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INTRODUCTION
Eating disorders are among the leading health problems in the United States. Typically diagnosed during adolescence, initial symptoms of eating disorders "are becoming more prevalent … in elementary and middle school years" (White, 2000). The most common eating disorders--anorexia nervosa, bulimia, and binge eating—involve issues and behaviors around body image distortions, food, and interpersonal relationships. Eating disorders are serious, complex, and sometimes fatal.
BACKGROUND
Throughout the United States, as many as 5 - 10 million adolescent girls and women and nearly 1 million boys and men are struggling with eating disorders (National Eating Disorders Association, 2001). In the past it was believed that the population at risk was affluent, young girls. More recent research reveals that risk factors for eating disorders are much broader and multifaceted (Marshall, 1998; ANRED 2002; White, 2000),
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Biologic risk factors: affective disorders, chemical deficiencies, endocrine abnormalities
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Individual risk factors: age (elementary through college age), low self-esteem, identity issues, gender
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Family risk factors: conflict avoidance, boundary issues, and dysfunctional patterns
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Cultural risk factors: emphasis on thinness, chronic dieting, and dissatisfaction with body.
The school nurse is in a prime position within the school setting to identify students with actual or potential eating disorders because of her/his regular contact and interaction with students.
RATIONALE
Studies indicate that eating disorders most commonly peak during the school age years and may be found during routine school nurse screenings or assessments (ADA, 1998; ANRED 2002; White, 2000). The school nurse office may offer a comfortable environment for students at risk for developing eating disorders to learn how to cope with destructive attitudes and behaviors. School nurses are excellent resources for staff members who have identified students at risk. The school nurse has connections with mental health-care providers and is often in a position to determine appropriate referrals/contacts within the community.
ROLE OF THE SCHOOL NURSE
The National Association of School Nurses believes that students with eating disorders have the right to receive health care that is planned, provided, supported and/or managed by the professional school nurse. School nurses are uniquely prepared to assess and to formulate a nursing diagnosis and plan of care for a student diagnosed with an eating disorder. As appropriate, the school nurse involves the family or outside referral agencies for further evaluations. Surveillance for risk factors and prevention through health education/support groups with at-risk youth provides an opportunity to identify students early. The school nurse can play a vital role in the promotion of greater therapeutic success and greater school success in the treatment of students with eating disorders.
REFERENCES
American Academy of Pediatrics (1996). Eating disorders: What you should know about anorexia and bulimia. Guidelines for teens. Elk Grove Village, IL: Author.
American Dietetic Association (ADA) (September 28, 1998). Position of the American Dietetic Association: Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified (EDNOS). Retrieved May 5, 2002, from http://www.eatright.com/adap0701.html
Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED). (2002, February). Statistics: How many people have eating disorders? Retrieved May 5, 2002, from http://www.anred.com/stats.html
Farley, D. (1997). On the teen scene: Eating disorders require medical attention. FDA Consumer Magazine. Retrieved October 29, 2002, from www.fda.gov/fdac/reprints/eatdis.html.
Marshall, L. (1998). Eating disorders. In M.A. Boyd & M.A. Nihart (Eds.), Psychiatric nursing: Contemporary practice (pp. 668-698). Philadelphia, PA: Lippincott.
National Eating Disorders Association (2001). Eating Disorders Information Index: Statistics. Retrieved May 5, 2002, from http://www.nationaleatingdisorders.org/custom/customPages/viewPage.asp?WebPage_ID=286&Profile_ID=41138
National Eating Disorders Association. Research on males and eating disorders. retrieved October 29, 2002 from http://www.nationaleatingdisorders.org
Orbanic, S. (2001). Understanding Bulimia: Signs, symptoms, and the human experience. American Journal of Nursing, 101(3). 35-41.
White, J. (2000). Eating disorders in elementary and middle school children: Risk factors, early detection, and prevention. Journal of School Nursing, 16, 28-36.
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