She runs three miles every day, but she always seems to be on a diet. He doesn't hang out with his friends as much because he has to work out. She seems thin to everyone else, but says she's fat.

Half a million American teens between age 13 and 18 struggle with some sort of eating disorder. The results can be serious, ranging from tooth decay and fatigue to high blood pressure and even death, according to the National Eating Disorders Association (NEDA).

How can teachers and coaches tell if one of their students has an eating disorder? And what can they do?

Children, preteens and teenagers can go through amazing growth spurts, shooting up like weeds over the summer, dropping baby fat, filling out muscles and turning into young adults almost overnight. But what if the development — or lack of development in their bodies leads kids to unhealthy eating disorders, like anorexia or bulimia, in order to attain their ideal body image?

The NEDA has a list of symptoms to give adults a heads up to spot if a youngster’s eating is out of control:

  • Dramatic weight loss
  • Preoccupation with weight, food, calories, fat grams and dieting
  • Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates)
  • Frequent comments about feeling "fat" or overweight despite weight loss
  • Anxiety about gaining weight or being "fat"
  • Denial of hunger
  • Development of food rituals (e.g., eating foods in certain orders, excessive chewing, rearranging food on a plate)
  • Consistent excuses to avoid mealtimes or situations involving food
  • Excessive, rigid exercise regimen — despite weather, fatigue, illness or injury — with the need to "burn off" calories taken in
  • Withdrawal from usual friends and activities
  • In general, behaviors and attitudes indicating that weight loss, dieting and control of food are becoming primary concerns

For coaches and trainers, the symptoms can be more specific, yet harder to see. Athletes especially those who are in sports where weight is an issue (gymnastics, wrestling, swimming, weightlifting) can be adept at hiding their eating disorders.

Signs for coaches and trainers to watch for are:

  • Decreased concentration, energy, muscle function, coordination, speed
  • Increased fatigue and perceived exertion
  • Longer recovery time needed after workouts, games, races
  • More frequent muscle strains, sprains and/or fractures
  • Slowed heart rate and low blood pressure
  • Reduced body temperature and being sensitive to cold — cold hands and feet
  • Complaints of lightheadedness and dizziness, abdominal pain
  • Poorer interaction with coaches/teammates
  • Perfectionism
  • Increased impatience, crankiness
  • Increased isolation
  • Difficulty with days off and tapering
  • Avoidance of water or excessive water intake
  • Preoccupation with one's own food
  • Preoccupation with other people's food
  • Ritualistic eating and/or avoidance of certain foods
  • Excessive concern with body aesthetic
  • Prolonged or additional training above and beyond that required for sport (e.g. extra sit-ups and laps, extra workouts)
  • Athletes on the team reporting concern about an individual

The earlier a person with an eating disorder gets help, the more likely he/she is to have a positive outcome. If you think your student or athlete could have an eating disorder, what can you do without violating the child's privacy or making the situation worse?

Don't try to solve the situation by yourself. Go see the school nurse and ask for help. Monitor the athlete's weight and vital signs. Also, be positive. Support from coaches, teachers, teammates and classmates can help someone who feels bad about themselves or their body.

For more information, contact the NEDA's toll-free Information and Referral Helpline at 800-931-2237, or go to