States push schools to fight eating disorders

Six weeks after Ella Brinkerhoff entered an Arizona residential treatment center for anorexia, the 15-year-old’s parents got a middle-of-the-night phone call from staff asking them to meet at the hospital. “We’re bringing your daughter so she doesn’t die on our campus,” Ella’s mom, Merissa, remembers the staff telling them on a summer night in 2021.

Ella’s eating disorder started with a desire to be healthy. But while her public school was teaching virtually during the pandemic, she began exercising compulsively and eating less. Soon after her school resumed in-person learning in March 2021, Ella’s parents asked her to eat under the nurse’s supervision. The arrangement did little good: Ella threw away some of her food before she went to the nurse’s office. Within two months, Ella found herself at the residential treatment center with a feeding tube, yet was still skipping her feeds. “I was so far gone that I didn’t want help,” she said.

Earlier this month, the West Virginia Legislature sent a bill to Gov. Jim Justice’s desk that would require schools to educate teachers and students about self-harm and eating disorders like Ella’s. A handful of states are considering legislative efforts to address eating disorders in schools, and President Joe Biden announced Feb. 21-27 to be National Eating Disorders Awareness Week. Those actions could bring needed attention to eating disorders—a problem children often hide from their parents. But some experts note that schools can play only a limited role in helping youth who struggle with their relationship to food.

In 2010, an eight-year study found that as many as 13.2 percent of adolescent girls had struggled with eating disorders such as anorexia, typically manifested as over-exercising or limiting food, or bulimia, in which sufferers often self-induce vomiting to reduce calorie intake. While females are two to five times more likely than males to have an eating disorder, according to the National Institute of Mental Health, a 2014 study found males are almost as likely to struggle with less severe symptoms of disordered eating. Research has suggested eating disorders may have a genetic component and affect multiple people in one family.

Pandemic lockdowns may have exacerbated the problem: The Eating Disorders Coalition for Research, Policy and Action said that medical admissions due to eating disorders more than doubled among adolescents in 2020. Christie Dondero Bettwy, who runs a Christian nonprofit in Arlington, Va., to support people with eating disorders, said interest in Rock Recovery jumped 420 percent “almost overnight” in March 2020. She cited anxiety and loss of routine during virtual school as potential culprits.

Del. Wayne Clark dubbed the West Virginia bill “Meghan’s Law” in honor of one of his twin daughters, a teenager who experienced a severe eating disorder. Last October, California Gov. Gavin Newsom signed a law requiring schools to add mental health topics, including eating disorders, to the high school health curriculum by January 2023. Pennsylvania lawmakers have introduced bills in the House and Senate that would require schools to provide information about eating disorders to parents. A similar law passed in Virginia in 2013. At the national level, Congress considered the Eating Disorder Prevention in Schools Act in 2020. It has since been expanded and introduced in both chambers in October as the Improving Mental Health and Wellness in Schools Act.

But methods schools have used to address health, such as BMI report cards or the “war on obesity,” haven’t always been helpful to students with eating disorders, said Bettwy, the Rock Recovery executive director. She agreed schools can play a front-line role in spotting eating disorders early, but said school-based efforts will always be limited: “You don’t know what’s helpful for one student versus another.”

The problem isn’t confined to public schools. Emily Wierenga grew up homeschooled, the daughter of a pastor and a nutritionist. Despite her mother’s efforts to shield her from body image concerns, Wierenga began restricting her food when she was 8 years old. Now a wife and mother of three, Wierenga has written about her experience and said her story shows that a “perfect environment” is not possible.

In July 2021, Ella’s parents moved her to a different residential treatment center in Texas. She had FaceTime calls with her family and eventually began reading her Bible and memorizing verses—even asking to watch church services on weekend evenings while other teen patients watched a movie. She went home two days before Christmas.

The teen has returned to school for half days for now, and she loves offering peer tutoring and working with students with special needs. She hopes others facing eating disorders don’t wait until their symptoms are severe to address it. “No matter what degree it’s at, it is awful and you are sick,” Ella said. “This thing is going to take everything away until you have absolutely nothing left, and I almost experienced that.”