Tips for School Personnel on Teaching Eating Disorders Curriculum by Divya Kakaiya, PhD, CEDS

Assume that all kids know what eating disorders are, therefore prevention is the key.

Do not show movies of persons with eating disorders even though the movie may show them dying. The majority of people with eating disorders will tell you that they learned their tricks on what to do from the movies. They are imitating the steps the person took in the movies. Most people who develop anorexia or bulimia will say they knew the purpose of the movie was to deter them from developing an eating disorder. They just left with a message that here was a brand new way to lose weight they had never thought of before. If you are showing movies as part of the health curriculum, STOP NOW!

The nova film, “Dying to be Thin” has had similar effects with students. The images of emaciated women are triggering girls to want to be that thin. It is NOT an appropriate tool.

In teaching eating disorder curriculum focus on the following instead:

  1. Teach children the health hazards of dieting.
  2. Teach them how to honor their bodies by not using diet pills, teach them about theharmful substances in diet pills.
  3. Teach them how not to support a $50 billion dollar dieting industry.
  4. Teach them about resisting the media pressures to be thin at all costs.
  5. Teach them tolerance for diversity of sizes.
  6. Teach them ways to overcome their body image issues.
  7. Teach them about what is unhealthy about the latest diet fad
  8. Teach them about the hazards of steroids.

To do all this effectively school personnel have to recognize that they are powerful role models for young people therefore if a teacher is on a diet and feeling great on the diet and talks about it a lot then the diet is being glamorized and the child will want to try it.

Show students the video “Body Talk” made by Body Positive or “Killing Us Softly 3″ by Jean Kilbourne. It teaches kids about being able to express their body image issues and resist media messages.

DO NOT MEASURE A CHILD’S BODY FAT WITH CALIPERS. This alone has triggered off thousands of eating disorders. Children are too vulnerable to be put through a grueling, humiliating exam that reveals to them a number upon which they can obsess on, and a number that gives them their esteem.

Copyright: Healthy Within, Dr. Divya Kakaiya, PhD, 2001

Overt Behaviors by Carolyn Costin, MFT

    1. Does your daughter constantly go on diets and/or make excuses for not eating?
    1. Does she exhibit bizarre food rituals or behaviors?
    1. Is she preoccupied with food and weight?
    1. Does she express herself in all-or-nothing, black and white, thinking?
    1. Does she avoid social situations, especially if they involve food?
    1. Has she started to lose friends and withdraw?
    1. Have you found hidden food, laxatives, diuretics, and/or diet pills?
    1. Does your daughter go to the bathroom or otherwise disappear after eating?
    1. Is she eating a great quantity of food but losing weight or not gaining?
    1. Has she started wearing baggy clothing and layers of clothes?
    1. Did you notice extreme mood swings in her that have no apparent source?
    1. Is food missing from the house with no explanation?
    1. Is she spending money with nothing to show for it?
    1. Does she fast occasionally with various excuses?
    1. Does she get up late at night and have trouble sleeping?
    1. Have her face and neck glands become swollen and puffy?
    1. Does she have signs of scars on the back of the hand (due to teeth marks from forced vomiting)?
    1. Does she seem tired and lack vitality?
    1. Does she get depressed and angry for no apparent reason?
    1. Do you feel as though you never see her eating?
    1. Is she losing weight and is defensive about it?
    1. Has your daughter become a vegetarian and/or otherwise avoid specific foods?
    1. Is your daughter almost illogical and paranoid about eating certain foods?
    1. Does she take showers after meals?
    1. Have there been signs of vomiting, although she never said anything about being ill?
    1. Are there any signs of enema or laxative abuse?
    1. Does she seem to feel cold all the time?
    1. Is her hair falling out and showing up on her hairbrush or in the shower?
    1. Does your daughter obsess over what others eat and does she want to cook for, bake for, and feed others?
    1. Is she preoccupied with or does she obsess over pictures of thin people?
    1. Does she obsessively weigh herself, panicking at your suggestion of taking the scale away?
    1. Does her diet contain an excessive amount of gum, coffee, diet soda, mustard, spices, and other non-calorie items?
    1. Has she become a calorie computer?
    1. Is she steadily gaining weight?
    1. Does she always want and/or use food as a reward?
    1. Has she had temper tantrums over food not being :just right”?
    1. Have you seen her with bloodshot eyes and burst blood vessels (from vomiting)?
    1. Has she had a increased number of cavities and/0r discoloration of the teeth?

*Source: Your Dieting Daughter by Carolyn Costin, MFT, 1997. Carolyn Costin is the director of the Monte Nido Treatment Center and the Eating Disorder Center of CA, for more information visit her websites at

How to Address the Parents by Divya Kakaiya PhD, CEDS

  • Expect the family to be in denial or avoiding the issue. This is very much a part of the initial phases of the family’s process.
  • Initially the parent may be admiring and envious of the child’s self-control and discipline.
  • The greatest reinforcement to parental resistance is today’s confusion about what truly constitutes healthy eating. Fat free and low fat eating id not invariably healthy. Parents often lose sight of the fact that even the healthiest food attitudes become unhealthy when imposed too stringently or carried to extremes. In moderation there are no bad foods.
  • For a parent to effectively support a child they have to look at and examine their own attitudes and feeling toward food and their body.
  • Remember parents feel very guilty about the extremes the child is displaying and they feel a need to avoid heir own distress.
  • Teach the parents that signs of disease or pre disease are disguised and difficult to detect.
  • Share with the parents what the other kids have been saying about their child. Give specifics i.e. she is throwing away her lunch; she is exercising in the bathroom; she is throwing up; she is dizzy and faint.
  • Give them a sheet on recognizing signs and detecting soft signs so they can valuate their children.
  • Teach parents to see dangers of excess in their children. Excess is a sign of disease or pre disease. Remind parents that eating disorders are secretive, symptoms show in a variety of ways and sometimes professionals make errors. Blood tests are not an indicator of disease. A child can be very, very underweight ands have normal lab work. Educate parents that weight alone is not an indicator of disease.
  • Early detection and early aggressive intervention can turn a disease process around. If a child has hidden and eating disorder for 2-3 years, it will take 3-5 years of treatment before the signs disappear.
  • Educate parents about excessive exercise and how it is a sign of an eating disorder. Studies have shown that 75% of eating disordered individuals use excessive exercise as a means of purging or reducing anxiety. They are unable to stop exercising even when they have injury and exhaustion. Eating disorders are common among athletically inclined subgroups such as dancers, skaters, gymnasts, wrestlers and track and field. The demands of these activities parallel the demands of the disease.
  • Teach parents that pathological behavior settle in when the child has lost control, when they no longer have free choice.
  • Keep persisting in addressing the issue with the parents even though they may get defensive or uncomfortable. Remember your persistence will save a life!

*Parts of this information were taken from When Your Child Has an Eating Disorder by Abigail Natenshon, Copyright 1999.

Weight and Shape Attitudes for Teachers

Part 1

Answer each question with the following scale (Never=0, Rarely=1, Sometimes=2, Often=3, Usually=4)

  1. When I exercise, my principal motive is compensating for food eaten, or otherwise managing my weight
  2. I weigh myself.
  3. I think negative things about overweight people when I see them or talk with them.
  4. I have admired slender people and think about how much better my life would be if I were slender.
  5. I look at myself in the mirror.
  6. I wear clothes I do not particularly like because they divert attention from my weight.
  7. I avoid activities that I enjoy because they might call attention to my weight or body shape.
  8. I think about my body shape.
  9. My weight or my eating influences how I think about (judge) myself as a person.
  10. I use the adjective “fat” when I want to make an insulting or disparaging remark about a person.

Part 2

Answer “True” or “False” for the following questions

  1. If I could take 15-25 pounds off my body from wherever I choose, and I would be guaranteed that I would not regain it, I would sacrifice five years of my lifespan.
  2. As I read the word “slob” the first word that comes into my mind is “fat.”
  3. Schools should maintain weight for height standards for participation in dance, cheerleading or drama.
  4. Regardless of my weight and shape, I like myself. It would not matter if I gained or lost weight, I would still be me, a worthwhile person.


Part 1: Add the numbers for your answers

Part 2: Give yourself 1 point each for the following answers (1=T; 2=T; 3=T; 4=F)


If your score on the first nine items is greater than 26, and your score on the second section is greater than 2, you may be promoting negative attitudes that are part of the cultural foundation of eating disorders.


A 5 Day Lesson Plan Book on Eating Disorders, M.P. Levine and L. Hill (1991). The National Eating Disorder Organization.

Maine, M. Body Wars, (2000). Gurze Books

What Teachers Can Do

Discourage Dieting. Adopt the NEDA slogan, “Don’t Weight Your Self-Esteem – It’s What’s Inside That Counts”

Practice what you preach. Create a safe environment by eating well-balanced meals, not diet bars or drinks. When you hear teachers talking about “being fat” or going on diets, challenge them. The same goes for kids. Whenever students begin talking negatively about their bodies or about restricting their food intake to lose weight, respond immediately and stress that their bodies need fuel several times daily to be able to think, grow, and be healthy. Remember, internal – not external – beauty is important.

Find out what kids are eating. Encourage the school food service to provide a broad range of meal options. Help students learn to trust their bodies, their hunger, and their ability to self-regulate.

Encourage healthy exercise. Help your school develop physical education programs for all students to enjoy. (One-sixth of school aged children in the U.S. are so weak and uncoordinated that they are considered “physically underdeveloped” by the President’s Council of Physical Fitness and Sports).

Teach respect! Establish a zero tolerance stance on teasing, taunting, and negative talk about children’s bodies in schools. Treat derogatory behavior the same way you would racial or sexual harassment.

Teach media literacy! Media literate students are more critical consumers because they know that every image, commercial and television show has a message, constructed by an individual or group with a particular agenda of point of view. Create experiential lessons, such as photo shoots and ensuing touch-ups, visiting ad agencies or developing news shows.

Write letters and make phone calls! Survey your school for weightism and do something about it. for example, if P.E. teachers practice routine body fat testing, tell them why that is unacceptable. You might need to take your issue to the administration, in which case you would want to forward copies to local newspapers, radio stations.

Source: Maine, M. Body Wars, (2000). Gurze Books