Eating Disorders

Many kids, particularly teens, are self-conscious about how they look. This is especially true when they are going through puberty and undergo dramatic physical changes and face new social pressures. Unfortunately, for a growing proportion of kids and teens, that concern may grow into an obsession, sometimes leading to eating disorders.

Each year, thousands of teens develop eating disorders and other issues with weight and body image.[1]Eating disorders are mental illnesses caused by a combination of biological, social and environmental factors. Problems with food and weight are not the underlying issues; eating disorders have more to do with self-esteem, control and other coexisting mental illnesses, such as depression, anxiety and obsessive-compulsive disorders. Anorexia nervosa, a type of eating disorder, ranks as the third most common chronic illness among adolescent females.[2]

Eating Disorders, Student Health and Academic Achievement

Most eating disorders occur between the ages of 13 and 17, when adolescents are dealing with puberty as well as other academic and social pressures.[3] Eating disorders can severely impact school performance because of the combination of nutritional and mental health issues. Students with eating disorders often have problems with concentration, memory and information processing. They may also become irritable, socially withdrawn and apathetic, and they may experience fatigue and develop a poor overall immune system due to poor nutrition. All of these effects impact student behavior, academic achievement and school attendance. Also, research shows that individuals suffering from eating disorders spend 70 to 90 percent of their waking hours thinking about food and weight-related issues.[4] A child who is plagued with these unhealthy thoughts can not thrive at school or beyond.

Help Students: Know the Warning Signs

Eating disorders can have long-term consequences. One in 10 cases results in death from starvation, cardiac arrest, suicide or other cause.[5] As school personnel, you can help students with eating disorders make a full recovery by recognizing early warning signs and making referrals to the appropriate school authority. The National Eating Disorders Association identifies the following warning signs of eating disorders, specific to school settings:


  • Diets or chaotic food intake; skips, throws or pretends to eat meals; obsesses over food.
  • Excessive exercise (daily and can not miss a day).
  • Frequent trips to the bathroom.
  • Wears baggy clothes to hide weight loss or gain.
  • Avoids the cafeteria; carries own food in backpack or purse.
  • Compulsive behavior and denying difficulty.


  • Change in attitude and performance.
  • Body image issues (mood affected by thoughts about appearance, overestimates body size, wants the “perfect” image and needs constant reassurance about looks).
  • Weight obsession (diets, avoids “fattening” foods, overweight but eats small portions in presence of others, and maintains a low weight to enhance performance in sports, dance, acting or modeling).
  • Appears sad, depressed or anxious; has low self-esteem.
  • Is the target of body or weight bullying.
  • Spends increasing amounts of time alone.
  • Overvalues self-sufficiency; reluctant to ask for help.


  • Sudden weight loss or fluctuation.
  • Abdominal pain; feeling faint, dizzy, cold and tired; developing slightly blue hands and feet due to poor circulation.
  • Dry skin and hair; dehydration.
  • Feeling full or “bloated.”

How to Approach a Student with an Eating Disorder

  1. If you suspect a student has an eating disorder, first talk to the student privately. Explain that you are concerned for his or her well-being.
  2. Use “I” statements when giving evidence of observed behaviors that have concerned you.
  3. Focus on health more than weight or food.
  4. If a student gets too upset or uncomfortable, it is OK to end the conversation. Leave a door open for the future to come back to the conversation.
  5. Be supportive when a student chooses to disclose a personal issue with you. Let the student know you understand how difficult it must be for him or her to share these issues. Do not agree to keep secrets.
  6. Coaches and physical education teachers should move the emphasis away from weight for certain types of athletics, such as gymnastics, ballet and track and field. For more tips for coaches, school nurses and counselors, see the National Eating Disorders Association’s Toolkit.
  7. Know your responsibility as school personnel and report concerns to the proper staff at your school (e.g., a social worker or school medical professional).
  8. Make modifications as requested for students being treated for eating disorders (e.g., a student may need modifications related to the school schedule, class attendance, school meals and opportunities to eat at school).
  9. Use a form such as this when making observations about students of concern. The form can be used to discuss student behavior with other teachers who also work with the child regularly..
  10. Help prevent eating disorders by using anti-bullying messages and educating students on the topic. For more, see these teaching guides for grades 3-5, 6-8 and 9-12.