I’m a trustee and huge advocate of Beat, the eating disorders charity and I’m excited about an event they’ve got coming up which will see the advertising industry put in the hot seat whilst we debate what role fashion and advertising have to play in body image and eating disorders.You can find full details of the event below.

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Date: Friday 15 March 2013

Time: 10am – 3.45pm

Venue: London College of Fashion, Rootstein Hopkins Space, 20 John Princes Street, London, W1G 0BJ

Does the advertising industry already act responsibly on body image issues, or does there need to be legislation to protect people vulnerable to its influence?

Does advertising follow public opinion, not lead it? Isn’t body image just about personal vanity?
The Body Ideal Debate at the London College of Fashion will bring together views, opinion and expert witness on this fascinating topic.

Speakers from advertising, fashion, media and activism will raise the issues as they see them, inform the debate and get everyone thinking.

Audience participation will be encouraged, and we expect to see hearts and minds changed by the end of the day- we just can’t predict which way!

Confirmed speakers include:

Professor Frances Corner, Head of London College of Fashion

Susie Orbach, psychotherapist and writer

Wayne Hemmingway, designer and entrepreneur

Elspeth Lynn, creative director M&C Saatchi

Louise McCabe, Head of Corporate Social Responsibility ASOS

Download the final programme here

The debate will be of interest to the Advertising industry, staff and executives;

Photographers; Models, their agents and bookers; Designers and fashion industry experts

Fashion retailers; Marketing staff and executives

Educational establishments, fashion, media and related college students and staff

Clinicians and researchers into eating disorders and body image

Journalists, feature writers, magazine editors, and bloggers

The debate costs £175 which includes lunch and refreshments. Discounts available for bookings of three or more participants, and for Beat Professional Network members.

Book now:

Online: visit the Beat website

Over the phone: call Beat on 01603 753304

Email: conferences@b-eat.co.uk

Paper: download this booking form

Susan Ringwood, Chief Executive of Beat says “eating disorders are complex illnesses, with no single cause, but body image and self esteem are definitely part of the mix for most people affected. We’re really keen to raise this debate among people who know how the creative industries work, know the constraints and realities as well as see the possibilities for change”.

If you found that interesting, you may also like to watch this video from Huffpost live which discusses the issues in some depth.

Pro-ana – website that promotes anorexia

Pro-mia – website that promotes bulimia

Thinspiration / Thinspo – images to inspire weight loss

Fitspiration / Fitspo – images to inspire exercise / body building

In this post we’re going to consider pro-ana and pro-mia sites, who uses them, why they’re dangerous and what parents and schools can do to decrease they’re impact on the young people in their care.

What are pro-ana and pro-mia sites?

Pro-ana and pro-mia sites are websites that promote anorexic and bulimic lifestyles.  Set up by people with eating disorders looking to validate their illness and seeking suppo

rt to continue with their eating disorder from fellow sufferers these sites vary hugely in their precise content.  They are often a forum for people to exchange pictures and weight loss or purging tips and to encourage one another’s weight loss. 

Who uses pro-ana and pro-mia sites?

These sites are often a refuge for people suffering from eating disorders.  It’s common for sufferers to feel quite isolated having pushed away their family and friends preferring to seek out like-minded individuals online.  There are over 500 such sites and the latest studies predict that they attract more than 500,000 unique visitors a year of which the majority are teenage girls and one in five are aged between six and eleven.

Why are they dangerous?

These sites are dangerous because they encourage the users to embrace eating disorders – seeing them as a lifestyle choice rather than the serious mental health condition which they actually are.  The sites share tips and tricks designed to exacerbate eating disorders and there is often a support network which will encourage people to consume ever fewer calories, or purge longer and harder.  With most things in life, if you have a good teacher and a good support network then your skills in and dedication to a particular topic will increase more quickly and this is true also of anorexia nervosa and bulimia nervosa whose onset can be expedited and exacerbated by pro-ana and pro-mia sites.  The sites also make recovery far harder as they contradict anything a young person may be told about the benefits of recovery and the downsides of eating disorders.

Highlight alternative sources of information

Many young people come across these sites as they have body image issues or the early symptoms of an eating disorder and are looking for more information or support, coming across a pro-ana site can catapault them into a terrifying new world where their eating disorder may rapidly develop even if they don’t intend for that to happen.  As such, it’s important that we make it clear to young people where there are trusted sources of information and support about eating disorders – such as the Beat website and helpline (0845 634 7650).  Also let them know that you’re always happy to talk to them about concerns of this type.

Teach young people that eating disorders are serious mental health conditions

Ensure that young people understand that eating disorders are serious mental health conditions and not lifestyle choices as suggested by many pro-ana and pro-mia sites.  Young people need to know that eating disorders can be fatal – anorexia nervosa being the most lethal of all mental health conditions with 10% of sufferers dying from complications of the illness or suicide.

Encourage young people to share their concerns about their friends

Often, friends can be the first to pick up the early warning signs of eating disorders – or may know that a friend is actively using pro-ana or pro-mia sites (though they are likely to refer to them in quite a different way).  Explain to students who they should talk to if they’re concerned, why it’s important and what’s likely to happen next.  Teach students that a good friend is one who supports and looks out for a friend when they’re in need and that by alerting a teacher or parent to the early signs of an eating disorder they could be saving their friend’s life – even if their friend might be angry in the short-term.

Act on your concerns

If you suspect that a young person is using these sites then it’s vital that you intervene.  Talk openly to the young person and allow them to share any concerns they currently have with you.  You need to listen and ask plenty of open questions and be prepared to act on what you find out – this might mean referring the student to the lead teacher at school or the school counselor.  If you’re a parent it might mean talking to the school or visiting your GP.  But take some action and make sure the young person feels supported and cared for – and try to discourage them from using pro-ana sites, but be aware that cutting them off cold turkey or removing all of their internet access is likely to be counter-productive.  Instead take a controlled, respectful approach, discussing with the young person concerned why such sites are a bad idea and agreeing restrictions on their use until they can be weaned off or find a more acceptable alternative.

Other posts you might be interested in:

What’s the difference between a diet and an eating disorder?

What can teachers do to help pupils with eating disorders?

Overcoming pupil objections to informing parents about their eating disorder

Physical warning signs that a young person might have an eating disorder

Behavioural warning signs that a young person might be suffering from an eating disorder

Below, I’ve outlined 3 of the most common negative reactions you’re likely to encounter from parents and how to respond.

Parents think you’re blaming them for their child’s difficulties

It’s quite common for parents to think that you’re pointing the finger at them and that’s why you want them to be involved.

You should accept that the news may come as a horrible shock to parents and calmly explain that no blame is intended. You think they are good parents, which is why you’re seeking their support and help.

Useful phrases include:

“No one is to blame for Amy’s illness, not Amy, not us and not you.”

“You are clearly very supportive parents, that’s why we called you.”

“Amy is very lucky to have supportive parents such as yourselves.”

“We’re not interested in attributing blame, we just want to help Amy get better and we’re sure you can help.”

Parents think you’re blowing the problem out of proportion

Some parents will minimise the problem or refuse to accept that there is an issue at all.  In this instance you need to explain exactly what is causing your concern and why you think there is an issue. Parents who react like this are sometimes unaware of the existence of eating disorders. You may need to help them learn about such disorders and their ramifications.

Useful phrases include:

“You’re right, not everyone who goes on a diet has an eating disorder, but in James’ case there are certain warning signs that tell us he’s taken things too far.”

“James may be in the very early stages of an eating disorder but he is far likely to recover completely and be able to get on with his schoolwork and his life if we address his problems early.”

“The reason we’re worried about James is because we’ve noticed that….”

Parents don’t think the school should be involved

Occasionally a parent will feel that this type of concern is beyond the school’s remit and should be dealt with solely at home. Explain how the school will be able to offer support and guidance and discuss with them, on a basic level, that as the child spends half their time in school, the school does need to be involved as eating disorders continue 24 hours a day.

Useful phrases include:

“We’re keen to work with you and support you – we really think we can help.”

“If we all work together to support Sandra, she is far more likely to get better.”

“We’re not trying to tell you how to care for your daughter, we simply want to offer our support.”

I’ve put these suggestions together in a presentation that you might find useful for training purposes at school.  Please let me know if you find it useful or if you have any suggested additions or amendments.

Other posts you might find helpful

Overcoming pupil objections to informing parents about their eating disorder

The importance of early detection of eating disorders

What can teachers do to help pupils with eating disorders?

Other Posts you may find useful:

What is bulimia?

Eating disorders – dispelling urban myths

Overcoming pupil objections to informing parents about their eating disorder

Tackling the eating disorders taboo in school

Teaching pupils about eating disorders

Russell’s sign – callussed knuckles from repeatedly inducing vomiting

Never promise confidentiality

Of course, we all know that if there is any possibility of a pupil doing themselves harm then we simply cannot keep their confidentiality – it could put both the pupil, and your job, in jeopardy.  However, you can be sure that if a pupil does build up the courage to talk to you about their eating disorder, then one of their first pleas will be ‘Please don’t tell anyone!’

It can feel frustrating not being able to succumb to this caveat and it always feels entirely possible that you will lose the pupil’s hard-earned trust if you refuse, but being upfront and honest now will pay dividends in the long run.  If you promised to keep their trust then broke that promise, the fall-out would be far greater than if you tell a few difficult home truths now.

Involve the pupil

In order to retain the pupil’s trust you need to involve them in the process of informing others – always consider who, what, why and how with the pupil before you disclose details of their difficulties to anyone else.

WHO should you talk to?

Discuss with the pupil who you think needs to be told about their difficulties.  This list will depend on your school’s policies and procedures and how advanced the pupil’s eating disorder is, but people who you might want to consider informing are:

• The pupil’s parents
• The person with lead responsibility for eating disorders in your school, this may be the child protection officer, the head of pastoral care or the head teacher.
• The pupil’s form tutor
• School nurse / counselor
• A close friend of the pupil

WHY should you talk to them?

Talk to the pupil about why or why not specific people should be told about their eating difficulties.  You are likely to come up against a lot of opposition when you suggest telling their parents as pupils are often concerned about worrying their parents or think they will be upset or angry.  Eating disorders are a very secretive illness and it will have taken a huge amount of courage for the pupil to have confided in you, so the thought of telling other people will terrify them.  You need to be able to give justifications for sharing the information with each new person.  These may include:

• You have to, it’s school policy that X should be told
• They will be able to offer support
• They may have been worrying about the pupil and will be relieved that steps are being taken to address things
• They need to know so they can make certain allowances for the pupil

WHAT will you say?

As well as agreeing who you should speak to and why, you should discuss with the pupil exactly what information will be shared.  It’s likely that the pupil has told you a lot more than needs to be passed on and there may be some aspects of what they’ve shared that they consider to be embarrassing or highly personal and would prefer you left out when passing the information on.  Between you and the pupil you should be able to agree what each person needs to know in order to be able to offer the most appropriate support or follow up.  In general the pupil will feel happiest if you share a minimum of information, as they become more comfortable with talking about their eating disorder they may happily share more information.

HOW will you tell them?

Talk to the pupil about how the people you’ve agreed will be told about their eating disorder.  Do they want you to pass on the information?  Would they like to do it themselves?  Would they like you to support them in having the conversation?  Perhaps they’d like to work with you to write a letter if they think a face to face conversation would simply be too difficult.  Think too about where the conversation should take place, at school? At home? Outside of school? All these seemingly small factors can make a huge difference to a pupil who is panicking about their secret ‘getting out’.

Allow the pupil to feel in control

The important thing about this process is that you’re enabling the pupil to feel like they’re retaining some control of the process.  Of course you’ll have to do some steering to make sure that the appropriate people are informed, but if you work with the pupil and allow them to input into the process then they will feel like you’re on their side and that this process is happening with them not to them which is a very important distinction for someone who is coming to terms with an eating disorder – and whose symptoms are likely to be exacerbated any time they feel out of control.

Other posts you might find useful

Worried a pupil might have an eating disorder? When should you say something?

What should you say when a young person confides in you about their eating disorder?

Overcoming pupil objections to informing parents about their eating disorder

5 useful phrases when talking to someone with an eating disorder

Get to know their healthcare practitioner

The school should appoint a key person who is responsible for liaising with the unit where the child is resident – this could be the head of pastoral care or the child’s form tutor.  That person should make sure they have the full contact details of the key person who is assigned to the child’s care at the unit and make themselves known.  Arrange a meeting if possible, and if not then speak on the phone.  The aim of the meeting is to make it clear that:

• Who the main point of contact is at the school and how to get hold of them
• The school is keen to support the child’s recovery in any way possible – ask for guidance on this
• The school is happy to coordinate the provision and marking of academic work if appropriate
• The school would like regular updates about the child’s recovery
• You would like to know what it is appropriate to tell staff and pupils about the student’s absence
• You would like the child to know you called and that you / staff / friends are thinking of them

Don’t be afraid to ask for updates

Inpatient units are very busy places – it can be difficult for staff to keep on top of requests for regular updates about a particular patient, especially if these do not come from parents.  Of course, the staff all want what is best for the patient and are likely to be very helpful if you call to enquire about their progress so don’t be afraid to pick up the phone.  You should start your call by asking if it’s a good time, and if not, when would be the best time to call to talk to someone about X as it’s very possible that you’ve called at a difficult moment.

Providing academic work

The school should be prepared to provide and mark academic work if this is deemed appropriate by the unit.  Alternatively, the school may be asked to liaise with an onsite education team to discuss the student’s academic background and progress so that the onsite team can provide appropriate schooling.  Of course, during a stay at an inpatient unit, the main focus is on restoring health and not on academics so it is to be expected that the pupil will not make the usual expected academic progress.  However, following their inpatient stay pupils should be far more able physically, emotionally and cognitively to tackle their school work – though you should seriously consider revising your academic expectations during recovery.

Contact with friends

Depending on the severity of the pupil’s illness and the general approach taken by the unit, the amount of contact allowed with friends could vary greatly.  Many units will remove access to mobile phones and the internet during the most intense period of recovery – but they are still likely to welcome letters and cards from friends at school.  If visiting or phone calls are allowed, you should encourage pupils to maintain contact with their friend if they feel comfortable doing so.  Maintaining contact with their friends during an inpatient stay can help young people with eating disorders to remember who they were before their life was taken over by their eating disorder and this can be motivating during recovery.  If pupils are sending cards, letters or emails to their friend in an inpatient unit, please encourage them to continue doing so for the duration of their friend’s stay.  They may not receive any replies, but in almost all instances, cards, letters and other contact will be gratefully received by patients, even if they feel unable to formulate a reply.  If for any reason the contact is upsetting or inappropriate then the unit staff will let you know.

Preparing staff and peers for their return to school

There can be many questions surrounding a pupil’s return to school following a period of absence.  You cannot ignore the significance of this event and it is far better to think ahead and prepare staff and students by giving them an opportunity to explore their thoughts and questions prior to the pupil’s return.  You should be able to seek some guidance from staff at the unit about what information it is appropriate to share with staff and peers.

Seeking advice from the unit prior to return

There is a lot of information that can be usefully shared with the school by the unit prior to the pupil’s return.  This will not automatically happen so you need to be prepared to ask.  Key questions you can ask are:

• Does the pupil have a meal plan?
• How best can the school support the pupil during meals?
• How much sport / exercise should the pupil be allowed to undertake?
• What (if any) academic progress has the pupil made whilst in the unit?
• What should the school do if they are worried the pupil might be relapsing?
• Can the school retain regular contact with the unit for advice / updates?
• Who is responsible for the pupil’s care after discharge? Can they be put in touch with the school?

Opting for a phased return to school

A phased return to school can be a less daunting alternative for a pupil than going immediately from being a full time inpatient to a full time pupil overnight.  By working with staff at the unit alongside the pupil and their parents, you can agree a schedule for a phased return over a few weeks.  This might start with the pupil having increased access to school staff and friends at the unit, followed by a visit to school for a few hours.  You might then work towards them returning to school on a part time timetable and eventually attending full time.  Remember, it is better to take things slowly and at a pace that is manageable for the pupil rather than to try and rush things and risk ending up at square one.

Maintaining contact with the unit during recovery

If the pupil’s care still officially falls under the unit, then it is helpful if you are able to stay in regular contact with the staff there.  This can help you to tackle any difficult issues that arise during recovery and prevent a significant relapse.  If the pupil’s care is to be passed to an alternative care provider then you should try to arrange a meeting / telephone call with them so that they can support you, in supporting the pupil during recovery.

Other posts you may find useful

How and why you should alter your academic expectations for eating disorder sufferers

Mealtimes – 10 ideas for supporting recovering anorexics

What can teachers do to help pupils with eating disorders?

What not to say to recovering anorexics

Safe participation in schools sports for young people recovering from anorexia nervosa

Involving parents in their child’s eating disorder recovery

Over-exercise and anorexia nervosa

If left unmonitored young people suffering from anorexia nervosa will often choose to exercise hard for many hours a day in order to burn calories.  This level of activity is clearly unacceptable during recovery, but removing the ability to exercise or participate in sport at all can be detrimental to their long-term recovery.  It is important that pupils who habitually over-exercise learn to form a more healthy relationship with exercise in the same way that they must improve their relationship with food.

The social aspect of school sport

There is a certain extent to which it is important to try and include a pupil recovering from an eating disorder in as many normal school activities as possible – and sport / PE is no exception.  Exempting a pupil from PE quickly marks them as different which can feel stressful for them and lead to questioning and sometimes teasing from their peers.

Seek guidance from health providers

If the pupil is in some form of treatment, it is a good idea to approach their health providers to discuss what would be an appropriate level of sporting activity for them to be participating in.  At its most extreme, anorexia can result in patients being prescribed complete bed rest whilst their bodies are re-nourished.  However, if a pupil is considered well enough to attend school, then it is likely that their health practitioner will condone some level of exercise. 

Work with the pupil to agree a healthy exercise plan

As ever, it is important to ensure that the pupil is allowed to feel some sense of control over their own life.  Rather than being told exactly how much exercise they can do, and when, this should form the basis of a discussion between the pupil, the school, their health practitioners and their parents.  If the pupil desperately wants to be involved in a sporting activity at a level or intensity that is considered inappropriate by their health provider then instead of telling the pupil ‘no’ work together to decide what other recovery targets must be met before they are able to participate.  And think of ways to work towards these targets and to gradually increase their participation in their chosen sport. 

Work with parents

Where possible, parents should be involved throughout the conversation, but if this is not the case you should inform parents about the exercise plan agreed for their child.  It’s important that they are aware of how much and what types of exercise it is appropriate for their child to be taking as they will be responsible for monitoring the pupil’s exercise habits outside of school hours.  Make sure that the lines of communication are open or you may find a situation where the pupil plays the school off against their parents allowing each to believe they are doing no exercise in the other setting.

Exercise diaries

In more extreme cases, and particularly where a pupil is learning to overcome a compulsion to over-exercise, an exercise diary can be a helpful tool. Where, relevant, this is something that can be used to form the basis for discussion during treatment sessions so the pupil could choose to record thoughts and feelings in addition to stats about the amount and type of exercise undertaken.

Determine which types of activities are most acceptable

As well as the amount of exercise to be taken, there should be some discussion around the type of exercise that is appropriate.  If, for example, a pupil has been obsessively using gym equipment or cross country running in a quest to lose weight, this form of exercise may have extremely unhealthy associations for them and they may struggle to exercise in a measured way.  It can often make sense to avoid ‘trigger sports’ during the early days of recovery.  Equally, it may be inappropriate to allow a pupil to participate in a sport to competition level as their perfectionism and drive to succeed can make it difficult for them to avoid over-exercising and they may not be psychologically ready to be put into a highly competitive situation.  Additionally, sports which have weight category requirements are likely to be inappropriate until the pupil is at an advanced stage of recovery.  Again, their health care practitioner will be able to offer sound guidance on these points.

Ensure weight / physique is not a focal point for coaches

Any sports coach or PE teacher working with the pupil, either within school hours or extra-curricularly should be made aware of their eating disorder (with the pupil’s permission) so that they can help the pupil to exercise in a healthy way.  It is paramount that they do not make comments about the pupil’s physical appearance or weight, even if they perceive their comments to be positive.

Exercise and sport as a means of relieving stress

If an appropriate balance is found, sport and exercise can be a very positive outlet for a pupil’s stress during the difficult process of recovery.  Some slightly alternative options like yoga or pilates are well worth considering.

10 warning signs that a young person might have anorexia

How and why you should alter your academic expectations for eating disorder sufferers

Mealtimes – 10 ideas for supporting recovering anorexics

What can teachers do to help pupils with eating disorders?

What not to say to recovering anorexics

Other posts you may find useful

10 warning signs that a young person might have anorexia

5 useful phrases when talking to someone with an eating disorder

Healthy weight loss can put young people at risk of anorexia

Teaching pupils about eating disorders

Weight change – the ultimate eating disorder warning sign

Anorexia warning signs

If the school becomes aware of a pupil’s eating disorder before the parents then it’s important to invite parents on board to work with you to support their child’s recovery.

Once you have overcome any objections from the pupil, you should aim to organise a meeting with the parents as quickly as possible.

This post looks at how to organise the meeting and how to ensure it runs effectively

Think about location

With the help of the pupil, decide where the meeting should be held – at school, in their home or on neutral territory.  You should do whatever you think will make the pupil, and their parents, feel most comfortable.

Who should attend?

Obviously the pupil and their parents should be present, the pupil may also like to bring a friend along for support and you might decide to have a couple of different members of staff present – for instance the head of pastoral care and the pupil’s form tutor.  Again, you should check with the pupil about what they’ll feel comfortable with and try not to set up a scenario which will be too intimidating for the parent.

The room setup is important

Try to make sure that the room setup lends itself to open conversation – a round table, or no table at all feels less intimidating to all involved than being pitched against each other across a desk.  Make sure the room is a comfortable temperature and that there will be absolutely no interruptions.  Phones should be off and minds should be focused.

Make sure you have tea and tissues!

Tea or water will give people something to hold and divert their attention to during the more difficult moments – also you’re all likely to do a lot of talking so you may get thirsty.  Tissues too are a must.  This is likely to be a very emotionally charged meeting for all involved.  That’s okay as you’ll all soon be working together to make things better.

Remain objective

When outlining the pupil’s eating disorder to their parents, try to explain it objectively.  “We think Jane may be suffering from Anorexia… anorexia is…” is better than emotively charged statements such as “We’ve been distraught with worry, the weight has been dropping off Jane and she just hasn’t seemed happy for weeks.”

Focus on practical steps

This is not the place to dwell on WHY the pupil has developed an eating disorder.  Your job is not to look back but to look forwards at the practical steps towards helping the pupil get better.  Pscyhologists or counsellors far more qualified than you will explore the underlying reasons for the eating disorder with the pupil.  Your job is to work with the parents to ensure that pupil receives that help.

Agree next steps

By the end of the meeting, everyone should be agreed about what the next steps are and who is responsible.  This will probably involve the pupil and their parents visiting the family doctor and you might also like to arrange another meeting in a week or two to follow up.

Share your contact details and be available

Make sure that you give the parents your contact details and ensure that they feel welcome to use them.  Let them know the best time to contact you.  They are likely to have questions after the meeting as they will have had a huge amount to take in and to come to terms with.

Other Posts you might find useful

Overcoming pupil objections to informing parents about their eating disorder

Eating disorders policy for use in your school

Practical listening skills when talking to someone with an eating disorder

What should you say when a young person confides in you about an eating disorder