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Presented by the Eating Disorder Coalition of Iowa

The mission of the Eating Disorder Coalition of Iowa is to prevent eating disorders and to serve as a catalyst of hope, acceptance, understanding and healing for all impacted by eating disorders.

Source: 2013 EDCI Brochure

The Eating Disorder Coalition of Iowa envisions an Iowa without eating disorders.

Source: 2013 EDCI Brochure

Objective: To build the Southeast Polk School District’s knowledge of eating disorders

Types of Eating Disorders: • Anorexia Nervosa • Bulimia Nervosa• Binge Eating Disorder• Other Specified Feeding or Eating Disorders

Sources: 2013 Diagnostic Statistical Manual V for Psychiatric Disorders (DSM V)2014 ICD 10 Codes for Eating Disorders

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Anorexia Nervosa DSM-5 Diagnostic criteria for anorexia

• Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal, or, for children and adolescents, less than minimally expected.

• Intense fear of gaining weight or becoming fat, or persistent behavior to avoid weight gain, even though at a significantly low body weight.

• Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body shape or weight on self-evaluation, or persistent lack of recognition of the seriousness of current low body weight.

• Current subtypes: Restricting–vs-binge-purgeWarning Signs

• Dramatic weight loss, denial of hunger.• Preoccupation with weight, food, calories, fat grams, dieting.• Refusal to eat certain foods, progressing to restrictions against whole food

categories (e.g. no fats).• Frequent comments about feeling “fat” despite weight loss.• Hyperactivity.• Development of food rituals.• Consistent excuses to avoid mealtimes or situations involving food.

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• Excessive, rigid exercise regimen—despite weather, injury, illness.• Withdrawal from usual friends and activities.• Anxiety about gaining weight or being “fat”.

Health Consequences• Abnormally slow heart rate and low blood pressure, which means that the heart

muscle is changing. • Reduction of bone density, which results in dry, brittle bones.• Muscle loss and weakness.• Severe dehydration, which can result in kidney failure..• Growth of a downy layer of hair called lanugo all over the body, including the

face, in an effort to keep the body warm.• Fainting, fatigue, and overall weakness.• Dry hair and skin, hair loss is common.• Cold intolerance.

Sources: 2013 Diagnostic Statistical Manual V for Psychiatric Disorders (DSM V)2014 ICD 10 Codes for Eating Disorders

Bulimia NervosaDMS-5 Diagnostic criteria for bulimia nervosa

• Recurrent episodes of binge eating.• Recurrent inappropriate compensatory behavior to prevent weight gain, such as

self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting or excessive exercise.

• The binge eating and inappropriate behavior both occur on average, at least once a week for 3 months.

• Self evaluation is unduly influenced by body shape and weight.• The disturbance does not occur exclusively during episodes of anorexia nervosa.

Warning Signs• Unusual swelling of the cheeks and jaw area.• Discoloration or staining of teeth.• Evidence of binge eating, disappearance of large amounts of food in short

periods of time.• Evidence of purging behaviors, includes frequent trips to the bathroom after

meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.

• Calluses on the back of the hand or knuckles.• Excessive, rigid exercise regimen—despite weather, injury.• Creation of lifestyle or rituals to make time for binge-and-purge sessions.• Withdraw from usual friends and activities.

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• Behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

Health Consequences• Electrolyte imbalances that can lead to irregular heartbeats and possible heart

failure and death. Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviors.

• Tooth decay and staining from stomach acids released during frequent vomiting.• Inflammation and/or GERD and possible rupture of the esophagus.• Chronic irregular bowel movements and constipation as a result of laxative

abuse.• Gastric rupture is an uncommon but possible side effect of binge eating.• Recurrent binge-and-purge cycles can damage the entire digestive system.

Sources: 2013 Diagnostic Statistical Manual V for Psychiatric Disorders (DSM V)2014 ICD 10 Codes for Eating Disorders

Binge Eating DisorderDSM-5 Criteria for binge eating disorder diagnosis

• Recurrent episodes of binge eating.• Binge eating episodes are associated with three (or more) of the following:

• Eating much more rapidly than normal.• Eating until feeling uncomfortably full.• Eating large amounts of food when not feeling physically hungry.• Eating alone because of being embarrassed by how much one is eating.• Feeling disgusted with oneself, depressed, and very guilty after overeating.• Marked distress regarding binge eating is present.• The binge occurs, on average, at least once a week for 3 months. • The binge eating is not associated with the recurrent use of inappropriate

compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa and anorexia nervosa.

Warning Signs● History of significant weight changes● Experiences of weight stigma, weight-related bullying

Health Consequences• Weight gain.• Shame, weight stigma.• High blood pressure.• Heart disease.

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• Diabetes mellitus.• Gallbladder disease.• Musculoskeletal problems.

Sources: 2013 Diagnostic Statistical Manual V for Psychiatric Disorders (DSM V)2014 ICD 10 Codes for Eating Disorders; Binge Eating Disorder Association

Other Specified Feeding or Eating Disorders• Atypical anorexia nervosa (weight is not below normal).• Sub-threshold bulimia nervosa (with less frequent behaviors).• Subthreshold binge-eating disorder (with less frequent occurrences).• Purging disorder (purging without binge eating).• Night eating syndrome ( excessive nighttime food consumption).

Sources: 2013 Diagnostic Statistical Manual V for Psychiatric Disorders (DSM V)2014 ICD 10 Codes for Eating Disorders

Why•Food is not the issue! •Food is the tool of which a student depends on to control, to manipulate, to give them perceived empowerment.

•Behaviors are the student’s way of coping with the environment or situation.

Source: National Eating Disorder Association (NEDA)

Recognizing Eating Disorders in School● Behaviors

○ Difficulty focusing in class○ Increased or frequent use of bathroom, specifically after meals ○ Irritability, denial or minimizing of problem

● Food Talk○ Dieting or fear of certain foods○ “Wanting to get healthy”: 65% with EDO started here○ “I want to gain only muscle”○ Bad food/good food

● Clothing ○ “Not dressing for gym”○ Baggy clothing, or winter clothing all year- round.○ Layered clothing

● Food/Eating/Meals○ Skipping lunch or not eating enough at lunch○ Stop eating foods they use to eat and develop fear of these foods, they

become “scary” or “bad” or “unhealthy” foods. ○ Dropping out of food groups based on calories, fats.○ Not using meal ticket○ Making excuses such as “I’ve already eaten”, “Have to study” or “Need

to finish a project” to avoid eating with others.

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○ Eating in private, by oneself● Social

○ Avoiding social situations○ Isolating○ Peers voicing concern

● Physical○ Decreased performance in PE or sport, less stamina○ Hair loss, change in skin, emaciation○ Abnormal weight loss in a period of growth○ Compulsive exercise/movement○ Sleep concerns

Sources : NEDA, Eating Disorder Hope

▪ Learn about eating disorders. ▪ Be a good role model in your attitude about food, body image and

weight-related issues. Do not diet!▪ Discourage the idea that a particular diet, weight or body size will

automatically lead to happiness and fulfillment.▪ Understand the natural differences in body types, and the body’s

powerful attempt to maintain these naturally varied shapes and sizes.▪ Avoid categorizing food as good/safe, bad/dangerous or

healthy/unhealthy.▪ Become familiar with the changes during puberty.▪ Real kids come in all sizes and shapes.▪ Be Health-Focused not Weight-Focused.▪ Become familiar with Health at Every Size (HAES®).▪ WHAT MAGAZINES ARE AT HOME, WHAT DOES YOUR

VOICE SAY, WHAT ARE YOUR ACTIONS? Most appalling app-fat face

Source: Association of Size Diversity and Health, NEDA

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Reduce the Risk - Weighing• Healthy to NOT weigh students in front of each other, ideal is done in private in

the nurse’s office.• Healthy to NOT let students see their weight.• Healthy to NOT give students a certain weight to be, but emphasize growing.• Always be aware of puberty changes.

Puberty▪ Puberty normally occurs between the ages of 8 to 18.▪ The rate of weight gain during adolescence corresponds to that of the height

spurt.▪ In boys, peak height coincides with weight gain.▪ In girls, weight gain (20# - 40#) occurs 6 to 9 months before height changes.

Gong E, Heald FT. Diet nutrition and adolescence. In: Shils M, Young VR, eds. Modern Nutrition in Health and Disease. 7th ed. Philadelphia: Lea and Febiger: 1998

5th grade 6th grade 7th grade

Reduce the Risk - Food Talk• Healthy to communicate that all foods fit.• Healthy to teach why carbs, protein and fats are all needed.• Healthy to discuss food restriction leads to food interest and sweets/ fried/junk

foods can fit in smaller portions a couple times a week.• Healthy to not calorie count, but rather focus on internal cues.• Healthy to remind students they are still growing.

Reduce the Risk - School Environment● What posters and pictures are in the classrooms and halls. Do they show a

variety of bodies engaging in activities and sports?● What health messages are in the school? Do they promote weight over health?● What media messages are in the school?● Concerns when using the word healthy to describe food especially to those

students with food insecurity at home

Reduce the Risk - Communicate● Don’t try to fix it by yourself, a team is needed to treat this disease.● Communicate acceptance of person.● Communicate concerns of behavior.● Listen.● Compliment student on things other than appearance.

• I am so fat. = “What’s up with you saying that” or Tell me more .• That’s a bad food. = Where does it fit in a regular diet ? • Fatty, fatty 2 by 4. = Confront students doing bullying….Process with student

being bullied. • Struggling to eat. = “ I notice you are having a hard time eating, can you tell me

more?”

• Parents collaborate on menu planning with dietitian and with school food service director for menu selection.

• Students will likely not select their own food for a while. Varies with stage in recovery & eating disorder behaviors.

• Parents will portion meals brought in or speak with food service director of what portions they serve.

• Parents collaborate to eat meals at home and at school with student. May eat with a teacher, nurse, school counselor or meet parent in car to share meal together. Student may need redirection with eating.

• May graduate to eating with a few peers with adult in their office first and then with that peer in lunch room.

• Adult contact in lunch room may provide supervision. • Student may need to eat AM and PM snack. This can be accomplished with

permission of teacher of the class, with nurse or counselor or as improves, at the locker between classes.

• Student to eat meal within 30 minutes and snacks within 15 minutes. • Student to not be in bathroom 30 minutes after a meal.• May be held back from PE, Sport, Drill or Dance Team and Show Choir because

of activity level and burning calories/muscle.• As student recovers, the outpatient team will work with parents who work with

school/sport to gradually return to activity.

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• Females need menstrual cycle back for 2 cycles. Not just a matter of student being in weight range.

• Parents need to monitor classroom work on nutrition to make sure any assignments are appropriate for student (Recovery record vs. food record with calories) .

• Students may not be involved in preparing food, planning menus or shopping for groceries. As recovery proceeds, age appropriate daily nutrition living skills will be advanced.

Treatment TeamMental Health Therapist ( LMHC, LISW, LMSW, PhD, PsyD, EdD) Physician ( MD, DO, ARNP)Registered Dietitian Nutritionist ( RD, RDN)

Beyond the Treatment TeamParents School CounselorNurse CoachPE TeacherHome Economics or Health Teacher Food Service Director MentorFoster parentGrandparentsFriends

• Does your school have a confidential action plan? • Direct family to resources in community.• NEDA.org (parent toolkit, educator toolkit) and EDCIowa.org.• Parents check in regularly with point person at school if student in outpatient

• treatment or just returning from inpatient treatment.• Parents communicate with Food Service Director.

Suggestions from a Student Survivor• Doesn’t want her friends to become her therapist or dietician, just wants them to

be her friends like they were before the eating disorder.• Wants friends to be mindful of their word choices.• Wants friends to tell a concerned adult if they witness suspicious behavior.• Wants to be “normal” again.

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Our hope for all students● Eating adequately to meet the body’s daily nutritional needs (for ADL’s, sport

and growth).● A balanced sustainable relationship with food, free from negative or distorted

thoughts about oneself. ● Listening to and trusting your body’s internal cues to determine hunger and

fullness.

Where to go to find more information…

http://www.edciowa.orghttp://www.nationaleatingdisorders.org/http://www.anad.org/http://www.haescommunity.org/

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