A new way to teach children about eating disorders

An estimated 1.6m people in the UK have experienced an eating disorder. In the US, these figures are as high as 20m women and 10m men. With numbers like these, and rising levels of body disaffection among young people, tackling eating disorders is an increasingly urgent task.

As well as leading to potentially life threatening conditions, eating disorders have significant social and economic impacts. While we are often told of the burden of obesity on the NHS, it is also worth remembering that eating disorders are reported to cost the British economy £15 billion each year.

These figures are a powerful reminder of the futility of single solutions to complex health problems. The influential (but sometimes simple) approach that focuses on a response to the cult of slenderness, body image and the role of the media, has had a powerful impact on the programmes developed in schools. But eating disorders are extremely complicated conditions. To address this, we are undertaking a collaborative research project with the charity Anorexia and Bulimia Care to explore a more comprehensive approach.

Dealing with the psychological concept of “body image” for example, often focuses on teaching strategies to control an individual’s attitudes in response to external pressures such as media images and peer pressure (both online and offline). The argument goes that eating disorders are linked to the negative body images that develop as a result of the “cult of slenderness” in contemporary media.

While media imagery plays a part, focusing only on body image may be limiting. It fails to tackle the broader socio-cultural conditions within which body disaffection and eating disorders flourish. There is a need to recognise the limitations of a young person’s individual agency in the context of competing messages about healthy bodies that stir up emotions of fear, shame and disgust. Within popular culture, but also, crucially, within official health policy, bodies worthy of aspiration are thin, fit and desirable. They are certainly not “big”.

It may be time to move towards a health education about healthy bodies within a broader context that challenges body size as the focal point of health. “The Fat Pedagogy Reader” is a publication that supports building a more fat positive system of education. The research reveals that exploration of complex social environments should be as central to these programmes as weight, food and the media.

Because while body image, size and weight are certainly important factors, disordered eating and disaffection may equally be about issues of power and control. Research elsewhere points to a wide range of struggles for recognition that young people experience both within and beyond school boundaries. Yet the focus on the culture of slenderness and body image still occupies the focus of many education programmes designed to address body disaffection.

There is a real need for programmes to move beyond a focus on the individual and the perils of the media. We should be working towards a more sophisticated understanding of how culture, injustice and distress are experienced through young people’s bodies and eating practices.

A difficult subject

It is not sufficient or realistic to simply attempt to adjust the mindset of an individual through short term intervention, and expect large scale, lasting change. In order to reduce the incidence of eating disorders and body disaffection in schools a change is needed in the broader environment of school culture. This includes the attitudes of popular culture, parents, health promotion, sport and arts, and mental health services. This will enable moving beyond oppositional thinking about a body’s identity as simply fat or thin, healthy or unhealthy, and success or failure.

In the meantime it is important to recognise that current programs in this area are well intentioned, and not without merit. Teachers may feel torn between what are seen as competing health agendas. Schools are being positioned as vehicles through which to address a range of health problems, on the one hand the concerns about the rise in childhood obesity and on the other, rising levels of unhealthy weight loss.

Although eating disorders and obesity are part of a bigger picture of complex experiences, too often they are seen as having competing agendas and can leave teachers unsure of how best to address sensitive issues related to weight and the body. Current approaches are failing to address and challenge the stigma and stereotypes surrounding the concept of “being fat”. Failing to engage with the complex discourses that shape how children come to learn about the body and health risks fuelling bullying and perpetuating misinformed practices surrounding weight control in schools.

Emma Rich receives funding from the AHRC and from the Wellcome Trust (project exploring the use of digital health technologies) and has previously received funding from the ESRC.

Simone Fullagar has received funding from the Australian Research Council, Canadian Social Sciences and Humanities Research Council, European Commission, British Council, Cancer Research UK.

Niamh Ni Shuilleabhain does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.