For a comprehensive summary, please download NEDC’s booklet Eating Disorders in Schools: Prevention, Early Identification, Response and Recovery Support.
Schools and school staff are in an ideal position to support the prevention of eating disorders in the school community, to identify and respond when a student might be experiencing an eating disorder and to provide ongoing support throughout the recovery process.
School staff are not expected to understand all the serious medical and psychological complications associated with eating disorders (for more information, see page 10 of the booklet), however awareness of the risk factors, warning signs, impacts and complications will support school staff to recognise the need for early identification, prompt response and for appropriate supports to be in place.
Prevalence
Eating disorders are common. They can occur in people of any age, weight, size, shape, gender identity, sexuality, cultural background or socioeconomic group. While a person can experience an eating disorder at any age, eating disorders remain more prevalent among adolescents and young people, with the average onset for eating disorders between the ages of 12 and 25 years (1, 2). However, they can develop in children as young as five years old (3).
Many people experience disordered eating (i.e., symptoms and behaviours of eating disorders, but at a lesser frequency or lower level of severity) that do not meet criteria for an eating disorder. Approximately a third (31.6%) of Australian adolescents engage in disordered eating behaviours within any given year (4).
Body dissatisfaction can drive people to engage in unhealthy weight-control behaviours, particularly disordered eating. Disordered eating behaviours, and in particular dieting, are among the most common risk factors for the development of an eating disorder (5). If a student is engaging in harmful dieting practices (e.g., fasting or extreme restriction) or disordered eating behaviours, it is not advised to ‘watch and wait’ for the behaviour to potentially escalate further. Providing appropriate support at this time can prevent the progression of disordered eating behaviours into an eating disorder.
Risk factors
Awareness of the risk factors for eating disorders can help school staff to recognise the warning signs and red flags of eating disorders in students. High-risk groups that school staff may encounter include:
• Children and adolescents
• Females
• Students experiencing co-occurring conditions (e.g., diabetes, celiac disease)
• Students engaging in competitive occupations, sports, performing arts and activities that emphasise thin/lean body or shape/weight requirements (e.g., modelling, gymnastics, swimming, rowing, horse riding, dancing, athletics, wrestling, boxing)
• Students from LGBTQIA+ communities
• Students from culturally and linguistically diverse backgrounds
• Students who are neurodivergent (e.g., autistic people)
For biological and genetic, psychological and behavioural, and socio-cultural risk factors which may increase the vulnerability to developing an eating disorder, go to page 12 of the booklet.
Warning signs
Being informed about the warning signs of an eating disorder will help school staff recognise when a student may be experiencing an eating disorder. It can be challenging to identify the warning signs of an eating disorder. Many warning signs may not seem related specifically to the eating disorder or a student may present with no obvious signs. Some of the signs include:
• Experiencing difficulty concentrating or focusing in class
• Preoccupation with eating and food (or activities relating to food)
• Preoccupation with body shape, weight and appearance (e.g., focus on fitness, muscle toning and/or weightlifting, pursuit of leanness and muscularity)
• Avoidance of, or change in behaviour in social situations involving food (e.g., no longer sitting with friends at lunchtime, refusal of food in social settings)
• Avoidance of eating by giving excuses (e.g., claiming to have already eaten, claiming to have an allergy/intolerance to particular foods)
• Avoidance of activities requiring exposure of the body, such as swimming, or wearing excessively baggy or inappropriate clothing (e.g., lots of layers despite hot weather to hide the body)
• Compromised immune system (e.g., getting sick more often, regular days away from school)
• Sensitivity to the cold (e.g., feeling cold most of the time, even in warm environments)
For more physical, psychological, and behavioural warning signs, go to page 14 of the booklet.
It is never advised to ‘watch and wait’. If a student may be experiencing an eating disorder, school staff members need to be able to react quickly and appropriately. Early identification and prompt response when a person may be experiencing an eating disorder are particularly important as access to treatment leads to better recovery outcomes.
For guidance on what to do when a student at your school is identified as experiencing an eating disorder, we encourage staff to read our booklet, which has some excellent tips on how to respond to concerns. See page 17 of the booklet.
Understanding the care team and eating disorder treatment
Eating disorders require a person-centred and multidisciplinary team approach, integrating medical, mental health, nutritional and functional interventions to support optimal recovery outcomes. While it is not the responsibility of a school staff member to decide which type of treatment is required for a student, it is important for school staff to understand the care team and eating disorder treatment, to equip school staff to provide appropriate support to students during eating disorder treatment and recovery.
Learn more about the Care Team on page 26 of the booklet.
Learn more about the Stepped System of Care and eating disorder treatment on page 14 of the booklet.
Understanding the school’s role in recovery and support
It is helpful for school staff to understand the recovery process, to equip them with the knowledge to provide ongoing support to students throughout the recovery process. Learn more about Recovery on page 30 of the booklet here.
School staff play an important role in providing support to students during eating disorder treatment and recovery. They also have a role in supporting family and supports, and friends and peers of the person experiencing an eating disorder during this time.
Some of the things a school can do to support a student experiencing an eating disorder:
• Be flexible and understanding about absence from school and have communication processes in place with the student and their family
• Liaise with hospital teachers to support transitions between hospital and home
• Curriculum material may need to be amended or removed from lesson plans. Students may also need to be excused from participating in some physical activity, food technology, or health classes at school.
• Monitor physical activity during break times
• The school can recommend support and services to the siblings and friends of a person experiencing an eating disorder (e.g., sessions with the school counsellor, small group sessions with the wellbeing team, referral to appropriate external support
• Provide supervision at meal times
• Develop an eating disorder recovery support plan which provides school staff with clear guidance on supporting students returning to school following hospital treatment or after extended absence from school. Butterfly Foundation have developed a Supporting the Recovery of Students with Eating Disorders in Schools Within this resource, there is a section that covers Considerations for an Eating Disorder Recovery Support Plan. This plan can be used to support a student who has been diagnosed with an eating disorder or can be incorporated into the schools existing wellbeing plan.
Support and treatment services
Support and treatment services are vital to the care and recovery of the student experiencing an eating disorder.
If you are looking for treatment options for a student, please contact the Butterfly National Helpline. They offer free and confidential support and information to anyone concerned about eating disorders or body image issues. They provide information, referral options and brief counselling for eating disorders, disordered eating and body image concerns. Support is available via phone, online and email. Click here for more information and to access the Butterfly National Helpline.
Resources for individuals and support persons
There are many helpful, practical and empowering resources available for people experiencing eating disorders, their family and supports, and any person involved in providing care and support.
See page 36 of the booklet or see our website pages for people with lived experience and for families.
Prevention
All schools have a role in helping to prevent eating disorders. Eating disorder prevention refers to specific programs or interventions that are in place to reduce the modifiable risk factors for eating disorders and enhance the protective factors.
Anyone working within a school environment has a role to play in creating a safe and supportive environment that aims to prevent the development of an eating disorder. This may include teachers, staff involved directly in student welfare such as school counsellors or year coordinators, administrative staff or other roles including volunteers at the uniform shop or school canteen. Protocols for creating a supportive and protective school environment can also help to promote body acceptance.
Prevention approaches
• Creating an environment that fosters student wellbeing to support building self-esteem, body acceptance, and a healthy relationship with body, eating and physical activity
• Creating a safe and respectful environment that aims to eliminate teasing, bullying, and cyberbullying, particularly related to weight and/or appearance
• Ensuring that there are no anthropometric assessments completed with or by students including weighing and measuring (e.g., calculation of BMI, comparison of weight, food diaries, calorie counting etc.)
• Recommending that staff avoid making any comments about their own or other people’s bodies or food intake or choices
• Creating a non-diet culture with no comments or discussions about dieting
Curriculum messaging
The curriculum also provides an opportunity to communicate and deliver positive messaging related to eating, exercise and body image within schools.
Examples of topics and themes that could be incorporated into HPE teachings include:
• Improving body acceptance, self-esteem and self-worth
• Enhancing mental health literacy and mental health promotion
• Identifying concerns with mental health, eating and body image
• Coping skills, help-seeking strategies and support resources
• Enhancing media literacy, including use of social media
What to avoid
Despite the best intentions, sometimes general school activities can cause unintended harm. When communicating about food, eating and body image across all activities within schools, it is important to consider whether the activities have the potential to cause unintended harm.
Messages and communications within schools should not:
• Include anthropometric measures such as weight and body mass index (BMI)
• Provide nutrition advice that encourages dieting or labels foods as ‘good’ or ‘bad’
• Include stigmatising language or promote weight-bias
• Include messages that may increase body dissatisfaction, dieting, and promote weight-control behaviours
For more info on communicating about eating disorders with students, families and supports, go to page 18 in the booklet.
Eating disorder prevention programs
Eating disorder prevention programs refers to specific programs or interventions designed to reduce modifiable risk factors, enhance protective factors, and prevent people from developing eating disorders.
Effective eating disorder prevention programs should be evidence-based, interactive, safe and be delivered across multiple sessions. See page 40 of the booklet.
Available prevention programs
Butterfly Foundation prevention programs for schools
Butterfly works with schools to support and enhance existing wellbeing programs and to create environments that support body confidence in young people. Click here for more information.
Butterfly Body Bright
Butterfly Body Bright is a whole of primary school body image program for all Australian primary schools. Body Bright provides resources and support to teachers as well as their broader school community. Click here for more information.
Butterfly Body Kind Schools
Body Kind Schools is a free awareness activity that runs every September, inviting people working in primary and secondary schools to celebrate diversity and build body confidence and body kindness in young people. Click here for more information.
Media Smart
Media Smart is a school-based eating disorder risk reduction program that has been found to have a range of beneficial results in large-scale randomised control trials. Click here for more information.
The Embrace Collective – Body Confident Schools
The Embrace Collective provides evidence-based body image programs, professional development, and consulting services to encourage a whole school approach to creating a body confident school. This includes the Embrace Kids Classroom Program for years 5-8, and Body Blocks for early childhood educators. See The Embrace Collective website for further information.
You can also see The Embrace Collective's Creating Safe School Environments for All Bodies booklet.
The Embrace Collective - Body Blocks
A professional development program for early childhood educators to help early learners build a positive relationship with food, movement and their bodies. See The Embrace Collective website for further information.
Professional development for school staff
School staff can benefit from professional development to support them in understanding eating disorders and providing appropriate support to students during treatment and recovery.
Available professional development
Examples of professional development programs for school staff include:
The Butterfly Foundation provide staff professional development that can be tailored to the needs of the school. More information can be found here.
Eating Disorders Victoria provide professional development workshops to equip people working in education with the skills needed to identify and support students who may be at risk of an eating disorder. More information can be found here.
InsideOut Institute for Eating Disorders provides the eLearning course EducatED, which equips school staff with the necessary skills to identify and manage young people with eating disorders in the school environment. More information can be found here.
References
1. Hart LM, Granillo MT, Jorm AF, Paxton SJ. Unmet need for treatment in the eating disorders: a systematic review of eating disorder specific treatment seeking among community cases. Clin Psychol Rev. 2011;31(5):727-35.
2. Volpe U, Tortorella A, Manchia M, Monteleone AM, Albert U, Monteleone P. Eating disorders: What age at onset? Psychiatry Res. 2016;238:225-7.
3. Madden S, Morris A, Zurynski YA, Kohn M, Elliot EJ. Burden of eating disorders in 5–13-year-old children in Australia. The Medical Journal of Australia. 2009;190(8):410–4.
4. Hay P, Mitchison D, Collado AEL, González-Chica DA, Stocks N, Touyz S. Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population. J Eat Disord. 2017;5:21.
5. Patton GC, Selzer R, Coffey C, Carlin JB, Wolfe R. Onset of adol escent eating disorders: population based cohort study over 3 years. BMJ.
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