Binging, purging, starvation, excessive exercise, diuretic use, self-hate: these are the conventional signs of eating disorders. At Dartmouth, 8.9 percent of students reported have experienced an eating disorder or an eating-related concern, according to a Student Health Survey conducted in the Spring of 2010. Under 5 percent of students reported being diagnosed or treated for an eating disorder.
But the number of students, particularly women, who face disordered eating and other body image issues on campus is much higher than the reported numbers suggest, according to Kari Jo Grant, the coordinator of Health Education Programs at Health Services.
"Most people engage in some form of disordered eating," Grant said.
Regulating food consumption based on an external source constitutes disordered eating, she said.
"From a layperson's perspective, healthy eating is when a person is able to listen and respond to their own body cues and recognize what it needs," Grant said. "Stress and time constraints and peer pressure interfere with a person's ability to listen and respond to their bodies and this leads to disordered eating."
A 1999 study by College psychology professor Todd Heatherton and his colleagues found that 3.5 percent of Dartmouth women have a clinical eating disorder, 6.1 percent are considered sufferers of "subclinial" eating disorders, 14.9 percent are "problem dieters" and 23.7 percent are dieters.
People with eating disorders generally exhibit symptoms including binge eating two or more times per week, regular purging, feeling out of control during a binge, concern about binging, being dissatisfied with their current weight and appearance, as well as chronic dieting or a strong desire to lose weight, according to the American Psychiatric Association. Those who report a strong desire to be thinner may also have an eating disorder.
People diagnosed with subclinical eating disorders report similar but less extreme habits as someone with an eating disorder, according to Heatherton's study. Problem dieters were defined as those who reported dieting often or sometimes, some drive for thinness and bulimia, and sometimes engaging in binge eating without a loss of control or intense concern about their behavior. Dieters reported mild body dissatisfaction and restrictive eating. Nondieters were those who had no signs of disordered eating and rarely dieted, according to the study.
Students and staff interviewed by The Dartmouth said that body image issues and eating disorders affect both men and women, but that eating disorders are particularly prevalent among women.
"I think body image issues and eating disorders are more prevalent among girls, but girls are more open to talk about these issues," Natalie Obermeyer '12, an Eating Disorder Peer Advisor, said.
All EDPAs active and on campus this term are women, although in the past men have gone through training to become advisors, according to EDPA Alanna Kaplan '11, said.
"There seems to be some kind of barrier for men to become involved in this area," Grant said. "There's a perception that body image problems only impact women and a misunderstanding that it's always about food. These issues really do apply to men, especially in terms of exercise and working out at an unnecessary level, which is accepted and almost celebrated among men."
How disorders start
The term "eating disorder not otherwise specified" has become popularized in recent years and is used to describe anyone suffering from disordered eating, according to Heatherton.
One type of subclinial eating disorder that seems to be especially prevalent on the Dartmouth campus is what is known as orthorexia nervosa, according to students at Delta Delta Delta sorority's "Fat Talk Free Week" event on Nov. 10. This term is not officially medically recognized, but is used by professionals within the medical community to describe someone who has a fixation with extremely health-conscious eating.
Orthorexics have an obsession with defining what is "healthy" eating and what is "unhealthy" and tend to restrict their food consumption to an extreme level.
"Many girls are trying to be very healthy, but a lot of their sources of information like fitness magazines have a completely skewed image of what healthy means," said Meera Krishna '11, a psychology major who is writing her thesis about eating disorders at Dartmouth. "Some girls end up only eating salad, when in reality that's unhealthy you need carbs and protein and fat."
Those who are suffering from subclinical eating disorders, problematic dieting or even those who simply define themselves as dieters, are not necessarily ever diagnosed or identified.
"A lot of girls here are in this weird gray area," Krishna said. "They don't have a full-fledged eating disorder, but they have problems. They know they're not happy."
These problems are often exacerbated by stress that occurs in other area's of individuals lives, according to Heatherton.
"If you can help people deal with social anxiety and academic-related stress you would definitely reduce disordered eating problems," Heatherton said.
The perception that people are being evaluating can sometimes spill over from academic evaluation to personal and physical evaluation, he added.
WHO HAS EATING DISORDERS?
There are a myriad of stereotypes concerning what "type" of person develops an eating disorder, or suffers from disordered eating, according to Grant.
"Historically, eating disorders have been diseases of the upper-class white girl," Grant said. "But this demographic was the only one with access to treatment and health care, and thus the only one diagnosed and studied on a large scale."
Grant explained that those who seek help from her have come from all different socioeconomic, ethnic and geographic backgrounds. She said that disordered eating is much more a factor of personality and environment than race or class.
"It really comes down to individuals, their personalities and their coping mechanisms," she said.
At Dartmouth, and other elite academic institutions, personalities tend to fall in the category of perfectionist, according to Heatherton.
"Especially at Dartmouth, people are high achieving and perfectionist and body image can be an important part of identity," Heatherton said. "Studies have been done that show that the more elite the setting, the more likely eating disorders are to exist."
Krishna noted that women at Dartmouth fail to allow themselves to be average in any way.
"Many women here feel that the norms that apply to average women, concerning body image, don't apply to them," she said. "They consider themselves the extreme, and their perspective is warped. Women here are striving for perfection in every aspect of their lives."
Krishna said that many Dartmouth women take a "weird sense of pride" in being able to restrict what they eat and maintain impossible diets, while simultaneously exercising vigorously.
"A lot of times eating disorders are not really about food," Kaplan said. "It can just be a mechanism of gaining control over something in your life and this can manifest itself in controlling food and exercise."
Although genetics do play a role in determining a person's predisposition for or susceptibility to eating disorders, Heatherton said he believes that the causes of eating disorders are mostly determined by environmental factors.
"Since about the 1980s, there has been an incredible increase in disordered eating," Heatherton said. "It's hard to attribute this to anything other than environmental influence. Also there are dramatic differences in the rate of eating disorders across cultures."
The 30 students at Tri-Delt's "Fat Talk Free Week" discussion, which is part of the national sorority's Reflections Body Image Program, said that body image issues go under the radar at Dartmouth, or are recognized but not talked about openly.
"Dartmouth girls are expected to be effortlessly perfect," said Krishna, who instituted the Reflections Body Image Program at Kappa Delta Epsilon sorority this Fall. "They're not supposed to talk about working out or eating healthy it's a bizarre and unrealistic standard and expectation and inevitably sets girls up for constant failure, shame and frustration."
According to the program, one in eight adolescent girls nationally reported starving themselves to lose weight, 40 percent of mothers instruct their adolescent daughters to diet though 45 percent of these girls are of average weight. There are up to 10 million women and 1 million men suffering from anorexia or bulimia nationwide, which is more than the number of women who have breast cancer.
DRINKING, DIETING AND EATING DISORDERS
Alcohol consumption can also affect eating and exercise habits among students, according to Grant.
There is a strong link between binge drinking and eating disorders, according to a 2009 study done by the International Journal of Eating Disorders. The authors of the study argue that, given this connection, there should be proactive interventions for all college-aged women regardless of how much alcohol they typically consume.
A phenomenon colloquially known as "drunkorexia" is somewhat common among students with disordered eating habits, according to Grant.
"It's all a math game," Grant said. "If someone is counting calories, but still wants to drink and participate in the social scene, they might decrease their food intake in order to accommodate calories from alcohol into their diet."
When a person becomes intoxicated, he or she fails to self-regulate, and is overwhelmed by temptation, which can lead to binge eating, according to Heatherton. In order to diet a person overcomes his or her internal sensations, and thus when he or she is inebriated, sensations of fullness are ignored and excessive eating occurs.
Heatherton also explained that dieting usually results in a "spiral" effect that leaves the dieter in a position in which he or she becomes more vulnerable to eating disorders.
"Women undertake dieting because they feel unhappy about themselves and they think that if they lose weight they'll feel better about themselves," Heatherton said. "They endure a long series of stages in which they do not lose as much weight as they would like and respond to failing by, ironically, feeling worse about themselves. Over time, this lowers their self-esteem, but does not decrease their perfectionism, and sets them up for an eating disorder."
Heatherton, in a study of his called "Chronic Dieting and Eating Disorders: A Spiral Model," argued that dieting plays an active role in the "onset and maintenance" of eating disorders such as anorexia nervosa and bulimia nervosa. The study explores the process of dieting and both its mental and physical effects on girls and women.
"The dieter hopes that losing weight will transform her into someone who is more attractive, competent, and worthy," the study says. "Much is invested in the decision to diet, and dietary success or failure is likely to have important effects on subsequent self-esteem."
According to the study, women who diet successfully and do not undergo undue stress concerning their dieting habits make up the minority of dieters. Krishna said there are very few women at Dartmouth who are completely comfortable with their bodies and the way they look.
"I don't think there are many girls at Dartmouth who have not felt pressure in some way related to her body," she said.
