Eating Disorders in Schools

By BodyMatters therapist Sarah McMahon

Last week I had the wonderful opportunity to speak about eating disorders with some amazing middle school teachers who really strive to ensure the best educational environment for their students. There were some excellent questions about how to manage young people returning to school from a hospital admission related to an eating disorder. Below I clarify some of the issues schools experience when it comes to supporting young people in this context. Recommendations ensue.

Key principles:

1. The responsibility of treatment belongs to the family. Your role as the school is simply to support the family & the young person in treatment as the first priority
2. Accordingly, it is appropriate for you to have some contact with the treatment team on the basis that schooling will be disrupted. Managing school work load, supervision of meals & subjects such as PE where there is physical exertion should take place under the guidance of the treatment team. The treatment will be a collaborative effort with the family

Maudsley Family Therapy

Maudsley Family Therapy is the best evidence based treatment for a young person with restrictive eating disorder symptoms. This will therefore be the treatment of choice for young people discharged from hospital for an eating disorder.

A two week break from school is recommended following hospital discharge. This is so the parents can work hard on containing the eating disorder & building their skills to manage the eating disorder behaviour. This is a standard recommendation. As a school it is vital this recommendation is supported. If you have any concern about this, or if the family insists it is not necessary, contact the treating therapist & hospital to discuss. If there are difficulties t may be necessary to arrange regular medical case conferences that involve treating parties, the parents & a representative of the school to ensure all parties are working together to support the young persons recovery.

Usually a return to school is graded, working up to full time days at schools. Supervision of the meals is always ultimately the parent’s responsibility- not the schools, although I am aware of a number of schools who do provide this level support. In instances where this does occur it is important to be clear that the parents are still responsible for those meals and if there are any issues around compliance in eating it is the parents responsibility to work through that in treatment and not the responsibility of the school. Subjects & activities such as PE & sport should be reduced to enable a focus on recovery (and weight gain) to take place. The details of each of these variables differ between individual cases, based on the school, the family and the recovery of the young person. Decisions about these matters should take place under the guidance of the treatment team.

Given the evidence base behind Maudsley Family Therapy, it is also the treatment of choice for early intervention- when young people begin to exhibit restrictive eating. So there will be young people in your school undertaking this type of therapy who have not had a hospital admission. Similar to the recommendations above, a break from school at the commencement of treatment & meals supported by parents may be necessary measures introduced by the treating therapist.

Individual Therapy

Individual Therapy for eating disorders will usually be provided for young people with more bulimic symptoms. Parents may still be involved in these instances, however the therapist would be working more directly with the young person in a less structured way than with Maudsley Family Therapy. Individuals with bulimic symptoms tend to sit at a “healthy” body weight & experience a tremendous amount of shame and secrecy concerning this behaviour- so it is less likely they will be known to the school. However this cluster of symptoms is just as serious as restrictive symptoms and needs to be be managed sensitively and taken seriously.

Tips for schools

Regardless of the intervention taken, schools should consider the following as “non-negotiables” when a student has an eating disorder:

1. If possible, meet with the young person and ascertain how they think school can support them 
2. Provide practical support for the young person that enables them to focus on their treatment & recovery. This might include: allocating a teacher or school counsellor as a “support person”; establishing a “coping plan” to enable the young person to utilise skills they are developing in treatment; & reducing their workload; providing special provisions for exams & assessments; and ensuring effective communication between regular members of the school community around issues such as work load (whilst ensuring the young person’s privacy)
3. Maintain regular contact with the parents regarding treatment & progress
4. If parents are involved in meal support, ascertain how you can support parents to do this. For example, can a school room be allocated for this? Is there a private place that parents can park if the meals are to be eaten in the car? And so forth…
5. Maintain contact with the treatment team- at least initially and then if/ when issues arise. It may be good to set up regular contact time during the initial stages of treatment- monthly would be appropriate
6. Revisit school policies around welfare & eating disorders. You will need to identify what you can & cannot manage as a school, in the context of balancing the needs of the young person with the eating disorder & the interests of the rest of the grade/ school

Further support

I highly recommend Eating Disorders Victoria’s excellent resource for schools, which goes into considerable detail about how schools can work with young people with eating disorders. This document reviews the various stages of eating pathology in students- and how each of these can be managed by the school. It also considers a “whole school” approach to managing this problem- rather than focusing exclusively on the young sufferers themselves. The resource concludes with a whole school audit that can be undertaken by the school. We highly recommend this excercise if you have not undertaken something similar yourselves as a school.

BodyMatters welcomes enquiries from teachers and schools. We can work with schools on a consultancy basis to assist in managing eating disorders. We also deliver school workshops. Similar to Eating Disorders Victoria, BodyMatters advocates for a whole school approach to preventing & managing eating disorders. We can be contacted on 02 9908 3833 or via our website to discuss this further.