







































Children and Teenagers 
ISSN 2576-3709 (Print) ISSN 2576-3717 (Online) 

Vol. 4, No. 1, 2021 
www.scholink.org/ojs/index.php/ct 

64 
 

Original Paper 

An Investigation of Eating Disorders among Gifted Adolescents 
Sally R. Beisser1* & Catherine W. Gillespie1 

1 Teaching and Learning Department, School of Education, Drake University, Des Moines, Iowa, USA 
* Sally R. Beisser, Teaching and Learning Department, School of Education, Drake University, Des 

Moines, Iowa, USA 

 

Received: January 14, 2020     Accepted: January 23, 2021     Online Published: February 5, 2021 

doi:10.22158/ct.v4n1p64                            URL: http://dx.doi.org/10.22158/ct.v4n1p64 

 

Abstract 

Gifted students may experience greater risk of disordered eating, especially during adolescence, which 

is already a high-risk time for the development of eating disorders. In particular, the novel Covid-19 

global pandemic exacerbates stress that may influence adolescents with disordered eating. This study 

investigated eating disorders of 33 identified gifted adolescents (77% female) in one Midwest state with 

an online survey using a well-validated instrument, the Eating Disorder Examination-Questionnaire 

(EDE-Q), that contains subscales of eating restraint, eating concern, shape concern, and weight 

concern. Narrative responses were included in the data. Results indicated 20% of the gifted adolescents 

in this study revealed concerning responses about their weight, shape, and dietary restrictions. 

Voluntary comments revealed apprehension, concerns, and distress among some respondents. 

Recommendations are provided for teachers, parents, as well as for students themselves. 

Keywords 

eating disorders, gifted teens, mental health, survey research 

 

1. Introduction 

Gifted students may experience greater risk of disordered eating, especially during adolescence, which is 

already a high-risk time for the development of eating disorders. Fear of fatness and avoidance of fatness 

through dietary restraint, dieting, and fasting, place adolescents at greater risk for eating disorders. To 

date, there is very little literature on eating disorder experiences of gifted adolescents. Educators of gifted 

students are naturally concerned with facilitating advanced academic learning experiences for their 

students. However, they may be unaware of social-emotional needs, mental health challenges, and 

incidence of eating disorders. In particular, males are at higher risk of being unidentified, yet eating 

disorders of males are becoming more problematic, especially among people who do not think males 

have eating disorders. This study will provide essential information for educators, parents, and the 



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students themselves. The researchers were curious about the connections between gifted students and 

eating disorders. The overarching question became, “What are the experiences of gifted adolescents 

concerning their eating restraint, shape, and weight concern?” Although this study was conducted prior 

to the Covid-19 pandemic, the authors believe that this information is more important than ever, as 

people with mental health challenges, including eating disorders, are often negatively impacted by 

unexpected and stressful situations. 

 

2. Review of Literature 

2.1 Description and Prevalence of Eating Disorders 

Three primary eating disorders have been recognized by the most recent (2013) 5th edition of the 

American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V): 

Anorexia Nervosa (often referred to as anorexia or AN), Bulimia Nervosa (often referred to as bulimia or 

BN), and Binge Eating Disorder (often referred to as binge eating or BED). Each of these eating disorder 

diagnoses are described below in the three following paragraphs. If individuals do not meet the DSM-V 

criteria for full-blown eating disorders, they may still have clinically significant partial-syndrome eating 

disturbances that are equally worthy of clinical attention and further study (Bakalar, Shank, Vannucci, 

Radin, & Tanofsky-Kraff, 2015). 

Core features of anorexia include low weight status and dietary restriction. The typical clinical 

presentation of a person with anorexia includes undue concern about their own body shape or weight, 

weight concerns, and body dissatisfaction (Culbert, Racine, & Klump, 2015). Lifetime prevalence of 

anorexia ranges between 2-4% for women depending on the region and population studied and less than 

1% for men (Smink, van Hoeken, Hoek, 2012). In a U.S. sample of 35,995 participants, snapshot (not 

lifetime) prevalence was 0.77% for heterosexual respondents and more than double at 1.71% for 

non-heterosexual respondents (Kamody, Grilo, & Udo, 2019). In a surveillance study of the United 

Kingdom and Ireland, 305 cases of anorexia were reported over an 8-month period, with the average age 

of individuals being 14.6 and the majority being white (92%) young women (91%) (Petkova, Simic, 

Nicholls, Ford, Prina, Stuart, 2019). Although the percentages of people affected by anorexia in the 

population are low, 300 teens in two countries over eight months is still a sizeable number of young 

people. Help-seeking rates among the 275 out of 36,309 survey respondents who met criteria for anorexia 

were 34.5%%, with men and non-whites seeking help at lower rates than women and whites (Coffino, 

Udo, & Grilo, 2019). 

Bulimia typically includes binge eating, compensatory behaviors (purging), over-evaluation of body 

shape or weight, body dissatisfaction, weight concerns, and dietary restriction (Culbert, Racine, & 

Klump, 2015). Lifetime prevalence of bulimia ranges between 2-3% for women depending on the region 

and population studied and less than 1% for men (Smink, van Hoeken, & Hoek, 2012). Additionally, 

bulimia rates have decreased over the years whereas the other eating disorders have not decreased. In a 



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U.S. sample of 35,995 participants, snapshot (not lifetime) prevalence of bulimia was 0.24% for 

heterosexual respondents and more than triple at 1.25% for non-heterosexual respondents (Kamody, 

Grilo, & Udo, 2019). Help-seeking rates among the 91 out of 36,309 survey respondents who met criteria 

for bulimia were 62.6%, with men and non-whites seeking help at lower rates than women and whites 

(Coffino, Udo, & Grilo, 2019). It is noteworthy that the lowest number of survey respondents had 

bulimic symptoms compared to symptoms of anorexia (275/36,309) and binge eating disorder 

(256/36,309), yet it had they were the group most likely to seek help. 

Binge eating disorder is distinguished by binge eating without compensatory behaviors (purging). 

Clinically, a person with binge eating disorder may exhibit emotional eating in addition to the typical 

bulimia issues of over-evaluation of body shape or weight, body dissatisfaction, weight concerns, and 

dietary restriction (Culbert, Racine, & Klump, 2015). Lifetime prevalence of binge eating disorder 

ranges between 2-4% for women depending on the region and population studied and less than 1% to 2% 

for men (Smink, van Hoeken, & Hoek, 2012). In a U.S. sample of 35,995 participants, snapshot (not 

lifetime) prevalence of binge eating disorder was 0.81% for heterosexual respondents and more than 

doubt at 2.17% for non-heterosexual respondents (Kamody, Grilo, & Udo, 2019). Help-seeking rates 

among the 256 out of 36,309 survey respondents who met criteria for binge eating disorder were 49%, 

with men and non-whites seeking help at lower rates than women and whites (Coffino, Udo, & Grilo, 

2019). In an example of partial-syndrome eating disorders with wide-ranging impact, 154 undergraduate 

women at Palestine Polytechnic University were assessed and 50% had some level of binge eating 

symptoms (Badrasawi & Zidan, 2019). Those who struggled with binge eating were more likely to also 

have higher levels of depression, stress, and anxiety. 

2.2 Risk Factors for Eating Disorders 

Risk factor for eating disorders include those that are sociocultural or socio-environmental, such as social 

media and living in a culture that idealizes thinness, those that are psychological, such as inborn 

temperament and the trait of perfectionism, and those that are genetic or biological, such as hormonal 

changes and disturbances (Bakalar, Shank, Vannucci, Radin, & Tanofsky-Kraff, 2015). Reviewing all 

three of these spheres of influence over 50 research studies, Culbert, Racine and Klump (2015) 

concluded that all three of the areas interact with each other. For instance, when individuals do not 

internalize the cultural message of the thin ideal, that is partly due to genetics and partly due to the 

individual’s sociocultural environment. Even with the interactions among them, researchers were able to 

identify these variables as eating disorder risk factors: “sociocultural influences (media exposure, 

pressures for thinness, thin-ideal internalization and thinness expectancies) and personality 

characteristics (negative emotionality/neuroticism, perfectionism, and negative urgency)” (p. 1156). 

Biological factors such as serotonin or dopamine disturbances emerged not as risk factors, but rather as 

correlates of eating disorder development. Similarly, the following sociocultural and psychological risk 

factors predicted the onset of eating disorders for 1,272 women who were followed from a three-year 



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period from 18-21 years of age: internalization of the thin ideal, body dissatisfaction, denial of the costs 

of pursuing the thin ideal, dieting, fasting, overeating, positive expectations of what thinness would bring, 

and mental health care (Stice, Gau, Rohde & Shaw, 2017). 

Recent conceptualizations of the sociocultural effects of a culture that idealizes thinness points to the 

internalized thin ideal as being both a cultural and individual fear of fatness. Fear of fatness and 

avoidance of fatness predicted eating restraint among 79 young (averaging 19 years old) Australian 

women (MacLeod, Macleod, Dondzilo, & Bell, 2019). Dietary restraint can include taking smaller 

servings to avoid weight gain, and it is related to eating disorder symptoms. Specifically, dietary restraint 

predicts binge eating, and varies according to individuals’ level of sense of eating-related self-efficacy 

(which is people’s perception of their ability to control their overeating in various situations, including 

around holidays or when upset). In Linardon’s (2018) sample of 237 young women (averaging 25 years 

old), stronger eating-related self-efficacy was related to lower levels of binge eating, but no matter how 

much eating-related self-efficacy was exhibited, higher levels of eating restraint predicted higher levels 

of binge eating.  

2.3 Biological Risk Factors 

Biological risk for eating disorders includes hormonal including hormonal changes associated with 

puberty as well as genetic risk factors. Although genetic associations have been made with anorexia, 

bulimia, and binge eating disorder, the manifestation of these disorders is still multifactorial, including 

input from genetic and environmental factors (Bulik, Blake, & Austin, 2019). The presence of a definite 

genetic component to eating disorders could reduce the stigma and help individual who are struggling 

and their families to experience less shame about their condition, but unfortunately, according to 

one-third of 50 women with a history of eating disorders, blaming genetics could also increase stigma, 

one half of the interviewees thought that a genetic explanation would lead to less personal agency, and 

that would be harmful to people with eating disorders (Easter, 2012). Similarly, a study of 216 

participants investigating the impact of genetic explanations for eating disorder development, researchers 

found it less helpful to emphasize the biological nature of eating disorder development because although 

self-blame was avoided, recovery self-efficacy was decreased (Farrell, Lee, & Deacon, 2015). 

2.4 Other Familial Factors 

Over ten years ago, the Academy for Eating Disorders (AED) released a position paper emphasizing that 

although families can play a role in the development of their children’s eating disorders, it “stands firmly 

against any etiologic model of eating disorders in which family influences are seen as the primary cause 

of anorexia nervosa or bulimia nervosa, and condemns generalizing statements that imply families are to 

blame for their child’s illness” (Le Grange, Lock, Loeb, & Nicholls, 2010, p. 1). The AED organization 

argued instead for the engagement of families, where appropriate, in their children’s eating disorder 

recovery treatment. This is still somewhat of a contentious issue in the field of eating disorders. It is 

certainly too simplistic and not helpful in any way to assert that parents cause eating disorders. However, 



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families can play a role in the development of eating disorders, even if they are not the primary cause. For 

instance, in a study of 50 families with adolescents receiving treatment for eating disorders, it was found 

that the adolescents with eating disorders were more likely than the general population to have lower 

perceived family functioning (Tafà et al., 2017). Additionally, mothers of those with anorexia were more 

likely to be rigid, mothers of those with bulimia were more likely to be enmeshed, and mothers of those 

with binge eating disorder were more likely to be chaotic than those in the general population. Similarly, 

children’s attachment relationships with their parents can influence the development of eating disorders. 

Cortés-Garcia, Hoffman, Warschburger, and Senra (2019) found that secure attachments between 

mothers and children were protective against the later development of disordered eating among a general 

population sample of 904 boys and girls who were followed for six years, starting at age 10. Additionally, 

secure attachments to fathers were found to play a smaller but significantly positive role, especially for 

boys. Secure attachments to peers did not have any observable effect on disordered eating. 

2.5 Adolescents and Eating Disorders 

Three major studies have been conducted that follow children over a period of at least five years to 

determine the sequence of risk factors in the development of eating disorders (Davis & Smith, 2018; 

Goldschmidt, Wall, Zhang, Loth, & Neumark-Sztainer, 2016; Rohde, Stice, & Marti, 2015). All three 

studies point to the possible opportunity for early identification of and intervention with young people 

exhibiting eating disorder risk factors. 

When Rohde, Stice, and Marti (2015) followed 496 young women for eight years starting at age 13, they 

could determine who was at risk by age 14. Over the course of the study, 12% of the participants 

experienced at least one eating disorder. The sociocultural factors of perceived pressure to be thin, 

thin-ideal internalization, and body dissatisfaction all had positive linear relationships with increases in 

eating disorder symptoms, which of course was not positive at all for these young women. All the young 

women experienced the risk factors at higher rates as they got older, but those who developed eating 

disorders experienced the risk factors more from the start of data collection. 

Onset of puberty is one of the factors that contributes to the development of eating disorders. Davis and 

Smith (2018) followed 1,906 children from 5th to 10th grade (from age 11) and found that when onset of 

puberty leads to negative urgency (“When I am upset I often act without thinking”) and then in turn leads 

to thinness expectancies (“If I were thin, I would feel more worthwhile”) or eating expectancies (“eating 

helps me forget bad feelings, like being sad, lonely or scared”), binge eating or purging is a significantly 

significant possible result. It is a developmental sequence that could possibly be interrupted at any point. 

Davis and Smith (2018), like Rohde, Stice, and Marti (2015), concluded that risk factors for the later 

development of eating disorders can be identified in elementary or middle school. 

Goldschmidt, Wall, Zhang, Loth, and Neumark-Sztainer (2016) followed 1,902 young people over a 

10-year period starting in 7th grade (age 13). They found that although for over half of participants, 

overeating and binge eating decreased over time, those with greater psychological challenges (depressive 



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symptoms, body dissatisfaction, and low self-esteem) in late adolescence and early adulthood were more 

likely to have persistent eating disorder symptoms. Overeating was more likely to resolve itself among 

participants over time than was binge eating, although some earlier overeaters became later binge eaters. 

2.6 Eating Disorder Risk for Gifted Students 

There is no reason to suspect that gifted students are at lower risk for eating disorders than other students. 

Gifted students may experience a greater risk, especially during adolescence, which is already a high-risk 

time for the development of eating disorders. Fear of fatness and avoidance of fatness through dietary 

restraint, including dieting and fasting, all put individuals at greater risk for eating disorders. To date, 

there is very little researcher literature on the experiences of gifted adolescents. In 1991, Garner wrote, 

“Gifted adolescents may be more vulnerable to the development of both anorexia nervosa and bulimia 

nervosa because those youngsters possess many of the traits that have been identified as risk factors for 

these eating disorders” (p. 61), but others have not followed up by investigating gifted adolescents’ 

experiences of their food, eating, body and weight. The current study is a much-overdue response to 

Garner’s suggestion. 

 

3. Method 

This Institutional Review Board (IRB) approved study investigated the question, “What are the 

experiences of gifted adolescents concerning their eating restraint, shape, and weight concern?” In order 

to explore this research question, this study was designed to gather data directly from adolescent gifted 

students with an online survey that included a well-validated instrument, the Eating Disorder 

Examination-Questionnaire called the EDE-Q containing four subscales of eating restraint, eating 

concern, shape concern, and weight (Fairburn & Beglin, 1994). The EDE-Q has been widely-used 

enough that Berg, Peterson, Frazier and Crow (2012) were able to conduct a review of the reliability and 

validity literature on it based on 10 studies. They concluded that there is a robust test-retest reliability of 

on the four subscales of the EDE-Q. Additionally, EDE-Q’s validity in determining whether a person has 

an eating disorder was confirmed. 

3.1 Survey Design 

An online survey is an ideal method for allowing secondary gifted students privacy, autonomy, and 

confidentiality of responses. This online survey of 28 questions (Appendix A) was constructed using 

Qualtrics© survey software with five sections. First was a sliding scale containing four questions on 

“How happy are you with your weight, shape, eating, and eating restraint?” The scale represented a 

happy face J to an unhappy face L and representative faces in between. Next there were 12 questions on 

feelings pertaining to weight, shape, eating, and eating restraints with a range of seven responses from 

feeling concerns “every day” to “no days” with responses in between. The third section had eight 

questions about risk behaviors (e.g., throwing up) experienced in the last month with responses 

representing frequency. This section had seven questions on emotions tied to satisfaction with responses 



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ranging from “not at all” to “markedly”. The last section invited open-ended responses from participants. 

3.2 Participants 

In this Midwest state, the department of education lists 462 teachers or coordinators as “gifted education 

contacts”. An email was sent to all middle school and high school contacts. While the majority of these 

contacts listed appeared to work in middle school and high school settings, some contacts had changed, 

some emails were wrong, and some educators were responsible for both elementary and secondary 

students. Consequently, some emails bounced back as incorrect and others were forwarded to the correct 

recipient. Eventually, as a result of this outreach email, 462 gifted and talented education contacts were 

invited to recruit participants in the study by forwarding the survey link to parents of their gifted 

adolescent students. There were 23 female and 6 male respondents, with one participant defined as 

“other” for their gender. The participant age range was from 10 years of age to over 18 years, with 22.6% 

as an average age of 15 years. The 10-year-old was clearly an outlier with respect to the population of 

respondents, however, her sisters were taking the survey and she chose to respond. All participants were 

from the same U.S. state and were identified as Talented and Gifted (TAG) according to their school 

districts. There were an estimated 28,752 identified grade 7-12 (2020) gifted students in this state at the 

time of this study. 

3.3 Procedure 

An invitation email to TAG educators in each district included four research-based statements 

highlighting the severity and importance of disordered eating (Arcelus et al., 2011; Mond et al., 2014; 

Whitaker, 1992). Subsequently, those teachers or coordinators of gifted students in their districts were 

asked to forward the Qualtrics survey link (Appendix A) to the parents of the middle school and high 

school gifted students. Parents, then, were asked to share this survey with their gifted child or children. 

By this method, researchers were able to gain parental consent, from emails or from U.S. Postal Service 

as a hard copy to the researchers. Next, the gifted students sent the completed surveys back to the 

researchers, again via email or postal mail. The time frame of this study was approximately six months 

from the beginning of the initial communication to district educators until researchers received the 

completed confidential surveys through Qualtrics. A total of 30 responses were received. Considering the 

difficulty of getting this survey to the TAG teachers or coordinators, reaching the gifted adolescents, and 

securing parental consent, we were happy with this response rate. In this study, no direct benefit or 

compensation was provided. 

 

4. Results 

The EDE-Q (Fairburn & Beglin, 1994) scores were calculated (Table 2) for the group of respondents in 

this study and their scores are compared below to established community norms. Qualitative comments 

(Table 1) regarding eating habits and attitudes were reviewed, analyzed, and are presented below. While 

most participants did not offer qualitative responses, some comments were positive such as “I feel fine 



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about my body”, “I am very happy about my eating habits”, and “I think I'm happy with the way I look. 

My body has changed a lot recently, but I am happy with the way I look”. However other comments were 

concerning such as “I barely tolerate myself”. Table 1 represents examples of internal struggles with 

body image, social isolation, perceived lack of support, focus on controlling food, issues with food, 

image, eating, weight, and shape. All names represented in Table 1 are pseudonyms. 

 

Table 1. Narrative Comments on Weight, Shape, or Feelings about Eating 

Concerning Comments of Adolescents from Survey Data 

Erin reflects, “I’m not the skinniest girl in the world, nor do I come from a skinny family, so when I was 

younger I just kinda ate whatever I wanted. Lately I’ve been losing weight and since coming out as gay I’ve 

been trying to lose as much as possible”. 

Jennifer says, “I’m in recovery from anorexia, but I still struggle to an extreme every day. Whether with 

wanting to lose weight or feeling like I HAVE to maintain or gain weight to make everyone else happy. There are 

days I don’t eat so the next day I eat till I feel sick because I “have” to make up for it. I “have” to be the poster 

child in recovery. I have to make everyone happy”. 

Kim “I know I have an eating disorder, I have since around seven years old. It started with binge eating, I had no 

one to talk to and was very alone so I turned to food. In middle school I began restricting calories. I would eat a 

max of 300 calories a day. I was working out excessively. Whatever food I did eat was most likely thrown up. I 

still have issues with food, but I’m trying. I actually did a presentation in class on eating disorders. I would love 

to take part in this study. I am not happy with my body or shape. I have had issues with eating and my control 

over it my whole life. Thanks!” 

Megan: summarizes, “I....think about it more than I should. I know, technically, I am within normal weight for 

my age, but it doesn't...stop. Every time after I eat I look at my stomach in the mirror and go No. No this isn’t 

good enough. I know in my subconscious that the food I eat has to go somewhere but it doesn’t shake the 

feeling”. 

Sophie states, “It is really hard to get my mind off of food and the way I look a lot. It is a struggle”. 

 

The EDE-Q instrument is divided into four subscales (i.e., Restraint, Eating Concern, Shape Concern, 

and Weight Concern) and also offers a global score (i.e., a combination) of the four subscales. Gifted 

adolescent survey participants scored significantly higher in the Eating Concern subscale of the EDE-Q 

compared to established community norms (Table 2). This indicates greater concern among gifted 

student participants compared to community norms regarding their eating. 



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Table 2. EDE-Q Results Compared to Community Norms 

 Restraint 

Subscale 

Mean (SD) 

Eating 

Concern 

Subscale 

Mean (SD) 

Shape Concern 

Subscale 

Mean (SD) 

Weight 

Concern 

Subscale 

Mean (SD) 

Global Score 

Mean (SD) 

Gifted Survey 

Participants 

N=30 

1.7 (2.84) 1.84 (1.88)* 2.26 (2.25) 2.23 (1.88) 2.01 (2.22) 

Norms from 

Fairburn & 

Beglin, 1994 

N=241 

1.25 (1.32) 0.62 (0.86) 2.15 (1.60) 1.59 (1.37) 1.56 (1.21) 

Norms from 

Mond et al. 2006 

for their youngest 

group, 18-22 year 

olds 

N=1186 

1.29 (1.41) 0.87 (1.13) 2.29 (1.68) 1.89 (1.60) 1.59 (1.32) 

* p < .01 comparing study participants to Fairburn & Beglin, 1994 norms and also to Mond et al. 2006 

18-22 year old norms using a two-tailed independent samples t-test, assuming equal or unequal variances 

 

The Eating Concern subscale consists of responses to questions 7, 9, 19, 20, and 21 in the EDE-Q, which 

are as follows: 

7. Has thinking about food, eating, or calories made it very difficult to concentrate on things you are 

interested in (for example, working, following a conversation, or reading)? 

9. Have you had a definite fear of losing control over eating? 

19. Over the past 28 days, on how many days have you eaten in secret (i.e., furtively)? 

20. On what proportion of the times that you have eaten have you felt guilty (felt that you’ve done wrong) 

because of its effect on your shape or weight? 

21. Over the past 28 days, how concerned have you been about other people seeing you eat? 

These items are all scored on a 0-6 point scale, with 0=not at all or no days; 2=slightly or 6-12 days; 

3-4=moderately or 13-22 days, and 6=markedly or every day. Survey participants are closer to slightly or 

6-12 days out of the past 28, whereas community norms are closer to not at all or no days. 

 



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5. Discussion and Implications 

The statistically significant difference between study participants and established community norms 

(Table 2) is consistent with narrative comments of the respondents (Table 1) regarding their distress 

around eating where additional comments reflected dissatisfaction with body image, social isolation, 

perceived lack of support, focus on controlling food, issues with food, image, eating, weight, and shape. 

Not all gifted adolescents are overly concerned about food, eating, body image, or weight. However, 20% 

of the students in this study shared negative attitudes about their body image and eating habits, indicating 

possible risk factors for mental and physical health challenges. Educators of gifted are well-positioned to 

help students and their families receive information about disordered eating through knowledge and 

awareness of the potential that their students may be suffering silently about these issues. Teachers and 

parents will want to pay special attention to student behaviors and attitudes in order to help them receive 

early and appropriate interventions. 

Multiple risk factors have been identified among the participants in this study. Age alone is a known risk 

factor for disordered eating, as adolescents are more likely to experience eating disorders. Significantly, 

while this study was conducted prior to the Covid-19 pandemic, the authors believe that this information 

is more important than ever, as people with mental health challenges, including eating disorders, are 

often negatively impacted by unexpected and stressful situations. Students at risk are not likely to cope 

well with adjustments to teaching and learning environments, virtual communication, and online 

learning.  

Therefore, at the end of the survey, we encouraged students and families to seek resources they may need, 

such as the in-school counselor or a private counselor. We highly recommended the National Eating 

Disorders website https://www.nationaleatingdisorders.org/help-support as a resource. They have a 

screening tool and a helpline number +1 (800) 931-2237 on their website, among other valuable 

resources. These resources are invaluable for educators, parents, and students themselves. Another 

helpful website is National Association of Anorexia and Associated Disorders (ANAD) to learn about 

eating disorder identification and recovery. See this website: 

https://anad.org/education-and-awareness/about-eating-disorders/eating-disorders-statistics/ 

 

6. Recommendations for Practice 

School Personnel. Teachers, counselors, administrators, school nurses, dieticians, and other school 

personnel, including coaches, can help normalize body changes during adolescence through informal 

conversations, refraining from comments and comparisons about bodies, clothing, appearance, sexuality. 

and other issues related to body esteem. In addition, we encourage teachers to not ignore warning signs of 

possible eating disorders such as rapid weight loss or weight gain, sudden onset of food anxiety, baggy 

clothing, or submitting of written work that concerns food, eating, body, or weight issues. Educators can 

provide identification and early intervention by providing resources (including websites above) to 

https://anad.org/education-and-awareness/about-eating-disorders/eating-disorders-statistics/


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students whom they perceive to be at risk. They are in a unique position to provide support to ameliorate 

social isolation, facilitate peer support, and be aware of classroom and extra-curricular dynamics. 

Parents and Guardians. Parents of teens, who are appropriately less involved in the school setting, are 

encouraged to not overlook changing behaviors and attitudes of their gifted teens including food, eating, 

body, or weight issues. Be observant of family meals or celebrations with eating opportunities where 

their child seems to exhibit control or avoidance of food. Importantly, refrain from making negative 

comments about their own bodies or eating behaviors. If they suspect their teen is developing an eating 

disorder we encourage them to engage in a crucial conversation to discuss their concerns and to offer 

support to reassure their child of their unconditional love. In addition, parents can educate themselves of 

characteristics of anorexia, bulimia, and binge eating disorders. They may consult helpful resources 

including books, articles, websites such as the National Eating Disorders website 

https://www.nationaleatingdisorders.org. Community professionals may include the school counselor, 

pediatrician, dietician, private counselor, or eating disorder specialist. These non-school related health 

professionals are often covered by health insurance. 

Gifted Students. Gifted students with eating disorders are unlikely to recognize or address their own 

problematic eating or image behaviors or seek help from others. Therefore, teens would benefit from 

being open to conversations, care, and concern from others. Peers can provide timely support for their 

friends who have concerning issues with eating, body image, weight, and shape. Self-deprecating 

behaviors, while tempting for all teens, are particularly counter-productive with respect to developing 

body esteem. Finally, we encourage ongoing prevention, intervention, and encouragement from school, 

family, and friend support systems. 

 

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American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th 

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Badrasawi, M. M., & Zidan, S. J. (2019). Binge eating symptoms prevalence and relationship with 

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Easter, M. M. (2012). “Not all my fault”: Genetics, stigma, and personal responsibility for women with 

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binge eating in emerging adulthood: 10-year stability and risk factors. Developmental Psychology, 

52(3), 475-483. https://doi.org/10.1037/dev0000086 

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Appendix 

Appendix A 

Qualtrics Survey 

 

Title of Study: A Needs Assessment of Eating Disorders among Gifted Students 

Investigators: omitted for blind review 

 

The purpose of this study is to complete a needs assessment for eating disorder prevention or intervention. 

Gifted students in middle school and high school are invited to participate in this study to better 

understand issues related to weight, shape, and eating concerns.  

 

Procedures. If you agree to participate, you will be asked to complete an online survey of 32 questions 

that will take about 20 minutes of your time. The first four questions are a sliding scale of how happy you 

are with weight, shape, and eating. The rest of the questions ask about your activities in the month that 

include items such as limiting food, concern about weight or shape, losing weight, or exercise to control 

weight. Some questions define your age, sex, and school. The final section invites open ended comments. 

 

Risks. While participating in this study you may experience discomfort that relates to attitudes or habits 

that relate to eating, dieting, shape, or weight. However, there are no foreseeable risks in participation in 

this study.  

 

Benefits. If you decide to participate in this study there is no compensation. The information in this study 

may help gifted students and society in general, to gain information on possible issues related to eating, 

dieting, weight, or shape. 

 

Participant Rights. Your participation in this study is completely voluntary and you may skip survey 

questions or stop answering them at any time. This will not result in any consequence. 

 

Confidentiality. All responses are anonymous and confidential. You will not be identified in any way. 

Reports or publications no will represent only group data. Only the researchers have access to the data. 

  

Contacts and Questions. If you have questions about the survey, contact [authors].  

If you have questions about the research process, contact irb@drake.edu or call 515-271-3472. 

By starting this survey, you understand and voluntarily agree to participate in this study. Questions are 

welcome. Contact the researchers above. 

  



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Participant's Name _________________________________________ 

Date: _____________________________ 

  

Please keep a copy of this form for your records. 

 

How do you identify yourself? 

Male 

Female 

Other 

Your age?   10  11  12  13  14  15  16  17  18   18+ 

1.     How happy are you with your weight on most days? [Sliding scale] 

2. How happy are you with your shape on most days? [Sliding scale] 

  

3.     How happy are you about your eating on most days? [Sliding scale] 

4.     If you restrain your eating, how do you feel about it? [Sliding scale] 

 

Please rank the following statements based on feelings around eating in the last month. 

  

No 

Days 

1-5 

Days 

6-12 

Days 

13-15 

Days 

16-22 

Days 

23-27 

Days 

Every 

Day 



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1. Have you been 

deliberately trying to 

limit the amount of 

food you eat to 

influence your shape 

or weight (whether or 

not you succeeded)? 

       

2. Have you gone for 

long periods of time (8 

waking hours or more) 

without eating 

anything at all in order 

to influence or shape or 

weight? 

       

3. Have you tried to 

exclude from your diet 

any foods that you like 

in order to influence 

your shape or weight 

(whether or not you 

succeeded)? 

       

4. Have you tried to 

follow definite rules 

regarding your eating 

(for example, a calorie 

limit in order to 

influence your shape 

or weight (whether or 

not you have 

succeeded)? 

       



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No 

Days 

1-5 

Days 

6-12 

Days 

13-15 

Days 

16-22 

Days 

23-27 

Days 

Every 

Day 

5. Have you had a 

definite desire to have 

an empty stomach with 

the aim of influencing 

your shape or weight? 

       

6. Have you had a 

definite desire to have 

a totally flat stomach? 

       

7. Has thinking about 

food, eating, or calories 

made it very difficult 

to concentrate on 

things you are 

interested in (for 

example, working, 

following a 

conversation, or 

reading)? 

       

8. Has thinking about 

shape or weight made 

it very difficult to 

concentrate on things 

you are interested in 

(for example, working, 

following a 

conversation, or 

reading)? 

       



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No 

Days 

1-5 

Days 

6-12 

Days 

13-15 

Days 

16-22 

Days 

23-27 

Days 

Every 

Day 

9. Have you had a 

definite fear of losing 

control over eating? 

       

10. Have you had a 

definite fear that you 

might gain weight? 

       

11. Have you felt fat?        

12. Have you had a 

strong desire to lose 

weight? 

       

 

Questions 13-18:  Please select the appropriate number in the drop-down box on the right. 

Remember that the questions only refer to the past four weeks (28 days). 

  

13. Over the past 28 days, how many times have you eaten what other people would regard as an 

unusually large amount of food (given the circumstances)? 

     

14. On how many of these times did you have a sense of having lost control over your eating (at 

the time you were eating)? 

         

15. Over the past 28 days, on how many DAYS have such episodes of overeating occurred (i.e. 

you have eaten an unusually large amount of food and have had a sense of loss of control at the 

time)? 

     



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16. Over the past 28 days, how many times have you made yourself sick (vomit) as a means of 

controlling your shape or weight? 

     

17. Over the past 28 days, how many times have you taken laxatives as a means of controlling 

your shape or weight? 

         

18. Over the past 28 days, how many times have you exercise in a "driven" or "compulsive" way 

as a means of controlling your weight, shape or amount of fat, or to burn off calories? 

         

For questions 19 and 20:  Please select the appropriate number. Please note that for these questions 

that term "binge eating" means eating what others would regard as an unusually large amount of 

food for the circumstances, accompanied by a sense of having lost control over eating. 

  

No 

Days 

1-5 

Days 

6-12 

Days 

13-15 

Days 

16-22 

Days 

23-27 

Days 

Every 

day 

19. Over the past 28 

days, on how many 

days have you eaten in 

secret (i.e., furtively)? 

Do not count episodes 

of binge eating. 

       

20. On what 

proportion of the times 

that you have eaten 

have you felt guilty 

(felt that you've done 

wrong) because of its 

effect on your shape or 

weight? Do not count 

binge eating. 

       

For questions 21-28 please select the appropriate response to the right. 



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  Not at all Slightly Moderately Markedly 

21. How concerned are 

you over other people 

seeing you eat? 

    

22. Has your weight 

influenced how you 

think about (judge) 

yourself as a person? 

    

23. Has your shape 

influenced how you 

think about (judge) 

yourself as a person? 

    

24. How much would it 

have upset you if you 

had been asked to weigh 

yourself once a week 

(no more, or less, often) 

for the next four weeks? 

    

25. How dissatisfied 

have you been with our 

weight? 

    

26. How dissatisfied 

have you been with 

your shape? 

    



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27. How uncomfortable 

have you felt seeing 

your body (for example, 

seeing your shape in the 

mirror, in a shop 

window reflection, 

while undressing or 

taking a bath or 

shower)? 

    

28. How uncomfortable 

have you felt about 

others seeing your 

shape or figure (for 

example, in communal 

changing rooms, when 

swimming, or wearing 

tight clothes)? 

    

  

Please share any insight or thoughts on your feelings around your weight, shape, or feelings 

around eating. Please answer openly and honestly. Thank you for your reply. 

 


