Eating disorders are a complex mental health condition that affects a significant number of middle school and high school students. Eating Disorder Awareness Week, which is recognized annually in the last week of February, aims to raise awareness of this critical issue. Together, we can focus on more equity, early intervention, and education to spread awareness about eating disorders.
There is still a lot of stigma and shame around talking about eating disorders, making it difficult for people to talk about. Because of this stigmatization, those who struggle with what feels like a never ending cycle of an eating disorder feel especially uncomfortable talking about it. Brene Brown offers us insights into the shame that people with eating disorders experience in her book "The Gifts of Imperfection". Brown reflects that “shame loves secrecy,” implying that cultural and familial shame around eating disorders make it hard for people to ask for help even if they feel like they need it.
Eating Disorders & Students
Eating disorders are common in schools and we need to do more to work towards effective early intervention treatments, as well as recovery treatments. According toNational Eating Disorders statistics, “at any given point in time between 0.3-0.4% of young women and 0.1% of young men will suffer from anorexia nervosa.” In 2000, US high school students completed a self-report questionnaire that included the Eating Attitudes Test (EAT-26) with questions focused on purging or exercising to control weight, binge eating, and history of treatment for eating disorders. Overall, 25% of girls and 11% of boys reported eating disorder symptoms severe enough to need clinical evaluation. Eating disorders are more common amongst girls because of the societal norms around girls fitting into a certain body type or image that is deemed ‘desirable’ by others. Although girls make up the majority of the eating disorder population of students, boys are also affected and a group we should not ignore when thinking about the details of eating disorder treatment and programs.
Eating disorders have also been identified as one of the deadliest mental illnesses, with mortality rates higher than those of any other mental health condition. According to the National Eating Disorders Association, the mortality rate among people with anorexia is about 10%, and people with eating disorders are also at higher risk for suicide, together making it one of the most deadly mental illnesses. Eating disorders can lead to chronic lifelong health problems, such as heart disease, osteoporosis, and infertility. Early intervention and treatment plans for eating disorders are essential for the health of our students and communities.
The Role of Social Media & Health Education
Of these students, few had ever received eating disorder treatment pointing out the disparity between those struggling and those getting care and treatment. Eating disorder screenings in high schools can help with early intervention, preventing long term physical and mental health issues. Eating disorders have only become more common, surging during the pandemic due to increased screen time, isolation, lack of social interaction, and decreased health education programs. Students are spending more time on screens including social media and Zoom, which magnifies any body image issues that often contribute to the development of an eating disorder. According to a study by UC San Francisco, students are more likely to engage in binging as they spend more time on social media or watching TV. During the pandemic, social media usage was one of the few avenues to stay connected with other students, suggesting that social media usage is deeply integrated into students' free time as well as contributing to eating disorders.
In addition to an increase in social media usage, a decrease in health education programs are linked to an increase in eating disorders. According to Diane Farthing, a K-12 health teacher, schools have been forced to cut back on health education programs since the pandemic. In the same vein, calls to the National Eating Disorders Association hotline have increased 40% since March 2020 and hospitalizations for eating disorders have doubled. Eliminating classes that focus on nutrition, mental and physical health, how to get help if you are struggling, and how to find reliable health information discourages awareness and open discussions about eating disorders and other comorbid mental health issues. It’s no secret that eating disorders are a prevalent societal issue, and perhaps social media and lack of proper health education are contributing to this spike.
School & Gym Culture
Beyond social media and lack of education, school culture around athletics and body type can contribute to the development of eating disorders in middle school and high school students. According to Neolth, “In weight-class sports (wrestling, rowing, horse racing) and aesthetic sports (bodybuilding, gymnastics, swimming, diving) about 33% of male athletes are affected. For female athletes in weight class and aesthetic sports, disordered eating occurs at estimates of up to 62%.”
There is a growing student athlete, gym, and wellness culture that values thinness and muscularity over health and wellness. As much as going to the gym, working out, and general exercise are important for maintaining a healthy lifestyle, obsession with gym and wellness culture can lead to dependency and toxic levels of comparison with others. Trying to be the most built or most lean person in the gym can lead to individuals making drastic eating choices such as eating less than 850 calories or ‘bulking’ where you eat double or even triple your normal caloric intake. Unhealthy eating habits are born from comparing oneself to others, and is a common theme for student athletes who are typically competitive in nature.
Burgundy Walters, a student athlete from Mississippi State University, shares her personal experience as a student athlete who struggled with eating in her first year in college. For Walters, the pressure to attend practices, go to class, get tutoring help with homework, and maintain a social life meant that eating became her last priority. She and her teammates would go full days only eating a granola bar and felt low on energy at practices and in class. She shares that at one point “sleep became dinner. Yes, sleep. It became like a competition to see who could go the longest without eating and not pass out at practice.” Walters and her roommate were both on a student athletic team, and had similar struggles of making time to eat given their busy and demanding schedules. You can read more about how gym culture fuels eating disorders in Walters personal story.
How Schools Can Help
Schools can play a vital role in combating eating disorders among middle and high school students. Normalizing asking for help and recognizing that eating disorders can show up in any body type help make it easier to talk about. Promoting body positivity or neutrality, emphasizing the importance of self-acceptance and self-care rather than focusing on external appearance is a start at making it easier to talk about eating disorders. The Body Positive organization curriculum promotes the idea that healthy bodies can be all shapes and sizes, mitigating ideas that eating disorders are only seen in one body time as well as an idea of acceptance of what your body feels like instead of looks like. Feeling and being healthy regardless of body shape or size is essential, and we need school and social media environments to shift the discussion instead of the idea that being thin or athletic equals healthy and happy.
In addition to implementing curriculum like The Body Positive into schools, providing nutritious meals and education about nutrition that does not include weight, BMI, or other potentially triggering factors can be helpful for those recovering or struggling with an eating disorder. Schools can also support students who struggle with eating and body image by providing counseling services, peer support groups, and other resources. Lifting some of the shame that comes with eating disorders is achieved by a shift in school culture to become more aware of triggers, normalizing asking for help, as well as increased access to counseling treatment and services.
To conclude, eating disorders are a serious issue that affects many middle and high school students. Schools are well-positioned to help address this problem by promoting body positivity, providing nutritious meals and education, and supporting students who struggle with eating and body image. Understanding the mental health side of eating disorders is vital to getting to the root of the issues, which can be aided by the support of Neolth: Stress and Mental Health Support and improved counseling services. Overall, as a community of people in education, we must prioritize the health and well-being of young people and work towards creating a culture that values true health over appearance.
This article was co-written by Drishti More, Ginger Freeman, and Khrystina Warnstadt.
Drishti More (she/her), senior public health student at the University of Florida, is set to receive her Master's in Public Health in 2024. Her passion for health equity and accessibility has led her to work with organizations such as Neolth, the American Red Cross, and Days for Girls International. As an Outreach Intern at Neolth, Drishti is expanding knowledge of and access to stigma-free mental health care to students across the country.
Ginger Freeman (she/her) is an Editorial intern at Neolth and a senior at Santa Clara University studying Psychology, Public Health, and Asian Studies. Once she graduates, she plans to pursue a masters in counseling to become a licensed therapist. She is passionate about making mental health care more accessible and personalized, as well as applying zen theory to traditional psychotherapy. Through starting the conversation around mental health she hopes to reduce stigma and help people feel less alone! Outside of school, she enjoys spending time outside with friends, hot yoga, meditation, and listening to live music.
Khrystina Warnstadt (she/her) is the Outreach & Engagement Specialist at Neolth and an MSW student at the University at Buffalo, SUNY. While earning her BA and CGS from the University at Albany, SUNY, she discovered a passion for mental health, equity, and accessibility. Her passions led her to her work at Neolth, as well as with organizations such as Planned Parenthood, the NY Birth Control Access Project, and NAMI. She works with Neolth to bring mental health support to students worldwide and empower students to share their stories and eradicate the stigma around mental health.