Eating Disorders & Disordered Eating
 
Have you ever been on a diet or tried different dietary supplements to help you burn fat or build muscle? Have you ever worried about your weight and said things like, “I feel so fat!” Have you ever overeaten because you were feeling anxious, lonely, or depressed, and then felt really guilty and disgusted about yourself afterwards? Have you ever seen these types of concerns take over someone’s life and progress into a full-blown eating disorder? 

As many as 10% of high school and college students meet the strict diagnostic criteria for a serious eating disorder (including anorexia nervosa, bulimia nervosa, and binge eating disorder). Click here for more info about the clinical definitions and signs and health consequences of these serious disorders. 

Many more students struggle with sub-clinical eating problems (or “disordered eating”), which is alarmingly prevalent in college students and the general population. Disordered eating can include restrictive dieting, emotional overeating, compulsive exercise, severe body image disturbance, and use of various unhealthy weight management practices (such as fad diets, diet pills, anabolic agents, cigarette smoking, drugs, and/or excessive caffeine consumption). Not only can these disordered behaviors damage your physical health, but they can also compromise your emotional well-being, your social life, and your academic success. 

Read on to learn…
  • How healthy is your relationship with food and your body?
  • What causes eating disorders and disordered eating?
  • Steps you can take to help yourself.
  • How to help a friend (or your child).
  • How to prevent eating disorders and promote healthy eating and body image.
How Healthy is Your Relationship with Food and Your Body?
Eating behaviors, attitudes towards food, and body image function on a continuum from “Food is Not an Issue” at one extreme, to “Eating Disorders” at the other extreme. Click her to view the Eating Issues & Body Image Continuum and see where you fit. People can move into and out of each subcategory on the continuum during their lifetime.

Most people function in the “Concerned in a Healthy Way” category. This is the goal! However there is a tendency for people to slide into the “Food Preoccupied/Obsessed” and “Body Preoccupied/Obsessed” categories during the college years. This tendency may be related to a student's emotional and developmental stage of life, when he/she's struggling to establish his/her personal and professional identity and desperately wants to fit in. Or, it could be associated with the new stresses and pressures of the college environment. Not only is there extreme academic stress; but for many students, there is also the stress of trying to juggle school with a busy work, family, and social life.

No matter where you fit on the continuum, there are resources that can help you improve your eating behaviors, exercise patterns, and body image. Click here for more info about campus & community resources. 

Why Do Eating Disorders and Disordered Eating Develop?
Eating disorders and disordered eating behaviors are complex problems, stemming from a variety of cultural, social, familial, psychological, and biological influences. Contrary to what many people think, these disorders are NOT just about food and weight issues. Rather, food and weight issues are symptoms of a much more complicated, underlying problem.

To gain a greater understanding about eating disorders and the people who suffer from them, consider the many factors that contribute to their development. 

Size Prejudice
In American culture (and particularly in southern California), there is a lot of emphasis placed on body weight, size, and appearance. And, we are conditioned from a very young age to believe that self-worth is derived from these external characteristics. For example, being thin and/or muscular is associated with being “hard-working, successful, popular, beautiful, strong, and disciplined.” On the other hand, being “fat” is associated with being “lazy, ignorant, hated, ugly, weak, and lacking will-power.” These stereotypes are prevalent in our society; and they are reinforced by the media, our family and friends, and even well-respected health professionals. As a result, we often unfairly judge others and ourselves based on weight and size alone. We feel great anxiety and pressure to achieve and/or maintain a very lean physique. And, we erroneously believe that if we can just be thinner or more muscular, we can be happier, more successful, and more accepted by society. 

The Media
The media sets unrealistic standards for what body weight and appearance is considered “normal.” Girls are indoctrinated at a very young age that Barbie is how a woman is supposed to look (i.e. no fat anywhere on your body, but huge breasts!). NOTE: If Barbie were life-size, she would stand 5’9” and weigh 110 lb. (only 76% of what is considered a healthy weight for her height!). Her measurements would be 39-18-33, and she would not menstruate due to inadequate levels of fat on her body! Similarly, boys are given the impression that men naturally have muscles bulging all over their bodies. Take a look at their plastic action-figures (like GI Joe Extreme) in toy stores. If GI Joe Extreme were life-size, he would have a 55-inch chest and a 27-inch bicep. In other words, his bicep would be almost as big as his waist and bigger than most competitive body builders!’ These body ideals are reinforced every day on TV shows, movies, magazine covers, and even video games.

The media’s portrayal of what is “normal” keeps getting thinner and thinner for women and more muscular and ripped for men. Twenty-five years ago, the average female model weighed 8% less than the average American woman. Currently, the average female model weighs 23% below her average weight. Similar trends are seen with men. The average Playgirl centerfold man has shed about 12 lbs. of fat, while putting on approximately 27 lb. of muscle over the past 25 years.

With these media images and body ideals, it’s little wonder that women and men feel inadequate, ashamed, and dissatisfied with how they look. Only about 5-10% of women have the genetic make up to ever achieve the ultra-long and thin model body type so pervasive in the media. Yet that is the only body type that women see and can compare themselves to. Similarly, all boys see is a body ideal that for most men is impossible to achieve without illegal anabolic steroids. There is a physiologically limit to how much muscle a man’s body can attain naturally, given his height, frame, and body fat percentage. In other words, it’s physiologically impossible to gain unlimited pounds of pure bulging muscle mass while maintaining an ultra lean, ripped body (with only 3-7% body fat)--even when following the “perfect” training and diet program. Once you reach your maximal muscle mass, any further gains will come from both muscle AND fat. So, men who have greater muscle mass/size tend to have higher body fat percentages as well (e.g. 10-15%). Unfortunately, however, the action figure heroes on toy store shelves and male fitness models on magazine covers and ads suggest otherwise. 

Social & Family Pressures
In college, you may feel great pressure to be thin or super muscular in order to be accepted by your peers and attractive to potential romantic partners (especially in communities near Los Angeles, one of the most weight, diet, and fitness-crazed cities in the world!). If you’re living with a lot of other students (especially women) in a sorority/fraternity house or residence hall, the pressure may be even more intense. In these group living situations, you may be surrounded by negative “body talk” all the time…in the bathroom, in the dining halls, in your dorm room…there’s no escaping the comments (“Yuck! Look at my thighs…I’m so fat! I really need to go on a diet!”). All these comments can make you crazy! They can make you start worrying about your own weight and make you start feeling self-conscious about your own body, even though you never worried about it before.

Your mother, or other family member, may have done the same thing while your were growing up by making constant comments about her own weight (or yours) and enforcing lots of food restrictions on herself (or you). Early on, you may have gotten the message that you need to be thin in order to be accepted and loved by your parents.

If you’re an athlete, you may feel tremendous pressure to lose weight or body fat so you can make a specific weight class (i.e. wrestling, crew, boxing), race faster (i.e. running, cycling), or look more attractive to the judges or audience (i.e. gymnastics, dance, cheerleading, figure skating). The pressure may come from you, your teammates, your coach, and/or your parents.

Medical Weight Standards
Weight and height measurements are routinely done at health clinics; and you are often assigned a certain label (“underweight, healthy weight, overweight, or obese”) based on these measurements. Your clinician may even encourage you to lose weight, to see a dietitian, or to consider drugs or surgery, without even asking about your eating and exercise habits and considering your level of fitness. The clinician, of course, has good intentions. After all, clinicians are taught in their medical training about all the perils of “obesity.” And, they are reminded again and again (often by pharmaceutical company-sponsored meetings and events) that obesity is a “disease” that can (and should) be aggressively treated with drugs. 

Weight measurements may actually reflect bad eating habits, a sedentary lifestyle, and poor health and fitness, but not necessarily. In fact, there are many large, “overweight” (but fit) men and women who eat a balanced diet, exercise regularly, and enjoy excellent health (as indicated by their optimal blood pressure, blood cholesterol, and blood sugar levels). And, there are many “healthy weight” men and women who do not. 

If you have experienced this type of weight prejudice by the medical community, it’s understandable that your body image and self-esteem would suffer. After all, you are being told by one of the most powerful and respected members of society that you are “diseased.” The guilt, shame, and self-loathing associated with such a label does nothing to support healthy eating, physical activity, and good health. In many cases, it does just the opposite.

Personality Traits
Perfectionism, compulsiveness, competitiveness, and high achievement expectations are personality traits commonly associated with college students. These personality traits help you excel in college. But these personality traits may also carry over to other aspects of life (like wanting to be the perfect weight, eat the perfect diet, and have the perfect work-out program). Having these personality traits doesn’t cause you to develop an eating disorder, but they do put you at greater risk of developing one if other environmental factors are also present. 

Underlying Mood, Anxiety, or Personality Disorders
Many people who suffer from eating disorders also suffer from one or more other psychiatric problems, such as depression, obsessive-compulsive disorder, anxiety disorder, or borderline personality disorder. In fact, the disordered eating behaviors (e.g. binge eating, compulsive exercise, obsessive counting and controlling of calories) may be adaptive responses to an underlying chemical imbalance in the brain, which is causing the depression or anxiety. 

For instance, serotonin and cortisol are neurotransmitters (brain chemicals) that affect mood, sleep, and appetite. Low levels of serotonin (or high levels of cortisol) are often associated with depression, anxiety, poor sleep, and increased appetite. People suffering from low serotonin levels (or high cortisol levels) often participate in maladaptive behaviors that work to raise or lower them, respectively. Carbohydrate binges, compulsive exercise, and obsessive thinking all work to increase serotonin levels; so these behaviors temporarily correct the chemical imbalance in the brain. (NOTE: Cigarette smoking and excessive alcohol consumption may serve similar functions, as coping mechanisms for underlying biological or psychological problems.) 

Fortunately, there are several health-promoting behaviors that can normalize the balance between serotonin and cortisol (e.g. yoga or meditation, massage, expressive hobbies, full spectrum lighting, moderate physical activity, professional counseling, and avoiding alcohol, caffeine and aspartame). Regular participation in these health-promoting behaviors can decrease the need to engage in more damaging ones. The hard part is learning to replace the damaging behaviors with the health-promoting ones! 

Several prescription medications are also available to help normalize the balance between serotonin and cortisol. These medications may be required, along with the health-promoting behaviors listed above, to correct underlining chemical imbalances in the brain. 

If you experience extreme feelings of sadness or anxiety, difficulty sleeping, or change in appetite, talk to a clinician or counselor at the Student Health & Wellness Center. There are counseling services and medications available to help.

Emotional Eating (or Not Eating)
Throughout our life, we are conditioned to turn to food for security, comfort, and pleasure. As babies, the most powerful comforter when we were distressed was our mother’s milk. As toddlers, we were offered cookies and milk when we fell in the playground and got hurt. Throughout our school years, we were rewarded with sweet treats when we brought home good grades and punished for bad behavior by being sent to our rooms without dessert. It’s little wonder that as college students, food becomes a tranquilizer when we’re anxious and stressed, a mood elevator when we’re depressed, a comforter when we’re lonely, a reward when we’ve had a hard day, and an entertainer when we are bored. We learn to cope with uncomfortable feelings by stuffing them all down with food. Just like cigarettes, alcohol, and drugs, food becomes a temporary relief or escape.

In other situations, people learn to suppress uncomfortable feelings by focusing intently on their body weight and size. These are much “safer” issues. People often complain, “I feel so fat!” But, since when is fat a feeling? You don’t feel blonde or brunette; how can you feel fat? What are you really feeling when you feel “fat.” Are you feeling inadequate, insecure, sad, overwhelmed, abandoned? By becoming so absorbed in counting calories and worrying about weight, people can avoid thinking about these more painful and more difficult feelings. 

Psychological Issues

Control
In some cases, eating disorders can be rooted in past traumas. That is, sometimes eating disorders can develop, in part, from an attempt to manage difficult feelings around experiences from a person’s past. For example, imagine growing up with an alcoholic parent. In this case, no matter what the child does or how hard he tries, he cannot control or predict his world. Or suppose the child was sexually abused or raped as an adult. Violated and hurt, this person might seek an area of life that she can control: her diet and weight. In other cases, individuals with eating disorders may have had (or perceived) their parents to be very controlling in their lives. Again, eating patterns and restrictive behaviors are an area over which the parents cannot force them to conform, giving them some sense of control over their lives.

Fear
In cases of sexual abuse, disordered eating may serve as a protective shield from further abuse or attack. For instance, in anorexia nervosa, self-starvation may be a way for a young person to delay puberty and prevent developing an adult body (which may be the target of further sexual abuse). In binge eating disorder, overeating and being obese may be a way for a person to feel less attractive, less desirable, and more invisible (so future attacks are less likely to occur).

Sexual and Cultural Identity
Sometimes, disordered eating develops as a response to internal conflict with one’s sexual identity or cultural identity. For instance, a homosexual young man, who was constantly teased as a boy for his sexual orientation, may feel that his masculinity is threatened. He may become obsessed with building a muscular, “manly” body (a common feature of muscle dysmorphia) in an effort to restore feelings of masculinity (power and strength). 

Similarly, an African American young woman may find it difficult to hold onto her “body pride” as she moves from the black culture (which has strong ethnic identity and larger body ideals) into the white culture (which has very thin body ideals). Initially, she may feel great pressure to “fit in;” and as a result, she may reject herself, her larger body type, and her traditional cultural foods and become extremely restrictive in her eating. With time, she may feel ambivalence between wanting to hold onto her cultural roots and wanting to “fit in;” and this can result in bingeing and purging. Later, she may completely reject the white culture and all its dieting nonsense, and turn to compulsive overeating. 

Chronic Dieting
Ancel Keys conducted a classic study on the effects of semi-starvation on prisoners of war. He found that semi-starvation (like dieting/restrictive eating) causes several physical, emotional, and behavioral effects, which are classically seen in people suffering from eating disorders.
  • Decreased basal metabolic rate by 40% (in order to survive during periods of low calorie intake).
  • Feelings of anxiety, depression, dizziness, and weakness (as a result of semi-starvation).
  • Food preoccupation (e.g. collection of recipes, cookbooks, and menus and constantly thinking and dreaming about food).
  • Out-of-control binge eating (to the point of feeling bloated and uncomfortable) when they were finally given their daily food ration.
  • Feelings of embarrassment and guilt about their supposed “overeating” episodes.
  • Self-induced vomiting (in some) to get rid of the uncomfortable feeling.
Isn’t it ironic that today there are more diet books, diet foods, diet supplements, and diet products than ever before, and today people are more worried about their weight and size than ever before. Yet, today the rates of obesity are higher then ever. In fact, obesity has increased a shocking 50% over the past decade!!! And, eating disorders are just as prevalent as ever. There seems to be a direct association between “dieting” and gaining MORE weight and developing more disordered eating patterns. Click here to learn more about the effects of restrictive eating and why diets DON’T work.

How to Help Yourself
Click here for a few steps you can take to help yourself heal from food and body issues. Then, click on the following links for a more detailed discussion about specific disordered eating issues:
How to Help a Friend (or Your Child)
Click here for more info about…
How to Prevent Eating Disorders
The culture of disordered eating and body hatred is pervasive in our society. In fact, many people unintentionally encourage eating disorders in their friends, family members, teammates, and/or coworkers by the comments they make about food, weight, and body shape/size. 

Click on the following links to learn…

Sheri Barke, MPH, RD
COC, Student Health & Wellness Center
Rev. 2005