Eating Disorder Curriculum
Lesson Plan
OVERVIEW & PURPOSE
Students will understand the short term and long term consequences of eating disorders and how malnutrition affects the body.
TYPES OF EATING DISORDERS
Anorexia Nervosa-characterized by weight loss(or lack of appropriate weight gain in growing children), difficulties in maintaining an appropriate body weight(for height, age, and stature), as well as distorted body image
Bulimia Nervosa-characterized by a cycle of binge eating and compensatory behaviors such as self induced vomiting(purging), designed to undo or compensate for the effects of binge eating
Binge Eating Disorder-characterized by recurrent episodes of eating large quantities of food; feeling of loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures to counter binge eating
Orthorexia-describing an obsession with proper or ‘healthful’ eating
Other Specified Feeding or Eating Disorder (OSFED)-known as Eating Disorder Not Otherwise Specified(EDNOS), developed to encompass individuals who do not meet the strict criteria for anorexia or bulimia but still have a significant eating disorder
Avoidant Restrictive Food Intake Disorder (ARFID)-referred to as “selective eating disorder”, involves limitations in amount and/or types of food consumed, but does not involve any distress about body shape or size or fears of fatness
Pica-an eating disorder that involves eating items not considered as food and do not contain significant nutritional value (e.g. paint chips, sand, hair, dirt)
Unspecified Feeding or Eating Disorder-UFED applied to individuals where symptoms are characteristic of a feeding or eating disorder, that causes significant distress, but does not meet full criteria for any disorders in the feeding or eating disorder diagnostic class
Laxative Abuse/Compulsive Exercise-laxative use (repeated frequent action of taking laxatives) to the point to eliminate unwanted calories, lose weight, to “feel thin/empty”. Extreme, compulsive exercise that interferes with areas of one’s life.
EMOTIONAL + BEHAVIORAL WARNING SIGNS
-Preoccupation with weight, food, calories, carbohydrates, fat grams, and dieting
-Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbs, etc)
-Appears uncomfortable eating around others
-Food rituals (e.g eats only a particular food or food group {condiments}, excessive chewing, doesn’t allow foods to touch)
-Skipping meals or only eating small portions of food at meals
-Any new practices with food of diets (Veganism, no sugar, no carbs, etc.)
-Withdrawal from usual friends of activities
-Frequent dieting
-Extreme concern with body size and shape
-Frequent checking in the mirror for perceived flaws in appearance
-Extreme mood swings
PHYSICAL WARNING SIGNS
-Noticeable fluctuations in weight (up or down)
-Stomach cramps, constipation, acid reflux
-Menstrual irregularities (missing periods, or only having a period on hormonal contraceptives
-Difficulties concentrating
-Abnormal laboratory findings (anemia, low thyroid + hormone levels, low potassium, low white + red blood cell counts
-Dizziness upon standing
-Fainting
-Feeling cold all the time
-Sleep problems
-Cuts/calluses across top of finger joints (self-induced vomiting)
-Dental problems (enamel erosion, cavities, tooth sensitivity)
-Dry skin and hair, brittle nails
-Swelling around salivary glands
-Muscle weakness
-Cold, mottled hands and feet, or swelling of feet
– Poor wound healing
-Impaired immune function
RISK FACTORS
Biological- having a close relative with an eating disorder, having a close relative with a mental health condition, history of dieting, negative energy balance (burning off more calories than you take in), type 1 diabetes (¼ of women diagnosed with type one diabetes will skip insulin injections [known as diabulimia]
Psychological- perfectionism, body image dissatisfaction, personal history of an anxiety disorder, behavioral inflexibility
Social- weight stigma, teasing or bullying, appearance ideal internalization(socalilly ideal body), acculturation, limited social networks, historical trauma or intergenerational trauma
HEALTH CONSEQUENCES
Cardiovascular System- pulse and blood pressure begin to drop as the heart has less fuel to pump blood and fewer cells to pump wit. The risk of heart failure as the heart rate and blood pressure levels sink lower and lower. Purging by vomiting or laxatives depletes your body of electrolytes. Potassium plays a large part of helping the heart beat and muscles contract, and is depleted by purging. Electrolytes such as sodium and chlorine can become imbalanced by puring or drinking excessive amounts of water. Electrolyte imbalances can lead to irregular heartbeats and possibly heart failure and death. Reduced metabolic rate, as a result of the body’s attempt to conserve energy
Gastrointestinal System – slowed digestion(gastroparesis), vomiting interferes with the natural stomach emptying and the digestion of nutrients can lead to stomach pain and bloating, nausea and vomiting, blood sugar fluctuations, blocked intestines from solid masses of undigested food, bacterial infections, feeling full after eating small amounts of food, constipation, binge eating can cause the stomach to rupture, vomiting can cause the esophagus, and cause it to rupture, laxative abuse can damage nerve endings, intestinal obstruction, perforation, or infections, and malnutrition and vomiting can cause pancreatitis.
Neurological – obsessing about food and difficulties concentrating, extreme hunger or fullness at bedtime(issues sleeping), inadequate fat intake can cause numbness and tingling in hands feet and other extremities, electrolyte imbalance can lead to seizures and muscle cramps, if brain + blood can’t push enough blood to the brain, it can cause fainting or dizziness(especially upon standing), individuals of higher body weights can have an increased risk of sleep apnea.
Endocrine – without enough fat and calories levels of hormones can fall (estrogen, testosterone, and thyroid hormones), menstruation to fail to start, become irregular, or stop completely, bone loss ( osteopenia + osteoporosis), reduced metabolic rate, binge eating can cause a body person to become resistant to insulin — leads to type 2 diabetes, body’s core temperature to drop and hypothermia may develop, starvation can cause high cholesterol levels
Other health consequences – Low caloric and fat consumption can cause dry skin, and hair can become brittle and fall out, to conserve body warmth during periods of starvation, the body grows fine hair (called lanugo), prolonged dehydration can cause kidney failure, inadequate nutrition can decrease certain types of blood cells, anemia can develop (causing fatigue, weakness, and shortness of breath), malnutrition can also decrease infection-fighting white blood cells.
Death
BODY IMAGE
Body image is defined as one’s thoughts, perceptions, and attitudes about their physical appearance. How do you see yourself and feel about your body (e.g., height, shape, and weight) when you look in the mirror?
Positive body image is a clear, true perception of your shape; seeing the various parts of your body as they really are. Body positivity (or body satisfaction) involves feeling comfortable and confident in your body, accepting your natural body shape and size, and recognizing that physical appearance say very little about one’s character and value as a person.
A negative body image, on the other hand, involves a distorted perception for one’s shape. Negative body image (or body dissatisfaction) involves feelings of shame, anxiety, and self-consciousness. People who experience high levels of body dissatisfaction feel their bodies are flawed in comparison to others, and these people are more likely to suffer from feelings of depression, isolation, low self-esteem, and eating disorders. While there is no single cause of eating disorders, research indicates that body dissatisfaction is the best-known contributor to the development of anorexia nervosa and bulimia nervosa (Stice, 2002).
Body image concerns often begin at a young age and endure throughout life. By age 6, girls especially start to express concerns about their own weight or shape, and 40-60% of elementary school girls (ages 6-12) are concerned about their weight or about becoming too fat. (Smolak, 2011). Furthermore, over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives (Neumark- Sztainer, 2005). It is important to note that the age of onset differs depending on the individual, and these body image concerns may start younger, or never come up at all.
As with eating disorders, body image concerns can affect us all. While all ages, genders, and cultures are equally at risk for body image issues, there are traditionally different triggers and appearance-related pressures depending on one’s gender. In our Western culture, girls often feel pressure to succumb to the societal appearance-ideal (sometimes referred to as the thin-, beauty-, or cultural-ideal), whereas boys are often faced with social pressures to be lean and muscular.
The body positive movement is making great strides to promote size diversity, body acceptance, and a healthier body image for all ages, genders, races, abilities, etc. It is important that we continue to embrace body diversity by recognizing all bodies as good bodies. While we all may have our days when we feel awkward or uncomfortable in our bodies, the key to developing positive body image is to recognize and respect our natural shape and learn to overpower those negative thoughts and feelings with positive, affirming, and accepting ones.
MYTHS ABOUT EATING DISORDERS
Are eating disorders a choice? – Eating disorders are not a choice. They are complex medical and psychiatric illnesses that patients don’t choose. They are bio-psycho-social diseases, which means that genetic, biological, environmental, and social elements all play a role. Several decades of genetic research show that biological factors are an important influence in who develops an eating disorder. A societal factor (like the media-driven thin body ideal) is an example of an environmental trigger that has been linked to increased risk of developing an eating disorder. Environmental factors also include physical illnesses, childhood teasing and bullying, and other life stressors. Eating disorders commonly co-occur with other mental health conditions like major depression, anxiety, social phobia, and obsessive-compulsive disorder. Additionally, they may run in families, as there are biological predispositions that make individuals vulnerable to developing an eating disorder.
Do parents cause eating disorders? – Organizations from around the world, including the Academy for Eating Disorders, the American Psychiatric Association, and NEDA, have published materials that indicate that parents don’t cause eating disorders. Parents, especially mothers, were traditionally blamed for their child’s disorder, but more recent research supports that eating disorders have a strong biological root. Eating disorders develop differently for each person affected, and there is not a single set of rules that parents can follow to guarantee prevention of an eating disorder, however there are things everyone in the family system can do to play a role in creating a recovery-promoting environment. Psychologists have seen improvements in the speed at which children and adolescents begin to recover when including parents in the treatment process.
Are eating disorders really that serious? – Eating disorders have the highest mortality rate of any psychiatric illness. Besides medical complications from binge eating, purging, starvation, and over-exercise, suicide is also common among individuals with eating disorders. Potential health consequences include heart attack, kidney failure, osteoporosis, and electrolyte imbalance. People who struggle with eating disorders also have intense emotional distress and a severely impacted quality of life.
Aren’t eating disorders a girl thing? – Eating disorders can affect anyone, regardless of their gender or sex. Although eating disorders are more common in females, researchers and clinicians are becoming aware of a growing number of males and non-binary individuals who are seeking help for eating disorders. A 2007 study by the Centers for Disease Control and Prevention found that up to one-third of all eating disorder sufferers are male, and a 2015 study of US undergraduates found that transgender students were the group most likely to have been diagnosed with an eating disorder in the past year (Diemer, 2015).
It’s currently not clear whether eating disorders are actually increasing in males and transgender populations or if more of those individuals who are suffering are seeking treatment or being diagnosed. Because physicians may have preconceptions about who eating disorders affect, their disorders have generally become more severe and entrenched at the point of diagnosis.
HOW SOCIETY PLAYS INTO BODY IMAGE/EATING DISORDERS
Excessive use of Photoshop (in ads, tv shows, movies, and social media)
Glorifying the “Thin Ideal” (weight-loss ads, fashion ads, television, plastic surgery, etc.)
Fitspo and other social media challenges/trends (social media in general, Pro-Ana/Mia[idolizing the eating disorders, within Pro-Ana/Mia, diet tips, ways to lose ‘unnecessary weight’, and ways to become thinner])
The lack of body diversity in popular TV shows/Movies
How beauty is seen as ‘thin’
STAGES OF RECOVERY
1.Precontemplation – The Precontemplation Stage is evident when a person does not believe they have a problem. Close family and friends are bound to pick up on symptoms such as restrictive eating, the binge/purge cycle, or a preoccupation with weight, shape, and appearance even before the individual admits to it. They may refuse to discuss the topic and deny they need help. At this stage, it is necessary to gently educate the individual about the devastating effects the disorder will have on their health and life, and the positive aspects of change.
Do not be in denial of your child or friend’s eating disorder. Be aware of the signs and symptoms.
Avoid rationalizing their eating disordered behaviors.
Openly share your thoughts and concerns with your child or loved one.
2.Contemplation – The Contemplation Stage occurs when an individual is willing to admit that they have a problem and are now open to receiving help. The fear of change may be very strong, and it is during this phase that a psychotherapist should assist the individual in discovering the function of their eating disorder so they can understand why it is in their life and how it no longer serves them. This, in turn, helps the individual move closer toward the next stage of change.
If your child is under the age of 18, insist that they receive professional help from a qualified eating disorder specialist. Educate yourself about the disorder.
Be a good listener.
Do not try to “fix” the problem yourself.
Seek your own encouragement from a local eating disorder support group for family and friends.
3.Preparation – The person transitions into the Preparation Stage when they are ready to change, but are uncertain about how to do it. Time is spent establishing specific coping skills such as appropriate boundary setting and assertiveness, effective ways of dealing with negative eating disorder thoughts and emotions, and ways to tend to their personal needs. Potential barriers to change are identified. This is usually when a plan of action is developed by the treatment team, (i.e. psychotherapist, nutritionist, and physician) as well as the individual and designated family members. This generally includes a list of people to call during times of crisis.
If supporting a loved one in their recovery, identify what your role is in the recovery process.
Explore your own thoughts and beliefs about food, weight, shape, and appearance.
Ask your child/loved one and the treatment team how you can be best involved in the recovery process and what you can do to be supportive.
4.Action – The Action Stage begins when the person is ready to implement their strategy and confront the eating disorder behavior head on. At this point, they are open to trying new ideas and behaviors, and are willing to face fears in order for change to occur. Trusting the treatment team and their support network is essential to making the Action Stage successful.
Follow the treatment team’s recommendations.
Remove triggers from your environment: no diet foods, no scales, and no stress.
Be warm and caring, yet appropriate and determined with boundaries, rules, and guidelines.
Reinforce positive changes without focusing on weight, shape, or appearance.
5.Maintenance/Relapse – The Maintenance Stage evolves when the person has sustained the Action Stage for approximately six months or longer. During this period, they actively practice new behaviors and new ways of thinking as well as consistently use both healthy self-care and coping skills. Part of this stage also includes revisiting potential triggers in order to prevent relapse, establishing new areas of interests, and beginning to live their life in a meaningful way.
Applaud your loved one’s efforts and successes.
Continue to adjust to new developments.
Redefine the boundaries at home as necessary.
Maintain positive communications.
Be aware of possible recovery backsliding.
KNOW
Types of eating disorders
Contributing factors
Health consequences
Recovery Stages
How Body Image plays a role
How media/advertisements play into people developing an eating disorder
The common myths about eating disorders
UNDERSTAND
The differences in the types of Eating Disorders
Warning signs and risk factors
How the process of recovery works
How the media can influence how an individual develops an eating disorder
DEMONSTRATE
How an individual may develop an eating disorder, and what factors can play into it
How an individual can receive help and start the recovery process
SOURCE
https://www.nationaleatingdisorders.org