College weight management a multi-step process

Eating disorders most frequently target students in transition to high school or college.
The onset of an eating disorder often correlates with times of major transitions or stress. Some extreme behaviors include taking diet pills, inducing vomit and using laxatives or diuretics.

College is a time of transition, independence and, for some, the onset of an eating disorder.

“There’s this unfortunate normalization of diets and disordered eating,” said Jennifer Moran, clinical psychologist and college liaison for the Center for Eating Disorders. “For whatever reason, dangerously, I think, people are just like, ‘Diet pills are something that’s worth trying,’ or, ‘Oh, I purge every once in a while,’ when really, those are huge red flags."

Although someone can develop an eating disorder at any point in his or her life, according to Moran, the highest frequency of eating disorder occurrence are at ages 14 and 18, when most people make the transitions to high school and college. The onset of a disorder is often in times of such transitions or stress.

Although many students are concerned about gaining the “Freshman 15” or even the “Mizzou 22,” others might be coping with stress by turning to disordered eating or attempting to recover from an eating disorder they already struggle with.

“When they’re 18 in particular, a lot of people are living independently for the first time,” Moran said. “They may have to make choices about eating on their own for the first time.”

In addition to this, Katie Loth, a doctoral candidate in behavioral epidemiology, said disordered behaviors, once established, often continue throughout a patient’s life.

“It’s not something that just middle schoolers do or high schoolers do it, it’s something that people grow up with and follows them into adulthood,” Loth said. “People develop a habit, and it’s very hard for them to stop. I think a lot of it is habit for young people.”

Loth co-authored a longitudinal study on dieting and disordered behaviors in adolescents and young adults as a part of Project Eating Among Teens. The study followed survey results of two groups with mean ages of around 13 and 15 years and followed up with this group 10 years later. The study found when a disorder was reported in this group, it continued or increased with age.

It’s important to note the study was conducted on a normal population, not a population clinically diagnosed with eating disorders. However, Loth said some participants might exhibit behavior that could lead to a diagnosis of an eating disorder. The study focused on dieting, binge eating with loss of control, unhealthy weight control — which is defined as fasting, skipping meals, eating very little, using food substitutes (powders or special drinks) or smoking; and extreme weight control — defined as taking diet pills, vomiting or using laxatives or diuretics.

While Ted Mayer was the executive director of food services at Harvard, the university offered nutritional information on cards in front of the food served in dining halls, online, on frequently-updated posters and in large binders with recipe and nutritional information. In 2008, Harvard administrators made a decision to remove the menu cards.

“Specifically, we needed to address the challenge a quiet and surprisingly large contingent of our community faces with eating disorders,” Mayer said in a post on the Harvard University Hospitality & Dining Services blog. “Those individuals can place an undue emphasis on calories and other literal food values, making their placement over every food item a real challenge. Thus, we did what we felt best addressed the special health needs of those individuals, much as we support people with food allergies or religious dietary preferences."

He said since then, Hospitality & Dining Services found a combination of ways to provide information to help students with and without eating disorders and is also now in the process of using the Bon’App application for Android and the iPhone.

“Putting the signs in front of them seemed to be akin to putting a bottle of liquor in front of a recovering alcoholic,” Mayer said in an email.

He also said the decision involved the school’s deans, students, residential life and School of Public Health and that, for many, it was a learning moment since some students weren’t aware of this problem among their peers.

Knowing what does and does not trigger an eating disorder is not that simple, said David Herzog, M.D., founder and director of the Harris Center for Education and Advocacy in Eating Disorders at Massachusetts General Hospital.

“It presumes that either all individuals with eating disorders are similar and use information similarly,” Herzog said. “There’s a sense that individuals with eating disorders get too concerned about numbers, weight or calories.”

Wellness Resource Center registered dietitian Cindy Foley said she is not aware of anything specific on campus that might trigger an eating disorder, but she said group living arrangements might encourage unhealthy eating behaviors.

“I think sometimes the group setting can expose people to eating behaviors that they had not thought of,” Foley said.

Foley, along with a second WRC dietitian, is involved in the eating disorder committee on campus, which also includes psychiatrists and representatives from the counseling center.

“We have let them know what our appropriate involvement would be, and it is especially (important) in helping the people as they are normalizing their eating behavior,” Foley said.

Foley said she meets with students one-on-one, and it is best if the person also meets with a counselor concurrently.

Herzog said in order to know what information triggers the onset or relapse of disordered eating behavior, the subject would need to be studied specifically.

Loth said non-specific messages in dining halls are generally more effective.

"People just need to be intentional about what types of messages they’re putting in a dining hall,” Loth said. “Think about trying to make those messages broad and focused on a healthy lifestyle and healthy diet rather than weight loss."

For more information on eating disorders, see the graphic detailing on-campus resources.

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