Eating Disorders — Understanding and Identifying

February 25, 2014

New Year’s Resolution and Spring Break Extremes
Alison Epperson, Ph.D.
Assistant Professor, Health Ed.
Murray State University

How many times have you been to the gym since January 1st? As a regular patron of our wellness center, I get cracked up every year at the large volume of patrons coming into the facility eager to shed some additional weight gained during the “eating season” (what I refer to the time between Halloween and New Year’s), and attempt yet another New Year’s resolution.

Oftentimes, a different attitude for spending so much time in the fitness facility (I’m referring to the students) is dedicated to Spring Break (aka bikini week). Since most colleges/universities traditionally have spring break somewhere during the month of March, this leaves approximately 6-8 weeks from the start of the New Year for college students to get ‘beach ready.’ Since nearly every minute of college life seems to be documented and imaged via social media (Twitter, Facebook, Instagram, etc.) it appears as though both males and females feel extra pressure to appear fit and trim for the ritualistic southern migration to warmer climates.

Sadly, as our American culture has become obsessed with weight, we have in turn, created a monster. We chastise our own population for an obesity crisis, while seemingly ignoring the polar opposite, starvation. In my opinion, “diet” is now one of the worst four-letter words in our language because it is often carried to an extreme, not consistently followed, and repeated over and over again with no sustained positive long term effects.
In general, the term ‘eating disorder’ often brings to mind the two most notable terms: anorexia nervosa (calorie restriction) and bulimia nervosa (binge eating followed by purging). In actuality, when a person engages in disordered eating, they can fall into one of four categories as listed by the National Eating Disorders Association (NEDA) webpage www.nationaleatingdisorders.org
– Anorexia Nervosa
– Bulimia Nervosa
– Binge Eating Disorder
– Eating Disorder Not Otherwise Specified (ED-NOS)

Unfortunately, the list of contributing factors is extensive, so for the purpose of this article I will focus only on the psychological and social factors.
Certainly, encouraging and promoting regular, vigorous physical activates is the core of what we do in Campus Recreation. We understand the value and benefits of maintaining ‘total-wellness’ and strive to offer health-related programs and services which serve to meet those needs: environmental, physical, social, emotional, intellectual and even spiritual.

In the context of those six dimensions of optimal health, colleges/universities understand and recognize the increasing number of students coming to their institutions with mental health concerns and how lifestyle choices can negatively impact one or more of those dimensions, which significantly impacts a student’s academic success.
As noted in the above website, typically those who suffer from any form of disorder eating often report they do so as a method of control, or in the reinforcement of being recognized as looking good (i.e. extremely skinny). When factors/ pressures create chaos and confusion, controlling calories either as a coping mechanism or an as an attention seeking behavior becomes a way of feeling in control or successful.

As a female, probably one of the most rewarding or self-esteem boosting comments (either from another female or a male) is “You look great!” I mean really, who doesn’t want to be told they look great? However, not everyone’s criteria for looking ‘great’ is the same.

In every aspect of American culture, we promote and associate ‘looks’ as a method of acceptability — actresses and actors, fashion models, popular musicians, and the extremely popular television show, ‘The Biggest Loser’. When checking out at the grocery store, convenience store, or gas station, the customer is inundated with print media which either criticizes or praises any well-known cultural icon for how they look in a bathing suit.

Furthermore, the ‘image’ has now extended to female athletes, especially professionals in competitive sports such as ice skating, tennis, track, volleyball, swimming/diving, gymnastics, running and cheerleaders. When you think about it, some of uniforms leave very little to the imagination. Combined with the old saying “the camera adds 10 pounds,” only serves to increase pressure for those athletes to ‘fit’ in the uniform (or lack thereof).

According to the Ohio High School Athletic Association’s webpage http://www.ohsaa.org/medicine/eating.htm , “Eighty-six percent those diagnosed with disordered eating report onset of illness before the age of 20, and are significantly higher (15 to 62 percent) in the athletic population than the general population.”

The NCAA has attempted to increase awareness among college athletes, coaches and medical staff / athletic trainers of a condition call the “Female Athlete Triad.” The triad occurs in this pattern; athlete restricts calories → this calorie restriction drains the body of energy (athletes need a higher number of calories / energy to perform) → the reproductive system starts to shut down → less estrogen is available for the body → female stops having a menstrual period and bone density rapidly diminishes leading to early onset of osteoporosis.

Considering the fact that disorder eating leads to detrimental effects to the body such as heart conditions, decreased bone density, deprivation to major organs, and damage to the digestive tract and mouth, they must be taken seriously and identified and treated as soon as possible.
As mentioned in my previous article regarding ‘overstepping our boundaries’, there is naturally some hesitation to approach patrons with whom we do not have an established relationship but recognize as ‘regulars.’ It is walking a fine line and trying to determine “At what point should we be concerned about a student’s weight or obsessive exercising?”

Here are some thoughts to consider when trying deciding whether or not you should become involved or express a concern:

•  A patron who comes to your facility more than once a day, stays for extended periods of time, or attends multiple fitness/aerobics classes in the same day, or seems to frequent the restroom (this can be for purging or constantly checking the scale).
• Common signs of calorie depletion include — loss of hair, thin skin, blue finger nails and dizziness and bloodshot eyes
• Mood swings and irritability

What are some ways that you can reach out to your patrons without feeling evasive? Consider the following:

• Post signage above your scales which serve to remind — muscle weighs more than fat so don’t obsess over the numbers!
• Utilize the back of the bathroom stall door for posting information and availability of relevant campus services
• Regularly check attendance sheets or take attendance in all fitness classes and look for indications of ‘excessive participation’

In conclusion, disorder eating should be taken seriously and most people do not realize it is associated with mental health and causes life-threatening issues. Communicate with your staff the importance of what it is and how it occurs. Consider the statistics that indicate the highest percentage of those with diagnosed disordered eating are your clientele: campus recreation/ intramurals/ club sports/ fitness participants.

And most importantly, do not be afraid to offer help – ultimately our jobs are to assist our students become successful and healthy young adults!