Rosa Herrera

Eating Disorders Lesson Plan

Anticipatory Set:
Crash Course video.
Kahoot Game!
Only girls can get eating disorders False! Although they are most common among college
females, men and women of all backgrounds and ethnicities suffer from eating disorders and
body image issues.
Eating disorders aren't serious, they're just a phase: today in the U.S., an estimated 20
million women and 10 million men have suffered from a clinically significant eating disorder at
some point in their life. *prevalence rate comparison: 30 million Americans with ED; 6 million
Americans with Alzheimers. Eating disorders are psychological illnesses that often come with
serious consequences. Eating disorders are physically and emotionally destructive! People with
eating disorders need to seek professional help immediately. If not identified or treated in their
early stages, eating disorders can become chronic, debilitating, and life threatening. EDs are
the number one most fatal mental illnessthe mortality rate is 12 times higher than the death
rate associated with ALL causes of death for girls and young women age 15-24.
Causes of Eating Disorders
Eating Disorders are complex disorders, influenced by a facet of factors. Though the exact
cause of eating disorders is unknown, it is generally believed that a combination of biological,
psychological, and/or environmental abnormalities contribute to the development of these
illnesses.
Examples of biological factors include:
Irregular hormone functions
Genetics (the tie between eating disorders and ones genes is still being heavily
researched, but we know that genetics is a part of the story).
Nutritional deficiencies
Low dopamine and serotonin levels: dopamine is involved in regions of the brain
connected to hunger and eating like the hypothalamus. Some research has found that
binge eating appears to alter the regulation of dopamine production in a way that can
reinforce further binging- addictive
Examples of psychological factors include:
Negative body image
Poor self-esteem
Examples of environmental factors that would contribute to the occurrence of eating disorders
are:
Dysfunctional family dynamic
Professions and careers that promote being thin and weight loss, such as ballet and
modeling
Aesthetically oriented sports, where an emphasis is placed on maintaining a lean body
for enhanced performance.
Examples include:
Rowing
 Diving
Ballet
Gymnastics
Wrestling
Long distance running
Family and childhood traumas: childhood sexual abuse, severe trauma
Cultural and/or peer pressure among friends and co-workers
Stressful transitions or life changes
The most common behavior that will lead to an eating disorder is dieting.
My friend is obsessed with food. Theres no way she can have an eating disorder.
Actually, a red flag for an eating disorder is a sudden, extreme obsession with food, collecting
recipes and watching food TV. The less food they eat, the more they want to study it.
Isnt too thin so must be fine. Even if someone isnt dangerously underweight, they may still
have an illness that needs treatment. And because bulimics dont purge most of the calories
they consume, they are often of normal weight or may even gain some.
Young girls (1st-3rd) are not concerned about their weight:
According to the National Eating Disorder Association, 42% of 1st-3rd grade girls want to be
thinner.
51% of 9 and 10 year-old girls feel better about themselves if they are on a diet
46% of 9-11 year-olds are "sometimes" or "very often" on diets, and 82% of their families are
"sometimes" or "very often" on diets
81% of 10 year olds are afraid of being fat. 51% of 9 and 10 year old girls feel better about
themselves if they are on a diet.
Time Magazine reports that 80% of all children have been on a diet by the time that they have
reached the fourth grade
Over half of teenage girls and of teenage boys have used troubling weight control methods
like fasting, skipping meals, smoking, vomiting, or taking laxatives
Short Lecture/Lead Out
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5

Pica is an eating disorder that involves eating items that are not typically thought of as food and
that do not contain significant nutritional value. Dirt, paint, hair, paper, etc. The eating of
nonnutritive substances can be associated with another mental disorder, (e.g., intellectual
disability, autism spectrum disorder, schizophrenia) or medical condition (e.g., pregnancy or iron
deficiency anemia).
Warning signs:
Eating or swallowing substances that are not food.
An obstruction or perforation (hole) in the intestines. These may be caused by nonfood
substances building up in or perforating the intestines.
Heavy metal poisoning, caused by the ingestion of metal-based substances.
Mechanical bowel problems, such as a physical obstruction of the intestine, caused by
ingested items.
Intestinal obstruction, or a blockage that prevents food and water from passing through
the intestines.
 Bezoar, a mass of indigestible material found trapped in the gastrointestinal tract
(esophagus, stomach or intestines).
Intestinal perforation, caused by the ingestion of a nonfood item that creates a hole in
the wall of the stomach, intestines or bowels.
Infections such as toxoplasmosis and toxocariasis may occur as a result of ingesting
feces or dirt.
Poisoning, such as by ingestion of lead-based paint

ORTHOREXIA NERVOSA an obsession with eating foods that one considers healthy.
a medical condition in which the sufferer systematically avoids specific foods in the belief that
they are harmful. Following a healthy diet does not mean you are orthorexic, and there is
nothing wrong with eating healthfully. Unless, however, 1) it is taking up an inordinate amount of
time and attention in your life; 2) deviating from that diet is met with guilt and self-loathing;
and/or 3) it is used to avoid life issues and leaves you separate and alone.
www.eatingdisorderhope.com
Night eating syndrome is an eating disorder, characterized by a delayed circadian pattern of
food intake. ... It differs from binge eating in that the amount of food consumed in the
evening/night is not necessarily objectively large nor is a loss of control over food intake
required.
A subtype of body dysmorphic disorder, which in itself is a variant of obsessive-compulsive
disorder. Sometimes called bigorexia, muscle dysmorphia is the opposite of anorexia nervosa.
People with this disorder obsess about being small and undeveloped. They worry that they are
too little and too frail.
Rumination syndrome, or Merycism, is an under-diagnosed chronic motility disorder
characterized by effortless regurgitation of most meals following consumption, due to the
involuntary contraction of the muscles around the abdomen.
A feeding disorder in infancy or early childhood is a child's refusal to eat certain food groups,
textures, solids or liquids for a period of at least one month, which causes the child to not gain
enough weight, grow naturally, or cause any developmental delays.
www.endocrineweb.com
Diabulimia (a portmanteau of diabetes and bulimia) refers to an eating disorder in which people
with Type 1 diabetes deliberately give themselves less insulin than they need, for the purpose of
weight loss. Diabulimia is not currently recognized as a formal diagnosis by the medical or
psychiatric communities.
Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis in the DSM5, and was
previously referred to as Selective Eating Disorder. ARFID is similar to anorexia in that both
disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia,
ARFID does not involve any distress about body shape or size, or fears of fatness.
Although many children go through phases of picky or selective eating, a person with ARFID
does not consume enough calories to grow and develop properly and, in adults, to maintain
basic body function.
PRADER-WILLI: A genetic disorder that causes obesity, intellectual disability, and shortness in
height.
Anorexia athletica (sports anorexia), also referred to as hypergymnasia is an eating disorder
characterized by excessive and compulsive exercise.
Other Specified Feeding or Eating Disorder
(Described as Eating Disorder Not Otherwise Specified (EDNOS) DSM-IV)
A feeding or eating disorder that causes significant distress or impairment, but does not meet
the criteria for another feeding or eating disorder.
Examples include:
Atypical anorexia nervosa (weight is not below normal) includes those individuals who
meet the criteria for anorexia but who are not underweight despite significant weight loss.
Bulimia nervosa (with less frequent behaviors)
Binge-eating disorder (with less frequent occurrences)
Purging disorder (purging without binge eating)
Night eating syndrome (excessive nighttime food consumption)

ANOREXIA 2 general subtypes

Restriction: extremely low-cal diet, excessive exercise
Binge/Purge: eating but purging it all
Highest mortality rate of any psychological disorder. People can die as a direct result of extreme
weight loss and physiological damage
Mortality rates associated with major depression, PTSD, etc, tend to be the result of secondary
behavior like suicide or drug abuse.
Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate
weight gain in growing children); difficulties maintaining an appropriate body weight for height,
age, and stature; and, in many individuals, distorted body image. People with anorexia generally
restrict the number of calories and the types of food they eat. Some people with the disorder
also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.
Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities.
Historians and psychologists have found evidence of people displaying symptoms of anorexia
for hundreds or thousands of years. People in non-Westernized areas, such as rural China and
Africa, have also been diagnosed with anorexia nervosa.
To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be
met:
1. Restriction of energy intake relative to requirements leading to a significantly low body weight
in the context of age, sex, developmental trajectory, and physical health.
2. Intense fear of gaining weight or becoming fat, even though underweight.
3. Disturbance in the way in which one's body weight or shape is experienced, undue influence
of body weight or shape on self-evaluation, or denial of the seriousness of the current low body
weight.
Anorexia is the third most common chronic disease among young people, after asthma
and type 1 diabetes.
Young people between the ages of 15 and 24 with anorexia have 10 times the risk of
dying compared to their same-aged peers.
 Males represent 25% of individuals with anorexia nervosa, and they are at a higher risk
of dying, in part due to the fact that they are often diagnosed later since many people
assume males dont have eating disorders.
Bulimia Nervosa occurs in another 2 to 5 out of every 100 young women. This disorder is
characterized by a sense of loss of control when eating; often individuals will consume large
quantities of food in one sitting and then engage in compensatory purging behaviors (i.e.
vomiting, laxative use and/or compulsive exercise). Self-injury (cutting and other forms of self-
harm without suicidal intention)
Substance abuse
Impulsivity (risky sexual behaviors, shoplifting, etc.)
Binge eating disorder is a severe, life-threatening and treatable eating disorder characterized
by recurrent episodes of eating large quantities of food (often very quickly and to the point of
discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt
afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter
the binge eating. It is the most common eating disorder in the United States

Activity
Anorexia Simulation
Whole class- give 5 minutes

Discuss Health Consequences:

ANOREXIA: As the body is denied crucial nutrients, it slows down to conserve what little energy
it has. Abnormally slow heart rate, loss of bone density, fatigue, muscle weakness, hair loss,
severe dehydration, and low BMI- the defining characteristic of anorexia.
Bulimia: tooth decay and staining, inflammation of mouth and esophagus, irregular heartbeat,
irregular bowel movements, peptic ulcers, pancreatitis, and other organ damage.
Prevalence of Binge eating and bulimia is similar among ethnic groups in the US, anorexia is
more common among white, middle to upper-class women.
Cardiovascular system
Consuming fewer calories than you need means that the body breaks down its own
tissue to use for fuel. Muscles are some of the first organs broken down, and the most
important muscle in the body is the heart. Pulse and blood pressure begin to drop as the
heart has less fuel to pump blood and fewer cells to pump with. The risk for heart failure
rises as the heart rate and blood pressure levels sink lower and lower.
Some physicians confuse the slow pulse of an athlete (which is due to a strong,
healthy heart) with the slow pulse of an eating disorder (which is due to a
malnourished heart). If there is concern about an eating disorder, low heart rate
should be considered a symptom
Purging by vomiting or laxatives depletes your body of important chemicals called
electrolytes. The electrolyte potassium plays an important role in helping the heart beat
and muscles contract, but is often depleted by purging. Other electrolytes, such as
sodium and chloride, can also become imbalanced by purging or by drinking excessive
amounts of water. Electrolyte imbalances that can lead to irregular heartbeats and
possibly heart failure and death.
Gastrointestinal system
Slowed digestion known as gastroparesis. Food restriction and/or purging by vomiting
interferes with normal stomach emptying and the digestion of nutrients, which can lead
to:
Stomach pain and bloating
Nausea and vomiting
Blood sugar fluctuations
Blocked intestines from solid masses of undigested food
Bacterial infections
Feeling full after eating only small amounts of food
Constipation, which can have several causes:
Inadequate nutritional intake, which means theres not enough in the intestines
for the body to try and eliminate
Long-term inadequate nutrition can weaken the muscles of the intestines and
leave them without the strength to propel digested food out of the body
Laxative abuse can damage nerve endings and leave the body dependent on
them to have a bowel movement
Binge eating can cause the stomach to rupture, creating a life-threatening emergency
Both malnutrition and purging can cause pancreatitis, an inflammation of the pancreas.
Symptoms include pain, nausea, and vomiting.
Neurological
Although the brain weighs only three pounds, it consumes up to one-fifth of the bodys
calories. Dieting, fasting, self-starvation, and erratic eating means the brain isnt getting
the energy it needs, which can lead to obsessing about food and difficulties
concentrating.
Extreme hunger or fullness at bedtime can create difficulties falling or staying asleep.
The bodys neurons require an insulating, protective layer of lipids to be able to conduct
electricity. Inadequate fat intake can damage this protective layer, causing numbness
and tingling in hands, feet, and other extremities.
Individuals of higher body weights are at increased risk of sleep apnea, a disorder in
which a person regularly stops breathing while asleep
Endocrine
Reduced resting metabolic rate, a result of the bodys attempts to conserve energy.
Over time, binge eating can potentially increase the chances that a persons body will
become resistant to insulin, a hormone that lets the body get energy from carbohydrates.
This can lead to type 2 diabetes.
Other
To conserve warmth during periods of starvation, the body will grow fine, downy hair
called lanugo.
Severe, prolonged dehydration can lead to kidney failure.
https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed/health-consequences

Activity: Have the class find support for EDs online. There are a lot of resources out there
Only one third of individuals struggling with anorexia nervosa in the United States obtain
treatment
Of those practicing bulimia, only 6% obtain treatment. Of those practicing bulimia, only 6%
obtain treatment[7].
Most insurance plans won't cover long-term treatment stays of more than 90 days, but coverage
varies depending on the severity of the individual situation and the insurance plan. ... Finally,
you must prove to be capable of benefitting from the experience of inpatient therapy.
The most important thing to know about eating disorders treatment is that early intervention
makes a difference in success! The sooner an individual suffering from an eating disorder
receives treatment, the more likely she or he will be to recover.
Treatment involves an overall assessment, including history, current symptoms, physical status,
family or personal issues, and the presence of other disorders, such as anxiety disorders,
depression, and / or substance abuse. The most effective treatments of eating disorders include
psychotherapy or psychological counseling along with medical and nutrition support and
guidance.
Depending on the severity of the eating disorder, the patient may undergo group therapy,
individual therapy, outpatient hospital care, intensive outpatient therapy, partial
hospitalization(usually daylong programs for clients who may need more structure and contact
than outpatient treatment can provide.), residential treatment care(provide long-term treatment
for individuals with progressed eating disorders. The treatment needs of individuals will vary.),
or inpatient hospital care. Eating disorder therapy strategies may include (but are not limited to)
cognitive behavioral therapy, interpersonal psychotherapy, family therapy, and behavioral
therapy.

Discuss PRO ANA

A sense of community is not always a good thing
"Our goal is to keep people who are already anorexic as safe as possible ... and getting crash
dieters out of the community because the last thing we want to do is give someone an eating
disorder." They actively encourage sufferers to hide their illness. They are easy to find and tell
people that eating disorders are a "lifestyle choice" rather than mental illnesses. Lots of young
children use the internet
Physical perfection- these disorders have strong Cultural and Gender components
Ideal standard of beauty varies widely across cultures and time, thinness is far from a universal
desire, especially in countries where these is a lot of starvation and malnutrition, but in the
western world, thinness is more appealing, media shows thin models, ripped celebs, has
increased many people's dissatisfaction with their own bodies.

SIGNS AND SYMPTOMS

Physical
Significant weight loss or gain in a short period of time
Abdominal pain
Feeling full or bloated
Dry hair or skin, dehydration, blue hands/feet
Alteration or loss of menstrual cycle
 Chronic constipation
Low blood pressure/feeling cold
Behavioral
Dieting or irregular food intake
Pretending to eat, throwing food away
Exercising for excessive periods of time
Obsession with food
Frequent trips to the bathroom
Wearing baggy clothing to hide very thin body
Isolation
Emotional
Complaints about appearance
Fear about being or feeling fat
Sadness, depression, feeling worthless
Perfectionist attitude
Feelings of helplessness
Prone to stress and anxiety
Denial and inaccurate perception of body image/weight

Closure
DISCUSS as a class how teachers can help students.
A child feels more comfortable when they make the first move with regards to talking about
their eating disorder as this helps them to feel in control of the situation. To facilitate this, a
teacher can create situations for one on one time such as suggesting they stay after class to
discuss their homework. Often, a child with an eating disorder feels scared and alone, and
during the early stages may welcome the chance to offload to someone.
Remain calm and dont judge. Encourage the child to share their fears with questions such as:
You dont seem quite yourself lately, how can I help you? Avoid talking about food or weight
directly as this is likely to frighten the child. Take this first meeting gently and accept that you
are unlikely to get to the crux of the issue immediately. Focus on listening to the child. Work on
building a trusting relationship and ensure that they know when and where they can talk to you
further about whats on their mind.
Invite guest speakers such as nutritionists, people recovered from an ED, etc.

RECENT SCHOLARSHIP
About Eating Disorders. Eating Disorder Resource Center EDRC,
edrcsv.org/getting-help/about-eating-disorders/.
The Alliance for Eating Disorders Awareness. Eating Disorders Statistics.
www.ndsu.edu/fileadmin/counseling/Eating_Disorder_Statistics.pdf.
East, Rachel. Test Your Knowledge of Anorexia Nervosa. All IQ Tests, Fun Quizzes,
Personality Tests, Love Quizzes and Much More,
www.allthetests.com/quiz22/quiz/1176949853/Test-Your-Knowledge-of-Anorexia-Nervosa.
Ekern, Jacquelyn, and Baxter Ekern. Statistics on Eating Disorders: Anorexia, Bulimia, Binge
Eating. Eating Disorder Hope, Eating Disorder Hope,
www.eatingdisorderhope.com/information/statistics-studies.
Learn More About NEDA Walks Across the Country! National Eating Disorders Association,
2016, www.nationaleatingdisorders.org/.