A Teacher’s Guide

Eating disorders threaten physical and psychological well being and, sometimes, life itself. This coupled with the fact that eating disorders usually manifest themselves during puberty (usually between the ages of 12 and 25) and that cases of anorexia nervosa and bulimia nervosa have doubled over the past decade should be viewed as a call to action for teachers everywhere.

This is an overview of eating disorders and describes how teachers can help play a role in prevention. Although written for all teachers and administrators, this information will be of particular interest to health education, physical education and consumer science teachers, as well as coaches.

According to the National Institute of Mental Health, each year millions of people develop eating disorders. An estimated 4 – 6 percent of adolescents and young adults are affected by eating disorders. That means that in a class of 400 students, 4 or more students probably have eating disorders. While most cases are middle to upper-income women, researchers report an increasing number of cases among males and other age and socioeconomic groups.

There are various types of eating disorders, however anorexia nervosa and bulimia nervosa are the most commonly known. Binge eating disorder or BED, Night eating syndrome, orthorexia, bigorexia to name a few also require treatment.

Eating Disorders Defined

The following is the criteria for eating disorders. All criteria must be met in order for a case to be recognized as anorexia or bulimia.

Anorexia Nervosa:

  • refusal to maintain weight that is above the lowest weight considered normal for age and height
  • intense fear of gaining weight or becoming fat, even though underweight
  • distorted body image
  • in women, three consecutive missed menstrual periods without pregnancy

Bulimia Nervosa:

  • recurrent episodes of binge eating (minimum average of at least two binge-eating episodes a week for at least three months)
  • a feeling of uncontrollable eating during binges
  • regular use of one or more of the following to prevent weight gain: self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise
  • persistent over-concerns with body shape and weight

Binge eating disorder is defined as binge eating without purging (vomiting, abusing laxatives or over-exercising after eating). Although less is known about binge eating disorder, it is believed to be characterized by binges that occur, on average, at least twice a week. The binge consists of much more than most people would eat within and hour or two. The binge eater also feels out of control.

A binge-eating episode is also associated with at least 3 of the following characteristics:

  • eating much more rapidly than normal
  • eating until feeling uncomfortably full
  • eating large amounts when not physically hungry
  • eating alone as a result of embarrassment about the amount eaten
  • feeling disgusted, depressed or guilty afterwards

Signs and Symptoms of Eating Disorders

Anorexia is characterized by an intense fear of being fat. A person with anorexia hardly eats at all resulting in severe weight loss. Anorexics weigh at least 15% below the range of normal weight for age and height. Even when thin, individuals with anorexia see a person that is fat when they look in the mirror. Over time, women suffering from anorexia stop menstruating and may damage vital organs including the heart and brain. Anorexics may exhibit the following symptoms as well:

  • Cold sensitivity
  • Compulsive behavior
  • Edema
  • Fine, downy hair covering the body surface
  • Hoarding of food
  • Hypotension
  • Over-activity
  • Paleness (from iron deficiency) or a yellow tint to skin (resulting from eating large amounts of vegetables with carotene)
  • Delusion of fullness during starvation
  • Hoarding of food

Bulimia is a serious eating disorder typified by eating excessive amounts of food in a short time followed by purging (vomiting, use of laxatives, diuretics, strict dieting or fasting or vigorous exercise in order to rid the body of food and prevent weight gain). Some individuals can have both anorexia and bulimia. Often, people with bulimia can be hard to identify as they may exhibit average or above average weight. Individuals with bulimia may also exhibit the following additional symptoms:

  • Abdominal distention
  • Chipmunk-like appearance
  • Scarring on the back of one hand (from inducing vomiting)
  • Dental deterioration
  • Diuretic or laxative abuse
  • Weight fluctuation of more than 10 pounds in one-month period

It is important to realize that eating disorders are usually symptoms of underlying psychological problems. People with eating disorders “tend to be perfectionists who suffer from low self-esteem and are extremely critical of themselves or some aspect of their physical make-up. Studies have found that those with bulimia nervosa are often impulsive and are statistically at higher risk for other disorders such as depression and alcohol or other drug abuse. Anorexia nervosa patients, however, have often been described as “model children” who were very obedient, kept their feelings to themselves and were good students and athletes.” They also exhibit a striking pattern of depression.

What Teachers Can Do

The increasing incidence of eating disorders in adolescence demands new teacher awareness and understanding in order that schools can play a key role in prevention and early recognition of students with eating disorders.

Early Recognition:

Eating disorders are most successfully treated when discovered early; so school staff should be knowledgeable about and able to identify symptoms of eating disorders. Teachers also need a well-defined plan of action for intervention and must know where to refer students for assistance.


Schools can help prevent eating disorders by promoting sound nutrition principles and healthy body concepts through curriculum, staff role models and by providing a supportive environment.

Quality nutrition education not only strives to increase student knowledge of basic nutrition principles, but also to change attitudes and ultimately impact behavior. The CDC Guidelines for School Health Programs Promoting Lifelong Healthy Eating states that school-based nutrition education programs are most likely to be effective when they:

  • Help young people learn skills (not just facts).
  • Give students repeated chances to practice healthy eating.
  • Scarring on the back of one hand (from inducing vomiting)
  • Make nutrition education activities fun.
  • Involve teachers, administrators, families, community leaders, and students in delivering strong, consistent messages about healthy eating as part of a coordinated school health program.

Nutrition education should not be the sole focus of prevention efforts, however. Many researchers stress the importance of improving self-esteem, body image and coping skills of students. Students need to learn and practice expressing their feelings, dealing with negative comments or failure and even coping with family problems. These topics should be part of a comprehensive school health program.

Physical education teachers and coaches need to be especially alert to signs of eating disorders. Girls participating in sports where they are encouraged to diet are at special risk for developing eating disorders. Gymnasts, ice skaters, dancers and even runners are told time and time to go on a diet. Although not common in boys, sports like wrestling with specific weight categories, gymnastics, rowing and running, can put athletes at risk eating disorders too.

Athletes with eating disorders often find that they lack the energy or nutrients to perform at their best – the opposite of what they set out to do. Coaches should take special care to emphasize the importance of eating adequate calories and nutrients to support performance. Drastic or unhealthy weight loss techniques should be discouraged and athletes who need help with their diet should be referred to a registered dietitian for counseling. Coaches also need to advise students of the dangers of over-exercising. The body needs rest, to repair tissue and restore glycogen levels for peak performance.

Finally, schools need to provide an environment that promotes wellness instead of thinness. Does your school and/or school staff:

  • Recognize and address size discrimination?
  • Teach and model sound nutritional and exercise principles?
  • Recognize and provide counseling for students under stress?
  • Remove barriers to physical activity?
  • Know how to recognize and approach students with eating disorders?
  • Provide healthy food choices in the cafeteria, vending machines and at school events?
  • Promote student self-esteem and support networks?

If you answered yes to all of these, then your school is a true advocate for student health.

For more information or support please contact us a meedassociation@gmail.com or use our online helpline.