BodyWise handbook eating disorders information for middle school personnel

2005·3.6 MB·English

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Eating Disorders Information
for Middle School Personnel
The BodyWise Eating Disorders Information Packet for Middle School Personnel was prepared under
U.S.Department ofHealth and Human Services Program Support Center Contract Number 282-97-00709,
Task Order 2,for the Office on Women’s Health.Permission to reproduce this document is granted.
Washington,DC:September 1999,2nd ed.July 2000;3rd ed.April 2005.
T C
ABLE OF ONTENTS
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Understanding Disordered Eating and Eating Disorders . . . . . . . . . . . . . . . . . . . . . . .4
Key Information for School Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Eating disorders and disordered eating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Disordered eating affects learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Eating disorders as a mental and physical health issue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
The importance ofearly detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Members ofall ethnic and cultural groups are vulnerable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
The school community can help prevent eating disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Using the BodyWise Information Packet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

I
NTRODUCTION
“BodyWise fits beautifully with The BodyWise Handbook was developed by the The BodyWise materials seek to connect
our Girl Power! mission. Smart Office on Women’s Health (OWH),ofthe U.S. healthy eating,positive body image,and accep-
eating not only builds healthy Department ofHealth and Human Services tance ofsize diversity with favorable learning
bodies, it is linked to better (HHS),as a part ofits BodyWise Eating outcomes.They also encourage school person-
school performance, a more Disorders Initiative.Through this initiative,a nel to view disordered eating and eating disor-
positive self-image, and a packet ofmaterials designed to address eating ders not in isolation,but in the broader context
brighter future. Recent studies disorders and disordered eating among pre- ofhealth and risk-taking behaviors.
suggest that unhealthy eating adolescents was developed and distributed to
practices can begin in children school personnel nationwide in the year 2000. Studies in the last decade show that some
as young as 8 years old. Yet, These materials have now been updated and disordered eating is related to other health risk
adults who regularly interact revised.A new information sheet on eating dis- behaviors,including tobacco use,alcohol use,
with middle-school-aged chil- orders and obesity has also been added to the marijuana use,delinquency,unprotected sexual
dren are usually not adequately packet. activity,and suicide attempts.1The information
trained to recognize the poten- and suggestions provided throughout the
tial risk factors, signs, or The BodyWise initiative was developed to pro- BodyWise packet can be easily integrated into
symptoms of eating disorders vide school personnel and other adults who your existing curricula and health promotion
or disordered eating.” interact with students ages 9 to 12 with the activities.
—Wanda K. Jones, Dr.P.H., information and encouragement needed to cre-
Deputy Assistant Secretary for ate environments,policies,and programs that The BodyWise Handbookis one component of
Health (Women’s Health) discourage disordered eating.A second objective the BodyWise packet.The handbook includes
is to help identify youth who have warning signs four sections:
ofeating disorders.The long-term goal ofthis
(cid:1) Understanding Disordered Eating and Eating
initiative is to reduce the risk factors that may
Disorders—An overview ofdisordered eat-
contribute to the development ofeating disor-
ing and eating disorders,and a briefdefini-
ders and increase factors that may prevent eating
tion ofterms.
disorders among youth,such as self-esteem,pos-
itive body image,and empathy. (cid:1) Key Information for School Personnel—Six
main messages for school personnel that
The materials in this BodyWise Information form the core ofthe BodyWise initiative.
Packet on Eating Disorders for Middle School
(cid:1) How To Use the BodyWise Information
Personnel were developed by health communi-
Packet—A description ofthe materials con-
cations specialists in partnership with
tained within the BodyWise packet and how
researchers,clinicians,and educators commit-
they can be used by school personnel.
ted to increasing awareness about eating disor-
ders.In addition,school personnel provided (cid:1) Definitions—Detailed definitions ofeating
input into the development ofthese materials disorders,including diagnostic criteria from
by participating in focus group meetings con- the American Psychiatric Association.
ducted by OWH in ethnically and geographi-
cally diverse regions ofthe country. You are encouraged to reproduce the materials
in the BodyWise packet and distribute them to
The BodyWise packet features information other school personnel,parents,and students.
specifically directed to adults who work with
students in grades five,six,and seven.It
addresses the signs and symptoms ofeating
disorders,steps to take when concerned about
students,and ways to create a school environ-
ment that discourages disordered eating.
Eating Disorders Information for Middle School Personnel 3
U D E
NDERSTANDING ISORDERED ATING
E D
AND ATING ISORDERS
Pre- and early adolescence is a time ofphysical Young people may use food as a way ofcoping “My clothes weren’t right. My
and psychological change.As young people with these types ofstresses and other pressures parents were weird. I didn’t fit
grow into adulthood,they begin to express in their lives.Some students may attempt to in. . . I raised my hand too
their unique identities.Dramatic physical gain a sense ofcontrol by carefully regulating often at school. . . Then, at
changes—increases in height,weight gains,and what they eat—eating only certain foods or eat- age 10, it seemed I woke up to
sexual maturation—are often accompanied by ing very little.Others may overeat snack foods a body that filled the room.
mood swings,wavering self-esteem,and intense to reduce stress and relieve anxiety. Men were staring at me, and
peer pressure. the sixth-grade boys snapped
You may be familiar with one or more ofthe the one bra in the class. Home
During these years,young people become following scenarios: after school, I’d watch TV and
increasingly concerned with their appearance. pace. Munching chips. Talking
(cid:1) The student who eats only a small amount
They are exposed to media messages in music, to the dog. Staring out the win-
ofeach food on her plate because she’s
television,and advertising that often promote dow. Eating macaroni. Eating
afraid ofgetting fat.
the ideal female body as thin and the ideal male soup. Eating...”2
body as muscular. (cid:1) The adolescent boy or girl who comes home —Marya’s Story
to an empty house and eats whatever snack
Because our society is focused on appearance, foods are available.
body image becomes central to young people’s
(cid:1) The young girl who skips breakfast and
feelings ofself-esteem and self-worth—over-
lunch,has a candy bar and diet soda after
shadowing qualities and achievements in other
school,finds a way to skip the evening meal
aspects oftheir lives.Young girls start talking
with her family—and then goes on a secret
about “how they look”and “how much they
eating binge in the evening.
hate how they look.”They may dwell on the
“cellulite”in their legs or their not-flat enough (cid:1) The wrestler who fasts for 2 days before his
stomach and develop a fear offat—both in match to make weight,then eats nonstop
their food and on their bodies. for the next day or two.
(cid:1) The dancer,gymnast,or cheerleader who
Young people ofall ethnic and cultural back-
refuses meat,eggs,milk,or any foods she
grounds are subject to the influences ofthe
imagines might make her fat and unable to
dominant culture.They may associate success
perform.
or acceptance by their peers with achieving the
“perfect”physical standard portrayed by the (cid:1) The bright and confident class president
media.As a result,boys and girls may adopt who is teased about the size ofher body and
extreme forms ofexercise and bodybuilding. begins a fad diet to lose weight.
As their bodies are developing,students may Body dissatisfaction,fear offat,being teased,
experience teasing or negative comments about dieting,and using food to deal with stress are
their body size or shape from family or friends. major risk factors associated with disordered
Some may encounter sexual or racial discrimi- eating.
nation or harassment.Consequently,they may
feel shame,dissatisfaction,embarrassment,
rejection,or even hatred toward their growing
bodies.
4BodyWise Handbook
DISORDERED EATING BEHAVIORS (cid:1) Focusing excessively on
avoiding certain foods,
Disordered eating encompasses
particularly foods that con-
one or more of the following types
tain fat.
of behavior: EATING DISORDERS
(cid:1) Binge eating, particularly An eating disorder is a psychiatric illness with
(cid:1) Skipping meals.
snack foods and sweets. specific criteria that are outlined in the
(cid:1) Restricting food choices to a few “Diagnostic and Statistical Manual (DSM-IV-
(cid:1) Self-induced vomiting.
“acceptable” items. TR™)”published by the American Psychiatric
(cid:1) Taking laxatives, diuretics Association (see “Definitions”section ofthis
(water pills), or diet pills. handbook,pages 18 and 19).
Katie, now 14, was in third
grade when she began anorex- Eating disorders have both mental and physical
ic behaviors. “I compared DISORDERED EATING components with serious medical consequences
myself to others and to the Disordered eating refers to troublesome eating that can disrupt growth and development.
commercials on losing weight. behaviors,such as restrictive dieting,bingeing, Illnesses such as anorexia nervosa,bulimia ner-
And my mom and my friends’ or purging,which occur less frequently or are vosa,or binge eating disorder are among the
moms are always talking about less severe than those required to meet the full key health issues affecting adolescents and
dieting. Then one day this boy criteria for the diagnosis ofan eating disorder. young adults.Nine out ofevery 10 cases are
and I were kidding around and Disordered eating has been termed “restrained,” found among girls and young women.All
he said, ‘You’re fat.’ That did “dysfunctional,”or “emotional”eating,as well socioeconomic,ethnic,and cultural groups
it. I just stopped eating and I as “chronic dieting syndrome.”It can mean not are affected.
weighed myself all the time. eating enough.It can also mean eating too
This went on through fourth much,ignoring natural feelings offullness.
and fifth grades.” The summer
before sixth grade, Katie was In contrast,normal eating is controlled by an
put in the hospital.3 internal system that regulates the balance
between food intake and energy expendi-
tures—so that a person usually eats when hun-
gry and stops when full and satisfied.Normal
eating is flexible and includes eating for plea-
sure and social reasons.In normal eating,a
person follows regular habits—typically eating
three meals a day and snacks to satisfy hunger.
Normal eating provides nourishment for the
body,increasing energy and strength,and
enhancing health and feelings ofwell-being.4
Students engaged in disordered eating may
move back and forth across a continuum,
returning to normal eating after bouts ofdiet-
ing or binge eating.Disordered eating can
impair a student’s ability to learn when accom-
panied by undernourishment or preoccupation
with thoughts offood,body image,or hunger.
Disordered eating can also be an early warning
sign ofan eating disorder.Susceptible individu-
als may go on to develop an eating disorder
from which they cannot recover on their own.
Eating Disorders Information for Middle School Personnel 5
Anorexia Nervosa
Approximately one out ofevery 100 adolescent
girls develops anorexia nervosa,a dangerous
condition in which people can literally starve
themselves to death.5People with this disorder
eat very little even though they are already thin.
They have an intense and overpowering fear of
body fat and weight gain.
Bulimia Nervosa
Another two to five out ofevery 100 young
women develop bulimia nervosa,a pattern of
eating followed by behaviors such as vomiting,
taking laxatives or diuretics (water pills),or
overexercising to rid the body ofthe food or
calories consumed.6People with bulimia
nervosa have a fear ofbody fat even though
their size and weight may be normal.
Binge Eating Disorder
Binge eating disorder,characterized by frequent
episodes ofuncontrolled eating,is probably
the most common eating disorder.More than
one-third ofobese individuals in weight-loss
treatment programs report problems with
binge eating.7The overeating or bingeing is
often accompanied by feeling out ofcontrol Sari describes how her eating
and followed by feelings ofdepression,guilt, disorder began. “I was on this
or disgust. diet of 800 calories a day, and
I was losing lots of weight.
OVEREXERCISING (cid:1) Exercises despite being injured or ill. One day I was home alone and
I couldn’t get the chips in the
Overexercising, often practiced by peo- (cid:1) Defines self-worth in terms of
kitchen cabinet out of my
ple who have anorexia and bulimia, is athletic performance.
mind. I ate the whole bag—and
exercising frequently, intensely, or
(cid:1) Says she or he is never satisfied with then half a package of choco-
compulsively for long periods of time,
a performance or game; does not late-covered graham crackers.
primarily to compensate for food eaten
savor victories. I was so sick, I threw up. The
recently or to be eaten in the near
next time I went on a binge I
future. A person who overexercises Overexercising is of particular concern
felt disgusted with myself, but
might display one or more of the fol- when accompanied by disordered eat-
I didn’t throw up. So I stuck
lowing characteristics: ing, body dissatisfaction, fear of fat, or
my finger down my throat. It
obsession with weight and food.
(cid:1) Exercises more frequently and more was so easy to keep my behav-
intensely than is required for good ior a secret. I’d eat normally in
health or competitive excellence. front of everyone and binge
when my parents were work-
(cid:1) Gives up time from work, school,
ing, so they never heard me
and relationships to exercise;
vomiting. And I worked out at
likes to exercise alone.
least 2 hours every day.”8
6BodyWise Handbook
K I S
EY NFORMATION FOR CHOOL
P
ERSONNEL
Eating disorders may begin as disordered eating
behaviors at very young ages
Many studies show that disordered eating
behaviors begin as early as 8 years ofage,with
complaints about body size or shape.The
Harvard Eating Disorders Center (HEDC)
reports that in a study ofchildren ages 8 to 10,
approximately halfofthe girls and one-third of
the boys were dissatisfied with their size.Most
dissatisfied girls wanted to be thinner,while
about halfofdissatisfied boys wanted to be
heavier and/or more muscular.9
Many individuals with clinically diagnosed
anorexia nervosa and bulimia nervosa remem-
ber being teased or recall that their problems
first began when they started dieting.Similarly,
they recall experiencing body dissatisfaction
and/or fear offat,even though they were While only a small percentage ofpeople who
within the natural weight range for their age. diet or express body dissatisfaction develop
eating disorders,the beginning ofan eating
disorder typically follows a period ofrestrictive
dieting,a form ofdisordered eating for youth.
SIX KEY BODYWISE MESSAGES (cid:1) Early detection of an eating
disorder is important to
This section summarizes key Binge eating disorder is a newly recognized
increase the likelihood of
information for school personnel, condition that affects millions ofpeople.People
successful treatment and
which has been organized into with binge eating disorder have varying degrees
recovery.
six main messages: ofobesity.Most have a long history ofrepeated
(cid:1) Students of all ethnic and cul- efforts to diet and feel desperate about their
(cid:1) Eating disorders may begin
tural groups are vulnerable to difficulty in controlling food intake.Binge eat-
with disordered eating behav-
developing eating disorders. ing behaviors can begin during childhood.
iors at very young ages.
(cid:1) Each member of a school
(cid:1) Students’ ability to learn is The middle-school years—grades six,seven,
community can help create
affected by disordered eating and eight—are opportune times to recognize
an environment that discour-
and eating disorders. and discourage disordered eating behaviors.
ages disordered eating and
Although these behaviors may not constitute a
(cid:1) The problem of eating disor- promotes the early detection
serious illness,they are still unhealthy practices
ders is a mental health as of eating disorders.
that can affect students’ability to learn.They
well as a physical health
can also trigger a full-blown eating disorder in
issue. These messages form the core
a susceptible individual that requires intensive
of the BodyWise initiative and
treatment.
are included in the BodyWise
information sheets.
Eating Disorders Information for Middle School Personnel 7
Students’ ability to learn is affected by disordered
eating and eating disorders
“In our clinical practice we sur- weight-related issues. In addition,
veyed over 1,000 people with clin- people with disordered eating,
ically diagnosed eating disorders. may spend about 20 to 65 per-
We found that people with anorex- cent of their waking hours think-
ia nervosa report 90 to 100 per- ing about food. By comparison,
cent of their waking time is spent women with normal eating habits
thinking about food, weight, and will probably spend about 10 to
hunger; an additional amount of 15 percent of waking time think-
time is spent dreaming of food or ing about food, weight, and
having sleep disturbed by hunger. hunger.”15
People with bulimia nervosa
report spending about 70 to 90 —Dan W. Reiff, MPH,
percent of their total conscious Therapist and Author
time thinking about food and
documented.Numerous studies have reported
“Girls or boys who are self-con-
significant improvements in students’academic
scious about their weight and
achievement just from eating breakfast.
shape, engage in restrictive
dieting or excessive exercise,
When students are not eating well,they can
or think of their goals in terms
A review ofresearch compiled by the Tufts become less active and more apathetic,and
of pounds or fashion models
University School ofNutrition Science and interact less with their surrounding
are less interested in and less
Policy concludes that undernutrition—even in environment.11This in turn affects their social
able to participate in
its “milder”forms—during any period ofchild- interactions,inquisitiveness,and overall cogni-
learning.”16
hood can have detrimental effects on the cogni- tive functioning.In addition,undernourished
—Michael Levine, PhD,
tive development ofchildren.10Undernutrition students are tired and more vulnerable to
Professor, Department of
has an impact on students’behavior,school illness.They are also more likely to be absent
Psychology, Kenyon College
performance,and overall cognitive develop- from school.
ment.Undernourished students are hungry. “Although students with eating
Being hungry—experienced by everyone on Undernourished students may be disorders may display deterio-
occasion—causes irritability,decreased ability preoccupied with thoughts of food and rating school performance,
to concentrate,nausea,headache,and lack of weight. anorexic young women often
energy.Students with disordered eating behav- Students with eating disorders share some of have perfectionist attitudes
iors may experience these sensations every day. the same physical and psychological symptoms which enable them to maintain
Those who attend school hungry have dimin- as people who have experienced starvation. high levels of academic
ished attention spans and may be less able to For example,preoccupation with food was doc- achievement, despite their
perform tasks as well as their nourished peers. umented in the Minnesota Human Starvation being seriously malnourished.”
study12and,more recently,has been observed —Harold Goldstein, Ph.D.,
Deficiencies in specific nutrients,such as iron, in clinical practices with regard to eating disor- Former Clinical Director, Eating
have an immediate effect on students’memory ders.13One ofthe major effects ofstarvation Disorders Program, National
and ability to concentrate.The effects ofshort- and semistarvation appears to be an obsession Institutes of Mental Health
term fasting on academic performance are well with food.14
8BodyWise Handbook