Law and Order: EDU
Both New York and Virginia (where I live) are considering laws to help prevent eating disorders. No, they’re not making EDs illegal, but the state legislatures are taking steps to detect EDs earlier.
I can applaud the effort. However, I think the actual text of the bills and what they would do (or be able to do) leaves more than a bit to be desired.
In New York, bill S2530-2013 is intended “To create the Eating Disorders Awareness and Prevention Program within the Department of health and to require the health certificates required for attendance in public schools include an assessment of the student for eating disorders.”
The bill also requires that the health certificate required for school attendance also screen for the presence of an eating disorder.
Each such certificate shall describe the condition of the student when the examination was made, which shall not be more than twelve months prior to the commencement of the school year in which the examination is required, and shall state whether such student is in a fit condition of health to permit his or her attendance at the public schools. Each such certificate shall also state the student’s body mass index (BMI) and weight status category…Furthermore, each such certificate shall include an assessment of the student for eating disorders. Such assessment shall be conducted pursuant to standards established by the commissioner of health.
If it should be ascertained, upon such test or examination, that any of such students have defective sight or hearing, an eating disorder, or other physical disability, including sickle cell anemia, as above described, the principal or his or her designee shall notify the parents of, or other persons in parental relation to, the child as to the existence of such disability or disorder. If the parents or other persons in parental relation are unable or unwilling to provide the necessary relief and treatment for such students, such fact shall be reported by the principal or his or her designee to the director of school health services, whose duty it shall be to provide relief for such students.
Let’s dig into the nitty gritty of this: a media health awareness campaign about eating disorders is all well and good, but what will it actually contain? Just stuff about loving your body? Will it address all the nuances about EDs in males, minorities and other non-traditional (read: not white, rich, and female) groups? Does anyone know whether awareness campaigns for EDs actually work? Do they lead to earlier recognition and treatment?
Part of the awareness campaign is to let people know about appropriate treatment. Again, all well and good, but it doesn’t address MAJOR issues, such as lack of health insurance. Knowing that a psychologist in your town might be able to treat an ED doesn’t do you any good if you don’t have insurance, if your insurance won’t cover the ED expert and wants you to see someone else, will only cover 10 sessions with them, or other limitations. There are also large swaths of the country with no ED treatment whatsoever. Awareness is good, but it doesn’t address the treatment aspect.
Another issue is that most physicians wouldn’t recognize an ED if it bit them in the ass. I know only two people whose pediatricians or physicians took the appropriate action when they started to show pretty major clinical signs of an ED.
Also, the law doesn’t say how a person will be screened for an ED. It could be just asking the kid, “Do you have an eating disorder?” or even just measuring their BMI and assuming their not grossly over or underweight, then they’re fine. Most physician appointments in the US are about 15 minutes, if that. Forgive me, but you can’t adequately evaluate someone for a potential ED in 15 minutes, let alone the multitude of other things that must be done.
I also have big privacy concerns about being legally obligated to report your eating disorder to school authorities. I understand that if a student needs accommodations because of an ED or other condition that the school needs to know, but otherwise, it’s not the school’s business. So why is the school notifying parents about a kid’s ED? Shouldn’t the physician, the young person, and the parents all have a nice sit down if the physician detects that something might be wrong? Schools are NOT trained medical professionals and they should NOT be taking that role, in my opinion. I don’t want a school testing for obesity, either.
Then there’s the bill in Virginia, HB1406.
That the Department of Education, in conjunction with the Department of Health, shall develop and implement policies for providing parent educational information regarding eating disorders. The Department of Education and the Department of Health shall develop policies with input from organizations and entities including local school boards, school superintendents, the National Eating Disorders Association, the Virginia Association of School Nurses, the Virginia Chapter of the American Academy of Pediatrics, and the Virginia Academy of Family Physicians. In doing so, the Department of Education and the Department of Health shall identify and develop appropriate additions or revisions to the Virginia School Health Guidelines related to development of parent educational information, including guidance regarding the clear delineation of such health information from other administrative documentation. Additionally, the Department of Education and the Department of Health shall develop appropriate guidelines for local school boards regarding (i) the optional development of an eating disorder screening program; (ii) specification of training needs and requirements for personnel and volunteers; (iii) appropriate opt-out and exemption procedures; (iv) parental notification procedures for positive indications of an eating disorder; and (v) any issues requiring statutory or regulatory amendment. Such Departments shall provide guidelines to the Superintendent of Public Instruction for dissemination by no later than July 1, 2013.
Basically, the bill requires teachers who notice an eating disorder in their students to report it to the parents. What it doesn’t say is that teachers will be trained in how to recognize an eating disorder. Even if they were trained, how do we know that the training will be adequate? I think teachers should tell parents about significant behavioral changes or serious health issues (ie, drastic weight loss, evidence of purging), but I’m not sure about making this law. How many teachers see these things and do nothing? Would a law change that? A concerned teacher will probably do everything to help their student regardless of whether a law is telling them to take steps.
Then there are the many cultural issues surrounding mental health and treatment. Writes Tetyana on a Tumblr post on the subject:
I live in a very multicultural city, I mean very multicultural. This legislation might go down well for a white cis middle-class girl, but what about telling the parents of a trans black man from Nigeria that he’s starving himself? The legislation is not sensitive to cultural differences in dealing with mental health. It needs to be done with care, and I’m not sure teachers—unless properly trained—would be able to do that.
The issue of mandatory parental notification has also raised some serious eyebrows. I think the vast majority of parents do want to help their children, but as several people have pointed out to me, not all parents respond appropriately. What happens if a teacher tells a parent and a child is inadvertently harmed? Is the teacher liable? What happens if the parents don’t do anything? At least in the NY bill, it mentions that if the parents are unable to provide treatment then the school district will.
As well, I think the student should be brought into the conversation in an appropriate manner. Someone with an ED might not recognize how ill they are and brush off any worries (I know I did!), so a kid insisting they’re fine shouldn’t be the end of a potential concern. But the student can provide input on what’s going on in their life and in their head.
Again, I’m just not convinced that there’s a large number of teachers out there who are noticing potential EDs and then sitting on their hands. Providing more education to teachers and parents about the warning signs of EDs and what to be on the lookout for is a really good idea, but just sending a letter home about a potential ED won’t always solve things. Teachers are in a great spot to help, I’m not denying that. But I think this is one of those Band-Aid on a bullet hole solutions.
Rather than passing these laws, I would like to see better physician education, improved access to treatment, and, while we’re at it, better treatments. We do need to increase awareness and understanding of EDs to both parents and teachers and students. We do need to be better at detecting EDs earlier. I just think we can do better than these laws.