Back to the Cafeteria: Where Eating Disorders Thrive & How to Help

As we head back to school for the year, I am hearing a common them of concern come up with my clients and families receiving eating disorder treatment in Columbus, Ohio- How to navigate school lunch in the cafeteria with an eating disorder. Since this theme seems to be so common, I thought it would be helpful to write a blog about what the concerns are in the typical middle or high school cafeteria and how to address them with eating disorder treatment in mind.

 First, let’s talk about the common issues:

#1- Timing

Lunches can be extremely early or late in your child’s typical schedule. This means they might not feel hungry yet if they have an earlier lunch or they might be going too long without food between breakfast and lunch if it’s a later lunch. Give them time to adjust- this does not mean skipping meals. It means letting them know, “You may not feel hungry at lunch for a few weeks, and that’s ok. Your body needs fuel and you will need to eat anyway”. If their lunch is later, we may need to pack a snack to have before lunch. The typical human body functions best with fuel every 3-4 hours. So this means, if they are having breakfast at 7 AM and lunch isn’t until 12:50, they are going to require a snack in between to keep their body functioning and focusing properly. We do not want someone recovering from an eating disorder to be triggered by an empty stomach feeling or long periods of restricting. I suggest packing something quick and convenient they can eat in class or the hallway, such as a granola bar or a protein shake. Children and teens will likely push back against this, as they do not want to be seen as “different” for eating when others aren’t, but you can let them know, it is a requirement for their return to school. If the school gives you or them a hard time, ask for a note from your child’s eating disorder treatment team.

#2- Lack of Supervision

If your child is in or has been in eating disorder treatment and recovery, it is likely that some or most of their meals have been supervised by an adult (parent or other trusted caregiver). Return to school means you will not be there to monitor what they are eating or make sure they are eating at all. This is a scary place and usually the number one concern from my clients and their parents. Adolescents are worried with all of that freedom, their eating disorder will convince them not to eat and parents are worried about the same.

During times of stress and transition, it is typical for us as humans to rely on the coping skills that we are used to- unfortunately for eating disorder patients, this can mean going back to restricting or purging when stress is high in order to reduce in the moment anxiety.

Return to school is a big stressor for teens, so making sure they have plenty of other coping skills to use at school (fidgets, journaling, essential oils, a trusted friend or teacher, therapy, a comfort object) is going to be an important part of your plan. In addition to coping skills, it can be beneficial to implement a plan to increase supervision during lunch and reduce the urge to restrict. Some examples of how this could look:

-having the lunch supervisor check on your child throughout lunch to make sure they are eating

-have child send pictures of their lunch (before/after) or text what they are having

-eating in the nurses or guidance counselors office with a friend

-eating in a trusted teachers classroom with friends

-parent picking the child up for lunch and eating in the parking lot

These may sound extreme, and trust me your child will not like any of them, but they are ALL better than being pulled out of school completely to go to eating disorder treatment full time. I advise you to discuss these options with your child’s treatment team to see what is the best solution.

#3- PEERS!

This is by far the most anxiety provoking part of cafeteria lunches- other kids!

Your child has been home all summer, in the safety of their house, with chosen friends around. Now they are walking in to a melting pot of teenagers, gossip, judgement and social games- how stressful! Not to mention, not eating lunch seems to be more and more common these days. There is stress about where to sit, what to eat and how much to eat. There is comparison to what others are eating and worry about judgement from peers. The one thing all teenagers want is to be accepted by their peers- when there is an eating disorder present, this worry about acceptance is increased tenfold. Talk with your child about how they will handle this and strategies for challenging those anxious thoughts that will come up. Help your child to use CBT skills such as thought challenging to check the facts of what their brain is telling them (No, everyone is NOT staring at me, they are worried about themselves). Also help them to develop a support system at lunch for when things get hard. What friend can they lean on or look at when they are struggling and how can we help that friend to know what to do to help? I encourage clients with eating disorders to tell trusted friends about their diagnosis before going back to school so that they will have support during difficult times. That friend is not in charge of monitoring their meals, but they can change the subject or offer to take a walk if they notice stress arising. Offer to be with your child when they tell their trusted friend about the eating disorder and give support.

Lunch in the cafeteria can be like the Wild West, or better yet, Mean Girls. Make sure you have these conversations with your child frequently and check in on how things are going. Talk with your child’s eating disorder treatment team to make a plan for return to school and how to monitor progress down the line. Every plan and decision will look different based on where your child is in their treatment.

If you have a child or teen in Ohio who is dealing with eating concerns, please visit my site to learn more about eating disorder treatment in Ohio. I provide virtual eating disorder therapy services from Columbus, Ohio and work with teens and young adults in college. I treat anorexia nervosa and bulimia nervosa in adolescents in Ohio.

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This blog is intended to be educational and informational and does not substitute for professional medical and therapeutic help, which is highly recommended when treating an eating disorder. If you would like help treating your child’s eating issues or want to learn more, Schedule a free consultation call today.