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Home > School Health > Manual Contents > Eating Disorders

Eating Disorders


Eating disorders can take a variety of forms, including anorexia nervosa, bulimia, and binge-eating. Eating disorders tend to strike during the adolescent years, with an estimated 85% of cases beginning during this time. Health care professionals are seeing these illnesses more frequently in young adolescents and preteens. (Michel, Deborah and Willard, Susan When Dieting Becomes Dangerous, Yale University Press 2003) These are serious mental and physical health issues and can lead to life threatening situation and death. Adolescent girls experience the highest prevalence of eating disorders, nearly ten times more frequent than boys, however, males and individuals of all age groups can be affected. It is estimated that 0.5% of adolescent females in this country have anorexia nervosa and that 1% to 5% have bulimia. (PEDI January 2003, pp. 204-211)

Anorexia nervosa symptoms include:

  • self-starvation and excessive weight loss
  • preoccupation with food and losing weight
  • weighing themselves frequently
  • intense fear of weight gain
  • excessive exercise schedule
  • withdrawal from friends and usual activities
  • wearing baggy clothes to disguise thin body
  • loss of menstrual periods
  • dry skin and hair, dehydration
  • hypothermia
  • disrupted sleep patterns
  • low body weight

Bulimia nervosa symptoms include:

  • unusual concern with body weight
  • repeated purging after binge eating
  • may also use other forms of purging such as laxatives, diet pills and diuretics
  • dental caries/enamel erosion and periodontal disease

Binge eating symptoms include:

  • frequently eating large quantities of food in a short time period of time, often alone
  • feeling out of control or guilty after episode


Treatment requires a multidisciplinary team including a medical, nutritional and mental health component. Treatment may include individual therapy, family therapy and group treatment and can be provided on an outpatient basis or may require hospitalization, depending on the severity of physical and psychological status. A specialized eating disorder inpatient service is often the best choice when hospitalization is needed. Eating disorders often co-exists with other psychiatric disorders such as depression or obsessive compulsive disorder.

Prevention of Eating Disorders

It is a challenge to combat the national media perception that thin is necessary to be attractive. Encouraging healthy eating and regular exercise for every student has had positive results. Include these positive messages in health education curricula and in counseling individual students rather than focusing on body size. Avoid using food as a reward. Prevention programs are available for students and resources are listed below.

Role of the School Nurse:

  • Participate in the development of the health education curriculum,
  • Display messages of healthy eating and exercise in the school and school nurse office,
  • Be a role model for students and encourage other school staff to model healthy behaviors,
  • Be familiar with signs and symptoms of eating disorders,
  • Provide screening for body mass index (BMI) for all students according to guidelines,
  • If an eating disorder is suspected, assess student for behaviors and attitude regarding his/her weight,
  • Document BMI for students suspected of having an eating disorder (be aware of possible hidden objects to falsely increase weight),
  • Provide referral to the family and discuss options with the aim of having the student evaluated by their primary care physician,
  • With parental permission, consult with referral resources,
  • Prepare an individualized health plan (IHP) as necessary,
  • Educate school staff about eating disorders, and
  • Provide education to parents through presentations and school newsletters.


National Eating Disorders Association

Maternal and Child Health Resources -


AAP Article on Eating Disorders

  • http://aappolicy

Girl Power, Body Wise, for students

  • The National Women’s Health Information Center
  • Harvard Eating Disorders Center
  • Something Fishy- treatment finder data base-  (treatment finder data base)

New England Eating Disorders Program

Office of Substance Abuse, Information and Resource Center

Mainely Girls – learning collaborative treatment teams resources (check with Mary O:Rear)

  • (not gender specific)
  • is another resource. It looked relatively gender neutral

Young Women’s Health

  • is designed for girls.

Young Men’s Health

  • A companion website for young men  is designed for and by young men.

The School Health Manual is available electronically. Each section of the Manual is available as a separate electronic file from the WEB PAGE. This will allow for sections to be updated on an ongoing basis. The Table of Contents includes the dates of the current sections. Available at

Comments may be given to members of the School Health Advisory Committee (SHAC) or sent to the address below: 
School Nurse Consultant, Department of Education, 23 State House, Augusta, ME 04333