Toronto psychiatrist Leora Pinhas at the Hospital for Sick Children is studying a handful of case studies about kids that developed eating disorders in conjunction with school healthy living initiatives.
Here is an excerpt from a May 2013 Globe and Mail article by Adriana Barton about one case:
“The boy – we’ll call him Tim – signed up for every physical activity available at school, and logged hours a day on the stationary bike at home. After learning to read nutrition labels, he cut back on high-calorie foods, including cheese and meat.
Then one night he stuck his hand into boiling pasta to take out the butter his mother had added to the pot. Seven months after setting a goal at school to get fit, Tim was diagnosed with an eating disorder and weighed 95 pounds.
His preoccupation with food and exercise coincided with the school’s healthy-living initiative, which included rewards for packing a healthy lunch, said Leora Pinhas, a psychiatrist at the Hospital for Sick Children in Toronto.
Although Tim had perfectionist tendencies, she said, “I don’t think he would have had an eating disorder without this.”
Are well-intended school health programs playing a role in the development of eating disorders?
Schools do not cause eating disorders but they can play a precipitating role. Eating disorders develop for many reasons and there is often not one cause, it is important to make sure the messages we are teaching in school are helping and not harming.
From personal experience over the last thirteen years as a private practice dietitian that has seen many eating disorder clients, I can tell you that emphasis on “good” and “bad” foods and rewards has been one of the factors that has contributed to disordered eating as well as anorexia and bulimia.
One of my clients who is a thirteen year old boy with anorexia was triggered in health class. Doing well at nutrition and physical activity was something he could excel at. He still struggles with a fear of fat in foods since high-fat foods were labeled unfavorably.
Another one of my clients that was a teacher with bulimia instructed her students that white foods were bad and that they should avoid them. I had to coach her on the harm this was doing given some of her students likely came from Asian or European culture and ate white rice/white pasta as a staple. I also reminded her that our Canadian population health goals encourage about HALF our grains as whole grain (not ALL).
Obesity experts are concerned with the high levels of overweight and obese kids in Canada. Eating disorder specialists are concerned by the higher risk of dying young if you have an eating disorder. What can schools do to help?
- Teach kids balance: We eat for many reasons and kids need to be taught that eating fully is a balance of healthful choices (to nourish our physical well-being) as well as soulful choices (chosen for fun and enjoyment). One without the other provides challenges.
- Avoid “all or none” language: Kids need to be taught that there are no bad foods, just bad overall diets. All foods can fit and it is important to avoid labeling food as good or bad.
- Skip comparisons: Personal reflection on nutrition and physical activity is better than open comparisons among students. Comparing food choices, body composition and testing results related to food and activity is not the type of competition we want to encourage.
- Be cautious with tracking: While education about food groups and the science of why we need specific nutrients is important, avoid excessive tracking. Detailed tracking of grams of sugar, grams of fat or calories has the potential to become obsessive. Avoid electronic tracking methods. In the age of technology many of the apps available on smartphones count calories and weight rather than good nutrition habits.
- Educate parents: The biggest way kids learn about healthy eating, managing a healthy weight and preventing eating disorders is by role modeling at home. Parents have the biggest role in walking the talk with healthy habits at home and any efforts schools can do to include parents is ideal.