Helping all children become happy learners
Food is essential for life and our physical and mental well-being is directly influenced by the quantity and quality of what we eat. In the developed world, food is generally plentiful with a wide range of choice that is affordable and available. This has led to a large proportion of the population becoming overweight and an increasing proportion that are clinically obese. The consequences of eating too much are long term health issues and premature death. At the same time, there are also many individuals who eat too little or in other ways manage their diet in ways that puts their health at risk.
Happiness and emotional well-being are linked to our self-esteem and self-image. This includes how we perceive and feel about our bodies. Thus, our mental health is closely interwoven with our dietary choices and how this affects the way our bodies look. In a society where messages about the 'perfect body' pervade our media it is easy to feel a sense of inadequacy or failure if our perception of our own body does not match this ideal. This sense of failure can perversely reinforce behaviours that lead to over eating for some and starvation for others.
Like most behavioural conditions people are affected by eating disorders in different ways, at different times and frequencies and different levels of severity. It can affect all age groups though adolescence is a particularly challenging time. Teenagers often battle with their sense of self-worth, their self-identity and how they fit into the world. They are therefore particularly fragile at this age and the influences of peer groups; media personalites and the pressures of social-conformity can make eating disorders more likely.
Eating Disorder Risk Factors
Though anyone can have an eating disorder there are a number of known factors that carry an increased risk. These include:
involved in competitive sports
involved in performing arts such as dance
having autistic spectrum disorder
experiencing difficulties at home
having been abused physically, sexually or emotionally
highly academic girls who 'like to get things right'
Obesity has many long term health issues including increased risk of cancer, diabetes and heart disease. Many obese individuals have very poor self image and are therefore of increased risk of mental health issues such as depression. Obese children can be prone to bullying leading to social isolation and low self-esteem. It can also lead many individuals into eating disorders such as anorexia and bulimia nervosa. Though obese children need to reduce their body weight this needs to be done through a programme of support that maintains emotional well-being. Schools should consider all children that are overweight to be vulnerable and should consider what support needs to be offered or sought in order to maintain good mental and physical health.
Obesity can be described in societal terms as being the result of the over availability of food. However, this can be compunded by eating disorders such as Binge Eating Disorder.
Anorexia is a serious mental health condition affecting mainly girls (90%) though boys are increasingly being diagnosed. It is a very dangerous mental health disorder with some studies suggesting that up to ten per cent die from suicide or other medical complications. Anorexia may often be co-morbid with autustic spectrum disorder with possibly 20% of sufferers having autistic traits.
Anorexia occurs in less than 1% of the general population. However, the condition often tends to run in families so that the risk rises to about 5% when there is a family member with the condition. There is also evidence from work on genetics that anorexic women carry genes that create a defective protein that in turn affects mood and appetite.
Symptoms of Anorexia Nervosa
Body weight is significantly below average for age and height
The sufferer is unwilling to accept the seriousness of being underweight
Sufferers think they are fat or overweight
High anxiety and fear about getting fat or putting on weight
Excessive value placed on body image in defining themselves
In girls, menstruation stops
Other Warning Signs of Anorexia
Reluctance to remove outdoor clothing
Reluctance to do PE or obsession with PE and exercise
Lethargy and fainting
Binge Eating Disorder
About 1-2% of the population may fit the criteria for Binge Eating Disorder. This figure rises significantly in clinically obsese individuals. Diagnosis (DSM-5) is based on the following:
Binge eating episodes are recurrent and persistent
Binge eating episodes are associated with three (or more) of the following:
eating food very quickly
eating until feeling uncomfortably full
eating large amounts of food when not feeling physically hungry
eating alone because of being embarrassed by how much one is eating
feeling disgusted with oneself, depressed, or very guilty after overeating
Individuals experience severe distress over their binge eating
Absence of regular compensatory behaviors (self-induced vomiting, misuse of laxatives, diuretics, or enemas).
Sufferers of bulimia tend to have frequent reoccurring episodes of eating followed by purging - actions designed to prevent weight gain. Weight is usually within the normal range for age and height.
Symptoms of Bulimia Nervosa
Fluctuations in weight
Excessive or out of control eating
Excessive value placed on body image in defining themselves
Warning Signs of Bulimia Nervosa
Callused knuckles (known as Russell's Sign)
Using the toilet immediately following eating
Chewing gum or eating mints to mask smell of being sick
Swollen glands in neck - sufferers may try to hide this with clothes such as scarfs
Absorbed in own thoughts and lacking focus in lessons
Other Specified Feeding or Eating Disorder (OSFED)
Other Specified Feeding or Eating Disorder (OSFED) is a diagnosis covering those individuals who require support but do not meet the criteria for Anorexia, Bulimia or Binge Eating Disorder
There are five categories within the OSFED diagnostic criteria:
Symptoms are similar to anorexia but weight remains within a “normal” range.
Bulimia Nervosa (of low frequency and/or limited duration)
Symptoms of bulimia, except the binge/purge cycles don’t happen as often or over as long a period of time.
Binge Eating Disorder (of low frequency and/or limited duration)
Symptoms of Binge Eating Disorder, except the binges don’t happen as often or over as long a period of time.
Self-induced vomiting or abuse of laxatives that occurs with normal eating behaviours. Some individuals may be addicted to the 'high' associated with vomiting.
Night Eating Syndrome
Excessive eating at night, either after waking up from sleep, or by eating a lot of food after their evening meal. Often there is associated fasting during the daytime.
OSFED is an important diagnosis in that it captures individuals who would otherwise not meet the criteria for the three main eating disorders described in DSM-5. It also helps to recognise the significant mental distress that individual's experience. This is important in highlighting the need for support in managing the thoughts and feelings which undermine their mental health.
Schools, particularly in the secondary age range should have procedures for identifying and supporting students with eating disorders. These students should be considered highly vulnerable. Anti-bullying policies and initiatives should include eating disorders as possible outcomes of bullying. Designated staff should have awareness training in identifying and supporting students with eating disorders.
Schools should also work closely with parents to monitor and support the student. In agreement with the parents and/or the adolescent help should be ginven in making appropriate referrals to support agencies such as Child and Adolescent Mental Health Service (CAMHS).
Students with eating disorders may benefit from interventions to improve social skills and self-esteem. Other interventions such as Circle of Friends may be appropriate in some instances. It is important to provide the student with a staff member that they can go and talk with when necessary. Staff need to listen and where appropriate help students identify actions they are able and willing to take to improve their self-image and self-esteem.