By Corinne Stonebraker, Fall 2020.

Content Warning: This article discusses topics related to eating disorders and body image that may be triggering for some readers. 

The passage from high school to college is one of the most significant lifestyle changes that a young person will face. For many, this transitory period is marked by newfound independence, emerging adulthood, and often, an upheaval from their familiar home setting. Such an abrupt shift in lifestyle and environment is often associated with the onset or exacerbation of mental health issues, issues that often do not receive proper attention. Since the age of onset for eating disorders collides with the age most young people leave for college, universities should be seizing the opportunity for early intervention and prevention. Instead, eating disorders are practically an epidemic on college campuses.

College students face several mental and physical stressors as they transition from living at home. Transition periods often exacerbate pre-existing mental health issues, including eating disorders–students with prior eating disorders may find a reemergence or exacerbation of their symptoms. College students also deal with increased academic pressure, less structure, and a more peer-focused lifestyle. All these factors serve to undermine a person’s sense of control; a sense of control that food restriction, overexercise, and hyperfixation on body weight can provide. This is compounded by the departure from normal eating habits and difficulty managing food intake that students entering college experience, mitigated by all-you-can-eat, nutritionally deficient dining hall food. For many students, it is the first time they are providing food entirely for themselves.

9% of the United States population–nearly 28.8 million Americans–will have an eating disorder at some point in their lifetime.[1] Often, that point is between the ages of 18 to 21, incidentally, time at which many people attend a university.[2] Most estimates place the rate of diagnosed eating disorders in college students at around 15-20%. However, over 30% of students report engaging in disordered eating behaviors such as making themselves vomit, using diet pills, or engaging in compulsive exercise. Disordered eating describes certain behaviors relating to body image and food, which if left unaddressed can often develop into a clinical eating disorder.[3] When these disordered eating behaviors are frequent, if not constant, it is often indicative of an eating disorder. Another distinguishing factor is the level of obsession around eating habits and behaviors. A person with disordered eating habits may frequently think about food and body image, however, someone with an eating disorder will have these thoughts consume their life, interfering with work, school, and their personal life. Likewise, when someone’s disordered eating habits prevent them from functioning normally, this may point to an eating disorder. 

As college students, it is important to start a conversation about the prevalence of eating disorders on our campuses. If disordered eating habits develop during college, it is significantly more difficult to eliminate them later in life. The development of these disordered eating habits into full-fledged eating disorders can have deadly consequences–eating disorders are the mental illness with the highest mortality rate.[4] 

In addition to the mental and physical stress faced by college students, there is pervasive normalization of harmful behaviors and language concerning food and body image. Weight-focused phrases like “the freshman 15”, “the sorority 40”, or more recently, “the quarantine 15”, imply a negative connotation with a natural weight gain in response to a lifestyle change. Many future college students are “warned” about the freshman 15 before they even enter college, promoting unhealthy eating-focused language before school even starts. Party culture, a part of the college experience for many, is also marked by numerous harmful behaviors and language. It is frequently the norm to eat little or nothing the night before going out, whether it be to look a certain way in an outfit or to heighten the effects of alcohol. “Pulling trig” is a phrase often used in the context of social alcohol consumption that describes self-inducing vomiting after over-drinking. Party culture in of itself is not responsible for encouraging disordered eating habits, however, these habits are normalized by language and behavior that is common among partygoers. Although academics are the central focus of the college experience, many students can become overwhelmed with the workload and neglect their own self-care. During busy weeks like midterms or finals, many students find themselves skipping meals in order to dedicate more time to studying. Unfortunately, it has become standard practice to cite “not eating all day” as a marker of dedication to academic performance. 

The normalization of disordered eating habits among college students is not unavoidable; as members of the university community, the impetus is on us to make sure we are practicing self-care, looking out for our peers, and changing the way we talk about food and body image. Additionally, it is important to hold our Universities accountable for ensuring they provide adequate treatment and prevention programs. Campus mental health resources, which are already often strained, do not prioritize prevention or treatment for eating disorders, despite the high rates at which they occur among the student body.[5] Students seeking help are unlikely to receive adequate treatment at their college counseling centers, which frequently bear the weight of administrative budget cuts.[6] 

In order to reframe the way we think about and discuss eating disorders, it is important to address the myriad misconceptions surrounding them. Eating disorders do not have a certain “look”–different eating disorders can affect bodies in a multitude of ways. The notion that a person with an eating disorder has to be incredibly thin is not only incorrect, but harmful; people in larger bodies are just as susceptible to eating disorders, but are half as likely to be diagnosed.[7] Stereotypically, women are presented as the only group of people that are susceptible to eating disorders. However, there are significant numbers of male-identifying individuals who face eating disorders as well. Unfortunately, this stereotype means that men seek treatment at lower rates than their counterparts.[8] 

Discussion of eating disorders necessitates a discussion of their disparate impact. Black and indigenous people of color (BIPOC), people who identify as LGBTQ+, people with disabilities, and people in larger bodies all face barriers when it comes to diagnosis and treatment of eating disorders. Individuals in these groups report higher rates of eating disorders, but are often underdiagnosed and less likely to receive treatment. The underdiagnosis and mistreatment of eating disorders in marginalized groups only serve to further compound the healthcare inequity they already face.

Surround yourself with body-positive resources and role models, use compliments that don’t center weight or physical appearance, be mindful of how you talk about weight and eating habits, and most importantly, be patient and supportive towards those who may be struggling. If you or someone you know is struggling with disordered eating habits or an eating disorder, you can call or text the National Eating Disorders Association helpline at (800) 931-2237 for support, resources, and treatment options.

1. Eating Disorder Statistics. General & Diversity Stats: ANAD. (2020, October 22). https://anad.org/education-and-awareness/about-eating-disorders/eating-disorders-statistics/.  
2. Swanson, S., Crow, S., & Merikangas, K. (2010). Prevalence, correlates, and comorbidity of eating disorders in the National Comorbidity Survey Replication Adolescent Supplement (NCS-A). Comprehensive Psychiatry, 51(6). https://doi.org/10.1016/j.comppsych.2010.06.044   
3. Eating Disorders vs. Disordered Eating: What’s the Difference? National Eating Disorders Association. (2018, February 21).  https://www.nationaleatingdisorders.org/blog/eating-disorders-versus-disordered-eating. 
4. The Deadliest Disorder | Psychology Today. https://www.psychologytoday.com/us/blog/the-new-brain/201103/the-deadliest-disorder-0.  
5. Fair Budget UChicago Demands Reduced Counseling Wait Times, Improved Accessibility, and More at Wellness Center Forum. The Chicago Maroon. https://www.chicagomaroon.com/article/2020/1/22/fair-budget-uchicago-demands-reduced-counseling-wa/.  
6. Weale, S. (2016, September 21). Some universities need to triple mental health services funding, says report. The Guardian. https://www.theguardian.com/education/2016/sep/22/universities-triple-mental-health-services-funding-report. 
7. ANAD. (2020, October 22)
8. Eating Disorders in Men & Boys. National Eating Disorders Association. (2018, February 26). https://www.nationaleatingdisorders.org/learn/general-information/research-on-males.