In this continuing education webinar, When School Can Wait: Empowering Families and Providers Through Difficult Treatment Recommendations, Lorrie Balding, LCSW, Director of Family Services at Monte Nido, and Judy Krasna, Executive Director of F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders), explored one of the most challenging conversations providers have with families: recommending that a child, adolescent, or young adult temporarily step away from school to prioritize eating disorder treatment.

For many families, school represents stability, identity, achievement, and hope for the future. Recommending a leave of absence can feel counterintuitive, especially when a student continues to earn good grades or appears academically successful. Yet eating disorder recovery often requires a level of medical, nutritional, cognitive, and emotional healing that cannot occur while maintaining the demands of school.  

​​Helping families understand this reality requires more than clinical expertise. It calls for empathy, clear communication, and a shared commitment to placing recovery above academic timelines.​​​

​​​​Key Takeaways​​​

• ​​​​School may need to take a temporary back seat to eating disorder treatment​​, even when a student is academically successful or strongly motivated to remain in school.​​​

• ​​​​Providers should consider medical, nutritional, behavioral, cognitive, and psychological factors​​ when determining whether continued school participation is appropriate.​​​

• ​​​​Caregiver resistance is often rooted in understandable fears about identity, academics, relationships, and the future.​​ Helping families work through those concerns is an important part of treatment.​​​

• ​​​​Providers can help families reframe time away from school as an investment in recovery​​, rather than a failure or permanent interruption to education.​​​

• ​​​​Returning to school should be approached as a coordinated, phased process​​, with the treatment team, family, and school working together around readiness and appropriate supports.​​​     ​​

Why school and ​eating disorder ​recovery can come into conflict

School is an important developmental milestone and can provide routine, social connection, and a sense of purpose. At the same time, the physical and cognitive demands of an eating disorder can make remaining in school unsafe or interfere with meaningful recovery.  

Research summarized throughout the presentation reinforces why early, comprehensive treatment matters. Longer durations of untreated illness are associated with poorer outcomes, relapse risk increases when underlying eating disorder thoughts remain unresolved, and eating disorders continue to carry significant medical and psychiatric risks.  

When an eating disorder requires a higher level of care, the goal is not simply to stabilize medically. Recovery also involves restoring nutrition, improving cognitive functioning, reducing eating disorder behaviors, and strengthening coping skills before returning to everyday demands.

​​​When Should Providers Recommend Time Away From School?‍

Recommending time away from school is never about giving up on a student's education. Instead, it recognizes that recovery must come first in order for long-term academic success to remain possible.

Several clinical indicators may suggest that remaining in school is no longer appropriate.

These include:

• Ongoing monitoring needs for eating disorder behaviors

• Difficulty completing meals or maintaining nutritional structure

• Impaired cognitive functioning related to malnutrition

• Inability to participate safely in everyday roles, including functioning as a student, sibling, or friend

Importantly, chronological age alone does not determine readiness. Even young adults may experience impaired judgment or decision-making because of the effects of malnutrition and the eating disorder itself.

Rather than viewing time away from school as an interruption, providers can help families reframe it as an investment in recovery that ultimately supports a healthier return to academics.  

Reframing the conversation with families

One of the most effective shifts providers can make is changing the narrative around stepping away from school.

Instead of framing treatment as "dropping out" or "falling behind," families may benefit from language such as:

• Taking a break

• Postponing school

• Not right now

• Accelerating recovery

There is rarely a perfect time to pause school. Waiting for an ideal semester, athletic season, or academic milestone often allows the eating disorder to become further entrenched.  

Helping families understand that education can resume, while medical stability cannot always wait, creates space for more productive conversations about treatment.

Understanding why caregivers struggle​ with treatment recommendations​

Even when caregivers understand the clinical rationale, agreeing to remove a child from school can be emotionally overwhelming.

Parents may worry that:

• They are becoming "the bad guy."

• Their child will lose their identity.

• Academic momentum will disappear.

• Friendships and social development will suffer.

• Their child will resent them permanently.

These concerns are understandable because school often represents much more than academics. It can become closely tied to identity, future goals, family expectations, and feelings of success.

At the same time, students may strongly resist treatment recommendations. The presentation describes common responses that providers should anticipate, including increased resistance, heightened emotional dysregulation, attempts to divide caregivers and treatment providers, and efforts to negotiate around treatment recommendations.

Recognizing these reactions as part of the illness can help providers support caregivers without reinforcing the eating disorder.

​​​How providers can help​​​​ caregivers hold the line

Families often need just as much support as the patient during this stage of treatment.

Rather than focusing solely on convincing the student, providers can help caregivers feel confident enough to tolerate the discomfort that often accompanies recovery.

Helpful strategies include:

• Validating caregivers' grief and fear while remaining clinically consistent

• Helping all caregivers align around one treatment plan

• Establishing clear boundaries and expectations

• Encouraging caregivers to consider their responsibility for protecting recovery

• Reminding caregivers that temporary distress does not mean the recommendation is wrong

Maintaining a unified approach reduces opportunities for the eating disorder to exploit differences between caregivers or members of the treatment team.  

​​​Helping families set​​​​ realistic expectations about recovery

Recovery rarely follows a straight line.

The presentation introduces the concept of the "J-Curve," illustrating that progress often appears to worsen before meaningful improvement occurs. During early treatment, increased distress, frustration, or emotional reactions may actually reflect the disruption of eating disorder patterns rather than treatment failure.  

Families may also experience urgency to return to normal routines before recovery is fully established.

Several factors can contribute to this urgency:

• The student genuinely believes they are ready.

• Parents understandably want life to feel normal again.

• Anxiety creates a sense that returning to school is an immediate necessity.

• The eating disorder distorts insight into readiness.

Helping families anticipate these reactions allows them to interpret setbacks more accurately and remain committed to treatment goals.

Red flags that suggest a return to school is too soon

Returning to school should never be based solely on motivation or a desire to resume normal activities.

Several warning signs may indicate that additional recovery is needed before re-entry.

Medical concerns include:

• Ongoing weight loss or unstable weight restoration

• Bradycardia or unstable vital signs

• Continued medical instability

• Low energy that would make a full school day unsafe

Behavioral and psychological concerns include:

• Continued restriction or significant prompting around meals

• Active purging or compulsive exercise

• Persistent preoccupation with food or body image

• Limited insight into illness

• Anxiety about eating around peers

• Attempts to use school to conceal eating disorder behaviors

Environmental factors also matter. Family conflict, inconsistent treatment recommendations, secrecy, rigid thinking, and the absence of a coordinated school plan can all increase the likelihood of relapse.  

What readiness to return​ to school​ can look like

Returning to school is best viewed as a phased clinical decision rather than a single milestone.

Indicators of readiness include improvements across several domains:

Medical stability

• Stable vital signs

• Weight stabilization

• Improved stamina

• No acute medical concerns

Nutritional and behavioral stability

• Consistent meal completion

• Reduced eating disorder behaviors

• Ability to eat in less structured environments

Psychological readiness

• Reduced preoccupation with food and body image

• Ability to tolerate anxiety around peers

• Insight into triggers

• Effective use of coping skills

Practical readiness

• Trial days completed successfully

• School accommodations established

• Communication between the family, school, and treatment team

• Appropriate academic modifications when needed

These indicators emphasize that readiness involves far more than physical improvement alone.

​​​Creating a Coordinated Treatment and School Support Plan​​​​

Recovery is strengthened when everyone involved communicates the same expectations.

Families benefit from a coordinated team that includes medical providers, therapists, dietitians, psychiatrists, schools, and caregivers working toward shared goals.  

Providers can also reduce caregiver burden by serving as an administrative partner through activities such as:

• Writing medical leave documentation

• Communicating with school personnel

• Helping arrange accommodations

• Coordinating return-to-school planning

Removing these logistical barriers allows families to focus more fully on supporting recovery.

Supporting students returning to college

Returning to college requires thoughtful planning rather than simply resuming classes.

Protective supports may include:

• Establishing a treatment team before arrival

• Creating a written relapse prevention plan

• Identifying a trusted campus contact

• Reducing course loads when appropriate

• Coordinating meal plan accommodations

• Establishing regular communication with caregivers and providers

• Identifying campus mental health resources

• Building meal support and accountability into daily routines

For some students, delaying college or taking a gap year may offer the safest opportunity to establish lasting recovery before navigating a major life transition. The presentation emphasizes that a gap year should be viewed as an opportunity to strengthen health, independence, and long-term success rather than as a setback.

Recovery first, school second

For providers, recommending time away from school is rarely an easy conversation. It asks families to temporarily set aside expectations they have often held for years and replace them with a new measure of success: recovery.

Supporting caregivers through this decision requires empathy, confidence, and a willingness to reinforce the same message consistently over time. When providers help families understand that academic timelines can be adjusted while medical stability and brain healing cannot, they create space for decisions that protect both recovery and future educational success.  

Ultimately, school can wait. Recovery cannot.

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