In the last few years, the eating disorder cases treated by Dartmouth’s health services have increased in severity, College nutritionist and sports dietitian Claudette Peck said.
Eating disorders are one of the five most common issues the Counseling and Health Center sees, along with depression and anxiety, staff psychologist Nicole Hill said.
An increasing number of students are struggling with body image concerns during their time at the College, in addition to the freshmen who enter the College with histories of eating disorders, Hill said.
Peck said she believes part of the problem is a campus-wide lack of awareness, so students are reluctant to intervene when their peers might be having a dietary issue. As a result, the illness becomes more severe before the individual seeks help, she said.
The eating disorder consultation team manages about 20 to 30 students of concern who are actively seeking services at any given time, Peck said. She added that it is hard to give an exact number of Dartmouth students with eating disorders because there are some less severe cases not at the level of the consultation team, as well as many others who are not currently seeking help.
Two common signs are a preoccupation with weight, body shape, food or exercise and a desire to control behavior, Peck said. Physical appearance could be of concern, but is not necessarily an obvious indicator, she noted.
An eating disorder can serve as a coping strategy to gain a degree of control over an aspect of one’s life, Peck said. Perfectionism and anxiety can also contribute to the incidence of eating disorders, she added.
“There are genetic pieces that link certain types of character and temperament,” Peck said. “When you think about high-functioning college students, like those in the Ivy League and at a high level of education, they might fall prey to that type of disorder.”
Peck said that for some students, college is the first time theys have the freedom to choose what to eat, when to exercise and how to manage their own lives.
“A change in independence can certainly influence behavior,” Peck said.
A female member of the Class of 2018, who requested anonymity due to the personal nature of her story, said she has been in recovery from an eating disorder for two years. Her eating disorder mainly affected her during her junior year of high school due to stress both at school and at home, she said.
She said that she was in therapy the whole year, though what helped her most was developing a love of running the following summer.
“I felt strong about what my body could do,” she said. “During a race, I just had an epiphany of joy.”
Since she has been at the College, she said she has felt more confident in herself because she sees many people around her who are comfortable with themselves, regardless of their body type. Nevertheless, her weight has continued to be a source of stress as she tracks its fluctuations, she said.
“I don’t know how to eat like a normal person — I only know how to monitor everything I eat,” she said. “I think about food more than most people, but it’s definitely been more normal since I’ve gotten here.”
Peck said there are three distinct types of common eating disorders — anorexia nervosa, bulimia nervosa and binge-eating disorder — as well as a new disorder called avoidant/restrictive food intake disorder, or ARFID.
According to the National Eating Disorders Association, anorexia nervosa is characterized by excessive weight loss and self-starvation. Bulimia nervosa involves a cycle of binge eating and compensating behaviors, such as self-induced vomiting, while binge eating disorder involves recurrent episodes of binge eating without compensation afterwards.
ARFID was identified by the American Psychiatric Association in 2013 and involves an avoidance of certain foods that expands until the person’s diet no longer provides them with adequate calories or nutrition.
The students who struggle with eating disorders at the College are overwhelmingly female, though there are increasing numbers of male students seeking treatment as well, Hill said.
Peck said there is no doubt that men struggle with eating disorders, though they are often more reluctant to seek help because of a cultural view that eating disorders mostly affect women.
For athletes, their sport could be a protective mechanism that helps them embrace the physicality of their body, but it could also make them more susceptible to ideals of being lighter or thinner to enhance performance, Peck said.
Assistant director of peak performance Donnie Brooks said for sports where athletes need to reach a certain weight, such as crew, the focus is on making sure students can make that weight safely.
Strength and Condition coach Bob Miller said he takes the body weight of his athletes every week to monitor any drastic fluctuations. He added that coaches, athletes and dietitians work together to come up with individualized weight plans.
Hill said long-distance athletes, such as cross country runners, Nordic skiers and lightweight rowers, tend to be more vulnerable to overtraining or low body weight.
Peck works with athletes and teams to help them outline dietary plans, identify nutritious options at the Class of 1953 Commons and prepare healthy meals with groceries from local stores, Brooks said.
Heavyweight coxswain Greg Zales ’17 said that many rowers, himself included, do not find it easy to meet their target weights. He said he eats healthier and exercises more during the season, especially close to race day.
He noted that there are a lot of on-campus dining options, but it is difficult to control portions and find low sodium foods.
Crew team member Caroline Allan ’16 said she has been eating much healthier since she began rowing. The team does not emphasize being a certain weight and instead focuses on being healthy, she said.
“I don’t worry about restrictions, though other people on the team do think about it sometimes,” she said. “In general, being on an athletic team has probably helped my relationship with food and eating.”
For those struggling with eating disorders, the eating disorder consultation team takes a three-pronged approach — medical, nutritional and therapeutic, Peck said. Aside from physical recovery, the team helps patients dissect the triggers for their disorders and helps them find more productive coping strategies, she said.
Wellness program coordinator Maria Sperduto ’14 said programs at the Student Wellness Center focus on prevention by encouraging students to look after themselves holistically by taking care of their physical health in conjunction with other dimensions of well-being. The Wellness Center is also able to help refer students to other resources on campus, she said.
Hill said she believes people are aware of what eating disorders might look light, but cultural body type standards lead to admiration of weight loss and dieting.
“It’s harder for people to think of it as a problem,” she said.
The female ’18 who has recovered from an eating disorder said she went to a V-February event last winter where students talked about eating disorders and other mental health issues and had an inspiring conversation with a woman on the panel.
“She made me feel less alone, she was so open about it,” she said. “I’m trying to be more open. So many people have these feelings of feeling worthless, and no one wants to talk about it because of the stigma.”
