an ED and he said that it was the constant uncertainty; not knowing if I would be hospitalized, if it was getting worse, what was happening etc. Recovery healed our relationship but just being aware that Eating Disorders affect everyone in the family unit and checking in on other siblings in school is really valuable.​
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Communication

This is something that I grappled with for a long time. The idea that everything I said would be passed on was something that deterred me from talking. But it’s so important. Eating disorders thrive on secrecy. They thrive on miscommunication, mixed messages, and masking how you really feel.
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Amount of time needed for eating

​Someone with an Eating Disorder can take longer than usual to eat. When you’re starving, it’s a natural instinct to try and make the food last as long as possible (Farrer, 2018), because you don’t really know when your brain is going to allow you to eat again. Some common things that people might do are taking very small bites, cutting food up into tiny pieces, or separating food that’s designed to eat together. Just being aware of that and allowing flexibility around eating in class really helps.

 

Advance Warning

People with Eating Disorders want to be included! A common misconception is that people with EDs don’t like food, but in most cases that’s not true at all (Simmons and Ashford, 2019)! However, being presented with food when we’re not prepared for it can be very stressful, you’re torn between saying yes and but being consumed by overwhelming guilt and stronger Eating Disorder Thoughts or saying no which allows you to stay in your comfort zone, but the price is watching as everyone else gets to enjoy something that you desperately want to enjoy too. Giving a class advanced notice- as simple as ‘hey guys, it’s the last day of term/Easter/Halloween/ etc so I’m going to be bringing in some haribo’- allows that person extra time to prepare and look at how it might fit into their meal plan, making it easier for them to join in. If they say no, that’s okay too! It’s not an indicator of where someone is in their recovery!​
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Keeping Diet Culture out of the Classroom

If you, or a classmate is on a diet or are exercising with the intention of losing weight, try to keep it out of the classroom. Eating Disorders are very competitive illnesses and people who have them model the behaviors that are exhibited by other people (even if those people don’t have an Ed themselves).

 

There’s always hope

Eating Disorder recovery is not linear, and inevitably there are good days and bad days. Recovery can be exhausting and frustrating and some days you just don’t want to do it anymore. Slipping back into old habits is tempting because restriction quietens the ED voice. Having people to pick me up on those bad days was invaluable.​

 

But what do you say?

It's quite difficult to find the right words sometimes. You don't want to trigger someone, but at the same time you want to let them know that you care and you really want to say something, but what do you say?

• "I know it's difficult, but I'm proud of you.“
• “You have a great sense of humour!”
• “Food doesn’t need to be earned or ‘burned’”
• “I like your smile”
• "You're worth more than your eating disorder.“
• “If food was bad, it wouldn’t be sold in shops!”
• "It's okay to take a rest day."
• "I believe in you."
• "I'm here for you and I'm not going to leave."
• "I might not understand, but if you need someone to talk to, I will help as much as I can."
• "How are you?"
• "I like your bag/shoes/etc.“
• "I love you / I care about you."

Need some support

Recovery is extremely possible and extremely worth it. Eating disorders are not a choice, but recovery is and I’m so proud that I made that decision. It took everything I had to pull myself out of that dark place, but recovery has brought me so many things- my sense of humor, healing the relationship with my family, being able to care about things other than food, but most importantly it brought me me.

If you are worried about a child or young person there is a range of support that can help: 

• They can speak to their GP who may refer them to the Community Eating Disorders Team
• The Child and Adolescent website includes links and resources for a range of mental health issues.
• ​Beat – The Eating Disorders Charity
• NHS choices website
• YoungMinds

If they need urgent mental health support, for example they can no longer keep themeselves safe visit the urgent help page on this website. 

What is anxiety?

• Anxiety is a normal emotion. It helps us cope with difficult, challenging or dangerous situations.
• Anxiety is common. There are times when we all feel worried, anxious, restless or stressed.
• Anxiety becomes a problem when it stops a child from enjoying things they like to do, starts to affect their school, work, family relationships, friendships or social life.

 

Anxious feelings

When we become anxious our body prepares itself for some form of physical action, often called the “flight or fight” reaction. As the body prepares itself we may notice a number of physical changes such as:

• Shortness of breath.
• Tight chest.
• Dizziness or light-headedness.
• Palpitations.
• Muscle pain, especially head and neck pain.
• Wanting to go to the toilet.
• Shakiness.
• Sweating.
• Dry mouth.
• Difficulty swallowing.
• Blurred vision.
• Butterflies or feeling sick.

Often there is a reason for feeling anxious such as:

• Facing a difficult exam.
• Saying something to someone they may not like.
• Having to go somewhere new or do something scary.

Sometimes there may not be an obvious reason for feeling anxious. Anxiety can be caused by the way we think about things.

 

What is self-help guided CBT?

Cognitive Behaviour Therapy (CBT) is based on the idea that how we feel and what we do are due to the way we think. CBT is one of the most effective ways of helping children with anxiety problems.

CBT assumes that a lot of anxiety problems are related to the way we think. Because we can change the way we think, we can learn to control our anxious feelings.

• Thinking in more positive ways can help us feel good.
• Thinking in more negative ways may make us feel fearful, tense, sad, angry or uncomfortable

Teaching children to understand their thoughts is important. Children with anxiety tend to:

• Think in negative and critical ways.
• Overestimate the likelihood of bad things happening.
• Focus on things that go wrong.
• Underestimate their ability to cope.
• Expect to be unsuccessful.

Self-help guided CBT is a practical and fun way of helping children to:

• Identify these negative ways of thinking.
• Discover the link between what they think, how they feel and what they do.
• Check out the evidence for their thoughts.
• Develop new skills to cope with their anxiety.

Everyone feels low or down from time to time. It does not always mean something is wrong. Feeling low is common after distressing events or major life changes, but sometimes periods of low mood happen for no obvious reason.

You may find a child is feeling tired, lacking confidence, frustrated, angry and worried. A low mood will often pass after a couple of days or weeks and there are some easy things you can try and small changes you can make that will usually help improve a child’s mood.

 

Signs of low mood

• Sad
• Worried, anxious or panicked
• Tired
• A lack of self-confidence
• Frustrated or irritated
• Angry
• Not interested in things
• Withdrawing from usual activities, particularly ones that a child used to enjoy or value
• Having trouble sleeping

 

Tips for talking to a child about their mood

• Think about what you want to say and keep it simple
• Write down things that are concerning you before you speak to them
• Ask open ended questions which will allow them to say how they are feeling
• Choose statements that are facts not judgements
• Be calm and supportive
• Consider speaking to the school mental health lead

Bullying can have long-lasting effects on children and young people’s mental health, and the effects may be cyclical. Young people who have experienced bullying are more likely to experience mental health issues, and those who have mental health issues are more likely to be bullied.

While it’s vital that the whole school community takes an active anti-bullying stance all year round, Anti-Bullying Week provides a good opportunity to emphasise that stance to pupils, parents and carers and staff.

Mentally Healthy Schools have created a toolkit, that shares anti-bullying resources for pupils including lesson plans and videos, as well as information for school staff to help review anti-bullying policies and procedures.