Helping Your Student
Please note: For ease in reading, we have mostly used "she" and "her" in the description below even though eating disorders exist in men, women, girls, and boys. This advice is suitable for a student of either gender.
Approaching a student with an eating disorder can be tricky. If you are a coach, your student might be dieting, binge eating, or purging to meet expectations or to be part of the team's effort to win. As a teacher or coach, you can play a key role by trying to get your student to see that she needs help.
It is important to remember that an eating disorder is a desperate attempt to cope with underlying problems, and although you can see how unhealthy and unproductive it is, for your student it may feel like a lifeline. That is why it is common for individuals with eating disorders to be upset or mad if you try to help them. They may fear that you are going to take away their only coping mechanisms. A student might deny the problem, be furious that you discovered her secret, and feel threatened by your caring. Athletes are likely to be frightened that your awareness of their abnormal eating habits will jeopardize their participation in sports. Give them time and breathing space once you have raised your concerns.
Prepare yourself for your talk. Gather general information before you talk to the student. Learn about the resources for help in your school and community without revealing the pupil's identity.
Speak in an anonymous way with the school nurse or physician, health educator, and school administrator to determine whether there is a school policy about students with eating disorders (such policies are more likely to be in place at boarding schools). Find out what the ramifications might be for participation in classes and sports.
Read about eating disorders. The information provided in What Are Eating Disorders? will likely be helpful. Always talk privately to your student before letting others know about her by name, even if you strongly believe she is at risk. You can bring in other individuals later, but you risk breaking the student's trust if you talk about her without her knowledge.
Do other students know? The student you approach may ask whether you noticed her or whether other pupils came to you about her.
If other students do come to you, discuss with them whether they prefer their meeting with you to be confidential. If they want their conversation with you to remain confidential, you need to respect their request and reassure them that they did the right thing by communicating their concern. Tell them that you will follow through on their approach to you and place their concern in the hands of responsible adults who will do their best to help. Plan this part of your strategy before talking with the at-risk student. Check to see if any pupil who approaches you is also worried about himself, and offer the same kind of advice. Avoid getting involved in long talks with the concerned students about the at-risk student.
Plan with care. It is best to be able to offer your student a few options and resources. Locate a safe, and private place to talk. Plan ahead so you'll have the amount of time you will need to talk and be sure that you will not be interrupted or overheard.
Begin by telling the student that you are concerned about her and gently offer some specific observations about her emotional well-being or lack thereof. For example: "You seem (really) unhappy and preoccupied / withdrawn / anxious / fidgety / distant / jumpy / angry, and I'm worried about you."
If her performance has dropped in class or sports, give her specific observations. For example: "You don't seem to be having any fun anymore / You're pushing yourself too hard / You don't raise your hand anymore / You're working out so hard that it looks like you might be injuring yourself / Your energy's depleted / Your grades are slipping."
As you talk, communicate compassion about what is going on inside her. Listen to what she says without making judgments, interpretations, or promises that you will get very involved in her recovery.
Offer a few observations about her behavior to explain why you think she has an eating disorder. For example: "I see you skip meals / I watch you leave class and run to the bathroom / I hear you talk all the time about being afraid you are fat, what you ate, how many pounds you want to lose, how much you're going to exercise, etc."
It is important not to try to make a diagnosis or conduct therapy. Do convey that you have some sense that she may have an eating disorder and she needs to get help to evaluate this. If you have ascertained your school policy concerning participation in sports, explain in the most reassuring way possible what it is. For example: "As far as I know, our school has a policy that you will still be able to play sports and participate in all activities unless doing so would be dangerous to you."
If your student feels threatened by your discovery or observations, he may deny that he has a problem or get upset. If he gets upset or mad, stay calm. Do not panic or get angry. Do not get into a "Yes you do / No I don't" power struggle. Give him space to respond, listen to him, and ask him to listen to you. Remind him that teachers tell students when they are worried about them.
If she insists that she does not have a problem, or that she can stop on their own, you can say something like, "You know how it is with alcoholism and denial. The addiction makes it so hard to see when you have a serious problem and that you need help. I'm worried you're trapped in a similar kind of situation. I'm really worried about you, and even though I hear what you're saying, I think you are really struggling and you need help stopping. I believe in you and I know you deserve to get help and get better."
If she has tried to get better on her own and hasn't succeeded and is ashamed, point out that it is very hard to recover without help and that this is not a weakness or failure on her part. You may need to approach a student more than once before she will agree to get help.
Offer the name of a referral (physician or psychotherapist) for her to contact. Let her know that you'll touch base with her to follow up. Ask if it is okay for you to notify the referral person that he or she can expect to hear from her. In a few days, or whatever seems to be the right amount of time, check in with the student and ask if she contacted the person. Follow up with the referral person, and then continue to be supportive of the student as you would any student. Avoid comments about food, exercise, or appearance.
If she refuses help, reiterate the specifics of why you are concerned, and if needed, your belief that something further must be done. Do not prolong a conversation that is going poorly. Do get consultation from a professional. Depending on what the professional says, the age of the student, and the degree of risk, you may decide to approach the student again and tell her that you talked to the professional.
Stay calm and avoid sounding as if your mission is to rescue or cure her, but also let her know you are concerned that she has a serious problem and that it would be irresponsible for you not to try to help.
Eating disorders are serious physical and psychological problems, but not usually emergencies. However, if your student is fainting, depressed, suicidal, or otherwise in serious danger, get professional help immediately. For example: "I don't care if you're mad at me. Teachers don't let students suffer in danger and isolation."
Addendum for coaches:
Sports are great for girls' self-esteem and health. However, competitive female athletes are three times more at risk than other females for disordered eating, eating disorders, and particularly the female athlete triad: 1) amenorrhea, 2) osteoporosis, and 3) disordered eating. Girls with exercise-related amenorrhea (missed menses) are at increased risk for stress fractures and potentially irreversible bone loss.
Boys who participate in competitive sports (wrestling, crew, skating, dance, gymnastics, swimming, fencing) in which body size and weight influence performance are also at heightened risk for eating disorders. Boys and girls are under enormous pressure today from themselves, parents, coaches, athletic trainers, teammates, school, community, athletic associations, and school administrators to perform aggressively at any cost.
Sports programs with potentially harmful training techniques, constant focus on weight management, or prescribed weight goals may put girls and boys at elevated risk for disordered eating and eating disorders. Sports programs should prepare health guidelines for participation in all activities. They should also have well-developed educational materials and should provide ongoing preventive education and medical care, including a safety net and treatment team with school athletic trainers, coaches, and physicians.
To Learn More:
Click for Questions Frequently Asked by Educators
For policies on athletic participation in eating disorders, please view the following:
National Athletic Trainers' Association position statement: preventing, detecting, and managing disordered eating in athletes
Bonci, C.M., Bonci, L.J., Granger, L.R., Johnson, C.L., Malina, R.M., Milne, L.W., Ryan, R.R., Vanderbunt, E.M. National Athletic Trainers' Association position statement: preventing, detecting, and managing disordered eating in athletes. Journal of Athletic Training. 2008; 43: 80–108.
Position stand on the female athlete triad
IOC Medical Commission Working Group Women in Sport. Position stand on the female athlete triad. Medical Commission of the International Olympic Committee. 2005. Accessed January 24, 2012.
Coach and Athletic Trainer Toolkit
National Eating Disorders Association, 2010. Accessed January 24, 2012.
American College of Sports Medicine position stand. The female athlete triad
Nattiv, A., Loucks, A.B., Manore, M.M., Sanborn, C.F., Sundgot-Borgen, J., Warren, M.P; American College of Sports Medicine. American College of Sports Medicine position stand. The female athlete triad. Medicine and Science in Sports and Exercise. 2007; 39: 1867-82.
Eating Disorders in Sport
Sherman, R., Thompson, R. Eating Disorders in Sport. New York: Routledge; 2010.
Managing the female athlete triad
Sherman, R., Thompson, R. Managing the female athlete triad. NCAA Coaches Handbook. Indianapolis: National Collegiate Athletic Association; 2005.
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This page was last updated on January 24, 2012.