By Marcia Herrin, EdD, MPH, RD, FAED
Apart from summer camps or similar limited experiences, when young people go away to college, it may be the first time they have lived away from home and on their own. This big change, compounded with new food choices, crazy schedules, rigorous academic demands, and new social challenges, makes it no surprise that the first several years of college are considered to be a time of high risk for the development of an eating disorder. Recent surveys indicate that the rate of eating disorders among college students has risen to 10-20 percent of women and 4-10 percent of men.
If a student has recently recovered from an eating disorder or is currently struggling with one, parents need to first evaluate whether it is safe to go away to college. Knowing that entering college is contingent upon making progress in recovery can be motivating. If parents, in consultation with treatment providers, decide it is safe to enter college, it is their responsibility to ensure that the student has support and resources needed at school or in the nearby community.
Even recovered students may struggle with the new freedom to eat or not to eat now that they are beyond Mom or Dad’s watchful eyes. Other students have difficulty making food choices among the large array of delectable foods offered in campus cafeterias, or they founder when they find they do not have the same access to foods they are comfortable eating. For all of these reasons, parents should be particularly watchful as a child enters college. At the conclusion of this article is a “Guide to College Eating”.
Ideally, colleges have an adequately staffed eating disorder program right on campus, which will include experienced physicians (nurse practitioners and physician’s assistants also can provide competent medical monitoring), therapists, nutrition counselors, psychiatrists and support groups. Some colleges provide all or some of these services free of charge to enrolled students. Others limit the number of visits students can make each semester. Still other colleges refer students who need these services off-campus. Some colleges leave it up to the family to find community resources if their child needs that kind of support. The 2013 Collegiate Survey Project Eating Disorders on the College Campus: A National Survey of Programs and Resources commissioned by the National Eating Disorder Association (NEDA) lists the eating disordered-related services for 165 colleges. To read the full study results, download a directory of colleges with eating disorder programs and services, visit the Collegiate Survey Project homepage (http://www.nationaleatingdisorders.org/CollegiateSurveyProject).
If a student needs continuing support at college, parents are wise to arrange either a visit with or a phone call to the college’s health service or counseling center to ascertain the scope of services. Once a student is working with a professional on or off campus, the main responsibility of parents is to make sure their child is making and keeping medical, psychological, or nutritional appointments. Students over 18 years of age are afforded the same confidentiality as adults. But, this does not mean that parents cannot or should not let the professionals who are involved know their concerns.
Some college students do well with nothing more than regular phone/skype/email check-ins with their parents or hometown nutritionist, therapist, or physician. Others do best making a connection with a professional either at college or in the surrounding community. When students know that staying in college is contingent upon taking care of their bodies and overcoming some of their eating-disordered behaviors, many seem to be able to marshal personal resources (though they may need substantial family and/or professional help as well) to overcome even a serious eating disorder. This approach works if parents hold firm to their decrees. Students who do not make progress or relapse may be required by the college to take a medical leave of absence.
Students and parents should know that is not unusual for first-year college students to gain 10 to 15 pounds or more, and in some cases grow in height as well. This phenomenon has been labeled the “freshman 10” or the “freshman 15.” The substantial weight gains some first-year college students experience during fall semester can be explained several ways: College freshmen, often for the first time in their lives, are given the complete freedom to eat or not eat as they please at a time when many have not yet learned to manage their own eating. Some freshmen gain weight because they are taking in additional calories in the form of alcohol and/or party foods, which are found in abundance at the many food-related social events associated with college life. For others, the freedom of being away from home may trigger a latent binge-eating problem. Sometimes, the awareness that a student is gaining weight, for any of these reasons, is so demoralizing that he/she compounds his/her problem by consoling himself/herself through food.
Another explanation is that the college years are a time during which many adolescents finish growing. This is the time that many gain the pounds and even inches they need in order to reach their adult size and shape. While weight gain may seem to happen all at once, often because it is compounded by the dramatic change in eating habits I described earlier, when eating patterns settle down (as they usually do later in that first college year) weight gain stops. The average female college student usually fully develops by the end of her sophomore year, arriving at her adult height and the weight that would be safe for her to maintain as an adult. For males, development may continue through senior year or beyond.
This is a sensitive issue around which parents sometimes should tread lightly. The adage I recommend as a guide for parents and others when faced with a potentially sensitive weight increase is: “When in doubt, say nothing.” While no good ever seems to come from harping about weight gain, severe weight loss, on the other hand, carries with it serious medical risks and should be discussed.
Now a few words to directly to the students themselves:
There is no shame or harm in getting plenty of support. It is better to have more support than you need. I recommend to my patients going off to college to check-in with me or another member of their treatment team when they are home on breaks. I also recommend the food plan I developed for Dartmouth College students when I was a college nutritionist (see below). First, think about the food groups you need at each meal. Pick a decent serving of each group. Remember that you can try that tasty new food next time it shows up on the menu and it will show up again and again. Don’t skip meals. You will notice other students with eating disorders. It can feel that they are getting away with it. Remember you are the lucky one. Untreated eating disorders ruin lives.
College Food Guide
Fruit or Vegetable
Fruit or Vegetable
Fruit or Vegetable
Normal serving size usually is one cup or twice the size indicated on food labels.
Calcium Suggestions (1 serving = 300-500 mg)
milk, yogurt, cheese, frozen yogurt, tofu, calcium supplement
Complex Carbohydrate Suggestions
cereal, bagels, bread, crackers, rice, potatoes, pasta, corn
butter, margarine, peanut butter, cheese, cream cheese, salad dressing, mayonnaise, sauces, muffins,
bacon, nuts, olives, avocado, egg yolks, fried/sautéed foods, chips, ice cream, some meats
Fruit or Vegetable Suggestions
any fresh, cooked, dried, canned, or juiced fruits or vegetables
“Fun Food” Suggestions
any dessert, cookies, cake, ice cream, pudding, doughnuts, croissants, candy bars, chips, fries, non-diet soda
Protein Suggestions (1 serving = 20 grams of protein)
meat, fish, poultry, eggs, cottage cheese, Greek yogurt (1 cup), cheese, dried beans, hummus, tofu, tempeh, peanut butter, other nut butters
calcium, complex carbohydrates, fruit or vegetable, protein, fat, fun food
Developed by Marcia Herrin, EdD, MPH, RD, LD
For more information –
The Parents Guide to Eating Disorders (2007); Nutrition Counseling in the Treatment of Eating Disorders (2013); www.marciaherrin.com
About the author –
Marcia Herrin, EdD, MPH, RD, FAED, is the founder of Dartmouth College’s nationally renowned eating disorder program. Currently, Dr. Herrin conducts a private practice in Lebanon NH. She is the author of Nutrition Counseling in the Treatment of Eating Disorders (2013) and The Parent’s Guide to Eating Disorders (2007). Marcia received her doctorate in nutrition education from Columbia University. At the University of California-Berkeley, she received her masters degree and completed a dietetic internship. Marcia was honored as a fellow in the Academy of Eating Disorders in 2013. Marcia credits much of her success with patients with eating disorders and obesity to her own struggles with and recovery from these conditions.