*Editor's Note: This is the third part in a three-part series investigating eating disorders at the College.**##
In August of 2008, Katie "Cully" Cullinan '08, who had been battling an eating disorder for several years, committed suicide. Although Cullinan was not on campus at the time, her death spotlighted the pervasive issues of weight, body image, disordered eating, over-exercising and anxiety about food on the Dartmouth campus. To honor Cullinan, more than a hundred individuals participated in "Cully's Run" in May 2009 a 5-kilometer run that raised funds for the National Eating Disorders Association. The run is now an annual event.
Despite the visibility of resources on campus for people with eating disorders, students suffering from eating disorders often try to hide their problem, limiting the reach of programs designed to provide help, according to students and counselors interviewed by The Dartmouth. The opinions of those studying the problem diverge over the extent to which the College's efforts should go into programs that would treat existing eating disorders or, alternately, those that would work to prevent them.
The College offers a number of resources for those who battle body image issues, suffer from disordered eating or simply have concerns about eating or exercising in a college environment. These resources are available through Dick's House and other institutions on campus. Counseling and Human Development at Dick's House acknowledges a need for resources to help individuals like Cullinan and provides the Eating Disorders Program as a primary source for help, according to its website.
The Eating Disorders Program attempts to treat "the whole student" with a team of specialists focused on treating patients emotionally, socially and physically, according to Kari Jo Grant, coordinator of Health Education Programs at Health Services.
The team includes psychologists, psychiatrists, nutritionists, physicians, physician assistants, nurse practitioners and inpatient staff, according to the College's website.
Several additional resources are available for athletes alone, according to members of Dartmouth's athletic department.
Claudette Peck, the coordinator of Nutrition Programs, has open office hours for athletes with questions about their diets on Tuesdays and Thursdays, according to Anne Hudak, assistant athletic director for student enhancement. Coaches such as head woman's track coach Sandy Ford-Centonze make special efforts to discuss issues relating to body image with their student-athletes.
"I talk to my athletes about different elements that are extremely important, including nutrition, eating the right way, sleeping, hydrating," Ford-Centonze said. "I'm not just looking at eating disorders. I look at the entire picture doing things the right way. I want my athletes to be exercising, gaining weight and losing weight in the right way."
EDPA
The Eating Disorder Peer Advisor program was founded at Dartmouth in the summer of 1997 to raise awareness of issues related to eating disorders and to provide students with a resource to help their peers or to seek help for themselves, The Dartmouth previously reported.
"The program is successful if students are familiar with this resource and can receive more information concerning these problems, and trust that it is a safe opportunity for private consult," Grant said.
EDPAs generally have some personal experience with eating disorders, including exposure to eating disorders in high school or at Dartmouth, or having personally endured a disorder, several EDPAs said.
"Our job is to organize events around campus and be a resource to people," EDPA Isabel Hines '13 said. "I really want to act as a resource for people outside of my friend group."
Hines, who is also a Sexual Abuse Peer Advisor, a club figure skater and a participant in the Real Beauty Initiative, explained that one of her best friends in high school suffered from an eating disorder and had insufficient resources available to help her.
"When I got to Dartmouth I found this program where I could learn how to help people," Hines said. "And in the skating world, this was especially prevalent."
For those who approach EDPAs with concerns about a friend's symptoms, the EDPAs are trained to advise a routine process of personal communication between the alleged sufferer and the friend that does not involve a third party. The EDPAs encourage the person struggling to explore his or her health care and counseling options at Dick's House and to avoid simplifying the person's problem by assuming that she has control over her habits.
FROM HIGH SCHOOL TO DARTMOUTH
College psychology professor Todd Heatherton published a report in 1999 about disordered eating and the transition from high school to college. The report used data gathered from 342 Dartmouth women and found that disordered eating symptoms generally take root in early adolescence, often near the onset of puberty.
The college environment offers an array of factors associated with stress and instability, according to the report. When they first arrive at college, students may experience changes in roles and social identities, a loss of intimate social support and geographic relocation. This explains the change in individuals' perceptions of themselves between high school and college.
The study indicated that, compared to high school females, many more college women categorized themselves as overweight or unhappy with their bodies. Yet the majority of those surveyed were not classified as overweight by national standards, the study found.
Heatherton said that the increased prevalence of eating disorders for women at Dartmouth and its peer institutions is more a result of the "type" of people who attend elite colleges, rather than the environment at the College.
"I think we have a lot of resources here to make people realize that eating disorders are a problem, and if anything, the attention paid to these issues helps to decrease them," Heatherton said.
Eating disorders tend to arise in situations in which students rely on self-control and regulation in order to succeed, Grant said.
"I've noticed how much student success relies on resiliency and the ability to overcome obstacles they encounter," Grant said. "This stress is masked by different coping strategies, one of which is an eating disorder."
SOLUTIONS: PROACTIVE OR REACTIVE?
The results of Heatherton's research indicate that resources for students already struggling with disorders should take precedence over the creation of preventive programs, he said.
"The present study suggests that disordered eating patterns are deeply rooted by the time students have reached the end of high school," the study stated. "Therefore, it would appear that colleges should focus their efforts on treatment rather than prevention."
In the study, Heatherton also found that although the data in the study does not directly address the acquisition of eating disorders in adolescents, efforts to prevent eating disorders should be directed at early adolescents.
Meera Krishna '11, a psychology major who is writing her thesis on eating disorders at Dartmouth, suggested a slightly different approach. Her research has led her to believe that colleges should have a more proactive role in preventing eating disorders or disordered eating.
The college environment contributes to body image issues, causing women in particular to develop disordered eating habits, Krishna said.
"I think Dartmouth is really lacking in this area, mostly because I don't think they take a proactive stance on eating disorders," Krishna said. "A body image week is great, but this is something that has been happening for a really long time, and I think girls should be able to talk to people about these things before they are a problem."
Krishna's thesis explores whether or not peer-led eating disorder prevention is effective in the sorority system, at Dartmouth in particular, she said. Her research involved implementing the Reflections Body Image Program, which was created by Delta Delta Delta national sorority.
Krishna said she has received overwhelmingly positive feedback from the students who participated in the program at Kappa Delta Epsilon sorority, noting that they seemed enthusiastic about increased dialogue concerning body image issues.
With sororities in particular, room for improvement remains in the discussion of body image, Krishna said.
"I want to come up with some concrete ways we can move forward as a school," she said. "The solution starts with the students. Peers working with peers is more effective, according to research. The onus is on the students to make change."
Resources are available for students who recognize that they are struggling with a disorder, but for those who do not seek out help, little is in place to help them, Krishna said.
THE LIMITS OF CAMPUS RESOURCES
A survey that Heatherton conducted at Harvard University indicates that college students are overwhelmingly reluctant to seek help if affected by an eating disorder or disordered eating.
Several EDPAs said that many people suffering from eating disorders are unwilling to identify themselves, even to a friend or peer. This is reflected in the number of students who seek advice from EDPAs for their friends who are unwilling to receive help independently.
"Generally, the students who come talk to me want advice on how to help a friend," Alanna Kaplan '11, an EDPA intern, said. "We then determine whether it is a problem the friend should actually be concerned about, and if it is, where to go from there."
The struggle against body image insecurity and dissatisfaction is long and hard, but increased support from the College, heightened awareness of the issue and augmented discussion among students and student organizations can help alleviate these problems and provide a healthier environment for students, according to EDPAs interviewed by The Dartmouth.
Some believe that a change in culture concerning the approach to physical appearance is essential in the movement to decrease body image problems on campus.
"A really good way to combat eating disorders is to recognize a person for who they really are and put less emphasis on body and looks," Natalie Obermeyer '12, an EDPA, said. "It's about getting involved on a deeper level and finding out what excites a person."
