2-Pane Combined
Full Summaries Sorted

Healthy eating in schools, overweight and `eating disorders': Are they connected?

Author: Dixey, Rachael

Dixey, Rachael. “Healthy Eating in Schools, Overweight and `eating Disorders’: Are They Connected?” Educational Review, vol. 50, no. 1, Feb. 1998, p. 29. EBSCOhost, doi:10.1080/0013191980500103.

ABSTRACT This paper raises questions about the increase in 'eating disorders' and the widespread preoccupation with diet and weight among girls in both primary and secondary schools. Obesity and overweight are also on the increase (in adults and children) and are seen as priorities to be tackled by health promotion. Empirical research is required to investigate the effects of educational messages aimed at children about fat in the diet and healthy eating, and their possible implication in the increase in both overweight and in pre-occupation with body size. Is health education actually part of the problem, making girls more conscious of their weight? The paper reviews some of the relevant literature and also suggests practices in schools which may help or hinder true 'healthy eating' and healthy perceptions of self Whilst teachers should not be expected to tackle clinical cases of 'eating disorders', there is much that can be achieved in schools to promote children's self-esteem and positive body image, together with teaching about food and eating.


It appears that 'eating disorders'--anorexia nervosa, bulimia nervosa and generally 'chaotic' or 'disturbed' eating patterns--are on the increase among young people, especially girls, but also among boys. Obesity and overweight too are increasing, in adults and children. There is also explicit concern about young people's diets (Johnson & Hackett, 1993) and their sedentary lifestyles (Cale & Almond, 1992a,b). Whereas perceived 'eating disorders' tend not to be addressed in the classroom but are seen as within the realm of health staff or the educational psychologist, there has been a response to concerns about healthy nutrition and exercise, which has been to introduce healthy eating into the curriculum. However, has one effect of this been to add to the existing pressures to be thin and thus, unwitting, to add to the problem of 'eating disorders'? To answer this question properly empirical research is required on how healthy eating messages (especially about fat) are received. This paper attempts to speculate on the possible connections and suggests some helpful ways forward in terms of education.

Children and Nutrition Education

A starting point is to ask whether young people do in fact attend to the healthy eating messages or are we overestimating their power in influencing children's actions? Children appear to be well informed about healthy eating (Backett & Alexander, 1991; Young, 1993) and can recite the orthodoxy concerning what they should and shouldn't eat. Eleven year olds in one study felt that someone who ate healthy foods would be 'thin', 'not that skinny', 'not fat either' and they knew that 'if you eat too much you get fat'. They also felt that healthy foods were home-made foods and 'proper meals'. They had a notion of healthy eating which equated with balance and with food being nutritious (Ross, 1995). Similar points were made by the children in the work of Williams et al. (1989). Research is required to show whether and how children act on this knowledge. Ross (1995, p. 319) notes that 'The health-giving attributes of foods appear to have little significance for these children ...'. Sherratt's study (1996) of slightly older children (12 and 15 year olds) showed that they were well aware that fat in the diet was unhealthy and was associated with coronary problems. However, she also found 'widespread confusion about the fat contents of food' (p. 171) and that children did not have sufficient knowledge or enough understanding to choose a low fat diet. This finding is similar to other studies (Lund et al., 1991; Resnicow & Reinhardt, 1991). Some young people, however,--dieters--clearly have changed their behaviour, but this may be in response to a wish to change body shape rather than to be healthy; they may perceive low fat and 'healthy' foods to be low calorie foods (and vice versa). Crawley & Shergill-Bonner (1995), looking at the nutrient intakes of 16-17 year old girls who were dieting, showed that they consumed more low fat spreads, skimmed milk, cottage cheese, yoghurt, salad vegetables and fruit than girls who were not dieting. This is not surprising, but these dieters were failing to achieve the reference nutrient intake for a range of micronutrients and thus did not have a 'healthy' diet. Many studies are chiefly concerned with nutrition and health and do not especially consider children's understanding about fat in relation to body image. However, a recent study of adults and healthy eating showed that respondents felt no incentive to eat healthily unless weight loss was a consequence (Mackreth, 1996). It would be unsurprising if children felt the same.

The 'clinical' or 'subclinical' cases of anorexia nervosa and bulimia nervosa which occur towards one extreme and which may mask a variety of underlying problems are clearly of concern. However, they are not the subject of this paper. What will be considered here is the widespread obsession with food and not eating, dieting and weight loss that typifies the experience of many, perhaps the majority, of girls and women. A large number of studies now show that dieting is a 'normal' eating style for women (Herman & Polivy, 1991), if this means restricting the total amount eaten, avoiding certain types of food and going without food for periods of time. Moreover, studies also show that weight concerns exist among younger and younger age groups. Adolescent girls have been studied by Toro et al. (1989), Davies & Furnham (1986), Moses et al. (1989) and, more recently, pre-adolescent girls (Hill et al., 1992; 1994). These latter studies show clearly that not only are 9 year old girls concerned about weight, but that they also restrain their food intake. Hill et al. (1994, p. 102) comment that what was 'most revealing is the number of girls who are highly restrained but who were not overweight'. Thus girls are responding to their perceptions of their weight and dieting accordingly. The study of Wadden et al. (1989) of 15 year old girls shows that dissatisfaction with body image is more strongly associated with perceived weight than actual weight. This is confirmed by the work of Hill (1993). Likewise the survey by Currie & Todd (1990) of children's health behaviours in Scotland found that losing weight is a preoccupation of 50% of girls, the majority of whom were likely to be of normal weight. The same features were found in black and minority ethnic communities in Britain; Mumford & Whitehouse (1991) found high rates of eating disorders among Asian girls. As with younger females, the reasons adult women give for dieting are to do with body image rather than with health (Barker & Cooke, 1992). All the evidence indicates that there is widespread dissatisfaction with body and weight among girls and women in Western countries. The work of Lintunen et al. (1995) and that of others (Marsh, 1989; Rauste-von Wright, 1989) show that girls have a poor self-image, with 'great differences in perceived appearance between the sexes' (Lintunen et al., 1995, p. 21).

Dieting and Eating Disorders

Research is beginning to see a definite link between dieting and eating disorders. Killen et al. (1993, p. 371) suggest 'dieting itself may actually potentiate disordered eating through cycles of dieting and weight regain making future attempts at weight loss more difficult'. If this is the case, the large number of dieters is clearly a cause for concern. Moreover, they are dieting not for health reasons, but because of a dissatisfaction with perceived body size. Whilst the picture is simplified here, it does raise questions about why both overweight and eating disorders are increasing. Educators may suggest ways of reducing weight other than slimming diets (such as increasing exercise, switching to a healthy, balanced diet and making gradual but permanent lifestyle changes), but these messages are taking hold only slowly. The point remains--and it is a concern for many health educators--have the messages about healthy eating been 'read' by girls and women (and by some boys) as meaning that they should lose weight, thus adding to the pressures to be slimmer which they face already?

There is not the space here to discuss where these pressures come from. Briefly, however, two critiques have emerged. Firstly, rather than individualising the problem, which is what a focus on 'eating disorders' does, the feminist movement suggests that it is society, with its disordered view of women, the body and food, which is the problem. Thus compulsive eating, self-starvation, bingeing and purging are all strategies which women use to deal with the contradictions, that women are the chief nurturers and providers of food, but are also expected to conform to an ideal body shape and in order to 'be slim' they have to deny themselves food. Orbach (1978) pointed out that Fat is a Feminist Issue and this theorising about The Tyranny of Slenderness (Chernin, 1989) to explain why the majority of women have 'problems' with food has been well expounded elsewhere. The pressure from women's magazines has been analysed (Snow & Harris, 1986). These also provide an outlet for manufacturers of slimming products. Neale et al. (1992) estimate the number of women who slim in the UK each year at 14.2 million, 2.6 million of whom use 'novel slimming products' such as replacement meals. Women and girls are thus presented with ideal body images and also with the means to achieve this for themselves.

A second set of explanations comes from those who suggest that the Health Movement itself is part of the problem (White et al., 1995). If the Health Movement had engendered a move towards each individual taking responsibility for eating healthily and having a slim, fit body, it is clear that these trends affect children too. Indeed, some health education campaigns explicitly use children to trigger their parents into thinking about healthier lifestyles.

Healthy Lifestyles Education in Schools

Whilst the notion of the health promoting school and the use of the school as a setting within which to tackle the health issues of young people is to be welcomed, there is no existing research evidence which says whether the messages received by children in schools about a healthy body weight and healthy eating reinforce unhealthy dieting and preoccupation with the body. It is possible, however, to see practices in schools which may affect the process of children becoming body and food obsessed.

Firstly, schools could adopt a style of nutrition education which acknowledges society's pressures to be thin and which promotes a more positive body image, which suggests healthy ways to be an appropriate weight (i.e. other than dieting) and which explicitly looks at the way which the socialisation process can lead to confused feelings about food. This would mean tackling the kind of practices which Burnett (1994) found in her study of the use of sweets are rewards in schools. These practices reinforce the idea that sweets are special and thus could contribute to their use in 'comfort eating' in later life. It would also mean being careful with the images used in nutrition education, so that the idea of healthy eating is primarily about eating a balance of foods and not about being 'too fat'.

Education explicitly aimed at preventing problematic eating is rare. As NeumarkSztainer et al. (1995, p. 24) remark,

The high and apparently growing rates of eating disturbances, and the difficulty of successfully treating them, have led several authors to stress the importance of prevention. However, surprisingly few published reports describe and/or evaluate prevention programmes.

The authors describe their own, seemingly successful, intervention programme, carried out in Israel. A taught programme, 'The Weigh to Eat!', was given over 10 weeks, 1 hour per week. The effects of the intervention were maintained for 2 years and it was effective 'in both the prevention of unhealthy dieting and bingeing and in the modification of a number of unhealthy eating behaviours among a sub-group of overweight girls' (p. 30). They conclude that it may be most cost effective to identify high risk groups and to concentrate secondary prevention efforts on them. Further, 'A similar conclusion was also reached by Killen et al. who have published the only other long-term (2-year follow-up) controlled study in this area' (p. 30). Killen et al. (1993) note that there is

... at present, little, if any research effort ... devoted to the promotion of healthful weight regulation among normal weight children and adolescents and no controlled studies have examined programs designed to prevent eating disorders. (p. 371)

Their intervention consisted of 18 lessons to 931 girls aged 11-13 on the harmful effects of unhealthy weight regulation, promotion of healthy weight regulation through sound nutrition and aerobic physical activity, and the development of coping skills 'for resisting the diverse sociocultural influences that appear linked to the current popular obsessions with thinness and dieting' (p. 372). This kind of intervention in the classroom, then, may be one way forward and could be adapted for use in the UK. (There is a 'The Weigh to Eat!' teacher's guide, 112 pp.)

A major issue in the UK concerns the entire place of food and food studies in the school given the changes made by the National Curriculum. Fine (1993) asks 'Is there a future for food in the curriculum?' and Stitt et al. (1995) lament the decline of cooking skills, which leave young people more at the mercy of pre-packaged food, lacking in confidence in handling food and with less control over food. Lang & Baker (1993, p. 200), describing the 'Get Cooking' project, suggest that teachers are fighting back and 'organizing some marvellous initiatives in class, at lunchtimes and at weekends' to restore cooking skills. However, there remain urgent questions about schools having the time and resources to devote to learning about food, nutrition and eating.

An essential feature of the health promoting school is that attention is paid not only to what occurs in the classroom, but also in the whole school and between the school and the family and wider community. One priority within nutrition education in health promoting schools has been to minimise the contradictions between what is taught in the classroom and what is 'picked up' by children in actions and policies within the school as a whole. Young describes the policy in one school, which removed all confectionery and fizzy drinks, replacing them with fresh and dried fruit, lower fat crisps and fresh fruit juices. No tuck shop and no vending machines were allowed. Ingredients in the food provided at lunch times were changed; for example only wholemeal bread was used for sandwiches. He concludes that policy such as this can have a significant impact on young people's actual behaviour and food choices. The availability of sandwich making facilities instead of the tuck shop saw a decrease in children's consumption of biscuits, sweets and chocolate in the morning break and an increase in sandwich consumption (Young, 1993). A healthy eating campaign designed to change choice of food in the school dining room in Birmingham saw similar success (Harden, 1994). A scheme set up to reward schools which had a 'healthy break time' policy, where one of the criteria for qualification was that if food was permitted at break time only fruit or milk could be taken, has shown similar success (McKinley et al., 1995). As snack foods are amongst those likely to be high in calories and as adolescents shown an increase in snacking, attempts to educate and regulate about these foods could be a positive way of enabling young people to maintain their weight in a healthy fashion. Hopefully, all these initiatives may enable children to eat more healthily and not put on excess weight. However, concern can be raised about whether these types of policy initiatives, where only certain foods are permitted, detract from the spirit of voluntarism enshrined in educational approaches, where children are educated and encouraged but in the end can still make choices from a full range offered.

Teaching about food and ensuring consistent policies and practices about food is only part of the picture, however. If eating problems are symptoms of a young person having difficulties with some of the developmental tasks of adolescence or with body-image, self-esteem and so on, then any educational intervention needs to tackle these. There may therefore be a preventive role within sex education, if the tasks of adolescence include defining a sexual identity and developing intimate relationships. Establishing an identity and becoming an individual are also important tasks with which schools can help. To develop the confidence, self-esteem and general well-being of all children in the entire school, has enormous implications for the ambience and ethos of the school. It would mean more resources and more training for staff. Currie & Todd (1990, p. 25), noting that girls with poor body image are more likely to want to change their bodies and are more likely to smoke, drink, get drunk and be trying to lose weight through dieting, go on, logically, to say that 'Education for a healthy and positive body image may be one way in which to tackle the somewhat negative health habits adopted by girls with poor body image'. This may be an essential way forward, but there is a dearth of materials for teaching in this area. [One book which has emerged in Australia to meet this gap is by Cooke (1994), aimed at girls and young women.]

Enabling young people to produce a critique of the pressures to be a certain shape and working to develop young people's confidence, sense of self-worth and social skills are two major projects. A third is to provide health enhancing means of maintaining a sensible weight. A broad programme of health education is needed, which looks not only at food and eating but also at the food, eating and weight aspects of the usual health education 'topics'. This would include, for example, the need to look at the appetite suppressant qualities of tobacco when discussing smoking, at the calorific values of alcoholic drinks, at the effect on weight of exercise and so on.


The disordered view of the body, food and eating which society has, which results in so many women and girls living with dissatisfaction regarding their bodies, must be a cause of concern to all those working with young people. Health educators have to ask whether this 'disordering' is partly produced by the message about overweight which they expound and by the 'healthist' movement which they have helped to create the climate for. Health education does take responsibility for how messages are decoded by those on the receiving end, but the effect on young people of healthy eating campaigns particularly the 'don't be overweight' message has not been properly researched. There needs to be greater collaboration between researchers in the various allied fields. There also needs to be greater clarification of the teacher's role; they clearly should not be expected to tackle clinical cases of eating disorders (under which there may be all manner of complicated issues, including sexual abuse), but they could become equipped to educate about food and eating so as to reduce children's concerns about body weight and so in the long run decrease the numbers of dieting and becoming overweight.

Correspondence: Dr Rachael Dixey, Health Promotion, Faculty of Health and Environment Care, Leeds Metropolitan University, Leeds LS1 3HE, UK.

DMU Timestamp: February 03, 2020 23:30

0 comments, 0 areas
add area
add comment
change display
add comment

Quickstart: Commenting and Sharing

How to Comment
  • Click icons on the left to see existing comments.
  • Desktop/Laptop: double-click any text, highlight a section of an image, or add a comment while a video is playing to start a new conversation.
    Tablet/Phone: single click then click on the "Start One" link (look right or below).
  • Click "Reply" on a comment to join the conversation.
How to Share Documents
  1. "Upload" a new document.
  2. "Invite" others to it.

Logging in, please wait... Blue_on_grey_spinner