Addressing disordered eating in post-primary schools in Northern Ireland: a mixed-methods study of pupil and caregiver perspectives

The prevalence of eating disorders (ED) among children and young people is becoming an increasing issue worldwide. Also of concern is the prevalence of disordered eating (DE), with an estimated 1 in 6 children in Northern Ireland engaging in disordered eating behaviours, which is often a precursor to a clinical ED in later life. The current study aimed to explore (1) How do sixth form pupils experience and make sense of disordered eating within the school context? (2) What are pupils’ views on the quality and adequacy or school-based education, identification and support for DE/ED? (3) How do caregivers perceive the role of schools in identifying and supporting pupils with DE/ED? A total of 66 sixth form pupils from schools in Northern Ireland completed an online survey exploring their perceptions of DE/ED; their experiences of receiving school-based support if applicable and their opinions on how schools could work to prevent DE/ED through education initiatives. Additionally, 29 caregivers of school-aged children with DE/ED completed an online survey to obtain their experiences of accessing school-based support for their child and their views on DE/ED education. Five sixth form pupils participated in follow-up semi-structured individual or friendship group interviews to further explore their perceptions, attitudes and ideas regarding these topics. Surveys were analysed using descriptive statistics and thematic analysis, while the interviews were analysed using reflexive thematic analysis. Findings indicated that DE and body image concerns were prevalent among pupil participants and normalised within peer and school environments. Many DE behaviours go unrecognised due to social norms around diet restriction and misconceptions of DE and ED. School based support and education was limited, inconsistent and inaccessible, with stigma, confidentiality concerns and lack of staff training listed as barriers to seeking support. Caregivers highlighted mixed opinions of school support and challenges with multi-agency collaboration. Both pupil and caregivers expressed strong support for comprehensive and inclusive school-based education and support around DE/ED. The findings suggest that schools can play a key role in the prevention and identification of DE/ED. Whole-school evidence-based approaches that prioritise education, staff training and clear support pathways may help to reduce stigma, improve early intervention, and better support young people experiencing DE/ED.