“Mom, I Feel Fat"

The college academic year is ending and your daughter is coming home for the summer. You last saw her spring break and you noticed she seemed thinner than usual and wasn’t eating as well, but you blame that on her needing to complete a paper.

You meet her at the airport and you are shocked at how much weight she has lost. When you tell her she looks too thin, she says. “Really? I think I look fat. I certainly feel fat.”

What would you do?

Unfortunately, this scenario plays out all too often. College is the prime time for anorexia, bulimia, and other eating disorders to emerge. The pressure of college is likely to bring out eating disorders in people with a genetic and psychological predisposition.

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When I started working at the University of Florida over twenty years ago, I treated many women with eating disorders, but I thought the number would decline as women became more confident in their abilities and felt less judged by their outward appearance. Time has proven me wrong, and eating disorders continue to flourish on college campuses. A 2013 report from the National Eating Disorders Association shows that over a 13-year period, eating disorders (bulimia, anorexia, binge eating, and subclinical eating disorders) increased from 7.9% to 25% for males and 23.4% to 32.6% for females at one university. In other words, the preoccupation with weight and body image increasingly affects men as well as women.

Why do college students continue to have disordered eating? Media pressure to be thin has grown since the 1950s and has been linked to the increase in eating disorders. Social media continues to fuel this increase with its focus on image and with the existence of pro-eating disorder sites where people share self-destructive eating behaviors. The National Eating Disorders Association has worked with social media to block harmful websites and create sites where people can promote healthy behavior.

In light of the growth in eating disorders, parents should take a role in ensuring their children get early treatment to prevent progression to a life threatening condition. Many students lack insight into the seriousness of these problems and often need encouragement to pursue treatment. The most severe forms of eating disorders, anorexia and bulimia, require urgent evaluation and care. People with anorexia have 12 times the death rate of others aged 15-24 due to starvation, suicide, and substance abuse. People with bulimia are also found to have increased death rates from medical problems and suicide. All people with eating disorders, even people who do not meet full criteria for bulimia and anorexia, have increased chances of an early death.

Eating disorders involve a self-critical view of one’s body as well as preoccupation with weight and food. People with anorexia see themselves as fat even though they are underweight. They eat minimally, and some will purge through exercise, vomiting, or laxatives. People with bulimia binge and purge on a regular basis, but may have a normal or above normal body weight. People with binge eating disorder will binge frequently, and are often overweight. Your child can have an eating disorder even if she only has some of these behaviors.

So what would you do if your child has symptoms of anorexia, bulimia, or another eating disorder?

Whether your child is home for the summer or at school, you should seek a comprehensive eating disorder treatment program. You could see what eating disorder services the college offers, keeping in mind that many colleges will only provide short-term care. The most important thing is to assemble a treatment team consisting of a primary care doctor, psychiatrist, psychologist, and nutritionist.

1. The primary care doctor will assess and monitor your child’s physical safety. Eating disorders can lead to electrolyte abnormalities, arrhythmias, bone loss, tooth damage, and a cessation of menses. The primary care doctor will evaluate your child’s weight and labs, and help you decide if hospitalization is necessary. The primary care doctor will continue to monitor weight to make sure there is steady weight gain in the case of anorexia.

2. The psychiatrist will evaluate your child’s emotional safety and assess for suicidal thoughts and behaviors. She will evaluate for and treat other diagnoses common in people with eating disorders like depression, bipolar disorder, anxiety, obsessive-compulsive disorder and substance use disorder. She can also treat bulimia with certain antidepressants that decrease binge and purge behaviors.

3. The psychologist will choose a therapy that is best suited to your child’s problem. Individual, group and often family therapy promote recovery. Many women with eating disorders use food and weight to cope with stress or problems in relationships. The psychologist will help your child expand her range of coping skills beyond eating behaviors.

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4. The nutritionist will help your child return to healthy eating habits and a good weight in a way that is medically safe.

There is great hope for women and men with eating disorders. The earlier they get treatment, the more likely they are to make a full recovery. For example, if bulimia is treated within 5 years of onset, there is an 80% chance of recovery.

If you believe your child has an eating disorder, you can find treatment resources by calling the campus counseling center or the National Eating Disorders Helpline at 1-800-931-2237. With prevention and early treatment, let’s lower the prevalence of these all too common and potentially deadly disorders.

©2016 Marcia Morris, All Rights Reserved

Details have been altered to protect patient privacy.

If you’re interested in reading about a particular topic regarding college wellness and your child’s mental health, please email me at marciamorrismd@gmail.com (link sends e-mail)