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
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
Steps you can take to help yourself.
How to help a friend (or your
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
& 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
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
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.
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 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
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
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.
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
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
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
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.
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.
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
Self-induced vomiting (in some) to get rid of the uncomfortable
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
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
Click on the following links to learn…
Sheri Barke, MPH, RD
COC, Student Health & Wellness Center