Roughly 190 million Americans are either overweight or obese, prompting health professionals to declare a crisis that demands a re-examination of the nation’s relationship with food. But that is only one side of the story.
According to the Renfrew Center Foundation for Eating Disorders, nearly 24 million people in the United States suffer from unhealthy eating habits at the other extreme.
“In the last year, I have lost a best friend, several friends and quite a few other acquaintances that I knew from treatment facilities. All have died from eating disorder complications,” said Cristina Richardson (COL ’16), who herself struggled with an eating disorder in elementary and high school.
“I also have at least three friends that I expect to lose soon because their bodies have shut down completely and are on the brink of death. I don’t think that people always believe the statistics about eating disorder deaths, but they are real and eating disorders do kill.”
Patterns of disordered eating coincide with the college years primarily for women — up to 18 percent of women compared to 0.4 percent of men reported history of an eating disorder by the first year of college, according to a study by the National Association of Anorexia Nervosa and Associated Disorders. These frequencies only increase as students continue through college.
In the National College Health Assessment from spring 2012, 86.6 percent of college students reported feeling overwhelmed in the 12 months prior to taking the survey. For some students, eating disorders develop as a consequence of attempting to use control over eating as a means of coping with the anxiety and competition around them.
With these contextual patterns in mind, it comes as little surprise that up to 20 percent of Georgetown’s student body suffers from an eating disorder.
“Eating disorders are not just about food and weight. They are also about control and perfection. I equated starvation and bones with control and perfection. … With every bite of food, I felt like I was losing control and further away from perfection,” Richardson said. “Also, part of eating disorders is competition. … I was always competing with myself to go lower, and whenever the scale stayed the same or rose, the pain was too much.”
Results from the most recent NCHA indicated that 1.5 percent of the Georgetown student population reported experiencing anorexia and 2.1 percent bulimia in the last 12 months. According to Carol Day, a registered nurse and director of Health Education Services, the real numbers today are closer to around 6 to 6.5 percent, but not even these numbers account for the sizable student population struggling with other types of eating disorders.
“My professional guesstimate is about 15 to 20 percent, which is probably conservative,” Day said.
For those previously suffering with eating disorders, coming to Georgetown can stall their recovery if external pressures on campus trigger a return to unhealthy behavior.
“Georgetown influences people [who] are trying to recover in a negative way,” Day said.
A female student, who will be referred to as Amy for the sake of anonymity because of the sensitivity of the subject, agreed with Day’s statement.
“When I came to Georgetown I wasn’t too worried about anything triggering me, as I felt I was in a really good place mentally,” said Amy, who is recovering from an eating disorder. “However, there are lots of things that if I weren’t secure in my health would be troubling.”
For Caroline Joyce (NHS ’15), the combination of a past experience with an eating disorder and fear of the “freshman 15” fostered a negative relationship with food her first year on campus.
“The [types] of people [who] come in are already susceptible to it,” Joyce said. “Everyone’s attitude here about it just fosters that.”
Joyce’s experiences with an eating disorder began as a freshman in high school.
“I saw that my sister had written down everything she had eaten in a notebook. As soon as I saw my sister’s notebook, it was game over.”
After having struggled in high school, transitioning to Georgetown for Joyce prompted the continuation of a poor mentality toward eating. In addition to obsessing over food consumption, those with eating disorders often supplement their attempts to be thin through other unhealthy behaviors, including restricting food intake until a certain time in the day and engaging in excessive exercise.
Richardson even resorted to over-the-counter “solutions.”
“I would purge to get rid of the food and get rid of some of the feelings of hatred [from binge eating]. … Purging, even to the sight of blood, made things a little better. In addition to throwing up, I abused a number of over the counter medications to aid in the purging process. I had a turning point one night when I almost suffered a heart attack and stroke from the severe electrolyte imbalance I had from a massive laxative overdose and ipecac abuse. However, like most people with eating disorders, this wasn’t enough to stop me. The fear and hatred of eating was too much. It was so bad that suicide often seemed like a better solution than to continue trapped in the cycle of bulimia.”
Today, diagnosing eating disorders usually involves the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. The DSM explicitly defines anorexia nervosa and bulimia. For those who do not fit the criteria for anorexia or bulimia, the classification is simply “eating disorder not otherwisespecified.”
The disorder is particularly difficult to diagnose because it becomes so much a part of who the sufferer is.
“I got so used to lying to avoid food that it became a small price to pay for avoiding the horrors of eating. This might be hard for someone who doesn’t have an eating disorder to imagine. It was my worst fear, and the fear was so intense that I wanted to die instead of face it. … If I looked into the mirror after fasting for a day, and then I ate something and looked at myself again, I literally looked in my mind like I had gained 50 pounds.”
Yet even with the upcoming revisions to the diagnosing criteria, the emphasis remains on eating. For many with this condition, eating disorders are connected with behavior. Just as one might attempt to control one’s weight through food, exercise becomes a method of control. At Georgetown, this is sometimes apparent at Yates Field House.
“There is definitely an emphasis on being thin and attractive, and a lot of it is cloaked in the name of being healthy, which is exemplified with behaviors at Yates,” said Amy, the anonymous student.
According to Haley Coghill (COL ’11), assistant fitness director at Yates, common behaviors among Georgetown females at the gym include working out with anorexia or exercise bulimia, which involves bingeing and then working out to the point of throwing up. Whereas females might spend hours at the gym to lose weight, males exhibit similar behaviors in attempts to gain muscle. Often, inadequate nutrition and energy accompany these overextending gym efforts.
At Yates, the staff does not receive formal training about how to recognize the warning signs for students who might be struggling with unhealthy behaviors, according to Coghill.
However, there are strategies in place for addressing concerns. Every hour, a manager on duty conducts a usage report by observing the fitness floor. If the manager notices someone who has been working out for an extended period of time in one day or several days in one week, or attending multiple fitness classes in a day, the staff can flag GOCards to keep track of that person’s visits.
If monitoring raises more red flags, a staff member will speak with the student and refer him or her to Health Education Services. Depending on the severity of the situation, a student may be banned from Yates until a doctor provides a written letter stating an improvement to the student’s health.
In addition, Coghill and Meghan Dimsa, Yates director of Fitness and Wellness, led a training session for resident assistants in the fall about what to do when they suspect someone might be struggling with an eating disorder. A major difficulty for students is identifying when a situation is serious enough to warrant concerns without jumping to conclusions.
“You can’t just assume. You can’t know what is going on in someone else’s body,” Coghill said.
Georgetown students have two main resources for helping combat unhealthy body image and its associated behavior. Health Education Services provides guidance about nutrition and weight management, whereas Georgetown Counseling and Psychiatric Service offers individual psychiatric counseling. However, these resources are restricted in their ability to help students because of limited staff and funding. For example, for nutrition guidance, students previously had access to a dietician at O’Donovan Hall, but that position is currently vacant.
Although increasing awareness and encouraging students to seek help is important, Day acknowledged the unfortunate reality that the university would not have the capacity to meet all students’ needs if there was a sudden increase in demand.
Because peers are often the ones having conversations with and observing each other on a regular basis, having students address concerns about those they suspect are struggling could encourage others needing help to seek it. Of the approximate 1,000 appointments Health Education Services sees every year, Day says about 300 of them involve students who have concerns about a peer’s eating or workout habits.
“This is a problem that is incredibly more prevalent than we acknowledge, and it’s frustrating to watch as such an important and consuming mentality eats at so many beautiful people,” SarahBaran (COL ’14), a student who has friends struggling with eating disorders, said.
Unfortunately, the lines can be blurry. Even for those who do recognize the warning signs, it can be difficult to know how to tell someone that he or she needs help. Changing the way people talk about eating disorders could go a long way in lessening the negative stigma associated with them.
Although it can be difficult to initiate, Joyce believes that the willingness to have these conversations with one another is critical to eventually changing the dialogue.
Understanding the disorder itself and working towards recovery is possible, Richardson reiterates.
“It took many years, many hospitals, many near-death situations and a lot of pain, but there is another side and recovery is possible. … One of the misconceptions about recovery is that it happens as soon as you can eat and that you are forever cured.”
As with any mental illness, eating disorders are a manifestation of underlying issues. Recovery is a process that depends on this aspect of understanding.
Now healthy, Richardson reflects on her recovery process.
“I really had to figure out why I couldn’t be happy unless I was starving and why I binged [and] purged. … Like many diseases, eating disorders are usually a life-long battle. However, the battle is worth it. Three years ago, I wanted nothing more than to die. Now, I am happy and healthy, and I love life.”