Permission to reprint this article was received by the Ontario Principals’ Council. The original article appeared in The OPC Register, Vol. 24 No.3.
On December 5, 2021, I walked out of Hamilton Health Sciences McMaster Children’s Hospital (MCH), having spent most of the night in the ICU with my 17-year-old daughter. Her body, to preserve itself, had used up so much of its energy stores that it was now turning to muscle for fuel. Her heart, an essential muscle for survival, was beating at a critically low resting rate. Her once long strawberry blond hair had completely fallen out. She was perpetually cold and dizzy, and struggled to lift her once athletic runner’s build into her ICU bed.
In the months leading up to this day, I had watched my daughter starve herself as we, as a family, waited for the much-needed intervention from public health support. Now, as I left her behind in the hospital, I was aware that in less than four hours, I would need to look forward and welcome hundreds of other children to the start of a new school day.
My name is Dave Gervais, and like many of you, I am a parent, currently of teenage daughters.
I am also a veteran elementary school principal. Many would say that school is my playground. I love what I do, and feel fortunate that as principals we can impact and change students’ lives.
In the days that followed my daughter’s admission to the hospital, my wife and I took turns visiting her at McMaster’s Eating Disorders Unit (EDU). This is an incredibly tough place to be as a parent or guardian, but we were also relieved that our daughter would now receive the life-saving intervention she so desperately needed.
More unsettling was that in this same unit was the daughter of a co-worker, whom I had confided to just weeks earlier about the struggles my daughter was having. These concerns would be officially diagnosed as anorexia nervosa combined with restrictive eating and purging. My co-worker and I now chatted over a hospital coffee, discussing the odds that both our daughters were sharing the same EDU care. We both acknowledged that even though we were both respectively responsible for the well-being of other children, we were lost as to how best to help our own.
While it is still not clear what causes Eating Disorders (ED), they are an extremely serious illness, according to James Lock and Daniel Le Grange, both renowned professors of Psychiatry and Pediatrics and both are Directors of Eating Disorder Programs. By nature, these disorders are self-perpetuating and “insidious.” They have the highest mortality rate of any psychiatric disease, and require a team of professionals and specialized treatments to help patients recover.
Children with such a disorder battle themselves. In essence, the traits that make my daughter successful in life are the same traits that made her “successful” in her ED. Someone with an ED recently shared with me that “we look at not eating as ‘success.’” The same drive, control and level of self-discipline that led our daughter to achieve high honours, place at various track meets and essentially take care of herself were refocused on excelling at not eating and meeting an unfathomably low weight goal.
In coming to terms with my daughter’s ED, I began sharing our family’s story – with my daughter’s knowledge and permission – and soon found that everyone I shared it with either knew of someone who had this disorder, or had struggled with it themselves. Shortly after, another colleague reached out to me looking for resources because their son was struggling with ED. Following that, another coworker shared their life-long battle with an ED, stating, “Dave, we need to do something about the language we use around food at our school.”
It seemed that both my personal and professional lives were highlighting the depth and breadth of the most fatal mental health disorder out there, and that educating ourselves and supporting our students’ well-being in this area was something we needed to do.
An article published this January from Hamilton Health Sciences examining the complexities of eating disorder diagnosis stated, “Referrals and admissions have exploded, up 90 per cent and 50 per cent respectively above pre-pandemic levels.” So what can we, as school leaders, do? The sooner warning signs of this disorder are recognized and addressed in children, the greater the chances that it will not develop into a full-blown ED – and this is where schools come in.
For most students, Snapchat, Instagram and TikTok are part and parcel of their daily digital interactions and consumption. The documentary The Social Dilemma on Netflix depicts how media filters on social media platforms create a distorted image of oneself, leading to self-esteem and self-image challenges in young girls. Ask most students from Grade 4 up, and they will tell you that their main communication tool is Snapchat.
Snapchat is not only a cursed word for school principals in dealing with cyberbullying; it has also been identified as a cause of “unrealistic ideals of physical appearance” in a February 15, 2021 research study by Kaitlyn Burnell, Allycen Kurup and Marion Underwood. They found that “taking selfies with Snapchat lenses [filters], in general, was associated with body image concerns.” Similarly, an investigative report from January 16, 2022, by Global News reporters Saba Aziz and Leslie Young entitled “Instagram vs Reality: The perils of social media on body image,” depicts how one young Instagram user “manipulated photos by using body contouring apps and filters on Instagram to slim her face, give herself bigger lips or a more narrow and pointed nose;” another user said the most challenging part for him when using this platform was “seeing ordinary people, his peers and sometimes his friends, who seemed to have the perfect body and the perfect life.”
Changing one’s appearance is only one piece of this puzzle. My daughter shared with us that TikTok became a source of reinforcement for her disorder. She found herself following a community of teens and “influencers” who shared their progress toward extreme weight loss and outlined methods to do so. This is one area where our schools must continue our focus: educating students and supporting them in their use of social media in relation to body image and mental health.
I’ll circle back to the conversation I had with my co-worker, the teacher who shared that she wrestles with ED and wants to see a change in the language used around food. She commented that some co-workers use certain terms around food like “healthy,” “bad for you” and “junk food.” She believes that this, coupled with the people around her commenting on how good she looked as she lost weight, was why her disorder first took root. Our conversation led to a robust dialogue identifying further areas where we could draw awareness around our daily practice.
For example, why during “nutrition time” do educators sometimes encourage students to eat certain foods first? How do we respond when we see a student bringing cookies and cheese strings most days for lunch? Are we presenting the Canada Food Guide to students in a way that promotes all foods from all backgrounds, or inadvertently identifies some foods as “unhealthy” or “not good for you,” unintentionally promoting inequality and ill feelings in students? My daughter and the medical practitioners at the McMaster clinic will tell you, “Food is medicine”. This mantra certainly points to the fact that all food is fuel for our body, and perhaps we need to internalize this mantra to fuel new language awareness in our schools as we strive to create a food-neutral environment.
My journey highlighted that for most educators, not much is known about Eating Disorders. My wife and I did not receive a call from our daughter’s school indicating that she was not eating, nor would we have expected this. As parents, we had little knowledge about this illness ourselves, and for the longest time assumed our daughter would move past this “phase.” It took us many months of advocating for care before our daughter finally received a diagnosis of ED, and by then it had taken hold.
My daughter estimates that from the time her disorder started until the time she was admitted to hospital, 1.5 years had passed: that’s a terribly long time to fight this illness alone. I’ve often wondered if her journey would have been different if we had some sense of early warning or some awareness ourselves.
Identifying or picking up on ED behaviours in a school setting may be challenging, but adding this knowledge to our repertoire of skills can lead to conversations with students and parents/caregivers that, in a very real sense, can save lives.
There are many resources to support awareness in this area. The incredible healthcare team at MCH provided us with many reading resources; Help Your Teenager Beat an Eating Disorder was one of the most valuable in helping us understand and take steps to support our daughter in her recovery. It is one that I continue to pass along.
There are some early warning signs in the development of an eating disorder and it is important for all school personnel to be aware of these signs. Dr. Lock and Dr. LeGrange, as mentioned earlier, encourage educators to be aware of new behaviours such as, but not limited to,
- a new interest in diet books
- evidence of visiting pro-anorexia or Eating Disorder websites
- dieting behaviour
- the sudden decision to become a vegetarian
- increased picky eating, especially eating only “healthy foods”
- always going to the bathroom immediately after eating and
- an unusual number of stomach flu episodes.
The National Eating Disorder Information Centre (NEDIC) shares that other symptoms to look for in a school setting can include:
- skipping meals
- abnormal weight loss or gain
- chest pain
- constantly feeling cold
- dizziness or fainting
- frequent stomach aches and
- avoiding eating with others.
In my experience with my daughter, I would also add two other warning signs: a change in wardrobe, such as wearing oversized clothing, and hair loss.
My daughter’s recovery is promising, and she has become an influencer in her own right. She removed TikTok from her phone and has since assisted several peers in finding help for their restrictive food behaviours.
The memory of helping her into an ICU bed will stick with me for the rest of my life. If things happen for a reason, it is this: to inspire change in our schools.
It is with my daughter’s permission, and that of my colleagues, that I share our personal journey with you. My hope is that as educators, we will examine the culture around food within our schools, re-evaluate how we foster or discuss a positive self-image in our learners, and bring this disease to the forefront of our thinking when supporting the well-being of students and colleagues.
Food is medicine, but education can be a cure.