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.
For a comprehensive summary, please download NEDC’s booklet Eating Disorders in Schools: Prevention, Early Identification, Response and Recovery Support here.
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.
Recognise the 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:
Physical warning signs
• Rapid weight loss or frequent changes in weight
• Fainting or dizziness
• Lethargy and low energy
• Swelling around the cheeks or jaw, calluses on knuckles, damage to teeth and bad breath which can be signs of vomiting
• Sensitivity to the cold (e.g., feeling cold most of the time, even in warm environments)
• Compromised immune system (e.g., getting sick more often, regular days away from school)
Psychological warning signs
Psychological warning signs can be difficult to detect. They usually only come to light through changes in behaviour or through discussion and conversation. Psychological warning signs may include:
• Experiencing difficulty concentrating or focusing in class
• Feeling anxious around meal times
• 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)
• ‘Black and white’ thinking (e.g. rigid thoughts about food being ‘good’ or ‘bad’)
• Changes in emotional and psychological state (e.g. depression, stress, anxiety, irritability, low self-esteem)
• 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)
Behavioural warning signs
Behavioural symptoms are commonly present in those with eating disorders. While you may recognise some of these symptoms in someone you care about, these signs can still be concealed and may be difficult to detect.
• Dieting behaviour
• Avoidance of eating by giving excuses (e.g., claiming to have already eaten, claiming to have an allergy/intolerance to particular foods)
• Evidence of binge eating (e.g. disappearance or hoarding of food)
• Frequent trips to the bathroom during or shortly after meals
• Vomiting or using laxatives, enemas or diuretics
• 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)
• Compulsive or excessive exercising (e.g. exercising in bad weather, continuing to exercise when sick or injured, and experiencing distress if exercise is not possible)
• Extreme sensitivity to comments about body shape, weight, eating and exercise habits
Understand who is most at risk
Eating disorders can occur in people of all ages and genders, across all socioeconomic groups, and from any cultural background. There are many risk factors that increase the likelihood that a person will experience an eating disorder at some point in their life. Knowing who is most at risk of developing an eating disorder can help educators, teachers and trainers know who will benefit most from preventative interventions.
High risk groups that you may be in contact with as an educator
• Children and adolescents
• Females, particularly during key transition periods, for instance from school to adult life
• People with a family history of eating disorders
• People who are interested in weight loss
• 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)
Eating disorders in males
While eating disorders are often portrayed as illnesses that only affect females, large population studies suggest that up to a quarter of people suffering with anorexia nervosa or bulimia nervosa are male, and almost an equal number of males and females suffer with binge eating disorder. We also know that underdiagnosis and cultural stigma mean that the actual proportion of males with eating disorders could be much higher.
One unique difference between males and females with eating disorders is that men often engage in compulsive exercise as a compensatory behaviour, typically with the aim of achieving a more muscular, and not just slender, body type. Compulsive exercise describes a rigid, driven urge to exercise and is a serious health concern.
To find out more, see the NEDC fact sheet Eating Disorders in Males.
KEY STEPS: What to do if you suspect someone has an eating disorder
Be familiar with Mental Health First Aid
The Mental Health First Aid guidelines for eating disorders provide evidence based recommendations about how to help a person developing or experiencing an eating disorder.
While there is no 'right' or 'wrong' way to talk to someone with an eating disorder, there are some important steps you can take to be prepared.
For more information, see the NEDC booklet: Eating Disorders in Schools: Prevention, Early Identification and Response.
Express your care and concern
The first steps toward treatment and recovery from an eating disorder are often very hard to take. However, if you suspect that someone has an eating disorder it is important that they seek help immediately.
The sooner a person starts treatment for an eating disorder, the shorter the recovery process will be. Seeking help at the first warning sign is much more effective than waiting until the illness is in full swing.
For an extensive list of tips and important things to avoid, see the NEDC booklet: Eating Disorders in Schools: Prevention, Early Identification and Response.
Seek help early
The importance of seeking help early cannot be overstated. The earlier an intervention occurs, the shorter the duration of the eating disorder, and the greater the likelihood of full recovery, especially in children and younger adolescents.
You can help by remaining supportive, positive and encouraging.
Carers also have access to specialised services for support and advice. You can access these here.
In a school context: Establish a support network
A student places a huge amount of trust in a teacher by disclosing a mental health issue and so it is important to respect that trust and respond appropriately to any such disclosure. One element of an appropriate response is the need to respect the confidentiality of the student.
Always be upfront and honest about your duty of care and any responsibility you may have to report issues to other members of staff, the student’s family or any external authorities. Ideally you should obtain the student's permission to pass their information on, but if this is not possible be clear about who you are going to tell and why. Try to minimise the number of people who are told to show the student you are trustworthy and are respecting their privacy.
For more specific information on following school policy and confidentiality, see the NEDC resource: Eating Disorders in Schools: Prevention, Early Identification and Response.