By Dan Furness and Leila Holmyard

 

 

Eating disorders are among the most fatal mental health disorders, and their impact on students' physical and emotional health, as well as their academic and social development, can be profound. As international school staff, it is crucial to understand how to effectively support students who have been diagnosed with an eating disorder. This guide provides 9 practical steps for schools to consider.

 

 

This article does not constitute clinical guidance and should not be used for clinical decisions.

1. Early intervention & identification

Early intervention is key to successful treatment outcomes for eating disorders. If an eating disorder is suspected, it is essential to address the issue promptly. School counsellors and other support staff often play a key role in the identification and response process. It’s important to provide them with regular professional development to effectively identify and support the early signs of eating disorders.

There are three types of changes or behaviours that, if noticed, should be communicated to your school counsellor and/or Safeguarding Lead in accordance with your school’s safeguarding policies and procedures. These do not inherently signal a concern but do suggest the situation may need to be assessed to ensure the well-being of the student.

• Eating behaviours including avoidant, limiting, or excessive patterns. This might include discarding or giving their food away, eating very slowly or secretly, replacing food with excessive drinking of fluids like water, tea or coffee, or having a strict routine when eating that, if changed, can illicit an angry response. 
• Behavioural changes that might include frequently going to the toilet after meals, restless pacing during class or mealtimes, avoiding physical activity or engaging in excessive physical activity, or expressing feelings of guilt or shame after eating. More general behaviour changes might be sudden mood swings, isolating themselves from others, sudden anger or being more withdrawn.
• Physical changes that staff might notice are typically around notable or unusual changes in a student's body size or the clothes they choose to wear, such as clothes that are excessively large or exceptionally revealing. Students might also show increased sensitivity to cold and display physical signs such as dry skin, brittle nails, hair thinning, growth of fine hair (lanugo), calluses/cuts at the tops of fingers, and fainting.

Given the potential dangers of an eating disorder and the benefits of early intervention, parents should be informed by the school of such concerns so that they can seek professional help and, potentially, a diagnosis for their child. This is not a breach of confidentiality if the school is concerned for the health, safety, and well-being of the child. It is essential for a student's care to be supported by professionals who can address the mental health components, create a nutritional plan and manage any medical complications. Schools should be aware that students with a diagnosis are likely to require support over time in an individualised way that supports them to achieve sustained wellbeing and manage the condition effectively. The next points describe some ways to achieve this.

2. Creating a safe & supportive environment

After a diagnosis, it is important to consider which staff should be informed to reduce the occurrence of repeated disclosures and inadvertently harmful comments or interactions. The school counsellor or Safeguarding Lead should coordinate this process, giving the student as much agency as possible. Students should be encouraged to share what makes them feel safer and empowered, and how they think the school can best support them.

3. Supervising meals & snacks

Supervision during meals and snacks may be advised by medical professionals. In such cases, supervision should be carried out in a consistent and respectful way. Students may continue to eat with peers or the supervising teacher could join them for the meal. Involving the student in identifying which staff should supervise them along with what this supervision looks like can help ensure the supervision is effective and supportive.

 

 

4. Remaining mindful of language & avoiding self-disclosure

School staff should be mindful of the language used when discussing food and body image. This should form part of the school’s safeguarding training, with clear guidelines and norms established to support all students. Staff should avoid making comments about any student's appearance, body size, or eating habits, as these can be misinterpreted and may inadvertently reinforce disordered thoughts. Similarly, staff should avoid self-disclosure about their own meals, eating habits, or body shape or size.

5. Providing practical support

Every student's experience will be different, but schools can provide practical, holistic support under the guidance of medical professionals. This may include extra help for missed schoolwork, home tutoring referrals, shortened school days, excusal from PE and sports, reduced workload, extended due dates, extended time for meals, and supervision at meals and snacks.

6. Maintaining confidential communication

Clear and confidential communication is essential when a student returns from treatment or has a new diagnosis. The counsellor or Safeguarding Lead should work closely with the student, their parents and school staff to create a clear, documented, and responsive school support plan or safety plan. This should be regularly reviewed as circumstances and needs change. Everyone involved needs to understand their role and be aligned, including when the plan is updated. Expectations of confidentiality should be clearly communicated to those involved. Trust can easily be lost if staff are overheard discussing a care plan in the corridors or the staffroom.

7. Considering boarding & residential settings

Students residing in boarding or other residential environments require special considerations and additional partnership between the school and the medical team. Schools should work with medical professionals to assess and determine the student's medical and psychological readiness to remain in boarding. Ensuring the student's safety while under the care of boarding staff must remain the top priority. Boarding staff should be provided with the professional development they need to understand and support students with disordered eating. Structure is an important part of any support plan and an informed residential environment can help provide this.

8. Encouraging peer support

Encouraging helpful and safe peer support for students with eating disorders is important. Schools can educate students about eating disorders, emphasizing empathy and sensitivity when discussing topics related to food and body image and can plan to do so as part of their Social and Emotional Learning (SEL) curriculum. Promoting positive interactions and providing clear guidelines on how to support friends can help students navigate their challenges together in a safe and compassionate manner. We know that students will often look to their peers for support before telling staff or their parents they need help. Educating students on the pathways to help their friends get the support they need is crucial.

9. Partnering with parents

Developing supportive partnerships with parents is crucial for supporting students with eating disorders. Clear communication with parents helps them understand early concerns that might be raised by the school, so they can take them seriously and support their child effectively. When talking with parents, it’s important to create shared goals and to be prepared to answer the questions and natural fears they have about this topic. Staff should be careful to consider cultural and logistical factors and understand any barriers to engaging with a medical professional or trained clinician.

The school counsellor can act as a bridge between the school and home, helping parents understand the importance of follow-up care and supporting them in accessing resources. The school should also seek formal consent to engage directly with medical professionals to ensure consistency and continuity of care.

During these conversations, it is important to be clear from the beginning regarding what the school can and cannot offer. Discuss safety at school, including how confidentiality will be maintained, identification of safe spaces and friendships, and establishment of regular check-ins with a counsellor. Schools can proactively engage in a mapping exercise to identify and build relationships with medical professionals and other external providers to whom they can refer families for specialist support. This can also include an exploration of the legal context in relation to this topic, including laws related to confidentiality, mandatory reporting and medical consent.

Conclusion

Supporting students with eating disorders in international schools requires a comprehensive approach that includes early intervention, creating a safe and supportive environment, providing practical support, fostering peer support, and involving parents. By collaborating with medical professionals and other external providers, schools can enhance their ability to respond to the needs of students and support their families in accessing appropriate support and care.