Eating Issues in Schools: Detection, Management, and Consultation With Allied Professionals

Abstract

It is well documented that eating disorders tend to emerge in adolescence and young adulthood. Recent epidemiological research indicates that the highest incidence (new cases) of anorexia nervosa occurs in young females between the ages of 15 and 19 (Keski-Rahkonen et al., 2007), whereas the highest incidence of bulimia nervosa occurs in young females between the ages of 16 and 20 (Keski-Rahkonen et al., 2009). Because of this age of onset, many individuals who develop eating disorders are students who spend a significant amount of time at school around their peers and school faculty. School counselors, therefore, are in a unique and important position to detect student eating issues in the early stages and to take steps to ensure that student needs are being met. The prevalence of eating-related problems in the schools is difficult to pinpoint. Although anorexia and bulimia are relatively rare in the general population, the most often diagnosed eating disorder is eating disorder not otherwise specified (EDNOS), the category researchers know the least about (Striegel-Moore & Bulik, 2007). In addition, many adolescents struggle with potentially serious eating issues that do not meet the diagnostic criteria for an eating disorder. A recent nationally representative sample of American high school students revealed that a staggering 59.3% of girls and 30.5% of boys were trying to lose weight (Centers for Disease Control and Prevention [CDC], 2010). Nearly 15% of girls and 7% of boys acknowledged having engaged in unhealthy dieting behaviors within the past month (CDC, 2010). Subclinical eating problems such as these can lead to the development of various mental health problems in young adulthood, including depression, anxiety, and substance abuse disorders (Lewinsohn, Striegel-Moore, & Seeley, 2000). Finally, eating disorder statistics do not account for adolescents who in some way are dissatisfied about their body size or shape. Research indicates that between 40% and 70% of adolescent girls are dissatisfied with two or more aspects of their bodies (Levine & Smolak, 2004). Body dissatisfaction is so widespread among adolescent girls that it could be considered a normative discontent (Levine & Smolak, 2004, p. 74). The American School Counselor Association (ASCA) promotes the school counselor's understanding of the continuum of mental health services, including prevention and intervention strategies for addressing academic personal/ social and career development to enhance student success in school counselor preparation programs (ASCA, 2008, p. 39). However, school counseling students are not required to take courses in psychopathology (Council for Accreditation of Counseling and Related Educational Programs [CACREP], 2009). This gap in training could lead school counselors to believe that they cannot adequately manage eating issues in the school setting. This is not necessarily the case. Although it is outside the school counselor's scope to diagnose students with specific mental disorders, they have a critical role to play in assessment, support, referral, and follow-up services (Geroski, Rodgers, & Breen, 1997). Consultation can enhance this role, and counselors can benefit from the existing knowledge base on consultation (Zins, 2002). In alignment with the ASCA National Model, consultation with parents or guardians, teachers, and community agencies to meet student needs is a key element of the delivery system (ASCA, 2005). ASCA (2005) promotes the delivery of responsive services in the schools to address the wide range of needs and concerns of students through counseling, consultation, and referral. It is possible for school counselors, therefore, to take on an expanded role with regard to eating-related problems in schools that encompasses assessment, consultation, and ongoing case management. Thus, the purpose of this article is to provide school counselors with a resource for assessing and managing eating issues in the schools, including when and how to consult with other human service professionals. …