When Sophie first comes back to college after lockdown, it doesn’t take long for her tutor to spot that something isn’t right. Sophie doesn’t look different, but she has stopped going to the canteen at lunch - she’s spending all her breaks in the study space instead. She’s also not taking part in tennis, an activity that she always loved.

These are some of the warning signs of an eating disorder, and because Sophie’s tutor has spotted them early, she is able to get support before things escalate further.

Eating disorders can develop at any age, but anorexia nervosa usually develops at 16-17 and bulimia nervosa at 18-19. This puts colleges on the front line, with a crucial role to play in identifying problems. 

In an ideal response scenario, events will play out as they did in Sophie’s case. However, during the first lockdown, students were (and in some cases still are) not physically able to attend college. And with eating disorder referrals on the rise, it seems that being cut off from their usual college support networks could be taking its toll on young people.

But just how worried should colleges be? And what, if anything, can they do to reverse this worrying trend?

Statistics from the charity Beat show that there has been a large increase in the number of people seeking help for eating disorders since the coronavirus crisis began. 

“We have noticed a huge jump in people reaching out for help since the start of the pandemic,” says Rebecca Willgress, Beat’s head of communications. “In September 2020, there was a 78 per cent increase in demand compared to February.”

It’s a similar picture in child and adolescent mental health services (Camhs), according to Dr Tara Porter, acting lead clinical psychologist at the Royal Free Hospital in London. She specialises in treating young people with eating disorders, and has seen an increase in referrals over the past few months.

“It’s like a second pandemic,” Porter says. “Typically, August would always be a little bit quiet and then we’d get a raft of referrals in September. [But] this year, all through the summer, the referrals did not stop. They are just coming, coming, coming.”

In colleges, too, cases appear to be on the rise, even where the total number of students who are disclosing a problem around eating is still relatively low.

“In the last three to four weeks, we have seen a sudden spike in young people disclosing to all three campus safeguarders that there is an eating issue,” says Nikki Lane, assistant principal student wellbeing and support at East Coast College, which has campuses in Great Yarmouth, Norfolk, and in Lowestoft, Suffolk. 

Likewise, Michelle Dowse, deputy principal at Cambridge Regional College, says that her team is seeing a pattern. “We are starting to see an increase in eating disorders, or at least the potential for it - so a number of students who are not eating because they’re anxious, for example, or because they don’t like eating in public,” she says.

But what is it about the pandemic that is causing an increase in eating disorders? Willgress says that the ongoing, widespread sense of stress is having a significant impact.

“People with eating disorders have had to cope with extreme changes to their daily routine and treatment programmes, along with worries about being isolated or unable to see their support network,” she says. “This has the potential to be extremely triggering to anyone affected, and it is not surprising to see such a large increase.”

The Covid-19 pandemic is driving a general increase in anxiety, but it could also be contributing to a rise in eating disorders in another way, Porter says. The virus has brought with it a raft of new rules and restrictions, which are making young people feel that they have less control over their lives. This is important, Porter says, because “when everything is out of control, people try to find aspects of their lives to control”.

“When you think about how teenagers rebel against their parents, the task of being a teenager is to separate: separation and individuation, to find your own way,” she explains. “In March, April, May, there weren’t really many ways to do that.”

And with limitations placed on how young people can socialise, when they attend college and even whether or not they can sit their exams, it is perhaps not surprising that more of them than usual would turn to controlling what they eat.

Of course, eating disorders are not caused by anxiety or a loss of control alone. The contributing factors are complex - according to Willgress, “stressful life events such as bullying, bereavement or family troubles can be a risk factor”. There is also a growing body of research to suggest that genetics, metabolism and brain structure may all have a role to play.

But, whatever the causes, being away from the safeguards of college is certainly not helping the issue, says Jemma Michelson, a teacher at the Royal Free Hospital Children’s School, who works with students undergoing intensive treatment for eating disorders. “[College] is an extra safeguard, isn’t it? It’s the daily eyes,” she says. “That whole safeguard of seeing it, noticing, and communicating with the young person and the parents was lost in Covid.

“You have these young people in their baggy pyjamas all day on their screens. And you’ve got really stressed-out parents who are trying to keep their jobs.”

So what can colleges do to counteract these issues? The progress of the Covid-19 pandemic is out of their control - and blended or remote learning has had to become the norm for some courses in order for colleges to comply with guidance. 

There are certainly no easy solutions, but there are steps that colleges can take to make staff more aware of the issue and better equipped to respond when they suspect a student may be developing disordered eating patterns.

It starts with establishing what Dowse calls a “culture of vigilance”. “[We make] sure that all of our staff are aware of what to look out for, so we have a lot of focus on training our staff in terms of mental health and being able to spot signs,” she says. 

In the current circumstances, this needs to include training in how to identify problems remotely as well as in person, she adds. And once an issue is identified, the first step should be to encourage students to talk to their GP.

Training staff to spot the signs is a key part of the strategy at Weston College in Somerset, too. Georgie Ford, lead specialist practitioner in mental health at the college, says that this goes hand in hand with working with external services, which will be able to provide help with this.

“Our key advice here would be to make friends with all of your external support agencies,” she says. This includes establishing relationships with Camhs, clinical commissioning groups and charities such as Beat and the Anna Freud Centre - the key being to make sure that those relationships are collaborative and sustainable.

“It’s so easy to say, ‘Oh well, it’s an eating disorder, it’s really dangerous, so we just need to refer them to Camhs,’” Ford says. “But in our head here, that’s not a feasible option. The eating disorder, whether it’s dysmorphia or anorexia, permeates every aspect of their entire lives. And when we think that a lot of these students are with us for the majority of their week, college is their life. So it permeates everything we do.”

The problem, therefore, requires a whole-college approach, building mental health support into the curriculum and making sure that any provision is “meaningful” and “not tokenistic”, she adds. 

Lane agrees here. She says that at East Coast College, they cover mental health through their tutorial programme and focus on addressing the factors that may be at the root of disordered eating (for example, bullying or unhealthy relationships), in the hope that they can get ahead of the problem and prevent any patterns from “setting in”.

This preventative work is important, because while colleges will, of course, work to support a young person who already has an established eating disorder, the help that FE staff can offer once it gets to this point is limited - and they shouldn’t be trying to take on the role of a therapist or other medical professional, suggests Ford.

“It’s so difficult in the field of eating disorders, because we want so much to create an open environment but what we don’t want to do is to step over the educational boundaries here, because they are such a dangerous thing,” she says.

However, preventative measures can be very effective, says Dowse. This is a big part of the provision that her college has put in place. “A lot of work goes into building the self-esteem and confidence of young people and educating them around mental health issues to try and do that preventative education,” she says. 

With regard to what that might look like in practical terms, at East Coast College, staff do work with students around self-image, and use restorative practices to tackle any issues with relationships or bullying - making sure that they pay attention to any historical problems as well as what students might be experiencing in the here and now.

Meanwhile, Ford says that Weston College has recently introduced a programme of staff training around emotional literacy, so that they are able to help students to better identify and manage their emotions.

“We have found that the restricting of eating or overeating tends to be ... the last thing at the end of a really complex chain of emotions. So we’re now trying, as a college, to help students to be emotionally literate, to understand what they’re feeling, why they are feeling it and how the behaviour plays out,” she explains.

Dowse also stresses the importance of students knowing that they have a safe space where they can go to seek support, both in college and online; her college has established a network called The Hub, which provides exactly that.

These kinds of approaches are likely to be helpful, according to Porter. She says that some colleges are already doing “wonderful” work around wellbeing. But, with the pandemic showing no signs of slowing, staff need to remain vigilant. And now, more than ever, all colleges have to think carefully about the wider culture they are creating, and the messages they are sending to students about what is most important in life. 

“That’s saying: ‘Wellbeing is first of what we do. We want children to be happy, to be educated, to be safe, to be engaged in our society, in whatever role is important to them,’” Porter says

Michelson agrees. Young people need to be told that grades are not the only thing that matter, she says, and that they have equal value as members of society, regardless of whether they are studying maths or floristry. “So you’re not valued by the grades that you get; it’s rather that they complement your development as a human being at the end of the benchmark of your youth,” she says.

This will be a difficult message to communicate to learners, because it goes against society’s narrative, where there is “top-down” pressure for every student to be perfect, she adds.

But colleges have to try, because getting this point across is crucial, says Porter.

“It can’t be that we’re putting kids in this high-pressure environment, where we only talk about success at school in the context of getting these exams, not about the other things they do or the sort of person they are, and then tag on some mental health services,” she says. “That’s like cutting an artery and giving you a Band-Aid. It’s just not going to work. You have to put wellbeing first.” 

Helen Amass is Tes’ deputy commissioning editor

This article originally appeared in the 13 November 2020 issue under the headline “What colleges can do to fight a rise in eating disorders”