In honor of National Eating Disorders Awareness Week next week, I wanted to share a really important article that I wrote a while back. Y’all, eating disorders are not to be ignored. Let’s destroy the myths. Let’s get the facts. Let’s celebrate the heroes who have accomplished recovery. Let’s talk about it.
Here’s the Skinny: The Truth Behind Anorexia Nervosa on College Campuses
Two college females reveal what it truly means to be beautiful, happy and healthy in a society where “skinny” has become the epitome of perfection.
All Part of the Routine
She wakes up in the morning, yawns and wipes her eyes. She throws on her Nike shorts and running shoes and heads straight to the gym before a single thought even crosses her mind.
It’s become her daily routine. She runs. And runs. She just keeps on sprinting, focused only on the number on the “calories burned” calculator and her feet pounding on the treadmill. Her stick-thin legs are exhausted, but she can’t ignore the constant nagging voice in the back of her head telling her to just keep going.
After one hour of exerting herself, her fatigued body tells her she’s hungry.
The voice in the back of her head, however, tells her that she’s not.
Back at her dorm, she hesitantly dips her spoon into her 100-calorie plain yogurt. Her stomach rumbles, ravenous after aggressively exercising on an empty stomach. She ponders anxiously about what she ate for dinner last night. Oh, that’s right. Nothing.
Two years later, Lily*, now a senior at Wake Forest University, looks back upon these distressing, hungry days and cringes.
“My eating disorder started the summer before my freshman year at Wake,” she reflects, “but I wasn’t fully diagnosed with anorexia until a year later.
“My mind was in a constant battle … half of my mind was saying, ‘Go ahead, eat it,’ and the other half was saying, ‘Don’t you dare touch that.’”
Lily was one of about 5 percent of 18- to 23-year-old women who meet the criteria for an eating disorder. Dr. Clinch, MD and WFU Student Health Services Clinical Director, defines an eating disorder as “a condition in which an individual struggles with their relationship with food, body image and/or exercise.”
“It can take several forms,” Dr. Clinch says. “In my experience, patients may experience their eating disorders in different ways over time.”
According to Lauren Smolar, Director of Hotline Services at National Eating Disorders Association (NEDA), anorexia nervosa is “characterized by self-starvation and excessive weight loss.”
While all sorts of eating disorder behaviors can affect college-aged women, 55 percent of college students treated for eating disorders are diagnosed with anorexia nervosa: the same disorder that has the highest mortality rate of any psychiatric disorder.
Morgan, junior at Wake Forest, is part of this 55 percent. She is diagnosed with anorexia nervosa at the end of her sophomore year of high school. Four years later, she relapses while in her sophomore year of college.
It’s the morning of Morgan’s weigh-in appointment and she is water loading: drinking excessive amounts of water so it seems like she weighs more in order to manipulate her doctors.
“I even strategically ate salty foods the day before my weigh-in,” she says, “just so I would hold more water I drank and have more water weight the next day.
“I would put on a front for every health professional that I saw and tell them that I was trying really hard and wanted to get better, when in reality I just wanted them all off my back so I could get back to it.”
Get back to what?
Get back to calorie counting. Get back to obsessing over food. Get back to waking up every morning with absolutely nothing on the brain but anxiety over what is going to be served for dinner that night.
Get back to the routine.
“It’s not denial. It’s fear.”
It’s been four years since Morgan was diagnosed with anorexia and is “recovering” – or so she thinks.
She stands on the scale at her weigh-in appointment as her nutritionist tells her that her body fat percentage is “like a 12-year-old girl.” Her weight constantly remains on the line of okay and not okay.
“I personally don’t believe I recovered between my first bout of anorexia and my relapse,” Morgan remembers.
“I was kind of just forced to physically reach an acceptable point, but nothing was done about the way I thought … aka, the actual ‘disorder’ was literally not touched,” she says. “It was still there, just as strong as ever.”
That’s because for most anorexia nervosa patients, starvation limits one’s ability to think rationally.
“It’s one of the things that makes treating eating disorders difficult,” says Heather Meyer, Staff Psychologist at the WFU Counseling Center. “Starvation often leads to denial.”
This denial makes it hard to determine the actual statistics of eating disorders, leaving one to wonder how many people suffer without ever getting professional help.
“Denial can be very strong and it can be scary to seek help. Many individuals who experience an eating disorder do not engage in care from a mental health or medical provider,” Dr. Clinch says. “They can go for years, suffering from their illness before it is diagnosed, if ever.”
For some patients like Morgan, friends and peers will express concern far before the person is officially diagnosed.
It’s an ordinary day in high school and Morgan is waiting outside with her best friend. In the midst of ordinary conversation, her friend turns to her and asks the question for the first time: “Are you okay?”
Morgan recalls her friend’s worry very clearly:
“She said she had been getting lots of questions about me. She even said one of the boys we had hung out with a few days before then had referred to me as ‘the anorexic one.’”
Yet despite these recurring questions of concern, Morgan can’t see that she is withering away in front of her family and friends’ eyes. She even tunes out the repeated question coming from her aunt and mom, family members whom she has idolized since she can remember:
“Morg, you seem like you’ve lost a lot of weight. Are you okay?”
The truth is, no, Morgan isn’t okay. She has a battle going on in her head, an internal conflict that most anorexia patients deal with 24/7.
Patti Patridge, Licensed Professional Counselor located in Winston-Salem, says: “One part recognizes the problem and wants to get rid of it, the other is scared and tells her it’s really not a problem. I see this as fear, rather than denial.”
The battle against her disorder and her inner thoughts has begun. It’s not Morgan who doesn’t want to get better. It’s the evil voices of the disorder or, as she calls it, “Ana,” that won’t allow her to change.
Back at home, Lily fights her own internal demons. She sits on her couch the summer after her first year at college with a broken heart. Her friends ask her to hang out, but she simply isn’t happy. Her loved ones want her to get better, but she doesn’t listen.
She wants to change, but she is terrified of gaining one single pound. To Lily, disobeying “Ana” means the end of the world.
Living in a Weight Loss Culture
After a long summer, Lily steps back onto the WFU campus, discouraged and overwhelmed. All she sees is perfection. People more motivated and smart than her, not to mention more beautiful and blonde, are everywhere she looks.
This overwhelming presence of “beautiful and blonde” perfection can set impossible expectations for women.
According to Dr. Clinch: “Media and our culture do promote both eating disorders and disordered eating as well as issues with body image and satisfaction. Unrealistic models of beauty are held up as the ideal.”
Patti Patridge agrees and argues that we live in a culture where beauty and a small body are touted as most attractive. “Working hard to achieve such a body is a strength,” she says, “which becomes the perfect storm in which to lose weight.”
Dr. Clinch also struggles with the extreme focus of weight loss that has had devastating effects on our society. On one hand, there is a need to reduce obesity in order to combat illnesses such as heart disease, diabetes and strokes.
“Health care providers have made recommendations whose focus is to counsel individuals to lose weight to prevent these illnesses,” she states.
But on the other hand, this focus on numbers can be absolutely destructive to one’s mental health.
“Imagine the patient who comes to their doctor restricting calories to 500 per day, exercising three hours a day, avoiding friends and social events because there is food.”
Lily and Morgan are these patients. They stand in line at restaurants that have government-mandated calorie-counts on their menus, such as Panera or Chick-fil-A, and become completely paralyzed.
Dr. Clinch says: “Beverage machines have labels on them that read, ‘Choose wisely, calories count!’ I cannot tell you how triggering this has been for my patients who know they need to eat more.”
Walk into any college’s cafeteria and just listen to the conversations: “I can have this because I’m going to the gym later,” or, “I can’t have that cookie, I’ve got to get that spring break body!”
“We need to become aware about our permission to eat,” Dr. Clinch says. “It is so common now that we don’t see it as damaging.”
Yet sometimes media and society is not all to blame.
Morgan says: “My eating disorder has not been much about how I actually look. It’s been more about control and stress. I felt as though everyone had their lives together, and I was the only one that didn’t … my disorder told me to keep up with my habits, and I would be better than everyone at one thing, at least.”
For Morgan, to let go of the control of this “one thing” means embarking on the biggest struggle of her life: recovery.
Kicking “Ana” Out
I don’t understand how people are just a-okay with tossing a Snickers in their mouth, Lily thinks to herself. She just told her mom about her eating disorder, who has called every doctor she could to find her daughter the best help possible. Lily is terrified. The girl that analyzes the amount of calories in a Lifesavers mint is about to embark on the toughest journey of her life.
The recovery process begins and it is nearly impossible. It’s heart-wrenching and traumatic, a battle that not only Lily fights, but a battle that her friends and family also wrestle with.
“I wanted to change because my friends and family were rooting for me, and I no longer wanted the disease to control me,” Lily remembers. “But I definitely had my ups and downs while looking in the mirror because I was so terrified of gaining weight.”
Recovery happens very slowly. It’s a long, dragged out tiredness, one that often leads to lost friendships and anxiety from family members.
Before Morgan starts recovery, she sees how worried her family is. She sees her mom cry as she asks Morgan what she’s eaten that day, if she’s eaten enough, if she’s eaten at all.
True friends voice their concerns, but friends who are not as genuine just leave.
“I was so sick of it all,” Morgan says, “so, I eventually tried to fix my mindset and kick ‘Ana’ out of my head for good.”
Luckily for Lily and Morgan, professional nutritionists and therapists are available to ease the difficulty of the recovery process.
Therapy plays such a crucial role in recovery. According to Dr. Clinch, “Understanding the trigger and learning new ways to manage the pain allows patients to release their eating disorder.”
However, getting an eating disorder patient to actually connect with their therapist can be difficult. Patients are forced to get out of their routines and reflect upon their experiences – experiences that, at this point, have become habit.
“I went to so many professionals,” Morgan says. “I developed a hatred for my pediatrician … but I think only because she was the one who ‘caught me’ or ‘found me out.’”
This “hatred” Morgan experiences is normal. An eating disorder can be “very mean and rigid,” according to Patti Patridge. “It can cause one to lie to herself, so sometimes pushing someone a little out of their comfort zone is important for growth.”
Lily takes similar steps to kick “Ana” to the curb. She meets Susie, a nutritionist, who changes her life. They talk about everything: boys, clothes, school and the food she eats that week.
“She would reassure me that whatever I felt was okay,” Lily says. “She would reiterate this is a process and I’m going to do well going forward.”
Most therapists also involve parents in the treatment process as much as possible to make sure they are fully educated about eating disorders and their own child’s experience with one.
Patti Patridge stresses the importance of this involvement, emphasizing that work should be done with everyone “to negotiate what will be helpful and supportive versus what will feel controlling or triggering.”
For Lily, strong support from friends and family is ultimately what enables her to continue pushing herself until she gets better.
“Having my friends and family tell me I looked better and better as I gained weight was what really pushed me to continue my treatment,” she recalls.
Lily’s experience with recovery is hard, but it pays off. Her mind and heart are no longer at war and she’s “simply happier.”
Yet not everyone is this lucky.
It’s Time to Speak Up
The numbers are increasing, and the statistics are scary, shocking and heartbreaking.
According to a survey done among 3rd-grade girls, many of them are already dieting and unhappy with their bodies.
The National Eating Disorders Association reports that 42 percent of 1st-to 3rd-grade girls want to be thinner. 81 percent of 10-year-old girls are afraid of being fat. In elementary schools, 25 percent of girls diet regularly and can talk about calorie restriction and food choices for weight loss.
“The age at which children become aware of the meaning of weight and dieting is disturbing,” Dr. Clinch remarks. “This is so sad to me.”
Children as young as 8 years old have become exposed to our culture’s strong emphasis on weight, beauty, diet and exercise.
Patti Patridge says, “While eating a healthy diet and exercising regularly are important for maintaining a healthy body, the culture has taken it to an extreme, and we tend to focus on weight rather than health.”
So, what can we do?
NEDA professionals admit that while there has been an increase in programs that encourage body positivity and self-confidence on college campuses, there are still lots of mixed messages and pressures that can use some improvement.
Some campuses are doing a better job than others. The University of South Carolina has “The Body Project,” a small group conversation about body image and the influences of cultural and social interactions. Student advocates at California State University-Northridge hosted a series of programs during “National Eating Disorders Week” to promote self-confidence and eating disorder awareness around campus. Nationally, the “Body Positive” program trains students, faculty and staff on issues about body image and how to promote healthy attitudes.
However, according to Morgan, some schools “avoid the subject.”
She says: “Wake just doesn’t advertise enough for the things they do have, like the counseling center. I think it would be beneficial for Wake to speak up about body image and eating disorders.
“I have seen so many girls struggling on the outside that I can’t even imagine how many are struggling on the inside.”
Dr. Clinch reports that there are actually a few programs at WFU “currently underway to help chip away and challenge the pervasive national attitudes about body image to begin to shift toward a healthier balance,” but they are “still working” to bring the “Body Positive” program to campus.
However, rather than depend on these developing on-campus support groups, Morgan is one of many eating disorder patients who has turned to social media for support during her recovery process. She maintains an Instagram account where she posts her thoughts and her yummy food creations.
She says, “It’s just somewhere I can post what’s going on in my head … I have people who understand what I’m going through and they listen and offer support.”
Morgan also follows other recovery accounts and keeps track of their influential journeys.
“My favorite account is *****,” she says. “I have seen her entire inspiring transformation through all her ups and downs. I feel like I am kind of her friend in some way even though I do not know her.”
There’s Still Hope
Nationwide, the statistics of anorexia nervosa may continue to grow, but not all hope is lost.
After years of battling a controlling disease that wreaked absolute havoc on Morgan’s body and mind, she is healthy enough to study abroad her junior year of college.
Traveling abroad gets Morgan out of her comfort zone. She changes her environment completely, surrounding herself with great friends, fun activities and even better food. She gets out of her harmful routine and starts to live again.
“I could keep my mind away from thinking in old ways and getting into old habits,” she proudly reflects. “I made so much progress that it was easier to keep the improvements going when I got back home.”
Lily makes similar improvements after enduring her own battle with anorexia. After endless therapy sessions and visits to her life-changing nutritionist, she can smile again.
“The sense of freedom I’ve gained after my eating disorder is incredible,” she gushes, a radiant smile on her face. “When I’m having a bad day, I remember that even my worst days now are better than my best days then.”
Lily gains control. But this time, it’s not about food. Years after battling a disease that could have taken her life, she has control over her body, mind and, most importantly, her happiness.
*Names have been changed for privacy reasons.