Healthy eating and eating disorder education for college students

How common are eating disorders in college students?

It’s impossible to tell exactly how many college students struggle with eating disorders. The conditions are notoriously private, and people who struggle are often in denial of the seriousness of their condition or loathe to disclose what they’re going through.

Still, what data is available suggests that eating disorders and disordered eating behaviors in college students are on the rise, with 4.2% of college students following a restricted diet for weight loss in 1995 but 22% doing the same by 2008.¹

Although it’s commonly assumed that women are more likely to experience an eating disorder, the reality is that all college students are at risk for developing these behaviors. A survey by the American College Health Association found:¹²

• 3% of college-aged women and 0.4% of men received a diagnosis of anorexia
• 2% of college-aged women and 0.2% of men reported a previous bulimia diagnosis
• 4% of college-aged women and 1% of men admitted using laxatives or engaging in self-induced vomiting in an attempt to lose weight

At-risk populations for eating disorders

Certain student populations may be more at risk for eating disorders than others. For example, transgender students have reported disordered eating behaviors, including vomiting, use of diet pills, and laxative use, at four times the rate of their cisgender classmates.⁶ 

Sexual minority students also show elevated rates of compensatory behaviors compared to their heterosexual classmates, particularly cisgender men.⁶

Student-athletes may also be at an increased risk of eating disorders. Research suggests anywhere up to 19% of male college athletes and as many as 45% of female college athletes struggle with these conditions.⁷

Eating disorder risk factors for college students

Several factors coalesce around college that could increase the likelihood of developing an eating disorder.

The college environment

The college environment itself presents many conditions that could open up the possibility of developing an eating disorder. Some potentially contributing factors include: 

• Increased workload and learning issues
• Less structure and reduced parental presence and support
• Unscheduled eating
• All-you-can-eat dining halls
• Loss of personal space and privacy, especially when living with roommates

Without their usual routine and family support, especially when far from home, students may develop disordered eating behaviors to deal with the stressors of college in an attempt to feel in better control of their lives.¹

Access to an unlimited and large variety of food in college dining halls can also present problems for students. Those restricted in their diets at home may find this overabundance of food to trigger binge eating.

Furthermore, students may feel anxious about their lack of control over food choices in the college food hall, which could trigger disordered eating behaviors.

New social pressures

New college students face many new social pressures, including finding ways to fit in with new classmates, roommates, and social groups. 

The pressure to conform to make friends can be immense. Many students turn to fraternities and sororities as a way to assimilate. But members of these organizations have been found to struggle with poor self-esteem and disordered eating behaviors.⁹

The confluence of greater autonomy, greater options for feeding oneself, and social events that involve alcohol or unhealthy food can also lead many college students to gain weight. Colloquially called the “freshman 15,” fear of this scenario could lead a student to push in the other direction instead, exerting more control over their diet or workout routine to avoid putting on those first-year pounds.¹⁰

Stress and anxiety

The pressure to maintain good academic standing in college can cause increased stress, anxiety, and depression, which may contribute to the development of an eating disorder.¹¹

Additionally, research has shown that students with depression, generalized anxiety disorder, panic disorder, self-harm, and suicidal ideation are more likely to screen positive for an eating disorder.¹²

Health-related behaviors

Certain health-related behaviors associated with the college experience have been shown to increase the likelihood of developing an eating disorder. They include:¹²

• Binge drinking
• Marijuana use
• Cigarette smoking
• Frequent exercise
• Gambling

Personality traits

Certain personality traits, including perfectionism, have been tied to a higher risk of developing disordered eating behaviors.¹³ Perfectionism, in particular, may be triggered by the pressure of college to maintain grades, make certain clubs or teams, or fulfill other social or academic obligations. 

Unpredictable peers, new roommates, and uncertainty in where one stands in the social pecking order can also contribute to the sense of a loss of control, which people with certain personality traits may attempt to cope with through exerting extra control over their food and exercise routine.

Warning signs of an eating disorder in college students

Effect of eating disorders on college students

Eating disorders and disordered eating behaviors are often associated with significant health concerns, as well as a negative impact on a student’s academic performance, social life, and overall college experience.⁴

Undergoing intensive and time-consuming treatment can interfere with students participating in the full college experience they hope for. This may mean some students delay treatment or ignore their disordered eating behaviors. In fact, denial of any problem is very common.

However, If a student doesn’t seek treatment for their eating disorder, there can be serious long-term medical consequences. The longer an eating disorder goes untreated, the more serious the physical and mental complications can be, and the harder it can be to treat the eating disorder and associated conditions.

For parents of college students with eating disorders

If your child is planning to attend college soon but has an eating disorder or is showing signs of disordered eating behaviors, it’s essential you consider whether sending them now is the right time.

Tips for maintaining eating disorder recovery in college

You can’t guarantee a relapse won’t occur in college, but there are things you can do to help maintain your recovery.

How to manage eating habits in college

Those who go away to college encounter many changes to navigate, such as: 

• Being away from a familiar environment and usual routines
• Getting adjusted to a new place
• Meeting new people, making new friends
• Building a new lifestyle

There are also the pressures of learning how to manage your time, schedule, and academic workload. 

These changes can be overwhelming, and in the face of those feelings, people may turn to food as a comfort or a way to help them feel more in control. In either case, the concept can be dangerous.

So, what steps can you take to ensure you’re eating well at college and getting all the nutrients you need to maintain a healthy and properly functioning body and mind? 

Of course, many factors can affect your physical and mental well-being, not just food. But research has found there are two things you can do every day that can have a positive impact on your well-being and grade point average (GPA):²¹

1. Get enough sleep
2. Eat breakfast

As for when, what, and how much to eat, it’s time to ditch all the food rules you’ve learned so far in life and follow just one rule: tune into your body’s cues.

What is intuitive eating?

Your body knows what to do when it comes to food. It will tell you when it’s hungry, what it’s hungry for, and how much to eat.

Sounds simple, doesn’t it? But it’s not so easy when you’ve been conditioned to ignore your body’s cues by a lifetime of well-meaning but misleading messaging from the media, “health” and fitness companies, and even healthcare providers around food, eating, fitness, and health telling you what you “should” or “shouldn’t” eat or do.

Here are just a few of those harmful messages:

• There are “good” foods and “bad” foods. “Healthy” choices and “unhealthy” choices. 
• “Cheat” foods, “free” foods, and “green” foods. 
• There are “supposed” to be three meals a day: breakfast, lunch, and dinner, eaten at specific times and involving certain types of foods. 

Not to mention all the messages your parents may have told you:

• “Don’t snack between meals.” 
• “Don’t spoil your dinner.” 
• “Don’t eat after 8 pm.” 
• “You can’t have dessert until you’ve eaten all your dinner.” 
• “You’ve had enough.” 
• “You can only have cake on special occasions.”

And then there are the messages you may be hearing or telling yourself now:

• Don’t drink your calories. 
• Save your calories for later if you know you’re going to “overindulge.” 
• You can eat “junk” food if you exercise it off. 
• Since you were “bad” and overindulged in something yesterday, you need to be “good” today.

All this goes against your body’s built-in ability to tell you what, how much, and when it needs to nourish itself. Following rules like these can be dangerous and feed disordered eating patterns, which can lead to serious harm, including full-blown eating disorders, mental health challenges, medical complications, and even worse.

Alcohol and eating disorders

There may be pressure to drink alcohol or try other substances at college. And this may be very hard to avoid. Being away from home and having freedom can lead to risky behavior. 

But it’s important to be aware of the very real dangers of alcohol, the risks of substance abuse, and the consequences of overdoing it. Alcohol is dehydrating and can act as an amnesiac, loosen inhibitions, and impair judgment.  It is also a toxin to the body and can be deadly. 

Alcohol consumption is also strongly correlated with eating disorders.

When to get help

If you suspect you or a friend may have a problem with alcohol or any other substance, it’s crucial to get help as soon as possible. This may not be easy. Denial is a powerful force that drives many people to continue self-destructive habits until serious damage has been done. It’s helpful to talk to a counselor about how to approach this topic. And it’s important to remember it’s not a sign of weakness or failure. It takes great courage and strength to face your challenges.

How to help a college friend with an eating disorder

Eating disorders are dangerous conditions and can even be deadly if left untreated. If you have a college friend you suspect or know is struggling, it’s important to help them find appropriate treatment and care.

Still, the process will likely not be easy. Eating disorders tend to be particularly sensitive issues, with many people struggling to admit the severity of their condition or even that they have a problem at all.

Where to find help for college students

Despite the high prevalence of eating disorders among college students, it appears many aren’t receiving the help they need. Recent research found that only 20% of college students diagnosed with an eating disorder reported receiving mental health treatment within 12 months.¹²

The barriers to care on campus for eating disorders can contribute to this issue. Understaffing at college counseling centers and the increased number of students with mental health issues may be part of the problem, as well as stigma, shame, and financial costs.⁴

Despite these challenges, there is effective help and support for those who need it. Many colleges offer counseling services for students who are struggling for any reason. These counselors can help directly or point students toward more specific eating disorder-related programs. Some colleges also have eating disorder specialists on campus.

What eating disorder treatment looks like

Eating disorders are typically treated by a multidisciplinary team, which includes a collaborative approach from a therapist, dietician, nutritionist, and medical doctor. The severity of a person’s eating disorder, the state of their mental well-being, and any co-occurring disorders—like depression—will determine the course of treatment.

Generally speaking, the goals of eating disorder treatment are to:

• Prevent disordered eating behaviors, such as fasting, purging, binging, excessive exercise, and restriction
• Establish the underlying causes of the maladaptive eating behaviors and introduce alternative coping mechanisms to college stressors
• Create a plan to prevent relapse
• Address other mental problems and medical complications

Residential and inpatient eating disorder treatment may be required in cases where a person requires round-the-clock monitoring and structure to engage in their care plan. But many common treatments for eating disorders can work around college commitments and include:

• Cognitive behavioral therapy (CBT): This form of talking therapy focuses on negative thoughts and beliefs about food, as well as the underlying triggers that cause them. CBT teaches an individual to identify these problems and learn healthy ways to cope with difficult emotions.²⁶‍
• Nutritional counseling: Carried out with a registered dietitian, nutritional counseling is a key part of eating disorder treatment.¹⁹ It teaches a person how their eating disorder may be preventing them from getting the nutrients their body needs to function. Furthermore, nutritional counseling helps to develop a meal plan, develop normal eating patterns, improve their relationship with food, and work towards a stable, healthy body weight.‍
• Family-based therapy: As opposed to addressing the root cause of an eating disorder, family-based therapy teaches families as a unit about eating disorders so they can support their child, sibling, or friend through recovery.¹⁶‍
• Acceptance and commitment therapy (ACT): ACT is used to help those with eating disorders to recognize and accept their thoughts and emotions. Acknowledging the thoughts and urges tied to their disorder can help individuals develop a better understanding of their triggers.²‍
• ‍Group therapy: Many people with eating disorders find it incredibly healing to discuss their fears and concerns with others in a similar situation to them. Group therapy helps people form genuine connections, which is so valuable during recovery, especially when at a college far from home.
• ‍Intensive outpatient treatment (IOP): If it fits in around campus life, IOP is an excellent treatment option for those who respond better to treatment in a more structured environment. Patients typically attend an outpatient clinic for a few hours a couple of days a week to receive additional support.