Bye bye BMI: Food and wellbeing education in schools overhauled to prevent eating disorders in young people
Food and nutrition education in schools will be overhauled in 2024 and 2025, after a successful advocacy campaign for changes to the Australian Curriculum to prevent the development and relapse of eating disorders.
Teachers are now advised to avoid activities that could do more harm than good for students, such as recording and comparing body weight and body measurements; calculating body mass index (BMI) or caloric intake; and recording what they eat in food diaries. The advice covers several learning areas to make teachers more aware of the potentially negative impact of teaching about food in ways that involve judgement, numbers or rigid food rules.
The advice has recently been published in the Curriculum connection: Food and Wellbeing resource which was updated to align with Version 9 of the Australian Curriculum. The development of this important advice followed collaborative advocacy between The Embrace Collective and Eating Disorders Families Australia (EDFA), spearheaded by EDFA member and parent Kylie Burton.
“There used to be more than 340 search results in the Australian Curriculum for terms such as BMI, weight, calories, healthier, class surveys, food and diet. Now there is only one - and that links to the advice for teachers to avoid these types of activities,” Ms Burton said.
Earlier this year, Ms Burton’s daughter, who had already been hospitalised twice with anorexia nervosa, returned to school only to be faced with a six-week maths unit on measurement that included diet advice and body measurements. In the first lesson, students were asked to record each other’s height and weight so they could use formulas to calculate their BMI and plot their results on a graph.
“That very first lesson was an obvious tipping point for her. I saw her behaviour change - she came home and told me about it straight away. She and her friends were very upset and embarrassed. There was a group of them that just stopped eating lunch together at school and my daughter started relapsing.
“I shared a post on the EDFA Facebook page, and I started to get a lot of replies about very similar situations from families all over the country, about triggering class work in several subjects and different year levels from prep all the way through to TAFE. I realised it was a big, nationwide problem,” said Ms Burton.
As a former Dance, HPE and English teacher herself, Ms Burton is quick to focus on the opportunity, rather than blaming teachers.
“Prior to my daughter being sick, I wouldn't have had this depth of understanding, and I know how overwhelming it can be catering for all these different students’ needs, so there's absolutely no criticism of teachers. They want to do the right thing - it's just about awareness, and understanding how those tasks can be processed by someone with body image concerns. I’ve also heard from many teachers, who have found the content triggering for themselves and are welcoming the new guidelines and resources.”
Ms Burton, Eating Disorders Families Australia and The Embrace Collective wrote an open letter to the Australian Curriculum Assessment and Reporting Authority (ACARA) to petition for the change, which was also signed by several eating disorder organisations and advocates.
"These changes have potentially saved lives and protected many families from years of distress as they help a loved one to recover from an eating disorder," Eating Disorders Families Australia Executive Director Jane Rowan says. "We were proud to stand with Kylie and The Embrace Collective to make a collective call for urgent action."
Dr Zali Yager, Executive Director of The Embrace Collective and Adjunct Associate Professor in the Institute of Health & Sport at Victoria University, has a health and physical education background and specific expertise in figuring out ‘what works’ to help young people feel better about their bodies. She has been advocating for changes in teacher practice in health and physical education for many years.
“The focus has always been on removing activities that might be triggering for those vulnerable to eating disorders, but also the activities that focus on categorising food into ‘good’ and ‘bad/junk’ food categories, and those perpetuating misinformation and oversimplification of the level of control we have over our weight which can lead to increased stigma, bias and discrimination against people in larger bodies.
“BMI was never designed to be an individual measure of weight status, let alone health. Categorising students into weight categories when they are with their peers, and when teachers are not adequately trained to communicate the complexity of the science around weight, can be extremely damaging for young people.”
The advice to teachers now states:
The following activities should be avoided to prevent causing unintended harm:
Critiquing and comparing personal food and wellbeing choices and habits with those of other people, including calculating kilojoules/calories; assessing body weight and body measurements; calculating BMI (body mass index); and recording food intake in food diaries.
Focusing on constant improvement for all students to be “healthier” and using the terms “good” and “bad” foods.
These actions are aligned with the National Eating Disorder Collaboration (NEDC) National Strategy for Eating Disorders.
Hilary Smith, National Manager at the NEDC and health promotion professional said, “The National Eating Disorders Strategy is world-leading in setting out key standards and actions for the whole system of care for eating disorders. In relation to eating disorder prevention, it has set the global precedent for broad based actions to improve the safety of messages that people receive about food, health, brains and bodies and seeks to drive important culture change.
“It is wonderful to see these changes to the curriculum coming into effect as a key action in promoting body appreciation and positive relationships with food and eating, particularly in this critical developmental stage when the risk of eating disorder onset is high. This aligns directly with the Prevention Standards contained within the National Strategy.
“A particularly important factor is the way that these changes have been integrated across the curriculum, so that the harm minimisation approach is consistent, whether in a health class, a maths class or in drama, biology or food technology.”
If you or someone you know is concerned about their body image or eating, please contact the Butterfly Foundation Hotline on 1800 33 4673.
STATISTICS
According to recent Australian research, 22% of the adolescent population, 33% of girls and 13% of boys aged 11-19 met the criteria for an eating disorder (Mitchison et al., 2020).
There has been a 63% increase in eating disorder presentations to The Royal Children’s Hospital in Melbourne since the COVID-19 pandemic (Springall et al., 2022) and in particular, incidence among children aged 5-12 has doubled (Morris et al., 2022).
In research from the US and Canada, where they reviewed admission charts for patients with AN, health education was specifically mentioned as a trigger in 14% of cases (Chen & Couturier, 2019; Lin et al., 2023).
Recent economic analysis has revealed that the past 10 years of the BMI screening and reporting program in 15 states in the USA has cost US$210 million, and has not been projected to prevent any cases of child obesity (Poole et al., 2023). De-implementation of BMI screening practices has now been recommended
READ MORE
See the blog piece from EDFA here.
ADDITIONAL RESOURCES
Body Blocks by Embrace Kids - The world’s first publicly available, broadly disseminated body image program for early childhood educators to help young children develop positive relationships with food, movement and their bodies. Available to early childhood educators, pre-school, kindergarten and foundation teachers for free, as part of the Embrace Kids Australia Project that has received funding from the Australian Government.
Embrace Kids Classroom Program - A curriculum-aligned program for Years 5-6 and Years 7-8 that brings the EMBRACE KIDS film into the classroom, exploring themes of body image, bullying, gender identity, advocacy, representation and more. The program is being disseminated for free to primary and secondary school teachers and wellbeing leaders in 2024, as part of the Embrace Kids Australia Project that has received funding from the Australian Government.
Eating Disorders Families Australia (EDFA) - Support and advice for teachers and families.
NEDC Eating Disorders in Schools: Prevention, Early Identification, Response and Recovery Support - This booklet provides all school staff with guidance, tools and resources to assist in reducing eating disorder risk as well as supporting students who may be experiencing an eating disorder:
National Eating Disorders Strategy 2023-33 - A roadmap and tool to help people at all levels and in all settings work in a coordinated and sustained way to improve Australia’s response to eating disorders.
REFERENCES
Chen, A., & Couturier, J. (2019). Triggers for children and adolescents with anorexia nervosa: a retrospective chart review. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 28(3), 134.
Lin, J. A., Jhe, G., Adhikari, R., Vitagliano, J. A., Rose, K. L., Freizinger, M., & Richmond, T. K. (2023). Triggers for eating disorder onset in youth with anorexia nervosa across the weight spectrum. Eating Disorders, 31(6), 553-572. doi: 10.1080/10640266.2023.2201988
Morris, A., Elliott, E., & Madden, S. (2022). Early‐onset eating disorders in Australian children: A national surveillance study showing increased incidence. International Journal of Eating Disorders, 55(12), 1838-1842.
Springall, G., Cheung, M., Sawyer, S. M., & Yeo, M. (2022). Impact of the coronavirus pandemic on anorexia nervosa and atypical anorexia nervosa presentations to an Australian tertiary paediatric hospital. Journal of paediatrics and child health, 58(3), 491-496.
