Eating Disorders Awareness in the Public School Setting
Dear Parent of Students in Grades Five through Twelve:
Code of Virginia, Section 22.1-273.2, Parent Educational Information Regarding Eating Disorders. The Code of Virginia requires that each school board shall annually provide parent educational information regarding eating disorders for pupils in grades five through twelve.
Eating disorders are serious health problems that usually start in childhood or adolescence and affect both girls
and boys. With early diagnosis, eating disorders are treatable with a combination of nutritional, medical, and therapeutic supports. Recognizing the importance of early identification of at-risk students, the 2013 Virginia General Assembly passed a law requiring each school board to provide parent educational information regarding eating disorders on an annual basis to students in the fifth through twelfth grades.
It is important to note that eating disorders are not diagnosed based on weight changes as much as behaviors,
attitudes, and mindset. Symptoms may vary between males and females and in different age groups. Often, a young person with an eating disorder may not be aware that he/she has a problem or keeps the issues secret. Parents/guardians and family members are in a unique position to notice symptoms or behaviors that cause concern. Noting behaviors common to people with eating disorders may lead to early referral to the primary care provider. It is important for eating disorders to be treated by someone who specializes in this type of care.
After reviewing the information on the reverse side of this letter, if you think your child may be showing signs of a possible eating disorder, please contact your primary health care provider, school nurse, or one of the resources listed below.
Academy for Eating Disorders (AED)
Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T.)
National Eating Disorders Association
Toll free, confidential Helpline, 1-800-931-2237
Additional resources may be found at:
Virginia Department of Education
http://www.doe.virginia.gov/support/health_medical/index.shtml, under the section titled, Eating Disorders
What Are Eating Disorders?
Eating disorders are real, complex, and devastating conditions that can have serious consequences for health, productivity, and relationships. They are not a fad, phase or lifestyle choice. They are potentially life-threatening conditions affecting every aspect of the person’s functioning, including school performance, brain development, emotional, social, and physical well-being.
Eating disorders can be diagnosed based on weight changes, but also based on behaviors, attitudes and mindset. Be alert for any of these signs in your child.
Key things to look for around food:
- Eating a lot of food that seems out of control (large amounts of food may
- disappear, you find a lot of empty wrappers and containers hidden)
- Develops food rules – may eat only a particular food or food group,
- cuts food into very small pieces, or spreads food out on the plate
- Talks a lot about, or focuses often, on weight, food, calories,
- fat grams, and dieting
- Often says that they are not hungry
- Skips meals or takes small portions of food at regular meals
- Cooks meals or treats for others but won’t eat them
- Avoids mealtimes or situations involving food
- Goes to the bathroom after meals often
- Uses a lot of mouthwash, mints, and/or gum
- Starts cutting out foods that he or she used to enjoy
Key things to look for around activity:
- Exercises all the time, more than what is healthy or
- recommended - despite weather, fatigue, illness, or injury
- Stops doing their regular activities, spends more time alone
- (can be spending more time exercising)
Physical Risk Factors:
- Feels cold all the time or complains of being tired all the time
- Likely to become more irritable and/or nervous
- Any vomiting after eating (or see signs in the bathroom of
- vomiting - smell, clogged shower drain)
- Any use of laxatives or diuretics (or you find empty packages)
Other Risk Factors:
- Believes that they are too big or too fat (regardless of reality)
- Asks often to be reassured about how they look
- Stops hanging out with their friends
- Not able to talk about how they are feeling
- Reports others are newly judgmental or “not connecting”
If Your Child Shows Signs of a Possible Eating Disorder
Seek assistance from a medical professional as soon as possible; because they are so complex, eating disorders should be assessed by someone who specializes in the treatment of eating disorders. The earlier a person with an eating disorder seeks treatment, the greater the likelihood of physical and emotional recovery.
Eating disorders affect both males and females
Weight is NOT the only indicator of an eating disorder, as people of all sizes may be suffering
How to Communicate with Your Child
- Understand that eating disorder sufferers often deny that there is a problem
- Educate yourself on eating disorders
- Ask what you can do to help
- Listen openly and reflectively
- Be patient and nonjudgmental
- Talk with your child in a kind way when you are calm and not angry, frustrated, or upset
- Let him/her know you only want the best for him/her
- Remind your child that he/she has people who care and support him/her
- Be flexible and open with your support
- Be honest
- Show care, concern, and understanding
- Ask how he/she is feeling
- Try to be a good role model-don’t engage in ‘fat talk’ about yourself
- Understand that your child is not looking for attention or pity
- Seek professional help on behalf of your child if you have ANY concerns
Code of Virginia, Section 22.1-273.2, Parent Educational Information Regarding Eating Disorders.
The Code of Virginia requires that each school board shall annually provide parent educational information regarding eating disorders for pupils in grades five through twelve.
Summary. Virginia Public Schools shall provide educational information to parents of students in grades five through twelve on an annual basis.
According to the National Eating Disorders Association (NEDA, 2013):
Eating disorders are real, complex, and devastating conditions that can have serious consequences for health, productivity, and relationships. They are not a fad, phase, or lifestyle choice. Eating disorders are serious, potentially life-threatening conditions that affect a person’s emotional and physical health.
Hill, Reid, Morgan & Lacy (2010) further report, “Despite relatively low prevalence from a public health perspective, eating disorders have a high mortality and morbidity that can be drastically reduced with effective treatment.”
In a policy statement by the American Academy of Pediatrics (2003), it is reported that the numbers of children with eating disorders has increased steadily since the 1950s.
The purpose of this section of the Guidelines is to provide best-practice guidance for developing local policy for distributing educational information to parents/guardians regarding eating disorders.
In compliance with the Code of Virginia § 22.1-273.2, each school board shall adopt policies to provide parent educational information on eating disorders for students in grades five (5) through twelve (12) on an annual basis.
Educational Material. Early detection and treatment of eating disorders offer the best opportunity for positive outcomes and minimal long-term consequences. Educational materials should include, at a minimum, the following science-based information:
- A description of eating disorders
- A description of how eating disorders are identified
- A statement describing why it is important to screen for eating disorders (early detection and treatment)
- A description of eating disorders screening
- Information on referral for assessment, diagnosis and treatment
- A description of potential treatment
Local policy should include the timeline for dissemination of information on an annual basis. There must be a clear delineation of such health information from other administrative documentation. Educational materials should be provided to parents/guardians using typical communication methods for the local school division. Examples include, but are not limited to:
- Information included in the student handbook
- A letter home in the report card
- Information posted to the school Web site or telephone notification
- A weekly folder
- A PTA/PTO newsletter
Optional Screening Program
Research shows (Austin, Ziyadeh, Forman, Prokop, Keliher and Jacobs, 2008) that population screening for eating disorders in high schools may identify at-risk students who may benefit from early diagnosis and intervention. Screening for eating disorders may ensure that early cases are detected and referred for appropriate follow up. However, population screening may have possible harmful effects for the vulnerable students involved. If screening is conducted, it should be done with a validated measure that is appropriate for the target age group. Should the local school division decide to conduct eating disorders screening, the following guidance is provided.
Screening program. The tool used for screening should be evidence-based and age appropriate. Local policy should clearly indicate which grade levels are screened on an annual basis. As required by the Code of Virginia § 22.1-273.2, the division must provide educational information to parents/guardians of students in grades five through twelve regardless of whether or not optional screening is conducted.
Personnel and training. Training needs will be directly related to the screening tool selected. Training for school personnel should be conducted by qualified licensed practitioners. Training should be conducted before the initial screening and as needed in subsequent years. School staff most qualified to perform eating disorders screening include psychologists, social workers, counselors and school nurses. Confidentiality of student health information shall be included in the training session. Because of the sensitive nature of eating disorder screening, volunteers should not be utilized.
Written notice of screening. School divisions conducting optional eating disorders screening shall provide written notice to parents/guardians a minimum of ten (10) business days prior to screening. The written notice shall include:
- The purpose of screening
- Information indicating when the screening will occur
- The procedure for notifying parents/guardians of students who are identified as needing follow-up for further testing/screening
- The procedure for parents/guardians to opt-out of screening for their child
Referral and Follow-Up. School divisions will determine the threshold for referral based upon the specific tool used for screening. Parents/guardians of all students who are identified as possibly “at risk” according to the screening tool will be notified by school personnel conducting the screening. Parents/guardians should be encouraged to schedule a follow-up evaluation for their children with their health care provider and/or a qualified eating disorders specialist. School divisions may request a notice of receipt from the parent, indicating the receipt of the referral and plans for follow-up care.
Documentation. Documentation of screening and referral should be maintained in a confidential manner according to the Family Educational Rights and Privacy Act.
Academy for Eating Disorders (AED)
American Academy of Pediatrics (AAP)
American Psychological Association (APA)
Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T.)
National Association of Anorexia Nervosa and Associated Disorders
National Association of School Nurses (NASN)
National Eating Disorders Association (NEDA)
National Institute of Mental Health
Academy for Eating Disorders (includes videos for parents)
Eating Disorders Information Network Tips for School Staff
Medical Guidelines for Physicians
National Association of Social Workers
NEDA Coach & Athletic Trainer Toolkit
NEDA Educators Toolkit
NEDA Parent Toolkit
Parenting During Eating Disorder Recovery
Austin, S.B., Ziyadeh, N.J., Forman, S., Keliher, A., and Jacobs, D. (2011). Eating Disorders Referral Rates Improved by Community-Led Nationwide Screening in U.S. High Schools. Children’s Hospital, Boston, MA.
Austin, S. B., Ziyadeh, N. J., Forman, S., Prokop, L.A., Keliher, A., and Jacobs, D. (2008). Screening High School Students for Eating Disorders: Results of a National Initiative. Preventing Chronic Disease, Volume 5(4). http://www.cdc.govped/issues/2008/oct/07_0164.htm.
Committee on Adolescence (2003). Identifying and Treating Eating Disorders. Pediatrics 111:1, 204-211.
Funair, M. (2013). Detecting symptoms, early intervention, and preventative education: eating disorders and the school age child. NASN School Nurse, 28, 163-166.
Hill, L.S., Reid, F., Morgan, J.F., and Lacey, J.H. (2010). SCOFF, the Development of an Eating Disorder Screening Questionnaire. International Journal of Eating Disorders, 43:4, 344-351.
Rosen, D. S. and Committee on Adolescence (2010). Identification and management of eating disorders in children and adolescents. Pediatrics, 126, 1240-12-53.