Everyone is concerned by increasing anorexia among adolescent girls, but few seem to realize that the very culture prevalent in schools that could be a contributory factor.
Research at the University of Western Sydney (UWS) reveals how the culture of secondary schools can unintentionally encourage anorexia nervosa in adolescent girls by over-emphasising self-discipline, competition and the virtue of being thin.
Chief investigator, Associate Professor Christine Halse from the UWS Centre for Educational Research, says some key indicators of anorexia, - such as high-levels of self-discipline and a strong desire for perfection - have distinct parallels with the practices, values and curriculum of secondary schools.
A total of 30 families were involved in the research, with in-depth life history interviews conducted with 24 girls between the ages of 14 and 20, who were receiving treatment for anorexia nervosa at two major hospitals in Sydney.
The study shows that schools play a critical role in the development of girls' self image, confidence and self-esteem, with many of the girls citing particular high school experiences as defining moments in their anorexia.
"In school environments where high achievers win awards and enjoy the esteem of their peers and under-achievers are regarded as failures, kids learn from a young age that success and achievement are desirable virtues," says Associate Professor Halse.
"When the culture and practices of schools focus excessively on competition and individual achievement, it can encourage a drive for perfection. This drive for perfection is a key feature of anorexia, and for vulnerable individuals it can extend to other areas of daily life."
The study also reveals that the typical anorexic behaviour of segmenting the day into tidy timeslots and self-imposing tight restrictions on eating and exercise can reflect the self-discipline that is encouraged by school practices.
"Schools are disciplined environments where timetables and bells are used to regulate the approved use of time, including where and when a student can eat," says Associate Professor Halse.
"Again, the virtue of discipline can unwittingly encourage and reinforce the behaviours and values of girls who are susceptible to anorexia."
Figures show that an estimated 1.6 per cent of the Western world's population, including Australia, suffer from a moderate to severe eating disorder, with rates continuing to rise, particularly among adolescent girls.
Schools are under increasing pressure from governments, academics and the media to do more to help stem the tide of eating disorders, but according to Associate Professor Halse, it can become a precarious balance.
"In the face of concerns about an obesity crisis, initiatives to promote a healthy lifestyle for the benefit of at-risk students can actually be harmful for others," she says.
"Physical education and learning about nutrition is an important course of study in schools, however, when health education equates slenderness with health and fitness, it can lead students to over-emphasise the importance of being thin - for girls who might already be feeling society's pressure this can fuel anorexic behaviour.
"The problem can be compounded by school activities, such as swimming carnivals and gym classes that make bodies the objects of public display and that encourage students to make physical comparisons of body shape and size."
Associate Professor Halse plans to conduct further research in this area, which she says will hopefully lead to more prevention programs in schools, enhanced treatment protocols for healthcare professionals, and stronger support systems for anorexia patients and their families.