Issue 84: Schools and Eating Disorders
About this resource
Butterfly Body Bright: Dr Stephanie Damiano
Body Confident Collective: Dr Zali Yager
NEDC new resources: Stigma and Substance Use
Upcoming professional development
Editor’s note
Schools across Australia have settled in to the first semester and this is often a time when struggles with disordered eating, eating disorders or body image in students can become visible to teaching and wellbeing staff, families and friends. Schools are in a unique position to support the prevention of eating disorders in their community, to identify and respond when a student might be experiencing disordered eating or an eating disorder, and to provide continuing support during the recovery process.
In this issue we spoke to eating disorder and body image experts and have collated the latest guidance, practical tools, and evidence-based resources to assist schools and school staff to effectively communicate about eating disorders with individual students, their families, and the wider community. School teaching and wellbeing staff can consult NEDC’s updated Eating Disorders in Schools booklet for guidance on how to respond when a student may be experiencing an eating disorder and to support prevention, early identification and intervention. Primary schools and families can access Butterfly’s Body Bright, a self-paced program with resources that aims to foster a positive foundation for body satisfaction, healthy eating and physical activity in children. The Body Confident Collective’s website, book, documentaries, podcasts and free programs for families and primary and secondary schools present information aimed at improving body image.
What policies and protocols can be put in place to support a student experiencing an eating disorder? How can schools manage a student’s return to classes after long-term hospital treatment? How can teachers communicate with families about concerns that have been raised? What prevention programs are available and appropriate for my school? NEDC’s Eating Disorders in Schools booklet provides schools with the key information and resources needed to effectively prevent, identify and respond to eating disorders in their community. You can also find quick links to Australian-based prevention programs and professional training for schools. Read more here.
Post-pandemic, young children are increasingly presenting with body image issues and problematic behaviours, with Butterfly noting a 109% increase in demand for facilitated sessions for Year 5s and 6s. Researcher Dr Stephanie Damiano spoke to us about how – and why – she designed Butterfly’s Body Bright program, a whole school approach geared towards supporting primary schools and families to develop positive body image and healthy attitudes and behaviours towards the body, eating and physical activity. Learn about it here.
“Something had to be done.” We interviewed Dr Zali Yager, co-founder of the Body Confident Collective (now rebranded as The Embrace Collective) with 2023 Australian of the Year Taryn Brumfitt. She tells us about the necessity for change-making, and the inspiration behind her move from academia and research into creating evidence-informed resources and engaging schools-based initiatives actively working to prevent harm. Read our Q&A here.
NEDC’s resource rollout continues. Access our newest fact sheets below and read about them here.
Eating Disorders and Substance Use
Learn about training and events taking place in Australia here.
The NEDC is about collaboration and connection. Please share this eBulletin with your child’s school, your GP, colleagues and friends.
Your input and your voice matter to us. Contact us at info@nedc.com.au
You can also participate through membership to the NEDC. If you’re not already a member, join us here.
NEDC’s Eating Disorders in Schools: Prevention, Early Identification, Response and Recovery Support
When a student is identified as being at risk of experiencing an eating disorder, or a school is informed that a student has been diagnosed with an eating disorder, it can be challenging time for the school community, with teaching and wellbeing staff, parents, carers, friends and peers unsure of the appropriate response. Our updated resource, NEDC’s Eating Disorders in Schools: Prevention, Early Identification, Response and Recovery Support aims to answer the many questions that are raised at these times.
Some of the common questions that a teacher may ask:
How do I know if a student may be experiencing an eating disorder?
What do I do if a student self-discloses?
What do I do if concerns are raised by a staff member or another student?
What do I do if advised by a family or other supports that a student has been diagnosed with an eating disorder?
How can we manage risk or crisis?
How can we support a student’s recovery journey?
What is an eating disorder recovery support plan and where can I find one?
Which school staff can help with prevention and what prevention programs are available?
NEDC’s updated schools booklet provides clear guidance, effective tools, and practical resources to help schools and school staff prevent, identify and respond to eating disorders in their community, and support recovery with compassion and care.
We step through gaining eating disorder knowledge, establishing clear communication protocols and, above all, encouraging help-seeking and supporting treatment and recovery where possible. We also provide tips on actions to avoid, such as making comments about a student’s size, weight or shape, minimising concerns, or apportioning blame. A student’s individual needs as they work through treatment and recovery should be the focus of the school, not their academic performance.
We encourage schools to have policies and protocols in place to support early identification and response when a student is experiencing an eating disorder and to adapt existing wellbeing plans to accommodate eating disorder treatment. We cover strategies for dealing with issues around attendance and absences, physical activity, meal supervision, and the impact on siblings and friends. Some school curriculum content can be triggering, particularly information related to food, eating and body measurements. It is not advisable to include calorie counting, anthropometric measurements (e.g., weight, BMI), maths questions related to food or weight, and content related to ‘healthy’ eating in lesson plans, and some amendments may need to be made.
Schools can play an important role in providing support to students during eating disorder treatment and recovery, as well as family and supports, and friends and peers of the person experiencing an eating disorder. It is important to build and maintain a non-judgemental and trusting relationship with the student and family and encourage help-seeking and professional assessment and support treatment and recovery.
Eating Disorders in Schools: Prevention, Early Identification, Response and Recovery Support provides the information needed to educate staff about the role schools can play and help guide teachers on where to find further resources. Download the document here:
Section One provides an overview of eating disorders, including common myths and misconceptions, different diagnoses, and the prevalence and impacts of eating disorders. (See p4 of the booklet)
Section Two assists school staff to identify eating disorders, highlighting the warning signs and risk factors for eating disorders in students. (See p12 of the booklet.)
Section Three offers advice on how best to respond when a student may be experiencing an eating disorder and how to manage risk and crisis situations. (See p17 of the booklet.)
Section Four provides an overview of eating disorder treatment and the care team. (See p26 of the booklet.)
Section Five describes the recovery process and the role schools and school staff can play in providing ongoing recovery support to students experiencing an eating disorder. (See p30 of the booklet.)
Section Six provides a directory of key eating disorder treatment and support services and resources for individuals and their support persons. (See p36 of the booklet.)
Section Seven provides an overview of eating disorder prevention in schools, including strategies and programs that schools and staff can implement. (See p40 of the booklet.)
To access Eating Disorders in Schools: Prevention, Early Identification, Response and Recovery Support booklet, click here.
Quick links: further resources for schools
The Butterfly Foundation provide staff professional development that can be tailored to the needs of the school. Click here. Butterfly also presents prevention programs that can be tailored for students, school staff and families and supports. Click here.
Butterfly have also developed a guidance resource, Supporting the Recovery of Students with Eating Disorders in Schools, which includes a section titled 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 a school's existing wellbeing plan. Click here.
Eating Disorders Victoria provide professional development workshops to equip people working in education (primary, secondary and tertiary) with the skills and knowledge needed to identify and support students who may be at risk of an eating disorder with an emphasis on awareness, early identification and early intervention. Click here.
InsideOut Institute 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. Click here.
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.
Butterfly Body Bright: Dr Stephanie Damiano
How can Body Bright help schools and families address the increasing prevalence of body image concerns in primary school children and support the prevention of body dissatisfaction and eating disorders?
In the last few years, we have seen that now more than ever young people are struggling with their body image and eating. Butterfly’s Prevention team has been working with Australian schools since 2007, and from 2019 to 2022, there has been a 109% increase in the demand for Butterfly’s facilitated sessions for Year 5s and 6s. The frequency and nature of enquiries has also changed, since the beginning of the pandemic, with school staff observing and reporting more students (particularly Years 4 to 6) struggling with body image and problematic behaviours.
Butterfly Body Bright is Australia’s first whole of primary school body image program, designed to support schools and families in the development of positive body image and healthy attitudes and behaviours towards the body, eating and physical activity from Foundation-Year 6. This evidence-informed, strength-based universal prevention program aims to help children thrive socially, emotionally and academically by reducing the influence of modifiable risk factors and strengthening protective factors that underpin the development of children’s body image. The long-term aim is to prevent the development of serious body dissatisfaction and disordered eating. School staff and families are also supported with information on early identification and intervention, should more serious issues be developing during primary school.
A pilot evaluation of the program showed statistically significant improvement in student’s body image, body appreciation, confidence to deal with appearance-teasing, and intention to seek help after just one Body Bright lesson. Results provide hope for what can be achieved when the whole school approach is implemented.
How does the Body Bright program work across the whole school community?
The whole school approach provides resources that can be flexibly implemented so that all members of the school community can be committed to promoting positive body image in children.
The whole school approach includes four components:
1. 17 expert-endorsed School Culture Guidelines for being a Body Bright school (which can be flexibly implemented).
2. Body Bright Staff Training (NESA accredited), which includes approximately four hours of comprehensive and interactive online training across five compulsory modules and one optional staff-support module. Training is self-paced, allowing staff to complete it as convenient. Staff can download six fact sheets, a staff room poster, an early identification and intervention toolkit, and checklist for classroom delivery. Staff must complete training to access the lesson plans.
3. 50 PDHPE curriculum-aligned lessons over the six BRIGHT themes that are age and developmentally appropriate across Foundation-Year 6, including downloadable digital materials and worksheets. The six themes of the program aim to support students to be (1) BRAVE against appearance teasing, (2) RESILIENT to unhelpful media messages, (3) INCLUSIVE of all bodies, (4) GRATEFUL for their amazing bodies, (5) HAPPY with joyful movement, and (6) THOUGHTFUL with their eating.
4. Free Body Bright Families resources online (including translated tip sheets), and templates and inserts for school newsletters so schools can share the Body Bright Family resources.
Does it also address bullying, teasing, peer and family influences and pervasive social media taking place outside the school environment?
The Body Bright themes address key risk and protective factors that underpin the development of children’s body image. The BRAVE theme addresses appearance teasing and bullying, which is an important peer risk factor. The aim is to promote positive peer interactions and reduce negative comments about appearance and appearance teasing and/or bullying. The RESILIENT theme promotes resilience to societal appearance ideals presented in the media by improving media literacy (and social media literacy in the older years). The recommended age for use of social media platforms is 13+, so we were mindful of not introducing concepts or use too early, but providing some guidance of how to navigate social media ‘when they start’.
The INCLUSIVE theme aims to reduce weight stigma by promoting celebration of diversity. The GRATEFUL theme aims to support body acceptance and self-esteem by focusing on unique strengths and qualities and practicing self-compassion and body appreciation. The HAPPY theme promotes staying healthy in mind and body with fun and regular movement. The THOUGHTUL theme promotes staying healthy through positive and balanced eating attitudes and behaviours.
We know that families are also an important influence for children’s body image, so we developed some free Body Bright Families resources online (including translated tip sheets), with more resources and activities to be added over time.
What are some of the curriculum-linked workshops, activities and materials included in the program, and how can schools and families use these resources?
All of the Body Bright lessons have been designed to align with the Australian Health and Physical Education Curriculum (ACARA v9.0) and the NSW, VIC and WA variations (see more here). However, due to the topics and activities included, lessons also align well with literacy and STEM areas of the curriculum. Butterfly Body Bright also aligns with the Australian National Children’s Mental Health Strategy (see more here).
Recently, the Body Bright Staff Training has been accredited by NSW Education Standards Authority (NESA) as professional development that contributes to the priority area of Student/child Mental health addressing standard descriptors 1.1.2 and 4.4.2 from the Australian Professional Standards for Teachers towards maintaining Proficient Teacher Accreditation in NSW. Butterfly Body Bright is also listed on the Victorian Schools Mental Health Menu, South Australian External Program Wellbeing Directory, and the Be You Programs Directory.
According to studies, negative body image and weight stigma can start with children as young as three, and many pre-adolescent girls and boys are dissatisfied with their bodies. How did your research in this field translate into the design of the Body Bright program?
I have always been passionate about supporting the mental health and wellbeing of young people. I was fortunate to be able to dedicate my research career to understanding the development of children’s body image and weight attitudes and developing educational resources for families and early primary school children. So having the opportunity to develop Butterfly Body Bright was the perfect avenue to combine my content expertise and experience with the amazing existing work of Butterfly’s Prevention Services and the goal to develop a national program that is accessible to primary schools right across the country. It is my hope that with Butterfly Body Bright we can truly make a real impact on how the next generation experience their relationship with their body, eating and physical activity.
Butterfly Body Bright was informed by an extensive review of the scientific literature that highlighted the need for the program and identified topics to address (including some of my own work). Sociocultural theories of the development of body image highlighted the key risk and protective factors that the program should address, including peer, media and family influences. The program’s development also aligns with principles of effective implementation that highlight the need for long-term and sustainable universal programs for children. In developing Butterfly Body Bright, I also led two studies to inform the development of the program, including a policy strategy study that informed the school culture guidelines, and a lived experience survey with 165 Australian adults who developed body image and/or eating concerns during primary school.
Student responses to Body Bright lessons
Here is some feedback received by students who were involved in the pilot evaluation:
“More comfortable in my body and how to stand up for it.” (Year 6 student)
“The lesson made me feel more knowledgeable about body shaming and if anything happens, I know how to deal with it.” (Year 6 student)
“That most pictures on the internet are not what you think they are, some might be photoshopped.” (Year 4 student)
Lived experience survey
Butterfly conducted a lived experience survey with 165 Australian adults who developed body image and/or eating concerns during primary school. When asked “Given your experience, were there ways in which you think your primary school could have helped, or things they could have done better to support you?” some respondents said:
“Attitudes towards food/weight- we were taught about good/bad foods and that being overweight was bad. Teasing about one’s weight or shape was dismissed by the adults as ‘kids will be kids.’” (Jasmin, 34)
“Avoid making ‘Health and Fitness’ the sole focus of a term of work. All subjects were linked into this topic for the term. We were also weighed in front of the whole class and had to keep a food journal.” (Anonymous, 26)
“Been more informed of eating disorders and the signs to look for. More pro-active in helping children who are picked on or bullied. Showing concern and discussing with self and family if signs prevalent to problems at home or at school.” (Kaye, 58)
“Body image education. That every body is different and there isn’t a standard to meet. It’s normal to not be thin. You don’t need to look a certain way to be attractive or of value.” (Ruth, 22)
Dr Stephanie Damiano is the Manager of Butterfly Body Bright, Butterfly Foundation’s whole of primary school body image program. Her role entails program development and evaluation and supporting primary schools to foster positive body image in all children. Stephanie came to this role with a PhD in psychology. Since then, Stephanie has dedicated her research career to understanding the development of body image in children and the related risk and protective factors, as well as developing educational and parent resources aimed at promoting a positive foundation for children’s developing body image. Stephanie continues her research work in an honorary research fellow position in the EMBodIED Research Group in La Trobe University’s School of Psychology and Public Health.
Body Confident Collective: Dr Zali Yager
After 16 years as a body image researcher, you went on to co-found the Body Confident Collective (now known as The Embrace Collective) a not-for-profit research translation organisation. What inspired you to move into adapting knowledge gained by evidence-based research into practical, real-world initiatives?
There were so many little moments that led to this big decision- but some of them really stand out to me. One was being on a bus and the man I was speaking to shared how his wife was struggling with body image issues after having their first child. I was working on research in the Body Confident Mums project at the time, but when he asked if I had any resources that might help her, I realised that all I had done was write journal articles for other academics to read and hadn’t made anything to help the people I wanted to help with this work. The decision to move into research translation was reinforced more recently when I spoke to a girl in Year 10 at the same high school I went to, and when she shared the things about the curriculum and the school environment that had triggered her eating disorder, it was the very same things that had triggered mine 20 years ago. Nothing had changed. Something had to be done.
I loved working in research and academia, but after years and years of trying to make things happen with very little funding, I realised that I was not OK with the fact that (at the time) we still didn’t have widely available school-based programs to help our kids, we still didn’t have resources educating people in roles like sports coaches and fitness professionals in terms of what could help and what could harm kids in their environment. I wasn’t OK with the world not having those things because we didn’t get a grant for it. In the research world there is a sense that there is always more research that needs to be done before we are sure about something, and there is, but after 40 years of collective research in the body image field, we (as researchers) know enough to start telling people what we know to prevent some of the harm that we keep seeing happen in the world.
How can body image and eating disorder researchers tap into The Body Confident Collective’s mission of disseminating research and resources to reach a wider audience?
One of the things that always struck me about our field was that we have a whole lot of incredibly passionate people working in this space, but often alone, in their own offices, with clients or at their universities. We came together at conferences, and would talk about big issues, and things that needed to change in the world, but then go back to our offices, on our own, and feel like we could never make that change happen- at least that’s how I felt.
The whole idea behind the Body Confident Collective [BCC] was to bring all of these people together to harness their expertise and knowledge to create change. To change the things about the world that made us, and make others feel shame about their bodies, and to provide the resources, but also change the environments, that perpetuate weight stigma and body dissatisfaction and result in poor physical and mental health outcomes.
Researchers can connect with us to write program dissemination and knowledge translation into their grant applications, and researchers can consult with us to access user engagement to inform research and resources and ensure that their recruitment strategy reaches the people they need it to. We also welcome and work with researchers who want to write about what they know as a blog piece on The Embrace Hub or create other resources that can be hosted there for young people, parents, teachers, and sports coaches. We’re all about helping researchers get all of the good stuff out of their heads and out of their office and to the people who need it, and creating a bridge to help researchers learn more from their end-user audiences to plan the projects that will make a difference.
You also co-founded the Embrace Hub with 2023 Australian of the Year Taryn Brumfitt. Embrace Hub encompasses the website, podcast and books, the 2022 documentary Embrace Kids and the upcoming Embrace Kids Classroom Program. How can these resources be used by schools, children, and parents to promote positive body image in young people?
Over the course of creating the Embrace Kids film and The Embrace Hub over the past few years, both Taryn and I recognised the power of bringing together the science and evidence with creative engaging approaches. We learned so much from each other and we will actually be more formally recognising this partnership and rebranding the Body Confident Collective to become The Embrace Collective this month. Although we had planned this six months ago, there is a lot more to do and a lot more attention on this work now with Taryn as Australian of the Year!
There are so many great body image resources out there, and so many great people have been doing this work for such a long time. The vision for The Embrace Hub was to provide engaging, evidence-informed resources that promote protective factors for positive body image directly to young people, but also support parents, sports coaches, and teachers to create positive home, school, and sporting environments. The resources we have developed (and will continue to develop) showcase the other excellent programs in this space from The Butterfly Foundation and other eating disorder organisations. There’s everything from blog posts and printable posters to podcasts, and free school programs for primary and secondary schools.
How can people such as parents, teachers and the general public, who want to know more about understanding body image and eating disorder issues, learn about research that traditionally can be difficult to access or interpret?
There’s a lot of information out there, but often you don’t need to know a lot or read academic journals to figure things out. We’re working on translating and bringing together key research on the topic to create easy-to-read blog articles that can explain things like: why we shouldn’t be weighing kids in schools, or how to talk about bodies and weight. If there’s something you want to know that we don’t have information about, we would love to hear it so we can create what you need. Taryn and I also published a book last year called Embrace Kids that brings together so much of the research in this space, with contributions from so many amazing researchers and experts from all over the world, like Dr Jennifer Webb at UNC, Zoë Bisbing from My Body Positive Home, Fiona Sutherland (@themindfuldietitian), Danni Rowlands and Dr Stephanie Damiano from The Butterfly Foundation. I’m not just mentioning it to plug my own book- it’s actually a really great summary of everything people need to know!
Another of your school initiatives is the Goodform project, aimed at improving body image in teenage boys and reducing muscle-building supplement use. As Associate Professor at the Institute for Health and Sport at Victoria University, your research on boys aged 14-16 in Australia found that 49.8 per cent had used protein powder, 8.4 per cent used creatine, and 62 per cent intended to use protein powders in the future (Yager, McLean, 2020). Can you tell us how your prior research informed this project, and how it can be used by schools and parents?
The Goodform Project was the culmination of around 18 years of research trying to unravel the complex picture of body image for boys and men. Once we finally got measures that were relevant to boys’ body image, the data showed that they were just as dissatisfied as girls, but it affected them in different ways and they engaged in different behaviours as a result. Around 10 years ago when we reviewed the classroom-based body image programs, very few had actually had a positive impact on boys’ body image, and the co-ed programs were typically effective for either the boys or the girls.
Coming from a Health and Physical Education background, and teaching people who would become teachers, I knew that the boys and men needed a different approach to what body image programs typically took for girls and women. I was curious about whether critiquing muscle building supplement use might be a more tangible vehicle to create dissonance around the hyper-muscular ideal for men- as opposed to sitting around chatting about how they felt about their bodies. Our wonderful Goodform team, including Dr Scott Griffiths, Dr Sian McLean, and Dr Jo Doley, received funding from the World Anti-Doping Association and brought together two programs that had been effective for boys in other contexts, and trialled whether these resources could improve body image in the universal, classroom setting.
Our evaluation didn’t show that boys improved relative to control groups - there is no research happy ending to this story - but there were lots of potential explanations for the findings. Doing school-based research with boys, and during Covid certainly wasn’t easy! We learned a lot in the process and I think the resources might be more effective among boys who have concerns already. Schools are welcome to access the program and modify it to suit their needs, and I would love it if a research team wanted to trial the efficacy of the materials we developed in online delivery for the boys who are seeking out information on this topic.
Zali recently spoke to ABC News Daily on the body positivity campaign. Listen here.
Dr Zali Yager is the Executive Director of The Embrace Collective and Adjunct Associate Professor at the Institute for Health and Sport at Victoria University. Zali has a health and physical education background and is an internationally recognised expert in the body image space, known for figuring out “what works” to build body image in school and community settings and for her work with men and boys, and in the Body Confident Mums project. A 2021 Westpac Social Change Fellow who has presented her work around the world, Zali is passionate and driven by the desire to make research matter and create a safer body image environments for the next generation.
NEDC’s new resources
Lack of knowledge and misconceptions about the seriousness of eating disorders means that people living with eating disorders experience high levels of stigma. The stigma attached to these conditions can have significant negative consequences and impacts. Read about the research and learn about strategies to reduce stigma.
Download our Stigma and Eating Disorders fact sheet here.
Eating disorders and substance use disorders (SUD) often co-occur, and can cause complex emotional, physical, and social complications which can negatively impact a person’s health and quality of life. Find out about risk factors, warning signs, treatment approaches and avenues for support.
Download our new Eating Disorders and Substance Use fact sheet here.
Upcoming training and events
7-11 March: Perth: Temperament Based Therapy with Supports (TBT-S) Training for Treatment Providers and Carers, Western Australia Eating Disorders Outreach and Consultation Service (WAEDOCS), Women's Health and Family Services (WHFS) and Richmond Wellbeing
7-14 March: Dialectical Behavioural Therapy (DBT) for Eating Disorders: Who, How, Why & When?, The Centre for Eating, Weight and Body Image (CEWBI)
15-16 March: CBT-E Workshop, BodyMatters
16 March: Skills based caring for a loved one with an eating disorder, Eating Disorders Families Australia (EDFA)
21-29 March: CBT-Enhanced for Eating Disorders, The Centre for Eating, Weight and Body Image (CEWBI)
22 March and 5 April: Body Image Training for Educators, Butterfly
23-24 March: Eating Disorders Training for Dietitians, The Mindful Dietitian
23-25 March: Assessment and treatment of adolescents and adults with Eating Disorders in private practice: A comprehensive introductory 3-day workshop (Intro + CBT-E), Eating Disorders Training Australia
23 March: Understanding Eating Disorders in Young People, Butterfly
31 March-1 April: 2023 ANZAED Autumn Workshop Series (Geelong), Australia & New Zealand Academy for Eating Disorders (ANZAED)
28 April: Specialist Supportive Clinical Management, The Centre for Eating, Weight and Body Image (CEWBI)
Click here to access these and other upcoming events.
Click here to submit your own event.