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Understanding Eating Disorders

Eating disorders are a group of serious and sometimes life-threatening conditions that have a distinct impact on both the physical and psychological development of children and adolescents.  While an eating disorder can affect an individual at any age, they most often manifest between the ages of 13 and 17 with some studies suggesting the average age of onset to be steadily decreasing.  Collectively, eating disorders have the highest mortality rate of any psychiatric condition and are the third most common chronic condition among adolescents and young adults.  The significant medical complications associated with eating disorders and the often limited resources make a multidisciplinary approach to treatment and care essential.  School nurses are uniquely positioned to identify potential signs and symptoms of an eating disorder, provide medical support and monitoring as needed, coordinate care, and advocate for appropriate services.

Types of Eating Disorders

The pathophysiology and psychobiology of eating disorders are largely unknown but they are generally characterized by consequential and persistent disturbances in eating behaviors and associate distressing thoughts and emotions.  The most common types of eating disorders include:

Anorexia nervosa is an eating disorder involving a refusal to maintain an appropriate body weight for height, age, and stature; and often, a distorted body image, and an intense fear of gaining weight.  Individuals with anorexia typically restrict calories and certain food types.

Bulimia nervosa is an eating disorder characterized by repeated episodes of binge eating and inappropriate compensatory behaviors for the prevention of weight gain, including self-induced vomiting, excessive exercise, and/or misuse of laxatives or other medications.

Binge eating disorder is the most common eating disorder in the United States and involves recurrent episodes of eating large amounts of food (often very quickly)  and associated feelings of shame, guilt, and loss of control.

Avoidant restrictive food intake disorder (ARFID) is an eating disorder previously known as “selective eating disorder” and is similar to anorexia in that the individual severely limits or restricts the amount or types of foods they consume.  Unlike anorexia, ARFID is not associated with negative thoughts about body shape or size.

Eating Disorders and School

Eating disorders are marked by a range of emotional, physical, and behavioral changes, making early identification in adolescents, who frequently experience fluctuations in all three realms, difficult.  School nurses and other school professionals who work closely with students must diligently collaborate to identify potentially harmful shifts in students’ health, attitude, or conduct that could be early signs or symptoms of an eating disorder.  One of the most challenging aspects of an eating disorder is anosognosia, which means the individual suffering from the disease does not know they are sick.  Many times, students with eating disorders are high academic performers and successful in athletics and other extracurriculars.  One cannot tell just by looking at someone whether or not they are suffering from an eating disorder.  In addition to early recognition, engagement with the family and coordination with community providers for appropriate treatment may be managed and facilitated by the school nurse.  Lastly, fostering a supportive school environment during and after a student’s recovery process means establishing 504 plans, IEPs, or advocating other accommodation procedures that allow students to return to school and participate in activities as their health allows.

A common theme among individuals suffering from eating disorders is the lack of support.  They can feel isolated in their suffering or embarrassed by their behaviors.  Because school nurses and other staff have daily opportunities to interact with their students, they play an important role in promoting healthy approaches to nutrition and exercise, raising awareness of the negative effects of weight stigmatization, early identification of warning signs of eating disorders, and continued care and support through treatment and recovery.

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