Eating disorders in college students have become a significant concern. Eating disorders are not just about food; they are complex mental health issues that intertwine with stress, body image, and the pressure to fit in.
Understanding Eating Disorders
Eating disorders are complex mental health conditions that affect 10-20% of female college students and 4-10% of male college students, according to NEDA, the National Eating Disorder Association.[1]
Diagnosed eating disorders vary in presentation and symptoms, often showing up as extreme behaviors related to food and eating habits, leading to physical and emotional distress. It’s important to note that even if someone does not meet criteria for an eating disorder, or does not have a diagnosis that if you are struggling with your relationship with food, body image or disordered eating you deserve support and recovery. Not feeling “sick enough” is a common phenomenon that prevents people from getting adequate and timely care. College students, like many other demographic groups, can be susceptible to these disorders, which is why it’s so important to recognize the signs and symptoms.
Risk Factors for Eating Disorders in College Students
Societal Pressures: College students are exposed to societal pressures that idealize a specific body type, often depicted as “thin and fit”. These unrealistic beauty standards, perpetuated by media, fashion, and advertising, can lead to body dissatisfaction and low self-esteem. In an attempt to fit in or in response to the many changes and challenges of being in college, some students may find themselves engaging in disordered eating, disordered exercise or struggling with body image which might be setting the stage for the development of eating disorders.
Academic Stress: The academic demands of college can be intense, triggering stress and anxiety. Some students may turn to food as a coping mechanism to manage the pressure. For example, they may use food as a source of comfort or engage in binge eating during periods of stress. Alternatively, academic stress can lead to restrictive eating patterns as students seek a sense of control over their lives. Perfectionism can play a role. If school or social life is feeling out of control or uncomfortable, rigid food or exercise rules or behaviors might provide a feeling of control.
Independence and Autonomy: College often marks the first time students are responsible for feeding themselves. This newfound independence can result in stress or worry about eating the ‘right’ things or the initiation of restrictive diets – even if the intention is to ‘be healthy’. Some may experiment with extreme dietary restrictions, feel judged for their eating choices, or pressure to diet or restrict for special occasions like a costume party, Halloween or spring break.
Peer Influence: Peer groups play a significant role in shaping college life. Students may adopt their peers’ behaviors and attitudes regarding food and body image. If a college social circle promotes dieting, excessive exercise, or negative body talk, it can exert a powerful influence, increasing the risk of eating disorders among students.
Diet Culture: College campuses can be breeding grounds for diet culture and fitness trends. Students may feel pressured to follow restrictive diets or engage in intense exercise routines to achieve certain body ideals perpetuated by peers, media, or social media influencers. The prevalence of diet culture can normalize unhealthy behaviors and distort perceptions of what constitutes a healthy lifestyle.
Social Media and Body Comparisons: The pervasive presence of social media exposes college students to a constant stream of carefully curated images of “ideal” bodies. Comparing themselves to these images can fuel feelings of inadequacy and body dissatisfaction. Some students may resort to drastic measures to pursue the unattainable standards they encounter online.
Transition and Adjustment: The transition to college life can be marked by significant changes and challenges. New environments, academic pressures, and social adjustments can trigger emotional distress. Students may respond to these stressors by seeking control over some aspect of their lives, often turning to food and eating behaviors to regain a sense of stability or familiarity.
Recognizing Signs of Eating Disorders
Physical Signs: Physical changes are often the most visible indicators of eating disorders. Students may exhibit fluctuations in weight, brittle nails, hair loss, feeling cold all the time, feeling low energy, having swollen cheeks or damaged teeth from purging.. Something to keep in mind, however, is that you cannot tell someone is struggling with an eating disorder by appearance alone. Some people with eating disorders look “normal” on the outside but may still be severely struggling. In fact, assumptions about what people with an eating disorder look like can be a barrier that prevents someone from getting the help and support they need. If you or a friend are struggling with disordered eating behaviors or worries, you deserve to get support.
Behavioral Changes: Eating disorders can manifest in various behavioral changes. Secretive eating habits, such as eating alone or avoiding meals with others, can be a telltale sign of a problem. Students may develop rituals around food, such as cutting food into tiny pieces or excessively chewing. Frequent trips to the bathroom after meals can indicate purging behaviors. Hoarding or hiding food is also common, as are noticeable changes in eating speed or a fixation on calories and food labels. Someone might also start a new gym routine, feel rigid or obsessive about their meals or workout routine. You might notice someone who used to make time for social events or plans no longer being able to make it or feel as present as they used to.
Emotional Distress: Eating disorders often take a toll on emotional well-being. College students affected by eating disorders may become irritable, anxious, or depressed. They may display an intense preoccupation with body weight and shape, leading to a negative self-image and persistent feelings of guilt or shame. Obsessive thoughts about food, eating, and exercise can consume their mental space, making it difficult to focus on other aspects of life. Extreme mood swings, social withdrawal, and avoidance of social situations that involve food are common emotional signs.
Academic and Social Impacts: Eating disorders can significantly affect academic and social aspects of college life. Students may struggle to concentrate on their studies due to obsessions about food and body image. Frequent absences from classes or social activities are common as well. You may also notice increased isolation and avoidance of social gatherings that involve food. All of this can lead to fewer friendships, smaller support circles, and a harder time at college overall.
Physical Symptoms: Note that these are different from the physical signs of an eating disorder. Physical symptoms of eating disorders are what an individual experiences. Some students may experience dizziness, fainting, low energy levels, develop swollen salivary glands, gastrointestinal problems, acid reflux, digestive issues, feeling out of control around food, fatigue, weakness, difficulty focusing, extreme hunger, or a reduced or absent hunger cues.
Changes in Clothing: College is a fun time to experiment with style, but students struggling with eating disorders may use clothing as a way to feel more comfortable in their body or conceal their body shape. Wearing excessively loose-fitting or baggy clothing to conceal body shape and size or always dressing in layers, even in warm weather, to hide their appearance could be a sign that something is off.
Disordered or Excessive Exercise: Engaging in movement can be great for mental health but excessive or compensatory exercise is the opposite of healthy. Overexercising may be a sign of an eating disorder, disordered eating or unsustainable behaviors, particularly among college students with anorexia nervosa or bulimia nervosa. The term “exercise bulimia” describes engaging in intense and compulsive exercise routines to burn off calories or “compensate” for food intake.
Secrecy and Lying: College students with eating disorders tend to be secretive with their eating behaviors due to shame, stigma and embarrassment. They may lie about what they’ve eaten or where they’ve been, especially if they’re engaging in binging and purging behaviors. They may also hide food wrappers or evidence of excessive food consumption. Students may also say that they’ve already eaten to avoid eating in group settings. If you’ve noticed this in your teen, a friend, or yourself, remember that this secrecy is not coming from a place of malintent; instead, it may be a silent cry for help.
Alcohol and Drinking Culture: College drinking culture can add a new factor to your relationship with food and eating. Some students feel pressure to restrict eating or skip meals before a night out of drinking. When restricting during the day and drinking at night, students may be more prone to binge eating, eating foods they don’t typically allow themselves to eat. Often this is coupled with waking up and feeling guilt, embarrassment, shame around eating and wanting to compensate or restrict with food or exercise. This is a dangerous cycle that not only puts a student at risk of dehydration, vitamin deficiencies, alcohol poisoning or other harmful effects of drinking and feeling uninhibited, but also can be a slippery slope from ‘skipping a meal to drink tonight’ into an eating disorder, or repeating pattern.
Deterioration of Personal Relationships: Eating disorders can take a toll on personal relationships. Students may become distant from friends and loved ones as they prioritize their disordered eating behaviors. Frequent arguments or conflicts related to food, body image, or eating habits can strain relationships. The deterioration of personal connections can be indicative of underlying issues.
Denial and Defensiveness: College students with eating disorders often deny or become defensive about their behaviors when questioned or confronted. They may downplay the severity of their eating disorder or become evasive when asked about their eating habits.
Seeking Help and Treatment Options for College Students with Eating Disorders
Counseling and Therapy: If you or someone you love is showing signs of an eating disorder, nutrition counseling and therapy are integral to eating disorder treatment. College students can benefit from individual therapy, group therapy, or both. Therapists and dietitians with expertise in eating disorders can provide a safe space for students to explore the underlying emotional and psychological factors contributing to their disorders. Evidence-based approaches such as Cognitive-Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) and a collaborative care approach may be a part of treatment.
Nutritional Counseling: Nutritional counseling is crucial in helping students re-establish a healthy relationship with food. Registered dietitians or nutritionists with expertise in eating disorders can provide personalized meal plans, guidance on intuitive eating, and strategies for balanced nutrition. As a registered dietitian for college students with eating disorders, I regularly work with young adults to combat diet culture , alleviate food-related fears, and promote a positive and sustainable approach to eating.
Medical Monitoring: People with severe eating disorders may require medical monitoring to make sure their vitals are in working order. Regular medical check-ups can assess the physical health complications resulting from the disorder, such as electrolyte imbalances, heart issues, and nutritional deficiencies. Medical professionals can work closely with therapists and dietitians to ensure a comprehensive approach to recovery.
Support Groups: Support groups offer a valuable source of encouragement and connection for college students with eating disorders. These groups provide a platform for individuals to share their experiences, challenges, and successes with peers who understand their struggles. Peer support can reduce feelings of isolation and foster a sense of community during recovery.
Inpatient or Residential Treatment: In certain cases, college students with eating disorders may require inpatient or residential treatment programs. These programs provide 24-hour care and support, often in a structured and therapeutic environment. Inpatient treatment is designed for those with eating disorders who require a higher level of medical and psychiatric care. Residential treatment offers a higher level of support than outpatient programs, providing a safe and immersive space for healing.
Find Help at The Wellful
If you have read this article, check in and ask yourself what is coming up for you. If you resonate with some aspects of these behaviors, beliefs or patterns, I hope you know that you are not alone and that you deserve support and safe space to seek help. Even if you haven’t been formally diagnosed, just suspecting that this could be an issue is grounds for seeking treatment. The Wellful is here to help college students and young adults in this journey. Together, we’ll put together a plan that fosters a healthier, more balanced relationship with food and your body. As both your registered dietitian and dedicated cheerleader, I’m here to support you and be with you through all the challenges that come your way.
To get started, schedule a free 15-minute consultation with me, Brenna, RD. You can also contact the practice at 925-722-4109. Higher education and college are about learning. It’s time to learn how to take care of you.
[1] https://online.regiscollege.edu/blog/eating-disorders-in-college-students/
