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Just as we’ve started to adapt to socially distanced, virtual ways of living, we now seem to be returning “back” to typical routines of life, almost-post-pandemic. The “back to school” season looks quite different this year: it would seem that resuming our daily, in-person lives should be easy – after all, we’ve lived this way before. However, we’re facing more challenges with the adjustment than ever imagined.  From computer screens to campuses, schools are in the process of repopulating hallways after 18 months of desertion due to the COVID-19 pandemic. Throughout that time, eating disorder diagnoses continued to rise, notably correlated with the timeline and consequences of the pandemic. Below are a few considerations for adolescents and families navigating eating disorders, treatment, recovery, and the return to school this fall.

Encountering Triggers

Triggers may show up differently across individuals struggling with eating disorders. To complicate matters, eating disorders that have developed throughout the pandemic have not yet been managed in the school environment. Adolescents have widely taken to social media to stay connected and current, while unknowingly participating in a tumultuous exchange of information, status, and acclaim across virtual platforms. This has fostered comparisons of food choice, bodies, physical activities – often determined by the number of likes or followers on their social platforms. With the gradual transition out of this digital retreat, there is a high likelihood of social anxiety and comparison: except now in real time, in real peer groups: Who spent quarantine doing what? Who changed? Who didn’t? Who “decided to get healthy?” Who “let themselves go?” Separate from these harmful judgments of food choice and body, desires for productivity to compensate for the perceived lull throughout isolation may breed a drive for competition, perfectionism, and accomplishment.

Unfortunately, these perfectly coincide with the entire essence of school-based academics, activities, and athletics, and may even be encouraged. School health and nutrition classes may devote additional time on textbook nutrition topics: glorifying “healthy foods” and stigmatizing “junk foods,” and may even require the reciting of this information to pass the course. Further, to make up for any disjointed or bypassed sections in previous semesters, course loads are being filled to the brim to meet overall requirements, leaving less time for breaks, meals, snacks, and enjoyable extracurriculars. Safety parameters to protect from the spread of COVID, including plexiglass barriers, limited group sizes in the cafeteria, and reduced availability of foods and beverages may also create opportunities for restrictive eating disorder behaviors. Meal support, a critical component of eating disorder treatment may not be available. Triggers for eating disorder behaviors may be widespread and unpredictable, warranting increases in awareness and accessible support.

Back to School: Post COVID-19

While connection and person-to-person interactions have been limited since early 2020, new ways of accessing other individuals have been generated via online groups, classes, meetings, and sessions; also bringing the potential for connecting individuals struggling with eating disorders with helpful resources. Meeting with a counselor, therapist or dietitian, or participating in a peer support group can now be done from the comfort and privacy of the home. For some, this may even help decrease social anxiety to encourage meaningful connection and participation in supportive discussions. On the other hand, eating disorders have had greater potential to go unnoticed with the more distant nature of interactions, and in some cases – changes in food behaviors, body size, and activity patterns – may have even be celebrated by unknowing family, friends, and medical providers. Given risks of developing disordered eating patterns and/or mood disturbances in the adolescent population, schools and associated faculties (i.e. athletic teams or dietary departments) are encouraged to develop screening tools to assess for the presence of disordered behaviors, and further connect individuals with appropriate support and resources. Educational series regarding the nature and risks of eating disorders, as well as ongoing peer coaching, may be beneficial for maintaining eating disorder awareness and support.

Be on the Lookout

Any transition can be challenging, and eating disorder triggers may be variable and expansive, making awareness critical to supporting a loved one in eating disorder recovery. Staying alert to indications of eating disorder behaviors, both identified and potential, such as the following can serve as perfect opportunities for support and intervention with treating teams:

  • Be aware of increasing anxiety at home or in a new environment. Pressures may be high with navigating the unknowns of the school year, and/or compensating for previously adapted school schedules. Opportunities for regular meals and snacks may be deemed lower priority, and even bypassed in the busy school day to focus on the demands of academic course loads. Your loved one may express anxiety about social engagements and activities with friends.
  • Notice any deviations. Deviations from the consistency of a recommended meal plan, attending therapy or group sessions, and less engagement with support or self-care opportunities established with treatment providers may warrant concern. Food behaviors may be reinstated to cope with the potential demands and emotional stresses of these changes. Notice any changes to frequently accepted foods, patterns of flexibility, and consistency with meal plans. Gently bring attention to these observations and communicate as needed with the providing team.
  • Consider conversation themes. Discussions of food- and body-related topics, comparison to peers, health class topics, or athletic requirements may be a flag for concern. Particularly abrupt interest in athletics or performance-based extracurriculars may benefit from further discussion or exploration as well.
  • Observe opportunities for coping and self-care. With the support of treatment and outpatient providers, your loved one is learning to navigate their world without eating disorder behaviors. Coping skills, grounding tools, and self-care tasks (journaling, reaching out, tactile supports, taking breaks, etc. – the list goes on) suggest that your loved one may be managing without the eating disorder. The dwindling or absence of these necessary practices could suggest increasing difficulty with more healthy coping.

While experiencing any of these difficulties or noticing challenging triggers for eating disorder behaviors within loved ones may unnerving, these obstacles can create opportunities for integrating recovery-oriented approaches and supports for long-term health and wellness.

Integrating Recovery into a School Day

Successful transition through levels of eating disorder treatment already asks for comprehensive planning, communication, and support. With added considerations for a transition back to school, and doing so in a post-pandemic environment, planning and support take on a critical role in the recovery process. Priority on communication and connection will go a long way – whether it be encouraging your loved ones’ direct communication or requesting support from trusted friends, teachers, counselors, and coaches.

  • Collaborate with the school counseling staff to help integrate recommendations from the treatment team, encourage accountability, or help problem solve school-day challenges.
  • Discuss meal plan recommendations and any necessary dietary accommodations with school staff (i.e. ensure adequate meal and snack opportunities, as well as appropriate menu offerings, portions, and opportunities for variety).
  • Consider discussions and support of meal plan adjustments recommended with the start of a sport or activity season.
  • Connect the providing treatment team with relevant school staff as well, including counseling, dietary, and athletic departments to eliminate splitting and potential gaps between these supportive domains.
  • Practice setting boundaries in support of your loved one around triggering and harmful topics often normalized in academic curriculums: health and nutrition classes, weight assessments, BMI classifications, athletic requirements, etc.
  • Access outpatient support groups, now offered both in-person or virtually, in your community. These resources are often available through treatment programs, outpatient providers, and school counseling centers.

Integrating Academic Support Into Treatment

Should eating disorder treatment programming be recommended, your loved one’s needs will be evaluated across a variety of domains to identify the most appropriate course of treatment. Within this assessment, any necessary education accommodations will be discussed to encourage appropriate time and focus on participation in the treatment process. Treatment programs offered at the partial hospitalization and intensive outpatient levels may be attended in conjunction with regular or slightly modified school schedules. Recommendations for treatment at the residential level of care often require the most comprehensive education planning and accommodations, which can be navigated with the support of an education liaison. This liaison is available to facilitate communications between the medical and clinical providers in the treatment setting and the academic supervisors to identify appropriate accommodations, revised course requirements, extended deadlines, and a variety of additional supports to ensure priority focus on treatment while minimizing disruption to academic participation.

Focus on Wellness in the Transition Back to School

As the transition “back toward normal life” is exciting for many, it is important to remember that loved ones struggling with eating disorders are navigating additional complexities that make this process particularly difficult. Awareness of these challenges, as well as possible resources and strategies for coping with them, can shift these potential obstacles into an opportunity for strengthening recovery foundations, accessing support, and reintegrating into life with proliferating wellness.

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Carly Heynes MS, RDN, CLC

Carly Heynes is a Registered Dietitian based in California with over a decade of experience in the field of nutrition and dietetics, with specialization in behavioral health nutrition and eating disorders over the last 6 years. She is the Registered Dietitian at Clementine Malibu Lake in Agoura Hills, CA and values the opportunity to guide adolescents and their families back toward freedom, flexibility, and fun with food. Carly strives to support individuals in rewriting narratives about nutrition that are no longer of service, and in establishing healthy relationships to food, body, and movement.