Well, I have drafted a letter to the 8th grade teacher referenced above. The materials she used in class had stuff like how to figure your ideal weight, a box to fill in how many calories you should eat per day to maintain your current weight, and how to figure how many calories your exercise is burning off. BUT it did also include things like diets don't work for the long term and are not a good idea for kids, you may lose lean muscle mass and gain back fat, etc. So anyway, here is my letter to her. PLEASE CRITICALLY REVIEW THE FACTS I ASSERT ... I won't send it for another day and want it accurate if possible. Any other input or concerns or criticism is also welcome. It is a hard question .... what should be taught .... the temptation to say NOTHING is probably not great and then it gets murky to decide what and how to teach about nutrition/health. I will try to email Stubby to see if he is okay with me using his posts ...
Hi Ms. 8th Grade Nutrition Teacher:
I first wanted to thank you for calling me the other night. You knew I was mad and called anyway and I really do respect and appreciate that. I am sorry to hear that you have some health issues you are dealing with and I was also very sad to hear of your loved one's ongoing situation. I have thought a lot about both of you since we hung up. I have also thought a lot about the question you asked me: What do I think should be taught in middle school health class about nutrition. I thought a lot about it because, although I know quickly what I do NOT think should be taught, it took me a bit to come up with themes that I think are appropriately taught.
Here is my current answer to your question:
1. For starters, I think every principal and every school counselor, and also any teacher (K-12) that will have anything to do with instruction on health, nutrition, mental health issues, fitness, or coaching, should be required to read the book Brave Girl Eating — and probably re-read it as a refresher every two years or so. I will buy you as many copies as you request if you will hand them out and ensure they are read by staff (not students). Seriously. I re-read it after our phone call.
A second book that is well worth the read is called Sick Enough and it focuses a bit more clinically on the physical and psychological ramifications of calorie restriction on the body. It is by a medical doctor in Colorado. I think I might even have a spare copy if you are interested and if not, I will buy you a copy if you will read it and pass it on to staff.
2. The themes I think should permeate the curriculum from pre-K forward are:
- Every body is different despite the obvious similarities. One kid might lose his last baby tooth at 9 years of age, another may still have a baby tooth at 14. Neither is better or worse and neither means one kid is more healthy than the other. One kid might start puberty at 9 years of age, for some kids development in that way does not begin until much later. Again, the vast majority of the time, those kids are equally “healthy” — their bodies just moved at a different pace on those things that could be seen from the outside.
b. “Healthy" is complex and cannot be judged by looking at any one part of the person, either from the outside or the inside. A person’s lab tests might say they are completely normal, while at that very moment a look at the rhythm of their heart might reveal a huge, life-threatening problem. (Sadly, this actually plays out with some frequency in the world of eating disorders, sometimes with only very modest weight loss or even just a failure to gain in the face of vertical growth).
c. All humans need to eat so that they grow their bodies, and brains, and organs, and muscles, and bones and that a person is not really “done" growing and developing until their mid twenties (the brain actually continues to create connections throughout life, as I understand it). Steady fuel is necessary (no missed meals) and that a variety of fuel source is necessary (carbs and protein and fat are all integral to proper growth and development). While I do not think this should be taught, overtly, I do think the theme of weight gain as opposed to weight loss or stagnation, should be heard any time it comes up naturally. Just like you would always stress inclusion and anti-bullying, any time it works in naturally, kids should be exposed to the expectation that they need to eat and grow and that weight gain each year is normal and necessary - and that a failure to do so is a red flag that should cause the child to discuss it with their parents/doctors.
d. I think I'd be okay with discussion about micronutrients and macronutrients and some broad overview of carbs, fats, proteins and how they work together to keep the body going. Like a calcium to bone connection. Lipid to brain health connection (actually, I would learn many more uses for fats … like hormonal regulation, etc, and be ready with why fat is so important to a growing and maturing body). Muscles need protein as well as carbohydrates and fat to properly develop and maintain strength.
e. A main component would include that bodies change over time and need different things at different times ... babies have different needs than thirty year olds; post menopausal women have different needs than thirty year old women; teen bodies are undergoing major changes and a person should expect to gain weight each year until their bodies (brain, bones, reproductive organs, etc) are fully matured and that typically would mean in their early twenties. Forty year old parents under the care of a doctor may be able to experiment with a particular diet, but a child doing so is very unwise.
So even though a 17 year old may pass for 25 at first glance, what is going on inside the body at the age of 17 is different than a 25 year old’s body. Just because a person has reached full height, and their shoe size has stopped going up, and they are menstruating, etc, they are not done growing and developing and steady fuel is needed. Restricting that process from fuel (food) is harmful. (I am not well enough educated on this but if I were going to teach health/nutrition to teens, this is the info I would learn inside and out — reading Sick Enough would be a good start, and then learn the fine points you choose to focus on).
f. I would remind them that this can be a rough part of life, and that if they have questions about nutrition or health, or if their thoughts or relationship with food or exercise or body image is concerning to them, to contact me (the teacher) and I can help coordinate with parents or proper people to get trusted answers to their questions ... sometimes the answers for one person are different for another.
g. I would mention that like lots of areas of medicine and science, our understanding continues to grow …. That we now know things we did not know when their parents were this age.
3. I think education of the teachers, counselors, school nurses, and principals must be thorough and continuing.
a. Of paramount importance, I think the teacher should know how to respond if a kid asks questions or indicates concerns about an Eating Disorder, and bring the proper support on board very quickly. Tell the parents what you see, and why it looks suspicious to you. Let them hear it and ignore if that is what they are going to do … but invite them to hear you out and to take what you say to their doctor for input.
b. I think the teacher should keep in mind that kids of that age don't have much say in what is in the house in terms of food. Not sure what good it does to tell a kid who doesn’t drive, doesn’t work, likely doesn’t cook for the family, likely does not have control over the schedule in terms of what meals are on the road, at home, in a restaurant …. that kid does not need to hear “don’t eat junk food” if their parent drives them to Burger King between obligations and the kid needs to eat.
That kid does not need to hear they are not “healthy” if they fail to eat “y” servings of fresh fruit and “x” servings of vegetables every day when they have no say in what is in the pantry. If there are medical concerns for a particular child’s weight, he or she need their parents and doctors to address it, individually. By all means, feel free to talk to the parents to be sure they are aware of your concerns if you feel that is appropriate. If there is a lack of food availability in a particular household, by all means, hook that kid or family up with help to get a variety of foods in the home. But don’t be the voice that starts a kid to restrict food, or diet, or exercise for the sake of exercise (not as part of a fun sport they enjoy with their family’s support). Don’t be the voice that makes a kid chose to skip a meal rather than to eat the processed mac and cheese available in his home.
c. Don’t feed into the advertisements, social media, etc, that promote thinness and outward indicators of “health.” These kids get plenty of free (and wrong) advice about not eating fat, not drinking their calories, doing crunches for healthy abs, avoiding carbs, etc … they don’t need that from you. From you, they need the antidote to that misinformation. They need to confidently hear it throughout the school curriculum … work it into Spanish class surreptitiously like you do anti-bullying; work it into PE by silently stopping the outrageous practice of taking weight and figuring bmi; work it into Publications by highlighting how photoshop distorts bodies and how those models look just like the students in real life … beautiful.
They need to hear facts, not soundbites or generalities. The fact is, their body, in middle school, is not done. It looks done. There are boobs and hair in the privates, they shop in the adult sections of clothing stores, and likely get to watch R rated movies, they get to stay home alone instead of having a babysitter, and their parents drop them off at the mall or movies instead of staying and supervising. All indicators that they are mature young adults. Great … but, their bodies are slightly over half way developing. The fact is, when they are in 8th Grade, their body still needs almost a decade of daily help in the form of steady fuel for growth and development. (One eating disorder doctor I spoke to talks about the Three B’s — brains, bones, babies … because restrictive eating (or negative energy balance caused by purging through exercise or otherwise, or by weight loss or stagnation) in adolescence compromises the proper development of needed brain connections, strong bones to last a lifetime, and can effect the ability to have babies. Not to mention things that may sadly hit closer to home for middle schoolers … their hair can thin and fall out; they may faint when going from sitting to standing and that could prompt a parent or doctor to remove driving privileges; their heart may shrink as the body uses it for fuel just like other muscles, etc.
d. That anything other than steady growth can cause major problems (personally I would not go into that much … but if you (or the State or School District) insists on an eating disorders unit, I’d certainly be honest … anyone can get one; they are not caused by parents; kids don’t choose them BUT sometimes kids choose voluntary actions that can morph into an eating disorder. Just like if you experiment with drugs, bad things can happen and you can get “hooked” — flirting with calorie restriction can morph quickly into an eating disorder that can take over your will and your life.
IF you are going to go into this at all, I would stress how medicine and science today understand eating disorders much better and differently than was understood twenty or forty or sixty years ago. I would make this clear because there will be vulnerable kids whose aunt or grandma or mom had an eating disorder and it just became part of who they are … we don’t settle for that anymore and we tackle the problem much more quickly, differently, and more completely than prior generations. There is hope of solid recovery, especially if the matter is addressed early!
IF you are going to go into eating disorders at all, it should be as true and as shocking as the black lung pictures …. IF you are going to have a unit on eating disorders, I’d be very sure any teacher is well tuned into the dangers of piquing interest in dieting or weight loss or exercise for the sake of exercise .. and I’d be very sure teachers did not inadvertently send kids on internet searches that would lead to eating disorder sites (there are tons that promote anorexia; give tips to fool parents and doctors; etc). I would want teachers to know things like I will paste below, written by username DAD, but I would not want a kid to get a copy of it — because all they have to do is google some of it to find their way to a website that is public but very much intended for carers and not kids or sufferers.
Here are DAD’s posts … the first and last are just about three years apart.
A. DAD Caregiver
Jan 01, 2013
OK - First question post.....
D, 14, has a professionally designed refeeding diet. She is generally compliant, but extremely anxious (constant shaking) about all the food. She accepts some foods, but flat out refuses to eat some things on her plan if she thinks they are "too sweet" or "too fatty". There are enough choices on the plan that we can work around some of the objections, but SHOULD we be doing this? A big part of me says that if she is getting her nutrition and necessary calories for restoration, I should not add to her anxiety by forcing her to eat the things causing the most fear. (Actually - everything causes fear these days....I'm talking about the 9's and 10's on the 1-10 scale of fear).
A big part of her fear right now is that she is convinced that since she has visibly put on a few pounds, that she is 'OK' now and that we are all trying to "make her fat". She has been caught doing some food hiding, attempting exercise and is monitored very closely (no bathroom time by herself, mom sleeping in the room with her) to prevent her from sabotaging these early stages of recovery. Is this a normal reaction from the young ED patient? She has all the facts, but is in deep denial.
Another regular "battle" is the "anorexic behaviors" while eating. We have been told to correct nibbling and breaking food into tiny bites. She does both at times and we are all annoyed with having to continually remind her "no nibbling" and "take normal bites". Could use some encouragement that we are on the right course with this one. (or correction if that is necessary!)
---- "Parenting is not for cowards."
B. DAD’s Caregiver
Jul 14, 2013
Sometimes just gotta get it off my chest somewhere. A virtual "scream into a pillow", if you will.....
So...things I can't stand about ED
1. Meal times. I used to love meal time. Now I come prepared for battle. I'm lucky - not every meal is an all-out war any more, but there is always, it seems, at least one behavior that needs to be confronted, or one questioning of portions or food choices by my D.
2. Reverting to pre-adolescent level of supervision.
3. Being exhausted all the time from the emotional drain.
4. The constant desire of the ED to argue about food. Doesn't ED get it? I'm not arguing back. I served it - you eat it - end of story.
5. Arguing with my W about ED. We try so hard to be on the same page, but we are not at some times. I think ED is all we talk about any more. I'm tired of talking about it.
6. How ED seems to lull you into a false sense of some recovery for a few days and then comes roaring back in all its glory. (today - wrapping almonds in a napkin to "soak up the extra fat" 3 months after WR.....seriously?!! Where did THAT come from?!)
7. Meticulous meal planning. I miss the days of "let's grab a sandwich and go" or "let's just hit the drive-through". This includes having to remember to pack and bring snacks EVERYWHERE. UGH!!!
8. Eye rolls and heavy sighs (OK - that is just being 15....but I'm tired of it, anyway!)
Please continue! I'm feeling a little better already!
---- "Parenting is not for cowards."
C. Dad’s post with a One Year Update:
Nov 22, 2013
Just wanted to take a moment to reflect on the unexpected journey we've taken in our lives this past year and to give thanks to all of you on this forum who have provided hope, encouragement and a shoulder to cry on! This disease really isolates a family, so the support of other parents has been incredibly valuable. I wish none of us had to be here, but am at the same time grateful for you as well.
So a year ago we noticed our lovely 14 YO D had suddenly stopped eating. Between Nov. 10 and Dec 7 she dropped over 20 lbs from what was a lean, healthy weight to dangerously thin. A week of medical stabilization and 2 weeks of inpatient treatment were our initiation into the world of ED. We were woefully unprepared (despite my degree in counseling....we never really discussed ED!) and had little idea what to expect. We had a great pediatrician that pointed us in the direction of Maudsley treatment methods. It took 3 tries to find the right psychiatrist and a couple counselors, but we eventually put together a decent team. For us the key has been a very skilled and experienced nutritionist who also serves as a secondary counselor.
So we entered the field of re-feeding. There have been epic battles of will, many tears, and sleepless nights, but we reached a goal weight (42 lbs gained) by around April 1. She has maintained that weight ever since. We had hoped to move quickly into stage 2, but ED has other ideas. We still had huge battles over food and fears surrounding food. Self-harm reared its ugly head in August and added a whole new realm of fear to battle-weary parents.
But as so many have written and the research supports, about 6-7 months after weight restoration, there are some wonderfully hopeful signs. Our D has started talking about how much she loves some foods (burritos, stir fries, and more) in the last couple weeks. Last week we went out to a restaurant (an inconceivable notion a few months ago) and she was fidgety...when we inquired she said she was starving and couldn't wait for the food to arrive! (We both sat calmly but were jumping up and down, cheering inside!) It was the first time we had heard her express feelings of hunger since this started. She still gives me a "look" when her snack is a candy bar or ice cream, but she eats and even says how good it tastes some time.
We realize that this journey is far from over, and that there are likely going to be setbacks as we proceed, but we are thankful for our beautiful and physically healthy daughter. Year 2 shall be one, I hope, of vigilance, caution and progress.
---- "Parenting is not for cowards.”
D. DAD’s Final Update
Dec 24, 2015
Hello Dear Friends
I write today with a very heavy heart. 3 weeks ago our beloved daughter who had fought so valiantly and was so proud of her work in recovery found herself struggling mightily against another serious relapse. She desperately hid her fight, although we certainly noticed ED behaviors returning and talked to her and her counselors about it. She vehemently denied any problems. For whatever reason she decided to not accept any of the help she was offered, and on Dec. 3 she ended her battle with ED, anxiety and depression on her own terms. We are, as you would expect, devastated by her loss.
I know this is not the encouraging outcome that we all are seeking so desperately, but we all know going into this fight that eating disorders are the deadliest mental illnesses out there.
Nonetheless - don't give up the fight. Ever. Living the fight is far preferable to this alternative. Every trip to a treatment center or a therapist - count it as a blessing. Every fight with an unreasonable and unpleasant child - look at it as better than no fight at all. It is so hard to find any joy in the middle of the battle, but I can tell you that it sure beats the alternative.
I'll leave my one last bit of encouragement to the words of Winston Churchill:
“Never give in. Never give in. Never, never, never, never—in nothing, great or small, large or petty—never give in, except to convictions of honour and good sense. Never yield to force. Never yield to the apparently overwhelming might of the enemy.”
---- "Parenting is not for cowards.”
I have not included DAD’s posts to be melodramatic. I have included them because I think it is vital for teachers and curriculum makers to re-think this pervasive message of anti-obesity that currently invades many corners of the curriculum. For a kid prone to an eating disorder, the damage is swift once they begin restricting or over-exercising. While doing the exact things they hear teachers preach, they put their childhood, their family lives and schedules and finances, their independence, and their very lives at stake.
Thanks again for the phone conversation and, if you made it through this letter, thanks for reading. In our phone call you mentioned that there is an upcoming unit on Eating Disorders. Please get me that material ahead of time … I might choose to pull both girls from those class periods, or may simps pre and/or de-brief them. I won’t know what I think is best for my kids until I see the material. I would urge you to consider giving ALL parents a heads up when “nutrition” or eating disorders will be the focus of a unit …. I can assure you mine is not the only family that might be sensitive to it.
Finally, I have not read this book, but have seen others favorably review it for use with and maybe by adult sufferers … it is Kathryn Hansen's book 'Brain over Binge’.
Good luck and I truly mean it when I say I will help in any way needed. Feel free to text that same number you called for anything.